Scielo RSS <![CDATA[Revista Panamericana de Salud Pública]]> http://www.scielosp.org/rss.php?pid=1020-498920100001&lang=en vol. 27 num. 1 lang. en <![CDATA[SciELO Logo]]> http://www.scielosp.org/img/en/fbpelogp.gif http://www.scielosp.org <![CDATA[<B>Innovative care and self-care strategies for people with chronic diseases in Latin America</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010000100001&lng=en&nrm=iso&tlng=en OBJETIVOS: Identificar estrategias innovadoras dirigidas a mejorar el cuidado y el autocuidado de los pacientes con enfermedades crónicas (EC) en América Latina y explorar el interés en crear una red latinoamericana de profesionales en ese campo. MÉTODOS: Estudio descriptivo exploratorio basado en una encuesta aplicada a expertos clave con reconocido liderazgo nacional o regional en la atención de pacientes con EC. El cuestionario de 25 preguntas recababa información sobre su experiencia en iniciativas de cuidado y autocuidado de pacientes con EC, la descripción de las iniciativas exitosas, la percepción de la capacidad de los países para innovar en este ámbito y el interés en participar en una red de profesionales latinoamericanos en ese campo, entre otras. Se realizó un análisis de contenidos para elaborar recomendaciones para la Región. RESULTADOS: Se obtuvo respuesta de 17 (37,8%) de los 45 expertos invitados; 82,4% afirmó conocer o participar en alguna iniciativa innovadora en el tema planteado. Existe un incipiente desarrollo de los tres tipos de estrategias innovadoras: cuidado por pares, cuidadores informales y telecuidado, esta última es la menos explorada. Hay un real interés en conformar una red latinoamericana para el desarrollo de estrategias innovadoras dirigidas al autocuidado de pacientes con EC. CONCLUSIONES: Las bases para una red de trabajo conjunto son promisorias y es prioritario fortalecer las competencias en esta área y desarrollar propuestas innovadoras para mejorar la atención de los pacientes con EC en la Región. Las medidas innovadoras deben ser complementarias y se deben ajustar al contexto específico de cada escenario.<hr/>OBJECTIVES: To identify innovative strategies for improved care and self-care of patients with chronic diseases (CD) in Latin America and to explore interest in creating a Latin American network of professionals in this field. METHODS: A descriptive study based on a survey of key experts with recognized national or regional leadership in CD patient care. The 25-question questionnaire sought information on their experiences with care and self-care initiatives for CD patients, descriptions of successful initiatives, the perceived ability of countries to innovate in this area, their interest in participating in a network of Latin American professionals in this field, and more. Content analysis was performed to develop recommendations for the Region. RESULTS: Responses were obtained from 17 (37.8%) of the 45 experts approached; 82.4% confirmed their knowledge of of involvement with an innovative initiative related to the subject. Initial development does exist in each of the three innovative strategy types: peer care, informal caregivers, and telenursing, the latter being the least explored. There is real interest in forming a Latin American network that focuses on development of innovative self-care strategies for CD patients. CONCLUSIONS: Support for a joint network is promising. Priorities are building skills in this area and developing innovative proposals for improved CD patient care in the Region. Innovative measures should be complementary and adapted to the specific context of each scenario. <![CDATA[<B>Association between particulate matter from biomass burning and respiratory diseases in the southern region of the Brazilian Amazon</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010000100002&lng=en&nrm=iso&tlng=en OBJETIVO: Investigar os efeitos de curto prazo da exposição ao material particulado de queimadas da Amazônia na demanda diária de atendimento ambulatorial por doenças respiratórias de crianças e de idosos. MÉTODOS: Estudo epidemiológico com delineamento ecológico de séries temporais. Os registros diários de atendimento ambulatorial foram obtidos nas 14 unidades de saúde do município