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Showing papers in "Revista Panamericana De Salud Publica-pan American Journal of Public Health in 2003"



Journal Article
TL;DR: This book discussesoonoses and communicable diseases common to man and animals, and their links to infectious diseases in humans and animals.

409 citations


Journal ArticleDOI
TL;DR: The prevalence of adult LTPA in Brazil was much lower than the levels that have been reported for developed countries, and there was a strong association between LTPA and socioeconomic status, measured either by income or schooling, independent of age, region, and urban or rural place of residence.
Abstract: OBJECTIVES: To describe the prevalence, frequency, type, motivation for, and demographic and socioeconomic distribution of leisure-time physical activity (LTPA) among adults in Brazil. METHODS: The data source for our study was the Brazilian Living Standards Measurement Survey (LSMS) (Pesquisa sobre Padroes de Vida), which was conducted in 1996 and 1997. This survey studied a multistage stratified probabilistic sample of 4 893 households, which included 11 033 persons who were 20 years of age or older. The surveyed households were selected in the two most populous Brazilian regions, the Northeast and the Southeast, where in total 70% of all Brazilians live. The selected persons responded to a series of questions concerning their leisure-time physical activities. RESULTS: Only 13% of the Brazilians surveyed reported performing at least a minimum of 30 minutes of LTPA on one or more days of the week, and only 3.3% reported doing the recommended minimum of 30 minutes on 5 or more days of the week. In younger age groups, men were more active than were women. However, this difference sharply decreased with increasing age, and by the age range of 40 to 45 years the prevalence of LTPA was similarly low in both genders. Men reported engaging in more team sports, and women reported more walking/jogging activities, but walking/jogging was relatively more common in both genders when physical activity was performed on 5 or more days of the week. Recreation was by far the leading reason given by men to engage in LTPA, while recreation, health concerns, and even esthetic concerns were all relevant for women. In both genders, health concerns tended to be relatively more important for those exercising more days of the week. Also in both genders, increasing age was associated with more frequent LTPA, more walking/jogging than team sports, and more health concerns reasons than reasons related to recreation. Among both men and women there was a strong association between LTPA and socioeconomic status, measured either by income or schooling, independent of age, region, and urban or rural place of residence. CONCLUSIONS: The prevalence of adult LTPA in Brazil was much lower than the levels that have been reported for developed countries. However, the demographic and social distribution of LTPA in Brazil followed a pattern similar to the one usually observed in developed nations, where men tend to be more active than women, increasing age limits LTPA, and higher socioeconomic status is associated with more LTPA. Our data will provide a baseline to evaluate the impact on LTPA of "Agita Brasil" ("Move, Brazil"), an initiative to encourage physical activity that was implemented in the country after 1997.

384 citations


Journal ArticleDOI
TL;DR: Organophosphate pesticides continue to pose a risk to human health in the United States and among the public there should be an increased awareness of environmental exposure to organophosphates as well as of the threat of chemical warfare or terrorism.
Abstract: OBJECTIVE: To review the public health significance of organophosphate pesticide exposure in the United States of America. Since the situation of high organophosphate pesticide exposure and the concomitant health risks in the developing countries of the world is well known, this article seeks to highlight the public health significance of organophosphate exposure in the United States, where it is less common than in many other nations. Looking at the situation in the United States would serve to further emphasize the seriousness of organophosphate pesticide-related health issues in developing countries. METHODS: A search for journal articles on organophosphate pesticides and organophosphate exposure was done on the PubMed electronic bibliographic database system of the National Library of Medicine of the United States. To supplement that search, information on organophosphate toxicity, biological monitoring, and regulation of pesticides was obtained from other published articles, textbooks, and relevant Internet sites. RESULTS: Organophosphate pesticides are a group of chemicals that are mainly used in agriculture. Organophosphates inhibit the activity of both the cholinesterase (ChE) enzymes-red blood cell (RBC) ChE and serum ChE-resulting in the cholinergic features of organophosphate toxicity. A 50% reduction in serum ChE activity from the baseline is an indication of acute organophosphate toxicity. The RBC ChE activity, which is less rapidly depressed than the serum ChE activity, is a measure of chronic exposure to organophosphates. Exposures to organophosphates are broadly classified into two categories: occupational and environmental. Occupational exposures occur among agricultural workers (including migrant farmworkers), industrial workers, pest control exterminators, and other workers. Nonoccupational exposure affects a large segment of the general population in the United States. Residential exposures come from organophosphate pesticide use by exterminators and by household residents as well as from dietary and accidental exposures. Other environmental exposures occur in public places and areas close to farms, and exposures could also happen from organophosphate use in chemical warfare or terrorism. In the United States some organophosphate pesticides are restricted by the Environmental Protection Agency in order to protect humans, animals, and the environment. In addition, the Food Quality Protection Act regulates dietary exposure to pesticides, particularly for infants and children. CONCLUSIONS: Organophosphate pesticides continue to pose a risk to human health in the United States. Biological monitoring should be used to strictly regulate occupational exposures to organophosphates and thus protect the health and safety of workers. Among the public there should be an increased awareness of environmental exposure to organophosphates as well as of the threat of chemical warfare or terrorism.

242 citations


Journal ArticleDOI
TL;DR: The introduction of rubella vaccine is cost-effective and cost-beneficial but requires ongoing strengthening of routine immunization services and surveillance systems.
Abstract: Worldwide, it is estimated that there are more than 100 000 infants born with congenital rubella syndrome (CRS) each year. In 1998, standard case definitions for surveillance of CRS and rubella were developed by the World Health Organization (WHO). In 2001, 123 countries/territories reported a total of 836 356 rubella cases. In the future more countries are expected to report on rubella as a global measles/rubella laboratory network is further developed under the coordination of the WHO. Operational research is being conducted to improve rubella surveillance. This includes projects on initiating CRS surveillance, comparative studies on diagnostic laboratory methods, and molecular epidemiology research to expand the global understanding of patterns of rubella virus circulation. In 1996 a WHO survey found that 78 of 214 reporting countries/territories (36%) were using rubella vaccine in their routine immunization services. By the end of 2002 a total of 124 of the 214 counties/territories (58%) were using rubella vaccine. Rubella vaccine use varies by stage of economic development: 100% for industrialized countries, 71% for countries with economies in transition, and 48% for developing countries. A safe and effective rubella vaccine is available, and there are proven vaccination strategies for preventing rubella and CRS. A WHO position paper provides guidance on programmatic aspects of rubella vaccine introduction. The introduction of rubella vaccine is cost-effective and cost-beneficial but requires ongoing strengthening of routine immunization services and surveillance systems.

