Resumo em Espanhol:

Debido a la importancia que la inocuidad de los alimentos entraña para la salud pública, se procuró determinar la calidad microbiológica de los alimentos que consumen los usuarios de los comedores comunitarios del conurbano de Buenos Aires, Argentina. Se trata de un estudio descriptivo, cuyo universo lo conformaron tres municipios con índices medianos y altos de pobreza, de los que se extrajo al azar una muestra de 52 comedores. La información se recolectó desde abril de 1994 hasta abril de 1995 inclusive, por medio de encuestas, observaciones directas y análisis microbiológicos del agua y los alimentos servidos. Los análisis del agua y los alimentos se ajustaron, respectivamente, a las recomendaciones del Código Alimentario Argentino y de la Comisión Internacional de Especificaciones Microbiológicas para Alimentos. Los resultados se interpretaron según los valores para alimentos cocidos acordados por el Grupo de Trabajo de Control de Alimentos. La parte microbiológica del estudio mostró que en 28 (54%) de los comedores la comida o el agua era inadecuada y en 11 (21%), ambas eran inadecuadas. Bacillus cereus fue la bacteria patógena que se encontró con mayor frecuencia en los alimentos analizados. Los factores significativamente asociados con condiciones microbiológicas insatisfactorias de las comidas y el agua fueron no desinfectar el agua (P = 0,009), la falta de higiene en el ambiente (P = 0,03), la presencia de roedores e insectos (P = 0,05), el sistema de provisión de materias primas (P = 0,01) y un número de usuarios menor de 100 (P = 0,008). Se concluyó que la desinfección del agua y la limpieza general de los comedores son medidas que pueden implantarse por medio de intervenciones educativas en materia de higiene y manipulación de alimentos dirigidas a los encargados y empleados de los comedores. Los resultados obtenidos también apoyan la conveniencia de incluir la evaluación sanitaria de los alimentos entre los criterios de evaluación general de los programas de asistencia alimentaria.

Resumo em Inglês:

Because of the importance of food safety for public health, a study was done to determine the microbiologic quality of foods provided to patrons of community dining halls in greater Buenos Aires, Argentina. The study was descriptive and was conducted in three municipalities with intermediate or high poverty indices; a sample of 52 dining halls was selected randomly from those municipalities. Information was Information was collected from April 1994 through April 1995 by means of surveys, direct observations, and microbiologic analyses of the water and food served. Water and food analysis followed the recommendations of the Argentine Food Code and the International Commission on Microbiologic Specifications for Foods, respectively. The results were interpreted according to the values for cooked foods agreed upon by the Working Group on Food Monitoring. The microbiologic analysis revealed that 28 (54%) of the dining halls had food or water of inadequate quality and 11 (21%) had inadequacies in both. Bacillus cereus was the most commonly found pathogenic bacterium in the food samples analyzed. The factors that were significantly associated with unsatisfactory microbiologic conditions in the food and water were lack of disinfection of the water (P = 0.009), lack of hygiene in the environment (P = 0.03), the presence of rodents and insects (P = 0.05), the supply system for raw materials (P = 0.01), and a relatively small number of users, i.e., fewer than 100 (P = 0.0008). It was concluded that water disinfection and general clean-up of the dining halls were measures that could be put in place by providing education in the areas of hygiene and food handling to supervisors and employees. The results obtained also indicate the need to include a food safety evaluation among the general evaluation criteria for food assistance programs.

