Showing papers by "Pan American Health Organization published in 2003"
TL;DR: Targeted fortification or the production of complementary foods fortified with micronutrients and of an adequate macro- and micronsutrient composition is one approach to help meet nutritional requirements during the vulnerable period of 6-24 mo.
Abstract: Adoption of the recommended breast-feeding and complementary feeding behaviors and access to the appropriate quality and quantity of foods are essential components of optimal nutrition for infants and young children between ages 6 and 24 mo. Iron, zinc and vitamin B-6 are deficient in complementary food diets in Bangladesh, Ghana, Guatemala, Mexico and Peru. Low intakes of iron are consistent with a high prevalence of anemia seen in this age group. The adequacy of observed intakes for calcium, vitamin A, thiamin, folate and vitamin C depends on the age range in question and the set of requirements used in the assessment. The lipid content of many complementary food diets is low. In addition to providing essential fatty acids, lipids are needed for the absorption of fat-soluble vitamins and also enhance the texture, flavor and aroma of foods, which may lead to increased intake. The relative roles of palatability, micronutrient deficiency and morbidity-induced anorexia in the appetite of infants and young children are not known. However, even among children who were growth retarded and had a total energy deficit compared with requirements, up to 25% of food offered was not consumed. This indicates that dietary quality rather than quantity is the key aspect of complementary food diets that needs to be improved. Targeted fortification or the production of complementary foods fortified with micronutrients and of an adequate macro- and micronutrient composition is one approach to help meet nutritional requirements during the vulnerable period of 6-24 mo.
171 citations
TL;DR: When the identified risk and protective factors were compared with those seen among young people in the United States, similarities as well as important differences were found.
Abstract: Objectives. This study sought to identify, among youths, factors associated with characteristics such as poor health status, substance use, and suicide risk and to explore the extent to which the risk and protective factors identified cut across healthcompromising behaviors. Methods. A survey was administered to representative samples of young people from 9 Caribbean countries. Results. Physical/sexual abuse and having a friend or relative who had attempted suicide were associated with an increased prevalence of health-compromising behaviors. Connectedness with parents and school and attendance at religious services were associated with fewer health risk behaviors. Conclusions. When the identified risk and protective factors were compared with those seen among young people in the United States, similarities as well as important differences were found. (Am J Public Health. 2003;93:456‐460)
170 citations
TL;DR: Fortification of wheat flour substantially improved folate status in a population of women of reproductive age in Chile and on blood folate concentration in women of childbearing age was evaluated.
Abstract: Since January 2000 the Chilean Ministry of Health has required the fortification of wheat flour with folic acid (FA) at a concentration of 2.2 mg FA/kg in order to reduce the risk of neural tube defects (NTD) in newborns. This policy was expected to result in a mean additional intake of approximately 400 microg FA/d. We assessed the effectiveness of the FA flour fortification program on bread folate content and on blood folate concentration in women of childbearing age in Santiago, Chile. The prefortification folate status of 751 healthy women of reproductive age was assessed. The folate content of 100 bread samples bought at retail bakeries was measured, average wheat flour consumption was estimated and postfortification FA dietary intake was calculated. The effect of flour fortification on blood folate concentration in this group of women (n = 605) was evaluated in a follow-up study. Blood folate concentrations of the 605 women in the follow-up group increased (P < 0.0001) following fortification. Before fortification the mean serum and red blood cell folate concentrations were 9.7 +/- 4.3 and 290 +/- 102 nmol/L, respectively, compared with 37.2 +/- 9.5 and 707 +/- 179 nmol/L postfortification, respectively. The mean FA content of bread was 2020 +/- 940 micro g/kg. The median FA intake of the group evaluated postfortification was 427 microg/d (95% CI 409-445) based on an estimated intake of 219 g/d (95% CI 201-229) of wheat flour, mainly as bread. Fortification of wheat flour substantially improved folate status in a population of women of reproductive age in Chile. The effect of the FA fortification program on the occurrence of NTD is currently being assessed.
169 citations
TL;DR: A proposed nutrient composition for fortified processed complementary foods (FPCF) is developed based on the other papers in this publication, which consider a number of factors such as age range, daily ration size, recommended nutrient requirements, contribution of human milk to these requirements, macronutrient interactions, compound bioavailability, methods of production and overage.
