Resumo em Espanhol:

Objetivos. Investigar la asociación entre los problemas conductuales y el consumo de tabaco en estudiantes adolescentes de seis países centroamericanos y la República Dominicana. Métodos. Los datos fueron extraídos de un estudio internacional en el que, en cada país, se aplicaron cuestionarios a 451-1 170 estudiantes adolescentes. Las evaluaciones se basaron en una versión adaptada al español del Cuestionario de Tamizaje del Consumo de Drogas (Drug Use Screening Inventory). Los análisis se realizaron mediante regresión logística condicional; los estudiantes se aparearon según el tipo de escuela y la zona, y se efectuaron otros ajustes estadísticos en función del sexo, edad y algunos factores de riesgo. Resultados. El consumo de tabaco presentó enormes variaciones de un país a otro. No obstante, combinando los datos de todos los países y controlando los efectos del sexo, edad, falta de participación en actividades recreativas, grado de irritabilidad y magnitud de los problemas escolares, familiares y de salud mental, se estimó que el consumo de tabaco en los jóvenes con los mayores grados de problemas conductuales era más de cinco veces mayor que en los jóvenes con los menores grados de problemas conductuales. Los análisis de cada país revelaron que los jóvenes con mayores problemas conductuales presentaban constantemente mayor consumo de tabaco que los jóvenes con menores problemas conductuales. Conclusiones. Estos resultados concuerdan con los de estudios anteriores acerca del consumo de tabaco en adolescentes con problemas conductuales. Aunque su magnitud varió en función del país de residencia, las asociaciones observadas fueron fuertes y significativas según los criterios convencionales en casi todos los países estudiados. Este es el primer estudio que se realiza en estos siete países para investigar posibles relaciones causales como estas. Son necesarias más investigaciones para ampliar los conocimientos sobre las diferencias observadas entre los distintos países y, en definitiva, para crear, poner en práctica y evaluar programas eficaces de intervención preventiva contra el consumo de tabaco.

Resumo em Inglês:

Objectives. The purpose of this study was to examine the association between behavioral problems and tobacco use among adolescent students in six countries of Central America and in the Dominican Republic. Methods. Data were drawn from a multinational collaborative study that included questionnaire surveys of between 451 and 1 170 school-attending adolescents in each of the seven countries studied. Assessments were based on an adapted, Spanish-language version of the Drug Use Screening Inventory (DUSI). The conditional form of logistic regression was employed for analysis, matching students on type of school and area, with further statistical adjustments for sex, age, and selected risk factors. Results. Occurrence of tobacco use was observed to vary dramatically from country to country. Nonetheless, for the combined group of countries, the estimated odds of tobacco use in youths at the highest levels of behavioral problems was more than five times that for youths at the lowest levels, after controlling for sex, age, lack of participation in recreational activities, level of irritability, and levels of problems with school, family, and mental health. Country- specific analyses show that youths at the highest levels of behavioral problems have a consistently greater occurrence of tobacco use as compared to youths at the lowest levels of behavioral problems. Conclusions. These findings are concordant with prior studies on tobacco use among adolescents with behavioral problems. Although the magnitude of observed associations varied according to the country of residence, the strength of these associations and their significance by conventional standards were observed in nearly all the countries sampled. This is the first study in these seven countries on potentially causal relationships such as these. More research is needed to augment our knowledge regarding the observed cross-country differences and ultimately to develop, implement, and evaluate effective tobacco preventive intervention programs.

Resumo em Espanhol:

Objetivos. Diseñar y poner a prueba un sistema de vigilancia que permita detectar y jerarquizar los problemas más relevantes de salud mental y establecer su asociación con las condiciones de vida de la comunidad estudiada. Métodos. El sistema se diseñó y puso a prueba en un centro de salud de la comuna La Florida, región metropolitana de Chile. Los problemas de salud que se sometieron a vigilancia con seguimiento mensual fueron: adicción (al alcohol, tabaco, drogas y benzodiazepinas), violencia (violencia o sospecha de violencia intrafamiliar y abuso sexual) y trastornos en niños (déficit de atención y trastornos de conducta). Mediante un sistema computacional de información geográfica se combinaron estos elementos con datos sociodemográficos de las personas que acudieron a consulta y con datos territoriales que pueden considerarse factores protectores o de riesgo de los problemas de salud, y algunos de los cuales constituyen indicadores de las condiciones de vida de las personas. Resultados. Se probó que el sistema de vigilancia epidemiológica propuesto --que incorpora las condiciones de vida y las variables ambientales-- es una buena herramienta para la acción en salud y complementa la visión parcial de los sistemas de seguimiento, que no incluyen variables de contexto y se centran sólo en los problemas de salud. La información sintetizada en mapas permite visualizar simultáneamente diferentes capas de información sobre los factores relacionados con los problemas de salud estudiados, asociados a un territorio específico, con todas las variables ambientales que implican, en un formato de lectura ágil y evidente por sí mismo. Conclusiones. Estos resultados y la opinión convergente de los médicos participantes y usuarios permiten afirmar que el sistema de vigilancia epidemiológica puesto a prueba en fase experimental logró cumplir los requerimientos básicos de un método de esta naturaleza.