Resumo em Espanhol:

Los potenciales provocados auditivos del tallo cerebral son un método sencillo y no invasor de evaluación de la función auditiva, que se utiliza ampliamente en niños para detectar tempranamente hipoacusia. Entre abril de 1992 y mayo de 1994, se estudiaron 400 niños mexicanos que presentaban, al menos, un factor de riesgo neonatal de hipoacusia. La media de la edad de los niños estudiados fue 6,6 meses y la media de la edad gestacional al nacer, 35,1 semanas. El 51% de ellos fueron tratados con amikacina. Se registraron 1427 factores de riesgo (3,5 por niño), entre los que predominaron la exposición a ototóxicos, la hiperbilirrubinemia y el peso al nacer <1 500 g. En 27% se encontraron alteraciones auditivas de tipo periférico y en 13%, ausencia de respuesta a estímulos auditivos. El bajo peso y la menor edad gestacional al nacer, la concentración máxima de bilirrubina en el suero, la presencia de sepsis, la hemorragia subependimaria o intraventricular, la ventilación mecánica y la exposición a ototóxicos se asociaron significativamente con la presencia de hipoacusia grave o profunda.

Resumo em Inglês:

Brainstem auditory evoked potentials provide a simple, noninvasive method of evaluating hearing function and have been widely used for early detection of hypoacusis in children. Between April 1992 and May 1994, a study was done of 400 Mexican children who presented at least one neonatal risk factor for hearing impairment. The average age of the children studied was 6.6 months and their average gestational age at birth was 35.1 weeks. Just over half of the children had been treated with amikacin. The study found 1427 risk factors (about 3.5 per child), the most common ones being exposure to ototoxic substances, hyperbilirubinemia, and birthweight <1500 g. In 27% of the children, peripheral auditory changes were found, and 13% did not respond to auditory stimuli. Low birthweight and young gestational age at birth, high serum concentration of bilirubin, sepsis, subependymal or intraventricular hemorrhage, mechanical ventilation, and exposure to ototoxic substances were significantly associated with the presence of severe or profound hypoacusis.

Resumo em Espanhol:

En abril de 1993 se realizó un estudio en 108 trabajadoras sexuales que ejercían la prostitución en Georgetown, Guyana. Mediante entrevistas y pruebas de sangre, se investigaron las relaciones entre la seroprevalencia del VIH y conocimientos sobre el sida, prácticas riesgosas, características de los clientes y uso de condones. Las mujeres que trabajaban en la calle -a diferencia de las que trabajaban en bares, hoteles y Puerto Georgetown- solían cobrar menos, estaban en peor situación socioeconómica y tenían clientes en circunstancias similares; por lo tanto, estas mujeres se clasificaron dentro de un estrato socioeconómico "inferior" y las restantes dentro de uno "superior". La seroprevalencia general del VIH observada en las trabajadoras sexuales fue de 25% (IC95% = 17 a 33%). Las 50 mujeres del estrato inferior tuvieron, sin embargo, una seroprevalencia relativamente alta (42% en comparación con 10% de las del estrato superior), y a ese grupo pertenecían 21 de las 27 mujeres seropositivas al VIH. El origen declarado de los clientes (guyaneses o extranjeros), la disposición de las trabajadoras a tener relaciones sexuales sin condón y el uso de condones por los clientes variaron según el estrato. Las participantes del estrato más alto estaban más dispuestas a tener relaciones sexuales sin condón y en ambos estratos las mujeres sabían poco sobre la causa del sida y la transmisión del VIH. Muchas trabajadoras declararon haber contraído una enfermedad de transmisión sexual (ETS) en los 2 años anteriores o haber consumido drogas ilícitas. Según los datos recogidos, los clientes guyaneses usan condones con menos frecuencia que los extranjeros, fenómeno que implica un mayor riesgo de contraer el VIH por contacto con un guyanés o de transmitirlo a un guyanés. La seroprevalencia del VIH en trabajadoras que dijeron tener solo clientes guyaneses fue estadísticamente mayor que la observada en las que declararon que sus clientes eran solo extranjeros. La seroprevalencia del VIH en mujeres que declararon tener más de cinco clientes a la semana fue estadísticamente mayor que en las que tenían menos clientes. La seropositividad al VIH fue relativamente frecuente entre las 12 trabajadoras que declararon haber usado cocaína. En general, los resultados confirman la necesidad de fortalecer las intervenciones dirigidas a las trabajadoras sexuales y a sus clientes y, particularmente, de hacer un esfuerzo concertado para intensificar la promoción, distribución y comercialización social de los condones; mejorar los servicios de atención de ETS que ofrezcan tratamiento y orientación a las trabajadoras sexuales, y ampliar las actividades educativas dirigidas a sus clientes guyaneses.

