Resumo em Espanhol:

OBJETIVOS: Evaluar la resistencia a antibióticos de cepas de Shigella spp. aisladas de muestras de heces en el nordeste argentino y caracterizarlas desde el punto de vista de su epidemiología molecular. MÉTODOS: Se estudiaron 132 aislamientos de Shigella spp. obtenidos de las heces de igual número de pacientes con diarrea que asistieron a diferentes laboratorios privados y estatales de las provincias del Chaco y Corrientes, Argentina, durante el período de 1998 a 2002. Cada cepa se caracterizó según su serotipo, su resistencia a 13 antibióticos individuales o combinados y su sensibilidad a las piocinas. A 52 cepas seleccionadas en función de sus perfiles de susceptibilidad antimicrobiana se les determinaron la dotación plasmídica mediante lisis alcalina y las secuencias repetitivas palindrómicas extragénicas mediante la amplificación de segmentos repetitivos de ADN con la reacción en cadena de la polimerasa (REP-RCP). Se aplicó la prueba de ji al cuadrado para comparar proporciones. El nivel de significación estadística fue de 0,05. RESULTADOS: Shigella flexneri fue la especie más frecuente (78%), seguida de S. sonnei (22%). En general, la resistencia de S. flexneri a los antibióticos estudiados fue mayor que la de S. sonnei y esta diferencia fue estadísticamente significativa (P <0,001) frente a ampicilina, tetraciclina, cloramfenicol y la combinación de ampicilina con sulbactama. Las cepas de S. flexneri también mostraron mayor multirresistencia que las de S. sonnei (84,5% frente a 31,0%; P <0,001). Las cepas aisladas de S. flexneri pudieron agruparse según 5 piocinotipos, 3 perfiles plasmídicos y 5 patrones de secuencias repetitivas palindrómicas. Por su parte, las cepas de S. sonnei conformaron 3 piocinotipos, 2 perfiles plasmídicos y 3 patrones de secuencias repetitivas palindrómicas. CONCLUSIONES: Las especies de Shigella estudiadas mostraron una elevada resistencia a los antibióticos de uso más frecuente, por lo que se deben poner en marcha actividades de vigilancia a fin de detectar y controlar la aparición de nuevas cepas resistentes. La aplicación de técnicas de tipificación epidemiológica puede ayudar a conocer con mayor precisión la distribución y evolución de cepas de microorganismos resistentes circulantes.

Resumo em Inglês:

OBJECTIVES: To evaluate the antibiotic resistance of strains of Shigella spp. isolated from feces samples from northeastern Argentina and to characterize the strains in terms of their molecular epidemiology. METHODS: We studied 132 isolates of Shigella spp. obtained from feces samples from 132 patients with diarrhea who were seen at various private and public laboratories in the Argentine provinces of Chaco and Corrientes during the period of 1998 to 2002. Each strain was characterized according to its serotype, its resistance to 13 individual or combination antibiotics, and its sensitivity to pyocins. With 52 strains selected in relation to their antimicrobial susceptibility profiles we conducted plasmid profile analysis using alkaline lysis, and the repetitive extragenic palindromic sequences were determined by amplifying repetitive DNA segments using polymerase chain reaction. The chi-square test was used to compare proportions, with a level of statistical significance of 0.05. RESULTS: Shigella flexneri was the most common species (78%), followed by S. sonnei (22%). In general, the resistance of S. flexneri to the antibiotics studied was greater than that of S. sonnei, and this difference was statistically significant (P < 0.001) for ampicillin, tetracycline, chloramphenicol, and the combination of ampicillin and sulbactam. The S. flexneri strains also showed multiple resistance more often than S. sonnei strains (84.5% vs. 31.0%; P < 0.001). The strains isolated from S. flexneri were grouped into five pyocin types, three plasmid profiles, and five patterns of repetitive palindromic sequences. The strains of S. sonnei formed three pyocin types, two plasmid profiles, and three patterns of repetitive palindromic sequences. CONCLUSIONS: Given that the Shigella species that were studied showed a high level of resistance to the most frequently used antibiotics, surveillance activities should be implemented in order to detect and control the appearance of new resistant strains. Applying epidemiological typing techniques can provide more precise information about the distribution and evolution of resistant strains of circulating microorganisms.

