Resumo em Espanhol:
OBJETIVO: Evaluar la correlación que existe entre ciertos aspectos autonotificados de la calidad de vida en la adolescencia temprana y el género, el color de la piel, la escolaridad materna en el momento del nacimiento y los cambios de situación socioeconómica que ocurren entre el nacimiento y los 11 años. MÉTODOS: Se llevó a cabo un estudio longitudinal de una cohorte de nacimiento compuesta por 5 249 personas nacidas en 1993 en Pelotas (Brasil) a las cuales se les realizó un seguimiento periódico desde el nacimiento hasta los 11 años. Las variables socioeconómicas se recogieron al momento del nacimiento en 1993 y nuevamente en el 2004. Se analizaron las siguientes ocho variables: la relación con la madre, la relación con el padre, los conflictos familiares, el castigo físico infligido por los padres, los problemas de las relaciones familiares, la discriminación, el fracaso académico y el temor al vecindario de residencia. Se realizaron ajustes mediante el uso de un modelo jerárquico. RESULTADOS: El color de la piel se relacionó con todas las variables (aún más en las personas que no eran blancas que en las blancas), con la excepción de los conflictos familiares. El castigo físico y el fracaso académico fueron más frecuentes en los hombres. La discriminación y el temor al vecindario fueron más prevalentes en las mujeres. La escolaridad materna en el momento del nacimiento presentó una relación inversa, especialmente con respecto a la pérdida o la repetición de un año escolar (19,5 veces más frecuente en el grupo con escolaridad materna más baja que en el grupo con la mayor escolaridad). Se encontró un perfil similar con los cambios de situación socioeconómica: una calidad de vida inferior en el grupo que siempre fue pobre (al nacimiento y a los 11 años de edad), en comparación con la del grupo que nunca lo fue. El temor al vecindario no se relacionó con la escolaridad materna ni con la variación de la situación socioeconómica. CONCLUSIONES: El sexo, el color de la piel, la escolaridad de la madre y los cambios de situación socioeconómica se relacionaron con varios aspectos de la calidad de vida que se evaluaron. Es importante considerar estos resultados cuando se formulen las políticas que tienen por objeto reducir al mínimo la falta de equidad al nacimiento, a lo largo de la vida y en las generaciones futuras.Resumo em Inglês:
OBJECTIVE: To examine associations between certain aspects of self-reported Quality of Life (QoL) in early adolescence, and gender, skin color, maternal education at birth, and changes in socioeconomic position (SEP) occurring from 0-11 years of age. METHODS: A longitudinal study of a birth cohort composed of 5 249 individuals born in 1993 in Pelotas, Brazil, who were followed periodically from birth to age 11. Socioeconomic variables were collected at birth in 1993, and again, in 2004. The following eight variables were analyzed: relationship with mother, relationship with father, family conflicts, physical punishment by parents, family relationship problems, discrimination, academic failure, and fear of neighborhood of residence. Adjustments were made using a hierarchical model. RESULTS: Skin color was related to all the variables (more so for nonwhites than for whites), except in family conflicts. Physical punishment and academic failure were more frequent in males. Discrimination and fear of neighborhood were more prevalent in females. Maternal education at birth was inversely associated, especially with failing/repeating a grade in school(19.5 times more frequent in the lower maternal education group than in the highest). A similar pattern was found with the SEP change: worse QoL in the group that was always poor (at birth and at 11 years of age) than in the group that was never poor. Fear of neighborhood was not related to maternal education or SEP change. CONCLUSIONS: Gender, skin color, maternal education, and SEP change were related to various measured aspects of QoL. These results should be considered in policymaking that seeks to minimize inequities at birth, across the life-course, and for future generations.Resumo em Espanhol:
OBJETIVO: Definir la contribución del Método de Días Fijos® (MDF) a la combinación de métodos anticonceptivos que ofrecen los servicios de salud en dos provincias del Perú, donde las tasas de prevalencia de anticoncepción ya son altas. MÉTODOS: El MDF se agregó a los métodos de planificación familiar ofrecidos por el Ministerio de Salud en dos provincias en el Perú en septiembre del 2002. Entre marzo y junio del 2004, se llevaron a cabo entrevistas retrospectivas a 1 200 mujeres que habían escogido este método anticonceptivo y lo habían usado durante un período de 2 a 20 meses. Se obtuvo también información a partir de las bases de datos de los servicios de salud que participaron en el estudio. Se recogieron datos para determinar la demanda del MDF, si las usuarias hicieron la transición del MDF a otros métodos modernos por el de los días fijos y con la continuidad del uso del método y su eficacia. RESULTADOS: La demanda del MDF se estabilizó en 6% de todas las nuevas usuarias de planificación familiar. La mayoría de ellas no estaba utilizando otro método de anticoncepción en el momento de comenzar a usar este método. Cerca de 89% de las mujeres que habían empezado a usar el MDF al menos 6 meses antes de la entrevista, todavía lo estaban usando 6 meses después. Se calculó que la tasa de embarazo con un uso típico del método durante 12 meses fue alrededor de 10,0 por 100 años-mujer. CONCLUSIONES: La adición del MDF a las opciones de métodos anticonceptivos propuestos por un programa puede aumentar la cobertura, incluso en entornos que ya cuentan con una alta tasa de prevalencia de anticoncepción. La mayoría de las mujeres que eligieron el MDF no había usado antes otro método moderno de planificación familiar. La continuación de su uso es comparable con la continuación de otros métodos modernos que dependen del usuario. La eficacia del MDF, cuando se ofrece en un contexto de prestación de servicios regulares es comparable con los resultados que se obtuvieron en el estudio de eficacia.Resumo em Inglês:
OBJECTIVE: To determine what contribution the Standard Days Method® (SDM) makes to the contraceptive mix offered by regular health services in areas of Peru where contraceptive prevalence rates (CPR) are already high. METHODS: SDM was added to the family planning methods offered by the Ministry of Health in two provinces in Peru in September 2002. Retrospective interviews were conducted in March-June 2004 with 1 200 women who had chosen SDM as their contraceptive method and had used it for 2-20 months. Data were also obtained from the databases of the participating health services. The evaluation covered SDM demand, whether or not clients were switching to SDM from other modern methods, and SDM continuation and effectiveness. RESULTS: Demand for SDM stabilized at 6% of all new family planning users. Most users had not been using any reliable contraception at the time they started using SDM. About 89% of those who began using SDM at least 6 months before the interview were still using it at 6 months. The 12-month typical use pregnancy rate was estimated to be around 10.0 per 100 women years. CONCLUSIONS: Adding SDM to a program's existing contraceptive method mix can increase coverage even in an already high-CPR setting. Most women who choose SDM do not switch from any other modern family planning method. Continuation compares well with other modern user-directed methods. SDM effectiveness, when offered in regular service delivery circumstances, compares well to efficacy trial findings.Resumo em Português:
OBJETIVO: Comparar os alunos de 12 anos das escolas públicas e privadas de Goiânia, Goiás, quanto à prevalência de cárie, condição periodontal, anomalia dentofacial e fluorose. MÉTODOS: Em 2003, o Projeto Condições de Saúde Bucal da População Brasileira 2002-2003 (SB Brasil) foi ampliado para Goiânia na forma de um estudo transversal, descrito neste trabalho. A amostra foi constituída por 1 947 escolares de 12 anos frequentando escolas da zona urbana do Município: 1 790 (91,9%) eram de escolas públicas e 157 (8,1%) de escolas privadas. Através de exame clínico, foram coletados dados sobre as seguintes condições bucais: cárie dentária (índice de dentes cariados, perdidos e obturado, CPOD), condição periodontal (índice periodontal comunitário, CPI), anormalidade dento-facial (índice de estética dental, DAI) e fluorose dentária (índice de Dean). Para comparação entre os grupos foram utilizados os testes do qui-quadrado e U de Mann Whitney. RESULTADOS: Houve diferença entre os tipos de escola para todas as variáveis investigadas. Os escolares de instituições públicas apresentaram índices mais elevados de cárie, condição periodontal e anomalia dentofacial do que aqueles de escolas privadas (P < 0,05). Os escolares de instituições privadas apresentaram maior prevalência de fluorose (P < 0,05). CONCLUSÕES: O tipo de escola foi associado à condição de saúde bucal dos escolares pesquisados. São recomendados investimentos em ações e serviços que busquem minimizar tais desigualdades e seus efeitos como parte das políticas de saúde bucal.Resumo em Inglês:
OBJECTIVE: To compare 12-year-old students from public and private schools in the city of Goiânia, Brazil, in terms of the prevalence of caries, periodontal conditions, dentofacial anomalies, and fluorosis. METHODS: In 2003, the 2002-2003 Oral Health Conditions in the Brazilian Population project (SB Brasil) was expanded to Goiânia as a cross-sectional study, as described in the present article. The sample included 1 947 students from urban schools: 1 790 (91.9%) attended public schools and 157 (8.1%) attended private schools. Data on the following oral conditions were collected through clinical examination: dental caries (decayed, missing, or filled teeth index, DMFT), periodontal condition (Community Periodontal Index, CPI), dentofacial anomaly (Dental Aesthetics Index, DAI), and dental fluorosis (Dean index). The groups were compared using the chi-square and Mann-Whitney U tests. RESULTS: There were differences between the public and private schools for all the variables. DMFT, CPI, and DAI indexes were higher in children from public schools (P < 0.05). Fluorosis was more prevalent in students from private schools (P < 0.05). CONCLUSIONS: The type of school was associated with the oral health condition of the children in this sample. Investments in actions and services to mitigate this inequality and its effects should be made as part of the policies to promote oral health.Resumo em Espanhol:
OBJETIVO: Evaluar la relación costo-efectividad del programa de vacunación universal con la vacuna antineumocócica conjugada heptavalente (VCN7) en niños menores de 5 años en Uruguay. MÉTODOS: Se desarrolló un modelo Markov simulando una cohorte de 48 000 niños nacidos en 2007 y su evolución hasta los 76 años de edad. El caso base usó un esquema de tres dosis con una duración estimada de protección de cinco años. La presunción de eficacia y efectividad de la vacuna se realizó acorde con estudios realizados en Estados Unidos con ajuste a la prevalencia-incidencia de serotipos en Uruguay. Los resultados se expresaron como costo incremental por año de vida ganado (AVG) y por año de vida [ganado] ajustado por calidad (AVAC). RESULTADOS: Para el caso base, el costo incremental fue de US$ 7 334,6 por AVG y US$ 4 655,8 por AVAC, previniéndose 8 muertes y 4 882 casos de otitis, 56 bacteriemias-sepsis, 429 neumonías y 7 meningitis. El modelo muestra sensibilidad a variaciones en eficacia, costo de la vacuna y tasa de mortalidad por neumonía. CONCLUSIONES: El programa de vacunación universal con VCN7 en Uruguay es altamente costo-efectivo y, en consecuencia, recomendable para otros países con carga de enfermedad neumocócica y cobertura de serotipos similares a Uruguay.Resumo em Inglês:
OBJECTIVE: Evaluate the cost-effectiveness ratio of the program for universal vaccination with heptavalent pneumococcal conjugate vaccine (PCV7) in children under 5 years of age in Uruguay. METHODS: A Markov model was developed that simulated a cohort of 48 000 children born in 2007 and their progress to age 76. The baseline case used a regimen of three doses with estimated protection for five years. The presumption of vaccine efficacy and effectiveness was based on studies conducted in the United States with adjustment for serotype prevalence-incidence in Uruguay. The results were expressed as the incremental cost per life year gained (LYG) and quality-adjusted life year (QALY) [gained]. RESULTS: For the baseline case, the incremental cost was US $7334.60 for each LYG and US $4655.80 for each QALY. Eight deaths and 4 882 cases of otitis, 56 cases of bacteremia-sepsis, 429 cases of pneumonia, and 7 cases of meningitis were prevented. The model shows sensitivity to variations in vaccine cost, efficacy, and pneumonia-related mortality. CONCLUSIONS: The universal vaccination program with PCV7 in Uruguay is highly cost-effective. Therefore, it is recommended for other countries with burden of pneumococcal disease and serotype coverage similar to those of Uruguay.Resumo em Português:
OBJETIVO: Analisar a tendência temporal da mortalidade por câncer do colo do útero segundo dados de óbito corrigidos ou não e verificar a associação entre essas informações e indicadores socioeconômicos selecionados em mulheres com 20 anos ou mais residentes no Nordeste do Brasil (capital e interior) no período de 1996 a 2005. MÉTODOS: Foram incluídos no estudo os óbitos por câncer do colo do útero captados do Sistema de Informações sobre Mortalidade (SIM) e aqueles identificados como sendo decorrentes dessa neoplasia após processo de correção. Através de regressão linear simples, foram analisadas as tendências temporais da mortalidade e as correlações com os indicadores socioeconômicos selecionados através de correlação de Pearson (r). RESULTADOS: As maiores taxas de mortalidade por câncer do colo do útero sem correção corresponderam às capitais e as menores foram observados no interior dos estados. Por outro lado, os maiores coeficientes de mortalidade corrigidos foram observados para o interior dos estados e os menores para as capitais, invertendo o quadro. Da mesma forma, as menores taxas de mortalidade sem correção foram observadas nos estados com maior pobreza, analfabetismo, fecundidade e mortalidade infantil, enquanto as maiores taxas de mortalidade sem correção foram observadas nas regiões com melhores indicadores sociais. As taxas corrigidas mostraram associação negativa com os indicadores que assinalam melhores condições de vida, e positiva com os indicadores que descrevem piores condições de vida. CONCLUSÕES: A utilização de dados não corrigidos de mortalidade pode levar à subestimação do câncer do colo de útero e comprometer as interpretações de análises comparativas sobre a magnitude, distribuição e fatores associados a essa doença. A magnitude desse câncer merece ser reavaliada, pelo menos no Nordeste do Brasil. Contudo, os resultados demonstram que já há resultados positivos da detecção precoce na região.Resumo em Inglês:
OBJECTIVE: To analyze the time trend of cervical cancer mortality based on adjusted or unadjusted mortality data and to investigate the association between these data and socioeconomic indicators in women aged 20 years or older in the Brazilian Northeast (in capitals and non-capital cities) during the period from 1996 to 2005. METHODS: All deaths from cervical cancer recorded in the Brazilian Health Ministry's Mortality Data System (SIM) were included in the study. Also included were the cervical cancer deaths identified after the adjustment process. Simple linear regression was used to analyze the time trends for mortality and their correlations (Pearson) with selected socioeconomic indicators. RESULTS: The highest mortality coefficients with unadjusted data were observed in capitals and the lowest were observed in non-capital cities. Conversely, the highest mortality coefficients with adjusted data were observed in non-capital cities. Similarly, the lowest unadjusted mortality rates were observed in the states with the most poverty, illiteracy, fertility, and child mortality, whereas the highest unadjusted mortality rates were observed in the regions with the best social indicators. Adjusted mortality rates showed a negative association with the indicators describing better living conditions, and a positive association with the indicators describing worse living conditions. CONCLUSIONS: The use of unadjusted mortality data may lead to underestimation of cervical cancer rates and compromise the interpretations of comparative analyses of the magnitude, distribution, and factors associated with this disease. The magnitude of cervical cancer should be reassessed at least in the Brazilian Northeast. However, the findings show that positive results have been obtained with early detection efforts in Brazil.Resumo em Espanhol:
OBJETIVO: Describir el proceso utilizado con el objeto de poner en práctica un sistema nacional integral, estandarizado y confiable de recopilación de datos sobre la atención y el tratamiento de la infección por el VIH en Guyana; suministrar ejemplos de los datos que se obtuvieron mediante el programa durante la ejecución; y subrayar las ventajas de la vigilancia para los programas nacionales. MÉTODOS: En el 2007, el Ministerio de Salud de Guyana y otros actores claves adaptaron al contexto de Guyana las directrices básicas de la Organización Mundial de la Salud sobre el seguimiento de los pacientes con VIH que reciben atención y tratamiento antirretrovírico; la adaptación implicó modificaciones en el expediente clínico, el registro de los pacientes, los informes transversales y los informes de cohortes. Después de una capacitación inicial y la retroalimentación por parte del personal médico, se finalizó un sistema nacional de seguimiento de los