Revista Panamericana de Salud Pública

Published by World Health Organization
Online ISSN: 1020-4989
Publications
Article
It is perhaps intuitively obvious that health and life are inseparable and, therefore, that matters of health must enter into any conceptualization of quality of life. However, the ethical and policy dimensions of the relationship between health and quality of life are not that straightforward.
 
Algorithm for referral to colposcopy at the seventh-anniversary visit, Guanacaste Project, Costa Rica, 2001-2002 a 
Case management at the exit colposcopy clinic during the seventh-anniversary year, Guanacaste Project, Costa Rica, 2001-2002 a 
Status of participants at the end of follow-up, by subcohort and overall, Guanacaste Project, Costa Rica, 2002 a 
Number of biospecimen samples collected during follow-up, Guanacaste Project, Costa Rica, 1994-2002 
Article
The Guanacaste study ("Guanacaste Project," or GP), was designed to investigate the role of human papillomavirus (HPV) infection and its cofactors in the development of cervical neoplasia and to evaluate new cervical cancer screening technologies. The follow-up phase of the GP was designed to study why a small proportion of women infected with HPV develop cervical intraepithelial neoplasia grade 2 (CIN 2), CIN 3, or cancer (these three together are globally referred to as > or = CIN 2, that is, CIN 2 or worse). The purpose of this article is to describe this prospective study in detail and to present the preliminary findings regarding the incidence of cervical neoplasia. A cohort of 10 049 randomly selected women from 18 to 97 years old from Guanacaste, a province in northwestern Costa Rica, was intensively screened in 1993-1994 and then followed up for seven years after being enrolled. A questionnaire for demographic and risk factors was administered, and a pelvic examination was performed on sexually active women at each follow-up visit in order to obtain samples for screening tests and for research purposes. The final diagnosis given at the end of the enrollment phase categorized women into several groups according to the perceived risk of their developing either high-grade precursors of cancer or cancer. These groups were followed up at different intervals according to the risk of developing > or = CIN 2. The most active follow-up (every 6-12 months) was concentrated on the women most likely to develop >or = CIN 2, based on cytology (n = 492). The remainder of the cohort was followed either annually (n = 2 574) or after five to seven years of passive follow-up (n = 3 926). All women with possibly severe lesions detected by any technique were referred to colposcopy for further evaluation and treatment, and they were also censored from the study. Lesions >or = CIN 2 served as both the censoring outcome and our surrogate for cancer risk. Participation during follow-up was high (near 90%). Suspected > or = CIN 2 by any screening technique censored 4.6% of women. Most of the women censored because of suspected > or = CIN 2 came from the large group perceived at entry as being at low risk of developing > or = CIN 2, but the greatest rates of progression to > or = CIN 2 were observed among women perceived at entry to be at highest risk of > or = CIN 2, based on their cytology, virology, or sexual behavior. The GP is the largest population-based longitudinal cohort for the study of HPV and cervical neoplasia in the world, and its results will hopefully let us soon plan future worldwide prevention strategies. Research projects such as this one require the long-term commitment of a large multidisciplinary team and ample financial resources. The intensive effort and expertise applied in all aspects of this study were key factors in its success as a model of cooperative, interdisciplinary cancer research in Latin America. Quality control played an important role at all times during the study and made it possible to adapt new diagnostic and screening technology to Guanacaste. The systematic follow-up of a population-based group of close to 10 000 women in Guanacaste should permit careful, time-dependent evaluation of factors postulated to be linked to the development of cervical cancer as well as the evaluation of clinical markers of disease progression. The study results that have already been published have validated sensitive screening techniques and have also promoted the use of more affordable screening techniques in resource-poor, developing countries. The GP has also contributed to building knowledge for the search for vaccines against HPV as part of the effort to develop an effective tool to reduce the incidence and mortality of cervical cancer worldwide.
 
Article
Dentro del marco del análisis de la décima revisión de la Clasificación Internacional de Enfermedades y Problemas de Salud Asociados (CIE-10), se realizó una comparación código a código entre las categorías diagnósticas de dos clasificaciones latinoamericanas —el Tercer Glosario Cubano de Psiquiatría (GC-3) y la Guía Latinoamericana para el Diagnóstico Psiquiátrico (GLADP)— y el capítulo de “Trastornos mentales y del comportamiento” de la CIE-10. El objetivo fue ayudar a definir qué categorías de la clasificación actual deberían ampliarse y qué nuevas categorías podrían añadirse a la futura CIE-11 para lograr una mayor aplicabilidad local en contextos socioculturales y clínicos distintos del estadounidense y del europeo, cuyas perspectivas han dominado la CIE históricamente. Se espera que el resultado contribuya a los es- fuerzos que se están llevando a cabo para desarrollar un sistema clasificatorio que sea genuinamente internacional. English: In the context of the updating of the International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), this study conducted a code-by-code comparison between the ICD-10 chapter "Mental and Behavioural Disorders" and the diagnostic categories of two Latin American classification schemes: the Third Cuban Psychiatric Glossary (GC-3) and the Latin American Guide to Psychiatric Diagnosis (GLADP). The objective was to help define what categories in the current classification should be broadened and what new categories might be added to the future ICD-11 to make it more applicable in local sociocultural and clinical contexts that differ from those found in regions whose perspectives have historically dominated the ICD, namely, the United States and Europe. It is hoped that the results will contribute to the efforts under way to develop a genuinely international classification system.
 
Article
To analyze the relationship between maternal and infant health and socioeconomic, cultural, and sanitation factors in Argentina; to evaluate how health program quality affects the primary health indicators for mothers and infants. This is a cross-sectional study with multiple variables. The authors studied six indicators for maternal and infant health: rates for maternal, infant, neonatal, and postneonatal mortality; the percentage of newborns with low birthweight; and the percentage of premature newborns. The study was conducted in 79 administrative units in 13 provinces that represent different geographic regions of Argentina. They included (1) the provinces of Salta and Jujuy in northwest Argentina; (2) the provinces of Córdoba, Santa Fe, and Buenos Aires in central Argentina; (3) the provinces of Entre Ríos and Misiones in the Mesopotamia or northeast region; (4) the provinces of San Luis, San Juan, and Mendoza in the Cuyo or northwest, Andean region; and (5) the provinces of Neuquén, Río Negro, and Chubut in the south. The explanatory variable in the study was the quality of health programs, controlled by socioeconomic, cultural, and sanitation factors in 1999 and 2000. The definition of program quality ("poor," "average," "good," and "very good") was based on quantitative and qualitative analysis of selected variables such as policies, organization, and procedures as determined by the investigators. Documentation was obtained from secondary official sources. The investigators interviewed 117 health system managers (including supervisors of provincial and local health programs, administrators of maternal and child health programs, and hospital directors), who provided information on characteristics and indicators of the health programs. There were marked geographic differences in the levels of maternal and infant health, medical care, and socioeconomic, cultural, and sanitation factors. Only 10.0% of health programs were classified as "very good," 35.4% as "good," 31.6% as "average," and 23.0% as "poor." There was a significant correlation (P < 0.05) between rates of infant and postneonatal mortality and adverse socioeconomic circumstances. There was also a significant correlation between the percentage of low birthweight infants and the quality of health programs. There are clear disparities in the level of maternal and infant health care in different administrative units in Argentina. The infant mortality rate was associated with variations in socioeconomic, cultural, and sanitation factors and with the quality of health programs. Health programs improved infant health when appropriately implemented, even in adverse socioeconomic and sanitation conditions.
 
Article
To study the prevalence of and major factors associated with recurrent wheezing in children younger than 13 years of age in the urban area of Rio Grande, in the state of Rio Grande do Sul, Brazil. The presence of recurrent wheezing was investigated in a cohort as part of a cross-sectional study that was begun in 1997 that focused on the morbidity from respiratory diseases in children then between 0 and 5 years of age. During home visits in 2004 a standardized questionnaire given by trained interviewers was used to obtain information concerning the family's socioeconomic and living conditions, maternal care during pregnancy and delivery, and children's current and previous morbidity patterns. The statistical analysis included the calculation of the odds ratio (OR) and 95% confidence interval (95% CI), with nonconditional logistic regression adjustment for potential confounding factors, according to a predefined hierarchical model. Of the 775 children studied in 1997, 685 were located in 2004 (loss of 11.6%). In this group, the prevalence of recurrent wheezing at the time of the interview was 27.9%. After adjustment, the risk factors were: current rhinitis (OR=45.7; 95% CI: 24.2 to 86.5), use of wood stove for cooking (OR=2.7; 95% CI: 1.4 to 4.9), child's history of acute respiratory infection (OR=2.1; 95% CI: 1.3 to 3.5), bottle feeding (OR=2.1; 95% CI: 1.1 to 3.8), history of asthma in siblings (OR=1.9; 95% CI: 1.2 to 3.2), maternal history of asthma (OR=1.8; 95% CI: 1.1 to 2.9), and fewer than six prenatal medical consultations (OR=1.6; 95% CI: 1.1 to 2.4). Paternal schooling<9 years was a protective factor against recurrent wheezing (OR=0.6; 95% CI: 0.4 to 0.9). These results suggest that the management of recurrent wheezing and asthma must consider checking for and simultaneously treating rhinitis. The measures to minimize the effects of recurrent wheezing should include educational and treatment programs focusing on asthma.
 