Resumo em Espanhol:

OBJECTIVO: Examinar en qué medida el uso de drogas por los pares y hermanos es factor pronóstico del abuso o la dependencia del alcohol y del uso de drogas distintas del alcohol en escolares mexicanos. MÉTODOS: Se recolectaron datos acerca de 1 203 estudiantes de los últimos años de primaria y de secundaria en el norte de México en mayo de 1998. La participación en el estudio fue voluntaria, y las respuestas fueron confidenciales. Mediante análisis de regresión logística se estimó la asociación entre el uso de drogas por los pares y hermanos por un lado, y por el otro el diagnóstico de abuso o dependencia del alcohol y el uso de sustancias distintas del alcohol en algún momento de la vida. RESULTADOS: Los estudiantes cuyos hermanos o pares ingerían bebidas alcohólicas y consumían otras drogas mostraron mayores probabilidades de satisfacer los criterios estándares de abuso o dependencia del alcohol, según los define el Manual diagnóstico y estadístico de enfermedades mentales, cuarta edición (MDE-IV), y de haber consumido drogas distintas del alcohol. Después de controlado el efecto de posibles factores de confusión, los adolescentes con los niveles más altos de abuso de sustancias por parte de sus pares se mostraron ocho veces más propensos a satisfacer los criterios de abuso o dependencia del alcohol y cuatro veces más propensos a consumir otros tipos de sustancias. Los adolescentes cuyos hermanos consumían drogas tenían una probabilidad dos veces mayor de satisfacer los criterios de abuso o dependencia del alcohol y una probabilidad 2,5 veces mayor de consumir drogas en comparación con jóvenes cuyos hermanos no consumían ninguna sustancia. CONCLUSIONES: Tal como indican otros resultados obtenidos con adolescentes en Estados Unidos de América, el uso de sustancias por los pares y hermanos es un factor de riesgo de consumo de sustancias en escolares en México. Estos últimos podrían beneficiarse de estrategias preventivas cuya eficacia en jóvenes estadounidenses se haya demostrado.

Resumo em Inglês:

OBJECTIVE: To examine the extent to which peer drug use and sibling drug use predict alcohol abuse/dependence disorder status and the use of drugs other than alcohol among school-based youth in Mexico. METHODS: Data were collected on 1 203 middle and high school students in northern Mexico in May 1998. Participation was voluntary, and responses were confidential. Logistic regression analyses estimated the association that peer drug use and that sibling drug use had with alcohol abuse/dependence diagnosis and the lifetime use of drugs other than alcohol. RESULTS: Students who had siblings or peers who used alcohol and other drugs were more likely to meet the standard alcohol abuse/dependence criteria defined by the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV), and were more likely to have used drugs other than alcohol. Controlling for potentially important confounders, we found that adolescents with the highest level of peer substance use were eight times as likely to meet alcohol abuse/dependence criteria and four times as likely to use other drugs. Youth who had siblings who used drugs were about twice as likely to meet alcohol abuse/dependence criteria and about 2.5 times as likely to use drugs other than alcohol when compared to youth with no sibling substance use. CONCLUSIONS: Consistent with extant findings among youth in the United States of America, peer and sibling substance use are major risk factors for substance use among school-based youth in Mexico. Students in Mexico may benefit from prevention strategies found to be effective among students in the United States.

Resumo em Português:

OBJETIVO: Traçar o perfil da mortalidade por doenças infecciosas e parasitárias na população de mais de 65 anos no Brasil e nas unidades da federação e investigar sua associação com determinadas variáveis socioeconômicas no período de 1980 a 1995. MÉTODOS: Foram utilizados os dados do Sistema de Informações sobre Mortalidade. Foram calculadas taxas de mortalidade padronizadas para tuberculose, tripanossomíase e septicemia, assim como a participação relativa dessas causas na mortalidade geral. Analisou-se a relação entre as taxas de mortalidade por doenças infecciosas e parasitárias e sexo e as seguintes variáveis socioeconômicas: produto interno bruto per capita; número de leitos hospitalares por habitante; relação entre a população urbana e a total; número de benefícios em manutenção pela previdência social por habitante; coeficiente de letalidade; e esperança de vida ao nascer. Para esta análise foi utilizado o modelo normal de regressão linear múltipla. RESULTADOS: Não houve alteração significativa no percentual de óbitos por doenças infecciosas e parasitárias na população idosa brasileira no período para ambos os sexos. Por outro lado, verificou-se uma importante transição no período, caracterizada pela diminuição da participação da tuberculose pulmonar e da tripanossomíase e pela tendência de aumento na participação da septicemia para ambos os sexos. A análise ecológica mostrou que os indicadores socioeconômicos analisados tiveram baixo poder explicativo para os diferentes padrões de mortalidade nas diferentes regiões do país. CONCLUSÕES: Os presentes resultados sugerem uma estagnação das políticas de prevenção e combate às doenças infecciosas e parasitárias como um todo. Essa observação, juntamente com a progressiva pressão populacional dos idosos, indica que os níveis de mortalidade por doenças infecciosas e parasitárias não deverão diminuir nessa faixa etária, pelo menos em um futuro próximo.

