Resumo em Espanhol:

El objetivo de esta investigación consistió en determinar por qué mueren los pacientes con tuberculosis (TBC) y si existen factores que contribuyen al desenlace fatal que puedan ser modificados. Durante un período de 29 meses, de octubre de 1993 a febrero de 1996, se realizó un estudio observacional transversal de los pacientes con TBC activa o secuelas ingresados en la planta de TBC del principal hospital público de la ciudad de Santa Cruz, Bolivia. Se revisaron los registros hospitalarios de los pacientes que fallecieron durante la hospitalización. Fallecieron 94 de 597 pacientes (15,7%) y se revisaron los registros hospitalarios de 90 de ellos. El promedio de edad fue de 35,1 años (desviación estándar de 16,7) y 45 pacientes (50%) eran varones. En el momento del ingreso, 42 de los 90 pacientes (46,7%) nunca habían recibido tratamiento antituberculoso, o bien solo lo habían recibido durante menos de un mes; 23 (25,6%) habían vuelto al hospital después de haber abandonado el tratamiento; 8 (8,9%) habían recibido un diagnóstico equivocado; 6 (6,7%) tenían secuelas de TBC; otros 6 estaban recibiendo tratamiento antituberculoso, y 5 (5,6%) padecían TBC resistente a múltiples fármacos. De los 90 pacientes, 83 (92,2%) tenían TBC pulmonar (mediana de lóbulos afectados: 4); 6 (6,7%) TBC pleural, y 12 (13,3%) TBC extrapulmonar (algunos pacientes presentaban más de una forma de TBC). El número mediano de días transcurridos entre el ingreso en la planta de TBC y el fallecimiento fue de 5,5. Las causas de muerte consistieron en: hemoptisis en 6 casos (6,7%); otras causas relacionadas con la TBC en 65 (72,2%); reacciones a fármacos en 6; causas no relacionadas con la TBC en otros 6, y causas indeterminadas en 7 (7,8%). Los factores que posiblemente contribuyeron a la muerte fueron el diagnóstico tardío (38,9%), los errores en la vigilancia del caso (14,4%) y los errores en el tratamiento (24,4%). En resumen, la mayoría de los pacientes con TBC activa o inactiva ingresados en nuestra planta fallecieron a consecuencia de la TBC. Hubo varios factores potencialmente corregibles que posiblemente contribuyeron al resultado mortal.

Resumo em Inglês:

The objective of this research was to analyze why patients with tuberculosis (TB) die and to evaluate whether there are factors contributing to their fatal outcome that could be corrected. A cross-sectional observational study was conducted of the patients with active TB or its sequelae admitted to the TB ward of the main public hospital in the city of Santa Cruz, Bolivia, over a 29-month period, from October 1993 through February 1996. The available records of the patients who died during hospitalization were reviewed. Out of 597 patients, 94 of them (15.7%) died. We examined the records of 90 of these 94 patients. Their mean age was 35.1 years (standard deviation, 16.7 years), and 45 of the patients (50.0%) were male. On admission 42 of the 90 patients (46.7%) had never been treated for TB or had received anti-TB treatment for less than one month, 23 (25.6%) had returned after having abandoned their TB treatment, 8 (8.9%) had had an erroneous diagnosis, 6 (6.7%) had tuberculosis sequelae, 6 (6.7%) were undergoing tuberculosis treatment, and 5 (5.6%) were known to have multidrug-resistant TB. Of the 90 patients, 83 (92.2%) had pulmonary tuberculosis (median lobes affected, 4), 6 (6.7%) had pleural tuberculosis, and 12 (13.3%) had extrapulmonary tuberculosis (some patients had more than one form of TB). Patients died a median of 5.5 days after entering the TB ward. The causes of death were: hemoptysis, 6 patients (6.7%); other tuberculosis-related causes, 65 patients (72.2%); drug reactions, 6 patients (6.7%); nontuberculosis causes, 6 patients (6.7%); and undetermined causes, 7 patients (7.8%). Factors possibly contributing to death were late diagnosis (38.9%), errors in follow-up (14.4%), and errors in treatment (24.4%). In conclusion, most patients with active or inactive TB admitted to our ward died as a consequence of tuberculosis. There were several factors possibly contributing to their fatal outcome that could be corrected.

