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

The present study reanalyzed data from the Dominican Republic National Health Survey, conducted in 1991, in order to identify the socioeconomic characteristics and the factors related to medical care, the pregnancy, and the child which influenced the total duration of breast-feeding (TDBF). A representative sample of 1984 mother-infant pairs was studied. Of the children of each mother, only the last one who was breast-fed and was less than three years old at the time of the survey was included. Data on TDBF and the factors studied were collected by interviewing the mothers. The risk of having been weaned at various ages was calculated by means of a life table, and the independent effect of each variable of interest was estimated using Cox's regression model. The median TDBF was 7 months and the relative weaning rate (RWR) was higher among weaned children (RWR = 8.56; 95%CI: 4.25-17.20), those whose mothers had a university education (RWR = 1.48; 95%CI: 1.24-1.77), those who began to suckle late (RWR = 1.25; 95%CI: 1.11-1.40), those who were born in public institutions (RWR = 1.62; 95%CI: 1.24-2.11) and private institutions (RWR = 2.19; 95%CI: 1.65-2.91), and those born to first-time mothers of a low socioeconomic level (RWR = 1.80; 95%CI: 1.45-2.24). Among the strategies of programs to promote breast-feeding, the importance of delayed weaning should be underscored, since this factor has the greatest influence on duration of breast-feeding.

The current epidemiologic profile of Brazil includes both the diseases of underdevelopment and those associated with modern life. Consequently, the country faces the difficult task of carrying out health promotion and protection activities aimed at controlling communicable diseases as well as noncommunicable chronic diseases (NCDs). This study sought to describe the epidemiologic situation of Brazilian adults with regard to NCDs and to present available data on the quality of care provided for these diseases and their social impact. To these ends, a literature review was conducted for the period 1964-1995--that is, since the beginning of the production and dissemination of data on cardiovascular diseases, cancer, and diabetes. Of the 153 bibliographic references that were discovered, 97 were used. The social, political, economic, and health inequities that exist among Brazil's geographic regions are reflected in the national scientific production, which is concentrated in the Southeast and South. Most of the studies based on primary data come from those regions. Information is scarce from the North-east, except the city of Salvador. Therefore, the health profile of adults--including risk factors and morbidity and mortality--can be better delineated for residents of the South and Southeast of the country, whereas for the other regions the necessary information is practically nonexistent. Risk factors linked to life-style are as widespread and important in Brazil as they are in industrialized countries. Prevalence and mortality rates among persons with or without certain socio-environmental risks (such as low level of schooling or unskilled occupations) indicate that NCDs predominate in the lowest social strata. Inter-regional differences in the prevalence of arterial hypertension and diabetes mellitus, the most common fatal cardiovascular causes, and the predominant cancers, as well as morbidity and mortality in both sexes, illustrate the political, social, and economic inequities of development in each region. Comparisons with other countries of the incidence of cardiovascular diseases in a capital in the Northeast or mortality from cardiovascular diseases in the capitals in the South and Southeast show, in the first case, that Salvador has the highest incidence among the Western countries analyzed and, in the second case, that the mortality data rank among the top seven. Cardiovascular diseases and diabetes show increasing trends, with the exception of a small decline for ischemic heart disease and cerebrovascular disease in the municipality of São Paulo. Deaths rates in hospitals from specific cardiovascular diseases and avoidable complications of diabetes are high, especially among indigent patients as opposed to private patients. Premature mortality, as measured by productive years of life lost, reflects the poor quality of medical care and the absence of targeted control programs. These data, combined with other sources of information,

Underregistration of homicides and suicides is a problem that exists in most of the countries of the region, owing to the variety of ways these causes are coded and analyzed, insufficient funding for information management, and lack of trained personnel, of coordinated data collection, and of a non-centralized system for issuing reports. The health sector plays an important role in recording information about violent acts, but the information collected and evaluated by the health services is usually limited to the sex and age of the victim, the nature of the injuries, and, occasionally, the type of weapon or means of aggression. The morbidity and mortality statistics compiled by the services do not reflect the true magnitude of the epidemiologic problem of violence because of, among other reasons, underreporting in emergency rooms and outpatient clinics. In addition, victims--for example, those who experience violence within their families--often do not seek services at health institutions.

This study was done to find out the incidence of Salmonella contamination of fish prepared and sold in 89 fixed and mobile food-vending establishments in the city of Guadalajara, Jalisco, Mexico. The pH of the samples analyzed varied between 3.8 and 5.2 (median = 4.55), and their temperature ranged from 9 to 29 degree C. Of the 221 samples studied (20 g each), 16% were positive for Salmonella. The proportions positive in fixed and mobile establishments were, respectively, 12% and 20%. The positive percentages were higher during mild and hot periods than during cold weather. The preenrichment technique proved less efficient for isolating Salmonella than direct enrichment. Salmonella was isolated from two of eight samples with pH below 4.0. The results indicate that eating ceviche may pose a health risk, especially for persons whose resistance to food-transmitted enteropathogens is low. Therefore, it should be emphasized that lime juice does not guarantee the safety of ceviche.

In view of the benefits of immunoprophylaxis among newborns of mothers who are seropositive for hepatitis B virus (HBV) surface antigen (HBsAG), these women must be correctly identified so that this measure can be instituted in Brazil. The research reported here studied 7992 women who gave birth in the Hospital das Clínicas of the Ribeirão Preto School of Medicine, University of São Paulo (HCFMRP-USP), Brazil, in order to determine the rate of serum reactivity of HBsAg and other markers of HBV infection among these women, and also to evaluate the risk factors for this infection. Serum reactivity for HBsAg was determined by means of an immunoenzymatic test (ELISA) carried out in two stages: the first with an incubation period of 2 hours (screening), and the second with an incubation period of 18 hours (confirmation) for those samples that were positive in the screening test. The markers anti-HBsAg, HBeAg, anti-HBcAg, and anti-HBeAG were tested in the samples that were confirmed positive. The screening test found 1.05% (95% CI: 0.84 - 1.30) of the samples to be positive for HBsAg. However, only 0.95% (95% CI: 0.75 - 1.19) were confirmed positive, the percentage being significantly higher among patients whose pregnancies had ended in abortion (1.84%) than among those who had given birth (0.84%) (X2, Yates correction = 7.76; P < 0.005). Risk factors for HBV infection could be identified for only 27.6% of the study subjects, based on their recall and reporting. Of the women with confirmed positive samples, 21.3% also were positive for HBeAG, indicating that these patients ran a greater risk of transmitting the virus vertically. These results underline the need for specific serologic studies in the final stage of pregnancy in order to offer the maximum benefit of neonatal immunoprophylaxis.