Scielo RSS <![CDATA[Revista Panamericana de Salud Pública]]> http://www.scielosp.org/rss.php?pid=1020-498920010002&lang=en vol. 9 num. 2 lang. en <![CDATA[SciELO Logo]]> http://www.scielosp.org/img/en/fbpelogp.gif http://www.scielosp.org <![CDATA[<b>The dilemma of</b> <b>diabetes</b>: <b>health</b> <b>care crisis in the Caribbean</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892001000200001&lng=en&nrm=iso&tlng=en <![CDATA[<b>Management of diabetes mellitus in three settings in Jamaica</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892001000200002&lng=en&nrm=iso&tlng=en Objectives. To evaluate the quality of diabetic care in three clinics (one of them private and the other two public) in Jamaica, which is a middle-income country with a high prevalence (13%) of diabetes. Methods. During a six-week census in 1995 at the three clinics we collected data retrospectively on a total of 437 diabetic patients. One of the clinics was a specialist public-hospital clinic ("SPMC"), one was a private group general practice ("PRMC"), and one was a public polyclinic ("PUBMC"). The patients' median age ranged from 56 years at SPMC and PRMC to 63 years at PUBMC. Median follow-up had been 6.0 years at SPMC, 9.2 years at PRMC, and 6.3 years at PUBMC. Results. Fewer than 10% of the patients were controlled with diet alone. Insulin was the most commonly prescribed agent at SPMC (46%), compared to 7% each at the two other clinics. Sulfonylurea drugs alone or in combination with metformin were the most common agents at PUBMC and PRMC. Overall, 40% of the patients had satisfactory blood glucose control (< 8 mmol/L fasting or < 10 mmol/L postprandial). There was no significant difference among the clinics in the proportion of patients with satisfactory blood glucose control (P = 0.26). A blood glucose measurement had been recorded in the preceding year in 84% of the patients at SPMC, 79% at PRMC, and 67% at PUBMC. Glycosylated hemoglobin was infrequently measured: 16% at SPMC, 10% at PRMC, and 0% at PUBMC. Overall, 96% of patients had had surveillance for hypertension, and 81% had had surveillance for proteinuria. Surveillance for foot and retinal complications was generally infrequent and had been noted in patients' clinic records most commonly at SPMC (14% for foot complications, and 13% for retinal complications). The staff at the three clinics seldom advised the diabetic patients on diet, exercise, and other nonpharmacological measures, according to the clinics' records. Conclusions. The management of diabetes in Jamaica fell short of international guidelines. Our results also indicate the need to better sensitize health care professionals to these standards in order to reduce the burden of diabetes.<hr/>Objetivos. Evaluar la calidad de la atención a los pacientes diabéticos en tres consultorios (uno privado y dos públicos) de Jamaica, un país con ingresos medios y una alta prevalencia de diabetes (13%). Métodos. Durante un censo de 6 semanas realizado en 1995 se recogieron retrospectivamente datos sobre 437 pacientes diabéticos en estos tres consultorios: un ambulatorio de especialidades de un hospital público (AEP), una clínica privada (CP) y una policlínica pública (PP). Resultados. La mediana de edad de los pacientes osciló entre 56 años en el AEP y la CP y 63 años en la PP. La duración mediana del período de observación fue de 6,0 años en el AEP, 9,2 en la CP y 6,3 en la PP. Menos de 10% de los pacientes fueron controlados únicamente con dieta. El tratamiento prescrito con más frecuencia en el AEP fue la insulina (46%, frente a 7% en cada uno de los otros dos consultorios). Las sulfonilureas, solas o combinadas con metformina, fueron los agentes más utilizados en la CP y la PP. En total, 40% de los pacientes tuvieron un control satisfactorio de la glucemia (< 8 mmol/L en ayunas o < 10 mmol/L tras las comidas) y no hubo diferencias significativas entre los consultorios con respecto al porcentaje de pacientes con control satisfactorio de la glucemia (P = 0,26). La glucemia había sido registrada en el año anterior en 84% de los pacientes del AEP, 79% de la CP y 67% de la PP. Las determinaciones de la hemoglobina glucosilada fueron raras: 16% en el AEP, 10% en la CP y 0% en la PP. En total, en 96% de los pacientes se había vigilado la hipertensión y en 81% la proteinuria. La vigilancia de las complicaciones retinianas y podiátricas fue generalmente infrecuente y había sido registrada en las historias clínicas principalmente en los pacientes atendidos en el AEP (14% para las complicaciones podiátricas y 13% para las retinianas). Según las historias clínicas, el personal de los tres consultorios raramente aconsejó a los pacientes sobre la dieta, el ejercicio y otras medidas no farmacológicas. Conclusiones. La conducta clínica ante la diabetes en Jamaica no cumple las directrices internacionales y es