Scielo RSS <![CDATA[Revista Panamericana de Salud Pública]]> http://www.scielosp.org/rss.php?pid=1020-498920080006&lang=en vol. 23 num. 6 lang. en <![CDATA[SciELO Logo]]> http://www.scielosp.org/img/en/fbpelogp.gif http://www.scielosp.org <![CDATA[<b>Knowledge of prenatal health care among Costa Rican and Panamanian women</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000600001&lng=en&nrm=iso&tlng=en OBJECTIVES: There is evidence that health care during pregnancy is a crucial component in ensuring a safe delivery. Because the infant mortality rate in Costa Rica is almost half the rate of Panama, the researchers tested the hypothesis that women in Costa Rica are more knowledgeable about prenatal health care than women in neighboring Panama. METHODS: A multiple-choice survey was used to evaluate women’s knowledge of prenatal care using WHO recommendations as the nominal standard. Oral surveys were administered to 320 women in Costa Rican and Panamanian health care clinics. The surveys consisted of multiple-choice questions designed to assess four specific domains of knowledge in prenatal care: nutrition, danger signs, threats from illness, and acceptable activities during pregnancy. Survey answers were scored, and significant factors in assessing women’s knowledge of prenatal care were determined using analysis of variance and general linear models. RESULTS: Costa Rican women scored higher than Panamanian women in most domains of knowledge in prenatal health care. Only country of origin and educational level were significant factors in determining knowledge of prenatal care. However, country of origin was a stronger predictor of knowledge of prenatal care than was having completed high school. CONCLUSIONS: These data suggest that Costa Rican women are more knowledgeable about necessary prenatal care than Panamanian women, and that this difference is probably related to direct education about and promotion of prenatal care in Costa Rica. This suggests an influence of cultural health care awareness that extends beyond the previously established negative correlation between maternal educational level and infant mortality.<hr/>OBJETIVOS: El cuidado de la salud durante el embarazo es un componente crucial para garantizar un parto sin riesgo. Como la mortalidad infantil en Costa Rica es casi la mitad de la registrada en Panamá, se probó la hipótesis de que las mujeres costarricenses conocen más acerca de los cuidados durante el embarazo que las panameñas. MÉTODOS: El conocimiento de las mujeres acerca de los cuidados de la salud durante el embarazo se evaluó mediante una encuesta, con las recomendaciones de la Organización Mundial de la Salud como estándar nominal. La encuesta se aplicó verbalmente a 320 mujeres en clínicas de Costa Rica y Panamá. Las preguntas de selección múltiple evaluaron el conocimiento en cuatro dominios específicos: nutrición, señales de alarma, amenazas por enfermedades y actividades aceptables durante el embarazo. Se asignaron puntuaciones a las respuestas. Se emplearon el análisis de varianza y modelos lineares para establecer los factores significativos que determinaron el conocimiento sobre los cuidados prenatales. RESULTADOS: Las mujeres costarricenses tuvieron una mayor puntuación que las panameñas en la mayoría de los dominios del conocimiento sobre los cuidados de la salud durante el embarazo. Los únicos factores significativos que determinaron esos conocimientos fueron el país de origen y el nivel educacional. El país de origen fue un factor de predicción de estos conocimientos más potente que haber completado la enseñanza media. CONCLUSIONES: Los resultados indican que las mujeres costarricenses tienen más conocimientos sobre los cuidados necesarios durante el embarazo que las panameñas y que esa diferencia puede estar relacionada con la educación directa sobre los cuidados prenatales y su promoción en Costa Rica. Esto podría indicar que hay una influencia de la cultura de concientización del cuidado de la salud que va más allá de la correlación negativa ya conocida entre la mortalidad infantil y el nivel de educación de la madre. <![CDATA[<b>Association between stress and depression levels and treatment adherence among HIV-positive individuals in Hermosillo, México</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000600002&lng=en&nrm=iso&tlng=en OBJETIVOS: Evaluar la asociación entre las variables relacionadas con el estrés, los motivos y la depresión en personas seropositivas al VIH y la adhesión al tratamiento, y analizar su consistencia según un modelo psicológico teórico. MÉTODOS: Estudio transversal con la participación de 25 mujeres y 39 hombres seropositivos al VIH atendidos en el Centro Ambulatorio para la Prevención y Atención a VIH/Sida e Infecciones de Transmisión Sexual, en Hermosillo, Sonora, México. Se exploraron las variables psicológicas y el grado de adhesión al tratamiento, las situaciones vinculadas con el estrés y el grado de depresión. Se elaboraron índices de las variables de interés asociadas con el estrés, los motivos y la depresión. La asociación entre las variables se determinó mediante regresión múltiple. RESULTADOS: En el mes previo al estudio, 