205 citations


Journal ArticleDOI
TL;DR: In this article, the prevalencia de ocho problemas neurologicos (migrana, enfermedad cerebrovascular, Parkinson, neuropatia periferica, trastornos del desarrollo neurologico, epilepsia, demencia and traumatismo craneoencefalico) in Colombia was determined as parte del estudio neuroepidemiology nacional (EPINEURO).
Abstract: OBJETIVO: Determinar la prevalencia de ocho problemas neurologicos -migrana, enfermedad cerebrovascular, enfermedad de Parkinson, neuropatia periferica, trastornos del desarrollo neurologico, epilepsia, demencia y secuelas de traumatismo craneoencefalico- en Colombia como parte del estudio neuroepidemiologico nacional (EPINEURO). METODOS: Se realizo una encuesta transversal en dos fases entre septiembre de 1995 y agosto de 1996. En la primera fase se identifico a las personas que podian estar padeciendo alguna enfermedad neurologica y en la segunda se hizo el diagnostico especifico. Se examino una muestra de 8 910 personas distribuidas en proporcion con la poblacion de cada una de las cinco zonas geograficas de Colombia, que son las regiones central, sudoccidental, noroccidental, oriental y la costa caribe. La evaluacion se realizo segun una version modificada del protocolo de neuroepidemiologia de la Organizacion Mundial de la Salud, ademas de un examen fisico simplificado. A los posibles pacientes de demencia identificados se les aplico un examen neuropsicologico, disenado para este estudio, con el fin de profundizar en los aspectos cognoscitivos. Se aplicaron las escalas de Hachinski, Yesavage y Blessed y los criterios diagnosticos del NINCDS-ADRDA para la enfermedad de Alzheimer, los del NINDS-AIREN para la demencia de origen vascular y los del DSM-IV para todo tipo de demencia. Se realizo una encuesta para determinar si habia secuelas de traumatismo craneoencefalico. Las personas mayores de 12 anos fueron evaluadas por neurologos de adultos y los menores de 12 anos por un neuropediatra. Se calcularon las prevalencias de trastornos neurologicos por edad y sexo, tanto por region como para el pais en su totalidad, y sus intervalos de confianza de 95%. RESULTADOS: La prevalencia por 1 000 habitantes de los trastornos investigados fueron las siguientes: migrana, 71,2 (intervalo de confianza de 95% [IC95%]: 65,5 a 76,8); trastornos del desarrollo neurologico, 46,1 (IC95%: 35,5 a 58,9); enfermedad cerebrovascular, 19,9 (IC95%: 14,3 a 27,4); demencia, 13,1 (IC95%: 8,5 a 19,3); epilepsia, 10,3 (IC95%: 8,5 a 13,0); neuropatia periferica, 8,5 (IC95%: 6,8 a 10,7); secuelas de traumatismo craneoencefalico, 6,4 (IC95%: 5,0 a 7,8) y enfermedad de Parkinson 4,7 (IC95%: 2,2 a 8,9). En todos los casos, menos en el de traumatismos craneoencefalicos, la prevalencia fue mayor en mujeres. CONCLUSIONES: Estos resultados permiten disenar politicas de salud mas actuales dirigidas a lograr una prevencion mas eficaz, un mejor control y un tratamiento mas adecuado de los trastornos neurologicos en Colombia. La facil aplicacion de las encuestas y el bajo costo de este tipo de investigaciones hacen que esta metodologia sea ideal para paises con carencia de recursos humanos especializados.

144 citations


Journal ArticleDOI
TL;DR: O habito de fumar entre irmaos e amigos foi o principal fator de risco para tabagismo na adolescencia, y o baixo rendimento escolar, a idade mais avancada, o sexo masculino, o trabalho remunerado e a separacao dos pais tambem foram identificados como fatores of risco.
Abstract: OBJETIVO: Descrever a prevalencia do tabagismo em adolescentes e os fatores associados ao tabagismo nesse grupo etario na America do Sul. METODOS: Foram pesquisadas as bases de dados MEDLINE (1966-2002) e Literatura Latino-Americana e do Caribe em Ciencias da Saude ("Lilacs") (1982-2002), alem de documentos governamentais e nao-governamentais e sites na Internet. Foram identificados 315 artigos, dos quais 45 foram considerados relevantes para o presente trabalho. RESULTADOS: Em todos paises estudados, foi grande a variacao nos niveis de prevalencia; tal variacao dependeu, em parte, do grupo etario enfocado e da definicao de fumante utilizada no estudo. O habito de fumar entre irmaos e amigos foi o principal fator de risco para tabagismo na adolescencia. O baixo rendimento escolar, a idade mais avancada, o sexo masculino, o trabalho remunerado e a separacao dos pais tambem foram identificados como fatores de risco. CONCLUSAO: Sao necessarios mais estudos de base populacional representativos dessa faixa etaria e criterios uniformes para definir os fumantes.

137 citations


Journal ArticleDOI
TL;DR: The Agita Sao Paulo Program as mentioned in this paper has been widely copied throughout Brazil and in other countries of Latin America, and the World Health Organization has characterized it as a model for other developing countries.
Abstract: The "Agita Sao Paulo" Program applies a multilevel intervention approach to promoting physical activity among the 37 million inhabitants of the state of Sao Paulo, Brazil. The verb "agita" means to move the body, but the term also suggests changing the way of thinking and becoming a more active citizen. Since being launched in 1996, the Program has been widely copied throughout Brazil and in other countries of Latin America, and the World Health Organization has characterized it as a model for other developing countries. The Program aims to disseminate a clear and simple message to the community as well as establish partnerships with governmental and nongovernmental organizations and other entities. The Agita Sao Paulo message encourages people to adopt an active lifestyle by accumulating at least 30 minutes of moderate physical activity per day, on most days of the week. The Program has three main target groups: students, workers, and the elderly. The Program organizes "mega-events" that simultaneously reach and involve large numbers of people, and it also conducts ongoing activities with institutions that become partners of the Program. Intervention studies that the Program has carried out on specific, small groups have found both changes in behavior and an increasing awareness of the Program's name and message. In addition, surveys have found that a growing number of persons in the state of Sao Paulo have become aware of the Program and its message and have changed their physical activity level. A number of the special features of and lessons learned from the Agita Sao Paulo Program may have contributed to its success, including: a multisectorial approach; broad use of partnerships; the inclusion principle (avoiding messages or attitudes that might exclude any social group); the scientific basis for all the Program activities; the extensive free media coverage that the Program has received; a "two-hats" approach, using either governmental or nongovernmental methodologies to promote physical activity, depending on the circumstances; cultural adaptation (using local culture to disseminate the message and make its assimilation easier); encouraging activities that are pleasurable; the clear, simple, feasible message of promoting physical activity; and evaluation of the various Program efforts. These distinctive characteristics help make the Agita Sao Paulo Program a model that could be used in other countries as an effective way to promote health through physical activity.