Resumo em Inglês:

OBJECTIVE: To describe the mortality due to infectious and parasitic diseases in persons over 65 years of age in all of Brazil and in individual states and to study the association between that mortality due to these causes and specific socioeconomic variables over the period from 1980 to 1995. METHODS: Data were obtained from Brazil's national Mortality Information System. Standardized mortality rates were calculated for tuberculosis, Chagas' disease, and sepsis. The relative contribution of these causes of death to overall mortality was also calculated. The study also analyzed the relationship between mortality rates and gender and the following socioeconomic variables: per capita gross domestic product; number of hospital beds per inhabitant; proportion of the total population living in urban areas; number of benefits provided per capita by the social welfare system; number of deaths reported for every 100 hospitalizations; and life expectancy at birth. A normal multiple linear regression model was used for this analysis. RESULTS: There were no significant changes in the proportion of deaths due to infectious and parasitic diseases in the elderly population during the period studied, regardless of sex. However, for both men and women there was a sizeable decrease in the impact of tuberculosis and Chagas' disease, while that of sepsis appeared to increase. According to the results of the ecological analysis, socioeconomic indicators had little power to explain the differences in mortality patterns seen in the different states of the country. CONCLUSIONS: Our results suggest that policies to prevent and control infectious and parasitic diseases among the elderly in Brazil have stagnated. Given this situation and the progressive increase in the elderly population, mortality due to infectious and parasitic diseases is not likely to decrease in this age group, at least in the near future.

Resumo em Espanhol:

OBJETIVO: Determinar los resultados del asesoramiento y de la prueba detectora de infección por VIH aceptados voluntariamente (APV) e identificar las barreras que impiden llevar el APV a la práctica cuando se ofrece como parte integral de la atención prenatal. MÉTODOS: En este estudio descriptivo investigamos los antecedentes de APV prenatal y de haber recibido la prueba detectora de infección por VIH en todas las mujeres que habían dado a luz en el Hospital Reina Isabel en Bridgetown, Barbados, entre abril y septiembre de 2002. Se recolectaron datos retrospectivamente a partir de las fichas de atención prenatal y por recordación durante entrevistas de cara a cara. RESULTADOS: De las 1 342 mujeres entrevistadas, a 954 (71,1%) se les había dado asesoramiento prenatal y se les había ofrecido la prueba detectora de infección por VIH. De las 954 mujeres encuestadas a quienes se les ofreció la prueba después del asesoramiento, 914 (95,8%) la aceptaron. De las mujeres encuestadas, 1 106 (82,4%) tenían documentada en su ficha una prueba detectora de infección por VIH, 914 (85,7%) recibieron la prueba después de un asesoramiento documentado, y otras 192 (14,3%) recibieron la prueba sin ninguna documentación de haber recibido un asesoramiento previo. En total, 822 (61,2%) de las 1 342 mujeres entrevistadas tenían documentado en su ficha el resultado de la prueba detectora de VIH en el momento de dar a luz. De las 1 106 mujeres con documentación de haber recibido la prueba, 284 (21,2%) no tenían anotado el resultado en el momento de dar a luz. La falta de un resultado documentado se debió principalmente a que la prueba nunca se realizó (45,0%), y en segundo lugar, a la falta de certeza en cuanto a la documentación. CONCLUSIONES: Veintinueve por ciento de las mujeres encuestadas no recibieron APV, lo cual es alarmante porque la alta cobertura y la buena calidad son imprescindibles para que el APV dé buenos resultados y rinda la debida eficacia en función de su costo. Catorce por ciento de las mujeres encuestadas que no quisieron recibir ningún asesoramiento recibieron la prueba detectora de infección por VIH. Esta situación no es aconsejable porque significa que a algunas mujeres se les aplica la prueba sin que entiendan a fondo las implicaciones de esta política. Esto, a su vez, podría reducir el impacto general del APV.

