Resumo em Espanhol:

OBJETIVO: Describir el perfil demográfico, las carácterísticas sociales y familiares y los hábitos de vida de las mujeres infectadas por VIH que dan a luz en Barbados, país del Caribe, en comparación con un grupo testigo compuesto de mujeres sin infección por VIH. MÉTODOS: Los datos en que se basa este informe fueron obtenidos del Programa Pediátrico para la Vigilancia del VIH en el Hospital Reina Isabel de Barbados. Los datos abarcaron a todas las mujeres en el país que estaban infectadas por el VIH y que dieron a luz entre 1986 y 2000. Datos similares se obtuvieron de un grupo testigo compuesto de mujeres que dieron a luz pero que no estaban infectadas por el VIH. De las fichas médicas de las mujeres se extrajo la información de tipo general que había sido anotada durante las consultas prenatales. Datos adicionales se recolectaron mediante entrevistas con las mujeres. RESULTADOS:Ciento ochenta y dos mujeres infectadas por el VIH dieron a luz durante el período de estudio, y un grupo de 202 mujeres que dieron a luz sin estar infectadas por el VIH sirvió de testigo. En comparación con las de este último, las mujeres infectadas por el VIH eran más jóvenes, multíparas más a menudo, y más propensas a haber estado sin empleo cuando estaban embarazadas. Las mujeres infectadas por el VIH también habían empezado a tener relaciones sexuales a más temprana edad, habían tenido más compañeros sexuales y eran más proclives a tener un compañero sexual de edad más avanzada. La mayoría de las mujeres infectadas por el VIH carecían de síntomas de sida y vivían con sus padres (la madre, el padre, o ambos) o el padre de la criatura en el momento de dar a luz. Además, llegada la consulta correspondiente a la sexta semana posparto, la gran mayoría de las mujeres infectadas por el VIH estaban dedicadas a cuidar a sus hijos. La proporción de mujeres infectadas por el VIH cuyo diagnóstico se hizo antes de que dieran a luz aumentó de manera significativa durante el período de estudio, habiéndose elevado de 25% durante 1986-1990 a 82% durante 1999-2000. Un poco más de la quinta parte de las mujeres infectadas por el VIH habían tenido uno o más embarazos después de enterarse de que estaban infectadas. CONCLUSIONES: La precocidad del comienzo de las relaciones sexuales así como el elevado número de embarazos, especialmente de parejas diferentes y más viejas, podrían haber contribuido de un modo significativo a la transmisión vertical y horizontal del VIH en Barbados. Será importante en un futuro realizar estudios sobre la incidencia de la infección por el VIH y sus tendencias en mujeres en fase reproductiva a fin de monitorear la epidemia de dicha infección en este país. Muchas de las mujeres infectadas por el VIH que dieron a luz en nuestro estudio estaban sin trabajo o enfermas y tenían varios hijos. Por consiguiente, es necesario ofrecerles a estas mujeres asesoramiento y seguimiento periódicos y, si es necesario, un apoyo económico, social y médico adicional a fin de ayudarlas a planificar y afrontar las consecuencias de su enfermedad y el cuidado de sus hijos más allá del período perinatal.

Resumo em Inglês:

OBJECTIVE: To describe the demographic profile, social and family characteristics, and life style traits of HIV-infected childbearing women in the Caribbean nation of Barbados in comparison to a control group of HIV-negative women. METHODS: Data for this report were drawn from the Pediatrics HIV Surveillance Program of the Queen Elizabeth Hospital in Barbados. The data covered all HIV-infected women in the country who delivered between 1986-2000, with similar data coming from a control group of HIV-negative childbearing women. Routine information recorded during antenatal care was obtained from the women's case records. Additional data were collected from interviews with the women. RESULTS: There were 182 HIV-infected women who delivered during the study period, and a group of 202 childbearing women served as controls. In comparison to the control group, the HIV-infected women were younger, more often multiparous, and more likely to have been unemployed at the time of their pregnancy. The HIV-infected women also had had an earlier onset of sexual activity, had had more sexual partners during their lifetime, and were more likely to be involved with an older sexual partner. At the time of giving birth most of the HIV-infected women were asymptomatic for AIDS and were living with either their parents (mother or father or both) or the baby's father. In addition, at the time of their six-weeks-postnatal visit, the large majority of the HIV-infected women were involved in caring for their children. The proportion of HIV-infected women who were diagnosed prior to childbirth increased significantly over the study period, rising from 25% during 1986-1990 to 82% during 1996-2000. Slightly over one-fifth of the HIV-infected women had had one or more subsequent pregnancies after they had learned that they were infected. CONCLUSIONS: The early age of sexual activity as well as repeated pregnancies, especially from different and older partners, may have contributed significantly to both vertical and horizontal HIV transmission in Barbados. Future studies of HIV incidence and its trend among childbearing women could be important for monitoring the HIV epidemic in this country. Many of the HIV-infected childbearing women in our study were unemployed, sick, and had multiple children. Therefore, to help them to plan for and cope with the disease and also the care of their children beyond the perinatal period, there is a need to provide the women with repeated counseling with continued follow-up and, where necessary, additional economic, social, and medical support.

