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

In Nicaragua, the principal cause of infant mortality is diarrhea, which is responsible for 40% of these deaths annually. This statistic reflects the low usage of health services and oral rehydration therapy (ORT). In an effort to improve the situation, several studies were carried out in Villa Carlos Fonseca municipio. This report describes two of those studies, one ethnographic and the other epidemiologic (conducted in 1989 and 1990, respectively), to find out beliefs and traditional health practices and their influence on the way in which mothers responded to their children's diarrheal illness. The ethnographic study involved interviewing 70 mothers with an average age of 28 years who had children under 2 years of age. The children represented two groups: one at high risk for diarrhea and the other at low risk. The objectives were to learn the traditional names for diarrhea, the perception of risk, and the treatments that were used. The epidemiologic study included 391 mothers over 14 years of age with one or more children under age 5 years, of whom 215 had had diarrhea in the two weeks preceding the survey. The objectives were to describe local beliefs and health practices and to determine the incidence of diarrheas according to the diagnosis made by the mothers. At least 12 types of diarrhea were identified, for which terms such as "empacho" and "sol de vista" were used. In most cases, the mothers had more confidence in folkloric treatments that they themselves or the traditional healers (curanderos) applied than in the services offered at health centers. This attitude limited their use of health services and ORT, although it was observed that in certain cases traditional treatments were used in combination with those of western medicine. There was a direct but nonsignificant correlation between the level of schooling of the mothers and the frequency with which they visited the health center. The authors suggest the effects of massages, herbal baths, and other traditional treatments should be studied to evaluate their effectiveness and adapt them, to the extent possible, to "modern" medicine. Health services providers should become familiar with traditional nomenclature and beliefs in order to be able to communicate better with mothers and steer them away from harmful practices toward improved results in infant diarrheal disease prevention programs.

The protection against leprosy conferred by BCG vaccination was evaluated in a case-control study. Selected for the study were 97 patients under 16 years of age who had been diagnosed with leprosy (cases) and 385 healthy persons (controls), who were matched according to sex, age, place of residence, and type of contact (intra- or extradomicilliary). The cases were selected from a register of active cases as well as a series of new leprosy patients treated in 50 centers in the city of São Paulo, Brasil. To estimate the protective effect of BCG, the prevalences of BCG scars among cases and controls were compared. The presence of one or more scars was associated with a protective efficacy of 90% (95% confidence interval: 78%-96%). Stratified analysis by age group, sex, socioeconomic level, and clinical form of leprosy did not reveal any important differences in the protection conferred by the vaccine. The significance of these findings and the appropriateness of using BCG in leprosy control programs is discussed.

The article begins with a discussion of some mortality statistics issues, problems encountered in the manual selection of underlying cause of death, and also the increasing need for information on associated causes. These circumstances led the National Center for Health Statistics to develop the computerized ACME System, which has been in use in São Paulo State since 1983. The ACME System's requirement of a mainframe computer, as well as other operational limitations, has prevented its installation throughout the country. In order to standardize and improve the quality of mortality data in Brazil, the Informatics Department of the Ministry of Health's National Health Foundation and the World Health Organization (WHO) Collaborating Center for the Classification of Diseases in Portuguese developed the microcomputer-based Underlying Cause Selection System (SCB) in 1993. This is an expert system that employs artificial intelligence techniques to reproduce the reasoning of a coder in selecting the underlying cause of death, according to the rules and provisions of the Ninth Revision of the International Classification of Diseases. The SCB has a very user-friendly interface, occupies 2.6 megabytes of hard disk space, and can run on any 386 or higher XT or AT computer. In addition to selecting the underlying cause of death, the system stores data on associated conditions.

This cross-sectional study, which was carried out between 3 May and 30 September 1993, involved examination with a pediatric otoscope of a random sample of 100 first-grade schoolchildren in a Buenos Aires hospital, followed by tonal audiometry and tonal sweep in 90 of those children. The objectives of the study were to discover the frequency of hearing disorders and to evaluate the importance of audiometric screening in the child population. The results were classified according to the type (conduction or perception) and degree (mild, moderate, or severe) of hypoacusis, which was detected in 36 children (39%). Of those affected, 35 had mild or moderate conduction hypoacusis (loss of less than 31 decibels [dB] or less than 41 dB, respectively). No case of severe hypoacusis was found. The authors consider that audiometric screening of children entering primary school is justified by the high frequency of preventable hearing problems and by the repercussions that those problems can have on speech and learning.