Resumo em Espanhol:

El presente trabajo tuvo por objetivo estudiar la influencia del estado nutricional, determinado por medición antropométrica, y las infecciones helmínticas sobre la respuesta inmunitaria de niños de bajo nivel socioeconómico en dos poblaciones rurales diferentes de Venezuela: El Cardón, Estado Nueva Esparta, y San Daniel, Estado Miranda. Participaron en el estudio 125 niños de ambos sexos entre 2 y 15 años de edad, cuyo estrato socioeconómico se determinó por el método de Graffar modificado. Se les realizó un examen físico y una evaluación antropométrica tomando en cuenta los indicadores peso-talla, peso-edad, y talla-edad según los parámetros establecidos por la OMS. También se les practicaron exámenes de heces, IgA secretoria en saliva e IgE sérica total e inmunoglobulinas específicas anti-Ascaris. Ambas poblaciones pertenecían a los estratos IV y V de la escala de Graffar, con un mayor número significativo (P < 0,001) de habitantes de estrato V en San Daniel. Los resultados sugieren que el grado de exposición y la susceptibilidad del individuo a los parásitos son factores que determinan las infecciones parasitarias y el comportamiento del sistema inmunitario. La intensidad de la carga parasitaria tiene una función importante en la estimulación de la IgE policlonal, lo que disminuye la efectividad de la respuesta específica para resistir esas infecciones. Por otra parte, las deficiencias nutricionales podrían alterar los mecanismos de inmunidad de las mucosas e influir negativamente en la síntesis de IgA secretoria y estimular la producción de IgE policlonal. Las condiciones ambientales y socioeconómicas deficientes favorecen una mayor exposición a los parásitos gastrointestinales y un estado nutricional deficiente, lo que modula la respuesta inmunitaria y afecta a los mecanismos de producción de la IgE sérica y la IgA secretoria.

Resumo em Inglês:

We investigated the influence of nutritional status, as determined from anthropometric measurement, and of helminthic infections on the immune response of children of low socioeconomic status in two rural communities in Venezuela: El Cardón in the state of Nueva Esparta and San Daniel in the state of Miranda. A total of 125 boys and girls between 2 and 15 years old participated in the study. Their socioeconomic stratum was determined by a modified Graffar method. A physical examination was performed, as was also an anthropometric evaluation that took into account three indicators--weight-for-height, weight-for-age, and height-for-age--according to parameters established by the World Health Organization. Other examinations included feces, secretory IgA in saliva, total serum IgE, and anti-Ascaris-specific immunoglobulins. The children in both of the communities were in strata IV and V of the of Graffar scale, with a significantly greater number of stratum V inhabitants in San Daniel (P < 0.001). The results suggest that exposure level and individual susceptibility to the parasites are determining factors in parasitic infection and immune system behavior. The intensity of the parasitic burden plays an important role in stimulating polyclonal IgE, which diminishes the effectiveness of the specific response to those infections. On the other hand, nutritional deficiencies could change the immune mechanisms of the mucous membranes, negatively influence the synthesis of secretory IgA, and stimulate the production of polyclonal IgE. Poor sanitary and socioeconomic conditions promote more exposure to gastrointestinal parasites and a deficient nutritional status, which modulates the immune response and affects serum IgE and secretory IgA production mechanisms.

Resumo em Português:

A taxa de mortalidade infantil é considerada síntese da qualidade de vida e do nível de desenvolvimento de uma população. Entretanto, essa taxa é muito sensível a ações simples, como terapia de reidratação oral, vacinação e reversão do desmame precoce, cuja cobertura tem sido ampliada. Assim, a taxa de mortalidade infantil pode não estar mais refletindo o modelo de desenvolvimento. Buscando um aprofundamento da discussão sobre a mortalidade infantil, o presente estudo analisou os 153 bairros do Município do Rio de Janeiro (RJ), Brasil. Nosso objetivo foi localizar áreas de risco e grupos prioritários de intervenção que visam diminuir a mortalidade infantil no município, abordando separadamente a mortalidade neonatal e pós-neonatal segundo os bairros. Além disso, foram identificados os fluxos entre o local de residência da criança e o local de óbito, relacionando-os à classificação socioeconômica dos bairros. A baixa freqüência de nascimentos em alguns bairros impediu a caracterização de áreas com risco de mortalidade estatisticamente significativo em relação à media do município. Cerca de um terço das mortes foram consideradas redutíveis mediante práticas adequadas de diagnóstico e tratamento. Somente 15% das causas de morte foram consideradas inevitáveis. Os componentes da mortalidade infantil apresentaram distribuição espacial dispersa, sem uma relação direta com o perfil socioeconômico; a mudança no perfil da mortalidade infantil e a possibilidade de intervenção parece deslocar-se cada vez mais para a esfera dos serviços de saúde, especialmente os médico-assistenciais. O fluxo das crianças entre o local de residência e o local de óbito mostra o deslocamento originado nas áreas mais pobres em direção às mais ricas, que concentram a maior parte das unidades de saúde. Essa tendência reafirma o papel fundamental do acesso à assistência médica de qualidade na determinação da mortalidade infantil.

Resumo em Inglês:

The infant mortality rate has been considered a summary of the quality of life and level of development of a given population. However, this indicator is very sensitive to such simple measures as oral rehydration therapy, vaccination, and continuation of breast-feeding. Given that such health activities have become more widespread, an infant mortality rate may no longer reflect a particular development model. With the aim of broadening the discussion regarding infant mortality, this study analyzed the 153 neighborhoods of the city of Rio de Janeiro, Brazil. Our objective was to identify areas with more risk, and the priority groups for interventions to decrease infant mortality. We analyzed neonatal and postneonatal mortality in each neighborhood. We also identified the children's home neighborhood and the location of their deaths and related these results to the socioeconomic classification of the corresponding neighborhoods. In relation to the average infant mortality rate for the city, we could not make statistically significant comparisons for some neighborhoods due to their small number of births. One-third of the infant deaths could have been prevented with early diagnosis and treatment. Only 15% of the deaths were considered unavoidable. Both neonatal mortality and postneonatal mortality were geographically dispersed, with no direct association with the socioeconomic profile of the neighborhoods. An analysis of the children's place of residence and the location of their deaths showed flows of patients from poor areas to more affluent city areas with better health services. This pattern highlights the effect of access to quality medical care on infant mortality.

Resumo em Espanhol:

Se realizó un estudio transversal en cuatro comunidades rurales del nordeste de la isla de Trinidad para determinar la calidad microbiológica de los suministros domésticos de agua y la relación entre dicha calidad y el origen del agua y los recipientes utilizados para su almacenamiento. Entre las 167 muestras de agua doméstica analizadas, se detectaron coliformes totales en 132 (79,0%), coliformes fecales en 102 (61,1%) y Escherichia coli en 111 (66,5%). Hubo diferencias significativas entre los pueblos con respecto a la proporción de muestras contaminadas con coliformes (P < 0,001) y E. coli (P < 0,001). De las 253 cepas de E. coli estudiadas, 4 (1,6%) eran mucoides, 9 (3,6%) hemolíticas y 37 (14,6%) no fermentadoras de sorbitol. De 69 aislados de E. coli en los que se analizó esta característica, 10 (14,5%) fueron citotóxicos para las células Vero. Veintiocho de 200 (14,0%) aislados de E. coli analizados pertenecían a serogrupos enteropatógenos. El origen más frecuente del agua fueron las fuentes (57 de los 167 domicilios; 34,1%). Ciento diecinueve domicilios (71,3%) recibían agua tratada (agua canalizada hasta el domicilio, de fuente o de camión cisterna), mientras que los otros 48 (28,7%) utilizaban agua no tratada (de lluvia, ríos/arroyos o pozos) como principal suministro de agua. El tipo de recipiente de almacenamiento en el domicilio se asoció con la contaminación por coliformes. El agua almacenada en bidones, barriles o cubos tenía mayores probabilidades de albergar coliformes fecales (74,2% de las muestras) que el agua almacenada en tanques (53,3% de las muestras), incluso después de controlar el efecto del origen del agua (P = 0,04). En comparación con el agua de otras fuentes, el agua canalizada hasta las casas tenía una probabilidad significativamente menor de estar contaminada por coliformes totales (56,9% frente a 88,8%; P < 0,001) y coliformes fecales (41,2% frente a 69,8%, P < 0,01), incluso después de tener en cuenta el tipo de recipiente de almacenamiento. Sin embargo, la contaminación fecal no se asoció con el origen tratado o no tratado del agua. Concluimos que el agua para beber de las comunidades rurales de Trinidad era en general no apta para el consumo humano debido a su contaminación tanto en el origen como durante el almacenamiento en el domicilio.