Resumo em Inglês:

Objective. To design and test a surveillance system to detect and rank the most significant mental health problems in a community and to establish their association with the living conditions in that community. Methods. The system was designed and tested at a primary health care center in the community of La Florida, which is in the metropolitan region of Santiago, the capital of Chile. The health problems that were under surveillance, with monthly monitoring, were: addiction (to alcohol, tobacco, and benzodiazepines or other drugs), violence (domestic violence and sexual abuse, real or suspected), and disorders in children (attention deficit and behavioral disorders). By means of a computerized geographical information system (GIS), those surveillance data were combined with other data. These other data included sociodemographic information on the persons who went to the health center for care as well as data on local risk factors and protective factors for health problems, some of which are indicators of the local residents' living conditions. Results. The proposed epidemiological surveillance system, which takes into account local living conditions and environmental variables, is a good tool for health action. The proposed system also complements the incomplete perspective of monitoring systems, which do not include variables describing the local context and that focus only on health problems. The information synthesized in the GIS maps makes it possible to simultaneously display different layers of information on factors related to the health problems studied, linked to a specific area and all its environmental variables, in an easy-to-read, self-explanatory format. Conclusions. These results and the concurring opinions of the participating physicians show that the experimental system effectively met the basic requirements of an epidemiological surveillance system of this kind.

Resumo em Português:

Objetivo. Isolar e identificar microrganismos em baratas capturadas em um hospital público e determinar o seu perfil de suscetibilidade antimicrobiana. Métodos. As baratas foram capturadas nos períodos matutino e noturno, colocadas em frascos desinfetados com álcool a 70%, transferidas para um frasco estéril e levadas ao laboratório. Consideraram-se as baratas íntegras e vivas, as quais foram colocadas em solução salina estéril (0,8%) e homogeneizadas. Essa solução foi semeada nos meios de cultura ágar MacConkey, caldo nutriente, infusão de cérebro e coração (ágar BHI), ágar Sabouraud e ágar manitol. As culturas foram examinadas em um estereomicroscópio para a contagem das unidades formadoras de colônias. Para a determinação do perfil de suscetibilidade antimicrobiana utilizou-se o teste de difusão de disco. Resultados. Detectou-se prevalência de 56% de enterobactérias e de 18% de estafilococos coagulase negativos. Identificaram-se 15 espécies de enterobactérias. As mais freqüentes foram Klebsiella pneumoniae (17%); Enterobacter aerogenes (14%); Serratia marcescens (13%); Hafnia alvei (12%); Enterobacter gergoviae e Enterobacter cloacae (9%); e Serratia spp. (6%). Tanto as enterobactérias quanto os estafilococos coagulase negativos apresentaram uma resistência significativa aos antimicrobianos, inclusive à oxacilina. Conclusões. A prevalência de bactérias enteropatogênicas e de estafilococos coagulase negativos isolados de baratas Periplaneta americana no hospital estudado demonstra a fragilidade das condutas adotadas tanto para o controle de vetores quanto para o uso dos antimicrobianos. Os resultados demonstram a necessidade da implementação de um programa efetivo de saneamento ambiental e do uso racional dos antimicrobianos dentro das instituições de saúde.

Resumo em Inglês:

Objective. To isolate and identify microorganisms from cockroaches that were captured in a public hospital and to test the antimicrobial susceptibility of these microorganisms. Methods. Cockroaches were captured in the morning and at night. They were placed in flasks rinsed with 70% alcohol, transferred to sterilized flasks, and then taken to the laboratory. Only cockroaches captured whole and live were utilized for the study. After being immobilized at 0 degrees C, each cockroach was placed in a test tube with sterile saline solution (0.8%) and then homogenized. The resulting solution was then placed in the following five culture media: MacConkey agar, nutrient broth, brain-heart infusion agar, Sabouraud agar, and mannitol. The cultures were examined using a stereomicroscope, and colony-forming units were counted. The disk diffusion test was used to determine antimicrobial susceptibility. Results. We found a 56% prevalence of enterobacteria and an 18% prevalence of coagulase-negative staphylococci. Fifteen species of enterobacteria were identified. The most frequent were Klebsiella pneumoniae (17%), Enterobacter aerogenes (14%), Serratia marcescens (13%), Hafnia alvei (12%), Enterobacter gergoviae and Enterobacter cloacae (each 9%), and Serratia spp. (6%). Both the enterobacteria and the coagulase-negative staphylococci showed significant resistance to antimicrobials, including oxacillin. Conclusions. The prevalence of enteropathogenic bacteria and coagulase-negative staphylococci isolated from Periplaneta americana cockroaches in the studied hospital reflects the weakness of the measures adopted both for vector control and for antimicrobial use. The results show the need to implement effective health-institution programs focusing on hygiene and the rational use of antimicrobials.