Abstract: A proposed nutrient composition for fortified processed complementary foods (FPCF) is developed based on the other papers in this publication, which consider a number of factors such as age range, daily ration size, recommended nutrient requirements, contribution of human milk to these requirements, macronutrient interactions, compound bioavailability, methods of production and overage. The proposed fortification levels are based on a daily ration size of 40 g for infants aged 6-12 mo and 60 g for children aged 12-23 mo. A desired protein-energy ratio of 6-10% is used to estimate energy from protein. The desired percentage of energy from lipid is estimated at 24% for infants aged 6-11 mo and 28% for children aged 12-23 mo, with the remaining energy to be supplied from carbohydrate. An FPCF should provide a quantity of iron sufficient to meet the Recommended Dietary Allowance in the form of dried ferrous sulfate of small particle size. Ascorbic acid, 70-140 mg for infants aged 6-11 mo and 50-100 mg for children aged 12-23 mo, will enhance iron absorption. Because of the lower bioavailability of zinc in cereal-based diets in developing countries, 4-5 mg of zinc in the form of zinc oxide is recommended. Proposed fortification levels are also provided for copper, calcium, vitamin D, magnesium, phosphorus, vitamin A, the B vitamins and iodine. To prevent micronutrient losses, it is recommended that the FPCF be precooked. The knowledge base to develop an FPCF is quite limited, and much additional research is needed before an optimal formulation can be recommended.
164 citations
TL;DR: Current concepts of the genesis of preeclampsia that include endothelial dysfunction, inflammatory activation, oxidative stress and predisposing maternal factors provide targets for well-designed nutritional investigation.
Abstract: Preeclampsia is a pregnancy-specific condition that increases maternal and infant mortality and morbidity. It is diagnosed by new-onset increased blood pressure and proteinuria during gestation; for many years these markers were the sole targets for study. More recently, increased attention to the multisystemic nature of the syndrome with involvement of almost all organs, activation of coagulation and increased sensitivity to pressor agents has expanded understanding of the disorder. The epidemiology of preeclampsia, being more common in poor women, long ago suggested that nutrients might be involved in the disorder. Numerous conflicting hypotheses were advanced but the testing of these hypotheses has either been done poorly or not at all. Review of the available data indicates very few studies that provide useful insights. In many studies the syndrome is poorly defined and in most studies nutritional data (questionnaires or biomarkers) are obtained on women with the clinical syndrome. In overtly preeclamptic women it is impossible to decipher cause from effect. Nonetheless, current concepts of the genesis of preeclampsia that include endothelial dysfunction, inflammatory activation, oxidative stress and predisposing maternal factors provide targets for well-designed nutritional investigation. In this review the current concepts of the pathogenesis of preeclampsia are reviewed and available data are assessed in light of these concepts. Targets for nutritional investigation based on the current knowledge of pathophysiology are suggested.
161 citations
TL;DR: This article summarizes the experiences of research projects in Bolivia, Peru, Kenya, South Africa, and Mexico on how factors that affect participation rates in cervical cancer prevention programs are categorized.
Abstract: Strategies for introducing or strengthening cervical cancer prevention programs must focus on ensuring that appropriate, cost-effective services are available and that women who most need the services will, in fact, use them. This article summarizes the experiences of research projects in Bolivia, Peru, Kenya, South Africa, and Mexico. Factors that affect participation rates in cervical cancer prevention programs are categorized in three sections. The first section describes factors that arise from prevailing sociocultural norms that influence women's views on reproductive health, well being, and notions of illness. The second section discusses factors related to the clinical requirements and the type of service delivery system in which a woman is being asked to participate. The third section discusses factors related to quality of care. Examples of strategies that programs are using to encourage women's participation in cervical cancer prevention services are provided. This paper is available too at: http://www.insp.mx/salud/index.html.
153 citations
28 Nov 2003
TL;DR: It is argued that there is a two-way link between poverty and health in which nutrition plays an important role both as an active and as a mediating factor.
Abstract: ▪ Abstract This paper is an attempt to discuss the problem of malnutrition within the framework of the global need for development and the challenges posed by the trends of neoliberalism and globalization. We argue that there is a two-way link between poverty and health in which nutrition plays an important role both as an active and as a mediating factor. Key concepts are exposed and expanded: (a) Development per se does not ensure better health; (b) unequal distribution of income has an independent effect on health indicators after adjusting for total income; (c) improving health can make an important contribution to reducing poverty; (d ) improving nutrition throughout the whole life course is an indispensable strategy for better health; (e) obesity has to be included amongst the most critical health problems, has different traits, and presents with different challenges in the developing world and in the industrialized countries.