The purpose of this research, which is part of a study on periodontal disease and its risk factors among workers in Araraquara, São Paulo, Brazil, was to determine the association between smoking and its frequency, on the one hand, and the presence of periodontal cavities on the other. A sample of 528 sugar and alcohol refinery employees from Araraquara between the ages of 18 and 64 was examined in March and April of 1992 by a trained examiner who applied the Index of Periodontal Treatment Needs in the Community. Questionnaires were used to record the individuals' age, smoking habits, and the number of cigarettes smoked daily. An oral examination was also performed to assess the presence of dental plaque and to determine the bacterial colony index. Data analysis revealed a positive association between the presence of periodontal cavities and smoking. After adjusting the data for age, presence of dental plaque, and bacterial colony index, the odds ratio for having periodontal cavities increased directly with the number of cigarettes smoked. These results suggest that smoking and its frequency should be taken into account when planning programs for the primary prevention and treatment of periodontal disease.

This cross-sectional, descriptive study was carried out in Morelia, Mexico, to find out the extend to which the public was buying essential drugs and other pharmaceuticals whose sale is prohibited or strictly regulated in other countries, and to determine the magnitude of the practice of self-medication. Customers buying drugs at 54 pharmacies were interviewed during peak shopping hours. The mode of acquisition of the drugs was classified as self-medication, medical prescription, or prescription from pharmacy salesperson, and the drugs were grouped as essential or nonessential. Products that are prohibited or greatly restricted in other countries were also identified. The most frequently bought products were analgesics and nonsteroidal anti-inflammatory drugs, vitamins, broad-spectrum antibiotics, steroids, cold and flu medications, narrow-spectrum antibiotics, and benzodiazepines. Of 1388 products sold, 394 (28.4%) appear on the list of essential drugs. The mode of acquisition was self-medication for 51.4% of the sales, medical prescription for 35.6%, and recommendation of a pharmacy employee for 13%. In addition, 14.3% of the products bought were prohibited or restricted in other countries. The results highlighted the need for greater precision in the General Health Law of Mexico with regard to regulation of drug sales. The results also imply the need for other actions, namely, educational campaigns directed to the general population to discourage self-medication; Strengthening of coordination between government and the pharmaceutical industry; improvement in the availability of and information on generic drugs; and modification of pharmacological training programs.

The fluoride content of a sample of bags of salt for sale in Mexico City was measured in order to estimate the proportion of marketed salt that contained the quantity of fluoride set by the National Program for Prevention of Dental Caries through Consumption of Fluoridated Table Salt. The effectiveness of that program had never been evaluated. In March 1993, bags of salt were obtained from 70 of the 3544 neighborhoods that make up Mexico City. The stores were selected by simple random sampling. Salt was likewise purchased from 20% of the 146 supermarkets and self-service stores in the city, also selected as a random sample. Then, blind measurement was done of the fluoride content of 221 bags of salt. The true content of this element was often found to be below the amount called for by the government. In addition, it did not coincide with the quantity indicated on the package label, which is a violation of the law.

Unboiled, unchlorinated drinking water is known to have been associated with epidemic transmission of cholera in Trujillo, Peru, in February 1991. In September of that same year, chlorination of the main water supply system was begun. Water quality in Trujillo at the central level is monitored at dams and principal distribution points, but the effects of this surveillance on the quality of the water distributed are not known. In order to evaluate water quality in the residential areas of Trujillo, water samples were collected in February 1993 from 30 systematically selected houses. The chlorine levels in the samples were measured, and cultures for coliform bacteria were done. The free chlorine concentration varied from 0 to 1.5 mg/L (median = 0.4 mg/L). No free chlorine was detected in 5 samples (17%), and in 14 (47%) the concentrations were less than 0.4 mg/L. Coliforms were found in 16 samples (53%), but none were fecal coliforms. These results demonstrate the wide variability in chlorine concentrations in the municipal water that is distributed to dwellings. This variability, together with the need to store drinking water in the house because of shortages, supports the recommendation of the Ministry of Health that residents should treat drinking water in their homes. The simple sampling framework employed in this study provided a rapid evaluation of the quality of municipal water supplied to consumers. Similar studies could be carried out easily in other metropolitan areas where water quality is suspect, in order to rapidly obtain essential information on water quality at the level of the consumer.