65,6% de los 64 participantes informó haber seguido fielmente el tratamiento indicado, mientras 34,4% incumplieron el tratamiento en alguna medida (χ2 = 6,250; P = 0,012). Según el análisis de regresión se encontró que solamente la combinación de niveles intermedios de estrés vinculado con la tolerancia a la ambigüedad y niveles bajos de depresión presentó una asociación significativa (F [3,58] = 3,298; P = 0,027) con la adhesión al tratamiento; la combinación de ambas variables explicó 38,2% de la varianza total encontrada. CONCLUSIONES: La combinación de los niveles de estrés vinculado con la tolerancia a la ambigüedad y de depresión podría emplearse como factor de predicción del fiel cumplimiento de las indicaciones médicas prescritas. Se deben tener en cuenta estos resultados al diseñar intervenciones y programas dirigidos a promover la adhesión al tratamiento en personas seropositivas al VIH.<hr/>OBJECTIVES: To evaluate the association between variables related to stress, reasons, and depression, and adherence to treatment in HIV-positive individuals, and to analyze the robustness according to a theoretical psychology model. METHODS: This was a cross-sectional study of 25 female and 39 male HIV-positive participants receiving services at the Outpatient Center for Prevention and Treatment of HIV/AIDS and Sexually-transmitted Diseases (Centro Ambulatorio para la Prevención y Atención del VIH/Sida e Infecciones de Transmisión Sexual) in Hermosillo, Sonora, Mexico. The psychological variables, the degree of treatment adherence, stress-related circumstances, and the severity of depression were examined. Rates were calculated for the key variables associated with stress, reasons, and depression. The associations among variables were determined by multiple regression. RESULTS: During the month preceding the study, 65.6% of the 64 participants reported having faithfully followed the prescribed treatment, while 34.4% had failed, in some way, to follow the treatment (¯2 = 6.250; P = 0.012). Regression analysis found that there was only one combination, an intermediate level of stress linked to tolerance of uncertainty and low levels of depression, that was significantly associated (F [3.58] = 3.298; P = 0.027) with adherence to treatment; the combination of these two variables explained 38.2% of the total variance found. CONCLUSIONS: The combination of stress levels with tolerance of uncertainty and depression could be used as a predictor for true compliance with prescribed treatment plans. These results should be taken into account when designing intervention and treatment-adherence campaigns in HIV-positive individuals. <![CDATA[<b>Characteristics of cannabis users seeking treatment in São Paulo, Brazil</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000600003&lng=en&nrm=iso&tlng=en OBJECTIVES: This article describes a sample of 160 adults selected to participate in a randomized controlled trial conducted at a specialized outpatient clinic for cannabis users in Brazil. It correlates consumption with several measures of marijuana use, comparing it with other samples. METHODS: Instruments used were the Composite International Diagnostic Interview (CIDI) and Wender Utah Rating Scale for screening and demographic data interviews, and the ASI, time-line follow back (TLFB), Marijuana Withdrawal and Marijuana Problem Scales, and Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) Checklist for cannabis dependence. RESULTS: Participants in the study were mostly single, white men; their mean age was 32.3 years. They had a mean of 15.6 years of formal education and 61.6% worked. The cohort started using marijuana at a mean age of 16.5 years and developed daily use by a mean age of 21 years. Subjects in the sample had used marijuana for a mean of 15 years. They used it for 92.2% of the 90 days prior to the interview and smoked a mean of 1.99 marijuana cigarettes per day during this period. Individuals in the group had experimented with other drugs, especially cocaine. CONCLUSIONS: Marijuana users in this sample matched the profiles of those investigated elsewhere, although they reported fewer symptoms of dependence. Marijuana users should be considered independently in substance abuse programs, because they require specific attention and treatment. Broader epidemiological studies should be conducted to determine the extent of marijuana use within the Brazilian population.