Scielo RSS <![CDATA[Revista Panamericana de Salud Pública]]> http://www.scielosp.org/rss.php?pid=1020-498920060003&lang=en vol. 19 num. 3 lang. en <![CDATA[SciELO Logo]]> http://www.scielosp.org/img/en/fbpelogp.gif http://www.scielosp.org <![CDATA[<B>El dengue, un problema creciente de salud en las Américas</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892006000300001&lng=en&nrm=iso&tlng=en <![CDATA[<B>Assessing HIV resistance in developing countries</B>: <B>Brazil as a case study</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892006000300002&lng=en&nrm=iso&tlng=en Increased transmission of resistant HIV has been raised as a potential consequence of expanded access to antiretroviral therapy. We review how limitations in resources and health care infrastructure may impact the transmission of resistant HIV, and we examine data from Brazil as a case study. We introduce a biological and clinical framework to identify the major determinants of transmitted resistance and to discuss how these determinants may be affected by a lack of infrastructure. We then use our framework to examine HIV resistance data from Brazil. This country was chosen as a case study due to its extensive experience delivering antiretroviral drugs and because of the availability of data on the prevalence of resistant HIV there. The data from Brazil show that antiretroviral therapy can be delivered in a resource-limited setting without resulting in widespread transmission of resistant virus. While the Brazilian experience does not necessarily generalize to countries with less health care infrastructure, neither theory nor data support a foregone conclusion that resistance will necessarily dominate HIV epidemics in the developing world to a greater extent than it does in the developed world.<hr/>Se ha especulado que el aumento de cepas del virus de la inmunodeficiencia humana (VIH) resistentes a medicamentos podría ser el resultado de un mayor acceso al tratamiento con antirretrovíricos. Tomando como ejemplo datos propios del Brasil, en este trabajo examinamos la manera en que la escasez de recursos y las carencias de la infraestructura sanitaria podrían estar influyendo en la transmisión de cepas resistentes de VIH. Empleamos un marco biológico y clínico para identificar los principales factores determinantes del aumento de la resistencia y exploramos la forma en que dichos factores podrían verse afectados por la falta de infraestructura. Posteriormente empleamos ese mismo marco para examinar las cifras de resistencia del Brasil, país que se eligió como ejemplo porque en él los medicamentos antirretrovíricos han tenido amplia distribución y porque hay abundantes datos acerca de la prevalencia de cepas de VIH en el territorio nacional. Las cifras del Brasil demuestran que se puede administrar el tratamiento con antirretrovíricos en lugares donde hay pocos recursos sin que ello provoque la transmisión generalizada de cepas víricas resistentes. Aunque la experiencia brasileña no necesariamente se puede proyectar a países con menos infraestructura sanitaria, no hay ningún esquema teórico ni datos que respalden la conclusión a priori de que en el mundo en desarrollo la epidemia de VIH transcurrirá con mayores cifras de resistencia que en países desarrollados. <![CDATA[<B>Validation of a questionnaire for epilepsy diagnosis in primary care services</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892006000300003&lng=en&nrm=iso&tlng=en OBJETIVOS: Evaluar la utilidad de un cuestionario para establecer el diagnóstico de epilepsia en niños de 1 a 10 años de edad y clasificar las crisis epilépticas en los servicios de atención primaria. MÉTODOS: Estudio observacional transversal; participaron 204 niños de 1 a 10 años de edad (102 con diagnóstico de epilepsia y 102 sin epilepsia) escogidos al azar en el Centro Regional de Epilepsias y en el Hospital Vicente Corral Moscoso, ambos de la ciudad de Cuenca, Ecuador. Los niños fueron pareados por grupos de edad (de 1 a 5 y de 6 a 10 años). Cuatro estudiantes del último año de la Escuela de Medicina de esa ciudad que desconocían el diagnóstico del niño aplicaron el cuestionario a un familiar del niño o a su representante. Se evaluó el grado de discriminación diagnóstica (validez) del cuestionario, la sensibilidad, la especificidad y el valor diagnóstico de un resultado positivo o negativo, con un intervalo de confianza de 95% (IC95%). Como criterio de referencia se utilizó el diagnóstico clínico emitido por especialistas. RESULTADOS: La evaluación realizada demostró que el cuestionario de diagnóstico estudiado tiene