130 citations


Journal ArticleDOI
TL;DR: This thorough revision contains new chapters on bioterrorism and emergency preparedness and new additions in epidemiology include anthrax and SARS.
Abstract: Introduction to Public Health, Fourth Edition offers a thorough, accessible overview of the expanding field of public health for students new to its concepts and actors. Written in engaging, nontechnical language, this best-selling text explains in clear terms the multi-disciplinary strategies and methods used for measuring, assessing, and promoting public health. Packed with illustrative real-world examples, this updated edition provides students with informative discussions of the current technical issues and practical obstacles facing public health practitioners and policymakers alike. Through coverage of new approaches to research and data collection, current best practices in the field, and the social and ethical challenges of devising public policy, Introduction to Public Health, Fourth Edition provides readers with a broad-reaching, practical framework for understanding the multifaceted forces and organizations of today's public health enterprise.

111 citations


Journal ArticleDOI
TL;DR: The elderly appear to be more likely than youth and younger adults to develop severe illness when infected with the dengue virus, in a pattern similar to that of infants.
Abstract: Objective. Severe dengue affects all age groups in the Americas, but little detailed information is available about this disease in the elderly. The objective of this article is to describe the disease in this age group. Methods. We reviewed suspected dengue-case investigation forms submitted with diagnostic samples as well as clinical reports from infection control nurses in Puerto Rico, for the period of 1994 through 1999. Results. We assigned the laboratory-positive case-patients to four age groups: infants (1 year: 554), youth (2 to 18 years: 6 857), adults (19 to 64 years: 9 433), and elderly (≥ 65 years: 822). Regardless of infecting serotype, the elderly were more likely to have been hospitalized (48% vs. 33%) (P < 0.01) and were less likely to show hemorrhage (26% vs. 33%) (P < 0.01). On multivariate analysis, controlling for gender and the presence of hemorrhage, the elderly had a higher risk for hospitalization and death than did the youths and the adults. Conclusions. The elderly appear to be more likely than youth and younger adults to develop severe illness when infected with the dengue virus, in a pattern similar to that of infants. The clinical evaluation of elderly patients with dengue must include a careful assessment of increased capillary permeability and occult hemorrhage in order to avoid complications from delayed identification and treatment of severe dengue infection. These findings are of increasing importance for dengue epidemiology and medical care in view of the expanding nature of dengue and dengue hemorrhagic fever in a world that also has a growing number and proportion of elderly persons. Dengue, aged, Puerto Rico.

102 citations


Journal ArticleDOI
TL;DR: The results indicate that town-level indices of socioeconomic status are significantly correlated with caries indices and emphasize the beneficial effect that fluoridating water has on reducing the prevalence of dental caries.
Abstract: OBJECTIVE: To investigate the association between dental caries among children in the state of Sao Paulo, Brazil, and town-level indices of socioeconomic development. METHODS: We examined 15 385 oral-examination records from children aged 5 or 6 years old from 129 towns and cities in the state of Sao Paulo. We studied two outcomes: (1) the mean number of decayed, missing, and filled deciduous teeth (dmft index) and (2) the care index, which is the proportion of decayed teeth that have already been filled. The explanatory variables were the child development index, human development index, illiteracy rate among subjects older than 20 years, household income, Gini coefficient, insufficient income, fluoridated water supply, number of dentists per 10 000 inhabitants, number of dentists in the public service per 10 000 inhabitants, and number of weekly hours of dentist work in the public service per 10 000 inhabitants. Multiple linear regression models were fitted to the two outcome variables (dmft index and care index). RESULTS: The multiple linear regression analysis showed that a higher dmft index was associated with a low child development index, a high illiteracy rate, and an unfluoridated water supply. The child development index was significantly associated with the care index, and the number of dentists in the public service per 10 000 inhabitants showed borderline statistical significance. CONCLUSIONS: Our results indicate that town-level indices of socioeconomic status are significantly correlated with caries indices. Our results also emphasize the beneficial effect that fluoridating water has on reducing the prevalence of dental caries and the fact that strategies for treating and preventing oral diseases should be emphasized within the context of overall health promotion for children.


Journal ArticleDOI
TL;DR: RSA is limited in the urban areas of Peru, and this low RSA level is a challenge for public health, and it confirms the need for promoting active lifestyles.
Abstract: OBJETIVOS: Determinar la frecuencia de la actividad deportiva en la poblacion urbana del Peru e identificar los factores sociodemograficos, economicos y ambientales asociados con ella. METODOS: Se utilizo la informacion recogida por la Encuesta Nacional de Hogares del segundo trimestre del ano 1997, Peru (ENAHO 97-II), a cargo del Instituto Nacional de Estadistica e Informatica del Peru. ENAHO-97 se baso en un muestreo probabilistico, multietapico y estratificado de todo el territorio nacional urbano dividido en ocho regiones geograficas: Lima metropolitana, costa norte, costa centro, costa sur, sierra norte, sierra centro, sierra sur y selva. En total se visitaron 14 913 hogares y fueron entrevistadas 45 319 personas de 15 anos o mayores. La informacion sobre la frecuencia de la practica deportiva fue clasificada en diaria, interdiaria (en dias alternos), semanal u ocasional. La actividad deportiva regular (ADR) se definio como la practica de cualquier deporte con una frecuencia diaria o interdiaria. Ademas se examinaron las preferencias y obstaculos para la practica deportiva. Se realizo un analisis descriptivo de los niveles de ADR segun el sexo mediante la prueba de ji al cuadrado. Se analizaron los factores asociados con la ADR mediante regresion logistica multiple condicional y analisis de residuos, multicolinearidad e interacciones. El nivel de significacion utilizado fue de 0,05. RESULTADOS: La practica de deportes al menos una vez a la semana y de ADR fue mayor entre los hombres (44,5 y 12,8%, respectivamente) que ente las mujeres (32,4 y 10,5%). El grupo de edad en que hubo una mayor practica de ADR fue el de 5055 anos en los hombres (20%) y el de 4045 anos en las mujeres (18%). Se encontro que en la zona de la selva, sierra centro y costa centro se practica mas deporte (15,3, 12,8 y 12,1%, respectivamente), mientras que en Lima metropolitana y sierra sur se observan los valores mas bajos (10,6 y 9,7%, respectivamente). El nivel de ingresos no mostro asociacion con la practica de ADR, aunque otras variables asociadas indirectamente con el nivel socioeconomico -como el mayor nivel educacional, tener empleo y tener acceso a Internet o a television por cable- y el consumo de informacion deportiva estuvieron significativa y directamente asociados con la practica de ADR. Las barreras mas frecuentes para la practica del deporte fueron la falta de tiempo y de infraestructura y el desinteres de la poblacion. La practica de ADR por parte de los miembros de un hogar estuvo significativamente asociada con la presencia de un jefe de hogar que practicaba deportes activamente. CONCLUSIONES: La practica de ADR en las zonas urbanas del Peru es escasa. Los mas afectados son los menores de 30 anos, las mujeres y los residentes del area metropolitana de la capital. Esta insuficiente practica de ADR constituye un reto para la salud publica y reafirma la necesidad de promover estilos de vida activos. La influencia positiva observada cuando el jefe del hogar es un deportista activo y la mayor ADR encontrada en zonas urbanas fuera del area metropolitana de Lima deben ser objeto de estudios mas profundos y deben tomarse en consideracion para el diseno de intervenciones especificas.

