• Caminando de la mano de los niños de América Perspectivas de los Héroes de la Salud Pública de la OPS

    Margarita Moreno, Elsa
  • Embarazo no deseado y aborto inseguro: dos problemas de salud persistentes en América Latina Editorial

    Espinoza, Henry
  • Contraceptive use among Jamaican teenage mothers Articles

    Drayton, Vonna Lou Caleb

    Abstract in Spanish:

    Objetivos. Comparar la prevalencia del uso de anticonceptivos entre madres adolescentes que estaban participando o no en un programa instaurado en Jamaica para abordar el grave problema que en este país representan los embarazos repetidos en adolescentes. Métodos. Se usó un diseño de cohorte histórica para evaluar el impacto del Programa para Madres Adolescentes del Centro de Mujeres de la Fundación Jamaica (The Women's Centre of Jamaica Foundation: WCJF) sobre el uso de anticonceptivos en la población de adolescentes de 16 años o menos que habían tenido su primer niño vivo en 1994. Resultados. El uso de anticonceptivos en el primer coito fue más frecuente entre las participantes en el programa del WCJF (44%) que entre las que no participaron (37%), pero la diferencia no fue significativa (P = 0,35). El uso de anticonceptivos tras el nacimiento del primer niño vivo también fue mayor entre las participantes en el programa (94%) que entre las que no participaron (86%), y esta diferencia fue significativa (P = 0,04). La prevalencia del uso de anticonceptivos en el último coito (en 1998) fue igual en ambos grupos (69%). Conclusiones. El uso de anticonceptivos en esta población jamaiquina fue más frecuente cuando la percepción de las encuestadas de su vulnerabilidad al embarazo era más aguda, esto es, después del nacimiento del primer niño vivo. Es necesario educar a todos los adolescentes de ambos sexos acerca de la importancia del uso continuo y eficaz de anticonceptivos, con el fin de reducir el riesgo de embarazos no deseados y de enfermedades de transmisión sexual.

    Abstract in English:

    Objective. To compare the prevalence of contraceptive use among teenage mothers who were participating, and teenage mothers who were not participating, in a program in Jamaica that had been established to deal with the country's serious problem of repeat pregnancies among adolescents. Methods. A historical cohort design was used to assess the impact that the Women's Centre of Jamaica Foundation (WCJF) Programme for Adolescent Mothers had on contraceptive use among the target population of adolescents 16 years and under who had experienced a first live birth in 1994. Results. Contraceptive use at first intercourse was found to be higher among WCJF program participants (44%) than among nonparticipants (37%), but this difference was not significant (P = 0.35). Contraceptive use after first live birth was also higher among WCJF program participants (94%) than among nonparticipants (86%), and this difference was significant (P = 0.04). Contraceptive prevalence at last intercourse (in 1998) did not differ between participants and nonparticipants (both 69%). Conclusions. Contraceptive use among this population in Jamaica was highest when the respondents' perception of vulnerability to pregnancy was most acute, that is, after the first live birth. All adolescents, both males and females, need to be educated about the importance of sustained and effective use of contraception in order to reduce the risk of unintended pregnancy and sexually transmitted diseases.
  • Ongoing, flexible distance learning through the Internet: Course on Decentralized Management of Human Resources in Health Care

    Struchiner, Miriam; Roschke, Maria Alice; Ricciardi, Regina Maria Vieira

    Abstract in Portuguese:

    O presente trabalho descreve o Curso de Gestão Descentralizada de Recursos Humanos em Saúde, um programa de educação a distância baseado na Internet para a formação e a educação continuada de profissionais de saúde. Este curso, uma iniciativa da Organização Pan-Americana da Saúde, visa atender às exigências de formar profissionais autônomos, que possam se atualizar constantemente sem terem de se afastar de seus locais de trabalho. O modelo proposto estimula um processo educativo que integra teoria e prática em contextos realistas e relevantes e que potencializa a participação ativa dos alunos, individual e coletivamente. O curso vem sendo submetido a uma série de estudos pilotos no Brasil, no Chile e no Peru. Depois dessas avaliações, uma série de adaptações vêm sendo feitas para facilitar a implementação definitiva do curso e para possibilitar a adequação dos conteúdos às reais condições de cada país.