Resumo em Inglês:

OBJECTIVE: To determine the success of voluntary counseling and testing (VCT) for HIV and to identify the barriers to implementation when VCT is offered as a package integrated with antenatal care. METHODS: In this descriptive study we investigated antenatal VCT and HIV testing in all post-parturient women at the Queen Elizabeth Hospital, Bridgetown, Barbados, who gave birth between April and September 2002. Data were collected retrospectively from the antenatal care record and by recall during one-on-one interview. RESULTS: Of 1 342 women surveyed, 954 (71.1%) received antenatal counseling and were offered an HIV test. Of the 954 women offered HIV test after counseling, 914 (95.8%) agreed to have the test. Among the women surveyed, 1 106 (82.4%) had a documented HIV test, 914 (85.7%) were tested after documented pretest counseling, and another 192 (14.3%) were tested without documented pretest counseling. Overall, 822 of the 1 342 women surveyed (61.2%) had a documented HIV test result in their antenatal case record at the time of delivery. Of the 1 106 women who had a documented HIV test, the test results were unavailable at the time of delivery in only 284 (21.2%). Among the reasons for unavailability of a documented HIV test result, the most common (45.0%) was that no test was done, followed by unclear documentation of the result. CONCLUSIONS: Twenty-nine percent of surveyed women failed to receive antenatal VCT and this is a cause of concern, for both the high coverage and good quality counseling are key to the overall success and cost effectiveness of the VCT program. Fourteen percent of the women surveyed who did not receive VCT were tested for HIV, a situation that is undesirable because some women may be tested without understanding the full implication of this policy, and as a result the overall impact of VCT may be reduced.

Resumo em Espanhol:

OBJETIVOS: Evaluar la eficacia de la vacuna cubana contra la leptospirosis vax-SPIRAL y aportar información adicional acerca de la seguridad de esta vacuna. MÉTODOS: Ensayo de eficacia (fase III) controlado, aleatorizado y con doble enmascaramiento de la vacuna cubana contra la leptospirosis vax-SPIRAL (Instituto Finlay, Cuba). Como control se utilizó la vacuna recombinante contra la hepatitis B Heberbiovac-HB (Heber Biotec, Cuba). Como unidad de aleatorización para la asignación al grupo de estudio o al grupo testigo se emplearon los 523 consultorios de los médicos de familia existentes en los municipios seleccionados. El estudio abarcó a toda persona de 20 a 64 años de edad de uno u otro sexo que residía en los municipios de Ranchuelo, Quemado, Santo Domingo, Encrucijada, Corralillo, Cifuentes y Camajuaní, en la provincia de Villa Clara, ubicada en la región central de Cuba, que aceptó participar voluntariamente en el ensayo. La vacunación se efectuó en los consultorios de los médicos de familia entre febrero y julio de 1998, con un intervalo de 6 semanas entre las dos dosis. El período de seguimiento fue de 12 meses. Se consideró positivo un caso si había recibido las dos dosis de la vacuna asignada y había enfermado de leptospirosis, con diagnóstico confirmado mediante métodos serológicos y microbiológicos, después de 21 días de aplicada la segunda dosis. Se calcularon la eficacia de la vacuna y el riesgo relativo (RR) de enfermar de leptospirosis después de la vacunación. Para el estudio de seguridad se escogió a dos personas al azar entre las personas vacunadas en cada uno de los consultorios que participaron en el estudio de eficacia. El seguimiento de las reacciones adversas locales y sistémicas lo realizaron los médicos de familia durante los siete días posteriores a la aplicación de cada dosis. El nivel de significación se fijó en 0,05. RESULTADOS: En total se vacunó a 101 832 personas, de las cuales 50 354 (49,4%) recibieron la vacuna contra la leptospirosis y 51 478 (50,6%) la vacuna de control. La eficacia de la vacuna vax-SPIRAL fue de 78,1% (IC95%: 59,2 a 88,3) y el RR de enfermar de leptospirosis de las personas vacunadas con respecto a las personas sin vacunar fue de 0,22 (IC95%: 0,12 a 0,41). El malestar general fue la reacción adversa sistémica más frecuente y el dolor espontáneo ligero en el sitio de la inyección el más frecuente de los efectos locales. En ambos casos estas reacciones fueron mayores en el grupo de estudio que en el grupo testigo (P= 0,003). No se produjeron reacciones adversas graves. CONCLUSIÓN: La vacuna cubana vax-SPIRAL se mostró segura y eficaz para el control de la leptospirosis, por lo que se recomienda su utilización para prevenir esta enfermedad en los grupos en riesgo de contraerla.