Resumo em Inglês:

A study of 108 female sex workers engaged in prostitution in Georgetown, Guyana, was made in April 1993. Based on interviews and procurement of blood samples, the study investigated relationships between HIV seroprevalences and AIDS knowledge, risk behaviors, client characteristics, and condom use. Street-walkers-as distinct from sex workers in bars, hotels, and Port Georgetown-tended to charge less, be worse off socioeconomically, and have clients who were similarly disadvantaged; they were therefore classified as belonging to a "lower" socioeconomic stratum, while the other workers were classified as belonging to a "higher" stratum. The overall HIV seroprevalence found among the sex workers was 25% (95%CI: 17%-33%). But the 50 subjects in the lower stratum had a relatively high seroprevalence (42%, as compared to 10% among those in the higher stratum), accounting for 21 of the 27 HIV-seropositive subjects. Reported patterns of client origins (Guyanese or foreign), worker willingness to have sex without a condom, and condom use by clients differed by stratum. Participants in the higher stratum were more disposed to having sex without a condom. The workers' knowledge of what causes AIDS and how HIV is transmitted was low in both strata; substantial numbers of workers said they had contracted a sexually transmitted disease within the past two years or were users of illicit drugs. Condom use is reportedly less common among Guyanese than foreign clients, suggesting a greater risk of contracting HIV from Guyanese clients or infecting Guyanese clients with it. The HIV seroprevalence among workers who said they had only Guyanese clients was statistically greater than the rate among those who said they had only foreign clients. The HIV seroprevalence among those reporting more than five clients per week was statistically greater than among those reporting fewer. HIV seropositivity was relatively high among the 12 workers who said they used cocaine. Overall, the findings supported the view that interventions targeted at female sex workers and their clients should be strengthened-more specifically, that concerted efforts should be made to intensify condom promotion, distribution, and social marketing; to improve STD services that provide treatment and counseling for female sex workers; and to increase educational activities among the workers' Guyanese clients.

Resumo em Português:

Com o objetivo de avaliar a evolução da positividade sorológica para doença de Chagas na comunidade rural de Cássia dos Coqueiros, Estado de São Paulo, Brasil, foram comparados dois estudos transversais realizados na localidade nos anos de 1971-1972 e 1989-1991. O primeiro levantamento utilizou reação de fixação de complemento para determinar a positividade para sorologia da doença. A prevalência total da doença de Chagas encontrada por este estudo foi de 16,6%, com variação de 2,9 a 61,9% (nos grupos etários de 10 a 19 e de 50 a 59 anos de idade, respectivamente). No estudo de 1989-1991, que utilizou imunofluorescência indireta, a prevalência total caiu para 10,1%, com valor mínimo de 0,4% (de 10 a 19 anos) e máximo de 44,8% (acima de 60 anos de idade). Entre pessoas nascidas em Cássia dos Coqueiros, o estudo de 1989-1991 mostrou positividade a partir da idade de 38 anos, com uma única exceção (um homem de 24 anos de idade). A queda no índice de positividade para doença de Chagas em Cássia dos Coqueiros no período analisado pode ser parcialmente devida a fatores sócio-econômicos, como melhoria das condições de vida e progressivo esvaziamento das áreas rurais. Porém, os resultados apontam para a aplicação domiciliar de inseticidas de ação residual, implementada pela primeira vez em 1950, como o fator determinante no combate aos triatomíneos e no controle da transmissão da doença. Os resultados sugerem que a interrupção da transmissão da doença pode ter ocorrido já ao final de 1954, consolidando-se posteriormente através da melhoria das condições sócio-econômicas e da eliminação do Triatoma infestans da área de estudo.