<hr/>OBJETIVOS: Describir una muestra de 160 adultos seleccionados para participar en un ensayo aleatorizado controlado, realizado en una clínica ambulatoria especializada para consumidores de marihuana en Brasil. Se asoció el consumo de marihuana con varias medidas relacionadas con este hábito y se comparó con otras muestras. MÉTODOS: Se empleó la Entrevista Diagnóstica Internacional Compuesta (CIDI) y la Escala de Valoración de Wender Utah para las entrevistas de tamizaje y la obtención de datos demográficos, y el Índice de Intensidad de la Adicción (ASI), la Línea Cronológica Retrospectiva (TLFB), la Escala de Abandono de la Marihuana, la Escala de Problemas por Marihuana y la lista de comprobación para la dependencia de la marihuana del Manual Diagnóstico y Estadístico de Trastornos Mentales (DSM-III-R). RESULTADOS: La mayoría de los participantes eran hombres blancos solteros; en promedio, la edad fue de 32,3 años y el nivel de escolarización de 15,6 años; 61,6% trabajaba. Como promedio, esta cohorte comenzó a fumar marihuana a una edad de 16,5 años y llegó a consumirla diariamente a los 21. Los participantes habían consumido marihuana durante 15 años y la consumieron 92,2% de los 90 días previos a la encuesta, con un consumo diario medio en ese lapso de 1,99 cigarrillos de marihuana. Miembros del grupo habían experimentado con otras drogas, principalmente cocaína. CONCLUSIONES: Los consumidores de marihuana estudiados se ajustan a los perfiles encontrados en otras investigaciones similares, aunque manifestaron menos síntomas de dependencia. En los programas para consumidores de estupefacientes se debe considerar a los consumidores de marihuana de manera independiente, ya que necesitan atención y tratamiento específicos. Se deben emprender estudios epidemiológicos más amplios para determinar la magnitud del consumo de marihuana en la población brasileña. <![CDATA[<b>Geospatial models for local health surveillance</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000600004&lng=en&nrm=iso&tlng=en OBJETIVOS: Generar un modelo geo-espacial para evaluar la exposición a plomo de escolares de 6 a 8 años, residentes de San Antonio Oeste, en la provincia de Río Negro, Argentina, localidad contaminada por una fundición en el casco de la ciudad y la acumulación a cielo abierto de sus residuos. MÉTODOS: El análisis espacial llevado a cabo de octubre a abril de 2006 incluyó la interpretación satelital y el georreferenciamiento de los datos para la espacialización de la información. Se tomó en cuenta la localización de las residencias sobre calles de tierra y la proximidad, desde el domicilio y/o la escuela de los niños bajo estudio, a los sitios-fuente como puntos de exposición. RESULTADOS: Las muestras de sangre tomadas a los niños en las escuelas en el área de influencia de alguna fuente, mostraron mayor abundancia de plombemias elevadas que las localizadas en otras áreas. Dichas plombemias se asociaron con la cercanía a alguna fuente y/o la ubicación de las residencias sobre calles de tierra. Los valores más altos de plomo en sangre correspondieron a mayores rangos de plomo ambiental. CONCLUSIONES: El análisis espacial constituyó una metodología complementaria útil para el análisis y la gestión de riesgo del sitio contaminado, al indicar una asociación positiva entre plombemias elevadas y la proximidad a la fuente, y/o el hecho de vivir en calles de tierra, que no se había hecho evidente mediante los análisis epidemiológicos tradicionales. Los resultados aportaron la evidencia científica necesaria para indicar la implementación de medidas de intervención directas sobre las fuentes de exposición y de educación, orientadas a fomentar hábitos dietéticos higiénicos en la población.<hr/>OBJECTIVES: To produce a geospatial model to evaluate lead exposure among school children from 6-8 years of age, in San Antonio Oeste, Rio Negro province, Argentina, an area contaminated by a foundry in the city center whose toxins were released into the open air. METHODS: The spatial analysis conducted from October-April 2006 included satellite interpretation and mapping of the data to geographically plot the information. Residences on dirt roads were included, as was the distance for each of the study children’s homes and/or schools to the site identified as the source of the exposure. RESULTS: Blood samples taken from children attending schools within the area surrounding the source showed higher lead levels than that of children in other areas. These lead levels were associated with the proximity to the source and/or with living on a dirt road. The highest blood lead levels corresponded to the higher environmental lead levels. CONCLUSIONS: Spatial analysis was shown to be a useful tool for site analysis and risk management since it indicated a definitive association between elevated lead levels and the proximity to the source, and/or residing on a dirt road, connections which had not been revealed with traditional epidemiological analyses. The results provided the scientific evidence needed to begin implementing interventions regarding the sources of exposure and education aimed at promoting more hygienic dietary habits among the population. <![CDATA[<b>Social participation in health in rural northeastern Brazil</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000600005&lng=en&nrm=iso&tlng=en OBJETIVOS: Analisar a participação social por meio dos Conselhos Municipais de Saúde (CMS) em dois municípios de pequeno porte do Nordeste do Brasil. MÉTODOS: Trata-se de um estudo exploratório, qualitativo, do tipo casos múltiplos, tendo como objeto de pesquisa os CMS de Lafayete Coutinho (Estado da Bahia) e Groaíras (Ceará). Os dados foram obtidos entre fevereiro e abril de 2005 por meio de análise documental, observação direta das reuniões dos CMS e entrevistas semi-estruturadas. Foram analisados decretos, leis e portarias municipais; relatórios anuais de gestão das secretarias