Resumo em Inglês:

OBJECTIVES: To evaluate the efficacy of vax-SPIRAL, a Cuban vaccine against leptospirosis, and to provide additional information concerning the safety of this vaccine (which was developed by Cuba's Finlay Institute). METHODS: This phase III efficacy trial of vax-SPIRAL was controlled, randomized, and double blind. The control vaccine used for the trial was Heberbiovac-HB (Heber Biotec, Cuba), a recombinant hepatitis B vaccine. The randomization unit for allocating persons to the study group or the control group were 523 family physician offices in the selected municipalities. The study covered the entire population of males and females from 20 to 64 years old who voluntarily agreed to participate, from the municipalities of Ranchuelo, Quemado, Santo Domingo, Encrucijada, Corralillo, Cifuentes, and Camajuaní, which are in the province of Villa Clara, in the central region of Cuba. The vaccinations were given in the physicians' offices between February and July 1998, with an interval of 6 weeks between the two doses. The follow-up period was 12 months. A case was considered positive if a person who had received the two doses of the vaccine became ill with leptospirosis more than 21 days after receiving the second dose, with the diagnosis confirmed through serological and microbiological methods. We calculated the efficacy of the vaccine and the relative risk of becoming ill with leptospirosis after the vaccination. For the safety study, two persons were chosen at random from among the individuals vaccinated at the office of each physician participating in the study. Follow-up of local and systemic adverse reactions was carried out by the family physicians during the seven days after the application of each dose. The level of statistical significance was set at 0.05. RESULTS: A total of 101 832 persons were vaccinated, with 50 354 of them (49.4%) receiving the leptospirosis vaccine and 51 478 of them (50.6%) receiving the control vaccine. The efficacy of the vax-SPIRAL vaccine was 78.1% (95% confidence interval (CI): 59.2% to 88.3%), and the relative risk of becoming ill with leptospirosis after receiving the leptospirosis vaccine was 0.22 (95% CI: 0.12 to 0.41). General discomfort was the most frequent systemic adverse reaction, and mild spontaneous pain at the injection site was the most frequent local effect. The local and systemic adverse reactions were both more frequent in the study group than in the control group (P = 0.003). There were no serious adverse events. CONCLUSION: The vax-SPIRAL vaccine proved to be safe and efficacious for leptospirosis control. The vaccine is recommended for use in preventing this disease among groups at risk of contracting it.

Resumo em Português:

OBJETIVO: Comparar a prevalência de cárie dentária em escolares que participaram de um programa semanal de bochecho com fluoreto de sódio a 0,2% com a prevalência de cárie em escolares que não participaram do programa. MÉTODOS: Estudo transversal na Cidade de Londrina, Estado do Paraná, Brasil, cuja população consome água fluoretada. Foram examinados 367 escolares de 12 anos: 190 participantes (51,8%) e 177 não participantes (48,2%) do programa semanal de bochecho. Os índices utilizados foram o de dentes cariados, perdidos e obturados e o de superfícies cariadas, perdidas e obturadas. Os exames foram conduzidos por três examinadores e a concordância no diagnóstico de cárie foi quase perfeita (K = 0,90). A cárie dentária foi considerada variável dependente. As variáveis independentes foram: a participação ou não no programa, estudar em escola pública ou privada, escovação dentária, quantidade de dentifrício utilizada, ingestão de doces e consulta ao dentista. RESULTADOS: O índice de dentes cariados, perdidos e obturados aos 12 anos foi 0,85 ± 0,059 (0,70 ±0,060 para não participantes e 1,0 ±0,058 para participantes). O índice de superfícies cariadas, perdidas e obturadas foi 1,16 ±0,017, variando de 0,34 a 1,66. Na análise bivariada, estiveram estatisticamente associados (P <0,05) com a presença de cárie: estudar em escola pública, participar no programa de bochecho e ingerir doces entre as refeições mais de uma vez por dia. Na análise de regressão logística multivariada, mantiveram-se associados com a presença de cárie estudar em escola pública (P = 0,0004) e ingerir doces (P = 0,0010). CONCLUSÕES: O programa de bochecho com flúor não esteve associado a menor prevalência de cárie, seja em escolas públicas ou privadas. Entretanto, outros estudos são necessários para análise de custo-efetividade do programa em populações com maior prevalência da doença. No nível de prevalência de cárie observado, o recurso destinado ao programa de bochecho com flúor poderia financiar outras ações de promoção de saúde.