Resumo em Espanhol:

Objetivo. Evaluar los conocimientos de madres peruanas sobre la neumonía y el reconocimiento de sus síntomas en niños menores de 5 años, la actitud de las madres hacia la búsqueda de asistencia médica cuando un hijo presenta signos de neumonía y percepción de las madres en torno a una campaña del Gobierno del Perú contra la enfermedad. Métodos. En este estudio transversal, 501 madres fueron seleccionadas aleatoriamente en 20 comunidades pobres de la zona metropolitana de Lima, Perú, y fueron entrevistadas entre junio y agosto de 2000. Mediante el uso del programa SPSS, se aplicaron las estadísticas descriptivas para resumir los datos demográficos y los que guardaban relación con los conocimientos de las madres en torno a la neumonía y con su capacidad para reconocer los signos de la enfermedad. Se realizaron cálculos cruzados y de ji al cuadrado para determinar la relación entre variables y hacer comparaciones. Resultados. Alrededor de 84% de las madres dijeron que sabían qué es la neumonía. La mayoría sabían que se trata de una enfermedad peligrosa. Una buena parte (58,7%) afirmó que la neumonía está causada por una atención inadecuada por parte de los padres. Solamente 28,9% creía que la neumonía está causada por un virus. Más de 80% identificaron correctamente la respiración rápida, la retracción torácica o ambas de una lista de posibles signos y síntomas de neumonía, y 94,6% dijeron que estaban preparadas para llevar a sus hijos al centro de salud más cercano si pensaban que el niño podía tener neumonía. Pese a que 57,1% dijeron haber oído de la campaña del Gobierno del Perú en torno a la enfermedad, 69,3% de estas madres no pudieron recordar el lema de la campaña. Las madres que dijeron haberse enterado de la campaña por la televisión fueron más propensas que las otras madres a reconocer correctamente los dos signos principales de neumonía presentados en la campaña. Conclusiones. Pese a que en años recientes parece haber aumentado el porcentaje de madres que se sienten capaces de reconocer un caso de neumonía por la respiración rápida y retracción del pecho, sigue habiendo un porcentaje importante de madres que siguen careciendo de información sobre la neumonía y sus posibles consecuencias letales. Es necesario seguir educando a las madres peruanas sobre las causas de la enfermedad, sus signos y síntomas y su tratamiento. Los resultados indican que la campaña del Gobierno del Perú en torno a la neumonía debe hacer mayor uso de la televisión y de los centros de saludu, donde la mayoría de las madres reciben atención médica e información de salud.

Resumo em Inglês:

Objective. To assess Peruvian mothers' knowledge and recognition of pneumonia in children under 5 years of age, the mothers' attitude toward seeking medical help if they had a child with signs of pneumonia, and their perception of a Government of Peru pneumonia campaign. Methods. In this cross-sectional study, 501 mothers were selected randomly from 20 low-income communities of the metropolitan area of Lima, Peru, and were interviewed between June and August 2000. Using SPSS software, descriptive statistics were applied to summarize the demographic data and the data regarding the mothers' knowledge of pneumonia and recognition of signs of the disease. Cross-tabulations and chi-squares were done to assess relationships between variables and to make comparisons. Results. About 84% of the mothers said that they knew what pneumonia is. Most believed that pneumonia is dangerous. A majority (58.7%) indicated that pneumonia is caused by lack of parental care. Only 28.9% believed that a virus causes the disease. More than 80% correctly picked rapid breathing and/or chest retraction from a list of possible signs and symptoms of pneumonia, and 94.6% said they were ready to take their child to the closest health center if they thought their child had pneumonia. Although 57.1% said they had heard about the Government of Peru pneumonia campaign, 69.3% of these mothers said they could not recall the motto of the campaign. Mothers who reported having heard of the campaign through TV were more likely than other mothers to correctly recognize the two major signs of pneumonia presented in the campaign. Conclusions. Although the percentage of mothers believing they can recognize pneumonia through rapid breathing and chest retraction seems to have increased in recent years, there is still a sizable percentage of mothers who remain uninformed about pneumonia and its possible fatal consequences. Efforts need to continue to educate Peruvian mothers about the causes, recognition of the signs, and treatment of pneumonia. The results suggest that the Government of Peru pneumonia campaign should use television much more, as well as the health centers, where most of the mothers receive medical attention and health information.