Journal ArticleDOI
TL;DR: Given the high prevalence of obesity that was found in the Costa Rican children, primary and secondary prevention measures are needed in order to reduce the proportion of deaths due to chronic nontransmissible diseases among Costa Rican adults in the coming decades.
Abstract: OBJECTIVE: Given that excessive body weight during childhood influences the development of several chronic diseases in adulthood, this study was conducted to determine the prevalence of overweight and obesity in urban and rural Costa Rican elementary school children. METHODS: The study was carried out from July 2000 to April 2001. A total of 1718 students ages 7-12 were selected from 34 schools in the capital city of San Jose and in other nearby urban and rural areas. Both younger children (ones aged 7 through 9 years) and older children (ones aged 10 through 12 years) with a body mass index (BMI) at or above the sex-specific 85th percentile were considered overweight. The younger children were classified as being obese if their triceps skinfold was greater than or equal to the 85th percentile for age and sex using the percentiles by age for children in the United States of America as normative standards. The older children were considered obese if they had a BMI at or above the sex-specific 85th percentile and both the triceps and subscapular skinfold thickness at or above the 90th percentile. RESULTS: The prevalence of overweight was 34.5%. Children aged 7-9, boys, children from urban areas, and children of a higher socioeconomic status had a higher prevalence of overweight. The prevalence of obesity was 26.2%. A higher prevalence of obesity was found among children aged 7-9, boys, children from urban areas, and children of middle socioeconomic status. CONCLUSIONS: Given the high prevalence of obesity that we found in the Costa Rican children, primary and secondary prevention measures are needed in order to reduce the proportion of deaths due to chronic nontransmissible diseases among Costa Rican adults in the coming decades.

Journal ArticleDOI
TL;DR: In this article, a cross-sectional study was carried out with women who were participating in the educational, cultural and medical care activities of the Open University of the Third Age (OUTA), a group that works to promote the welfare of elderly people in the city of Rio de Janeiro, Brazil.
Abstract: OBJECTIVE: To assess the prevalence of falls and their association with the use of medications among elderly women in the city of Rio de Janeiro, Brazil. Falls among the elderly are likely to gain additional public health importance in Brazil and many other developing countries given the rapid growth of the elderly populations in those nations. METHODS: A cross-sectional study was carried out with women who were participating in the educational, cultural, and medical care activities of the Open University of the Third Age (OUTA), a group that works to promote the welfare of elderly people in the city of Rio de Janeiro. The women in the study were all 60 years old or older, were able to walk, had no cognitive impairment, and were living in the community (rather than living in a facility exclusively for older persons). A questionnaire was used that asked about falls within the 12 months prior to the interview, medications used in the previous 15 days, current and past health problems, and demographic characteristics. Women who were interviewed face-to-face also had their blood pressure checked. Two outcome variables were defined: (1) "fallers," who had suffered one or more falls (contrasted with "nonfallers") and (2) "recurrent fallers," who had had two or more falls (contrasted with those who had had one or no falls, called "nonrecurrent fallers"). RESULTS: A total of 634 women were interviewed face-to-face at the OUTA facilities. Among these in-person interviewees, 23.3% reported one fall in the previous year, and 14.0% reported two or more falls in that period. Considering both prescribed drugs and over-the-counter drugs, only 9.1% of these women were not using any medications, 52.7% were using 1 to 4 medications, 34.4% were using 5 to 10, and 3.8% were using 11 to 17 medications. In comparison to nonusers, users of diuretics who also suffered from musculoskeletal disease were 1.6 times as likely to report having suffered a single fall in the preceding year, after adjusting for cardiovascular disease. Recurrent falls were reported 2.0 times as often among beta-blocker users as among nonusers, after adjusting for cardiovascular disease. The risk of recurrent falls among users of anxiolytics/sedatives who had postural hypotension was 4.9 times as high as among nonusers. CONCLUSIONS: Our data indicate an association between single falls and recurrent falls and several groups of medications. Some falls could be avoided through the more rational use of drugs, and measures should be developed and implemented to encourage this.

Journal ArticleDOI
TL;DR: A diminuicao no descarte e a prevalencia de doencas infecciosas entre doadores da Fundacao Pro-Sangue/Hemocentro de Sao Paulo em 2001 refletem o aumento na porcentagem de doadore de repeticao nesse banco de sangue.
Abstract: OBJETIVO: Analisar a evolucao, de 1991 a 2001, do descarte sorologico na Fundacao Pro-Sangue/Hemocentro de Sao Paulo, o maior banco de sangue da America Latina, e verificar a prevalencia de doencas infecciosas entre doadores dessa instituicao no ano de 2001. METODOS: Foram compilados os dados de descarte sorologico relativos aos anos de 1991 a 2001. Para determinar a prevalencia de doencas infecciosas, foram analisadas 9 942 amostras triadas em novembro de 2001, sendo as amostras reativas submetidas a testes confirmatorios. RESULTADOS: Foi encontrada uma diminuicao percentual significativa de descarte, de 20% em 1991 para 9% em 2001. A prevalencia de doencas infecciosas entre doadores em 2001 foi de 0,04% para virus da imunodeficiencia humana (VIH); 0,21% para virus da hepatite C (VHC); 0,06% para virus T-linfotropico humano (HTLV); para virus da hepatite B (VHB), as prevalencias foram de 0,14% para anti-HBc + HBsAg, 1,68% para anti-HBc + anti-HBs e 1,67% para anti-HBc isolado; 1,10% para sifilis; e 0,14% para doenca de Chagas. CONCLUSAO: A diminuicao no descarte e a prevalencia de doencas infecciosas entre doadores da Fundacao Pro-Sangue/Hemocentro de Sao Paulo em 2001 refletem o aumento na porcentagem de doadores de repeticao nesse banco de sangue.