Resumo em Inglês:

In order to assess the evolution of seropositivity for Chagas' disease in the rural community of Cássia dos Coqueiros, in São Paulo state, we compared two cross-sectional studies performed at that site in 1971-1972 and in 1989-1991. In the first survey the complement fixation test was used to determine seropositivity for the disease. In this study, the total prevalence of Chagas' disease was found to be 16.6%, with values ranging from 2.9 to 61.9% (in the 10-19 and 50-59 year age groups, respectively). In the 1989-1991 study, in which indirect immunofluorescence was used, the total prevalence dropped to 10,1%, with a minimum of 0.4% (in the 10-19 year age group) and a maximum of 44.8% (in persons over 60 years of age). Among subjects born in Cássia dos Coqueiros, the 1989-1991 study showed seropositivity after age 38, with only one exception (a 24-year-old man). The drop in the seropositivity index for Chagas' disease in Cásia dos Coqueiros during the period under study can be partially attributed to socioeconomic factors, such as improved living conditions and the progressive abandonment of rural areas. Thus, our results point to the spraying of households with residual insecticides, which began in 1950, as the pivotal factor in the fight against triatomine bugs and in disease control. Theses results suggest that transmission may have been interrupted as early as the latter part of 1954 and later consolidated as a result of improved socioeconomic conditions and the elimination of Triatoma infestans from the study area.

Resumo em Espanhol:

Streptococcus pneumoniae es uno de los principales agentes causales de infección respiratoria aguda (IRA) en niños y su resistencia a antibióticos se ha incrementado en todo el mundo. En este estudio se determinaron los patrones de susceptibilidad a antimicrobianos de S. pneumoniae colonizante de las vías respiratorias altas en 272 niños hospitalizados por neumonía en dos hospitales de Santafé de Bogotá. Se aisló S. pneumoniae en 114 pacientes (42%). Se observó susceptibilidad disminuida a la penicilina en 19 aislamientos (17%), con sensibilidad intermedia en 12 (11%) y franca resistencia en 7 (6%). Solo 1 de los 19 aislamientos resistentes a penicilina mostró también resistencia a la ceftriaxona. Se observó sensibilidad disminuida a la eritromicina en 3 aislamientos (3%), al cloranfenicol en 6 (5%) y al cotrimoxazol (trimetoprima + sulfametoxazol) en 46 (40%). Se encontró multirresistencia en 7 aislamientos (6%). El serotipo con sensibilidad disminuida a la penicilina que se halló con mayor frecuencia fue el 23F (68.4%). Se observó una asociación entre la edad, el uso previo de antibióticos y la colonización con S. pneumoniae con susceptibilidad disminuida a la penicilina o multirresistencia. Este estudio confirma la presencia de resistencia antimicrobiana de S. pneumoniae en Colombia y resalta la importancia del uso racional de los antibióticos y de la implementación de la vigilancia epidemiológica sobre este agente.

Resumo em Inglês:

Streptococcus pneumoniae is one of the principal causal agents of acute respiratory infection (ARI) in children, and its resistance to antibiotics has increased worldwide. This study examined the patterns of susceptibility to antibiotics of S. pneumoniae that had colonized the upper respiratory tract of 272 children hospitalized for pneumonia in two hospitals in Santafé de Bogotá. S. pneumoniae was isolated from 114 patients (42%). Diminished susceptibility to penicillin was noted in 19 isolates (17%), with 12 (11%) having an intermediate level of sensitivity and 7 (6%) showing outright resistance. Only 1 of the 19 isolates resistant to penicillin also showed resistance to ceftriaxone. There was diminished sensitivity to erythromycin in 3 isolates (3%), to chloramphenicol in 6 (5%), and to co-trimoxazole (trimethoprim + sulfamethoxazole) in 46 (40%). Resistance to multiple drugs was found in 7 isolates (6%). The most commonly encountered penicillin-resistant serotype was 23F (68.4%). An association was observed between age, prior use of antibiotics, and colonization by S. pneumoniae with reduced penicillin sensitivity or multiple-drug resistance. This study confirmed the presence of antibiotic-resistant S. pneumoniae in Colombia and highlights the importance of the rational use of antibiotics and of the implementation of epidemiologic surveillance for this agent.