138 citations
TL;DR: In this paper, the association of varicella break-through with asthma, ste- roids, age at vaccination, and timing of MMR vaccination was investigated. But the association was not associated with asthma or the use of inhaled steroids.
Abstract: Objective. Varicella breakthrough, the occurrence of varicella disease >42 days after vaccina- tion, is indicative of vaccination failure. A sevenfold increased risk of breakthrough among vaccinated chil- dren with asthma was observed in a 1996 varicella out- break in a child care center. More recent outbreak inves- tigations have also identified age at vaccination as a potential risk factor for breakthrough. We assessed the association of varicella breakthrough with asthma, ste- roids, age at varicella vaccination, and timing of measles- mumps-rubella (MMR) vaccination. Methods. We performed a retrospective cohort study among children born after 1993 and followed up through 1999 at 2 health maintenance organizations ((HMOs) A and B) in the United States. Information was obtained from automated vaccination, clinic, hospital discharge, and pharmacy records. Results. We identified 268 and 97 breakthrough cases among 80 584 and 8181 children vaccinated against vari- cella at HMOs A and B, respectively. Varicella break- through was not associated with asthma, inhaled steroids prescribed at any time, and oral steroids prescribed be- fore vaccination. An increased risk of varicella break- through was found in the 3 months immediately after prescription for oral steroids at HMO A (adjusted rela- tive risk (aRR): 2.4; 95% confidence interval (CI): 1.3- 4.4) and HMO B (aRR: 2.8; 95% CI: 1.0 -7.8), when varicella vaccine was given before 15 months of age at HMO A (aRR: 1.4; 95% CI: 1.1-1.9), and when varicella vaccination followed MMR vaccine within 28 days at HMO A (aRR: 3.1; 95% CI: 1.5- 6.4). Conclusions. Varicella vaccine failure in children was not associated with asthma or the use of inhaled steroids, but with the use of oral steroids. Administration of vari- cella vaccine before the age of 15 months may be associ- ated with a slightly increased risk of breakthrough dis- ease. As currently recommended, varicella vaccination should not be administered for 28 days after MMR vaccination. Pediatrics 2003;112:e98 -e103. URL: http: //www.pediatrics.org/cgi/content/full/112/2/e98; varicella
136 citations
TL;DR: The wide geographic distribution of T. brasiliensis, its high incidence observed in some states, and its variable percentages of natural infection by T. cruzi indicate the need for sustained entomological surveillance and continuous control measures against this vector.
Abstract: To clarify the epidemiologic importance of Triatoma brasiliensis, the most important Chagas disease vector in the Northeastern of Brazil, capture data related to this species, its distribution, capture index, and percentages of natural infection by Trypanosoma cruzi were examined in 12 different Brazilian states. The Brazilian National Health Foundation collected these data from 1993 to 1999, a period during which a total of 1,591,280 triatomines (21 species) were captured in domiciles within the geographic range of T. brasiliensis. Of this total, 422,965 (26.6%) were T. brasiliensis, 99.8% of which were collected in six states, and 54% in only one state (Ceara). The percentage of bugs infected with T. cruzi varied significantly among states, ranging from 0% (Goias, Maranhao, Sergipe, and Tocantins) to more than 3% (Alagoas, Minas Gerais, and Rio Grande do Norte) with an average of 1.3%. This latter value represents a dramatic reduction in the natural infection percentages since 1983 (6.7%) suggesting that, despite the impossibility of eradicating this native species, the control measures have significantly reduced the risk of transmission. However, the wide geographic distribution of T. brasiliensis, its high incidence observed in some states, and its variable percentages of natural infection by T. cruzi indicate the need for sustained entomological surveillance and continuous control measures against this vector.
131 citations
TL;DR: This work intends to review the evidence on how the individual or collective actions of human resources are shaping the reforms, by spotlighting the reform process, the workforce reactions and the factors determining successful human resources participation.
Abstract: The relationship between health sector reform and the human resources issues raised in that process has been highlighted in several studies. These studies have focused on how the new processes have modified the ways in which health workers interact with their workplace, but few of them have paid enough attention to the ways in which the workers have influenced the reforms. The impact of health sector reform has modified critical aspects of the health workforce, including labor conditions, degree of decentralization of management, required skills and the entire system of wages and incentives. Human resources in health, crucial as they are in implementing changes in the delivery system, have had their voice heard in many subtle and open ways – reacting to transformations, supporting, blocking and distorting the proposed ways of action. This work intends to review the evidence on how the individual or collective actions of human resources are shaping the reforms, by spotlighting the reform process, the workforce reactions and the factors determining successful human resources participation. It attempts to provide a more powerful way of predicting the effects and interactions in which different "technical designs" operate when they interact with the human resources they affect. The article describes the dialectic nature of the relationship between the objectives and strategies of the reforms and the objectives and strategies of those who must implement them.