municipais de saúde; planos municipais de saúde; e relatórios das conferências municipais de saúde. Também foram analisadas as atas dos conselhos desde a sua criação até o ano de 2004. Foram entrevistados 17 conselheiros de saúde, oito de Lafayete Coutinho e nove de Groaíras. RESULTADOS: Ambos os conselhos apresentaram irregularidades quanto à composição e à posse dos conselheiros, como a alta rotatividade de representantes e as constantes "reformulações" da composição do conselho. Além disso, o quadro dos CMS era totalmente renovado quando da posse de um novo prefeito. Também foram observadas irregularidades na freqüência das reuniões. Em Lafayete Coutinho, das 96 reuniões previstas foram realizadas 37; em Groaíras, das 186 reuniões previstas o CMS realizou 93. Na análise da atuação do CMS como formulador e controlador das políticas municipais de saúde, emergiram três categorias temáticas: estado de saúde da população e políticas públicas; organização e funcionamento dos serviços de saúde; e gestão financeira e prestação de contas. As entrevistas mostraram a insatisfação dos participantes com as práticas do CMS e a sua descrença quanto à representatividade e ao poder desses conselhos. CONCLUSÕES: É preciso repensar as estratégias de participação social no Brasil a partir da perspectiva do desenvolvimento de práticas sociais de amadurecimento político e elevação da consciência cidadã.<hr/>OBJECTIVES: To analyze the social participation taking place through Municipal Health Councils (MHC) in two small towns in northeastern Brazil. METHODS: A qualitative, exploratory, multicase study focused on the MHCs of Lafayete Coutinho (state of Bahia) and Groaíras (state of Ceará) was conducted. Data were gathered from February-April 2005 through analysis of documents, direct observation of MHC meetings, and semistructured interviews. Documents analyzed included decrees, laws, and municipal regulations; city health department annual management reports; municipal health plans; and reports of municipal health conferences. MHC meeting minutes for the period between inception of these councils and 2004 were also reviewed. Interviews of 17 council members took place, eight of whom were from Lafayete Coutinho and nine from Groaíras. RESULTS: Both councils had irregular practices regarding membership structure and nomination of members, such as frequent changes in appointed members and continuous "reshuffling" of council structure. In addition, new council members were appointed each time a new mayor took charge. Sporadic frequency of meetings was also observed. In Lafayete Coutinho, of 96 meetings planned, just 37 took place; in Groaíras, of 186 meetings planned, 93 took place. Analysis of MHC efforts to formulate and control municipal health policies revealed three themes: health status of the population and public policies; organization and functioning of health services; and financial management and accounting. The interviews showed that council members were dissatisfied with the practices of the MHCs and revealed a lack of confidence in how truly representative the councils are and how much power they have. CONCLUSIONS: Social participation strategies in Brazil must be reconsidered with an angle toward promoting political responsibility and raising awareness among citizens. <![CDATA[<b>Association between contraceptive discontinuation and pregnancy intentions in Guatemala</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000600006&lng=en&nrm=iso&tlng=en OBJECTIVES: To determine whether contraceptive discontinuation is associated with pregnancies that are conceived earlier than desired (mistimed) or are not wanted at the time of conception (unwanted). METHODS: Data were obtained from the 2002 Guatemala National Maternal and Child Health Survey. Pregnancies within the three years prior to and at the time of the survey (April 1999-November 2002) were classified as either "intended," "mistimed," or "unwanted." The key independent variable was whether the woman had used contraception within 12 months of the pregnancy and, for those who had used it, the reason for discontinuation (either to get pregnant or for another reason). A multinomial logistic analysis was used to determine the degree of association of discontinuation with pregnancy intentions. RESULTS: One of every five mistimed pregnancies and one of every six unwanted pregnancies followed discontinuations that were for reasons other than to become pregnant (e.g., contraceptive failure, side effects, and health concerns). Discontinuations for reasons other than to become pregnant were shown to be positively and significantly associated with a reported mistimed pregnancy (coefficient = 2.15; standard error = 0.27) or unwanted pregnancy (2.68; 0.37) compared to an intended pregnancy. Pregnancies preceded by discontinuations for reasons other than to become pregnant were also more likely to be reported as mistimed or unwanted than pregnancies of women who were not using contraception during the year prior to pregnancy. CONCLUSIONS: There is a need to increase contraceptive continuation. Any program should include an increased effort to reduce contraceptive failure and better address the side effects and the health concerns that women have that can lead to discontinuation. Non-users who want to delay or limit births should also be identified and targeted for outreach in order to reduce unintended pregnancies.