Article
To estimate antigen-specific and series-complete vaccination coverage among children aged 13 to 59 months in Buenos Aires; to compare the results of a community-based household survey with coverage rates obtained from administrative records; and to identify risk factors for incomplete vaccination. Census tracts in Buenos Aires were surveyed systematically in March and April, 2002. Three children aged 13 to 24 months and 25 to 59 months were surveyed per block in each census tract. Written documentation of vaccination was required. Risk factors associated with incomplete vaccination were identified with univariate analysis and multivariate logistic regression. A total of 1391 children were surveyed. Antigen-specific coverage ranged from 69.4% (95% CI 66.7%-72%) for Haemophilus influenzae type b vaccination to 99% (95% CI 98.4%-99.6%) for BCG vaccination. Except for measles, coverage estimates found in the survey did not differ substantially from those obtained from city health authority records. Multivariate logistic regression analysis showed child's age (P < 0.001) and vaccination provider (public or private) (P = 0.001) to be risk factors associated with incomplete vaccination. Not being the first child (P < 0.001) was associated with incomplete coverage under the long-standing program. Living in the Northern zone of the city (P = 0.001), being uninsured (P = 0.02), and lower educational level of the primary caregiver (P = 0.04) were risk factors associated with incomplete coverage under the current vaccination program. Although coverage rates for some vaccines were high, complete vaccination coverage remains low among children aged 13 to 59 months in Buenos Aires. Increasing coverage will require better access to vaccination, particularly in sections of the community with risk factors.
 
Article
To assess the safety and immune responses induced by a 13-valent pneumococcal conjugate vaccine (PCV13) after immunization of infants in Mexico. PCV13 was given with other routine childhood vaccinations to 225 infants in Mexico at ages 2, 4, 6, and 12 months. The proportions of subjects achieving immunoglobulin G (IgG) concentrations ≥0.35 µg/mL after the infant series and toddler dose were ≥93.1% and ≥96.7%, respectively, for all 13 serotypes. The serotype-specific pneumococcal IgG geometric mean concentrations after the infant series and toddler dose ranged from 1.18 to 9.13 µg/mL and from 1.62 to 15.41 µg/mL, respectively. The most common local reaction and systemic event after each dose were tenderness and irritability, respectively. Most fever was mild; no fever >40.0°C (i.e., severe) was reported. One subject withdrew because of Kawasaki disease 5 days after the first dose of vaccines, but this condition was not considered related to PCV13. Overall, PCV13 administered with routine pediatric vaccines was immunogenic and safe in healthy infants in Mexico.
 
Formal bases for national health research systems in the countries studied 
Article
This article discusses the main features of the national health research systems (NHRS) of Argentina, Bolivia, Brazil, Chile, Costa Rica, Cuba, Ecuador, El Salvador, Honduras, Panama, Paraguay, Peru, Uruguay, and Venezuela, based on documents prepared by their country experts who participated in the First Latin American Conference on Research and Innovation for Health held in April 2008, in Rio de Janeiro, Brazil. The review also includes sources cited in the reports, published scientific papers, and expert opinion, as well as regional secondary sources. Six countries reported having formal entities for health research governance and management: Brazil and Costa Rica's entities are led by their ministries of health; while Argentina, Cuba, Ecuador, and Venezuela have entities shared by their ministries of health and ministries of science and technology. Brazil and Ecuador each reported having a comprehensive national policy devoted specifically to health science, technology, and innovation. Argentina, Brazil, Costa Rica, Cuba, Ecuador, Panama, Paraguay, Peru, and Venezuela reported having established health research priorities. In conclusion, encouraging progress has been made, despite the structural and functional heterogeneity of the study countries' NHRS and their disparate levels of development. Instituting good NHRS governance/management is of utmost importance to how efficiently ministries of health, other government players, and society-at-large can tackle health research.
 
Article
To determine the national and state-level prevalence of endemic goiter associated with iodine deficiency in schoolchildren between 6 and 14 years of age in Brazil, based on data from a national survey carried out from 1994 to 1996. Thyroid inspection and palpation were performed on 178,774 schoolchildren between 6 and 14 years of age, in all the states of Brazil. A subsample was selected to measure the iodine content in their urine as well as the iodine content of the table salt used for cooking in their homes. The last survey before this one was carried out in 1975. We found an 86% decrease in the median prevalence of grade 1 and 2 grade 2 goiter, from 12% to 1%. In 21% of the municipalities, the observed prevalence was zero. From the 16,803 urine samples collected for iodine measurement, 7,702 were matched with the corresponding clinical record (a loss of 54%). The median urinary iodine level was 14.0 micrograms/dL, and without a significant correlation with the clinical data on goiter. The median iodine excretion level for the population in the states of Acre, Amapá, and Tocantins was equal to or below 9.0 micrograms/dL. In three municipalities, urinary iodine was below 2.5 micrograms/dL in all the samples: Paranã (in the state of Tocantins), Conceição (Paraíba), and Nova Roma (Goiás). The supplementary iodine found in the salt collected from households (458 samples collected) was below recommended levels, with 50% of them below 20 mg/kg (20 ppm). In 7% of the samples, the level of iodine was below 10 mg/kg of salt, even in salt-producing states such as Rio Grande do Norte. There is evidence goiter is expanding to parts of Brazil that more recently have been opened up for agriculture, with children in those areas being exposed to low levels of supplementary iodine in the salt used for cooking. We found an increased risk of goiter in areas with deficient iodine supplementation (< 10 mg/kg) (odds ratio = 1.85; Cornfield 95% confidence interval: 1.68-2.03).
 
Distribution by infecting serovars of Leptospira spp. detected by the microscopic agglitination test (MAT) in 100 randomly-selected sera from 147 immunoglobulin M enzyme-linked immunosorbent assay (ELISA)-confirmed cases of human leptospirosis from 14 Caribbean countries, 1997-2005 
Article
To determine the frequency of human leptospirosis in the sera of suspected clinical cases sent by 14 Caribbean countries for diagnosis to a regional laboratory in 1997-2005. All serum samples were initially tested using the immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) for leptospirosis. Demographic data (such as age and sex), month of the year and clinical manifestations that had been observed by the attending physician were related to seropositivity. The microscopic agglutination test (MAT) was used to serotype sera using a panel of 23 international serovars. Of 3 455 samples tested, 452 (13.1%) were seropositive for IgM antibodies to leptospirosis by the ELISA, with frequencies significantly (P < 0.05; χ2) different across countries and years. Among seropositive patients, the frequency of detection of leptospirosis (23.1%) was significantly higher in the age groups 1-20 years and 31-40 years combined compared with other age groups; and in male patients (72.1%) compared with female patients (19.7%) (P < 0.05; χ2). Chills, jaundice, vomiting, weakness, diarrhea, and kidney failure/problems were significantly (P < 0.05; χ2) exhibited at a higher frequency in seropositive, rather than seronegative patients. Using the MAT on 100 sera tested, 98 (98%) were seropositive, of which the serogroup Icterohaemorrhagiae was most prevalent with the detection of serovars Copenhageni (70%), Icterohaemorrhagiae (67%), and Mankarso (29%). Since only 13.1% of the suspected cases of leptospirosis were seropositive for IgM ELISA antibodies, other clinical conditions may have been responsible for the clinical manifestations observed, or the patient may have had chronic leptospirosis (IgG). In the Caribbean, serovars of the serogroup Icterohaemorrhagiae were responsible for most infections in the cases tested.
 