buena sensibilidad (95,10%; IC95%: 94,58 a 95,61) y especificidad (97,06%; IC95%: 96,58 a 97,59). El índice de validez fue de 96,08 (IC95%: 95,84 a 96,36), con un valor pronóstico de un resultado positivo de 97,00% (IC95%: 96,48 a 97,52) y un valor pronóstico de un resultado negativo de 95,19% (IC95%: 94,74 a 95,74). El grado de concordancia de la clasificación de las crisis epilépticas realizadas por los neurólogos y los estudiantes de medicina que utilizaron el cuestionario fue satisfactorio para las crisis generalizadas (índice k: 0,67). Según la prueba de reproducibilidad de resultados entre observadores, el índice k para el diagnóstico de los neurólogos fue de 0,80 y para el diagnóstico de los pediatras de 0,89. CONCLUSIONES: El cuestionario de diagnóstico evaluado posee una buena sensibilidad y una adecuada especificidad y puede ayudar a los médicos generales, después de un breve entrenamiento, a diagnosticar las crisis epilépticas en los servicios de atención primaria.<hr/>OBJECTIVE: To evaluate the usefulness of a questionnaire in primary health care services for establishing the diagnosis of epilepsy in children from 1 to 10 years old and for classifying their epileptic seizures. METHODS: This cross-sectional observational study was conducted in 2004. There were 204 children in the study (102 diagnosed with epilepsy and 102 without epilepsy). The children were randomly selected at the Regional Center of Epilepsies and the Vincent Corral Moscoso Hospital, which are both in the city of Cuenca, Ecuador. For the study, each child with epilepsy was matched with a child without epilepsy, in two age groups: 1 to 5 years old and 6 to 10 years old. Four students who were in their last academic year in the School of Medicine of Cuenca and who did not know the child's diagnosis utilized the questionnaire with a family member or other guardian of the child. The validity, sensitivity, specificity, positive predictive value, and negative predictive value of the questionnaire were calculated, with 95% confidence intervals (95% CIs). The clinical diagnosis carried out by specialists was used as the gold standard. RESULTS: The assessment showed that the questionnaire had good sensitivity (95.10%; 95% CI: 94.58%-95.61%) and good specificity (97.06%; 95% CI: 96.58%-97.59%). Validity was 96.08% (95% CI: 95.84%-96.36%), with a positive predictive value of 97.00% (95% CI: 96.48%-97.52%) and a negative predictive value of 95.19% (95% CI: 94.74%- 95.74%). The level of agreement in the classification of the epileptic seizures carried out by the neurologists and by the medical students who used the questionnaire was satisfactory for the generalized seizures (kappa = 0.67). Upon testing for interobserver agreement among the specialists, the kappa value for the diagnoses was 0.80 among the neurologists and 0.89 among the pediatricians. CONCLUSIONS: The diagnostic questionnaire that was assessed has good sensitivity and adequate specificity, and, after brief training, primary health care general practitioners can use it to help them diagnose epileptic seizures. <![CDATA[<B>The mental health status of Mayan refugees after repatriation to Guatemala</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892006000300004&lng=en&nrm=iso&tlng=en OBJECTIVE: Only one previous study had examined the epidemiology of mental health in Guatemalan refugees. The objective of this new study was to estimate the prevalence of mental illness and to assess factors associated with poor mental health among Guatemalan Mayan refugees who had been repatriated to Guatemala after spending 12-18 years in refugee camps in Mexico, and to compare the results for the repatriated Guatemalans with those for Guatemalan refugees who were continuing to live in Mexico. METHODS: In 2001 a cross-sectional survey of adults (> 16 years) was conducted with random household sampling proportional to the population size in each of the five repatriation villages surveyed. Posttraumatic stress disorder (PTSD), anxiety, and depression were measured by the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25. RESULTS: Together, the five repatriation villages had 565 households. Of the 565 households, 203 of them were approached to solicit study participation. A total of 179 households (one adult per household) agreed to participate, representing an overall participation rate of 88%, and one-third of all the households in the five communities. The respondents had personally experienced a mean of 5.5 trauma events and had witnessed a mean of 7.3 other trauma events. Of the respondents, 8.9% met the symptom