pacientes, que se puso a prueba y se puso en marcha en todos los centros de atención y tratamiento. Posteriormente, se realizaron visitas mensuales de supervisión y apoyo a los centros, con el fin de examinar la recopilación de los datos y validar los informes. RESULTADOS: La ejecución del programa de vigilancia de los pacientes permitió el análisis de los datos de las cohortes de pacientes en tratamiento antirretrovírico. Después de 12 meses, se encontró que 79% de una cohorte nacional combinada de los 50 pacientes que comenzaron tratamiento antirretrovírico en junio del 2007 estaban vivos y recibían tratamiento con antirretrovíricos de primera línea. Después de seis años, 58% de la primera cohorte de pacientes tratados con antirretrovíricos en el país (abril del 2002) estaban vivos, continuaban el tratamiento y solo dos pacientes (8%) recibían medicamentos de segunda línea. CONCLUSIONES: La ejecución de un programa nacional de supervisión de los pacientes con recopilación y notificación estandarizada de los datos en múltiples centros clínicos suministró en último término información importante y confiable sobre la utilización de los servicios, el desenlace clínico de los pacientes y las tasas de supervivencia con el tratamiento. Estos datos se usan a escala nacional con el fin de vigilar la eficacia del programa de atención y tratamiento de la infección por el VIH. La ejecución eficaz del programa exige la participación temprana de todos los actores claves comprometidos y un equipo de recursos humanos dedicado a velar por la sostenibilidad del sistema.Resumo em Inglês:
OBJECTIVE: To describe the process used to implement a comprehensive, standardized, and reliable national system for data collection for HIV care and treatment in Guyana; to provide examples of the program-level data resulting from implementation; and to highlight the monitoring benefits for national programs. METHODS: In 2007, Guyana's Ministry of Health and other key stakeholders adapted the World Health Organization's generic HIV care and antiretroviral therapy (ART) patient monitoring guidelines to fit the Guyana context, which included modifying the patient chart, patient registers, and cross-sectional and cohort reports. Following initial training and feedback from clinical staff, a national patient monitoring system (PMS) was finalized, piloted, and implemented at all care and treatment sites. Thereafter, sites received monthly supportive supervisory visits to review data collection and validate reports. RESULTS: Implementation of the PMS enabled analysis of cohort data for patients on ART. After 12 months, 79% of a combined national cohort of all 50 patients who started ART in June 2007 were alive and on first-line ART regimens. After six years, 58% of the first (April 2002) cohort of ART patients in the country were alive and on ART, with only two (8%) patients on second-line regimens. CONCLUSIONS: Implementation of a national PMS for standardized data collection and reporting across multiple clinical sites ultimately provided important and reliable information on utilization of services, patient outcomes, and survival rates on treatment. These data are used at the national level to monitor the efficacy of the HIV care and treatment program. Successful implementation requires early inclusion of all committed stakeholders and a dedicated human resource team to ensure sustainability of the system.Resumo em Espanhol:
OBJETIVO: Determinar y evaluar las asociaciones entre las variables que reflejan las condiciones del agua y el saneamiento ambiental y la mortalidad en niños menores de 5 años por un grupo de enfermedades de transmisión hídrica. MÉTODOS: Se realizó un estudio ecológico y exploratorio a partir de datos obtenidos del Censo Demográfico Nacional de 2000 y del Sistema Único de Salud para las 558 micro-regiones de Brasil. El modelo aplicó la técnica de regresión lineal múltiple y consideró como variable de respuesta la mortalidad por enfermedades de transmisión hídrica en menores de 5 años y, como variables explicativas, las condiciones del agua y el saneamiento y el nivel de escolaridad. RESULTADOS: Se observó una relación directa entre saneamiento inadecuado en la vivienda -incluidos desagües por canaletas y fosas rudimentarias, y disposición de la basura en terrenos baldíos o áreas públicas- y mortalidad en menores de 5 años por enfermedades de transmisión hídrica. También se encontró una relación inversa entre el nivel de escolaridad y la mortalidad de esos menores por dichas causas. CONCLUSIONES: Los mayores riesgos para la salud derivados del saneamiento inapropiado se registraron en las micro-regiones con gran concentración de poblaciones que, además de su condición económica humilde, tenían bajo nivel de escolaridad. Se destacan, como determinantes de la mortalidad, las condiciones generales de saneamiento y también otros factores asociados a la calidad y la infraestructura de las viviendas. La cobertura de abastecimiento de agua -que en Brasil alcanza a 90% de los hogares- no se mostró por sí sola como factor importante en la reducción de la mortalidad estudiada.Resumo em Inglês:
ABSTRACT OBJECTIVE: Determine and evaluate the relationship between the variables for water conditions, environmental sanitation, and mortality in children under 5 years of age associated with a group of waterborne diseases. METHODS: An exploratory ecological study was conducted based on data obtained from the 2000 national demographic census and the Unified Health System for the 558 microregions of Brazil. The model used multiple linear regression analysis. Mortality associated with waterborne diseases in children under 5 years of age was considered to be the response variable. Water conditions, sanitation, and level of education were considered to be explanatory variables. RESULTS: A direct relationship was observed between inadequate sanitation in the dwelling (e.g., sewerage disposal via rudimentary gutters and pits, the disposal of waste in uncultivated land or public areas) and mortality in children under 5 years of age associated with waterborne diseases. An inverse relationship was found between level of education and mortality associated with waterborne diseases in these children. CONCLUSIONS: The greatest health hazards related to poor sanitation were found in the microregions with a high concentration of low-income population with limited education. The general sanitation conditions and other factors related to dwelling quality and infrastructure are major determinants of mortality. Coverage of the water services, which reach 90% of households in Brazil, was not in itself found to be an important factor in the reduction of the mortality studied.Resumo em Espanhol:
OBJETIVO: Determinar la epidemiología de la enfermedad neumocócica invasora y la sensibilidad a los antibióticos y la distribución de los serotipos de S. pneumoniae en pacientes pediátricos en Lima, Perú. MÉTODOS: Estudio multicéntrico de vigilancia pasiva durante dos años, entre mayo del 2006 y abril del 2008, en 11 hospitales públicos y 5 consultorios privados de Lima, en pacientes menores de 16 años con cultivos de sitios estériles positivos para S. pneumoniae. Se determinó la sensibilidad a los antibióticos mediante Etest® (AB Biodisk, Solna, Suiza). Se serotipificaron las cepas mediante la reacción de Quellung. RESULTADOS: En total, se estudiaron 101 episodios de enfermedad neumocócica invasora, 68,3% de ellos en niños menores de 24 meses, con los siguientes diagnósticos: neumonía (47,5%), meningitis (38,6%) y septicemia (7,9%). La tasa de letalidad general fue de 22,0% y la tasa de letalidad por meningitis de 32,4%. Si bien 80,0% de los casos mortales ocurrió en menores de 24 meses, solo 50,7% de los casos no mortales (P < 0,05) ocurrió en este grupo de edad. Las tasas de resistencia fueron elevadas para trimetoprima-sulfametoxazol (76,2%), eritromicina (24,8%) y penicilina (22,8%). Los serotipos más comunes, 14, 6B, 19F, 23F y 5, representaron 69,7% de todas las cepas, y 87,0% de las cepas no sensibles a la penicilina. CONCLUSIONES: La enfermedad neumocócica invasora en niños hospitalizados en Lima se asocia con altos niveles de resistencia a los antimicrobianos y una tasa de letalidad elevada, especialmente en niños pequeños. Estos datos iniciales serán útiles para evaluar los efectos de la introducción de las vacunas.Resumo em Inglês:
OBJECTIVE: To determine the epidemiology of invasive pneumococcal disease (IPD) and the antibiotic susceptibility and serotype distribution of S. pneumoniae in pediatric patients in Lima, Peru. METHODS: A 2-year, multicenter, passive surveillance study conducted from May 2006- April 2008 in 11 public hospitals and five private laboratories in Lima, Peru, in patients less than 16 years of age with sterile site cultures yielding S. pneumoniae. Antibiotic susceptibility was performed by Etest® (AB Biodisk, Solna, Switzerland). Strains were serotyped by the Quellung reaction. RESULTS: In all, 101 IPD episodes were studied, 68.3% of which were among children less than 24 months of age. Diagnoses were: pneumonia (47.5%), meningitis (38.6%), and sepsis (7.9%). The overall case fatality rate was 22.0%; case fatality rate in meningitis was 32.4%. While 80.0% of fatal cases were in those less than 24 months of age, only 50.7% of non-fatal cases (P < 0.05) were in this age group. Resistance rates were high for trimethoprim/ sulfamethoxazole (76.2%), erythromycin (24.8%), and penicillin (22.8%). The most common serotypes were 14, 6B, 19F, 23F, and 5, which accounted for 69.7% of all strains and 87.0% of penicillin non-susceptible strains. CONCLUSIONS: IPD in hospitalized children in Lima is associated with high antimicrobial resistance levels and elevated case fatality rate, especially in young children. This baseline data will be useful for evaluating the effects of vaccine introduction.Resumo em Português:
OBJETIVO: Identificar as relações entre turismo e saúde e as metodologias empregadas em estudos publicados sobre esse tema. MÉTODO: Realizou-se uma busca nas bases PubMed e SciELO em março de 2008 utilizando a seguinte estratégia: traveler or traveller or tourism or tourist AND risk or hazard or vulnerability AND health or surveillance. Foram excluídos os artigos sobre saúde animal, artigos conceituais e de revisão, artigos sobre viajantes que não turistas, artigos escritos em idiomas diferentes de português, inglês, italiano e espanhol. Dos 153 artigos localizados, 112 foram eliminados e 41 foram examinados. RESULTADOS: O número de artigos sobre o tema cresceu de um artigo na década de 1970 para 34 na década de 2000. A maior parte dos estudos foi realizada na Europa, seguida das Américas, e abordou doenças transmitidas por insetos, doenças transmitidas entre pessoas por via respiratória e doenças gastrointestinais. Foi predominante a utilização de questionários para a coleta de dados, aplicados pessoalmente, por telefone ou por carta. Quanto ao local da pesquisa, 21 estudos foram realizados no local de origem da viagem, 17 no destino e 3 não informaram. Quatro estudos foram realizados antes da viagem, 9 durante a viagem, 24 após a viagem, e 3 não informaram. A maioria dos estudos abordou o turista como vítima preferencial de problemas de saúde, despreparado para enfrentar situações de vulnerabilidade durante a viagem. CONCLUSÕES: É clara a necessidade de implantar políticas de saúde voltadas para o turista, com ênfase em doenças infecciosas e ações emergenciais para detectar surtos envolvendo turistas. Também é necessário um sistema de vigilância e notificação específico para turistas, e maior preparo das instituições de saúde para atender demandas individuais dessa população.Resumo em Inglês:
OBJECTIVE: To identify relationships between tourism and health as well as the methods employed in studies about this topic. METHODS: The PubMed and SciELO databases were searched in March of 2008 using the following strategy: traveler or traveller or tourism or tourist AND risk or hazard or vulnerability AND health or surveillance. The following were excluded: articles on animal health, conceptual and review articles, articles about non-tourist travel, and articles written in languages other than Portuguese, English, Italian, and Spanish. Of 153 articles identified, 112 were excluded, and 41 articles were examined. RESULTS: The number of articles on tourism and health increased from one in the 1970s to 34 in the 2000s. Most studies were carried out in Europe, followed by the Americas, and most covered insect-borne diseases, respiratory diseases transmitted from person to person, and gastrointestinal diseases. Mail, telephone, or face-to-face questionnaires were generally used for data collection. In terms of location, 21 studies were performed at the place of departure, 17 at the destination, and in 3 this information was not specified. Four studies were carried out before the trip, 9 during the trip, 24 after the trip, and 3 did not specify this information. Most studies focus on the tourist as a likely victim of health problems, unprepared to face situations of exposure during the trip. CONCLUSIONS: The need to implement health care policies aimed at the tourist population is evident, with emphasis on infectious diseases and emergency actions to detect outbreaks involving tourists. A tourist-specific surveillance and notification system is also necessary, together with measures to prepare health care institutions to meet the individual demands of this population.