124 citations
TL;DR: The study showed elevated rates of overweight across the income level spectrum and factors such as urban development stage, income, education, and gender posed differential relationships with the risk of overweight must be considered in designing future public health interventions.
TL;DR: Follow-up care after an abnormal cytology screening in the San Marti region of Perú was very poor and could explain the lack of impact of cervical cancer screening.
TL;DR: Progress toward accelerated rubella control and CRS prevention in the English-speaking Caribbean and in Chile, Costa Rica, and Brazil is summarized and the feasibility of implementing recommended strategies and their rapid impact on disease burden is documented.
Abstract: Data from the regional measles surveillance system have documented widespread rubella virus circulation in many different countries in the Americas. In response to the ongoing endemic incidence of the disease and the potential for a major rubella epidemics in the region, the Pan American Health Organization Technical Advisory Group on Vaccine Preventable Diseases recommended the implementation of a regional initiative to strengthen rubella and congenital rubella syndrome (CRS) preventive efforts in 1997. This article summarizes and highlights the progress toward accelerated rubella control and CRS prevention in the English-speaking Caribbean and in Chile, Costa Rica, and Brazil. Useful knowledge is being generated for the adaptation of similar rubella strategies elsewhere. The findings also document the feasibility of implementing the recommended strategies and their rapid impact on disease burden.
TL;DR: Although most young people are healthy, problems indicate the importance of monitoring trends and designing effective youth health programs.
Abstract: Objectives. This study assessed youth health in the Caribbean Community and Common Market countries and describes the prevalence of health-related factors. Methods. We used a self-administered classroom questionnaire; questions addressed general health, health care, nutrition, sexual history, drug use, mental health, violence, family characteristics, and relationships with others. Results. Most youths reported good health; however, 1 in 10 reported a limiting disability or significant health problems. Violence was a pervasive concern. Of those who reported history of sexual intercourse, many reported that their first intercourse was forced, and nearly half reported that they were aged 10 years or younger when they first had intercourse. Conclusions. Although most young people are healthy, problems indicate the importance of monitoring trends and designing effective youth health programs.
TL;DR: The use of conjugate vaccine may be of potential benefit by reducing the childhood sequelae and mortality of pneumococcal infection in Brazil and the potential impact of the 7- and 9-valent conjugated vaccines on children up to age 5 years with severe pneumitis.
Abstract: The distribution of pneumococcal serotypes in Brazil was analyzed by age group and clinical diagnosis, using data obtained during 20 years of national surveillance. Serotypes 1 and 5 remained among the main serotypes in all age groups, increasing in frequency with age. Serotype 14 was prevalent among children, whereas serotypes 3 and 4 were most prevalent among the adult population. The potential impact of the 7- and 9-valent conjugate vaccines on children up to age 5 years with severe pneumococcal diseases was 58.2% and 73%, respectively; the highest coverage of the 7-valent vaccine for pneumonia was achieved for children aged 7 months to 2 years (70%), whereas, for meningitis, it was observed for children aged 7 months to 5 years (58.6%). The use of conjugate vaccine may be of potential benefit by reducing the childhood sequelae and mortality of pneumococcal infection in Brazil.
TL;DR: Risk factors found to be significantly associated with ACL were related to indoor transmission, peridomestic transmission, and human behavior.
Abstract: A case-control study was carried out during 1990-1994 to identify risk factors associated with American cutaneous leishmaniasis (ACL) in Santiago del Estero, Argentina. The study subjects consisted of 171 cases and 308 controls matched by age, sex, and place of residence. The analysis was performed by conditional logistic regression. Risk factors found to be significantly associated with ACL were related to indoor transmission (few rooms in the house, dirt floor, and a permanent opening in lieu of a window); peridomestic transmission (presence of a pond or woodland within 150 m of the house and an agricultural area within 200 m of the house); and human behavior (sleeping in the backyard, collecting water, bathing, and performing agricultural activities). Most transmission appears to have occurred indoors and in the peridomicile. These environments should be included in further research and control policies.
