Bulletin of the Pan American Health Organization最新文献

There is some uncertainty about the extent to which Latin America and the Caribbean have participated in the advances of health-related industrial biotechnology. This article reviews the available literature and seeks to provide an overview of the prevailing situation. In general, national governments and multinational agencies have provided most of the health-related biotechnology investments within this region. Efforts to achieve technology transfers, a subject of prime concern, have been developed by a number of programs including the WHO Special Program for Research and Training in Tropical Diseases, the UNDP/UNESCO/UNIDO Regional Biotechnology Program for Latin America and the Caribbean; PAHO's Program for the Regional Development of Biotechnology as Applied to Health; The PAHO/WHO Expanded Program on Immunization (EPI); and PAHO's Regional System of Vaccines (SIREVA). Regarding current production capacity, some successful efforts have been made to produce a variety of therapeutic products including recombinant and natural interferons, interleukins, insulin, and recombinant streptokinase; but in general the region's current potential in this area is at best incipient and uncertain. However, the region does have a limited ability to make diagnostic products and a well-established capacity for vaccine development. Overall, this picture suggests that the region has the potential to play a small but significant role in health-related biotechnology.

The influence and impact of PAHO publications on scientific production in the field of health in Latin America and the Caribbean was the subject of a study based on a sample of 45 biomedical journals published between 1985 and 1992 in 17 countries of the Region. A total of 8644 works (mostly articles), containing 82,143 citations, were studied. Of these, 3,806 citations were found to refer to works published by PAHO Headquarters in Washington, D.C.-the Boletín de la Oficina Sanitaria Panamericana receiving 1,444 (38% of the total), the English-language Bulletin of PAHO receiving 222 (6%), works in PAHO's Scientific Publications Series receiving 1064 (28%), and works in other PAHO publications receiving 1076 (28%). Overall, PAHO publications appeared to account for a significant share of the citations studied.

Long patient waiting time is a common problem in hospitals and urban health centers in Ecuador and elsewhere. Besides being a leading cause of patient dissatisfaction with health service quality, it is often related to short doctor-patient contact times that in turn can seriously reduce the technical quality of care. This article describes a quality improvement effort undertaken by the staff of the La Troncal Health Center in Ecuador, with the assistance of a quality assurance project of the University Research Corporation and the Ecuadorian Ministry of Health. Data on patient waiting times was collected and analyzed, and solutions were devised and implemented using quality assurance techniques. As a result, the average patient's total waiting time fell from 116 minutes per visit to 66, and his or her contact time with health center staff members increased from 11 minutes to 16. It appears that the methods and techniques applied have potential for use elsewhere, because they can be applied easily by health personnel, and their cost of implementation is relatively low.

This report presents the various cholera case definitions used by the affected countries of Latin America, shows the numbers of cholera cases and deaths attributable to cholera (as reported by Latin American countries to PAHO through 1993), and describes some regional trends in cholera incidence. The information about how cholera cases were defined was obtained from an October 1993 PAHO questionnaire. In all, 948429 cholera cases were reported to PAHO by affected Latin American countries from January 1991 through December 1993, the highest annual incidences being registered in Peru (1991 and 1992) and Guatemala (1993). The case-fatality rate over the three-year period, and also in 1993, was 0.8%. A general downward trend in the incidence of cholera was observed in most South American countries, while the incidence increased in most Central American countries. A good deal of variation was noted in the definitions used for reporting cholera cases, hospitalized cholera cases, and cholera-attributable deaths. Because of these variations, broad intercountry comparisons (including disease burden calculations and care quality assessments based on case-fatality rates) are difficult to make, and even reported trends within a single country need to be evaluated with care. The situation is likely to be complicated in the future by the arrival of V. cholerae O139 in Latin America, creating a need to distinguish between it and the prevailing O1 strain. For purposes of simplicity, wide acceptance, and broad dissemination of case data, the following definitions are recommended: Confirmed case of O1 cholera: laboratory-confirmed infection with toxigenic V. cholerae O1 in any person who has diarrhea. Confirmed case of O139 cholera: laboratory-confirmed infection with toxigenic V. cholerae O139 in any person who has diarrhea. Clinical case of cholera: acute watery diarrhea in a person over 5 years old who is seeking treatment. Death attributable to cholera: death within one week of the onset of diarrhea in a person with confirmed or clinically defined cholera. Hospitalized patient with cholera:a person who has confirmed or clinically defined cholera and who remains at least 12 hours in a health care facility for treatment of the disease.

This article describes a combination of methods--a solid-phase enzyme-linked immunosorbent assay (ELISA) combined with an ultramicroanalytical system (UMAS)--that can be used to measure tetanus antitoxin activity in human sera or plasma. The test, which is rapid and permits analysis of 78 samples of serum per reaction plate with a volume of 10 microL of diluted serum per sample, is proposed as an alternative to the traditional biologic assay in mice based on seroneutralization of a known dose of tetanus toxin. The study reported here compared these two procedures, using them both to evaluate 100 sera from the Clinical Laboratory of the General Calixto García Hospital in Havana, Cuba. The two sets of results showed a high degree of correlation (r = 0.99) when subjected to linear regression analysis (95% CI = 0.985-0.993). These and other findings indicate that the cheap and rapid ultramicroELISA method can perform certain tasks for which the slower and costlier traditional assay is not well suited, such as field evaluation of tetanus toxoid vaccines and identification of hyperimmune plasmas appropriate for use in producing specific antitetanus immunoglobulin.

The prevalence of vitamin A deficiency in a nationally representative sample of children 12-59 months old in Panama was assessed using serum retinol levels and dietary indicators. The median serum retinol level found was 1.27 +/- 0.42 mumol/L (38 micrograms/dL); 6.0% of the study sample providing adequate blood specimens had levels below 0.7 mumol/L (20 micrograms/dL), indicating deficient vitamin A intake. The Panama City Metropolitan Area and the country's western region had the highest prevalences of low serum retinol levels (below 0.7 mumol/L in 9% and 6% of the study children, respectively), as compared to overall prevalences of 5% in the two other regions studied. Low serum retinol levels were significantly more prevalent among Indians in the study group (primarily Guaymí Indians) than among non-Indians (13% versus 5%). Dietary information provided by the study children's mothers showed that high risk of inadequate dietary vitamin A intake closely paralleled low serum retinol levels; specifically, the highest prevalence of dietary inadequacy was found in the western region, especially among the Indians. The Panamanian Government is currently increasing distribution of high-dose vitamin A capsules to Indian preschoolers in Chiriquí and Bocas del Toro Provinces.