criteria for PTSD, 17.3% for anxiety, and 47.8% for depression. PTSD was associated with being seriously wounded and with having relatives or friends mutilated. Logistic regression analyses indicated that anxiety was associated with being sexually assaulted, being female, having friends or family mutilated, being seriously wounded, and having 6-12 children (vs. having 1-5 children). Depression was associated with having 6-12 children. Anxiety was significantly more prevalent among the refugees remaining in Mexico (54.4%) than it was among the repatriated refugees (17.3%). The difference in the prevalence rates was not significant for PTSD (11.8% for refugees remaining in Mexico vs. 8.9% for those repatriated) or for depression (38.8% for refugees remaining in Mexico vs. 47.8% for those repatriated). CONCLUSIONS: Psychiatric morbidity was common among the repatriated Mayans. The repatriation of refugees involves moving an already vulnerable, often traumatized population back to a place of distressing memories and still-unsettled conditions. There is a need to consider and plan for adequate mental health services for repatriating refugees.<hr/>OBJETIVO: Existe un solo estudio en el que se hayan examinado las tendencias epidemiológicas observadas en el ámbito de la salud mental en refugiados guatemaltecos. El objetivo de este nuevo estudio radica en calcular la prevalencia de enfermedades mentales y evaluar los factores asociados con el menoscabo de la salud mental en refugiados guatemaltecos de ascendencia maya que fueron repatriados a Guatemala después de pasar de 12 a 18 años en campamentos para refugiados en México, así como comparar los resultados observados en los guatemaltecos repatriados con los observados en refugiados guatemaltecos que siguieron viviendo en México. MÉTODOS: En 2001 se llevó a cabo una encuesta transversal de adultos (>16 años de edad) con muestras aleatorias de un tamaño que guardaba proporción con el de la población de cada una de las cinco aldeas de repatriados que se estudiaron. Se determinó la prevalencia del síndrome de estrés postraumático (SEP), de estados de ansiedad y de depresión mediante el Cuestionario de trauma de Harvard (Harvard Trauma Questionnaire) y la Lista 25 de verificación de síntomas de Hopkins (Hopkins Symptom Checklist-25). RESULTADOS: En las cinco aldeas de repatriados había en conjunto 565 hogares, de los cuales 203 fueron abordados para solicitar su participación en el estudio. Aceptó participar un total de 179 hogares (un adulto en cada hogar), equivalente a 88% de la muestra y a una tercera parte de todos los hogares en las cinco comunidades. Las personas que respondieron a la encuesta habían tenido individualmente un promedio de 5,5 experiencias traumáticas personales y habían presenciado un promedio de 7,3 episodios ajenos de carácter traumático. De las personas que participaron en la encuesta, 8,9% satisfacían los criterios diagnósticos de SEP, 17,3% los de ansiedad y 47,8% los de depresión. El SEP mostró una asociación con haber sufrido heridas graves y con tener parientes que habían sido mutilados. Los análisis de regresión logística revelaron una asociación entre la presencia de estados de ansiedad y el haber sufrido agresión sexual, ser mujer, haber tenido amigos o parientes mutilados, haber sufrido heridas graves y tener de 6 a 12 hijos (frente a tener de 1 a 5). La depresión mostró una asociación con tener de 6 a 12 hijos. Los estados de ansiedad mostraron una prevalencia significativamente mayor entre los refugiados que se quedaron en México (54,4%) que entre los que fueron repatriados (17,3%). En cambio, no se observaron diferencias significativas entre los refugiados que permanecieron en México y los que fueron repatriados en cuanto a las tasas de prevalencia de SEP (11,8% frente a 8,9%, respectivamente) y de depresión (38,8% frente a 47,8%, respectivamente). CONCLUSIONES: Se observaron problemas psiquiátricos frecuentes en los mayas repatriados. La repatriación de refugiados entraña movilizar a una población que de por sí es vulnerable y que ha sido víctima de muchos traumas a un lugar cargado de recuerdos dolorosos y donde siguen imperando condiciones muy precarias. Es preciso, por ende, contemplar la necesidad de planificar servicios de salud mental para refugiados repatriados. <![CDATA[<B>Epidemiologic surveillance of measles and rubella in Campinas (SP), Brazil</B>: <B>the reliability of the data</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892006000300005&lng=en&nrm=iso&tlng=en OBJETIVO: Avaliar e validar as informações sobre o sarampo e a rubéola