TL;DR: The strategy to exploit the genomic sequence of P. falciparum for malaria vaccine development is presented, working towards the development of a new generation vaccine based on the presumption that duplicating the protection induced by the whole organism may require a vaccine nearly as complex as the organism itself.
Abstract: Recent advances in the fields of genomics, proteomics and molecular immunology offer tremendous opportunities for the development of novel interventions against public health threats, including malaria. However, there is currently no algorithm that can effectively identify the targets of protective T cell or antibody responses from genomic data. Furthermore, the identification of antigens that will stimulate the most effective immunity against the target pathogen is problematic, particularly if the genome is large. Malaria is an attractive model for the development and validation of approaches to translate genomic information to vaccine development because of the critical need for effective anti-malarial interventions and because the Plasmodium parasite is a complex multistage pathogen targeted by multiple immune responses. Sterile protective immunity can be achieved by immunization with radiation-attenuated sporozoites, and anti-disease immunity can be induced in residents in malaria-endemic areas. However, the 23 Mb Plasmodium falciparum genome encodes more than 5300 proteins, each of which is a potential target of protective immune responses. The current generation of subunit vaccines is based on a single or few antigens and therefore might elicit too narrow a breadth of response. We are working towards the development of a new generation vaccine based on the presumption that duplicating the protection induced by the whole organism may require a vaccine nearly as complex as the organism itself. Here, we present our strategy to exploit the genomic sequence of P. falciparum for malaria vaccine development.
TL;DR: As of January 2003, no known indigenous measles transmission had occurred in the Region since November 2002, due to high political commitment and implementation of PAHO's recommendations, including strengthened supervision and monitoring to improve accountability at the local level.
Abstract: Since 1994, when the goal of interrupting indigenous measles transmission was adopted, important progress has been made toward the control of measles in the Americas. Thirty-nine (95%) of 41 countries reporting to the Pan American Health Organization (PAHO) conducted catch-up vaccination campaigns during 1989-1995 and follow-up measles campaigns every 4 years. Routine (keep-up) vaccination coverage in the Region increased from 80% in 1994 to 94% in 2000. Measles vaccination coverage ranged between 75% and 99% in 2000 and between 53% and 99% in 2001. As a result, in 2001, the total number of confirmed measles cases reached a record low of 537, 99% lower than the number reported in 1990. In 2002, only Venezuela and Colombia had known indigenous transmission. As of January 2003, no known indigenous measles transmission had occurred in the Region since November 2002. This is due to high political commitment and implementation of PAHO's recommendations, including strengthened supervision and monitoring to improve accountability at the local level.
TL;DR: BIDS demonstrates that a binational effort with local, state, and federal participation can create a regional surveillance system that crosses an international border and reduces administrative, infrastructure, and political barriers to cross-border public health collaboration.
Abstract: In 1997, the Centers for Disease Control and Prevention, the Mexican Secretariat of Health, and border health officials began the development of the Border Infectious Disease Surveillance (BIDS) project, a surveillance system for infectious diseases along the U.S.-Mexico border. During a 3-year period, a binational team implemented an active, sentinel surveillance system for hepatitis and febrile exanthems at 13 clinical sites. The network developed surveillance protocols, trained nine surveillance coordinators, established serologic testing at four Mexican border laboratories, and created agreements for data sharing and notification of selected diseases and outbreaks. BIDS facilitated investigations of dengue fever in Texas-Tamaulipas and measles in California–Baja California. BIDS demonstrates that a binational effort with local, state, and federal participation can create a regional surveillance system that crosses an international border. Reducing administrative, infrastructure, and political barriers to cross-border public health collaboration will enhance the effectiveness of disease prevention projects such as BIDS.
TL;DR: The results suggest that E4rec expressed in P. pastoris can provide partial protection against viremia, however, the results were not effective enough to use it as a vaccine candidate.
Abstract: A recombinant vaccine that expresses the envelope (E) gene of dengue virus type 4 was tested for immunogenicity and protection in Macaca fascicularis. One hundred micrograms of semipurified recombinant E protein (E4rec) expressed in Pichia pastoris was used to immunize three animals. Neutralizing antibodies to dengue 4 virus with a titer of 1:30 were detected in all immunized monkeys prior to challenge. Animals were challenged with 10(5) plaque-forming units of dengue 4 virus. One vaccine-immunized monkey was protected from viremia, while the other two were partially protected. Monkeys immunized with E4rec elicited the highest neutralizing antibody titers (P < 0.05) ranging from 1:85 to 1:640 at day 30. In both immunized and control animals, the longest duration of viremia correlated with earliest and highest level of IgM antibody to dengue virus. The vaccinated animals showed anamnestic antibody responses upon virus challenge, indicating successful priming by the recombinant vaccine. Our results suggest that E4rec expressed in P. pastoris can provide partial protection against viremia. However, the results were not effective enough to use it as a vaccine candidate. Further work is required to improve the quality of the immunogen.