    Abstract in English:

    This paper describes the Course on Decentralized Management of Human Resources in Health Care, which is an Internet-based distance learning program to train and provide continuing education for health care professionals. The program is an initiative of the Pan American Health Organization, and it was organized in response to the growing need for self-reliant professionals who can constantly upgrade their knowledge without having to leave their place of work. The proposed model promotes an educational process that brings together theory and practice in realistic and relevant contexts and that maximizes the participation of students, both individually and in groups. The program has been evaluated in pilot studies in Brazil, Chile, and Peru. Following these assessments, the course has been adapted to facilitate its implementation and to adjust its contents to fit each country's circumstances.
  • A mathematical model of the annual risk of tuberculosis infection in Cali, Colombia Artículos

    Pava, Elmer de la; Salguero, Beatriz; Alzate, Alberto

    Abstract in Spanish:

    Objetivo. El riesgo anual de infección tuberculosa (RAI) es la probabilidad de infectarse que tiene una persona sin contacto previo con el bacilo tuberculoso en el curso de un período de un año. El RAI es el indicador más apropiado para estimar la fuerza de la infección tuberculosa en una población. El objetivo de este trabajo consiste en estimar el RAI y su tendencia temporal en la ciudad de Cali, con datos proporcionados por la Secretaría Municipal de Salud. Métodos. Hemos usado un modelo determinístico para describir la dinámica de la tuberculosis pulmonar. Los flujos entre los subgrupos de población están basados en la historia natural de la enfermedad y se tienen en cuenta también los vacunados. Las condiciones iniciales y los valores de los parámetros fueron estimados a partir de los datos obtenidos. Resultados. Los valores medios del RAI en las décadas de los setenta, de los ochenta y de los noventa fueron del 1,24, 0,93 y 0,85%, respectivamente. Para evaluar la tendencia temporal, se intentó predecir el riesgo anual aplicando un ajuste por mínimos cuadrados no lineal a los datos de los porcentajes agregados de cada año. Con el polinomio que ajusta estos datos se obtuvo la tendencia hasta el año 2003, con un RAI previsto del 1,3%, que confirma un regreso al comportamiento observado en la década de los setenta. Conclusiones. El RAI estimado en Cali durante las décadas de los setenta, de los ochenta y de los noventa es muy alto si se compara con el de países como Holanda (0,012% en 1985), pero no si se compara con el de los países de Sudamérica, que van del 0,5 al 1,5%. El modelo y la simulación empleados demuestran una tendencia al aumento del RAI en la ciudad de Cali, y esa tendencia continuará si no se mejoran las medidas de control.

    Abstract in English:

    Objective. The annual risk of infection (ARI) for tuberculosis is the probability that an individual without previous contact with the tubercle bacillus has of being infected during the course of a year. The ARI is the most appropriate indicator for estimating the degree of tuberculosis infection in a population. The objective of this paper was to estimate the ARI and its trends in the city of Cali, Colombia, using data provided by the Municipal Secretariat of Health. Methods. We used a deterministic model of the dynamics of pulmonary tuberculosis. The flows among the population subgroups were based on the natural history of the disease, taking vaccination into account. Using the data from the Municipal Secretariat of Health, we estimated the initial conditions and the values of the parameters. Results. The mean ARI values were 1.24% in the 1970s, 0.93% in the 1980s, and 0.85% in the 1990s. In order to assess trends, we attempted to predict the annual risk, utilizing a nonlinear least-squares adjustment of the data on the overall percentage for each year. With that approach, we projected that the ARI in 2003 would be 1.3%, indicating a return to the patterns found in the 1970s. Conclusions. The estimated risk of tuberculosis infection in Cali during the decades of the 1970s, the 1980s, and the 1990s was very high in comparison with the risk in countries such as the Netherlands, which in 1985 had an ARI of 0.012%. However, the ARI in Cali is not so high in comparison to indices for other countries of South America, which range from 0.5% to 1.5%. This model and the simulation it produced showed a rising trend in the ARI for Cali, as well as demonstrated that the ARI will tend to continue to rise if control measures are not improved.
  • Selenium content of Brazilian foods

    Ferreira, Karla Silva; Gomes, José Carlos; Bellato, Carlos Roberto; Jordão, Cláudio Pereira

    Abstract in Portuguese:

    Objetivo. Determinar os teores de selênio em alimentos consumidos no Brasil. Métodos. O trabalho foi desenvolvido de 1993 a 1999. As amostras de alimentos foram coletadas no comércio varejista em vários estados do Brasil. Os teores de selênio foram determinados por meio de espectrofotometria de absorção atômica, utilizando-se a técnica de geração de hidretos, e oxidação da matéria orgânica por via úmida. Resultados. Os teores mais elevados de selênio foram encontrados nos produtos de origem animal, sobretudo nos pescados, e nos produtos derivados do trigo. Observou-se que os teores de selênio nos alimentos de origem vegetal foram, de modo geral, inferiores a 5,0 µg/100g. Conclusões. No Brasil, a presença de pescados, principalmente, e de outros produtos de origem animal é importante na dieta para garantir o consumo dos teores recomendados de selênio.