existentes no Sistema Nacional de Informação de Agravos de Notificação (SINAN) em Campinas, tomando como referência os dados do Sistema de Vigilância Sindrômica de Febre e Exantema (VigiFEx), que funcionou paralelamente ao SINAN no período de maio de 2003 a junho de 2004. MÉTODO: Foram comparados os dados anuais do SINAN de 1999 a 2003 e os dados do SINAN e do VigiFEx para o período de junho de 2003 a maio de 2004. Analisou-se o preenchimento dos campos número, data e município da notificação (variáveis chaves), nome da doença, data dos primeiros sintomas, nome do paciente, data de nascimento e idade, sexo e município de residência, data da investigação, antecedentes vacinais, presença de exantema, data de início do exantema e presença de febre; e casos suspeitos em gestantes, sinais e sintomas, data da coleta da primeira amostra, resultados, coleta de isolamento viral, classificação final, critério de confirmação/descarte, diagnóstico do caso descartado, evolução do caso e data de encerramento. Também foi analisada a concordância dos casos registrados entre as bases de dados. RESULTADOS: Foram identificadas 211 suspeitas de sarampo ou rubéola na base VigiFEx e 275 na base SINAN 12 meses. Todos os casos registrados apresentaram dados completos em relação às variáveis chaves. Os campos nome do paciente, agravo ou doença e município de residência também tiveram 100% de preenchimento. Mais de 95% de preenchimento foi observado para data de investigação, vacina contra o sarampo, vacina contra o sarampo e a rubéola e vacina contra a rubéola. As demais variáveis vacinais (número de doses e data da última dose) apresentaram elevados percentuais de não-preenchimento, assim como as variáveis exantema, febre e data de início do exantema. Houve inconsistência entre os sistemas, principalmente em relação às variáveis sobre antecedentes epidemiológicos, dados clínicos e conclusão do caso. Os dados do VigiFEx apresentaram melhor qualidade. CONCLUSÕES: É preciso avaliar rotineiramente os sistemas de informação de vigilância, imunização e laboratório para garantir a confiabilidade dos dados, de forma que possam embasar o planejamento de ações em saúde.<hr/>OBJECTIVE: To evaluate and validate the information concerning measles and rubella from the Brazilian National Disease Notification System (BNDNS) (Sistema Nacional de Informação de Agravos de Notificação, or SINAN) for Campinas, a large city in the state of São Paulo, Brazil, using as a reference the data from a control system, the Syndromic Surveillance System for Fever and Exanthem (SSSFE) (Sistema de Vigilância Sindrômica de Febre e Exantema, or VigiFEx), which operated from May 2003 through June 2004. METHOD: In our study we compared: (1) annual data from BNDNS for the years 1999 through 2003 and (2) data from BNDNS and data from SSSFE for the period of June 2003 through May 2004. We analyzed the rate of completion for key fields (record number, date of notification, and city of notification) as well as for name of disease, date of first symptoms, name of patient, birth date and age, sex, city of residence, date of investigation, immunization history, presence of exanthem, date at start of exanthem, presence of fever, suspected cases among pregnant women, signs and symptoms, date of collection of first sample, results with the sample, virus isolation, final classification, criteria for confirmation/exclusion of cases, diagnosis of excluded patients, development of the case, and date of closure. The level of agreement between the recorded cases in the two data banks was also analyzed. RESULTS: From June 2003 through May 2004, 211 suspected cases of measles or rubella were identified in SSSFE and 275 in BNDNS. All the records had complete information concerning the three key fields. The rate of completion was also 100% for patient name, disease, and city of residence. The completion rate was higher than 95% for date of investigation, measles vaccine, measles and rubella vaccine, and rubella vaccine. A lower completion rate was found for other vaccination variables (number of doses and date of last dose) and for exanthem, fever, and date of start of exanthem. The two information systems were not completely consistent, particularly in terms of variables related to epidemiologic background, clinical data, and case closure. The quality of the SSSFE data was higher. CONCLUSIONS: Epidemiologic surveillance, immunization, and laboratory information systems need to undergo routine evaluation to ensure that the data are reliable and can support the planning of public health efforts. <![CDATA[<B>A new