TL;DR: The authors examine developments vis-à-vis the characteristics of the Latin American and the Caribbean health-sector organizational preparedness and technological infrastructure, and propose policy and organizational actions to foster the development of eHealth solutions in the region.
Abstract: This paper reviews trends and issues in health and in the information and communication technologies (ICT) market as they relate to the deployment of eHealth solutions in Latin America and the Caribbean. Heretofore designed for industrialized countries and large organizations, eHealth solutions are being proposed as an answer to a variety of health-system management problems and health care demands faced by all health organizations including those in developing societies. Particularly, eHealth is seen as especially useful in the operational support of the new health care models being implemented in many countries. The authors examine those developments vis-a-vis the characteristics of the Latin American and the Caribbean health-sector organizational preparedness and technological infrastructure, and propose policy and organizational actions to foster the development of eHealth solutions in the region.
TL;DR: Overall, a similar pattern of prevalence and risk factors for mental health problems in children and adolescents in Latin American countries emerged, and rates of disorders in these children are similar to the 15 to 20% found in other countries.
Abstract: Objective:This report reviews population studies of child and adolescent mental health carried out in Latin America over the past 15 years. Also considered is the issue of how to meet the needs of children and adolescents who may present mental health problems in Latin America, given that most of them live in poverty in economies that are underdeveloped, providing limited resources.Method:Ten studies from six different countries were identified that employed some form of randomized sampling method and used standardized instruments for assessment. The authors present a summary of the main characteristics of these studies, highlighting methodological features that may account for differences in the rates obtained.Results:Overall, a similar pattern of prevalence and risk factors for mental health problems in children and adolescents in Latin American countries emerged. Moreover, rates of disorders in these children are similar to the 15 to 20% found in other countries. These findings are similar to those obs...
TL;DR: Targeting MR vaccination appropriately and using the opportunity to strengthen surveillance for rash illness has benefits beyond accelerated rubella control and CRS prevention, including strengthening of the measles eradication program.
Abstract: In 2000, Costa Rica set a goal for accelerated rubella control and congenital rubella syndrome (CRS) prevention in conjunction with its established measles eradication goal. To achieve this goal, a National Plan of Action for the integration of a measles-rubella (MR) vaccination strategy was implemented. The components of the national plan included conducting a national vaccination campaign with a single dose of MR vaccine for men and women aged 15-39 years, establishing routine postpartum MR vaccination of all previously unvaccinated women, maintaining high coverage among children with two doses of measles-mumps-rubella vaccine, strengthening the integrated measles and rubella surveillance system, and developing a CRS surveillance system. This report summarizes the results of a successful adult campaign. Targeting MR vaccination appropriately and using the opportunity to strengthen surveillance for rash illness has benefits beyond accelerated rubella control and CRS prevention, including strengthening of the measles eradication program.
TL;DR: Information is provided on how to improve the nutritional formulations of fortified complementary foods and the necessary conditions for a market approach to their production and promotion.
Abstract: Large numbers of infants and young children suffer from the short- and long-term health effects of poor breastfeeding and complementary feeding practices. Strategies to improve the availability of and access to low-cost fortified complementary foods can play an important corresponding role to that of behavior change in improving nutritional status of young children. However, the nutritional quality of complementary foods used in publicly funded programs is not always optimal, and such programs are costly and reach only a tiny fraction of those who could benefit. To broadly reach the target population, such foods need to be commercially available at affordable prices and promoted in a way that generates demand for their purchase. A sensible long-term policy for the promotion of low-cost fortified complementary foods calls for attention to their nutritional formulations and cost, the economics of production, and the legislative, regulatory, and competitive framework in which marketing occurs. This paper provides information on how to improve the nutritional formulations of fortified complementary foods and outlines the necessary conditions for a market approach to their production and promotion.
TL;DR: Risks posed by the importation of vaccinated animals becomes negligible when an adequate protocol--in compliance with the norms and recommendations of the Terrestrial Code--is applied, however, recently, export of live animals from countries that do not practise vaccination has also proven to pose a significant risk and the rules governing such transport may have to be reviewed.