necesario sensibilizar mejor a los profesionales sanitarios acerca de estas normas con el fin de reducir las consecuencias de la enfermedad. <![CDATA[<b>The prevalence of migraines among primary- and secondary-school students in Mérida, Venezuela</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892001000200003&lng=en&nrm=iso&tlng=en Objetivos. Determinar la prevalencia de la migraña en una población estudiantil del Municipio Libertador (Mérida, Venezuela), el efecto incapacitante de la cefalea en general y la proporción de individuos que se automedican. Métodos. Se aplicó una autoencuesta a una muestra de 1 714 alumnos de 10 a 21 años de edad seleccionada por muestreo estratificado y aleatorio simple. Resultados. La prevalencia de la cefalea fue de 84,4%, y la de la migraña de 16,8%. La migraña no tuvo un efecto incapacitante importante en esta población. De los estudiantes con cefalea, 69,2% no solicitaron asistencia médica y 80,3% se automedicaron. Conclusiones. La migraña es muy frecuente y las cifras de automedicación y carencia de asistencia médica indican que debe existir un déficit de cobertura de los servicios de salud y desinformación de la población que ocasiona un subregistro de la cefalea.<hr/>Objective. The epidemiological impact of headaches in populations is not adequately known since most of the data come from clinical studies. Therefore, we decided to survey a population of students in the municipality of Libertador, in the state of Mérida, Venezuela, to determine the prevalence of migraines, the incapacitating effect of headaches in general, and the proportion of individuals who self-medicate. Methods. We first used stratified sampling to choose schools in the municipality, and then simple random sampling to select which classrooms to survey. A total of 1 714 students, ranging in age from 10 to 21 years old, completed a survey. Results. Among the students, 84.4% of them reported having had headaches, and 16.8% of them reported experiencing migraines. We did not find a noticeable incapacitating effect of migraines in this population. Of the students who had had headaches, 69.2% of them did not request medical care, and 80.3% of them reported self-medicating. Conclusions. From these results we conclude that migraines are very frequent among this population. Judging from the levels of self-medication and the lack of medical attention for headaches, we believe there is a shortfall in health services coverage and a deficiency in public information, which together lead to an underreporting of headaches. <![CDATA[<b>Physical violence against women in Santa Fe de Bogotá, Colombia</b>: <b>prevalence and related factors</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892001000200004&lng=en&nrm=iso&tlng=en Objetivos. Estimar la magnitud del problema de la violencia conyugal que afecta a las mujeres que acuden a los servicios de salud pública en Santa Fe de Bogotá, Colombia, e identificar los factores asociados con el riesgo de ser agredidas físicamente. Métodos. Se analizaron los datos recolectados desde septiembre de 1998 hasta septiembre de 1999 mediante entrevistas de las 3 971 mujeres con niños menores de 6 meses de edad, que solicitaron consulta por diversas causas pediátricas (control del niño sano, vacunación o morbilidad del menor) o fueron atendidas por parto en la red de servicios de salud pública en la localidad de Suba, Santa Fe de Bogotá, Colombia. De la muestra indicada, 10 mujeres rehusaron participar y 804 no tenían compañero, por lo cual se excluyeron de los análisis. Resultados. De las 3 157 participantes que convivían con un compañero íntimo, 26,5% informaron que habían sido abofeteadas o empujadas por su compañero actual y 13,3% que habían sido agredidas gravemente por medio de golpes con el puño cerrado, patadas, golpes con algún objeto, "golpizas" y amenazas con un cuchillo o arma de fuego. Además de lo anterior, 26,2% de ellas indicaron que su compañero les imponía alguna prohibición. En los análisis bivariados, la violencia se asoció significativamente con menos escolaridad y menores ingresos (P < 0,001), mayor número de hijos (P < 0,001), mayor tiempo de unión con el compañero actual (P < 0,001), mayor frecuencia de conflicto con la pareja (P < 0,001), ausencia de otros familiares en el hogar (P < 0,01), historia de maltrato en la familia de origen (P < 0,001) y prohibiciones por parte del compañero (P < 0,001). La frecuencia del conflicto con la pareja y las prohibiciones fueron los factores más fuertemente asociados con la violencia, según el análisis multivariado. Conclusiones. Los servicios de salud pública son un buen lugar para detectar a las víctimas de la violencia intrafamiliar. Deben establecerse en ellos programas de detección precoz y de intervenciones efectivas. Los servicios de apoyo y protección de las víctimas tienen que extenderse y fortalecerse para prestarles orientación, asistencia jurídica, y capacitación laboral y educativa. También es importante desarrollar servicios alternativos apropiados para los agresores.