DTPw-HB/Hib combination vaccine for primary and booster vaccination of infants in Latin America</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892006000300006&lng=en&nrm=iso&tlng=en OBJECTIVES: In 1998 the World Health Organization (WHO) recommended the inclusion of Haemophilus influenza type B (Hib) conjugate vaccines in infant immunization programs, whenever in accordance with national priorities. GlaxoSmithKline Biologicals has developed a new pentavalent combined diphtheria-tetanus-whole cell pertussis-hepatitis B/Hib (DTPwHB/Hib) vaccine containing 5 µg of polyribosylribitol phosphate (PRP), and we assessed the immunogenicity and reactogenicity of primary and booster vaccination of healthy children with this new vaccine compared with a reference regimen consisting of the licensed DTPomega-HB (Tritanrix) and Hib (Hiberix) vaccines given as simultaneous concomitant injections. METHODS: We performed a randomized, double-blind study from September 1998 to August 1999 to establish the immunogenicity and reactogenicity of primary and booster vaccination of healthy children with the new pentavalent combined DTPomega-HB/Hib vaccine given as a single injection, compared with the reference regimen. RESULTS: Both vaccination regimens elicited excellent immune responses, with all subjects in both groups achieving seroprotective anti-PRP antibody concentrations of > 0.15 µg/mL one month after primary vaccination. The combined DTPomega-HB/Hib vaccine was non-inferior to the licensed vaccines in terms of seroprotection/seropositivity/vaccine response rates for all antigen components. Persistence of antibodies against all study vaccine antigens up to the time of booster vaccination was comparable between groups, and a marked increase of all antibody concentrations was observed after the booster dose. Both vaccine regimens were similar in terms of their overall reactogenicity profiles. CONCLUSIONS: Our results indicate that the new DTPomega-HB/Hib pentavalent combination vaccine provides an efficient and reliable way of implementing WHO recommendations for controlling hepatitis B and Hib infections on a worldwide basis.<hr/>OBJETIVOS: En 1998, la Organización Mundial de la Salud (OMS) recomendó que se incluyeran vacunas conjugadas contra Haemophilus influenzae tipo B (Hib) en los programas de vacunación de niños menores de un año, siempre que ello estuviera en consonancia con las prioridades nacionales. La compañía GlaxoSmithKline Biologicals ha creado una nueva vacuna pentavalente que es una combinación de la vacuna contra la difteria (D), el tétanos (T) y la tos ferina (P) (con antígeno tosferínico a base de células completas) y las vacunas contra la hepatitis B (HB) y contra Haemophilus influenzae tipo B (Hib) (DTPw-HB/Hib), con un total de 5 µg de fosfato de polirribosilrribitol (FPR). Hemos evaluado la inmunogenia y reactogenia observadas al aplicarse las dosis primaria y de refuerzo de esta nueva vacuna a niños sanos y las hemos comparado con las observadas al aplicar un régimen de referencia a base de las vacunas autorizadas DTPw-HB (Tritanrix) y antiHib (Hiberix) en forma de inyecciones simultáneas. MÉTODOS: Llevamos a cabo un estudio aleatorizado y con doble enmascaramiento de septiembre de 1998 a agosto de 1999 para establecer la inmunogenia y reactogenia observadas al administrarles a niños sanos la nueva vacuna combinada pentavalente (DTPw-HB/Hib) en una sola inyección, y compararlas con las observadas con el régimen de referencia. RESULTADOS: Se obtuvieron excelentes respuestas inmunitarias con ambos regímenes. Todos los niños vacunados en ambos grupos alcanzaron concentraciones séricas protectoras de anticuerpos antiFPR > 0,15 µg un mes después de recibir la dosis primaria. La vacuna combinada DTPw-HB/Hib no dio resultados inferiores a los obtenidos con las vacunas autorizadas en términos de los porcentajes de seroprotección, seropositividad y respuesta frente a todos los componentes antigénicos de la vacuna. La persistencia de anticuerpos contra todos los antígenos contenidos en ella hasta el momento en que se administró la dosis de refuerzo fue parecida en ambos grupos, y se observó un marcado aumento de las concentraciones de todos los anticuerpos después del refuerzo. La reactogenia general observada con ambos regímenes de vacunación fue parecida. CONCLUSIONES: Nuestros resultados indican que la nueva vacuna combinada pentavalente DTPw-HB/Hib ofrece una manera eficiente y confiable de poner en práctica las recomendaciones de la OMS para el control de la hepatitis B y de las infecciones por Hib en el mundo entero. <![CDATA[<B>Genomic