de Alta Floresta, Mato Grosso, região sul da Amazônia brasileira, no período de janeiro de 2004 a dezembro de 2005. Informação sobre os níveis diários de material particulado fino foi disponibilizada pelo Instituto Nacional de Pesquisas Espaciais. Para controlar possíveis fatores de confusão (situações nas quais uma associação não causal entre exposição e doença é observada devido a uma terceira variável), foram adicionadas ao modelo variáveis referentes a tendência temporal, sazonalidade, temperatura, umidade relativa do ar, precipitação pluviométrica e efeitos de calendário (como ocorrência de feriados e finais de semana). Utilizou-se regressão de Poisson via modelos aditivos generalizados. RESULTADOS: Um incremento de 10 µg/m³ nos níveis de exposição ao material particulado esteve associado a aumentos de 2,9 e 2,6% nos atendimentos ambulatoriais por doenças respiratórias de crianças no 6º e 7º dias subsequentes à exposição. Não foram encontradas associações significativas nos atendimentos de idosos. CONCLUSÕES: Os resultados sugerem que os níveis de material particulado das queimadas na Amazônia estão associados a efeitos adversos à saúde respiratória de crianças.<hr/>OBJECTIVE: To investigate the short-term effects of exposure to particulate matter from biomass burning in the Amazon on the daily demand for outpatient care due to respiratory diseases in children and the elderly. METHODS: Epidemiologic study with ecologic time series design. Daily consultation records were obtained from the 14 primary health care clinics in the municipality of Alta Floresta, state of Mato Grosso, in the southern region of the Brazilian Amazon, between January 2004 and December 2005. Information on the daily levels of fine particulate matter was made available by the Brazilian National Institute for Spatial Research. To control for confounding factors (situations in which a non-causal association between exposure and disease is observed due to a third variable), variables related to time trends, seasonality, temperature, relative humidity, rainfall, and calendar effects (such as occurrence of holidays and weekends) were included in the model. Poisson regression with generalized additive models was used. RESULTS: A 10 μg/m³ increase in the level of exposure to particulate matter was associated with increases of 2.9% and 2.6% in outpatient consultations due to respiratory diseases in children on the 6th and 7th days following exposure. Significant associations were not observed for elderly individuals. CONCLUSIONS: The results suggest that the levels of particulate matter from biomass burning in the Amazon are associated with adverse effects on the respiratory health of children. <![CDATA[<B>Human T-cell lymphotropic virus type I infection in patients with lymphoproliferative disorders at two sentinel sites in Cuba</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010000100003&lng=en&nrm=iso&tlng=en OBJETIVO: Determinar la frecuencia de la infección por el HTLV-I en pacientes con síndromes linfoproliferativos, así como en sus familiares y contactos sexuales, en dos sitios de vigilancia centinela en Cuba. MÉTODOS: Se analizaron todos los pacientes que tenían un diagnóstico presuntivo de neoplasias hematológicas entre enero de 1996 y enero de 2007 atendidos en los servicios de hematología del Hospital Hermanos Ameijeiras (HHA), de Ciudad de La Habana, y el Hospital Provincial Comandante Faustino Pérez (HPCFP), de Matanzas, Cuba. Se determinó la seropositividad al HTLV-I por ELISA y western blot y se confirmó la infección mediante la reacción en cadena de la polimerasa. Se estudiaron también los familiares y los contactos sexuales de los pacientes positivos. Se utilizó la prueba de la Z para la comparación de proporciones. RESULTADOS: La seroprevalencia de la infección por el HTLV-I en pacientes con síndromes linfoproliferativos fue de 0,4%, mayor en el HPCFP que en el HHA (6,1% frente a 0,2%; P < 0,001). No se encontraron diferencias significativas en la frecuencia de la infección según la edad, el sexo y el color de la piel. De los 53 familiares y contactos sexuales estudiados, 8 (15,1%) tuvieron diagnóstico positivo de infección por el HTLV-I. CONCLUSIÓN: La frecuencia de la infección por el HTLV-I en el grupo estudiado fue superior a la encontrada con anterioridad en Cuba. Se confirmó la utilidad de la vigilancia seroepidemiológica mediante centros centinela.