<hr/>Objective. Estimate the magnitude of the problem of violence in intimate relationships affecting women in Santa Fe de Bogotá, Colombia, and identify the factors related to the risk of being battered. Methods. The data analyzed were collected between September 1998 and September 1999 from interviews with 3 971 women who had a child less than 6 months old. The women interviewed were ones using public health services in the Suba area of Bogotá, either for pediatric attention (well-baby services, vaccination, an ill child) or for childbirth. Out of the 3 971 women, 10 of them declined to participate, and 804 of them were not in an intimate relationship and were excluded from the analyses. Results. Of the 3 157 participants, 26.5% of them reported that their current partner had slapped or pushed them, and 13.3% reported they had been hit with a fist, kicked, hit with some object, or beaten, or threatened with a knife or gun. In addition, 26.2% of the women said that their partner imposed some prohibition on them (on social activities, work, family planning, etc.). In the bivariate analyses, violence was significantly associated with: less schooling and lower income (P < 0.001), having more children (P < 0.001), a longer period of time living with the partner (P < 0.001), more frequent conflict with the partner (P <0.001), not having other family members living in the home (P < 0.01), a history of abuse in the family of origin (P < 0.001), and prohibitions imposed by the partner (P < 0.001). According to multivariate analysis, the two factors most strongly related with violence were frequency of conflict with the partner and prohibitions imposed by the partner. Conclusions. Public health services are a good place to identify victims of domestic violence, and early detection and intervention programs should be established there. Services to support and protect victims should be expanded and strengthened in order to provide those persons with guidance, legal assistance, education, and job training. Appropriate alternative services for aggressors also need to be developed. <![CDATA[<b>Underlying cause of death from external causes</b>: <b>validation of official data in Recife, Pernambuco, Brazil</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892001000200005&lng=en&nrm=iso&tlng=en Objetivo. Validar a causa básica da morte nas declarações de óbito por causas externas de menores de 20 anos residentes em Recife (PE), Brasil, em 1995. Métodos. O estudo foi dividido em duas etapas: codificação e validação. Nas duas etapas, os dados oficiais sobre causas de morte foram comparados aos dados obtidos na pesquisa. Para tanto, as declarações de óbito foram agrupadas em 5 categorias principais e subdivididas em 14 categorias secundarias de causa da morte; foram, também, comparadas individualmente até o quarto dígito da classificação suplementar para causas de morte da nona revisão da Classificação Internacional de Doenças. Analisou-se a concordância entre os dados oficiais e os dados do estudo através do índice kappa e da sensibilidade. A categorização da pesquisa foi tomada como padrão. Resultados. Na etapa de codificação, para o total das causas externas, o percentual global de concordância variou de 94% (cinco categorias) para 92% (14 categorias), caindo, por fim, para 81% (comparação até o quarto dígito). Na etapa de validação, o percentual global de concordância variou de 94% (cinco categorias) para 91% (14 categorias) e 73% (comparação até o quarto dígito). Conclusões. Os resultados revelam que, para obtenção de dados mais fidedignos, é necessário que as declarações de óbito sejam preenchidas pelo Instituto de Medicina Legal dentro de padrões recomendados; por outro lado, as guias de remoção de cadáveres precisam ser melhor preenchidas em hospitais e delegacias quando do encaminhamento ao Instituto. É fundamental gerar e divulgar dados mais precisos para que a sociedade conheça melhor o seu padrão de violência.