Showing papers by "Pan American Health Organization published in 1996"

Measles Elimination in the Americas: Evolving Strategies

Abstract: The strategy currently used to control measles in most countries has been to immunize each successive birth cohort through the routine health services delivery system. While measles vaccine coverage has increased markedly, significant measles outbreaks have continued to recur. During the past 5 years, experience in the Americas suggests that measles transmission has been interrupted in a number of countries (Cuba, Chile, and countries in the English-speaking Caribbean and successfully controlled in all remaining countries. Since 1991 these countries have implemented one-time "catch-up" vaccination campaigns (conducted during a short period, usually 1 week to 1 month, and targeting all children 9 months through 14 years of age, regardless of previous vaccination status or measles disease history). These campaigns have been followed by improvements in routine vaccination services and in surveillance systems, so that the progress of the measles elimination efforts can be sustained and monitored. Follow-up mass vaccination campaigns for children younger than 5 years are planned to take place every 3 to 5 years. ( JAMA . 1996;275:224-229)

The reemergence of visceral leishmaniasis in Brazil.

Abstract: Because of a complex array of factors, an increasing number of new and reemerging infectious diseases are being recognized in both industrialized and developing countries in the Americas (1,2). The expanding population, living in overcrowded conditions with inadequate housing and sanitary facilities, has been exposed to new diseases and human pathogens. For example, the appearance of the South American arenaviruses (Junin, Machupo, and Guanarito) illustrates how exploitation of new areas for human settlement and agriculture increases the likelihood that new infectious diseases will emerge. Cholera, plague, AIDS, dengue hemorrhagic fever, and urban/periurban visceral leishmaniasis are examples of new and reemerging diseases in the region.

Trends in cervical cancer mortality in the Americas.

Abstract: Each year approximately 52000 new cases of cervical carcinoma occur in Latin America and the Caribbean In contrast to developed countries where the incidence of cervical cancer has declined over the past 30 years there has been no such trend in Latin America This study used Pan American Health Organization (PAHO) data to estimate cervical cancer mortality trends in the 14 countries in the Americas for which data were available for at least 10 consecutive years the number of cervical cancer deaths was substantial and at least 75% of deaths from all causes were registered Marked declines in cervical cancer mortality in the US and Canada have occurred in all age groups (especially the 40-64 year group) since 1960; by 1990 the mortality rates from this cause were 14 and 17/100000 women respectively In the Latin American and Caribbean countries with available data cervical cancer mortality has remained fairly constant since 1960 at about 5-6 deaths/100000 women In Mexico Chile and Costa Rica cervical cancer mortality has increased over time largely among women over 40 years of age as a result of the concentration of screening efforts on younger women attending prenatal or family planning clinics In some Latin American countries declining cervical cancer mortality rates may be masked by improvements in death registration and the accuracy of death certification In general Latin American countries exhibit large within-country variation in cervical cancer incidence and mortality reflecting differential access to cervical cancer screening and treatment

Practices and attitudes among Swedish psychiatrists regarding the ethics of compulsory treatment

Abstract: Few empirical studies have examined the attitudes and ethical beliefs of psychiatrists. In this study, 328 members of the Swedish Psychiatric Association were randomly selected to respond to a questionnaire containing three clinical vignettes examining involuntary hospitalization, other compulsory interventions, and restraint. The questionnaire also contained 16 controversial statements and items on the abuse of psychiatry. A 60% response rate was obtained. Psychiatrists' responses were influenced not only by the severity of and risks associated with the patient's disorder, but also by family pressure which affected the decision-making process. Female psychiatrists less often suggested the use of physical restraints and the compulsory use of ECT. Sexual misconduct, and also the inadequate treatment of refugees, were the most frequently reported forms of abuse of psychiatry.