<hr/>OBJETIVOS: Determinar si la suspensión del uso de anticonceptivos (SUA) está asociada con embarazos concebidos antes de lo deseado (inoportunos) o no deseados. MÉTODOS: Se usaron los datos de la Encuesta Nacional de Salud Materna e Infantil en Guatemala de 2002. Los embarazos registrados entre los tres años previos a la encuesta (desde abril de 1999) y el final de la misma (noviembre de 2002) se clasificaron como deseados, inoportunos o no deseados. La variable independiente principal fue si la mujer había usado algún anticonceptivo en los 12 meses previos al embarazo y, en ese caso, la razón de la SUA (para lograr un embarazo u otra razón). Mediante el análisis logístico polinominal se determinó el grado de asociación entre la SUA y el tipo de embarazo resultante. RESULTADOS: Uno de cada cinco embarazos inoportunos y uno de cada seis embarazos no deseados sucedieron a la SUA por razones ajenas al deseo de un embarazo (por ejemplo, fallas o efectos secundarios del anticonceptivo, o consideraciones de salud). Se encontró una asociación directa y significativa entre la SUA por razones ajenas al deseo de quedar embarazada y los embarazos clasificados como inoportunos (coeficiente = 2,15; error estándar = 0,27) o no deseados (2,68; 0,37), en contraste con los embarazos deseados. Las mujeres que suspendieron el uso de anticonceptivos por razones ajenas al deseo de un embarazo presentaron una mayor probabilidad de considerar sus embarazos inoportunos o no deseados que las mujeres que no emplearon medios anticonceptivos en el año previo a su embarazo. CONCLUSIONES: Es necesario promover el uso continuado de los anticonceptivos. Los programas deben hacer un mayor esfuerzo para reducir las fallas de los anticonceptivos, informar mejor sobre los efectos secundarios y aclarar las preocupaciones sanitarias que puedan llevar a la SUE. A fin de reducir el número de embarazos no programados, se deben identificar y captar a las mujeres que no usan anticonceptivos y quieren demorar o evitar un embarazo. <![CDATA[<b>Characterization of autopsy-proven fatal asthma patients in São Paulo, Brazil</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000600007&lng=en&nrm=iso&tlng=en Few data are available on autopsy-proven fatal asthma patients in São Paulo, Brazil. We characterized 73 asthma patients who were autopsied at the Serviço de Verificação de Óbitos da Universidade de São Paulo between 1996 and 2004. An interview with the next of kin assessed socioeconomic status, history, and treatment of asthma. There were 42 women and 31 men. Fifty-six (76.7%) of them were older than 34 years. Sixty-three percent were Caucasians, 77.3% had < 8 years of schooling, and the median income was 1.6 times the minimum wage. Twenty-two patients (30.1%) were smokers and 14 (19.2%) were ex-smokers. Only 25 (34.2%) patients were regularly followed by a doctor. Only 12.3% received inhaled steroids. Thirty-five patients (47.9%) had moderate-to-severe asthma. Fifty-five (75.3%) deaths took place outside a hospital. We conclude that this population shares characteristics of severe or poorly controlled asthma, low educational and socioeconomic levels, and lack of medical care and of inhaled steroid use.<hr/>Se cuenta con poca información acerca de los pacientes fallecidos por asma certificada por autopsia en São Paulo, Brasil. Se caracterizaron 73 pacientes de asma sometidos a autopsia en el Serviço de Verificação de Óbitos da Universidade de São Paulo entre 1996 y 2004. Mediante entrevistas con sus parientes se estableció el nivel socioeconómico, los antecedentes de asma y el tratamiento seguido. Del los 73 pacientes (42 mujeres y 31 hombres), 56 (76,7%) eran mayores de 34 años; 63,0% eran caucásicos y 77,3% tenían menos de 8 años de escolaridad. La mediana de los ingresos era de 1,6 veces el salario mínimo. De los pacientes, 22 (30,1%) eran fumadores y 14 (19,2%) lo habían sido. Solamente 25 (34,2%) pacientes tenían seguimiento médico regular y solo 12,3% usaba inhaladores de esteroides; 35 (47,9%) presentaban asma moderada o intensa; 55 (75,3%) de las muertes ocurrieron fuera de los hospitales. Se concluye que esta población se caracterizaba por padecer de asma intensa o poco controlada, bajo nivel educacional y socioeconómico, carecía de atención médica y no usaba inhaladores de esteroides. <![CDATA[<b>Validez interna y externa de los ensayos aleatorizados por conglomerados</b>: <b>revisión sistemática</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000600008&lng=en&nrm=iso&tlng=en Few data are available on autopsy-proven fatal asthma patients in São Paulo, Brazil. We characterized 73 asthma patients who were autopsied at the Serviço de Verificação de Óbitos da Universidade de São Paulo between 1996 and 2004. An interview with the next of kin assessed socioeconomic status, history, and treatment of asthma. There were 42 women and 31 men. Fifty-six (76.7%) of them were older than 34 years. Sixty-three percent were Caucasians, 77.3% had < 8 years of schooling, and the median income was 1.6 times the minimum wage. Twenty-two patients (30.1%) were smokers and 14 (19.2%) were ex-smokers. Only 25 (34.2%) patients were regularly followed by a doctor. Only 12.3% received inhaled steroids. Thirty-five patients (47.9%) had moderate-to-severe asthma. Fifty-five (75.3%) deaths took place outside a hospital. We conclude that this population shares characteristics of severe or poorly controlled asthma, low educational and socioeconomic levels, and lack of medical care and of inhaled steroid use.