<hr/>Objective. To validate the underlying cause of death recorded on the death certificates for individuals under 20 years of age who died from external causes in 1995 in Recife, Pernambuco, Brazil. Methods. We divided the study into two stages, coding and validation. In both stages we compared the official data concerning causes of death to the data we obtained during our study. We grouped the death certificates into 5 broad categories according to the cause of death; we later subdivided them into 14 categories. We also individually compared the death certificates applying the four-digit system of the International Classification of Diseases, Ninth Revision (ICD-9). We assessed the agreement between the official data and our data in terms of sensitivity and the kappa coefficient. We took as the standard the categorization of the cause of death that we had made during our investigation. Results. In the coding stage, considering all the external causes of death, the overall agreement between the official data and our study data was 94% for the 5 categories, 92% for the 14 categories, and 81% for the four-digit ICD-9 system. In the validation stage the overall agreement was 94% for the 5 categories, 91% for the 14 categories, and 73% for the four-digit ICD-9 system. Conclusions. Our results suggest that for the death certificates to be reliable, the Institute of Legal Medicine must fill them out following recommended standards. In addition, hospitals and police departments must use greater care in completing the transfer slips that accompany the bodies that are sent to the Institute. More accurate data need to be generated and disseminated for a society to better understand its patterns of violence. <![CDATA[<b>Leprosy surveillance in low-prevalence situations</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892001000200006&lng=en&nrm=iso&tlng=en La mayoría de los países latinoamericanos han logrado reducir la prevalencia de la lepra a menos de 1 caso por cada 10 000 habitantes. En estos países, la etapa siguiente es eliminar la enfermedad en el ámbito subnacional, en los territorios que tienen tasas mayores de 1 caso por 10 000. Elementos como la transición demográfica, la existencia de áreas con elevada transmisión y la necesidad de emplear indicadores más sensibles obligan a modificar las estrategias básicas, fortalecer los sistemas de vigilancia y reorientar recursos según sea necesario. Es importante renovar el empleo de tácticas como la identificación de las áreas críticas, las intervenciones diferenciadas, la concentración de indicadores y la conjugación de la vigilancia pasiva y activa. Esto puede formularse rediseñando los sistemas de vigilancia para integrar los componentes clínico, de laboratorio, de investigación epidemiológica y de suministros. Los resultados del proceso deben aportar un conjunto mínimo de indicadores que permitan monitorear y evaluar la efectividad y la eficiencia del plan de acción para la etapa posteliminación.<hr/>The majority of the countries in Latin America have reduced the prevalence of leprosy to less than 1 case for every 10 000 persons. The next step in these countries is to eliminate the disease at the regional and local level, in "pockets" that still have rates higher than 1 per 10 000. Given the demographic transition, the existence of areas with high transmission levels, and the necessity for more sensitive indicators, there is a need to change basic strategies, strengthen surveillance systems, and refocus resources. It is important to revamp efforts through such tactics as identifying priority geographical areas, customizing interventions, improving indicators, and combining passive and active surveillance. This can be done by redesigning surveillance systems to integrate the clinical, laboratory, epidemiological-research, and supply components. The results of the process should provide a minimum set of indicators that make it possible to monitor and evaluate the effectiveness and efficiency of action plans for the postelimination stage. <![CDATA[<B>La encefalopatía espongiforme bovina y la variante de la enfermedad de Creutzfeldt-Jakob</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892001000200007&lng=en&nrm=iso&tlng=en La mayoría de los países latinoamericanos han logrado reducir la prevalencia de la lepra a menos de 1 caso por cada 10 000 habitantes. En estos países, la etapa siguiente es eliminar la enfermedad en el ámbito subnacional, en los territorios que tienen tasas mayores de 1 caso por 10 000. Elementos como la transición demográfica, la existencia de áreas con elevada transmisión y la necesidad de emplear indicadores más sensibles obligan a modificar las estrategias básicas, fortalecer los sistemas de vigilancia y reorientar recursos según sea necesario. Es importante renovar el empleo de tácticas como la identificación de las áreas críticas, las intervenciones diferenciadas, la concentración de indicadores y la conjugación de la vigilancia pasiva y activa. Esto puede formularse rediseñando los sistemas de vigilancia para integrar los componentes clínico, de laboratorio, de investigación epidemiológica y de suministros. Los resultados del proceso deben aportar un conjunto mínimo de indicadores que permitan monitorear y evaluar la efectividad y la eficiencia del plan de acción para la etapa posteliminación.