Boletin de la Oficina Sanitaria Panamericana. Pan American Sanitary Bureau最新文献

We describe the epidemiology of AIDS as it pertains to health workers in Mexico. Of the 12,151 cases notified in adults up until 1993, 2.9% occurred among such workers. Two cases of occupational transmission have been documented. Seroprevalence surveys have shown an infection rate of less than 0.1%. Nonetheless, the frequency with which hepatitis B viral markers are present (11.8% of anti-HBs antibody carriers and 2% of anti-HBsAg antibody carriers) points to the fact that mechanisms for the transmission of both types of viruses are at work. Surveys conducted among health workers to explore their knowledge and attitudes on the subject of AIDS indicate that they share many false notions about the disease and that they stigmatize its victims. Educational campaigns have improved knowledge about the illness but have not modified people's attitudes significantly. Holding workshops has proved to be the most useful strategy for attitude modification. We describe a few strategies that may be useful for changing negative attitudes among health personnel. When calculating the frequency with which biosafety measures are implemented, it has been noted that their application is erratic. Epidemiologic studies have confirmed the existence of an association between the time of occupational exposure and the presence of hepatitis B viral markers. Many people reject adopting certain measures, such as anti-hepatitis vaccination. Finally, we analyze the need for continuous training and supplies if increased biosafety measures are to be adopted.

This study sought to establish the prevalence of infection with the hepatitis B, C, and D viruses (HBV, HCV, and HDV) and to describe their transmission among the Parakanã, an indigenous tribe in Pará State, Brazil. This tribe's first contacts with broader Brazilian society occurred in the 1970s and 1980s. As of October 1992, the tribe consisted of 350 individuals, of whom 222 lived in the village of Paranatinga and 128 in the village of Maroxewara. Serum samples from 96.9% of this population were tested for markers of infection with the above-named viruses by means of enzyme immunoassays. Another 106 serum samples collected from Parakanã in the 1970s were also tested. The results obtained with the modern samples showed an overall prevalence of HBV infection of 84.7% among the residents of Paranatinga, 14.4% of whom were carriers. In Maroxewara, the overall prevalence of infection was only 17.7% and no carriers were detected in the study population. HBV carriers were negative for markers of HDV infection. The prevalence of HCV infection, confirmed by immunoblot, was 1.4% and 1.6% in Paranatinga and Maroxewara, respectively. Among the notable findings of this study were that horizontal transmission of HBV takes place at an early age in Paranatinga; that HBV infection prevalences differ greatly between two nearby villages belonging to the same tribe; that HCV infection was detected in both villages; and, from the historic sera, that the prevalence of HBV infection was low and HCV infection was absent during the first years in which the Parakanã people had outside contact.

The health system in Brazil has undergone profound changes since the 1980s. In the state of São Paulo, the processes of decentralization to the municipio and regional levels, as well as integration of health services, began in 1983. This study describes the strategies adopted by the Ministry of Health of the state of São Paulo to implement these processes and create 65 regional health offices, and discusses the role of these offices in the new unified health system. It is concluded that decentralization has resulted in increased local government participation in financing the health system, that production of medical and community health services has grown, and that health indicators have improved.

With the increased presence of Chagas' disease in urban areas and the rising importance of transfusional transmission of Trypanosoma cruzi, a proper and realistic approach to hemotherapeutic treatment has become crucial in Brazil. Bringing together data from various institutions, this study analyzed hemotherapy and the problem of transfusional Chagas' disease in 850 Brazilian municipalities from 1988 to 1989. It was found that some type of hemotherapy was practiced in 68.8% of these municipalities at the time, this practice being qualitatively and quantitatively proportional to the population size of the municipality. The official blood bank system supplied the blood used in 13% of these services. In relation to prevention of the main diseases transmissible by transfusion, prior screening of donors was carried out by 75.2% of the services for syphilis, 65.4% for hepatitis, 53.8% for AIDS, and 66.9% for Chagas' disease. These percentages vary by region and by size of the municipality. The majority of donors are classified as voluntary, with only 2% categorized as paid donors. In the case of Chagas' disease, most services used only one serologic technique to screen donors, most commonly hemagglutination or immunofluorescence, while only 10.3% of services had previous experience with chemoprophylaxis using gentian violet. The proportion of potential donors with positive serology for anti-Trypanosoma cruzi antibodies was around 1%. These data were confirmed by information from blood banks and Brazilian hemotherapy professionals.

The objective of this cross-sectional study was to estimate mortality and morbidity from asthma in Mexico by federative entity (state) of residence, age, and sex during the period between 1960 and 1988. Statistics published by the National Institute of Statistics, Geography, and Information Science were reviewed, as were vital statistics and information from other sources. Data were selected on mortality, hospital admissions, and outpatient visits, as well as population by federative entity, age, and sex. Mortality and morbidity rates were adjusted for age using the direct method. From 1960 to 1987, mortality decreased for both sexes. The groups with the highest asthma mortality were those under 4 years of age and those over 50. From 1960 to the present, the state with the highest mortality was Tlaxcala. Hospitalizations increased from 10 to 140 per 100,000 population for the country as a whole. When both outpatient visits and hospitalizations were considered, the morbidity rates rose from 180 to 203.4 per 100,000 between 1960 and 1970. In 1970, hospital morbidity was higher among males than females. From 1960 up to the 1990s, the highest rates of hospitalization and outpatient visits were registered among those under 4 and those over 60. The states with the highest asthma hospitalization rates were Morelos, Baja California Sur, Nuevo León, Durango, and Tamaulipas. It is concluded that asthma mortality in Mexico is showing a downward trend, while morbidity is increasing considerably, especially among adolescents.

Although the existence of chronic carriers of Vibrio cholerae has been posited, the information in this regard is limited and contradictory. In order to determine the usefulness of the encapsulated string test (enterotest) for detecting V. cholerae in duodenal secretions of biliary origin (biliduodenal secretions), 59 patients (30 males and 29 females) over the age of 15 with clinically and bacteriologically diagnosed cholera were evaluated. All the patients, who were treated at the María Auxiliadora Departmental Hospital in Lima, Peru, were put on the same rehydration regimen and were given 2 g of tetracycline daily for 3 days. Between 24 h and 7 days after completion of the antibiotic treatment the first control tests were performed: culture of biliduodenal secretions obtained using enterotest and culture of feces obtained by rectal swab. No patient had diarrhea at the time of the first test. The biliduodenal secretion cultures revealed the presence of V. cholerae in five patients (8.5%) (four females and one male), while the fecal culture yielded negative results in all cases. One week later the control test was repeated on four of the five patients. All the biliduodenal secretion cultures were negative and only one fecal culture was positive at this stage. The patient in question was subjected to the same control tests one week later and both were negative. It is concluded that enterotest can be a simple, well-tolerated, low-cost method for detecting V. cholerae carriers.