Article
To characterize current regulatory practices and trends relating to competing medications in 14 Latin American and Caribbean countries. Between July 2004 and April 2005 we collected information on national regulations and policies that established or contained a definition of "generic drug" and related terms in 14 Latin American and Caribbean countries: Argentina, Barbados, Bolivia, Brazil, Colombia, Costa Rica, Ecuador, Guatemala, Mexico, Nicaragua, Panama, Paraguay, Peru, and Venezuela. We also compiled information on the incentives to register and produce competing medications, promotion of the use of International Nonproprietary Names (INNs) for pharmaceutical substances, the regulation of bioequivalence studies, and the replacement of prescription medications with less expensive alternatives. We noted three patterns in the regulations: (1) countries that encourage financial support for competing medications, extensively promote the use of INNs, and place no restrictions on the replacement of innovative (proprietary) medications with competing products (Argentina, Colombia, Costa Rica, Ecuador, and Paraguay); (2) countries with policies aimed at showing therapeutic equivalence, which limits substitutions to approved products from a list of authorized competing medications that must be prescribed by their INN and must use distinctive labeling (Brazil, Mexico, Panama, and Venezuela); and (3) countries at a beginning stage in the process of regulation (Barbados, Bolivia, Guatemala, Nicaragua, and Peru). This variety leads to difficulties in characterizing pharmaceutical markets, and can lead to misleading categorizations. Efforts to harmonize policies should consider the possible relationship among definitions adopted in different countries, the development of national pharmaceutical markets, and national policies to stimulate competition.
 
Article
Objective: To estimate the benefits, cost-effectiveness (i.e., value for money), and required financial costs (e.g., affordability) of adding human papillomavirus (HPV) vaccination to Peru's cervical cancer screening program. Methods: Evidence (e.g., coverage, delivery costs) from an HPV vaccination demonstration project conducted in Peru was combined with epidemiological data in an empirically calibrated mathematical model to assess screening (HPV DNA testing three to five times per lifetime) and HPV vaccination under different cost, coverage, and efficacy assumptions. Model outcomes included lifetime risk of cancer reduction, cancer cases averted, lives saved, average life expectancy gains, short-term financial costs, and discounted long-term economic costs. Results: Status quo low levels of screening (e.g., cytologic screening at 10.0% coverage) reduced lifetime risk of cervical cancer by 11.9%, compared to not screening. Adding vaccination of preadolescent girls at a coverage achieved in the demonstration program (82.0%) produced an additional 46.1% reduction, and would cost less than US$ 500 per year of life saved (YLS) at ~US$ 7/dose or ~US$ 1 300 at ~US$ 20/dose. One year of vaccination was estimated to cost ~US$ 5 million at ~US$ 5/dose or ~US$ 16 million at ~US$ 20/dose, including programmatic costs. Enhanced screening in adult women combined with preadolescent vaccination had incremental cost-effectiveness ratios lower than Peru's 2005 per capita gross domestic product (GDP; US$ 2 852, in 2009 US$), and would be considered cost-effective. Conclusions: Preadolescent HPV vaccination, followed by enhanced HPV DNA screening in adult women, could prevent two out of three cervical cancer deaths. Several strategies would be considered "good value" for resources invested, provided vaccine prices are low. While financial costs imply substantial immediate investments, the high-value payoff should motivate creative mechanisms for financing and scale-up of delivery programs.
 
Article
Latin America faces unique challenges in the treatment of type 2 diabetes mellitus. The Asociación Latinoamericana de Diabetes (Latin American Diabetes Association, ALAD) brought together medical associations in 17 countries in Latin America to produce a consensus statement regarding the treatment of type 2 diabetes. The goal of the document is to provide practical recommendations that will guide clinicians through a simple decision-making process for managing patients. The cornerstone elements for therapeutic decision making are: severity of hyperglycemia, clinical condition of the patient (stable or with metabolic decompensation), and body mass index. The consensus includes a section devoted specifically to patients with obesity. Information is presented as highly-relevant clinical questions. The algorithm is based on the scientific recommendations of the 2006 ALAD guidelines (a document prepared using an evidence-based approach) and data from recent randomized controlled studies.
 
Article
To describe the levels of non-HDL cholesterol and correlated factors in a group of Brazilian male and female children and adolescents. From March to October 2002 we evaluated 2,029 schoolchildren from 7 to 17 years old in the town of Maracaí, São Paulo, Brazil. The biochemical determinations of triglycerides, total cholesterol, and high-density lipoprotein (HDL) cholesterol were carried out using enzymatic reactions and the Vitros 750 analyzer. Low-density lipoprotein (LDL) cholesterol levels were calculated using the Friedewald formula: LDL cholesterol = total cholesterol-HDL cholesterol-(triglycerides/5). Non-HDL cholesterol was calculated by subtracting HDL cholesterol from total cholesterol. The correlation between non-HDL cholesterol levels and LDL cholesterol levels was 0.971 (P < 0.001). Non-HDL cholesterol had a stronger correlation than did LDL cholesterol with all the variables under study: total cholesterol, triglycerides, HDL cholesterol, very low-density lipoproteins, body mass index, and waist circumference. The non-HDL cutpoints identified as corresponding to the four cutpoints of LDL cholesterol (110, 130, 160, and 190 mg/dL) indicating the need to treat dyslipidemia in children and adolescents were, respectively: 127.8, 149.2, 181.2, and 213.2 mg/dL. Our findings contribute toward estimating non-HDL levels in Brazilian children and adolescents. The results also indicate that non-HDL cholesterol is a reliable and less costly method for researching the presence of dyslipidemias in this age group.
 
Article
The purpose of this study was to evaluate the efficacy of the 17D yellow fever vaccine in the conditions under which it is used in public health services. In 1989, a nonconcurrent prospective study was carried out in Bocaiúva, Minas Gerais State, Brazil, 6 months after mass vaccination of the population. The study population was made up of first-grade students from all the schools in Bocaiúva. The exposed group consisted of a simple random sample of vaccinated students (n = 173) and the unexposed group consisted of all those who had not been vaccinated (n = 55). Serum samples were examined with the neutralization test in mice; these tests were conducted blind, that is, the examiner did not know the vaccination status of the subject. The serology results were as follows: of those vaccinated, 75% were seropositive, 17% were seronegative, and 7% showed an inconclusive result; in the unvaccinated children, these results were 9%, 87%, and 4%, respectively. The age-adjusted seropositivity ratio between vaccinated and unvaccinated children was 7.6 (95% CI: 3.4 to 16.7). The proportion of seropositivity attributable to vaccination, adjusted for age, was 86.8% (95% CI: 70.6 to 94.0). The results showed that the efficacy of the vaccine, defined by means of seropositivity for the virus, was below the levels expected for the 17D vaccine. This may have been due to operational failures in the conservation or application of the vaccine. The results point to the need for routine systematic evaluations by the health services after mass utilization of the vaccine.
 
Article
To help assess the causes and frequency of acute respiratory illnesses (ARI) during the first 18 months of life in Chile, a cohort of 437 children born in good health between May 1991 and April 1992 was followed at an urban health clinic in northern Santiago. Information was obtained from medical checkups performed at the clinic, from emergency health care services, from private physicians, and from interviews with each child's mother when the child was enrolled in the study and when it was 6, 12, and 18 months old. Followup was completed for 379 (87%) of the children. ARI accounted for 67% of all 3762 episodes of illness recorded for these children in the 18-month study period, 1384 (55%) of the ARI episodes affecting the upper respiratory tract and the remaining 1144 (45%) affecting the lower. The overall rate of ARI observed was 33 episodes per 100 child-months of observation. The incidences of upper, lower, and total ARI episodes decreased significantly in the third six months of life. A statistically significant association was found between upper ARI ( > or = 2 episodes) and maternal smoking ( > or = 5 cigarettes per day), but no significant associations were found with any of the other risk factors studied. However, lower ARI ( > or = 2 episodes) was significantly associated with maternal schooling ( or = 4 episodes) was significantly associated with these factors and also with the existence of one or more siblings, birth in a cold season, limited breast-feeding (
 
Article
To determine the prevalence of Trypanasoma cruzi antibodies among the population under 18 years of age in the state of Veracruz, Mexico, and to identify risk factors associated with housing conditions and vector presence and distribution. A cross-sectional, epidemiological study of the population under 18 years of age living in 10 of the 11 health districts of the state of Veracruz, Mexico, from 2000 to 2001. Presence of T. cruzi antibodies was determined by hemagglutination inhibition test (HAI) and enzyme-linked immunosorbent assays (ELISA) of serum samples spotted on filter paper, and confirmed by HAI, ELISA, and indirect immunofluorescence assay (IFA) on serum samples. A questionnaire was administered to determined housing conditions, and entomological indices for triatomines were calculated for both the intra- and peridomiciliary areas. The results were analyzed using bifactorial and multifactorial unconditional logistic regression. Of the 150 individuals presenting an initial reaction, 14 were confirmed positive (5 by HAI, ELISA and IFA; 6 by HAI and ELISA, and 3 by ELISA and IFA), for a total prevalence rate of 0.91% (95% CI: 0.85-0.94). All of the confirmed-positive cases were from five of 14 health districts, with the Tuxpan district having the highest prevalence rate: 5.2% (95%CI: 1.2-9.0). Risk factors included having noticed cracks in the house walls and gaps in the roof. The only species of vector captured was Triatoma dimidiata. The entomologic indices for infestation, colonization, and natural infection were: 10.9%, 50.0%, and 9.0%, respectively. Active, vector-borne transmission of T. cruzi was confirmed in the state of Veracruz, Mexico, with an overall antibody seroprevalence rate of 0.19% among the population under 18 years of age. Seroprevalence rates among this segment of the population, which serves as a sentinel group, should be closely monitored to determine if more stringent methods of vector control and epidemiological surveillance are needed.
 