Resumo em Espanhol:

Se han creado numerosos instrumentos estandarizados para evaluar el estado de salud y la eficacia de los tratamientos. Sin embargo, la mayoría de ellos han sido desarrollados y validados en la lengua inglesa. En la literatura se recomienda la utilización de escalas y cuestionarios estandarizados cuyos resultados puedan ser comparados internacionalmente. Las diferencias culturales no permiten hacer una simple traducción de estos instrumentos. En este artículo se resumen normas sistematizadas para la adaptación cultural de instrumentos utilizados en salud ocupacional, derivadas de investigaciones especializadas.

Resumo em Inglês:

Numerous standardized questionnaires and other instruments for evaluating health status and treatment effectiveness have been developed. However, the majority of these instruments have been constructed and validated in English. The scientific literature generally recommends the use of scales and standardized questionnaires whose results can be compared internationally. However, because of cultural differences, it is not sufficient to just do a simple translation of these instruments. Drawing on specialized research in this area, this article presents a summary of systematized standards for the cultural adaptation of instruments used in occupational health.

Resumo em Inglês:

Being increasingly threatened by the worldwide antismoking struggle, the major tobacco companies are eager to improve their public image. This leads the companies to adopt inconsequential "measures" such as the tobacco industry's "new" standards for tobacco marketing that were "voluntarily" issued in September 2001 by the British American Tobacco company. These measures are clearly attempts to reduce the disapproval generated by the companies' promotion and advertising campaigns, which indirectly target young people. With these standards the tobacco companies supposedly commit themselves, among other things, to not using advertising directed at youth and to not selling or distributing tobacco products in places frequented by young people. This document explains why these measures are completely ineffective, are not anything new, and are a subtle effort to feign a conscientious, responsible attitude, which is far from genuine. As long as there are marketing activities directed at adults, young people will be exposed to the influence of those activities. Many countries have completely prohibited the marketing of tobacco products, given that the "new" marketing standards do not represent progress in any way whatsoever.

Resumo em Espanhol:

En la actualidad, el tabaco mata cada año a unos 4 millones de personas en todo el mundo. Se espera que esta cifra aumente a 10 millones de personas al año en las próximas tres décadas, y más del 70% de estas muertes ocurrirán en países en desarrollo. La Organización Mundial de la Salud (OMS) y sus Estados Miembros han tomado una serie de medidas para contribuir a detener este aumento de la mortalidad. Uno de los aspectos analizados ha sido la necesidad de una regulación más eficaz de los productos del tabaco. Este documento resume algunos de los principales temas de una monografía reciente de la OMS acerca de este problema, en la que se recapitula gran parte de la información presentada y discutida en la conferencia de la OMS sobre productos del tabaco que tuvo lugar en Oslo, Noruega, en febrero de 2000. La monografía identifica las deficiencias de las actuales regulaciones sobre los cigarrillos y otros productos del tabaco y contiene recomendaciones acerca de las acciones que los gobiernos y otras autoridades deberían adoptar para remediar dichas deficiencias.

Resumo em Inglês:

This document summarizes key recommendations on assisting health care personnel who have experienced occupational exposure to blood or other body fluids that might contain hepatitis B virus (HBV), hepatitis C virus (HCV), or human immunodeficiency virus (HIV). The document is based on a report prepared jointly by four agencies of the Government of the United States of America: the Centers for Disease Control and Prevention, the Food and Drug Administration, the Health Resources and Services Administration, and the National Institutes of Health. Their report updated and consolidated earlier guidelines from the Public Health Service of the United States. With respect to HBV it is recommended that postexposure management include initiation of the hepatitis B vaccine series to any susceptible, unvaccinated person. When either the source is positive for the hepatitis B surface antigen or the exposed individual has not been vaccinated or, if in spite of being vaccinated, had not developed an adequate antibody response, vaccination should be accompanied by the administration of hepatitis B immunoglobulin. With HCV exposure the administration of immunoglobulins or of antiviral agents (e.g., interferon with or without ribavirin) is not recommended. The appropriate measures consist of determining if the source and the exposed individual are infected. If the source is HCV-positive, the exposed person should undergo follow-up HCV testing in order to determine if infection develops. The recommendations for prophylaxis after exposure to HIV consist of, in the majority of cases, administering for 4 weeks a basic regimen of two drugs (zidovudine (ZDV) and lamivudine (3TC), lamivudine and stavudine (d4T), or stavudine and didanosine (ddI)). Where there is a higher risk of transmission, this basic regimen can be expanded with the addition of a third antiretroviral. The report also considers various special circumstances such as a delay in reporting the exposure, exposure to substances from an unknown individual, exposure during pregnancy, resistance of the source virus to antiretroviral agents, and toxicity of the postexposure regimen.