<hr/>The majority of the countries in Latin America have reduced the prevalence of leprosy to less than 1 case for every 10 000 persons. The next step in these countries is to eliminate the disease at the regional and local level, in "pockets" that still have rates higher than 1 per 10 000. Given the demographic transition, the existence of areas with high transmission levels, and the necessity for more sensitive indicators, there is a need to change basic strategies, strengthen surveillance systems, and refocus resources. It is important to revamp efforts through such tactics as identifying priority geographical areas, customizing interventions, improving indicators, and combining passive and active surveillance. This can be done by redesigning surveillance systems to integrate the clinical, laboratory, epidemiological-research, and supply components. The results of the process should provide a minimum set of indicators that make it possible to monitor and evaluate the effectiveness and efficiency of action plans for the postelimination stage. <![CDATA[<B>Serotipos de <I>Chlamydia trachomatis</I> y riesgo de carcinoma cervical de células escamosas</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892001000200008&lng=en&nrm=iso&tlng=en La mayoría de los países latinoamericanos han logrado reducir la prevalencia de la lepra a menos de 1 caso por cada 10 000 habitantes. En estos países, la etapa siguiente es eliminar la enfermedad en el ámbito subnacional, en los territorios que tienen tasas mayores de 1 caso por 10 000. Elementos como la transición demográfica, la existencia de áreas con elevada transmisión y la necesidad de emplear indicadores más sensibles obligan a modificar las estrategias básicas, fortalecer los sistemas de vigilancia y reorientar recursos según sea necesario. Es importante renovar el empleo de tácticas como la identificación de las áreas críticas, las intervenciones diferenciadas, la concentración de indicadores y la conjugación de la vigilancia pasiva y activa. Esto puede formularse rediseñando los sistemas de vigilancia para integrar los componentes clínico, de laboratorio, de investigación epidemiológica y de suministros. Los resultados del proceso deben aportar un conjunto mínimo de indicadores que permitan monitorear y evaluar la efectividad y la eficiencia del plan de acción para la etapa posteliminación.<hr/>The majority of the countries in Latin America have reduced the prevalence of leprosy to less than 1 case for every 10 000 persons. The next step in these countries is to eliminate the disease at the regional and local level, in "pockets" that still have rates higher than 1 per 10 000. Given the demographic transition, the existence of areas with high transmission levels, and the necessity for more sensitive indicators, there is a need to change basic strategies, strengthen surveillance systems, and refocus resources. It is important to revamp efforts through such tactics as identifying priority geographical areas, customizing interventions, improving indicators, and combining passive and active surveillance. This can be done by redesigning surveillance systems to integrate the clinical, laboratory, epidemiological-research, and supply components. The results of the process should provide a minimum set of indicators that make it possible to monitor and evaluate the effectiveness and efficiency of action plans for the postelimination stage. <![CDATA[<B>Eficacia de la vacunación masiva contra la enfermedad por meningococos del grupo C en Québec</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892001000200009&lng=en&nrm=iso&tlng=en La mayoría de los países latinoamericanos han logrado reducir la prevalencia de la lepra a menos de 1 caso por cada 10 000 habitantes. En estos países, la etapa siguiente es eliminar la enfermedad en el ámbito subnacional, en los territorios que tienen tasas mayores de 1 caso por 10 000. Elementos como la transición demográfica, la existencia de áreas con elevada transmisión y la necesidad de emplear indicadores más sensibles obligan a modificar las estrategias básicas, fortalecer los sistemas de vigilancia y reorientar recursos según sea necesario. Es importante renovar el empleo de tácticas como la identificación de las áreas críticas, las intervenciones diferenciadas, la concentración de indicadores y la conjugación de la vigilancia pasiva y activa. Esto puede formularse rediseñando los sistemas de vigilancia para integrar los componentes clínico, de laboratorio, de investigación epidemiológica y de suministros. Los resultados del proceso deben aportar un conjunto mínimo de indicadores que permitan monitorear y evaluar la efectividad y la eficiencia del plan de acción para la etapa posteliminación.