Resumo em Espanhol:

OBJETIVO: Evaluar la prevalencia e intensidad de las infecciones por geohelmintos en niños de dos comunidades hiperendémicas tratadas con técnicas antihelmínticas diferentes: una con tratamiento selectivo o individual, y la otra con tratamiento masivo reiterado. MÉTODOS: La población estuvo compuesta por 909 niños de uno u otro sexo, con edades entre 2 y 13 años, que vivían en dos comunidades marginales de la ciudad: Las Lomas y El Abasto, Santa Fe, Argentina. Se realizó un trabajo prospectivo longitudinal, cuasiexperimental, de comunidades. Durante los 22 meses del estudio se llevaron a cabo 5 controles parasitológicos, evaluados desde el punto de vista cualitativo y cuantitativo, y se dispensaron tratamientos antihelmínticos después de los controles 0, 2, 3 y 4. En Las Lomas se aplicó el tratamiento selectivo a los casos con diagnóstico parasitológico positivo que integraban la muestra A (n = 55) y en El Abasto, tratamiento masivo a todos los niños, incluidos los integrantes de la muestra B (n = 50). Ambas muestras fueron escogidas para realizar los controles. RESULTADOS: Se comprobó una prevalencia e intensidad de la infección por Ascaris lumbricoides significativamente mayor en El Abasto. No se detectaron diferencias para Trichuris trichiura. Al comparar las prevalencias y cargas parasitarias de A. lumbricoides entre los controles realizados dentro de una misma comunidad (inicio y final del estudio) no se observaron diferencias significativas en la muestra A, aunque sí en la muestra B. En cuanto a T. trichiura, se detectaron diferencias significativas entre ambos controles en las dos muestras. CONCLUSIONES: Solo el tratamiento masivo y reiterado logró disminuir eficaz y significativamente la prevalencia y la carga parasitaria de A. lumbricoides durante el período estudiado.

Resumo em Inglês:

OBJECTIVE: To compare the prevalence and intensity of soil-transmitted nematode infection among children from two hyperendemic communities who were treated with antihelminthic drugs under two different regimens: selective or individual treatment was administered to members of one of the communities, and repeated mass treatment was given to the control community. METHODS: The study population was comprised of 909 children of both sexes between the ages of 2 and 13 from two peri-urban communities: Las Lomas and El Abastos, both in Santa Fe, Argentina. A prospective, longitudinal, quasi-experimental study was carried out in these communities. During the 22-month study period, 5 parasitologic controls were performed and results were qualitatively and quantitatively examined. Treatment with antihelminthic drugs was given at controls 0, 2, 3, and 4. At Las Lomas, selective treatment was administered to those in sample A (n = 55) who were positive for parasites; in El Abasto, mass treatment was given to all children, including those in sample B (n = 50). Both samples received follow-up. RESULTS: The prevalence and intensity of A. lumbricoides infections were found to be significant in El Abasto. No differences were detected in the case of T. trichiura. When prevalence and parasitic burden of A. lumbricoides were compared among controls within a single community (at the beginning and end of the study), no significant differences were observed in sample A, but a significant difference was seen in sample B. Insofar as T. trichiura is concerned, there were significant differences among controls in both samples. CONCLUSIONS: Only repeated and massive treatment significantly lowered the prevalence and intensity of A. lumbricoides infections during the study period.