Estimates of recent use of tobacco, alcohol, and other drugs among school students, Panama, 1996 
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Article
This report provides the first epidemiological evidence on tobacco, alcohol, and other drug use among school students in Panama, using data from a student survey completed in 1996. Specifically, we examine sex, age, grade level, type of school, and urban-rural variations in the occurrence of tobacco, alcohol, and other drug use. Estimates of lifetime prevalence and past-year use of these products were obtained using data from Panama's 1996 National Youth Survey on Alcohol and Drug Use (n = 6,477). To account for the multistage sampling design of the survey, all estimates and respective standard errors are derived by the Taylor series approximation method using Epi Info 6.0 CSAMPLE software. In general, more males, more older students, and more students in higher grades have used licit and illicit drugs, even though male-female differences tend to be small. Public-private school differences and urban-rural trends vary depending on the drug. The findings of this study are discussed in relation to the epidemiology and prevention of drug use in Panama. Based on these data, we seek to provide information to be used by the Government of Panama in its planning for prevention programs directed toward students in Panamanian schools.
 
Article
To define and compare the types of injuries from external causes in patients more than and less than 18 years of age treated by the Mario Correa Rengifo Hospital. An analysis was conducted of data retrieved from the Sistema de Vigilancia de Lesiones de Causa Externa (Surveillance System for Injuries from External Causes) maintained by the Mario Correa Rengifo Hospital in Cali, Colombia, to compare minors (less than 18 years of age) with adults during January 2004-December 2007. A total of 4 507 minors were seen, most of whom (69.3%) were boys, with unintentional injuries (75.5%); however, 88% of the intentional injuries were person-to-person and 12% were self-inflicted. Injuries had occurred most frequently in the home (44.1%) and on the street (39.5%); the most frequent activity was recreation (53.3%). The minors had more head injuries (odds ratio [OR] = 1.62; P = 0.0000) and maxillofacial injuries (OR = 1.49; P = 0.0000) than did the adults. Alcohol had been consumed in 5.8% and drugs in 2.6%, both of which increased intentional injuries (alcohol OR = 4.25 and drugs OR = 1.56). The number of patients less than 18 years of age with injuries from external causes being treated at the Mario Correa Rengifo Hospital is constantly rising. The circumstances regarding injuries seen in children and adolescents differ from those of adults in that minors tend to suffer more unintentional injuries in the home or in the street where they play regularly. It is important that special educational and structural strategies be implemented to prevent injuries of this type.
 
Article
This study presents data on general mortality and mortality from external causes (traffic accidents and homicides) among adolescents 10 to 19 years of age in Rio de Janeiro Municipality, Brazil, from 1980 to 1994. The purpose of the study was to describe and put into context mortality from external causes and to identify areas of the Municipality where the risk of these occurrences is highest. The study also sought to identify trends and seasonal patterns of this mortality and to place violence within the ambit of public health through application of the epidemiologic surveillance approach. Information on mortality was extracted from death certificates provided by the State Health Secretariat of Rio de Janeiro. A total of 20,224 death certificates were studied. The populations used as the denominators for determining rates were estimated from the censuses of 1980 and 1991. For purposes of the analysis; the Municipality was divided into eight programmatic areas, each composed of diverse neighboring districts. A time series analysis was done for traffic accidents and homicides. The results showed that external causes were the leading causes of death in the 10-19 age group, and that during the study period deaths from these causes had increased, especially among males. The results also revealed that mortality was heterogeneously distributed in areas of the Municipality that differed socioeconomically. The study points to the need for better integration of the health sector with other sectors and institutions and for a restructuring of the health system with regard to epidemiologic surveillance of violence.
 
Article
To determine the prevalence of overweight and identify its risk factors in school girls between the ages of 12 and 19 in a semi-urban region of Ecuador and to explore the potential relationship between the adolescents' body mass index (BMI) and their physical activity, caloric intake, and macronutrient intake, as well as between their BMI and their parents' estimated BMI. From January through April 2001 a cross-sectional study was conducted with a sample of 302 adolescent girls who attended high schools in Cumbaya and Tumbaco (14 km northeast of Quito) and who were selected by systematic random sampling. Anthropometric measurements were taken on all girls and their total calorie and macronutrient intake was measured by means of a 24-hour recall questionnaire. A physical activity questionnaire was also administered, and estimates were made of their parents' BMI. Of the study participants, 8.3% were overweight and 0.7% were obese. In 40.7% of the first group, the excess body weight had a gluteofemoral distribution; in 51.9%, it had an intermediate type of distribution; and in 3.7% it had an abdominal distribution. There was a negative correlation between the adolescents' BMI and their physical activity and calorie intake (P < 0.05), whereas a positive correlation was seen between their BMI and the mother's estimated BMI (P < 0.05). The prevalence of overweight found in this study is similar to that found in an earlier country-wide study but was less than that detected in reports from industrialized countries and other countries of Latin America. Factors appearing to have the greatest impact on an adolescent girl's BMI were physical activity and estimated maternal BMI, regardless of total energy intake and dietary composition.
 
Article
OBJECTIVE: To evaluate the association between exposure to the main chemical contaminants in drinking water and the rise in cancer cases among the population under age 19. METHODS: A systematic review was undertaken of the scientific literature compiled in the MEDLINE (via PubMed©), EMBASE©, Web of Knowledge, Cochrane Library Plus, Latin American and Caribbean Literature on Health Sciences (LILACS), SCOPUS, and SCIRUS databases. The descriptors used were "neoplasms" and "water pollution, chemical," limited to studies that included people under age 19. Articles selected were of any type in any language, from the inception of the indexing of the primary source until March of 2011. RESULTS: The search generated 266 articles, from which 20 were selected after applying the inclusion and exclusion criteria. Drinking water contaminants analyzed were arsenic, disinfection byproducts, nitrogen compounds, petroleum derivatives, agricultural pesticides, radionuclides, and others of industrial origin. The majority of the studies did not find a significant link between exposure to drinking water contaminants and the increase in cancer cases in the under-19 population segment. In some of the studied populations a significant dose-response relationship was observed. CONCLUSIONS: Taking into account that the articles located were insufficiently up-to-date, more studies are required in order to know the effect of drinking water contamination on cancer rates, in particular among children and youths, who are more susceptible.
 
Article
The analysis of scientific production in Puerto Rico is largely unexplored. The main aim of this study is to present the characteristics and trends of cancer publications in Puerto Rico's biomedical journals and their relationship with the island's cancer mortality. A PubMed and a hard-copy search were performed to retrieve cancer-related articles published in the Puerto Rico Health Sciences Journal and the Boletín de la Asociación Médica de Puerto Rico from 1903 to 2005. Bibliometric indicators studied included the number of authors and references by article, first author's institutional affiliation and country, document type, and language. The study type and tumor classification were also recorded. Cancer proportional mortality (M%) in Puerto Rico and the proportion of cancer-related articles (P%) published were also evaluated. The annual percent change (APC) was estimated to assess trends. A total of 369 articles were retrieved. The institutions with the majority of publications were universities (39.6%), English was the predominant publication language (72.1%), and the principal document type was original papers (69.6%). Epidemiologic studies were the dominant study type (62.1%), and the most studied cancers were digestive (15.4%) and gynecologic (9.6%). Although the P% has increased since 1913 (APC = 1.2%), the M% increased at a faster pace (APC = 2.7%). Although a growth in the number of cancer publications is observed in these journals, it does not parallel the increase in proportional mortality. A better understanding of the cancer publications in Puerto Rico is essential to establish priorities, define future areas of research, and develop cancer control strategies.
 