<hr/>The majority of the countries in Latin America have reduced the prevalence of leprosy to less than 1 case for every 10 000 persons. The next step in these countries is to eliminate the disease at the regional and local level, in "pockets" that still have rates higher than 1 per 10 000. Given the demographic transition, the existence of areas with high transmission levels, and the necessity for more sensitive indicators, there is a need to change basic strategies, strengthen surveillance systems, and refocus resources. It is important to revamp efforts through such tactics as identifying priority geographical areas, customizing interventions, improving indicators, and combining passive and active surveillance. This can be done by redesigning surveillance systems to integrate the clinical, laboratory, epidemiological-research, and supply components. The results of the process should provide a minimum set of indicators that make it possible to monitor and evaluate the effectiveness and efficiency of action plans for the postelimination stage. <![CDATA[<B>Plaguicidas y salud pública</B>: <B>métodos integrados de control de los mosquitos</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892001000200010&lng=en&nrm=iso&tlng=en La mayoría de los países latinoamericanos han logrado reducir la prevalencia de la lepra a menos de 1 caso por cada 10 000 habitantes. En estos países, la etapa siguiente es eliminar la enfermedad en el ámbito subnacional, en los territorios que tienen tasas mayores de 1 caso por 10 000. Elementos como la transición demográfica, la existencia de áreas con elevada transmisión y la necesidad de emplear indicadores más sensibles obligan a modificar las estrategias básicas, fortalecer los sistemas de vigilancia y reorientar recursos según sea necesario. Es importante renovar el empleo de tácticas como la identificación de las áreas críticas, las intervenciones diferenciadas, la concentración de indicadores y la conjugación de la vigilancia pasiva y activa. Esto puede formularse rediseñando los sistemas de vigilancia para integrar los componentes clínico, de laboratorio, de investigación epidemiológica y de suministros. Los resultados del proceso deben aportar un conjunto mínimo de indicadores que permitan monitorear y evaluar la efectividad y la eficiencia del plan de acción para la etapa posteliminación.<hr/>The majority of the countries in Latin America have reduced the prevalence of leprosy to less than 1 case for every 10 000 persons. The next step in these countries is to eliminate the disease at the regional and local level, in "pockets" that still have rates higher than 1 per 10 000. Given the demographic transition, the existence of areas with high transmission levels, and the necessity for more sensitive indicators, there is a need to change basic strategies, strengthen surveillance systems, and refocus resources. It is important to revamp efforts through such tactics as identifying priority geographical areas, customizing interventions, improving indicators, and combining passive and active surveillance. This can be done by redesigning surveillance systems to integrate the clinical, laboratory, epidemiological-research, and supply components. The results of the process should provide a minimum set of indicators that make it possible to monitor and evaluate the effectiveness and efficiency of action plans for the postelimination stage. <![CDATA[<b>Earthquakes in El Salvador</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892001000200011&lng=en&nrm=iso&tlng=en The Pan American Health Organization (PAHO) has 25 years of experience dealing with major natural disasters. This piece provides a preliminary review of the events taking place in the weeks following the major earthquakes in El Salvador on 13 January and 13 February 2001. It also describes the lessons that have been learned over the last 25 years and the impact that the El Salvador earthquakes and other disasters have had on the health of the affected populations. Topics covered include mass-casualties management, communicable diseases, water supply, managing donations and international assistance, damages to the health-facilities infrastructure, mental health, and PAHO's role in disasters. <![CDATA[<b>Use and abuse of amphetamine-type stimulants in the United States of America</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892001000200012&lng=en&nrm=iso&tlng=en In recent years the United States of America has experienced economic growth, low unemployment, low inflation, and technological advances. However, coexisting with these favorable conditions are underlying and underaddressed social inequalities that may have an impact on patterns of use and abuse of substances, including amphetamine-type stimulants (ATSs). For example, since 1975 most of the increase in national income has benefited people who are at the top 20% of the income range. There are disparities between those who do have and those who do not have the skills needed to thrive in a technologically dependent society, and the gap may be widening. New patterns of substance abuse being seen in the United States may in part be explained by the increasing competition to survive