Journal Article
TL;DR: The edicion de Zoonosis and enfermedades transmisibles comunes al hombre y a los animales, the tercera, se presenta in tres volumenes: I. Bacteriosis and micosis; II. Clamidiosis, rickettsiosis and virosis, and III. Parasitosis.
Abstract: Esta edicion de Zoonosis y enfermedades transmisibles comunes al hombre y a los animales, la tercera, se presenta en tres volumenes: I. Bacteriosis y micosis; II. Clamidiosis, rickettsiosis y virosis, y III. Parasitosis. Confiamos en que el libro continuara siendo util para profesores y alumnos de las escuelas de salud publica, medicina y medicina veterinaria; trabajadores de organismos de salud publica y de salud animal; medicos, veterinarios e investigadores, y todos aquellos interesados en el tema. Esperamos, tambien que este libro contribuya a la aplicacion de los conocimientos y recursos de las ciencias veterinarias para la proteccion y el mejoramiento de la salud humana.

Journal ArticleDOI
TL;DR: O passivo ambiental da fundicao de chumbo, desativada em 1993, permanece como um fator de risco relevante para elevar os niveis desse metal no sangue de criancas, particularmente aquelas that apresentam transtornos do habito alimentar.
Abstract: OBJETIVO: Determinar os niveis de chumbo no sangue de criancas que moravam proximo a uma fundicao de chumbo desativada na Cidade de Santo Amaro da Purificacao, Estado da Bahia, em setembro de 1998; e identificar fatores associados a variacao destes niveis. METODOS: Estudo de corte transversal com criancas de 1 a 4 anos de idade que residiam a menos de 1 km da fundicao. Maes ou responsaveis por 47 criancas responderam questionarios sobre transtornos do habito alimentar (comer barro, terra, reboco ou outros materiais) e outros aspectos epidemiologicos relevantes. A concentracao de chumbo no sangue foi determinada por espectrofotometria de absorcao atomica. RESULTADOS: O nivel medio de chumbo foi de 17,1 ± 7,3 mig/dL. Os niveis de chumbo no sangue foram cerca de 5 mig/dL mais elevados em criancas que tinham transtorno do habito alimentar, independentemente da idade, presenca de escoria visivel no peridomicilio, situacao de emprego do pai, historia familiar de intoxicacao pelo chumbo e desnutricao. CONCLUSOES: O passivo ambiental da fundicao de chumbo, desativada em 1993, permanece como um fator de risco relevante para elevar os niveis desse metal no sangue de criancas, particularmente aquelas que apresentam transtornos do habito alimentar.

Journal ArticleDOI
TL;DR: In this article, a study of 2, 367 women living in Mexico used Stata to document the practice of actividades fisicas ligeras and pesadas, particularmente of deportes and ejercicios, in 12 to 49 year olds.
Abstract: OBJETIVO: Documentar la practica de actividades fisicas ligeras y pesadas, particularmente de deportes y ejercicios, en mujeres de 12 a 49 anos en Mexico, y evaluar su asociacion con algunas caracteristicas sociodemograficas. METODOS: Se estudio una muestra de 2 367 mujeres de 12 a 49 anos de edad residentes en Mexico en 1999 mediante el analisis secundario de los datos de la Encuesta Nacional de Nutricion de Mexico, 1999 (ENN-99). En esta encuesta se utilizo un esquema de muestreo polietapico, estratificado, por conglomerados que conformo una muestra final de 21 000 hogares de todo el pais. Mediante un cuestionario se evaluo el tiempo dedicado a las distintas formas de actividad fisica y se midio la actividad en equivalentes metabolicos (MET) segun una escala puntual. Las variables dependientes del estudio fueron el tiempo dedicado a actividades fisicas pesadas (las que exigen un gasto de energia equivalente a 5 MET/hora) y el dedicado a actividades ligeras o sedentarias (tales como estar sentada en el trabajo o fuera de el, ver television, video, cine o teatro y dormir). Las variables independientes fueron la edad, escolaridad, paridad, region del pais y area de residencia (urbana o rural), nivel socioeconomico (medido mediante un indice elaborado a partir de las condiciones de la vivienda y la posesion de enseres domesticos) y estado marital. Se evaluo la asociacion entre las variables independientes y la practica de deportes y se calcularon las razones de posibilidades brutas con intervalos de confianza de 95%. Para identificar la asociacion entre la practica de deportes y las variables independientes se utilizo un modelo de regresion logistica ajustado segun el efecto de posibles variables de confusion. Se ajusto tambien mediante un factor de ponderacion la probabilidad de que una mujer fuese seleccionada para la muestra, y para controlar el efecto de diseno producido por la agrupacion de observaciones en esta muestra se utilizo la rutina de analisis de muestras complejas svy de Stata, version 7.0. RESULTADOS: Se analizo la informacion obtenida de 2 367 mujeres. Las mujeres encuestadas dedicaron 0,08 horas diarias, en promedio, a practicar deportes y 1,25 horas diarias a actividades fisicas pesadas. Solo 16% informaron que practicaban algun deporte con regularidad. Al hacer ajustes segun todas las variables independientes, las mujeres mayores de 30 anos y las de 21 a 30 anos tuvieron una menor razon de posibilidades (RP) en lo que respecta a la practica de deportes que las de 20 anos o menos (RP = 0,53; intervalo de confianza de 95% [IC95%]: 0,33 a 0,84 y RP = 0,35; IC95%: 0,23 a 0,54, respectivamente). El mayor nivel de escolaridad y no haber tenido hijos fueron variables directamente asociadas con la practica de algun deporte. El area de residencia (urbana o rural), el estado marital y el nivel socioeconomico mostraron diferencias entre los grupos. No obstante, estas no resultaron significativas una vez que se hicieron los ajustes segun las otras variables del estudio. El tiempo dedicado al deporte contribuyo solo en 10% al total de la actividad pesada y en 0,7% al total de la actividad fisica evaluada en MET. Las mujeres de 31 anos de edad o mas y las que tenian una escolaridad de nivel secundario tuvieron menos posibilidades de estar en el 10% inferior en terminos de actividad que las menores de 21 anos o que las que tenian una escolaridad de nivel primario. CONCLUSIONES: Este estudio demuestra que la practica de deportes no es frecuente como forma de actividad fisica en mujeres en edad reproductiva en Mexico, especialmente entre las mayores de 20 anos y las de baja escolaridad, lo que a su vez puede contribuir al aumento de la prevalencia de la obesidad y de las enfermedades cronicas.