Abstract: The Terrestrial Animal Health Code of the OIE (World organisation for animal health) (the Terrestrial Code) makes recommendations for international movements of live animals and animal products because of a possible generic risk of foot and mouth disease (FMD) for these different commodities. For instance, international movement of vaccinated live animals or products of such animals is restricted due to the possible masking of clinical disease as a result of vaccination and to the perceived risk of persistently infected animals among vaccinated livestock. In addition, bilateral agreements between exporting and importing countries on the importation of animal products can be based on the 'equivalence' of the animal health conditions in both countries, or on formal or informal risk assessments in accordance with the norms and recommendations of the Terrestrial Code. In this regard, an exporting country may be required to prepare a complete and transparent document describing the animal health situation, including the factors required to assess the risk involved. Furthermore, expert committees of importing countries regularly evaluate and verify these conditions in exporting countries. The level of confidence in the information obtained by the expert committee can then be entered into the risk analysis equation. An important FMD risk reduction factor for the importation of animals and animal products is early recognition of the disease at the source of the commodity by alert stakeholders, such as official and private veterinarians and the chain of the livestock industry. This is true for all countries irrespective of their vaccination status. The risk posed by the importation of vaccinated animals becomes negligible when an adequate protocol--in compliance with the norms and recommendations of the Terrestrial Code--is applied. However, recently, export of live animals from countries that do not practise vaccination has also proven to pose a significant risk and the rules governing such transport may have to be reviewed. Disease surveillance, biosecurity at the farm level, traceability and control of the source cattle and slaughterhouse inspections are the main risk reduction measures for meat and meat products from vaccinated cattle. If these animals are slaughtered and processed under good management practice--in accordance with the norms and recommendations of the Terrestrial Code--these products present a negligible risk for the introduction of FMD. Risk reduction by maturation and deboning is an important procedure, but is probably overemphasised. Mechanical contamination of cattle carcasses with 'carrier virus' from the pharyngeal area during slaughter and processing is very unlikely. Risk assessments showed that the importation of milk products from countries or zones that practise vaccination of dairy herds poses a negligible risk. Risk assessments also demonstrated that the importation of bovine embryos from vaccinated cows--in accordance with the norms and recommendations of the Terrestrial Code--poses a negligible risk. Likewise, the risk from the importation of semen from vaccinated bulls is also negligible when an adequate test protocol is applied in accordance with the Terrestrial Code.
TL;DR: Current data suggest interruption of indigenous measles transmission in Brazil, and the last outbreak occurred in February 2000, with 15 cases.
Abstract: In 1992, Brazil adopted the goal of measles elimination by the year 2000; however, in 1997, after a 4-year period of good control, there was a resurgence of measles in Brazil. In 1999, to achieve the elimination goal, Brazil implemented the Supplementary Emergency Measles Action plan, with one measles surveillance technician designated to each state. Of 10,007 suspected measles cases reported during 1999, 908 (9.1%) were confirmed, and of them 378 (42%) were confirmed by laboratory analysis. Of 8358 suspected measles cases reported in 2000, 36 (0.4%) were confirmed (30 [83%] by laboratory); 92% of the discarded cases were classified on the basis of laboratory testing. In 2001, only 1 of 5599 suspected measles cases was confirmed, and it was an imported case from Japan. The last outbreak occurred in February 2000, with 15 cases. Current data suggest interruption of indigenous measles transmission in Brazil.
TL;DR: If the department of Jutiapa is to be freed and kept free from domestic infestation, the efficacy of the insecticide spraying needs to be improved, spraying techniques need to be reviewed, and insecticides need to been re-applied at regular intervals.
Abstract: In 2000, a national control operation against the triatomine vectors of Trypanosoma cruzi, based on house spraying with residual pyrethroid insecticides, was initiated in Guatemala The impact of the operation against Triatoma dimidiata in the most heavily infested department, Jutiapa, was evaluated by pre- and post-spraying surveys of the vector populations Of the houses checked for Tri dimidiata in the baseline surveys, 183% were found to be infested with the bug, and in 121% of the villages investigated more than half of the houses were found to be infested The later survey was conducted after 24,250 houses and their associated peridomestic structures (in the 336 villages in which >5% of the houses had been found infested in the pre-spraying survey) had been sprayed As a result of just this one round of spraying, the mean percentage of houses found infested in each of the villages surveyed twice fell from 360% to 89% After the spraying, the percentage of houses infested in each sprayed
TL;DR: Regular, moderate physical activity, including dailyactivities such as climbing stairs, brisk walking, and biking, can reduce stress,leviate depression and anxiety, enhance self-esteem, and increase mentalalertness.