risk and personal responsibility in health</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892006000300007&lng=en&nrm=iso&tlng=en With the advent of genomic research, a new category of risk has emerged-genetic risk-from which an individual cannot be separated. Among the outcomes of this model is a discussion on personal accountability, according to which an individual may both be exempted from events related to certain states of health ("blame it on the genes") or be blamed for those events ("transmitter of disease"). In addition, the search for genes to explain disease erases the line between what is normal and what is pathological, with a growing tendency towards considering individuals with no or very mild clinical manifestations as being "ill." The great emphasis on genomics may lead to both an exaggerated attention to genetics rather than social and environmental factors and to a reductionism that favors sociobiological explanations for human behavior. In addition, in this scenario, the right to information may paradoxically stimulate some to consume goods and services in order to prevent a hypothetical illness that could occur at some point in time as a result of genetic predisposition-goods and services that may not be available to everyone. It is essential that such issues be considered with the same urgency with which the genomic paradigm is being developed. <![CDATA[<B>Actitudes ante el tamizaje de cáncer de colon y recto en personas de origen mexicano que viven en los Estados Unidos</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892006000300008&lng=en&nrm=iso&tlng=en With the advent of genomic research, a new category of risk has emerged-genetic risk-from which an individual cannot be separated. Among the outcomes of this model is a discussion on personal accountability, according to which an individual may both be exempted from events related to certain states of health ("blame it on the genes") or be blamed for those events ("transmitter of disease"). In addition, the search for genes to explain disease erases the line between what is normal and what is pathological, with a growing tendency towards considering individuals with no or very mild clinical manifestations as being "ill." The great emphasis on genomics may lead to both an exaggerated attention to genetics rather than social and environmental factors and to a reductionism that favors sociobiological explanations for human behavior. In addition, in this scenario, the right to information may paradoxically stimulate some to consume goods and services in order to prevent a hypothetical illness that could occur at some point in time as a result of genetic predisposition-goods and services that may not be available to everyone. It is essential that such issues be considered with the same urgency with which the genomic paradigm is being developed. <![CDATA[<B>Patrones de consumo de tabaco en estudiantes de 13 a 15 años</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892006000300009&lng=en&nrm=iso&tlng=en With the advent of genomic research, a new category of risk has emerged-genetic risk-from which an individual cannot be separated. Among the outcomes of this model is a discussion on personal accountability, according to which an individual may both be exempted from events related to certain states of health ("blame it on the genes") or be blamed for those events ("transmitter of disease"). In addition, the search for genes to explain disease erases the line between what is normal and what is pathological, with a growing tendency towards considering individuals with no or very mild clinical manifestations as being "ill." The great emphasis on genomics may lead to both an exaggerated attention to genetics rather than social and environmental factors and to a reductionism that favors sociobiological explanations for human behavior. In addition, in this scenario, the right to information may paradoxically stimulate some to consume goods and services in order to prevent a hypothetical illness that could occur at some point in time as a result of genetic predisposition-goods and services that may not be available to everyone. It is essential that such issues be considered with the same urgency with which the genomic paradigm is being developed. <![CDATA[<B>Papel de las comadronas en las comunidades cakchiqueles de Guatemala</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892006000300010&lng=en&nrm=iso&tlng=en With the advent of genomic research, a new category of risk has emerged-genetic risk-from which an individual cannot be separated. Among