    Abstract in English:

    Objective. To determine the selenium content of foods consumed in Brazil. Methods. The project was carried out between 1993 and 1999. The food samples were collected in stores in several Brazilian states. The levels of selenium were determined by hydride generation atomic absorption spectrophotometry and by wet oxidation. Results. The highest levels of selenium were found in animal products, especially fish, and in wheat products. We found that plant products generally had selenium levels of less than 5.0 µg/100 g. Conclusions. In Brazil a diet rich in animal products, especially fish, is important in ensuring consumption of the recommended levels of selenium.
  • Breast cancer in Latin America and the Caribbean Articles

    Robles, Sylvia C; Galanis, Eleni

    Abstract in Spanish:

    Hace tan solo dos décadas, el cáncer de mama no se consideraba un problema de salud pública importante en América Latina y el Caribe (ALC). Sin embargo, las tasas de mortalidad del cáncer de mama han estado en aumento durante al menos 40 años en la mayoría de los países de ALC. Se cree que el desarrollo socioeconómico y los consiguientes cambios de los comportamientos reproductivos a lo largo de los últimos 50 años han contribuido a aumentar el riesgo de cáncer de mama. Ese mismo desarrollo socioeconómico ha aumentado también los conocimientos de la mujer sobre la salud y, por consiguiente, la demanda de servicios de calidad. En los países industrializados se están poniendo en práctica el tamizaje y protocolos terapéuticos de gran calidad como principal estrategia para controlar el cáncer de mama. Los estudios realizados demuestran que, de los tres métodos de tamizaje existentes (mamografía, examen clínico de la mama y autoexploración de la mama), solo la mamografía en mujeres de 50 a 69 años ha sido eficaz para reducir la mortalidad, en un 23%, según las estimaciones. Aunque hay mucha controversia acerca de los beneficios y de la relación costo-efectividad del tamizaje mamográfico en mujeres de 40 a 49 años, en algunos países, como Australia, los Estados Unidos de América y cuatro países europeos, se recomienda que los médicos valoren su necesidad en cada caso. Una encuesta que hemos realizado en países de ALC muestra que la mayoría de sus políticas de detección del cáncer de mama no están justificadas por las pruebas científicas disponibles. Además, como demuestran las razones relativamente elevadas entre la mortalidad y la incidencia, los casos de cáncer de mama no están siendo tratados adecuadamente en muchos países de ALC. Antes de seguir desarrollando programas de detección, estos países necesitan evaluar la factibilidad de diseñar y poner en práctica normas terapéuticas adecuadas y de proporcionar un amplio acceso a los servicios diagnósticos y terapéuticos. Dada la importancia actual del cáncer de mama en ALC, es esencial que tanto las mujeres como los profesionales sanitarios tengan acceso a información actualizada sobre la cual basar sus decisiones.

    Abstract in English:

    As recently as two decades ago breast cancer was not a significant public health concern in Latin America and the Caribbean (LAC). However, mortality rates from breast cancer have been increasing for at least 40 years in most LAC countries. Socioeconomic development and consequent changes in reproductive behaviors over the past 50 years are thought to have contributed to the increased risk of breast cancer. Socioeconomic development has also increased women's health awareness and therefore the demand for quality services. In industrialized countries, screening and widely available, high-quality treatment protocols are being implemented as the main strategy for breast cancer control. Studies show that out of three available screening methods (mammography, clinical breast examination, and breast self-examination), only mammography for women 50<FONT FACE=Symbol>-</FONT>69 years of age has been effective at reducing mortality, and has done so by an estimated 23%. While there is much controversy about the benefits and cost-effectiveness of mammography screening for women aged 40<FONT FACE=Symbol>-</FONT>49, some countries, including Australia, the United States of America, and four European nations, recommend that physicians assess the need for it on an individual basis. A survey that we conducted of LAC countries shows that most of their breast cancer screening policies are not justified by available scientific evidence. Moreover, as seen by relatively high mortality/incidence ratios, breast cancer cases are not being adequately managed in many LAC countries. Before further developing screening programs, these countries need to evaluate the feasibility of designing and implementing appropriate treatment guidelines and providing wide access to diagnostic and treatment services. Given the relevance of breast cancer in Latin America and the Caribbean today, it is crucial that both women and health care providers have access to up-to-date information on which to base their decisions.
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  • Unwanted pregnancy: impact on health and society in Latin America and the Caribbean Temas de Actualidad