Abstract: The health benefits of regular participation in sports and aerobic fitness havebeen well recognized for more than 30 years. However, over the past decadenew scientific evidence has shown that physical activity need not be strenu-ous to be beneficial to health. In fact, 30 minutes of moderate-intensity physi-cal activity every day or on most days of the week provides important healthbenefits. This modest but regular amount of activity can greatly reduce or pre-vent the risk of cardiovascular disease, type 2 diabetes, osteoporosis, coloncancer, and breast cancer. Regular, moderate physical activity, including dailyactivities such as climbing stairs, brisk walking, and biking, can reduce stress,alleviate depression and anxiety, enhance self-esteem, and increase mentalalertness (1). Moreover, school-age children who are regularly active demon-strate enhanced school performance and a better sense of personal and socialresponsibility than those who are more sedentary (2).Most of those health benefits have been widely publicized and tosome extent enjoy popular recognition. Nevertheless, sedentary lifestyles arepredominant in most urban areas worldwide. Indeed, inactivity constitutes animportant risk factor behind the epidemic rates of noncommunicable diseases(NCDs). In its
TL;DR: For individuals who are probably more immune, CMT was found to be a poor predictor of increased risk of subsequent malaria, although for individuals who had experienced their first malaria episode more than 4.5 years previously or those with few or no malaria episodes during the last 2‰years, this finding is surprising.
Abstract: The objective of this study was to describe the association between self-reported compliance with last malaria treatment (CMT) and occurrence of malaria during follow-up, controlling for current risk factors. We conducted a prospective open cohort study in Leonislândia, a rural area of Peixoto de Azevedo City, in the Amazon region of Mato Grosso, Brazil. A total of 414 individuals were interviewed at baseline regarding CMT and followed-up for either 8 or 4 months to assess malaria incidence. The associations between CMT and occurrence of malaria were examined through multiple linear regression (when the outcome was malaria episode frequency) or Cox regression (when the outcome was time to malaria onset). Poor CMT (prior to baseline) was identified as an important predictor of the occurrence of subsequent malaria episodes during follow-up among individuals with an indication of being less immune - those whose first malaria episode was relatively recent or those who had an increased number of malaria episodes during the last 2 years. Moreover, surprisingly, it seems that for individuals who are probably more immune (individuals who had experienced their first malaria episode more than 4.5 years previously or those with few or no malaria episodes during the last 2 years), CMT was found to be a poor predictor of increased risk of subsequent malaria. These findings provide compelling evidence for the need to further study CMT and its effect on malaria outcomes.
TL;DR: In this article, the authors present for countries and territories of the Region of the Americas data on the number of blood donations, proportion of voluntary blood donors versus remunerated blood donors, coverage of screening for infectious agents, and separation of donated blood into its components.
Abstract: OBJECTIVES: This article has two objectives: (1) to present for countries and territories of the Region of the Americas data on the number of blood donations, proportion of voluntary blood donors versus remunerated blood donors, coverage of screening for infectious agents, and separation of donated blood into its components and (2) to explore the relationships of those characteristics with economic and organizational factors in the countries and territories. METHODS: We carried out comparative analyses using population and health information gathered annually by the Pan American Health Organization (PAHO) from national health officials from the countries in the Americas, as well as economic information (gross national product (GNP) per capita) obtained from publications of the World Bank. RESULTS: There is a direct correlation between the availability of blood for transfusion and GNP per capita. Seven countries with a GNP per capita above US$ 10 000 per year account for 38% of the Regional population but 68% of the Regional blood donations. Voluntary blood donation is more common in the countries with better blood availability. There is no association between GNP per capita and coverage of screening for infectious agents. Nevertheless, of the six countries with a GNP per capita below US$ 1 000, only one of the six screens all units for human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B surface antigen (HBsAg). Countries with a higher proportion of voluntary blood donors tend to have lower prevalence rates of infectious markers. Separation of blood into its components is also more common in countries with higher blood donation rates. CONCLUSIONS: The availability, safety, and quality of blood for transfusion in the Americas needs to be improved. As part of that effort, national policies and strategies must be put into place so that the resources already allocated for blood services are better utilized.