the outcomes of this model is a discussion on personal accountability, according to which an individual may both be exempted from events related to certain states of health ("blame it on the genes") or be blamed for those events ("transmitter of disease"). In addition, the search for genes to explain disease erases the line between what is normal and what is pathological, with a growing tendency towards considering individuals with no or very mild clinical manifestations as being "ill." The great emphasis on genomics may lead to both an exaggerated attention to genetics rather than social and environmental factors and to a reductionism that favors sociobiological explanations for human behavior. In addition, in this scenario, the right to information may paradoxically stimulate some to consume goods and services in order to prevent a hypothetical illness that could occur at some point in time as a result of genetic predisposition-goods and services that may not be available to everyone. It is essential that such issues be considered with the same urgency with which the genomic paradigm is being developed. <![CDATA[<B>Percepciones acerca del uso de fármacos abortivos en mujeres de Colombia, Ecuador, México y Perú</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892006000300011&lng=en&nrm=iso&tlng=en With the advent of genomic research, a new category of risk has emerged-genetic risk-from which an individual cannot be separated. Among the outcomes of this model is a discussion on personal accountability, according to which an individual may both be exempted from events related to certain states of health ("blame it on the genes") or be blamed for those events ("transmitter of disease"). In addition, the search for genes to explain disease erases the line between what is normal and what is pathological, with a growing tendency towards considering individuals with no or very mild clinical manifestations as being "ill." The great emphasis on genomics may lead to both an exaggerated attention to genetics rather than social and environmental factors and to a reductionism that favors sociobiological explanations for human behavior. In addition, in this scenario, the right to information may paradoxically stimulate some to consume goods and services in order to prevent a hypothetical illness that could occur at some point in time as a result of genetic predisposition-goods and services that may not be available to everyone. It is essential that such issues be considered with the same urgency with which the genomic paradigm is being developed. <![CDATA[<B>Abandono espontáneo del hábito de fumar durante el embarazo en mujeres estadounidenses de bajos ingresos</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892006000300012&lng=en&nrm=iso&tlng=en With the advent of genomic research, a new category of risk has emerged-genetic risk-from which an individual cannot be separated. Among the outcomes of this model is a discussion on personal accountability, according to which an individual may both be exempted from events related to certain states of health ("blame it on the genes") or be blamed for those events ("transmitter of disease"). In addition, the search for genes to explain disease erases the line between what is normal and what is pathological, with a growing tendency towards considering individuals with no or very mild clinical manifestations as being "ill." The great emphasis on genomics may lead to both an exaggerated attention to genetics rather than social and environmental factors and to a reductionism that favors sociobiological explanations for human behavior. In addition, in this scenario, the right to information may paradoxically stimulate some to consume goods and services in order to prevent a hypothetical illness that could occur at some point in time as a result of genetic predisposition-goods and services that may not be available to everyone. It is essential that such issues be considered with the same urgency with which the genomic paradigm is being developed. <![CDATA[<B>Riesgo de transmisión de la tripanosomiasis americana por triatominos en México</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892006000300013&lng=en&nrm=iso&tlng=en With the advent of genomic research, a new category of risk has emerged-genetic risk-from which an individual cannot be separated. Among the outcomes of this model is a discussion on personal accountability, according to which an individual may both be exempted from events related to certain states of health ("blame it on the genes") or be blamed for those events ("transmitter of disease"). In addition, the search for genes to explain disease erases the line between what is normal and what is pathological, with a growing tendency towards considering individuals with no or very mild clinical manifestations as being "ill." The great emphasis on genomics may lead to both an exaggerated attention to genetics rather than social and environmental factors and to a reductionism that favors sociobiological explanations for human behavior. In addition, in this scenario, the right to information may paradoxically stimulate some to consume goods and services in order to prevent a hypothetical illness that could occur at some point in time as a result of genetic predisposition-goods and services that may not be available to everyone. It is essential that such issues be considered with the same urgency with which the genomic paradigm is being developed. <![CDATA[<B>La temporada de picadura de <I>Anopheles darlingi</I> y su relación con el control del paludismo en Bolivia</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892006000300014&lng=en&nrm=iso&tlng=en With the advent of genomic research, a new category of risk has emerged-genetic risk-from which an individual cannot be separated. Among the outcomes of this model is a discussion on personal accountability, according to which an individual may both be exempted from events related to certain states of health ("blame it on the genes") or be blamed for those events ("transmitter of disease"). In addition, the search for genes to explain disease erases the line between what is normal and what is pathological, with a growing tendency towards considering individuals with no or very mild clinical manifestations as being "ill." The great emphasis on genomics may lead to both an exaggerated attention to genetics rather than social and environmental factors and to a reductionism that favors sociobiological explanations for human behavior. In addition, in this scenario, the right to information may paradoxically stimulate some to consume goods and services in order to prevent a hypothetical illness that could occur at some point in time as a result of genetic predisposition-goods and services that may not be available to everyone. It is essential that such issues be considered with the same urgency with which the genomic paradigm is being developed. <![CDATA[<B>Dengue and dengue hemorrhagic fever</B>: <B>research priorities</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892006000300015&lng=en&nrm=iso&tlng=en Dengue is one of the most important infectious diseases in tropical and subtropical countries. At present, the only strategy available to reduce the incidence of dengue is vector control. The World Health Organization and the Pan American Health Organization have called on all nations to take the needed steps to help diminish the burden of this disease and its medical and socioeconomic impact. It is hoped that it will be possible to reverse the increase in dengue and help control its spread through a coordinated, effective international response, along with epidemiological, clinical, and virological research that brings together the most advanced methods and techniques. This piece summarizes the most up-to-date information on dengue, analyzes current epidemiologic trends in the Region of the Americas, discusses the main global and Western Hemisphere initiatives to control the disease, and presents the main areas of research that should be developed in the immediate future. <![CDATA[<B>Erratum</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892006000300016&lng=en&nrm=iso&tlng=en Dengue is one of the most important infectious diseases in tropical and subtropical countries. At present, the only strategy available to reduce the incidence of dengue is vector control. The World Health Organization and the Pan American Health Organization have called on all nations to take the needed steps to help diminish the burden of this disease and its medical and socioeconomic impact. It is hoped that it will be possible to reverse the increase in dengue and help control its spread through a coordinated, effective international response, along with epidemiological, clinical, and virological research that brings together the most advanced methods and techniques. This piece summarizes the most up-to-date information on dengue, analyzes current epidemiologic trends in the Region of the Americas, discusses the main global and Western Hemisphere initiatives to control the disease, and presents the main areas of research that should be developed in the immediate future.