<hr/>OBJECTIVE: To determine the prevalence of human T-cell lymphotropic virus type I (HTLV-I) infection among patients with lymphoproliferative disorders, as well as among their family members and sexual contacts, at two sentinel sites in Cuba. METHODS: An analysis was conducted of all the patients with a presumptive diagnosis of hematological malignancies seen by the hematology departments of the Hospital Hermanos Ameijeiras (HHA), City of Havana, and the Hospital Provincial Comandante Faustino Pérez (HPCFP), Matanza, Cuba, in January 1996-January 1997. HTLV-I seropositivity was determined by ELISA and Western Blot, and infection was confirmed by polymerase chain reaction. The positive patients' family members and sexual contacts were also assessed. The Z-test was used to compare proportions. RESULTS: Seroprevalence of HTLV-I infection in patients with lymphoproliferative disorders was 0.4% higher at the HPCFP than at the HHA (6.1% versus 0.2%, P < 0.001). There were no significant differences in prevalence by age, sex, or skin color. Of the 53 family members and sexual contacts studied, 8 (15.1%) were positive for HTLV-I infection. CONCLUSION: The prevalence of HTLV-I in the study group was higher than previously found in Cuba. The value of seroepidemiological surveillance through sentinel sites was confirmed. <![CDATA[<B>Variability in HIV-1 partial genomic sequences in Costa Rican patients</B>: <B>analysis with different bioinformatics tools</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010000100004&lng=en&nrm=iso&tlng=en OBJECTIVE: To estimate subtype and genomic variability in the HIV pol gene of Costa Rican patients by using different bioinformatics tools and to use this information to establish new policies to better manage these patients. METHODS: A total of 113 pol sequences available from Costa Rican patients under highly active antiretroviral therapy were analyzed by using the Genotyping, REGA, Stanford, and MEGA programs. The pol sequences came from 77 virologic failures (VF) and 36 basal samples (BS). Of the 77 VF, 22 also were sequenced in the env region. RESULTS: No major differences were found among the variables studied. However, there was a tendency for more variability in VF patients with a high baseline viral load. In the pol gene, 75%-83% of BS and 66%-75% of VF samples were pure B subtype by Genotyping and REGA, respectively. The other samples presented variations related mainly to circulating recombinant form CRF12 by genotyping or to CRF17 or -29 by phylogenetic analysis or a new possible BD recombinant with all programs. In the Stanford program, all variable samples showed a subtype B with high polymorphism. The variability in the env sequences was lower than that in the pol region. CONCLUSION: The B subtype is predominant in Costa Rican HIV-positive patients. There is high variability within sequences with potential recombination between B and F or D subtypes. The BD recombinant has not been previously reported. This high variability is likely the result of possible recombinant events, nonadherence to antiretroviral therapy, sexual intercourse without protection, and many sexual partners. Similar studies should be done in other countries in the Region, in particular in those places with extensive immigration, in order to decrease the possibility of virus variability as well as the cost of antiretroviral therapy.<hr/>OBJETIVOS: Determinar el subtipo y la variabilidad genómica del gen pol del VIH de pacientes costarricenses mediante diferentes herramientas bioinformáticas y el uso de esta información para establecer nuevas políticas para mejorar el diagnóstico y el tratamiento de estos pacientes. MÉTODOS: Se analizaron 113 secuencias del gen pol de pacientes costarricenses bajo tratamiento antirretrovírico de gran actividad mediante cuatro programas: Genotyping, REGA, Stanford y MEGA. Las secuencias pol analizadas provenían de 77 casos considerados fracasos virológicos (FV) y 36 muestras iniciales (MI). También se secuenció la región env de 22 de los 77 