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

The principal aim of this work was to report the reintroduction of dengue virus serotype 3 in the Americas after an absence of 17 years. In addition, it describes the most common symptoms associated with classical dengue and hemorrhagic dengue and presents data on the distribution of the epidemic in the various comprehensive local health care systems of Nicaragua. The study group consisted of 39 patients hospitalized in Managua and León for dengue with hemorrhagic manifestations and hemorrhagic dengue. Of these patients, 34 were classified as probable or confirmed cases of dengue. The most frequent symptoms were fever, headache, vomiting, and muscle and joint pains. The tourniquet test was positive and thrombocytopenia was confirmed in 56% and 44% of the patients, respectively. Epistaxis (67%) was the most common hemorrhagic sign. Of the 356 serum samples received through the dengue surveillance systems in October 1994, IgM antibodies were detected in 43%. The virus was isolated from 5 of 24 samples tested (serotype 3 from 3 and serotype 1 from 2). The reintroduction of serotype 3 of dengue into the Region was demonstrated, along with its ability to produce epidemics of hemorrhagic dengue. The countries are warned that if they do not quickly take the measures described in the guidelines for the prevention and control of dengue and dengue hemorrhagic fever, new epidemics may occur in the Americas, given the large number of persons susceptible to this serotype and the high density of the mosquito vector in most of the countries of the Region.

This descriptive study was done using official data on mortality from cirrhosis of the liver for the year 1989. Its objectives were: (a) to describe mortality from cirrhosis of the liver in Brazilian adults; (b) to estimate the productive years of life lost (PYLL) prematurely (between 20 and 59 years of age) from this cause; and (c) to identify any regional differences in mortality or PYLL. The crude data were adjusted by age and sex, using the 1980 population of Brazil as the standard. Calculation of PYLL was based on the formula of Romeder and McWhinnie for years of potential life lost, modified by the author to express productive years of life lost. The crude death rates were higher in the Southeast and North, and in all regions they were higher in males, the countrywide male/female ratio being 4.5. Mortality rates among males varied from 14.37 per 100,000 in the Center-West to 35.86 per 100,000 in the Southeast; for females the rates ranged from 3.49 to 8.5 per 100,000 in the Center-West and North, respectively. The mortality curves by age for men showed a decline or stabilization after age 60, except in the North. For men in that region, the curve continued to rise, and the rate reached 86.37 per 100,000 after age 70. The curves for women also rose, most markedly in the North and Northeast. The age-adjusted rates showed a reduction for women in the Southeast, while rates in the North remained higher. Mortality from cirrhosis of the liver accounted for 48.7% of deaths from disorders of the digestive system among men and 24.1% among women. Of the 138,860 PYLL from cirrhosis of the liver in 1989, 83.2% were lost among males, while the average for the country, around 15.5 years, was similar for both sexes. However, the average PYLL for men and women in the North and women in the Center-West was much higher than in the other regions. The data suggest that cirrhosis of the liver among men in all the regions, except the North, is probably attributable to alcoholism. Among males from the North, there is strong evidence that cirrhosis with a viral etiology (hepatitis B and C virus) also exists. For women, the evidence suggests that cirrhosis of viral etiology predominates.

The HIV/AIDS epidemic has been simplistically interpreted as a phenomenon restricted to risk groups that are socially and spatially circumscribed. However, epidemic trends in recent years have demonstrated the need to employ open diffusion models that emphasize social interaction as a means of spread of HIV. This study is a spatial analysis of the AIDS epidemic in Brazil, which sought to incorporate variables reflecting economic and demographic events into a system for processing geographically referenced health information. Findings indicate that metropolises and regional urban centers, mainly those in the Southeast, play an important role in the spread of the epidemic, not only because of their population density but also because they are centers of trade and social interaction. In smaller cities located in the state of São Paulo, a large number of AIDS cases among injecting drug users are concentrated, revealing the routes and centers of cocaine use.

This work reports on a preliminary study carried out in Nicaragua to build a profile of the contamination of cow's milk with 10 organochlorine pesticides and make recommendations based on the findings. Between December 1993 and March 1994, milk samples were collected from 48 different sites in the country. The samples were analyzed for residues of hexachlorobenzene (HCB), alpha-BHC, lindane, aldrin, dieldrin, oxychlordane, heptachlor epoxide, and the principal metabolites of DDT (p,p'-TDE, p,p'-DDE, and p,p'-DDT) by means of solid-phase extraction from milk fat, and the quantity of the residues was determined by gas chromatography with electron capture detection. Heptachlor epoxide was found in 1 milk sample, dieldrin in 1, lindane in 3, oxychlordane in 3, alpha-BHC in 3, aldrin in 6, HCB in 9, and metabolites of DDT in 39 (81% of the samples). The six samples most heavily contaminated with by-products of DDT came from the departments of León and Chinandega, in the Pacific region, where there used to be intensive cotton production. The highest concentration was found in the sample from Malpaisillo, with 1105 micrograms of pesticide per kg of milk fat. The authors recommend that studies should be done so that the risk of contamination of other food products can be estimated, and that the public's health should be protected through strict control of the production or importation, storage, sale, and use of organochlorine pesticides.

Since 1989, the public health education section of the University of São Paulo (USP), Brazil, has been using the focus group technique to identify educational problems and evaluate programs being developed. The focus group is a research technique that allows qualitative data to be collected through group sessions involving 6 to 15 persons with some shared trait (for example, sex, age, occupation, role in the community). The group discusses various aspects of a specified subject. This paper describes five research projects in which this technique was used. The projects were carried out by professors in the School of Public Health/USP in the state of São Paulo between 1989 and 1992 with population groups and in health institutions. These experiences showed that the technique is efficient, permitting rapid identification and in-depth analysis of problems from the point of view of the population. Among the drawbacks to the technique is that it uses a small and nonrandom sample, which means that in certain cases focus groups should be considered a complement to quantitative studies. The data described here provide knowledge of perceptions, ideas, opinions, expectations, and social images-in short, the cultural and verbal universe of the population. With this information, educators and administrators can plan and evaluate education programs on the basis of the needs and views of the people they serve, putting into practice the plan to make education more democratic and responsive to the needs of its public.