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TL;DR: The results showed that a small difference in monthly family income was sufficiently sensitive to identify elderly persons in worse health, even within a community that appears to be uniformly poor.
Abstract: OBJECTIVE: Despite the vast scientific literature on the social determinants of health, there is still a debate on the extent to which this relationship remains in old age. The objective of this study was to examine the association between socioeconomic circumstances and health among older adults in a small town in Brazil. METHODS: The study was carried out in Bambui, a town of around 15 000 inhabitants that is located in the state of Minas Gerais, which is in southeastern Brazil. From 1 177 residents aged 65 years or older, 1 074 of them (91.2%) were interviewed and 997 (84.7%) were examined (physical measurements and blood tests). Those in the lowest third of the distribution of total household monthly income, with an income of less than US$ 240 per month, were compared with those who had an income above that level. RESULTS: Lower family income was independently associated with: (1) some lifestyle risk factors (less consumption of fresh fruits or vegetables and less frequent exercise during leisure time in the preceding 30 days), (2) several indicators of worse health status (General Health Questionnaire score, self-rated health, self-rated visual acuity, level of difficulty in walking 300 meters, inability to perform routine activities because of a health problem in the preceding 2 weeks, and seropositivity for Trypanosoma cruzi), (3) a higher number of nonprescribed medications used in the preceding 3 months, and (4) a higher number of hospitalizations in the preceding 12 months. Obesity was more frequent in the higher-income group. CONCLUSIONS: The results of this study do not confirm observations in some developed countries of a lack of association between socioeconomic status and health among the aged. Our results showed that a small difference in monthly family income was sufficiently sensitive to identify elderly persons in worse health, even within a community that appears to be uniformly poor.

Journal ArticleDOI
TL;DR: Human and canine VL are unevenly distributed in Venezuela and the distribution may reflect such factors as differences among the states in human population density, vector density, and the presence or absence of other trypanosomatidae.
Abstract: OBJECTIVE: To report recent data on the distribution of human and canine visceral leishmaniasis (VL) in Venezuela, and to highlight problems associated with effective control measures. METHODS: We report the number of cases, incidence rate, age and sex distribution, and mortality rates for human VL (HVL) for the period of 1995 through 2000, based on National Registry of Leishmaniasis data. We carried out serological studies on a total of 3 025 domestic dogs from the 12 states in Venezuela reporting cases of human VL in this 1995-2000 period and also from the state of Yaracuy, where cases were reported earlier during the decade of the 1990s. RESULTS: From 1995 through 2000, 242 cases of HVL were reported from 12 states, in various sections of Venezuela. There was a relatively stable national incidence rate of 0.2 cases per 100 000 persons per year. Of the 242 cases, 26.0% were from Margarita Island, one of the three islands that make up the state of Nueva Esparta (Margarita Island was the only one of the Nueva Esparta islands that had HVL cases). Over the 1995-2000 period, the annual incidence rates for Nueva Esparta ranged from 1.7 to 3.8 cases per 100000 population. Males in Venezuela were more frequently affected (59.5%) than were females (40.5%). In terms of age, 67.7% of the VL patients were < 4 years of age, and 80.6% were younger than 15 years. The mortality rate among the persons with VL was 7.85% during the 1995-2000 period. Serological screening with rK39 antigen of 1217 dogs from Margarita Island found a 28.5% positivity rate (testing of dogs was not done on the two other islands of Nueva Esparta). In contrast, the rate was 2.8% in the 1 808 samples from dogs from 12 states on the mainland. CONCLUSIONS: Human and canine VL are unevenly distributed in Venezuela. The distribution may reflect such factors as differences among the states in human population density, vector density, and the presence or absence of other trypanosomatidae. Particularly high infection rates in very young children as well as in domestic dogs occur in semiurban communities of Nueva Esparta, where other human-infecting trypanosomatidae have not been reported. Control measures related to limiting canine infection might contribute to disease control where VL infections are frequent. Reducing VL mortality requires increased awareness among medical professionals of the possibility of VL in the differential diagnosis of hepato-splenic syndromes, particularly in children.

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TL;DR: The results indicate that receiving care in the public day care facilities had a positive impact on the nutritional status of the children over the one-year study period, except for weight-for-height in children younger than 24 months.
Abstract: OBJETIVO: Investigar o crescimento de criancas atendidas em creches publicas no Municipio de Sao Paulo. METODO: Utilizando um procedimento de amostragem, foram sorteadas 21 creches e 849 criancas; 821 iniciaram o estudo. Este artigo refere-se as 420 criancas que foram pesadas e medidas em tres ocasioes no periodo de 1 ano (outubro de 1999, abril de 2000 e outubro de 2000). O teste do qui-quadrado de McNemar foi utilizado para verificar mudancas na proporcao de desnutricao e sobrepeso ao final das tres avaliacoes. Uma analise de variância a dois fatores foi utilizada para comparar as medias dos escores Z de altura para idade, peso para idade e peso para altura nas tres observacoes. RESULTADOS: A prevalencia de deficit de altura para idade na primeira observacao foi de 7,1%, concomitante com uma prevalencia de sobrepeso de 5,7%. A prevalencia de deficit de peso para altura na primeira observacao foi de 0,2%, e a de deficit de peso para idade, 2,9%. Em 1 ano, a prevalencia de deficit de altura para idade diminuiu 56% (P = 0,007), e a de sobrepeso aumentou 17,5% (P = 0,33). A prevalencia de deficit de peso para idade caiu para 1,7% (P = 0,56); e o deficit de peso para altura aumentou para 0,5% (P = 0,99). Assim como a desnutricao, o sobrepeso foi mais prevalente entre os menores de 24 meses. A variacao temporal da media de todos os indices antropometricos mostrou-se significativamente positiva, com excecao do indice peso para altura entre os menores de 24 meses. CONCLUSOES: Os resultados sugerem que a creche teve impacto positivo sobre o estado nutricional ao final de 1 ano. Contudo, e necessario acompanhar o crescimento das criancas em creches para evitar que a desnutricao nao reverta em outro problema de saude publica - o sobrepeso.

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TL;DR: The situation with respect to physical activity in Chile and the policies and strategies that have been developed in order to combat sedentary lifestyles is described and analyzed in this paper, where a policy to develop physical activity was implemented as a part of the country's general health promotion policy, which is overseen by the CHILE LIFE Council (Consejo VIDA CHILE), which is made up of 28 Chilean institutions.
Abstract: This piece describes and analyzes the situation with respect to physical activity in Chile and the policies and strategies that have been developed in order to combat sedentary lifestyles. The level of sedentary lifestyles in the Chilean population is very high, with 91% performing less than 30 minutes of physical activity three times per week. This predicament has worsened as a result of increased urbanization and economic growth over the past decade, with a resulting increase in the number of cars and televisions, along with a rise in the number of hours that workers are on the job each day. In order to deal with this situation a policy to develop physical activity was implemented as a part of the country's general health promotion policy. This policy is overseen by the CHILE LIFE Council (Consejo VIDA CHILE), which is made up of 28 Chilean institutions. The policy encompasses various strategies, such as preparing guides to active living for the Chilean population, conducting educational activities and human resources training for kindergartens and other schools, establishing regulatory measures, performing research, carrying out media campaigns, reclaiming public spaces for recreation, and creating incentives for physical activity in the workplace. These strategies have been well received by the general population, academicians, professionals, and technicians. This makes it possible to foresee achieving in the medium and long term the objectives that have been set: more active lives and a better state of health for the Chilean population.