<hr/>Se cuenta con poca información acerca de los pacientes fallecidos por asma certificada por autopsia en São Paulo, Brasil. Se caracterizaron 73 pacientes de asma sometidos a autopsia en el Serviço de Verificação de Óbitos da Universidade de São Paulo entre 1996 y 2004. Mediante entrevistas con sus parientes se estableció el nivel socioeconómico, los antecedentes de asma y el tratamiento seguido. Del los 73 pacientes (42 mujeres y 31 hombres), 56 (76,7%) eran mayores de 34 años; 63,0% eran caucásicos y 77,3% tenían menos de 8 años de escolaridad. La mediana de los ingresos era de 1,6 veces el salario mínimo. De los pacientes, 22 (30,1%) eran fumadores y 14 (19,2%) lo habían sido. Solamente 25 (34,2%) pacientes tenían seguimiento médico regular y solo 12,3% usaba inhaladores de esteroides; 35 (47,9%) presentaban asma moderada o intensa; 55 (75,3%) de las muertes ocurrieron fuera de los hospitales. Se concluye que esta población se caracterizaba por padecer de asma intensa o poco controlada, bajo nivel educacional y socioeconómico, carecía de atención médica y no usaba inhaladores de esteroides. <![CDATA[<b>Primer aislamiento del virus del Nilo occidental en el Caribe</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000600009&lng=en&nrm=iso&tlng=en Few data are available on autopsy-proven fatal asthma patients in São Paulo, Brazil. We characterized 73 asthma patients who were autopsied at the Serviço de Verificação de Óbitos da Universidade de São Paulo between 1996 and 2004. An interview with the next of kin assessed socioeconomic status, history, and treatment of asthma. There were 42 women and 31 men. Fifty-six (76.7%) of them were older than 34 years. Sixty-three percent were Caucasians, 77.3% had < 8 years of schooling, and the median income was 1.6 times the minimum wage. Twenty-two patients (30.1%) were smokers and 14 (19.2%) were ex-smokers. Only 25 (34.2%) patients were regularly followed by a doctor. Only 12.3% received inhaled steroids. Thirty-five patients (47.9%) had moderate-to-severe asthma. Fifty-five (75.3%) deaths took place outside a hospital. We conclude that this population shares characteristics of severe or poorly controlled asthma, low educational and socioeconomic levels, and lack of medical care and of inhaled steroid use.<hr/>Se cuenta con poca información acerca de los pacientes fallecidos por asma certificada por autopsia en São Paulo, Brasil. Se caracterizaron 73 pacientes de asma sometidos a autopsia en el Serviço de Verificação de Óbitos da Universidade de São Paulo entre 1996 y 2004. Mediante entrevistas con sus parientes se estableció el nivel socioeconómico, los antecedentes de asma y el tratamiento seguido. Del los 73 pacientes (42 mujeres y 31 hombres), 56 (76,7%) eran mayores de 34 años; 63,0% eran caucásicos y 77,3% tenían menos de 8 años de escolaridad. La mediana de los ingresos era de 1,6 veces el salario mínimo. De los pacientes, 22 (30,1%) eran fumadores y 14 (19,2%) lo habían sido. Solamente 25 (34,2%) pacientes tenían seguimiento médico regular y solo 12,3% usaba inhaladores de esteroides; 35 (47,9%) presentaban asma moderada o intensa; 55 (75,3%) de las muertes ocurrieron fuera de los hospitales. Se concluye que esta población se caracterizaba por padecer de asma intensa o poco controlada, bajo nivel educacional y socioeconómico, carecía de atención médica y no usaba inhaladores de esteroides. <![CDATA[<b>Necesidad de mejorar la detección de la insuficiencia renal crónica en América Latina</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000600010&lng=en&nrm=iso&tlng=en Few data are available on autopsy-proven fatal asthma patients in São Paulo, Brazil. We characterized 73 asthma patients who were autopsied at the Serviço de Verificação de Óbitos da Universidade de São Paulo between 1996 and 2004. An interview with the next of kin assessed socioeconomic status, history, and treatment of asthma. There were 42 women and 31 men. Fifty-six (76.7%) of them were older than 34 years. Sixty-three percent were Caucasians, 77.3% had < 8 years of schooling, and the median income was 1.6 times the minimum wage. Twenty-two patients (30.1%) were smokers and 14 (19.2%) were ex-smokers. Only 25 (34.2%) patients were regularly followed by a doctor. Only 12.3% received inhaled steroids. Thirty-five patients (47.9%) had moderate-to-severe asthma. Fifty-five (75.3%) deaths took place outside a hospital. We conclude that this population shares characteristics of severe or poorly controlled asthma, low educational and socioeconomic levels, and lack of medical care and of inhaled steroid use.