Resumo em Inglês:

A cross-sectional study was conducted in four rural communities of northeastern Trinidad to determine the microbial quality of water supply to households and that quality's relationship to source and storage device. Of the 167 household water samples tested, total coliforms were detected in 132 of the samples (79.0%), fecal coliforms in 102 (61.1%), and E. coli in 111 (66.5%). There were significant differences among the towns in the proportion of the samples contaminated with coliforms (P < 0.001) and E. coli (P < 0.001). Of 253 strains of E. coli studied, 4 (1.6%) were mucoid, 9 (3.6%) were hemolytic, and 37 (14.6%) were nonsorbitol fermenters. Of 69 isolates of E. coli tested, 10 (14.5%) were verocytotoxigenic. Twenty-eight (14.0%) of 200 E. coli isolates tested belonged to enteropathogenic serogroups. Standpipe, the most common water source, was utilized by 57 (34.1%) of the 167 households. Treated water (pipeborne in homes, standpipes, or truckborne) was supplied to 119 households (71.3%), while 48 households (28.7%) used water from untreated sources (rain, river/stream, or well) as their primary water supply. The type of household storage device was associated with coli-form contamination. Water stored in drums, barrels, or buckets was more likely to harbor fecal coliforms (74.2% of samples) than was water stored in tanks (53.3% of samples), even after controlling for water source (P = 0.04). Compared with water from other sources, water piped into homes was significantly less likely to be contaminated with total coliforms (56.9% versus 88.8%, P < 0.001) and fecal coliforms (41.2% versus 69.8%, P < 0.01), even when the type of storage device was taken into account. However, fecal contamination was not associated with whether the water came from a treated or untreated source. We concluded that the drinking water in rural communities in Trinidad was grossly unfit for human consumption, due both to contamination of various water sources and during household water storage.

Resumo em Espanhol:

En 1998, el Ministerio de Salud de Colombia inició la vacunación contra Haemophilus influenzae b (Hib) en menores de 1 año. En 1999 se evaluó el impacto de esta intervención en la incidencia de la meningitis bacteriana aguda (MBA) utilizando los datos del sistema de vigilancia por laboratorio que coordina desde 1994 el Grupo de Microbiología del Instituto Nacional de Salud. En el análisis se comparó el número anual de casos de meningitis por Hib en niños menores de 1 año que se diagnosticaron en el sistema de vigilancia, antes de introducirse la vacuna, con el número de casos registrados durante el primer año después de iniciada la vacunación. El número de casos esperado, según el promedio anual de los diagnosticados entre junio de 1994 y mayo de 1998, se comparó con el número de casos observado después de la vacunación entre junio de 1998 y mayo de 1999. Para controlar la calidad del sistema de vigilancia, se realizó un estudio similar de los casos de meningitis por Streptococcus pneumoniae. En los análisis se incluyeron solamente los datos de los departamentos que habían participado con mayor regularidad en la vigilancia. Entre 1994 y 1998 se confirmaron, respectivamente, 45, 37, 61, 64 y 31 casos de MBA por Hib, mientras que en el período posvacunal se esperaban 52 casos y se observaron 31 (P < 0,001). Durante los mismos períodos anuales se confirmaron también 32, 26, 43, 48 y 42 casos de MBA por S. pneumoniae en menores de 5 años, cifras que no representaron una disminución significativa del número de casos esperados. Sin embargo, la reducción observada en los casos de meningitis por Hib fue de 40%, porción no atribuible a cambios en el sistema de vigilancia. Concluimos, por lo tanto, que esta disminución se debió en su mayor parte a los efectos de la vacunación.

