Bulletin of the Pan American Health Organization最新文献

This article seeks to describe trends in relative mortality from cerebrovascular diseases (CVDs) in Brazilian state capitals from 1950 through 1988. Absolute numbers of deaths from all causes; from CVDs; and from ill-defined signs, symptoms, and afflictions were obtained from official Brazilian mortality statistics. In calculating relative CVD mortality, deaths from ill-defined signs, symptoms, and afflictions were excluded. The collected data permitted calculation of relative CVD mortality in most state capitals for 1950, 1955, 1960, 1961-1965, 1966-1970, 1971-1975, 1977-1980, 1981-1985, and 1986-1988. During the study period CVD mortality was found to play an increasing role in overall mortality in all the state capitals. Regional grouping of data showed greater relative CVD mortality in the South and Southwest Regions toward the start of the study period. However, over the course of this period the part that CVD mortality played in overall mortality grew most rapidly in the less-developed North, Northeast, and Center-West Regions. In general, relative CVD mortality data in nearly all the state capitals demonstrate the attention that needs to be devoted to CVDs within the context of adult public health. In particular, there is a clear need to greatly strengthen and improve the marginal existing programs for detection and control of hypertension and diabetes in Brazil. This should be done by assessing international experience with programs of this type and adapting that experience to Brazilian conditions. Beyond that, it will be important to support health promotion and protection efforts that can deal with risk factors and secure prevention through lifestyle modification--something that can provide benefits in dealing not only with CVDs but also with diabetes, obesity, and certain neoplasias.

The 1992 study reported here assessed relationships between potable water supply and trash collection practices and the prevalence of dengue vector mosquito (Aedes aegypti) breeding sites in 30 towns located along the north coast of Venezuela. Within each study town, 100 homes were chosen. At each of these homes the number of water-bearing containers and containers harboring A. aegypti were determined and interviews were conducted to obtain information about the local water supply, trash collection services, and excreta disposal. In general, A. aegypti breeding indexes were high: 55% of the residences were found to harbor A. aegypti immature forms; there was an average of 118 breeding sites per 100 residences; and 24% of the water-bearing receptacles were observed to contain the mosquito. The statistical method of principal component analysis was employed to rank the 30 towns in terms of variables describing public service deficiencies, and correlations existing between the variables studied were determined. Direct correlations were found between two water supply variables (frequency and duration of water supply interruptions), between the excreta disposal and trash collection variables, between the duration of water supply interruptions and the Aedes breeding indexes, and between the duration of water supply interruptions and the mean number of A. aegypti breeding sites found in water storage containers. Overall, the towns with the poorest services were found to have the highest breeding indexes and the greatest numbers of water storage containers harboring the mosquito. It is concluded that public service (water supply and waste disposal) deficiencies were largely responsible for A. aegypti propagation in the study towns. Accordingly, it is recommended that local programs be implemented for recycling containers, constructing water storage tanks that cannot harbor Aedes larvae, and conducting health education and community participation campaigns directed against the mosquito.

This article describes a survey conducted in the State of Veracruz, Mexico, to estimate neonatal tetanus (NNT) mortality. The survey, which entailed visits to 72,720 households, collected data on 8,401 live births and 209 infant deaths occurring between April 1988 and May 1989. Twenty-six of the 209 fatalities conformed to a WHO standard case definition of death from neonatal tetanus. The estimated neonatal tetanus mortality was thus 3.1 deaths per 1,000 live births (95% confidence limits = 1.7, 4.5). Comparison of this rate to reported figures suggests that for every NNT death recorded in Veracruz during the study period, as many as 50 others went unreported. A case-control study nested within the survey was conducted to assess preventable NNT risk factors. Limited information on 13 NNT deaths and 217 controls showed an increased risk for neonates who were delivered at home and whose parents' ethnic background was Mexican Indian. Five of the 13 fatalities had their umbilical cords cut with a domestic or traditional cutting tool such as a reed cane, as compared to none of the 217 controls. The observed vaccine efficacy of 2+ doses of tetanus toxoid was 70% (95% confidence limits = 52, 100). Both the mothers of neonates who died of NNT and their controls missed an average of five opportunities to receive tetanus toxoid. These findings underscore the need to launch a perinatal health program serving Mexico's high-risk populations.

This report describes a management information system (MIS) designed by PAHO's Health Systems and Services Division in collaboration with technical experts from a number of different countries. This MIS, a methodology currently used at the institutional or national level in more than 21 countries of the Americas, is a strategic and practical instrument that is easy to apply, interpret, and use, and whose purpose is to facilitate fundamental changes in health management. Based on the management concept that inputs, processes, and outputs are quantifiable, the MIS places special emphasis on health system productivity, an essential condition for achieving health coverage that is both adequate and equitable.

The investigation reported here examined scientific publications from Barbados, Jamaica, and Trinidad and Tobago over the period 1976-1990. Its purpose was to provide new information about Caribbean research in the health field through assessment of published works. To this end a broad array of journal subject categories was examined using SCISEARCH, an international index of medical and scientific literature. In all, 1,712 titles (articles, editorials, reviews, letters, meeting abstracts, and notes) were selected for analysis. This analysis indicated that Jamaica accounted for about three-quarters of the titles and that there had been a steady increase in the number of titles published over the study period that was most marked in Barbados. Most of the principal authors were affiliated with the University of the West Indies, and nearly one-third of the titles were published in the West Indian Medical Journal, the sole publication from the three study countries that SCISEARCH listed. Most of the subjects covered fell within the area of "general medicine" rather than experimental medicine or public health. However, of the 383 titles dealing with experimental medicine, nearly all (331) originated in Jamaica. In contrast, less than half of the 262 titles in the public health field came from Jamaica, a relatively large number (106) originating in Trinidad and Tobago. Most of the 1,712 titles (63.8%) dealt with topics outside the priority areas identified by the Caribbean Ministers of Health as part of the Caribbean Cooperation in Health (CCH) Initiative.