Resumo em Espanhol:

Con objeto de aportar información necesaria en la búsqueda de métodos más prácticos y fiables para estudios de base poblacional sobre la diabetes mellitus, en este trabajo se comparan cinco formas de estimar las tasas de prevalencia. Se analizaron datos secundarios de un estudio transversal en una muestra por conglomerados de la población adulta residente en nueve capitales de estados del Brasil, realizado de 1986 a 1988. Los 21 846 participantes originales se clasificaron en diabéticos o no diabéticos de acuerdo con cinco métodos distintos: cuestionario domiciliario de toda la población de la muestra (M1), cuestionario individual de la población seleccionada (M2), medición de glucemia capilar en ayunas > o = 120 mg/dL (M3), cuestionario individual y glucemia capilar en ayunas > o = 120 mg/dL (M4) y cuestionario individual y glucemia capilar en ayunas > o = 200 mg/dL y glucemia capilar 2 horas después de sobrecarga oral de glucosa > o = 200 mg/dL (M5). Se determinó la concordancia entre los cinco métodos por comparación de las tasas obtenidas y empleo del coeficiente kappa. Las tasas de prevalencia de diabetes estandarizadas por edad variaron según el método analizado; con M1 se subestimaron los valores detectados por M2; con M3 se calcularon valores más altos que con M2 excepto en el grupo de edad de 60 a 69 años, y con M5 las tasas fueron más altas que con M4 excepto en el grupo de edad de 30 a 39 años. Según las tasas estandarizadas por edad, M1 detectó 84% de los valores estimados por M2; M2 detectó 91% de los de M3; M3 detectó 70% de los de M4; y M4 detectó 86% de los de M5. Las estimaciones de diabetes previamente diagnosticada fueron 64% y 55% del total estimado por M4 y M5, respectivamente. Los valores kappa fueron iguales a 0,70 o mayores en M1 contra M2, M1 contra M4, M2 contra M4 y M3 contra M4. Dados los resultados de este estudio, se concluye que los cuestionarios usados en M1 y M2 son métodos apropiados para detectar los casos de diabetes mellitus previamente diagnosticados y se recomienda su uso para evaluaciones o planeamiento de servicios de salud. La medición de glucemia en ayunas (M3) como método exclusivo no reportó ventajas sobre el cuestionario individual (M2). Entre los métodos combinados o múltiples, la glucemia en ayunas junto con el cuestionario individual (M4) fue eficiente en relación con M5, que incorpora la glucemia a las 2 horas después de la ingestión de una sobrecarga oral de glucosa.

Resumo em Inglês:

To aid in the search for more practical and reliable methods for use in population-based studies of diabetes mellitus, this article compares five ways of estimating prevalence rates. The analysis was performed on secondary data from a cross-sectional study of a cluster sample of the adult population in nine state capitals in Brazil. The original study was carried out from 1986 to 1988. The 21 846 participants were classified as diabetic or not diabetic by five different methods: household questionnaires administered to the entire sample population (M1); individual questionnaires administered to the selected population (M2); measurement of fasting glucose levels in capillary blood, with levels > or = 120 mg/dL as the cutoff (M3); individual questionnaire and fasting capillary blood glucose > or = 120 mg/dL (M4); and individual questionnaire plus fasting capillary blood glucose > or = 200 mg/dL and capillary glucose 2 hours after oral glucose loading > or = 200 mg/dL (M5). Agreement between the methods was determined by comparison of the rates obtained and use of the kappa coefficient. The age-adjusted prevalence rates of diabetes varied according to the method used. Values obtained with M1 were lower than those indicated by M2; M3 values were higher than M2 values, except in the age group 60-69 years; and with M5 the rates were higher than with M4, except among persons 30-39 years old. With regard to the age-adjusted rates found by the various methods, M1 detected 84% of the M2 estimate, M2 detected 91% of the M3, M3 detected 70% of the M4, and M4 detected 86% of the M5. Previously diagnosed diabetes cases accounted for 64% and 55% of the totals estimated by M4 and M5, respectively. Kappa values were at least 0.70 for M1 compared against M2, M1 against M4, M2 against M4, and M3 against M4. Based on the results of this study, it was concluded that the questionnaires used in M1 and M2 constituted appropriate methods for detecting previously diagnosed cases of diabetes mellitus, and their use is recommended for the purposes of health services planning or evaluation. Fasting glucose measurement (M3) as the sole method did not show a significant advantage over the individual questionnaire (M2). Of the combined or multiple methods, fasting glucose together with the individual questionnaire (M4) was efficient in comparison to M5, which incorporated measurement of blood glucose 2 hours after oral glucose ingestion.

Resumo em Espanhol:

Este estudio describe el comportamiento de ocho programas estadísticos (BMDP, EGRET y SYSTAT), al realizar una regresión logística con una base de datos simulados en la cual existe un problema numérico creado por la presencia de una celda con frecuencia igual a 0. Los programas responden de manera heterogénea a este problema. La mayor parte de ellos ofrecen señales de alarma, aunque muchos presentan, simultáneamente, resultados incorrectos entre los cuales destacan los intervalos de confianza que tienden al infinito. Estos resultados pueden desorientar al usuario. Se describen diferentes criterios orientativos para detectar estos problemas en situaciones de análisis reales y se recuerda la importancia de la interpretación crítica de los resultados de programas estadísticos.

Resumo em Inglês:

This study describes the behavior of eight statistical programs (BMDP, EGRET, JMP, SAS, SPSS, STATA, STATISTIX and SYSTAT) when performing a logistic regression with a simulated data set that contains a numerical problem created by the presence of a cell value equal to zero. The programs respond in different ways to this problem. Most of them give a warning, although many simultaneously present incorrect results, among which are confidence intervals that tend toward infinity. Such results can mislead the user. Various guidelines are offered for detecting these problems in actual analyses, and users are reminded of the importance of critical interpretation of the results of statistical programs.

Resumo em Inglês:

In Latin American and the Caribbean, a woman who is abused by her partner tends to deny the fact that she is the object of violence out of embarrassment, fear of revenge on the part of the assailant, or tacit consent on the part of the family and society at large. If she finally appeals to the justice or health care system, no one alleviates her circumstances, since both sectors operate independently and less efficiently than if intersectoral coordination existed. In June 1994 PAHO initiated a project in 16 countries involving the creation within the community of branches of the justice and health care systems, police, churches, non-government organizations, and community groups. These meet on a regular basis with the aim of launching a coordinated response to domestic violence. At the national level, the project fosters policies and legal norms that strengthen the institutional capacity to respond to the problem. Links with the media are also being promoted in order to combat social beliefs and attitudes that lead to women being abused in their own homes.

Resumo em Inglês:

As a result of national and international conflicts, the number of refugees and displaced persons in various countries of the world is increasing. The complex and protracted nature of these conflicts often forces refugees to remain away from their countries for long periods, living in refugee camps. Many refugees come from countries where tuberculosis is endemic and, once the immediate problems of establishing a camp are overcome, this disease becomes the principal problem affecting refugee camps. In order to advise the persons in charge of refugee camps on how to set up tuberculosis control programs, this document details the general requirements and specific recommendations of WHO for the implementation of such programs, as well as guidelines for their evaluation and monitoring, including criteria that would justify camp closure.