Journal ArticleDOI
TL;DR: The number of cases of hepatitis B is still growing in Brazil, and it is important to consider that underreporting may have affected the results described in this study.
Abstract: OBJETIVO: Tracar um panorama da infeccao por hepatite B no Brasil, na Regiao Sul e no Estado de Santa Catarina para o periodo de 1996 a 2002, considerando aspectos epidemiologicos como faixa etaria. FONTE DOS DADOS:Os dados foram obtidos a partir de levantamento bibliografico e consulta a Secretaria de Vigilância Epidemiologica do Estado de Santa Catarina e a Fundacao Nacional de Saude (FUNASA). RESULTADOS: No Brasil, de 1996 a 2000, a hepatite B foi o segundo tipo de hepatite viral mais prevalente (25%), tendo sido a hepatite A lider em casos (43%). Em Santa Catarina houve predominio de hepatite B em relacao as outras hepatites de 1997 a 2001. O sexo mais atingido pela hepatite B foi o masculino e a maior incidencia de hepatite B foi observada na faixa etaria dos 20 aos 49 anos para Santa Catarina e acima dos 30 anos para o Brasil. O Sul foi a regiao brasileira que apresentou a maior incidencia de hepatite B no periodo de 1997 a 1999. Em Santa Catarina, o maior numero de casos entre 1996 e 2002 ocorreu na macrorregiao sul, seguida das macrorregioes nordeste e extremo oeste. CONCLUSOES: Ainda e crescente o numero de casos de hepatite B no Brasil e deve-se considerar que a subnotificacao pode afetar os numeros apresentados. Em todo o Brasil, a vacinacao deve ser estendida a adolescentes em regioes de prevalencia moderada a alta


Journal ArticleDOI
TL;DR: In this paper, a study of 1709 criancas and adolescentes living in a cidade de Jequie, Estado da Bahia, Brazil, found that 32.2% of the crianca e adolescentes infected by T. trichiura and S. mansoni were anemic.
Abstract: OBJETIVO: Investigar os fatores de risco para anemia por deficiencia de ferro em criancas e adolescentes (7 a 17 anos) infectados por helmintos. METODOS: Foi realizado um estudo transversal com 1709 criancas e adolescentes residentes na cidade de Jequie, Estado da Bahia, Brasil, que apresentavam infeccao leve ou moderada por Schistosoma mansoni, Ascaris lumbricoides, Trichuris trichiura e ancilostomideos. Foram obtidos dados sobre niveis de hemoglobina (hemoglobinometro portatil), consumo alimentar (inquerito recordatorio de 24 horas), infeccao parasitaria (metodo Kato-Katz), condicoes ambientais e domiciliares, renda e escolaridade dos responsaveis. Os fatores de risco para anemia na populacao foram estudados com base em um modelo hierarquico de causalidade. RESULTADOS: A prevalencia de infeccao por T. trichiura, A. lumbricoides, S. mansoni e ancilostomideos foi de 74,8, 63,0, 55,5 e 15,7%, respectivamente. Constatou-se que 32,2% das criancas e adolescentes eram anemicos. Depois do ajuste para variaveis de confusao, os resultados da analise multivariada mostraram que a renda familiar per capita abaixo de um quarto do salario minimo (27 dolares), o sexo masculino, a faixa etaria de 7 a 9 anos e a ingestao inadequada de ferro biodisponivel foram significativamente associados a anemia. CONCLUSOES: As acoes para controle da anemia no grupo de maior risco, conforme identificado no presente estudo, devem visar o aumento do consumo de alimentos ricos em ferro e da biodisponibilidade do ferro ingerido, bem como a melhoria das condicoes socio-ambientais.

Journal ArticleDOI
TL;DR: The game known as Jugando en salud: dengue, a teaching/learning tool leading to the incorporation of schoolchildren enrolled in secondary school in the control of Aedes aegypti and d Dengue prevention activities in the municipality of Girardot, Aragua state, Venezuela, was highly accepted.
Abstract: OBJETIVO: Evaluar el juego conocido por Jugando en salud: dengue, como medio de ensenanza-aprendizaje que favorece la incorporacion de los escolares de la segunda etapa de educacion basica a las actividades de control del mosquito Aedes aegypti y de prevencion del dengue en el municipio de Girardot, Estado Aragua, Venezuela. METODOS: Se efectuo un estudio descriptivo cuasiexperimental basado en una investigacion de campo realizada en 9 escuelas seleccionadas por muestreo aleatorio sistematico entre las 29 escuelas estatales del municipio de Girardot, Estado Aragua, Venezuela, que tenian tres o mas salones de sexto grado de primaria. En cada escuela se constituyeron tres salones de trabajo: en el grupo de salones no. 1 (210 estudiantes) se practico el juego tres veces por semana durante 60 dias y al maestro se le entrego un material teorico sobre el dengue; en el grupo de salones no. 2 (196 estudiantes) se utilizo solo el material teorico que se le entrego al maestro, y en el grupo no. 3 o grupo de control (215 estudiantes) se siguio la programacion habitual establecida por el Ministerio de Educacion. A los escolares participantes se les realizo una evaluacion antes y despues de aplicar el programa propuesto, con un cuestionario que fue evaluado mediante una escala de Likert. Se calcularon las medidas de concentracion y dispersion de los datos obtenidos durante las evaluaciones. Se empleo el analisis de la varianza de clasificacion simple para comparar los promedios de los datos obtenidos en los distintos salones y detectar diferencias significativas entre los grupos en cuanto a conocimientos y destrezas antes y despues de aplicar el programa propuesto. Se utilizo la prueba de Scheffe para determinar diferencias dentro de los grupos. RESULTADOS: En la investigacion participaron 621 escolares de 8 a 16 anos de edad (media: 11,8 anos). De los 210 estudiantes que participaron en el juego, 41% lo valoraron ''de alta aceptacion'' y 45% ''de muy alta aceptacion''. Los conocimientos sobre el dengue y las destrezas (conjunto de habilidades adquiridas) medidos antes de aplicar el programa previsto fueron inferiores (6,5 y 18,4 puntos, respectivamente) a los obtenidos en la prueba final (8,25 y 22,9 puntos, respectivamente; P < 0,05). Se evidencio un mayor aprendizaje en los grupos que utilizaron el juego mas el material teorico (grupos de salones no. 1) y el material teorico solamente (grupo de salones no. 2) que en el grupo de control (grupo de salones no. 3) (P < 0,05). Tambien se encontro que los estudiantes de los grupos de salones nos. 1 y 2 incorporaron mas destrezas y habilidades que los del grupo de control (P < 0,05). CONCLUSIONES: El juego tuvo muy buena aceptacion entre los estudiantes de la segunda etapa de la ensenanza basica. Les permitio adquirir mas conocimientos sobre el dengue y desarrollar habilidades y destrezas conducentes a su incorporacion en actividades para la prevencion de la enfermedad en sus respectivas comunidades. Se recomienda extender este juego a todas las escuelas basicas como una via para fortalecer el proceso educativo e incorporar a los ninos a las actividades de control del dengue.