Resumo em Inglês:

In May 1998 the Ministry of Health of Colombia started a universal vaccination campaign against Haemophilus influenzae type b (Hib) for children under one year of age. The impact of this intervention on the incidence of acute bacterial meningitis was assessed in 1999, using data from the laboratory-based surveillance system coordinated since 1994 by the Microbiology Group of the Colombian National Institute of Health. The analysis compared the annual number of cases of Hib meningitis in children under one year of age diagnosed through the surveillance system before the vaccine was introduced with the number of cases reported during the first year after the vaccine's introduction. The expected number of cases, given the average annual number of cases diagnosed between June 1994 and June 1998, was compared with the number of cases observed after the vaccination program was introduced, from June 1998 through May 1999. To control for the quality of the surveillance system, a similar analysis was done for cases of meningitis due to Streptococcus pneumoniae. The analysis was restricted to those departments of Colombia that had consistently participated in the surveillance system. For the years 1994 through 1998 the numbers of confirmed cases of Hib meningitis were, respectively, 45, 37, 61, 64, and 31. In the period after the vaccine's introduction 31 cases were observed, as compared to the 52 expected (P < 0.001). During the same annual periods there were 32, 26, 43, 48, and 42 confirmed cases of meningitis from S. pneumoniae in children less than 5 years old, showing no significant reduction in the expected number of those cases. The 40% decrease noted in Hib meningitis cases was not attributable to changes in the surveillance system and was due mainly to the effects of the vaccination program.

Resumo em Espanhol:

La neumonía adquirida en la comunidad es una de las principales causas de morbilidad y mortalidad en la infancia. Estudios realizados en países en desarrollo indican que los cuadros de neumonía más graves se asocian a causas bacterianas, con predominio de Streptococcus pneumoniae, seguido por Haemophilus influenzae tipo b. El manejo de esas infecciones en los menores de 2 años se ve dificultado por la carencia de vacunas apropiadas y por la disminución de la susceptibilidad de S. pneumoniae a la penicilina y a otros antibióticos. En 1993, por iniciativa del Sistema Regional de Vacunas (SIREVA) de la Organización Panamericana de la Salud y con la financiación de la Agencia Canadiense para el Desarrollo Internacional (Canadian International Development Agency: CIDA), se diseñó un estudio para identificar los tipos capsulares de S. pneumoniae que causan enfermedad invasora en los niños latinoamericanos menores de 5 años, con el propósito de determinar tanto la composición ideal de una vacuna conjugada que pudiera emplearse en la Región como la susceptibilidad a la penicilina de los aislados de S. pneumoniae. La iniciativa fue aceptada por Argentina, Brasil, Colombia, Chile, México y Uruguay. En este informe se analiza la información sobre la neumonía por S. pneumoniae generada en los países participantes. Se captaron 3 393 niños con infecciones sistémicas por S. pneumoniae, de las cuales 1 578 correspondían a neumonías. El análisis se concentró en los 1 409 casos de neumonía de Argentina, Brasil, Colombia, México y Uruguay. La distribución por edades evidenció un franco predominio de los menores de 2 años (63,8%). Se identificaron 12 tipos capsulares prevalentes, de los cuales los serotipos 14, 5 y 1 ocuparon los tres primeros lugares en la mayoría de los países. En el período 1993-1998, la resistencia a la penicilina aumentó en los cinco países; al comienzo del estudio, los mayores porcentajes correspondieron a México (47,0%) y los menores a Colombia (12,1%). La resistencia a la penicilina se asoció con un reducido número de serotipos capsulares, fundamentalmente el 14 y el 23F, el primero resistente a la penicilina y a la trimetoprima-sulfametoxazol, y el segundo multirresistente. La frecuencia de la resistencia a la trimetoprima-sulfametoxazol fue elevada en todos los países y el valor máximo correspondió a Argentina (58,0%). La disminución de la susceptibilidad al cloranfenicol tuvo baja frecuencia, salvo en Colombia (23,4%). La resistencia a la eritromicina fue baja en todos los países y todos los aislados fueron sensibles a la vancomicina.