Resumo em Português:

OBJETIVO: Determinar os níveis de chumbo no sangue de crianças que moravam próximo a uma fundição de chumbo desativada na Cidade de Santo Amaro da Purificação, Estado da Bahia, em setembro de 1998; e identificar fatores associados à variação destes níveis. MÉTODOS: Estudo de corte transversal com crianças de 1 a 4 anos de idade que residiam a menos de 1 km da fundição. Mães ou responsáveis por 47 crianças responderam questionários sobre transtornos do hábito alimentar (comer barro, terra, reboco ou outros materiais) e outros aspectos epidemiológicos relevantes. A concentração de chumbo no sangue foi determinada por espectrofotometria de absorção atômica. RESULTADOS: O nível médio de chumbo foi de 17,1 ± 7,3 mig/dL. Os níveis de chumbo no sangue foram cerca de 5 mig/dL mais elevados em crianças que tinham transtorno do hábito alimentar, independentemente da idade, presença de escória visível no peridomicílio, situação de emprego do pai, história familiar de intoxicação pelo chumbo e desnutrição. CONCLUSÕES: O passivo ambiental da fundição de chumbo, desativada em 1993, permanece como um fator de risco relevante para elevar os níveis desse metal no sangue de crianças, particularmente aquelas que apresentam transtornos do hábito alimentar.

Resumo em Inglês:

OBJECTIVE: To determine the blood lead levels in children living an inactive lead foundry in the city of Santo Amaro da Purificação,state of Bahia, in September of 1998; and to identify factors associated with differences in these levels. METHODS: Cross-sectional study with children between 1 and 4 years of age living within 1 km of the lead foundry. Mothers or guardians of 47 children answered a questionnaire concerning ingestion of clay, soli, plaster and / or other materias (pica),and other relevant epidemiological aspects. The concentration of lead in blood was determined by atermined by atomic absorption espectrophotometry. RESULTS: The mean lead level was 17.1 ± 7. 3 mug/dL. Blood lead levels were approximately 5 mug/ dl greater amoong children with pica, regardless of age, visible presence of scum surrounding the home, employment status of the father, family history of lead poisoning, and malnutrition. CONCLUSIONS: The environmental legacy of the lead foundry, which was shut down in 1993, continues to represent a relevant risk factor for increased blood lead levels in children, especially those presenting pica.

Resumo em Espanhol:

OBJETIVO: Dado que el peso corporal excesivo durante la niñez influye en el desarrollo de varias enfermedades crónicas en la adultez, se llevó a cabo este estudio en escolares de nivel primario de áreas urbanas y rurales de Costa Rica, para determinar la prevalencia del sobrepeso y la obesidad. MÉTODOS: El estudio se llevó a cabo de julio de 2000 a abril de 2001. Se seleccionó un total de 1 718 estudiantes de 7 a 12 años de edad de 34 escuelas de la capital (San José) y de áreas rurales y urbanas cercanas. Se consideró que tenían sobrepeso tanto los niños menores (de 7 a 9 años) como los mayores (de 10 a 12 años) cuyo índice de masa corporal era igual o mayor al del 85% de los niños, según sexo. Se consideraron obesos a los niños menores si el pliegue cutáneo de sus tríceps era igual o mayor al del 85% de los niños estadounidenses de la misma edad y sexo, como estándares normativos. Se consideraron obesos a los niños mayores si su índice de masa corporal era igual o mayor al del 85% de los niños del mismo sexo y el espesor del pliegue cutáneo, tanto de tríceps como subescapular, era igual o mayor al del 90%. RESULTADOS: La prevalencia de sobrepeso fue del 34,5%. Niños de 7 a 9 años, los varones, niños de áreas urbanas y los niños de nivel socioeconómico más alto tenían mayor prevalencia de sobrepeso. La prevalencia de obesidad fue del 26,2%. Se encontró mayor prevalencia de obesidad entre niños de 7 a 9 años, varones, los niños de áreas urbanas, y aquéllos de nivel socioeconómico mediano. CONCLUSIONES: Dada la alta prevalencia de obesidad que se encontró en los niños costarricenses estudiados, es necesario aplicar medidas primarias y secundarias para reducir la proporción de muertes atribuibles a enfermedades crónicas no transmisibles entre adultos costarricenses en los próximos decenios.