Article
Infectious diseases have traditionally been one of the leading causes of death in developed countries. The objectives of this research were to: 1) quantify the importance of infectious diseases as a cause of premature mortality in Spain between 1908 and 1995, and 2) determine the frequency and distribution of the infectious diseases with the greatest impact on premature death. The study was carried out based on data on mortality from infectious causes published by the National Institute of Statistics in the Movimiento natural de la población (Natural Movement of the Population) for the study period. Three indicators of premature mortality were used: the potential years of life lost (PYLL), the crude rate of PYLL per 1 000 population, and the percentage and the average of PYLL. Between 1908 and 1995, the number and the rate of PYLL from infectious causes clearly declined. The decrease was more prominent starting in the 1950s, and it was seen in all age groups. Tuberculosis was the leading cause of premature death from the beginning of the century until the 1970s, but after that, the leading causes became pneumonia and AIDS. The impact of infectious diseases as determinants of premature death in Spain declined during the 20th century, especially starting in the 1970s.
 
Article
Since the 1970s, when the world seemed on the threshold of malaria eradication, the incidence of the disease has increased in several countries. The upturn in cases raised a series of questions, and for some time malariologists and public health authorities scarcely understood what was happening. In an attempt to better comprehend the process, this article reviews the frequency of malaria cases in São Paulo, Brazil, between 1930 and 1990, examining the following factors in each of three 20-year time periods: the importance of malaria in the society, the conditions under which the disease occurred, the epidemiologic knowledge of the time, the technical instruments available to fight it, and the control strategies that were used. Through the construction of technological models based on these factors, it became clear that the occurrence of the disease, knowledge about it, and, consequently, the ways it was dealt with changed over time. In light of this research, the article discusses current options for the control of malaria.
 
Article
Since the 1970s, when malaria had seemed at the threshold of eradication, its incidence has increased in several countries of the world. This situation posed a series of questions, and for some time malariologists and public health authorities scarcely understood what was happening. In order to better comprehend the process, the author of this article studied the frequency of malaria cases in São Paulo, Brazil, from 1930 to 1990, attempting to examine the following factors in each of the periods studied: the importance of malaria in the society, the conditions under which the disease occurred, the epidemiologic knowledge of the time, the available technical instruments, and the control strategies that were used. Through the construction of technological models based on these factors, it became clear that the occurrence of the disease, knowledge about it, and, consequently, the ways it was dealt with changed over time. In light of this research, the paper discusses current options for the control of malaria.
 
Article
This paper reviews malaria control initiatives in Brazil, from the Malaria Eradication Campaign (Campanha de Erradicação da Malária), which was launched in 1965 and was based on spraying dichlorodiphenyltrichloroethane (DDT) and on administering antimalarial drugs, to the implementation, in 2000, of the Program for Intensification of Malaria Control in the nine-state Legal Amazon region of Brazil (Plano de Intensificação das Ações de Controle da Malária na Amazônia Legal), which was implemented in response to the World Health Organization's Roll Back Malaria effort. Among the Brazilian initiatives discussed are epidemiological stratification, the Impact Operation (Operação Impacto), the Amazon Basin Malaria Control Project (Projeto de Controle da Malária na Bacia Amazônica), and the Integrated Malaria Control Program (Programa de Controle Integrado da Malária). Although there was progress in the control of malaria before the Intensification Program was launched in 2000, the actions carried out were not sustained. From 1998 to 1999 there was even a 34% increase in the number of malaria cases in the Brazilian Amazon. The Intensification Program set a goal, in comparison to 1999, of reducing by 50% the number of malaria cases by the end of 2001 and of cutting by 50% the mortality due to malaria by the end of 2002. Data for 2001 showed an overall 39% decrease in the number of malaria cases in the nine Amazonian states of the Intensification Program. The smallest decrease (15%) was in the state of Amapá, where the plan was not implemented until the second half of 2001. In terms of incidence by species, there was a 35% reduction in cases caused by Plasmodium falciparum and a 41% reduction in cases caused by P. vivax. The only independent variable that explains this reduction is the implementation of the Intensification Program. Although preliminary, these results indicate considerable gains. Decisive to this progress has been the strong mobilization of federal, state, and municipal governments.
 
Article
Since 1969 the International Atomic Energy Agency and the World Health Organization (along with the Pan American Health Organization, working with countries in Latin America and the Caribbean) have operated postal dosimetry audits based on thermoluminescent dosimetry (TLD) for radiotherapy centers. The purpose of these audits is to provide an independent dosimetry check of radiation beams used to treat cancer patients. The success of radiotherapy treatment depends on accurate dosimetry. Over the period of 1969 through 2003 the calibration of approximately 5,200 photon beams in over 1,300 radiotherapy centers in 115 countries worldwide was checked. Of these audits, 36% were performed in Latin America and the Caribbean, with results improving greatly over the years. Unfortunately, in several instances large TLD deviations have confirmed clinical observations of inadequate dosimetry practices in hospitals in various parts of the world or even accidents in radiotherapy, such as the one that occurred in Costa Rica in 1996. Hospitals or centers that operate radiotherapy services without qualified medical physicists or without dosimetry equipment have poorer results than do hospitals or centers that are properly staffed and equipped. When centers have poor TLD results, a follow-up program can help them improve their dosimetry status. However, to achieve audit results that are comparable to those for centers in industrialized countries, additional strengthening of the radiotherapy infrastructure in Latin America and the Caribbean is needed.
 
Article
To describe epidemiologic trends in mortality from cardiovascular diseases (CVD), ischemic heart disease (IHD), and acute myocardial infarction (AMI) in Costa Rica, by sex and geographic region, between 1970 and 2001. We performed a descriptive study of mortality from CVD, IHD, and AMI in Costa Rica between 1970 and 2001. Information was obtained from the Central American Population Center's database. Mortality data for IHD and AMI between 1970 and 2001 were analyzed in accordance with the latest revision of the International Classification of Diseases (ICD). Costa Rica's territory was divided into the following regions: the metropolitan area (8 cantons), the semi-urban area of Valle Central (18 cantons), the rural area of Valle Central (17 cantons), the semi-urban lowlands (12 cantons), and the rural lowlands (26 cantons). Mortality trends by quinquennia (between 1970 and 1999) and for the 2000-2001 biennium were examined in the form of crude mortality rates per 100 000 inhabitants for each cause or group of causes, by age, sex, and year of death. All rates were adjusted for sex, age, year of death, and geographic region through the direct method of standardization, using the population of Latin America in 1960 as the standard population. Mortality from CVD dropped by an average of 33% (46.6% among women and 20.2% among men), while mortality from IHD rose by an average of 18.4% (6.1% among women and 28.4% among men). The adjusted mortality rate for AMI among men rose by 12.8% over the study period and dropped slightly by 4.4% among women. Mortality from CVD, IHD, and AMI was greater in men than in women during the entire study period. Mortality rates for IHD and AMI rose in semi-urban and urban areas, especially in the rural lowlands, where they increased with respect to the 1995-1999 rates by 123.9% and 76.9%, respectively. A reduction in mortality from CVD was noted. The largest rates were seen among men and in persons 75 years of age or older. The largest increases in mortality rates from IHD and AMI were seen in semi-urban and rural areas, among men, and in persons 75 years of age or older. Special attention should be paid to risk factors for CVD, such as smoking, arterial hypertension, overweight and obesity, sedentary habits, and an unhealthy diet.
 
Article
Two anthropometric surveys of children and adolescents have been carried out in Cuba with national samples. A third study done in the province of Ciudad de la Habana provided information on the physical characteristics of the population in that area and a baseline for the periodic evaluation of its nutritional status. This article compares the weight and height results obtained in these surveys for children 0 to 5 years old who lived in this province with the international reference standards proposed by WHO. The results show that, despite the economic difficulties the country has faced, the prevalence of malnutrition is low. In 1993, the prevalence of low height-for-age was 3.1%; that of low weight-for-height, 0.4%; and that of low weight-for-age, 1.5%. Overweight was the most common type of malnutrition, with a prevalence of 5.2%. Between 1972 and 1993, the prevalence of chronic malnutrition fell 32.6%, acute malnutrition was reduced by 69.2%; malnutrition of all types decreased by 44.4%; and overweight fell 48.5%.
 