Resumo em Inglês:

Community-acquired pneumonia is one of the leading causes of infant morbidity and mortality. Studies conducted in developing countries indicate that the most serious symptoms of pneumonia are associated with bacterial causes, mainly Streptococcus pneumoniae, followed by Haemophilus influenzae type b. Managing those infections in children under two years of age is hindered by the lack of appropriate vaccines and by the decreased susceptibility of S. pneumoniae to penicillin and other antibiotics. In 1993, at the initiative of the Regional System for Vaccines of the Pan American Health Organization, and with funding from the Canadian International Development Agency, a study was designed to identify the S. pneumoniae capsular types that cause invasive disease in Latin American children under 5 years of age. The objective of the study was to determine the ideal composition of a conjugate vaccine that could be used in Latin America, and the penicillin susceptibility of the S. pneumoniae isolates. The initiative was undertaken in Argentina, Brazil, Chile, Colombia, Mexico, and Uruguay. This report analyzes the information that the participating countries generated on pneumococcal pneumonia. A total of 3 393 children were found with systemic S. pneumoniae infections, of which 1 578 corresponded to pneumonias. The analysis focused on 1 409 cases of pneumonia in Argentina, Brazil, Colombia, Mexico, and Uruguay. Of the children, 63.8% of them were under two years of age. Twelve prevalent capsular types were identified, of which serotypes 14, 5, and 1 were the three most common in the majority of the countries. At the beginning of the study the highest level of penicillin resistance was found in Mexico (47.0%), and the lowest in Colombia (12.1%). Over the 1993-1998 period, resistance to penicillin increased in the five countries. Penicillin resistance was associated with a small number of capsular serotypes, mainly 14 and 23F. The first of those serotypes was resistant to penicillin and to trimethoprim-sulfamethoxazole, and the second was multiresistant. The frequency of resistance to trimethoprim-sulfamethoxazole was high in all of the countries; Argentina had the highest level, 58.0%. A decrease in susceptibility to chloramphenicol was uncommon, except in Colombia, where there was a resistance level of 23.4%. Resistance to erythromycin was low in all the countries, and all the isolates were susceptible to vancomycin.

Resumo em Espanhol:

Durante el período 1991-1992, la vigilancia activa de las intoxicaciones agudas por pesticidas en una región montañosa de Ecuador cultivadora de papas reveló una tasa de 171/100 000, debido, sobre todo, a la exposición ocupacional a pesticidas organofosforados y carbamatos. La exposición ocupacional de los trabajadores agrícolas fue la causa más frecuente de intoxicación (32 trabajadores del sexo masculino y 1 del sexo femenino, de un total de 50 casos). De estos 33 casos, 28 informaron que su trabajo inmediatamente antes de la intoxicación consistía en la aplicación de pesticidas, y más de 80% mencionaron el uso de pesticidas incluidos en la Categoría de Riesgo I de la Organización Mundial de la Salud. La tasa de mortalidad global relacionada con los pesticidas, de 20,5/100 000, y la tasa de suicidios de 17,1/100 000 se encuentran entre las más elevadas de todo el mundo. A las tasas de cambio existentes entonces, se estimaron los siguientes costes medianos asociados a estas intoxicaciones: costes directos por atención sanitaria pública y de la seguridad social, US$ 9,85/caso; costes por atención sanitaria privada, US$ 8,33/caso, y costes indirectos por tiempo de trabajo perdido, US$ 8,33/trabajador agrícola. Cada uno de estos costes fue más de cinco veces superior al salario agrícola diario, que entonces era de aproximadamente US$ 1,50. Con el fin de obtener información adecuada para la toma de decisiones acerca del empleo de pesticidas serían necesarias nuevas evaluaciones de los costes de las intoxicaciones por pesticidas en otros contextos. Además, se debería evaluar de nuevo el control integral de las plagas como una tecnología adecuada para reducir la carga económica de las intoxicaciones por pesticidas en los países en desarrollo.