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TL;DR: Em idosos com amputacao de membros inferiores, atendidos no ambulatorio de amputados de um hospital universitario do Municipio of Campinas, Sao Paulo, Brasil, uma tendencia diferenca significativa entre o grau de satisfacao individual com os diferentes dominios e a percepcao desses dominios na comparacao com outras pessoas da mesma id
Abstract: OBJETIVO: Em idosos com amputacao de membros inferiores, atendidos no ambulatorio de amputados de um hospital universitario do Municipio de Campinas, Sao Paulo, Brasil, identificar relacoes entre a satisfacao global com a vida e a capacidade funcional; avaliar o grau de satisfacao com os dominios saude, capacidade fisica/dependencia, capacidade mental e integracao/envolvimento social; e identificar relacoes entre a satisfacao global com a vida e a satisfacao com os dominios. METODOS: Foram avaliados 40 idosos (30 homens e 10 mulheres), com idade media de 74,5 anos (60 a 79 anos), submetidos a amputacao acima dos maleolos ha no minimo 1 ano e em acompanhamento para reabilitacao entre junho de 1994 e junho de 1999. O instrumento utilizado para a coleta de dados foi composto por: 1) avaliacao da capacidade funcional (indice de Barthel); 2) avaliacao da satisfacao global com a vida (modelo de Cantrill); e 3) avaliacao da satisfacao com os dominios saude, capacidade fisica/dependencia, capacidade mental e integracao/ envolvimento social, em termos individuais e em comparacao com outros idosos. RESULTADOS: Os participantes apresentaram elevado nivel de satisfacao global com a vida (media de 7,1; mediana de 7,5; desvio padrao de 2,73). Nao houve correlacao significativa entre a satisfacao global com a vida e a capacidade funcional. Nao houve diferenca significativa entre o grau de satisfacao individual com os diferentes dominios e a percepcao desses dominios na comparacao com outras pessoas da mesma idade; em ambos os casos, a satisfacao observada foi alta. Houve correlacao significativa apenas entre a satisfacao global com a vida e os dominios saude (individual e comparada) e capacidade fisica (comparada). CONCLUSOES: Os resultados sugerem uma tendencia dos idosos com amputacao a expressarem uma avaliacao positiva sobre seu bem-estar. Esta observacao, aliada a escassez de estudos sobre o assunto, justifica a realizacao de novas pesquisas sobre o bem-estar subjetivo da populacao idosa e permite um novo olhar sobre a reabilitacao dos idosos com amputacao de membros inferiores.

Journal ArticleDOI
TL;DR: A orientacao face a face, realizada em diferentes momentos, levou a mudancas significativas nos indices of aleitamento exclusivo no periodo de 1990 e 2001.
Abstract: OBJETIVO: Realizar uma revisao da literatura e uma avaliacao dos estudos sobre intervencoes com aconselhamento face a face para a promocao do aleitamento exclusivo. FONTE DOS DADOS: Foram pesquisadas as bases de dados MEDLINE, Literatura Latino-Americana e do Caribe em Ciencias da Saude (LILACS) e Cochrane Library no periodo de 1990 e 2001. Foram selecionados estudos que descrevessem o aconselhamento face a face as maes no periodo pos-natal ou no pre e pos-natal. Nao foram incluidos estudos descrevendo a intervencao somente na gravidez. Os estudos foram classificados conforme os criterios modificados de Downs e Black. RESULTADOS: Foram incluidos 19 estudos. O tempo de acompanhamento dos bebes, o tipo de intervencao realizada e as caracteristicas etnicas, socioeconomicas e reprodutivas dos grupos estudados foram bastante variaveis. As limitacoes mais frequentes foram descricao inadequada dos fatores de confusao e das caracteristicas da amostra, metodologia pobremente documentada e ausencia de analise ajustada para fatores de confusao. Dezessete estudos mostraram um efeito benefico da intervencao, embora a magnitude de tal efeito tenha variado bastante. Dois estudos mostraram um efeito dose-resposta, isto e, o impacto foi diretamente proporcional ao numero de visitas. Apenas um estudo relatou um efeito nulo da intervencao sobre os indices de aleitamento exclusivo aos 3 e 5 meses. Contudo, dentre os 19 estudos avaliados, este teve o menor numero de sessoes de orientacao (no maximo duas). CONCLUSOES: A orientacao face a face, realizada em diferentes momentos, levou a mudancas significativas nos indices de aleitamento exclusivo. A presente analise sugere ainda que o apoio as maes deve continuar apos a alta hospitalar e incluir orientacoes quanto a tecnica de amamentacao e a resolucao de problemas.

Journal ArticleDOI
TL;DR: The data show the importance of early diagnosis for sickle cell disease, so as to prevent the frequent infectious complications faced by patients, in the state of Rio de Janeiro.
Abstract: OBJETIVO: Descrever os principais resultados do programa de triagem neonatal para a doenca falciforme do Estado do Rio de Janeiro em 15 meses de funcionamento (agosto de 2000 a novembro de 2001). METODOS: A partir de agosto de 2000, amostras de sangue passaram a ser coletadas de todos os recem-nascidos atendidos em postos de atencao basica a saude no Estado para triagem neonatal da doenca falciforme. Essas amostras sao submetidas a cromatografia liquida de alta resolucao. Se o cromatograma resultante for compativel com a doenca falciforme, a crianca e seus pais sao encaminhados para confirmacao diagnostica e tratamento. RESULTADOS: De agosto de 2000 a novembro de 2001, 99 260 recem nascidos participaram da triagem. Houve um caso de homozigose para Hb C. Um em cada 27 recem-nascidos triados pelo programa apresentou o traco falciforme (Hb AS). A doenca falciforme foi constatada em 83 casos (um caso novo para cada 1 196 nascimentos): 62 Hb S, 18 Hb SC, 3 Hb SD. Uma crianca nao compareceu para confirmacao diagnostica. As 82 criancas acompanhadas apresentaram 15 intercorrencias (infeccoes de vias aereas superiores, febre, sequestro esplenico, sindrome mao-pe e crises de vaso-oclusao), motivando sete internacoes. Houve necessidade de transfusao sanguinea em 15 criancas, mas nenhuma tornou-se alo-imunizada. Os demais bebes estao evoluindo satisfatoriamente com o uso de penicilina profilatica. CONCLUSOES: Nossos dados evidenciam a importância do diagnostico precoce da doenca falciforme, de forma a prevenir e evitar as frequentes complicacoes infecciosas enfrentadas por esses pacientes.