Percentage growth (by five-year period over the years 1973-1992) in the number of articles appearing in the selected health-related journals whose primary authors resided in one of the six study countries
Article
The production of articles resulting from biomedical, clinical, and public health studies that originated in Argentina, Brazil, Chile, Cuba, Mexico, and Venezuela from 1973 through 1992 was analyzed to discover trends in health research in Latin America. From the database of the Institute for Scientific Information (ISI), 41,238 articles with first authors who resided in those countries were extracted. These articles were analyzed by subject area, type of study, country, number of authors and institutions that participated in the investigation, and citations received by each article. Also analyzed were 95 articles in epidemiology selected from a pool of 570 published by authors from the six countries in 11 public health journals that enjoy international prestige. The results showed that the number of published works increased by 117% between the first and last five-year periods within the study period. Clinical research was distributed the most evenly among the countries, and public health research was the most concentrated (60.7% originated in Brazil). The numbers of biomedical and public health research articles showed relatively more growth than those reporting on clinical research throughout the period. A relative decrease was found in articles by only one author, which suggests a greater frequency of team efforts, and an increase was seen in articles with authors tied to two or more national or foreign institutions, which indicates greater cooperation between institutions and countries. The average number of citations received by each article was 3, which was less than half the number received by the articles in the ISI database (7.78). Regarding the subset of 95 articles in epidemiology, the great majority (96%) dealt with infectious diseases or maternal and child health, while in the international literature 78% of such articles were about chronic diseases. This group of articles gave evidence of more cooperation with international institutions and had a citation index of 4.36 per article. It is concluded that, despite the inherent limitations, this type of study reveals some general trends in the development of research in the six Latin American countries with the greatest scientific production and makes it possible to formulate hypotheses on the factors that influence these trends. Taken with the paper caution, the results of studies like this one can be of great value in defining health science and technology policies.
 
Current status of cystic echinococcosis control program in South America, 2010  
Impact of cystic echinococcosis control programs in South America, 1974-2010
Article
Cystic echinococcosis (CE) is one of the most prevalent zoonoses in Argentina, Brazil, Chile, Peru, and Uruguay. Control programs in South America were originally modeled after programs developed in insular territories, such as Tasmania and New Zealand. The advent and proven effectiveness of praziquantel, plus the experience of insular models, produced high expectations for rapid advances; however, after 30 years of praziquantel use, no endemic area in South America has obtained eradication. In fact, only modest gains in CE control have been made and impact on prevalence among humans has been slight. A major impediment has been the infrastructure needed to administer praziquantel to dogs in rural areas 8 times per year over numerous years, a requirement for rapid attack stage 1. Such an infrastructure has not been financially or politically sustainable in endemic areas, which tend to be the poorest. On the other hand, certain areas in Argentina have had success with simple and economically viable alternatives. Based primarily on continuous field work supported by the local community, these strategies have significantly decreased transmission to humans, the health sector's main objective. In addition, new possibilities and tools, such as the EG95 vaccine, are being evaluated; as are early detection and treatment of asymptomatic carriers.
 
Annual incidence of malaria in the Limbé River valley compared to all of Haiti, 1975-1997 a 
Intersection points for annual rainfall (cm) and annual incidence of malaria (positive slides) for specific years at Bon Samaritain Hospital, Limbé, Haiti, 1975-1985 
Article
In the Limbé River valley of northern Haiti a retrospective study at the Bon Samaritain Hospital (BSH) determined the total number of cases and the cyclical nature of malaria from 1975 through 1997, examined the relationship between rainfall and malaria from 1975 through 1985, and compared the incidence of malaria at that hospital with general trends for Haiti for 1975 through 1996 as reported by the World Health Organization (WHO). During 1975-1997, 27,078 positive cases of malaria were diagnosed at BSH; 50% of these cases occurred during 16 weeks out of the year, during a summer peak in June and July and a winter peak in December and January. For 1975-1985, there was no significant correlation between the incidence of malaria and annual rainfall. The strongest correlation was observed between weekly rainfall and weekly incidence of malaria when the data was staggered to allow a lag of 9-11 weeks between rainfall and new malaria cases. The lag period is explained by the time required for the creation of breeding sites after rain, the life cycles of the Anopheles albimanus mosquito and the Plasmodium falciparum parasite, and the incubation period for falciparum malaria. The incidence of malaria in the Limbé River valley loosely followed the trends in all of Haiti and also supported WHO reports indicating that malaria in Haiti has been in a general decline since the mid-1980s. By showing the seasonal trends for malaria in the Limbé valley and the relationship between rainfall and malaria over an extended time period, this study provides a means to measure the effectiveness of malaria control efforts in the region.
 
Article
The objective of this work was to contribute local data concerning the full adult height of women in Cordoba, Argentina, and to explore the possibility of a secular trend in their heights. For the study, 513 women were examined during May and June 1994. All of the women were between 18 and 40 years of age and were mothers of children who were included in a study on lactation, feeding, growth, and development in Córdoba. The measurements were carried out applying standardized techniques and using as a reference standard the 50th-percentile level data from the U.S. National Center for Health Statistics. The mean full height of the Córdoba population studied was 157.9 cm, 0.97 standard deviation (SD) below the reference norm. For the women from the highest of six socioeconomic strata, the mean height was 159.7 cm (-0.67 SD); the mean for women from the lowest stratum was 156.2 cm (-1.25 SD). The difference in the means of those two socioeconomic groups was statistically significant (P < 0.001). Of the population studied, 2.3% (6.4% of the lowest social stratum) were shorter than 145 cm. In order to explore the possibility of a secular trend, the resulting data were categorized into two groups according to the mother's age at the time of the anthropometric examination, one group with a mean age of 24 and a second group with a mean age of 34. The younger women had a mean adult height 0.4 cm greater than that of the older women (P = 0.47). This secular increase in height is notably smaller than that reported for other Argentine provinces (1.2 and 1.4 cm/decade) and somewhat lower than the average reported in population studies in Australia, Belgium, the United States, Japan, and Norway (0.6 cm/decade). The authors conclude that in the period analyzed, 1978-1988, the living conditions in the city of Córdoba have not improved in a way that is reflected in a significant increase in the height of adult women. The authors recommend that maternal health and nutrition programs concentrate their resources on the mothers from the lowest socioeconomic stratum who are shorter than 145 cm.
 
Article
Results from three national surveys in Haiti suggest that the prevalence of stunting, underweight, and wasting in children fell considerably between 1978 and 1990. In the following four years, rates of stunting and underweight levelled off, while that of wasting nearly doubled. Child nutrition deteriorated dramatically during a period of intense political crisis and international sanctions that included a strictly enforced trade embargo. Human welfare should be monitored whenever international sanctions are imposed to regulate a country's behavior.
 
Article
To examine the trends in mortality from drowning in Mexico and each of its federal states during the period from 1979-2005. Mortality rates and trends were estimated for the study period from Mexico's official data based on the International Classification of Diseases, 9th and 10th revisions. Results were analyzed by age group, sex, and year registered, as well as by state and size of city or town of residence. From 1979-2005, there were 107 319 deaths by drowning registered. The mortality from drowning rate decreased 65.31% (from 6.58 per 100 000 inhabitants in 1979-1981 to 2.28 per 100 000 inhabitants in 2003-2005). This decrease was evident in all the age groups (ranging from 68.10% among 5-9 year olds to 54.30% among 1-4 years) and by state (ranging from 87.19% in Colima to 36.58% in Nayarit). During the three-year period from 2003-2005, drowning mortality was relatively greater among men and boys than among women and girls (rate: 5.46 (95%CI: 5.15-5.80); among the age groups 1-4 years (4.27 per 100 000) and 60 years or older (3.37 per 100 000 inhabitants); in the Tabasco state (5.92 per 100 000 inhabitants); and among towns with fewer than 2 499 inhabitants (4.03% per 100 000 inhabitants). In Mexico, the drowning mortality drowning rate is on a downward trend, although it remains a serious public health problem. Intensified efforts are needed to harness information regarding accidentals death from this cause, both from the epidemiological surveillance angle as well as through the implementation of eradicating interventions.
 