Resumo em Inglês:

OBJECTIVE: To compare the prevalence of dental caries in two groups of schoolchildren: (1) schoolchildren participating in a weekly 0.2% sodium fluoride mouth-rinsing program and (2) schoolchildren not participating in the program. METHODS: This cross-sectional study was conducted in the city (municipality) of Londrina, in the state of Paraná, Brazil; the city has fluoridated drinking water. We examined 367 12-year-old children: 190 participants in the weekly mouth-rinsing program (51.8%) and 177 nonparticipants (48.2%). The prevalence of caries was determined based on the scores for decayed, missing, and filled teeth and for decayed, missing, and filled surfaces. The examinations were performed by three examiners, with nearly perfect agreement in their diagnosis of caries (kappa = 0.90). The dependent variable was dental caries. The independent variables were: participation or nonparticipation in the mouth-rinsing program, attending a private school or a public school, frequency of tooth-brushing, amount of toothpaste used, consumption of sweets between meals, and visits to the dentist. RESULTS: The decayed, missing, and filled teeth score (mean and standard deviation) at 12 years of age was 0.85 ± 0.059 overall, 1.0 ± 0.058 for program participants, and 0.70 ± 0.060 for nonparticipants. The decayed, missing, and filled surfaces score (mean and standard deviation) was 1.16 ± 0.017, with it ranging from a low of 0.34 in one private school to a high of 1.66 in one public school. Bivariate analysis showed an association between caries (P < 0.05) and the following variables: attending a public school, participating in the mouth-rinsing program, and consuming sweets between meals more than once a day. In the multivariate analysis, attending a public school (P = 0.0004) and consuming sweets (P = 0.001) remained associated with the presence of caries. CONCLUSIONS: The weekly mouth-rinsing program was not associated with a decreased prevalence of caries, in either the public schools or the private schools. However, additional research is needed to assess the cost-effectiveness of fluoride mouth-rinsing programs in populations with a higher prevalence of caries. Given the caries prevalence that we found in the schoolchildren whom we studied, the resources allocated to the fluoride mouth-rinsing program for them should probably be used to pay for other health-promotion activities with them.

Resumo em Espanhol:

OBJETIVO: Estudiar el sobrepeso y el acondicionamiento aeróbico en niños de tercero y cuarto grado de primaria en una ciudad de Estados Unidos de América (El Paso, Texas) y una ciudad de México (Chihuahua, Chihuahua), ambas situadas en la frontera entre esos dos países o cerca de ella, así como comparar los resultados observados en esas dos ciudades con resultados obtenidos anteriormente en otras muestras infantiles en Estados Unidos. MÉTODOS: Seguimos a un grupo de niños en El Paso (427 varones y 385 niñas, 93% de los cuales eran de ascendencia mexicana) que cursaban el tercero o cuarto grado de primaria y evaluamos cambios en el índice de masa corporal (IMC). En la ciudad de Chihuahua medimos el IMC en una muestra transversal de niños de tercer grado (221 varones y 237 niñas) y de cuarto grado (268 varones y 215 niñas). A todos los niños estudiados en ambas ciudades se les tomaron mediciones de IMC y del pliegue cutáneo del tríceps. El IMC se usó para estimar el riesgo de sobrepeso (un IMC igual o mayor al del percentil 85 para la edad y el sexo) y para detectar la presencia de sobrepeso (un IMC igual o mayor al del percentil 95 para la edad y el sexo). La distancia que los niños en El Paso corrieron en nueve minutos se usó para evaluar su grado de acondicionamiento aeróbico (el cual no se midió en los niños de Chichuaua). En El Paso los datos se recolectaron en 1999, 2000 y 2001 y en Chichuahua, en 2000 y 2001. RESULTADOS: En los varones de El Paso se observó un aumento significativo de 22 a 28% en la frecuencia de sobrepeso durante el año transcurrido entre tercero y cuarto de primaria, así como un aumento significativo de 37 a 44% en el riesgo de sobrepeso. En las niñas de El Paso se produjo un aumento significativo del riesgo de sobrepeso, de 29 a 37%, en el mismo período de un año. Los varones y las niñas en El Paso mostraron un estado de acondicionamiento aeróbico menor, en grado significativo, que muestras de niños de ambos sexos tomadas en distintas partes de los Estados Unidos. Los niños de tercero y cuarto grado de primaria en Chihuahua mostraron tasas de riesgo de sobrepeso y de sobrepeso similares a las de los niños que cursaban los mismos grados en El Paso. CONCLUSIONES: Los niños en El Paso y en Chihuahua mostraron una mayor frecuencia de sobrepeso que los niños blancos que no eran hispanos en distintas partes de Estados Unidos. Los niños en El Paso mostraron un menor grado de acondicionamiento aeróbico que los niños blancos que no eran hispanos y que otros niños mexicanoestadounidenses en los Estados Unidos. Estos resultados demuestran claramente que es necesario tomar medidas en las zonas fronterizas de México y Estados Unidos para poner en marcha programas de actividad física y de nutrición orientados a frenar el aumento de la obesidad en la población.

Resumo em Inglês:

OBJECTIVE: To study overweight and aerobic fitness among children in the third and fourth grades of elementary schools in a city in the United States of America (El Paso, Texas) and a city in Mexico (Chihuahua, Chihuahua) that are on or near the border between those two countries, and to compare the results from those two cities with earlier findings for other children in the United States. METHODS: We followed the El Paso children (427 boys and 385 girls, 93% of them of Mexican descent) from third to fourth grade and assessed the change in their body mass index (BMI). In the city of Chihuahua we cross-sectionally measured the BMI of a sample of third grade children (221 boys and 237 girls) and a sample of fourth grade children (268 boys and 215 girls). BMI and triceps skinfolds were measured for all the children studied in the two cities. BMI was used to assess risk for overweight (at least the 85th percentile BMI for age and gender) and overweight (at least the 95th percentile BMI for age and gender) in all the children. The distance that El Paso children ran in nine minutes was used to assess their aerobic fitness (aerobic fitness was not measured in the Chihuahua children). The data from El Paso were collected in 1999, 2000, and 2001, and the Chihuahua data were collected in 2000 and 2001. RESULTS: In the El Paso boys, overweight significantly increased in the one year from third grade to fourth grade, from 22% to 28%, while risk for overweight significantly increased, from 37% to 44%. In the El Paso girls, risk for overweight significantly increased over the same one-year period, from 29% to 37%. The El Paso boys and girls were significantly less fit when compared to samples of children from throughout the United States. Third and fourth grade children from Chihuahua had similar rates of risk for overweight and of overweight when compared to the children from the same grades in El Paso. CONCLUSIONS: Children in both El Paso and Chihuahua were more overweight than were non-Hispanic white children throughout the United States. In addition, the children in El Paso were less aerobically fit than were non-Hispanic white children and than were other Mexican-American children in the United States. These results clearly show that efforts should be made in the border regions of both Mexico and the United States to develop physical activity and nutrition programs to help stem rising rates of overweight.

Resumo em Espanhol:

En los Estados Unidos de América y en la mayoría de los países de América Latina y el Caribe se está observando un aumento de la obesidad y otros trastornos con los que esta se asocia, tales como la diabetes, la hipertensión arterial, y las enfermedades cardiovasculares. Tomados en conjunto, estos trastornos causan dos tercios de todas las muertes y menoscaban enormemente los presupuestos destinados a la atención sanitaria, así como la productividad económica y la calidad de la vida. Consumir una dieta sana y mantenerse físicamente activo son maneras eficaces de evitarlos. Cada vez son más quienes opinan que es tarea prioritaria de la salud pública adoptar un enfoque preventivo para combatir estas afecciones. Lo que resulta difícil es no limitarse a entregarle al paciente una receta personal para que cambie de conducta. No tiene mucho sentido predicarle que "coma más frutas y verduras" cuando los alimentos procesados de mala calidad y los bocadillos para entre las comidas se venden por todas partes, son más baratos y hasta tienen algo de chic. Por consiguiente, hay que procurar que haya mayor acceso a y predilección por las verduras, frutas y granos sin refinar; desincentivar la producción y el consumo de alimentos a base de grasas saturadas; crear incentivos que fomenten el consumo de aceites de origen vegetal; rotular bien los productos y proporcionar información adecuada sobre ellos; y regular la propaganda dirigida a los niños, que son impresionables y no saben distinguir entre lo propagandístico y lo recreativo. De hecho, algunas de esas medidas se están empezando a producir voluntariamente. La creciente demanda del público las reforzará, pero también harán falta medidas reguladoras y fiscales y la toma de responsabilidad frente al público. Asimismo, podría parecer inútil aconsejarles a las personas que hagan más ejercicio cuando sienten que no tienen suficiente tiempo y dinero para practicar deportes y cuando se corre peligro en las calles. Hoy en día hay numerosas opciones que facilitan la decisión de mantenerse activo. En el trabajo algunas son el uso de las escaleras, la introducción de pausas para actividades físicas, y la creación de incentivos a favor del uso del transporte público. En las escuelas, las clases de gimnasia benefician a los niños porque los ayudan a desarrollar sus habilidades físicas y porque les inculcan de por vida el hábito de ser activos. En países y ciudades de Europa donde hay buenos sistemas de transporte e incentivos para montar en bicicleta, los paseos en bicicleta y a pie representan alrededor de 30% de todos los traslados de un lugar a otro en un día en particular. En Bogotá, Colombia, se ha creado una extensa red de rutas para ciclistas por toda la ciudad, gracias a lo cual el ciclismo se ha triplicado en los últimos cuatro años. La obesidad y otras enfermedades crónicas son problemas de salud pública muy alarmantes. Sabemos por qué estos trastornos se han vuelto más frecuentes en años recientes, qué los produce y qué medidas se deben tomar para contrarrestarlos, pero aún no abundan los valores sociales que impulsan las acciones para prevenirlos.

Resumo em Inglês:

In the Region of the Americas the emerging and reemerging infectious diseases that had the greatest impact on health, in terms of their incidence and the number of deaths that they caused during the five-year period of 19992003, were: malaria, yellow fever, dengue hemorrhagic fever, AIDS, anthrax, and SARS, as well as infection by hantavirus and by West Nile virus. The appearance of epidemics of emerging and reemerging diseases is related to biological, social, and economic factors. Growth in international trade, the movement of large numbers of people across national borders, the variability and genetic adaptability of the causative microorganisms, and inefficiencies in public health systems help to spread infections and epidemics. To avoid or reduce the serious effects of these epidemics, countries should give priority in their national agendas to surveillance of emerging and reemerging diseases and should implement a set of measures to combat the diseases. The most important of these measures is to develop a strategy that is based on early warning and rapid response mechanisms, with personnel and laboratories as well as communications networks that link laboratories with health service providers. This strategy should be backed by priority funding and adequate policies.

Resumo em Inglês:

The Centers for Disease Control and Prevention (CDC) of the United States of America recently issued a set of guidelines on how different community health services should prepare for and respond to the reemergence of severe acute respiratory syndrome (SARS). This document summarizes the recommendations of the CDC for basic health services. Disease surveillance in communities and hospitals should be performed in light of existing information on risk factors, particularly those related to geographic dissemination patterns and to documented transmission of SARS-CoV, the coronavirus that causes SARS. As long as no cases of person-to-person disease transmission are reported anywhere in the world, efforts should be aimed at early detection and notification of cases and of groups of people who are in contact with one another and who have severe respiratory infections of undetermined cause, such as pneumonia, which could signal the reemergence of SARS. If cases of transmission of SARS-CoV have been reported, the aim should be to immediately identify and notify any cases detected in order to take appropriate diagnostic and therapeutic measures and to facilitate outbreak control. The reach of surveillance and reporting activities in specific communities should depend on how widely the disease has spread, both in the community and in local health services. Physicians and public health workers should be familiar with ways to detect SARS cases early, as well as with existing norms for reporting any cases detected.