<hr/>Se cuenta con poca información acerca de los pacientes fallecidos por asma certificada por autopsia en São Paulo, Brasil. Se caracterizaron 73 pacientes de asma sometidos a autopsia en el Serviço de Verificação de Óbitos da Universidade de São Paulo entre 1996 y 2004. Mediante entrevistas con sus parientes se estableció el nivel socioeconómico, los antecedentes de asma y el tratamiento seguido. Del los 73 pacientes (42 mujeres y 31 hombres), 56 (76,7%) eran mayores de 34 años; 63,0% eran caucásicos y 77,3% tenían menos de 8 años de escolaridad. La mediana de los ingresos era de 1,6 veces el salario mínimo. De los pacientes, 22 (30,1%) eran fumadores y 14 (19,2%) lo habían sido. Solamente 25 (34,2%) pacientes tenían seguimiento médico regular y solo 12,3% usaba inhaladores de esteroides; 35 (47,9%) presentaban asma moderada o intensa; 55 (75,3%) de las muertes ocurrieron fuera de los hospitales. Se concluye que esta población se caracterizaba por padecer de asma intensa o poco controlada, bajo nivel educacional y socioeconómico, carecía de atención médica y no usaba inhaladores de esteroides. <![CDATA[<b>El periodismo científico en América Latina</b>: <b>¿se informa correctamente a la población?</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000600011&lng=en&nrm=iso&tlng=en Few data are available on autopsy-proven fatal asthma patients in São Paulo, Brazil. We characterized 73 asthma patients who were autopsied at the Serviço de Verificação de Óbitos da Universidade de São Paulo between 1996 and 2004. An interview with the next of kin assessed socioeconomic status, history, and treatment of asthma. There were 42 women and 31 men. Fifty-six (76.7%) of them were older than 34 years. Sixty-three percent were Caucasians, 77.3% had < 8 years of schooling, and the median income was 1.6 times the minimum wage. Twenty-two patients (30.1%) were smokers and 14 (19.2%) were ex-smokers. Only 25 (34.2%) patients were regularly followed by a doctor. Only 12.3% received inhaled steroids. Thirty-five patients (47.9%) had moderate-to-severe asthma. Fifty-five (75.3%) deaths took place outside a hospital. We conclude that this population shares characteristics of severe or poorly controlled asthma, low educational and socioeconomic levels, and lack of medical care and of inhaled steroid use.<hr/>Se cuenta con poca información acerca de los pacientes fallecidos por asma certificada por autopsia en São Paulo, Brasil. Se caracterizaron 73 pacientes de asma sometidos a autopsia en el Serviço de Verificação de Óbitos da Universidade de São Paulo entre 1996 y 2004. Mediante entrevistas con sus parientes se estableció el nivel socioeconómico, los antecedentes de asma y el tratamiento seguido. Del los 73 pacientes (42 mujeres y 31 hombres), 56 (76,7%) eran mayores de 34 años; 63,0% eran caucásicos y 77,3% tenían menos de 8 años de escolaridad. La mediana de los ingresos era de 1,6 veces el salario mínimo. De los pacientes, 22 (30,1%) eran fumadores y 14 (19,2%) lo habían sido. Solamente 25 (34,2%) pacientes tenían seguimiento médico regular y solo 12,3% usaba inhaladores de esteroides; 35 (47,9%) presentaban asma moderada o intensa; 55 (75,3%) de las muertes ocurrieron fuera de los hospitales. Se concluye que esta población se caracterizaba por padecer de asma intensa o poco controlada, bajo nivel educacional y socioeconómico, carecía de atención médica y no usaba inhaladores de esteroides. <![CDATA[<b>Preparedness planning for an influenza pandemic</b>: <b>regional efforts</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000600012&lng=en&nrm=iso&tlng=en Few data are available on autopsy-proven fatal asthma patients in São Paulo, Brazil. We characterized 73 asthma patients who were autopsied at the Serviço de Verificação de Óbitos da Universidade de São Paulo between 1996 and 2004. An interview with the next of kin assessed socioeconomic status, history, and treatment of asthma. There were 42 women and 31 men. Fifty-six (76.7%) of them were older than 34 years. Sixty-three percent were Caucasians, 77.3% had < 8 years of schooling, and the median income was 1.6 times the minimum wage. Twenty-two patients (30.1%) were smokers and 14 (19.2%) were ex-smokers. Only 25 (34.2%) patients were regularly followed by a doctor. Only 12.3% received inhaled steroids. Thirty-five patients (47.9%) had moderate-to-severe asthma. Fifty-five (75.3%) deaths took place outside a hospital. We conclude that this population shares characteristics of severe or poorly controlled asthma, low educational and socioeconomic levels, and lack of medical care and of inhaled steroid use.<hr/>Se cuenta con poca información acerca de los pacientes fallecidos por asma certificada por autopsia en São Paulo, Brasil. Se caracterizaron 73 pacientes de asma sometidos a autopsia en el Serviço de Verificação de Óbitos da Universidade de São Paulo entre 1996 y 2004. Mediante entrevistas con sus parientes se estableció el nivel socioeconómico, los antecedentes de asma y el tratamiento seguido. Del los 73 pacientes (42 mujeres y 31 hombres), 56 (76,7%) eran mayores de 34 años; 63,0% eran caucásicos y 77,3% tenían menos de 8 años de escolaridad. La mediana de los ingresos era de 1,6 veces el salario mínimo. De los pacientes, 22 (30,1%) eran fumadores y 14 (19,2%) lo habían sido. Solamente 25 (34,2%) pacientes tenían seguimiento médico regular y solo 12,3% usaba inhaladores de esteroides; 35 (47,9%) presentaban asma moderada o intensa; 55 (75,3%) de las muertes ocurrieron fuera de los hospitales. Se concluye que esta población se caracterizaba por padecer de asma intensa o poco controlada, bajo nivel educacional y socioeconómico, carecía de atención médica y no usaba inhaladores de esteroides. <![CDATA[<b>Panosis</b>: <b>a new word or a forgotten world?