Protective efficacy of BCG against leprosy in Sao Paulo

Abstract: The case-control study reported here evaluated the protective effect of BCG vaccine against leprosy in Sao Paulo, Brazil. Seventy-eight patients under age 16 who had been diagnosed as having leprosy (cases) and 385 healthy individuals (controls) were selected and matched by sex, age, place of residence, and type of exposure to leprosy (intradomiciliary or extradomiciliary). The cases were drawn from an active patient registry and from a group of new leprosy cases treated at 50 health centers in the cities of Bauru and Ribeirao Preto in the state of Sao Paulo. In order to estimate the protective effect of BCG, the prevalences of BCG scars in cases and controls were compared. The presence of one or more scars was associated with an estimated protective efficacy of 90% (95% confidence interval: 78% to 96%). Stratified analysis by age group, sex, socioeconomic level, and clinical form of the disease revealed no significant differences in the protection provided by the vaccine. However, it seems clear that more data will be needed in order to accurately assess the true relevance of BCG for leprosy control programs.

Measles Elimination In the Americas-Reply

Abstract: In Reply. —We thank Mr Gay and Dr Nokes for their comments concerning our article. In their letter, they question the use of the Pan American Health Organization's operational criterion of the accumulation of 1 birth cohort of susceptible preschool-aged children for determining the proper interval between follow-up campaigns. We agree with Gay and Nokes that an epidemiologically based mathematical model could provide valuable guidance in determining the appropriate interval for follow-up campaigns and that the longer the intervals between such campaigns, the more economical and feasible such a strategy would be. As noted, however, a more conservative strategy is currently recommended that for most countries will call for a "followup" campaign every 4 to 5 years. The present strategy was adopted for 2 principal reasons. Most important is the fact that, until now, measles transmission has never been interrupted over any large contiguous area for more than a matter

Towards community diagnosis of dementia: Testing cognitive impairment in older persons in Argentina, Chile and Cuba

Abstract: Extensive research into the risk factors associated with dementia, how best to diagnose this syndrome and how to help families care for dementia patients has not been undertaken in Latin American countries, where the family and government support systems differ from developed nations. In an attempt to identify the risk factors associated with dementia in the cultural context of Latin America and to assist health planners and researchers in preparing for future needs of families in an ageing society, the Pan American Health Organization undertook the first-ever study of the prevalence of dementia in Latin America. The study consisted of a cross-sectional examination of non-institutionalized individuals 60 years of age and older in Buenos Aires (Argentina), Santiago (Chile) and Havana (Cuba). The study had a two-phase research design: a screening phase for the identification of persons with cognitive impairment and a confirmation phase for diagnosis of the presence of dementia. This article reports the results of the first phase of the collaborative multicountry study.

Introduction to the Special Issue: Timely Detection of Cervical Cancer

Abstract: Among women in Latin American and Caribbean countries where cervical carcinoma is the most common type of cancer efforts to detect and treat the disease have been largely unsuccessful due to the practice of screening young women at low risk who attend family planning clinics and prenatal care visits. All women regardless of age or socioeconomic status must have access to screening and treatment. Those with abnormal Pap test readings should undergo additional diagnostic procedures to rule out or confirm the presence of a malignant tumor or high-grade lesion. Given the serious consequences of both false-positive and false-negative results screening tests should be subject to strict quality control procedures. It is essential that womens and nongovernmental organizations health service administrators and professional associations participate in determining the most appropriate preventive strategies for each country as well as for the various socioeconomic strata and cultural contexts.

SUMA (Supply Management Project), a management tool for post-disaster relief supplies.

Abstract: Frequently in the wake of disasters, large amounts of humanitarian supplies arrive from multiple sources within the country or from abroad. Only a portion of these donations actually responds to specific requests from the affected country. A significant part consists of unsolicited donations whose value--in terms of meeting immediate, life-threatening needs--is questioned by many disaster managers. In 1990, WHO initiated a supply management project, known as "SUMA", to provide national authorities with a management tool and the skills to sort and inventory large amounts of relief supplies in a short period of time. It is a technical cooperation programme to assist the local coordinating agency to get an accurate picture of what is potentially available in the affected area, and to sort the most valuable relief items from those of doubtful usefulness. National authorities have developed their SUMA teams in many situations, both in Latin America and the Caribbean; this article describes three of these experiences. A flood in Costa Rica, in 1995, where the Red Cross assumed national responsibility for managing relief supplies donated locally. The earthquake in Paez, Colombia, also in 1995, where the National Disaster Committee activated SUMA for all supplies sent to the disaster area, with the exception of specialized health shipments channelled through the Ministry of Health. In Haiti, in 1994, a complex disaster was compounded by a tropical storm. All civilian supplies arriving at the airport were processed by the SUMA team which included customs officers among its members. The traditional problem of unsorted and inappropriate supplies, noted in most international disasters, seems to have been negligible, a trend which can perhaps be credited to 20 years of preparedness activities in Latin America and the Caribbean. The superficial analysis of the data underlines the potential for operational research on the standardized databases generated by SUMA.