Resumo em Inglês:

OBJECTIVE: Given that excessive body weight during childhood influences the development of several chronic diseases in adulthood, this study was conducted to determine the prevalence of overweight and obesity in urban and rural Costa Rican elementary school children. METHODS: The study was carried out from July 2000 to April 2001. A total of 1718 students ages 7-12 were selected from 34 schools in the capital city of San José and in other nearby urban and rural areas. Both younger children (ones aged 7 through 9 years) and older children (ones aged 10 through 12 years) with a body mass index (BMI) at or above the sex-specific 85th percentile were considered overweight. The younger children were classified as being obese if their triceps skinfold was greater than or equal to the 85th percentile for age and sex using the percentiles by age for children in the United States of America as normative standards. The older children were considered obese if they had a BMI at or above the sex-specific 85th percentile and both the triceps and subscapular skinfold thickness at or above the 90th percentile. RESULTS: The prevalence of overweight was 34.5%. Children aged 7-9, boys, children from urban areas, and children of a higher socioeconomic status had a higher prevalence of overweight. The prevalence of obesity was 26.2%. A higher prevalence of obesity was found among children aged 7-9, boys, children from urban areas, and children of middle socioeconomic status. CONCLUSIONS: Given the high prevalence of obesity that we found in the Costa Rican children, primary and secondary prevention measures are needed in order to reduce the proportion of deaths due to chronic nontransmissible diseases among Costa Rican adults in the coming decades.

Resumo em Português:

OBJETIVO: Descrever a utilização de capacete entre vítimas de acidentes de motocicleta ocor ridos em Londrina, uma cidade de médio porte do Estado do Paraná, Brasil, além de verificar fatores associados à não-utilização desse equipamento de segurança no momento do acidente. MÉTODOS: Foram analisados dados de ocupantes de motocicleta atendidos pelo único serviço de atendimento pré-hospitalar de Londrina durante o ano de 1998. As variáveis estudadas foram: uso de capacete no momento do acidente, idade, sexo, posição na motocicleta (condutor ou passageiro), hálito etílico, horário, dia da semana, mês e região onde ocorreu o acidente. RESULTADOS: A taxa média de uso de capacete foi de 63,2%. Fatores independentemente associados ao não-uso desse equipamento foram, em ordem de força de associação: ser menor de 18 anos (OR = 6,61); presença de hálito etílico (OR = 3,93); acidente ocorrido durante a noite (OR = 2,51); acidente ocorrido fora da região central da cidade (OR = 2,27); e acidente durante o final de semana (OR = 2,25). CONCLUSÕES: É urgente a implementação de políticas públicas visando à promoção de um transporte mais seguro para motociclistas, à educação contínua em práticas de direção defensiva e ao estímulo ao uso de equipamentos de segurança, como o capacete. Além disso, é preciso que as ações de intervenção levem em conta que o comportamento no trânsito é produto do contexto social e do momento histórico.

Resumo em Inglês:

OBJECTIVE: To describe helmet use among motorcyclists injured in traffic accidents in Londrina, a medium-sized city in Paraná, a state in southern Brazil, and to identify factors associated with not wearing a helmet at the time of the accident. METHODS: We analyzed data concerning motorcycle users (drivers and passengers) who received care in 1998 from the only pre-hospitalization trauma and emergency care ambulance service in Londrina. The following variables were assessed: helmet use at the time of the accident; age; sex; seating position (driver or passenger); smell of alcohol on the breath; time of the day, day of the week, and month when the accident happened; and location of the accident (in the downtown area or outside of it). RESULTS: The average rate of helmet use was 63.2%. Factors independently associated with not using a helmet were (according to strength of association): being younger than 18 years of age (odds ratio (OR) = 6.61), having alcohol on the breath (OR = 3.93), accident occurring at night (OR = 2.51), accident happening outside the city's downtown area (OR = 2.27), and accident taking placing during the weekend (OR = 2.25). CONCUSIONS: It is imperative to implement public policies aimed at promoting safety for motorcyclists, ongoing education in defensive driving, and the use of helmets and other safety equipment. Interventions should take into account that driving behaviors depend not just on individuals but also on the overall social and historical context.

Resumo em Inglês:

In recent years, agencies that provide technical cooperation in health have increased their contractual relationships with private consulting entities. This has made it possible to respond in a timely manner to the support needs that countries have, to develop skills at the national level, and to reduce the operating costs for the cooperation agencies. However, these relationships risk moving the cooperation agencies away from generating ideas and new knowledge, which, until recently, was considered one of their essential roles. Contracting with private enterprises will almost certainly increase in the coming years. This makes it worth reviewing the tasks that correspond to the cooperation agencies in this scenario as well as mechanisms to see that these relationships result in the greatest benefit for deprived groups. Actions that can be undertaken immediately include organizing the "structural capital" (such as programs, databases, strategies, and organizational "culture," structure, systems, and procedures) of the technical cooperation agencies, precisely identifying tasks that cannot be delegated, and adequately designing and controlling terms of reference.