</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000600013&lng=en&nrm=iso&tlng=en Few data are available on autopsy-proven fatal asthma patients in São Paulo, Brazil. We characterized 73 asthma patients who were autopsied at the Serviço de Verificação de Óbitos da Universidade de São Paulo between 1996 and 2004. An interview with the next of kin assessed socioeconomic status, history, and treatment of asthma. There were 42 women and 31 men. Fifty-six (76.7%) of them were older than 34 years. Sixty-three percent were Caucasians, 77.3% had < 8 years of schooling, and the median income was 1.6 times the minimum wage. Twenty-two patients (30.1%) were smokers and 14 (19.2%) were ex-smokers. Only 25 (34.2%) patients were regularly followed by a doctor. Only 12.3% received inhaled steroids. Thirty-five patients (47.9%) had moderate-to-severe asthma. Fifty-five (75.3%) deaths took place outside a hospital. We conclude that this population shares characteristics of severe or poorly controlled asthma, low educational and socioeconomic levels, and lack of medical care and of inhaled steroid use.<hr/>Se cuenta con poca información acerca de los pacientes fallecidos por asma certificada por autopsia en São Paulo, Brasil. Se caracterizaron 73 pacientes de asma sometidos a autopsia en el Serviço de Verificação de Óbitos da Universidade de São Paulo entre 1996 y 2004. Mediante entrevistas con sus parientes se estableció el nivel socioeconómico, los antecedentes de asma y el tratamiento seguido. Del los 73 pacientes (42 mujeres y 31 hombres), 56 (76,7%) eran mayores de 34 años; 63,0% eran caucásicos y 77,3% tenían menos de 8 años de escolaridad. La mediana de los ingresos era de 1,6 veces el salario mínimo. De los pacientes, 22 (30,1%) eran fumadores y 14 (19,2%) lo habían sido. Solamente 25 (34,2%) pacientes tenían seguimiento médico regular y solo 12,3% usaba inhaladores de esteroides; 35 (47,9%) presentaban asma moderada o intensa; 55 (75,3%) de las muertes ocurrieron fuera de los hospitales. Se concluye que esta población se caracterizaba por padecer de asma intensa o poco controlada, bajo nivel educacional y socioeconómico, carecía de atención médica y no usaba inhaladores de esteroides. <![CDATA[<b>Fe de errata</b>: <b><i>Trypanosoma cruzi</i></b><b> I: único tipo del parásito tripanosómico circulante en Panamá (Rev Panam Salud Publica/Pan Am J Public Health 2008;23(5):357)</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000600014&lng=en&nrm=iso&tlng=en Few data are available on autopsy-proven fatal asthma patients in São Paulo, Brazil. We characterized 73 asthma patients who were autopsied at the Serviço de Verificação de Óbitos da Universidade de São Paulo between 1996 and 2004. An interview with the next of kin assessed socioeconomic status, history, and treatment of asthma. There were 42 women and 31 men. Fifty-six (76.7%) of them were older than 34 years. Sixty-three percent were Caucasians, 77.3% had < 8 years of schooling, and the median income was 1.6 times the minimum wage. Twenty-two patients (30.1%) were smokers and 14 (19.2%) were ex-smokers. Only 25 (34.2%) patients were regularly followed by a doctor. Only 12.3% received inhaled steroids. Thirty-five patients (47.9%) had moderate-to-severe asthma. Fifty-five (75.3%) deaths took place outside a hospital. We conclude that this population shares characteristics of severe or poorly controlled asthma, low educational and socioeconomic levels, and lack of medical care and of inhaled steroid use.<hr/>Se cuenta con poca información acerca de los pacientes fallecidos por asma certificada por autopsia en São Paulo, Brasil. Se caracterizaron 73 pacientes de asma sometidos a autopsia en el Serviço de Verificação de Óbitos da Universidade de São Paulo entre 1996 y 2004. Mediante entrevistas con sus parientes se estableció el nivel socioeconómico, los antecedentes de asma y el tratamiento seguido. Del los 73 pacientes (42 mujeres y 31 hombres), 56 (76,7%) eran mayores de 34 años; 63,0% eran caucásicos y 77,3% tenían menos de 8 años de escolaridad. La mediana de los ingresos era de 1,6 veces el salario mínimo. De los pacientes, 22 (30,1%) eran fumadores y 14 (19,2%) lo habían sido. Solamente 25 (34,2%) pacientes tenían seguimiento médico regular y solo 12,3% usaba inhaladores de esteroides; 35 (47,9%) presentaban asma moderada o intensa; 55 (75,3%) de las muertes ocurrieron fuera de los hospitales. Se concluye que esta población se caracterizaba por padecer de asma intensa o poco controlada, bajo nivel educacional y socioeconómico, carecía de atención médica y no usaba inhaladores de esteroides.