Control of Culex quinquefasciatus in pit latrines, using shredded, waste polystyrene.

Abstract: As an alternative to the use of commercially available, expanded-polystyrene beads, a study was made of the effectiveness of shredded, waste polystyrene (SWAP) for the control of Culex quinquefasciatus. The relevant physical properties of the SWAP were first investigated in the laboratory. Then, under field conditions in wet pit latrines, mosquito emergence rates were measured before and after application of the material. In the laboratory, when compared with the commercial product, the irregular shape of the SWAP particles greatly reduced their capacity to spread over the water surface and the interstitial air spaces also permitted respiration and development of mosquito larvae. Nevertheless, under field conditions, with careful application of the SWAP over the water surfaces in wet pit latrines, almost complete control of mosquito breeding was observed within a few days. This was sustained for 60 days, at which time observations were discontinued. SWAP appears to offer an effective, cheap and readily available alternative to the commercial product for the control of C. quinquefasciatus. The practicality of using it in community-based, mosquito-control programmes warrants further study.

Reducing corporal punishment of children: a call for a regional effort

Abstract: Few violations of human rights awaken greater societal concern and repugnance than those perpetrated against children. Yet the number of reports of child maltreatment not only has reached overwhelming proportions but seems to be continuing to rise (2). The scientific literature and the media often report on children being subjected to violence at home, in the community, and at school. In the United States of America, 2.7 million children were reported abused or neglected in 1991 (2). In Brazil, merchants are believed to have ordered the murder of street children because they were perceived as a public nuisance (3). In some countries of the Americas, the future does not bode well with regard to child maltreatment, owing to the spread of all types of violent behavior and mounting social ills such as premature

The effects of volcanoes on health: preparedness in Mexico.

Abstract: The article reviews the most important aspects of volcanic eruptions and presents a summary of the harmful materials they emit. The main health effects can be classified as either physical (trauma, respiratory diseases, etc.) or psychological (depression, anxiety, nightmares, neurosis, etc.). Popocatepetl, the most famous active volcano in Mexico, lies on the borders of the States of Mexico, Puebla and Morelos. In 1993, seismic activity intensified, as did as the emission of fumaroles, followed in December 1994 by moderate tremors and strong emissions of gases and ash. In 1996, a number of seismic events led to an unexpected explosion. A daily emission of 8,000 to 15,000 tonnes of sulfur dioxide has been measured. Popocatepetl is located in a densely populated region of Mexico. A complex network to monitor the volcano using sophisticated equipment has been set up, including visual surveillance, seismic, geochemical and geodesic monitoring. An early warning system (SINAPROC/CENAPRED) has been developed to keep the population permanently informed. The warning system uses colour codes: green for normal, yellow for alert, and red for warning and evacuation. An emergency plan has been prepared, including evacuation and preparation for medical centres and hospitals in the region, as well as intense public information campaigns.

Information for health and human development

Abstract: Information is one of the most powerful instruments of change known to man. It can be used to relieve much pain and suffering, because the basic infrastructure of any successful enterprise is based not only on the management of the physical, financial, and human resources but also on information resources. This paper describes the relationship between health and human development and outlines the roles health sciences librarians might consider in managing information to ensure health, to assist not only medical scientists but also the powerful members of the community. No persons should be hampered in their ability to make decisions about health matters because they did not have access to information librarians have at their disposal.