Resumo em Inglês:

Active surveillance of acute pesticide poisonings in a potato-growing region of highland Ecuador during 1991-1992 uncovered a rate of 171/100 000, due predominantly to occupational exposures to organophosphate and carbamate pesticides. Occupational exposure among agricultural workers was the most common reason for poisoning (32 male workers and 1 female worker, out of a total of 50 cases). Of these 33 cases, 28 of them reported pesticide application as the work task just prior to poisoning, with over 80% citing the use of World Health Organization Hazard Category I pesticides. The suicide rate of 17.1/100 000 and the overall mortality rate of 20.5/100 000 that we found are among the highest reported anywhere in the world. At the exchange rates prevailing at that time, median costs associated with these poisonings were estimated as follows: public and social security health care direct costs of US$ 9.85/case; private health costs of US$ 8.33/case; and lost-time indirect costs of US$ 8.33/ agricultural worker. Each one of those costs was over five times the daily agricultural wage, which was then about US$ 1.50. Further costing of pesticide poisonings should be carried out in other settings to provide appropriate information for decisions about pesticide use. In addition, integrated pest management should be further evaluated as an appropriate technology to reduce the economic burden of illness from pesticide poisonings in developing countries.

Resumo em Português:

O presente trabalho foi desenvolvido como parte de um estudo multicêntrico da Organização Mundial da Saúde e da Organização Pan-Americana da Saúde que avaliou reformas do setor de saúde e suas implicações para a enfermagem em diversos países. Nosso objetivo foi conhecer as visões dos enfermeiros que atuam em hospitais filantrópicos no Município de Ribeirão Preto, Estado de São Paulo, Brasil, acerca das transformações na prática de enfermagem como conseqüência da implantação do Sistema Único de Saúde no Brasil. Os dados foram obtidos através de entrevistas estruturadas com sete enfermeiros que preenchiam os critérios de seleção nos três hospitais filantrópicos de Ribeirão Preto. Os enfermeiros relataram que o atendimento do paciente pelo SUS sofreu prejuízos em termos de diminuição de leitos e declínio na qualidade do atendimento. Conforme os relatos, num primeiro momento o SUS incrementou a infra-estrutura dos hospitais filantrópicos, porém mais tarde as reformas passaram a promover a melhoria do atendimento à clientela privada e de convênios particulares. Além disso, os enfermeiros enfatizaram a sobrecarga de serviço e os baixos salários. Finalmente, os depoimentos sugerem que o Sistema Único de Saúde está em crise. De modo geral, os enfermeiros relacionaram a crise do Sistema às dificuldades de financiamento e pagamento.

Resumo em Inglês:

This paper describes part of a multicenter study sponsored by the Pan American Health Organization to assess health care reforms and their implications for nursing in several countries. The objective of this research was to learn the views of nurses working in philanthropic hospitals in Ribeirão Preto, in the state of São Paulo, Brazil, regarding the changes in nursing practice coming from Brazil's health care reform and implementation of the Unified Health System (UHS). Data were obtained through structured interviews with seven nurses who met the selection criteria, from the three philanthropic hospitals in Ribeirão Preto. The nurses reported a decline in the quality of care and in the number of beds for UHS patients. The nurses reported that UHS implementation initially led to infrastructure improvements in the philanthropic hospitals. However, the reforms eventually shifted toward improving the care of private and privately insured patients. In addition, the nurses emphasized their heavy work loads and low pay. The nurses' reports indicated that Brazil's UHS is going through a crisis. In general, the nurses linked this crisis to problems in funding and allocation of resources.

Resumo em Inglês:

As one of the activities of the Rabies Reference Laboratories Consortium of the Pan American Health Organization, a technical consultation meeting was held in late 1999 where well-known experts from Europe, North America, and South America analyzed the contributions to rabies epidemiological surveillance in Latin America and the Caribbean made by techniques of antigenic typing based on monoclonal antibodies and by techniques of genetic typing based on gene sequencing.