Article
To investigate the trends and regional patterns in mortality from oral cancer and pharyngeal cancer in Brazil from 1979 through 2002. Data were obtained from the Mortality Information System (Sistema de Informações sobre Mortalidade) database, which is compiled by the Ministry of Health of Brazil. Mortality rates were adjusted by gender and age. The Prais-Winsten generalized linear regression procedure was used to calculate the annual increase or decrease in mortality rates. The time trends for mortality due to oral cancer and to pharyngeal cancer were analyzed by specific anatomical site and by region of the country (North, Northeast, South, Southeast, and Center-West). In all five regions of Brazil over the period studied, oral cancer mortality remained stable for both genders, but pharyngeal cancer mortality increased for both genders. Mortality from cancer affecting the lips, tongue, gums, mouth floor, palate, other parts of the mouth, and tonsils showed a statistically significant decrease over the period. However, mortality from cancer affecting the oropharynx, hypopharynx, and ill-defined and undefined sites of the oral cavity and the pharynx showed a significant increase. Mortality rates for both oral cancer and pharyngeal cancer were higher in the South and Southeast regions of the country than in Brazil's three other regions. The relatively larger decrease in mortality from cancer affecting the lips, gums, and other anatomical sites more easily accessible to clinical inspection suggests a possible link between oral and pharyngeal cancer survival and an improved provision of health care services in Brazil in recent decades.
 
Article
To describe the trends in mortality from scorpion stings in Mexico as a whole and in each of its states for the period of 1979 to 2003. We estimated the crude and standardized mortality rates due to scorpion stings and the trends during the period studied based on official mortality data for Mexico, using the codes (E905.2 and X22, respectively) from the 9th and 10th editions of the International Classification of Diseases. The results were stratified by age group. The frequencies of deaths from scorpion stings were compared using relative risk (RR), with 95% confidence intervals (CIs). Between 1979 and 2003 in Mexico, 6,077 deaths from scorpion stings were registered. A statistically significant downward trend was found in standardized mortality rates (beta = -0.195; P < or = 0.001), with a total reduction of 86.5% for the period of 2001-2003 versus 1979-1982. For the 2001-2003 period, the highest mortality rates were in children under 1 year of age (7.07 per 1,000,000), children 1 to 4 years old (3.78 per 1,000,000), persons 60 and older (0.84 per 1,000,000), and males (0.81 per 1,000,000). Persons in communities with fewer than 2,500 inhabitants had a relative risk that was 11.8 times (95% CI: 7.86 to 17.72) that found in communities with more than 20,000 inhabitants. The states with the highest mortality rates were in the central and western regions of the country. Despite the sustained decline in the number of deaths from scorpion stings in the last 20 years in Mexico, there is still an important public health problem. The groups that are most affected are children under 5 and the elderly. Measures should be taken so that in all communities, especially small ones, adequate resources and information are available to provide for the prompt care of persons who suffer a scorpion sting.
 
Article
To evaluate and compare adult mortality from diseases of the circulatory system (CDs), especially ischemic heart disease (IHD) and cerebrovascular disease (CVD), from 1980 through 2002 in the Brazilian states of Rio de Janeiro, Rio Grande do Sul, and São Paulo and their capital cities (respectively Rio de Janeiro, Porto Alegre, and São Paulo), taking into account the impact of deaths due to ill-defined causes on mortality rates. We estimated mortality rates (crude and adjusted by age and sex) from CDs overall and from IHD and CVD among individuals aged 20 years or older. These rates were weighted with a portion of the deaths from ill-defined or unknown causes, in the same proportion as deaths from CDs, IHD, and CVD in relation to deaths overall, excluding deaths from ill-defined causes. Using linear regression models, we also estimated the mean values of and annual differences in the weighted adjusted mortality rates. The reference population was that of the state of Rio de Janeiro in 2000. The annual decline in the weighted adjusted mortality rates from CDs ranged from -13.1 per 100,000 individuals in the state of Rio de Janeiro to -8.7 per 100,000 in the city of São Paulo. For IHD, the annual declines were greatest in the city of Rio de Janeiro (-5.0 per 100,000) and the state of Rio de Janeiro (-4.5 per 100,000), and smallest in the state of Rio Grande do Sul (-2.8 per 100,000) and the city of São Paulo (-2.7 per 100,000). With CVD, the range that was found extended from -6.5 per 100,000 in the state of Rio de Janeiro to -2.9 per 100,000 in the city of Porto Alegre. The decreases in weighted adjusted mortality rates from CDs, IHD, and CVD occurred after 1980, so it is unlikely that the declines resulted from controlling risk factors or from the practice of myocardial revascularization. The decreases might be related to a period of strong economic development preceding the declines, which translated into improved living conditions and reduced exposure to infections in the perinatal period and childhood.
 
Article
To assess the impact of structural adjustment on health indicators in Latin America and the Caribbean during 1980-2000. This was an ecological study. Public spending and per capita gross domestic product (pcGDP) figures were obtained from the World Bank, and life expectancy (LE) and infant mortality (IM) figures were obtained from the World Health Organization. Structural adjustment (government downsizing) was assessed by looking at the change in the amount of spending taken up by the government (or the reduction in public spending) in Latin American and Caribbean countries during 1980-1990. Changes in health indicators were measured in terms of the percentage variation in LE and IM. The variations found in Latin America and the Caribbean were compared to those seen in different groups of countries in other parts of the world during 1980-2000. Pearson's chi squared test was used to explore the associations between the decrease in public spending and health indicators. In order to estimate the health effects of such changes, a multivariate linear regression model was created, with adjustments for pcGDP. A deceleration in the rise of LE and in the decline of IM in Latin America and the Caribbean was noted, especially over the period from 1980 through 1990. Significant associations were observed between health indicators and the change in public spending in all groups of countries included in the study. When adjustments were introduced into the multiple regression model, the only associations that remained were seen in Latin America and the Caribbean. In the decade of 1980, adjustments in macroeconomic policies had a negative effect on social indicators, specifically those that had to do with health conditions in Latin America and the Caribbean. Such an effect lasted throughout the following decade.
 
Article
To analyze trends in age-adjusted lung cancer mortality rates in Mexico for the period of 1980 through 2000. The trends were assessed using the adjusted rates of mortality from lung cancer, year of death, year of birth, age at death, state, and standard population. The standardized mortality rate and the index of potential years of life lost were used to compare incidence and premature deaths. The standardized mortality rate was analyzed by age groups according to the age at death (30-74 years), five-year observation period (1980-1999), and birth cohort (1910-1950). Nonparametric Spearman correlations were calculated for per capita tobacco consumption, social marginalization, and emigration. The adjusted mortality rate from lung cancer declined from 7.91 per 100 000 in 1989 to 5.96 per 100 000 in 2000. This pattern correlated with the reduction in per capita tobacco consumption, from 2.145 kg in 1959 to 0.451 kg in 1982. The latent period for the appearance of lung cancer in Mexico was 30 years. The male:female ratio was 2.4:1. The highest adjusted mortality rate was found in men who were 70-74 years old at the time of death. The adjusted mortality rates were low among the cohorts of persons born in 1945 or later, and those rates declined over the 1980-2000 period. The index of potential years of life lost and the incidence of premature death were greater among men. The mortality rates for the cohorts of men born between 1915 and 1940 showed a slight decline over the 1980-2000 period; beginning with men born in 1944 the rates increased slightly, mainly among men 30-34 and 35-39 years old at the time of death. For women the adjusted mortality rates were highest among those 75 or older; the rates gradually declined among the women born between 1945 and 1960, with the largest decrease among women 30-34 years old. The adjusted mortality rates varied according to the five-year observation period, the year of death, and birth cohort and gender. The correlation coefficient for the adjusted mortality rate by state and social marginalization was -0.70 (P = 0.00). There was no statistically significant correlation with the index of emigration (P = 0.56). Mortality from lung cancer has declined in Mexico. Morbidity and premature death due to lung cancer are greater in the states of northern Mexico.
 
Standardized mortality rates for selected respiratory diseases (per 1 000 inhabitants) among the population 60 years of age or more, by sex, State of S?o Paulo, Brazil, 1980?2009  
Specific mortality rates for selected respiratory diseases (per 1 000 inhabitants) among the population 60 years of age or more, according to sex, State of S?o Paulo, Brazil, 1980?2009  
Article
To evaluate mortality trends before and after the anti-influenza vaccination campaigns among the elderly in Brazil. This was an ecological time-series study of mortality from respiratory diseases among the elderly living in the state of São Paulo, Brazil, in 1980 - 2009. Mortality rates were calculated using death data from the Ministry of Health's Mortality Information System and population data from the Brazilian Institute of Geography and Statistics. Polynomial regression models were used to evaluate mortality trends by sex and age group (60 - 69 years; 70 - 79, and 80 years or older) before and after the beginning of influenza vaccination campaigns. An increase in the respiratory mortality rates was observed in 1980 - 1998, mainly among males. The rate and velocity of the increase was higher among the older age groups. In the years following the vaccine campaigns (1999 - 2009), respiratory mortality rate trends by sex and age stabilized in São Paulo state. A greater reduction in mortality rates would be observed if vaccinal coverage against influenza were greater and more homogenous. New strategies to increase the uptake of vaccine among the elderly are needed to reach higher coverage levels, especially in municipalities with older and larger populations.
 