financially and interpersonally, the need that those failing to adapt to rapid technological change have to escape psychologically and existentially, and the desire of the socially alienated and disenfranchised to self-medicate with ATSs and at least temporarily avoid social and economical inequities. According to the 1998 National Household Survey on Drug Abuse, an estimated 13.6 million Americans were users of illicit drugs (1). This number is less than the 13.9 million estimated for 1997, and by comparison less than the highest level, in 1979, when the estimate was 25 million. With respect to stimulants in particular, the overall level of usage has remained constant, but increases have been observed in specific high-risk populations, who need focused outreach and intervention efforts. This article will focus on ATSs in the United States, including relevant demographic and cultural dimensions of their use and abuse, and suggested directions for future ATS research and program development.<hr/>En los Estados Unidos de América, la popularidad de los compuestos anfetamínicos de consumo legal e ilegal, junto con las prácticas de uso y abuso que con ellos se asocian, han variado a lo largo del tiempo y en distintos lugares. Estos compuestos, que en épocas anteriores evocaban la imagen de obreros blancos de sexo masculino y de personas que seguían regímenes dietéticos de moda para adelgazar, actualmente son consumidos, a menudo en cantidades excesivas, por poblaciones más diversas y numerosas. La magnitud de este uso y abuso de anfetamínicos, que fluctúa según la zona geográfica y el ambiente social y cultural de la localidad, puede cambiar paulatinamente. Los estimulantes anfetamínicos (EA), especialmente la metanfetamina, son ubícuos en los establecimientos nocturnos donde se reúne a bailar la juventud en los Estados Unidos. El uso y abuso diseminados de estas sustancias se observan en poblaciones que consideran menos peligrosos a los EA que a otras sustancias como la cocaína y la heroína. Entre estos grupos de usuarios se encuentran los jóvenes que carecen de representación social, los homosexuales, los bisexuales, los trabajadores del sexo y los estudiantes de bachillerato y universidad. Los EA son relativamente baratos y se fabrican fácilmente en los Estados Unidos. Por consiguiente, es probable que estas drogas sigan siendo codiciadas y disponibles en el mercado ilegal por muchos años más. Dado que el uso y abuso de EA son, en gran parte, prácticas ilegales y clandestinas en los Estados Unidos, resulta imposible enumerar todas las poblaciones que usan EA o que abusan de ellos. Hacen falta estadísticas y sistemas de información más exactos, mejor coordinados y de base poblacional para poder identificar los patrones de uso y abuso de EA y sus tendencias. Esta revisión se apoya en varias fuentes de datos para delinear los aspectos demográficos y culturales del uso y abuso de EA. El trabajo también señala el rumbo que deben seguir los estudios sobre EA en el futuro y los programas de control. <![CDATA[<b>Public health action plan to combat antimicrobial resistance</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892001000200013&lng=en&nrm=iso&tlng=en Antimicrobial resistance constitutes a growing threat to everyone, regardless of age, sex, or socioeconomic status. The problem could end up reversing the dramatic reduction in morbidity and mortality from infectious diseases that was achieved with these drugs over the last half century. Although it is impossible to end the problem of antimicrobial resistance, it is possible to make it manageable. To reach this goal, there is a need to improve the monitoring of emerging resistance problems, to extend the useful life of antimicrobials, to develop new drugs, and to apply other measures to prevent and control resistance such as improved vaccines and better methods to diagnose and control infections. In spite of the urgency of the problem, meeting these objectives has not been easy, and the achievements so far have fallen short. Given this situation, in 1999 several agencies of the Government of the United States of America formed a special task force to prepare a public health action plan on antimicrobial resistance. The plan is intended to reflect a broad consensus within the United States Government concerning how to address the resistance problem, with cooperation from the private sector and the broader society. This document is the first of two parts of that action plan, and it is devoted to the resistance problem in the United States. The document describes the plan's objectives and action steps in four primary areas: surveillance, prevention and control, research, and product development. <![CDATA[<b>Betrayal of trust</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892001000200014&lng=en&nrm=iso&tlng=en Antimicrobial resistance constitutes