    Langer, Ana

    Abstract in English:

    Engaging in sexuality and reproduction should always be something that is wanted and planned. Unfortunately, when that is not the case, one result can be unwanted pregnancy. Unwanted pregnancies have consequences for women, their families, and their countries. This document reviews the causes and results of unwanted pregnancy, emphasizing the impact that this problem has on Latin America and the Caribbean (LAC). Four reasons why unwanted pregnancy is a continuing problem in LAC are: 1) people's growing desire to have smaller families, 2) the unmet need for family planning, 3) the fact that contraceptive methods are not 100% effective, and 4) unwanted sexual relations. Unwanted pregnancies especially affect adolescent women, single women, and women over 40 years of age. Given their desperate situation with an unwanted pregnancy, some women opt for an unsafe abortion, which can lead to their death. Other women can go so far as to commit suicide, or be murdered by a family member or other person who is unhappy that the pregnancy has occurred. It has been found that women who decide to continue with the pregnancy have higher risks of suffering an illness, and the same is true for the child. Reducing unwanted pregnancies and treating post-abortion complications are key to lowering maternal mortality and morbidity. This necessitates developing mass communication programs that address gender issues, education programs for girls, and sex education programs. It is also vital to make available to all persons reproductive health services that include family planning methods. In the countries of LAC with laws that specify grounds for legally ending a pregnancy, it is necessary that health care be organized to actually provide this service, and that health care programs obtain the safest, most effective technologies now available for ending a pregnancy.
  • New recommendations from the United States Government on breast cancer screening Current Topics

    Abstract in Spanish:

    En los últimos años ha habido grandes controversias y debates sobre la eficacia de diferentes métodos de detección del cáncer de mama. En un esfuerzo por proporcionar orientaciones más claras tanto a las mujeres como a los profesionales de la salud, un grupo de expertos reunido por el Gobierno de los Estados Unidos de América, el llamado U.S. Preventive Services Task Force (USPSTF), publicó en febrero de 2002 un informe en el que se afirma que la mamografía permite salvar vidas y que su realización debería comenzar en la quinta década de la vida de la mujer. Este grupo de expertos dice también que no hay datos suficientes para hacer recomendaciones a favor o en contra de otros dos métodos de detección: el examen clínico de la mama y la autoexploración mamaria rutinaria. El presente documento resume las recomendaciones del informe del USPSTF, así como las principales consideraciones clínicas y pruebas científicas que presentó en áreas como la exactitud y fiabilidad de las pruebas de detección, la eficacia de la detección temprana del cáncer de mama, cuándo detener el tamizaje, el intervalo de tiempo más apropiado entre las pruebas y los potenciales perjuicios del tamizaje.
  • HIV/AIDS in the workplace: Practical recommendations from the International Labor Organization Temas de Actualidad

    Abstract in English:

    There are now some 36 million people in the world infected with HIV/AIDS. It is estimated that more than 23 million of them are economically active, including 642 000 persons in Latin America and the Caribbean. In the workplace, HIV/ AIDS reduces incomes, imposes added costs on companies, and undermines fundamental labor laws due to the discrimination and rejection that infected individuals suffer. In response, the International Labor Organization (ILO) has produced a document entitled An ILO code of practice on HIV/AIDS and the world of work, which is summarized in this piece. The ILO document aims to help those in the workplace to cope with the HIV/AIDS epidemic through a set of guidelines related to: (a) preventing infection, (b) managing and reducing the impact that HIV/AIDS has on the workplace, (c) delivering care and support for infected workers and, in general, to all the people affected by this epidemic, and (d) eliminating discrimination against persons who are infected or are suspected of being infected. The ILO Code is intended to help in preparing and adopting specific measures in the workplace, thus promoting dialogue and other forms of cooperation among the government, employers, workers and their representatives, workplace health and safety officers, HIV/AIDS specialists, and other interested parties. The intention is also for the Code recommendations to be implemented and integrated with national laws, policies, and programs; company or business agreements; and workplace policies and action plans. This ILO Code is an important step in the struggle against HIV/AIDS. Aimed at governments, employers, and workers throughout the world, the Code recommendations constitute a useful tool in addressing the problem of HIV/AIDS in the workplace, in a just manner. As a "motor" of society, work cannot remain separated from issues of such great social impact.
Organización Panamericana de la Salud Washington - Washington - United States
E-mail: contacto_rpsp@paho.org