Influence of PAHO publications on scientific production in the health field in Latin America and the Caribbean.

Abstract: 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 Boletin 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.

Reflections on hospital quality assurance programs.

Abstract: s and Reports 171 Evaluating quality means making value judgments about the results of technical and/or administrative procedures. It is important to understand that such value judgments should not be based on subjective personal preferences, but should be related to standards objectively set in advance. These standards or indicators are basic tools for the evaluation process. On the other hand, the need for indicators should not lead to an obsessive preoccupation with the establishment of minimal standards, above which everything is considered good. If one targets minimal standards, one will never reach excellence. QA strives to guarantee that results of an administrative or technical action are adequate, considering local characteristics and existing restrictions -in other words, if the results are consistent with the local possibilities and resources. However, one cannot accept inferior performance just because it is compatible with local standards; to do so is to risk keeping quality at low levels. A balance must be maintained between what is adequate and what is appropriate in each case. Research on applying quality management to health care systems suggests that a good QA program should be guided by the following four basic principles (10): 1. It is adjusted to the needs and expectations of the patients and the community. 2. It is focused on systems and processes. 3. It uses information to analyze quality. 4. It is based on a team approach to problem solving and quality improvement. Quality assurance must be distinguished from classification and accreditation. Classification ranks institutions by type, size, or other criteria. Accreditation is an instrument to assess the amount and quality of resources available and seeks to evaluate quality of care based on widely accepted, externally generated standards. Some authors believe it should precede any attempt at implementing a QA program (II). QA is an internal process, while the other two are conducted by outside sources. BASIC CHARACTERISTICS OF QA Among the characteristics of QA programs, the following should be highlighted: (a) simplicity, (b) continuity, (c) confidentiality, (d) decentralization, and (e) selfevaluation (22). (a) A QA program can and must be simple. Any institution with a minimal organizational structure should be able to implement a QA program. The first and most important requisite is the will to do so. The tendency to procrastinate is a great obstacle; the right moment never seems to come. Someone in the institution must take the lead and start the process. The leader may not be a senior staff member, but support from the senior management group is indispensable. (b) Continuity and perseverance are fundamental to the success of the program. QA cannot be a short-term project, started in response to a crisis or to maintain the image of the institution. A QA program that is begun with the wrong motivation will not get off the ground. The main thrust of QA is behavioral change, which does not happen overnight. It takes time to see consistent results. Quality assurance is part of a process of change within the institution, always targeted to higher levels of achievement and, therefore, to continuous improvement. (c) Confidentiality should be maintained in order to convince everyone of the impartiality of the process, which does not aim to assign blame but rather to stimulate people to improve their performance. The information generated and transmitted within a QA program is only pertinent to those who can do something to correct possible errors and learn from them. This does not abrogate the obligation the hospital has 172 Bulletin of PAHO 30[2), 1996 toward its patients nor the need to keep them informed. (d) Even if the coordination and control of the QA process is at the central level, it will only be effective if it is performed at the periphery of the system, which means the operational units of the hospital where services are being delivered to the customers. (e) To the extent possible, QA should stimulate self-assessment and not be an exercise in control and supervision from above. It must be assumed that the organization’s personnel are mature adults who are interested in doing their jobs well and that feedback mechanisms are sufficient to let them know at what level of quality they are performing. This feedback must be aggregated and followed up by the higher echelons of the organization that will sanction performance levels.

Campylobacter Jejuni Repeated Infections in Children from Rural Guatemala

Abstract: In Guatemala, as in many other developing countries, diarrhoeal diseases continue to be the most important public health problem, with a high incidence and a heavy toll in childhood mortality. Among the many causes of diarrhoea, C. jejuni 1 is seldom reported in the routine search for pathogens due to the special conditions it requires for isolation and growth. This infection has been associated with mild, acute or persistent diarrhoea1. In Guatemalan children, seven percent of the C. jejuni infections result in acute dysentery2. As C. jejuni is only susceptible to erythromycin, it is crucial to make the differential diagnosis from dysentery caused by Shigellae or by Entamoeba histolytica, in order to prescribe the appropriate treatment3.