a growing threat to everyone, regardless of age, sex, or socioeconomic status. The problem could end up reversing the dramatic reduction in morbidity and mortality from infectious diseases that was achieved with these drugs over the last half century. Although it is impossible to end the problem of antimicrobial resistance, it is possible to make it manageable. To reach this goal, there is a need to improve the monitoring of emerging resistance problems, to extend the useful life of antimicrobials, to develop new drugs, and to apply other measures to prevent and control resistance such as improved vaccines and better methods to diagnose and control infections. In spite of the urgency of the problem, meeting these objectives has not been easy, and the achievements so far have fallen short. Given this situation, in 1999 several agencies of the Government of the United States of America formed a special task force to prepare a public health action plan on antimicrobial resistance. The plan is intended to reflect a broad consensus within the United States Government concerning how to address the resistance problem, with cooperation from the private sector and the broader society. This document is the first of two parts of that action plan, and it is devoted to the resistance problem in the United States. The document describes the plan's objectives and action steps in four primary areas: surveillance, prevention and control, research, and product development. <![CDATA[<b>Reshaping health care in Latin America</b>: <b>a comparative analysis of health care reform in Argentina, Brazil, and Mexico</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892001000200015&lng=en&nrm=iso&tlng=en Antimicrobial resistance constitutes a growing threat to everyone, regardless of age, sex, or socioeconomic status. The problem could end up reversing the dramatic reduction in morbidity and mortality from infectious diseases that was achieved with these drugs over the last half century. Although it is impossible to end the problem of antimicrobial resistance, it is possible to make it manageable. To reach this goal, there is a need to improve the monitoring of emerging resistance problems, to extend the useful life of antimicrobials, to develop new drugs, and to apply other measures to prevent and control resistance such as improved vaccines and better methods to diagnose and control infections. In spite of the urgency of the problem, meeting these objectives has not been easy, and the achievements so far have fallen short. Given this situation, in 1999 several agencies of the Government of the United States of America formed a special task force to prepare a public health action plan on antimicrobial resistance. The plan is intended to reflect a broad consensus within the United States Government concerning how to address the resistance problem, with cooperation from the private sector and the broader society. This document is the first of two parts of that action plan, and it is devoted to the resistance problem in the United States. The document describes the plan's objectives and action steps in four primary areas: surveillance, prevention and control, research, and product development. <![CDATA[<b>Bioética y cuidado de la salud</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892001000200016&lng=en&nrm=iso&tlng=en Antimicrobial resistance constitutes a growing threat to everyone, regardless of age, sex, or socioeconomic status. The problem could end up reversing the dramatic reduction in morbidity and mortality from infectious diseases that was achieved with these drugs over the last half century. Although it is impossible to end the problem of antimicrobial resistance, it is possible to make it manageable. To reach this goal, there is a need to improve the monitoring of emerging resistance problems, to extend the useful life of antimicrobials, to develop new drugs, and to apply other measures to prevent and control resistance such as improved vaccines and better methods to diagnose and control infections. In spite of the urgency of the problem, meeting these objectives has not been easy, and the achievements so far have fallen short. Given this situation, in 1999 several agencies of the Government of the United States of America formed a special task force to prepare a public health action plan on antimicrobial resistance. The plan is intended to reflect a broad consensus within the United States Government concerning how to address the resistance problem, with cooperation from the private sector and the broader society. This document is the first of two parts of that action plan, and it is devoted to the resistance problem in the United States. The document describes the plan's objectives and action steps in four primary areas: surveillance, prevention and control, research, and product development.