Article
to evaluate mortality from all causes, diseases of the circulatory system (DCS), ischemic heart disease (IHD), and cerebrovascular diseases (CVD) from 1980 to 2006 in Rio de Janeiro, Rio Grande do Sul, São Paulo, and their capitals, taking into consideration the impact of deaths due to ill-defined causes. population and mortality data were obtained from the Unified Health System's Data Bank (DATASUS). Mortality from the diseases of interest and from ill-defined causes was adjusted by the direct method for adults older than 20 years of age. Since the mortality rates from ill-defined causes increased markedly after 1990, proportional mortality rates from ill-defined causes were calculated. Linear regression models were used for analysis of trends. a relevant decline in all-cause mortality was observed in the three states and capitals. Rio de Janeiro and its capital had the highest rates of all-cause mortality. DCS mortality declined more than all-cause mortality. Proportional mortality from ill-defined causes in Rio de Janeiro and its capital was higher than in all other states and capitals starting in 1990. CVD mortality fell in the study period, especially in Rio de Janeiro and its capital. The state of Rio de Janeiro also had the highest IHD mortality rates until 1993. Among the capitals, São Paulo presented the highest IHD mortality rates starting in 1992. the decline in all-cause mortality resulted mainly from the decline in DCS mortality. In turn, the decline in DCS mortality was partly due to the reduction in CVD mortality, especially in the state of Rio de Janeiro.
 
Article
The present study aimed at identifying supply and demand of university-level nursing programs in São Paulo, Brazil, during the 1980s. A questionnaire was sent to the 28 nursing programs (public and private) existing in São Paulo in 1991. The 24 institutions that responded to our survey provided information on: year when the program was established, year when program was officially recognized by the Ministry of Education and Culture; year when entrance examinations began to be required for the nursing program; sources (public or private) of financial support received; and number of students accepted for each term (day or night) in 1980 and 1991. The data collected revealed that every year fewer students applied to nursing programs in São Paulo. In 1986, 34% of the vacancies remained unfilled; this was the lowest occupancy rate registered during the period studied. The situation outlined by our study suggests that in the medium and long run nursing work potential in Brazil could be compromised.
 
Tendencia de la mortalidad infantil, neonatal y residual, en Costa Rica, 1972-2010
Article
Identify trends for different types of birth defects and their impact on infant (IMR) and neonatal (NMR) mortality rates in Costa Rica from 1981 to 2010. Infant, neonatal, and postneonatal mortality trends were analyzed, using data from the Central American Population Center, which uses the International Classification of Diseases, versions 9 and 10, to classify causes of death. For each group of birth defects, a Poisson log-linear regression model was constructed. IMR and NMR, relative risk, and 95% confidence intervals (95%CI) were calculated for the three decades (1981-1990, 1991-2000, and 2001-2010). Estimates were compared using Wald chi square. Comparison of the 1980s and the 2000s found a significant decrease in NMR and IMR from birth defects in these decades, from 2.37 (95%CI: 2.26-2.48) to 2.13 (2.03-2.23) and from 4.13 (3.99-4.27) to 3.18 (3.05-3.31), respectively. Reduction in IMR was significant for birth defect groups for nervous, digestive, and circulatory systems. There was also a significant drop in NMR for nervous and digestive system groups. All other groups experienced a significant increase or no change. IMR and NMR from birth defects have decreased, although these rates have increased proportionately due to a greater decline in other causes. This reduction is much smaller for neonatal mortality. Primary prevention and neonatal care of birth defects should be strengthened.
 
Article
To understand the possible effect that length of time has on disease severity with sequential dengue infections. Death and hospitalization rates for dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) per 10,000 secondary dengue-2 infections were compared in the same age group for two dengue-2 (DEN-2) epidemics in Cuba. The first DEN-2 epidemic affected all of Cuba in 1981; the second one, in 1997, impacted only the city of Santiago de Cuba. The sensitizing infection for DHF/DSS for each of the DEN-2 epidemics was dengue-1 (DEN-1) serotype virus, which was transmitted in 1977-1979, that is, 4 years and 20 years before the two DEN-2 epidemics. Using published seroepidemiological data from the cities of Havana and Santiago de Cuba, we estimated the rates at which persons aged 15-39 years old and those 40 years and older were hospitalized or died of DHF/DSS in Havana and in all of Cuba in 1981 and in just Santiago de Cuba in 1997. Among adults 15-39 years old the death rate per 10,000 secondary DEN-2 infections was 38.5 times as high in Santiago de Cuba in 1997 as in Havana in 1981. As a further indication of the increased severity coming with a longer period between the initial DEN-1 infection and the secondary DEN-2 infection, the case fatality rate for that same age group was 4.7 times as high in Santiago in 1997 as it was in Havana in 1981. We found a marked increase in severity with the longer of the two intervals (20 years) between an initial DEN-1 infection and a secondary DEN-2 infection. Such a difference may be due to subtle shifts in causative dengue strains or to changes with the passage of time in the circulating population of human dengue antibodies. These observations have important implications for dengue control, pathogenic mechanisms, and vaccine development.
 
Description of sample in terms of demographic, socioeconomic, and behavioral cha- racteristics, Pelotas, Brazil, 2006 a 
Article
To explore the association between maternal low birth weight (LBW) and adverse perinatal outcomes and to discriminate between confounders and mediating factors of these associations in a population-based birth cohort of Southern Brazil. Data from 794 female members of the 1982 Pelotas Birth Cohort Study known to have delivered a live-born singleton offspring up to December 2004 were analyzed. Maternal birth weights were recorded in 1982. The associations between maternal and offspring characteristics were estimated by Poisson regression. Confounding was tested for socioeconomic, demographic, and psychosocial factors. Maternal anthropometric characteristics and hypertensive diseases during pregnancy were considered mediating factors. An increase of 100 grams (g) in mothers' birth weight predicted a gain of 21 g in their infants' birth weight (95% confidence interval (CI) 13.0-29.0 g, P < 0.001). Maternal LBW was associated with offspring LBW (prevalence ratio (PR) 2.28 (95% CI 1.34-3.89), P = 0.002), preterm birth (PR 1.78 (95% CI 1.12-2.81), P = 0.01), and small for gestational age (SGA) (PR 1.93 (95% CI 1.14-3.26), P = 0.01). A causal chain linking maternal LBW and offspring SGA was mediated by maternal prepregnancy weight. Offspring of young women born with LBW are more likely to be LBW, preterm, and SGA. Public health strategies aimed at decreasing the frequency of LBW are necessary to reduce the perpetuation of adverse perinatal outcomes in later generations. The intermediate role of prepregnancy weight among LBW women opens a promising window to decreasing the prevalence of SGA in similar populations.
 
Article
To update the information on the geographic distribution of bat-transmitted rabies foci in Colombia and evaluate the biotic and abiotic conditions associated with the incidence of this disease in the country. Observational study of a database containing information on the wild rabies foci identified between 1982 and 2010 and the cattle population in each municipality. The municipalities were classified according to the disease's risk of transmission, and an environmental characterization of 15 variables was carried out. A maximum entropy model was developed to predict which areas had conditions appropriate for the presence of the Desmodus rotundus vector infected by the virus and to evaluate the importance of the variables employed. There were 2 330 foci in 359 (31.8%) of the country's 1 128 municipalities; 144 municipalities were classified as high risk. The highest incidence rates were found in Montería, Valledupar, Riohacha, Aguachica, Unguía, Acandí, Río de Oro, Tibú, Sahagún, and San Onofre. Rabies foci were found year-round but were more frequent (linear correlation [r] = 0.64) during the dry months (January to April). Temperature and precipitation were the variables contributing the greatest robustness to the prediction model. Prevention and control measures should be implemented in high-risk municipalities. The best months for conducting vaccination campaigns are June, November, and December. In future analyses, biotic interaction variables should be included to improve the predictive capacity of the model.
 
Top-cited authors
Paulo Capel Narvai
  • University of São Paulo
Jeffrey David Sachs
  • Columbia University
José Leopoldo Ferreira Antunes
  • University of São Paulo
Maria Cristina Schneider
  • Georgetown University
Maria G Guzman
  • Abilene Christian University