FV. RESULTADOS: No se encontraron diferencias importantes entre las variables estudiadas. No obstante, se observó una tendencia a una mayor variabilidad en los pacientes FV que tenían una elevada carga viral inicial. Con respecto al gen pol, 77-83% de las MI y 66-75% de las muestras de los FV eran del subtipo B puro según Genotyping y REGA, respectivamente. Las otras muestras presentaron variaciones relacionadas principalmente con la forma recombinante en circulación CRF-12 según Genotyping, con la CRF-17 o la CRF-29 según el análisis filogenético, o una nueva posible forma recombinante BD según todos los programas. Con el programa Stanford, todas las muestras variables reflejaron un subtipo B con elevado polimorfismo. La variabilidad de la secuencia env fue menor que la de la región pol. CONCLUSIONES: El subtipo B fue el predominante en los pacientes positivos al VIH en Costa Rica. Existe una alta variabilidad en las secuencias con una posible recombinación entre los subtipos B, y F o D. La forma recombinante BD no se había notificado antes. Esta elevada variabilidad parece ser el resultado de posibles eventos de recombinación, la falta de adhesión al tratamiento antirretrovírico, las relaciones sexuales sin protección y numerosas parejas sexuales. Se deben emprender estudios similares en otros países de la Región, en particular en los lugares con mucha inmigración, para reducir tanto la posibilidad de que el virus varíe como el costo del tratamiento antirretrovírico. <![CDATA[<B>Transcultural adaptation into Brazilian Portuguese of the effort-reward imbalance scale</B>: <B>a study with bank workers</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010000100005&lng=en&nrm=iso&tlng=en OBJETIVO: Descrever a adaptação transcultural da escala effort-reward imbalance para o português brasileiro e analisar a validade e a confiabilidade da adaptação. MÉTODO: Foi utilizado o método da tradução/retrotradução. A consistência interna, a confiabilidade teste-reteste e a estrutura fatorial da escala adaptada foram testadas em uma amostra de 100 trabalhadores de um banco estatal brasileiro, de ambos os sexos, com diferentes idades e níveis educacionais. RESULTADOS: A versão adaptada foi denominada escala de desequilíbrio esforço-recompensa. Dos 100 trabalhadores, 62% eram do sexo masculino. A idade variou entre 23 e 65 anos (média de 39 anos); a escolaridade, entre 3 e 27 anos (média de 15 anos); e o tempo de trabalho na empresa, entre 1 e 31 anos (média de 11 anos). O alfa de Cronbach para as três dimensões da escala - esforço, recompensa e comprometimento excessivo - foi de 0,70, 0,95 e 0,86, respectivamente. Os coeficientes de correlação intraclasse para as mesmas dimensões foram 0,82, 0,96 e 0,91. A análise fatorial manteve todos os itens iniciais da escala e foi consistente com os componentes de construto do modelo teórico. CONCLUSÃO: Os resultados indicam que a adaptação transcultural para português brasileiro da escala de desequilíbrio esforço-recompensa foi bem-sucedida e é adequada para avaliar esse desequilíbrio em ambientes de trabalho.<hr/>OBJECTIVE: To describe the transcultural adaptation of the effort-reward imbalance scale into Brazilian Portuguese and to examine the resulting construct's validity and reliability. METHOD: Forward and backward translation was used. Internal consistency, test-retest reliability, and factor structure were tested in a sample of 100 individuals of both sexes working at a large government-owned Brazilian bank. The sample included different age groups and schooling levels. RESULTS: The adapted version was named escala de desequilíbrio esforço-recompensa. Cronbach's alpha for the three scale dimensions-effort, reward, and overcommitment-was 0.70, 0.95 and 0.86, respectively. Intraclass correlation coefficients for these dimensions were 0.82, 0.96, and 0.91, respectively. Factor analysis kept all the initial questionnaire items and was consistent with the theoretical construct of the model. CONCLUSION: The results indicate that the transcultural adaptation into Brazilian Portuguese of the effort-reward imbalance scale was successful and is adequate to assess this situation in work environments. <![CDATA[<B>Injuries from falls and associated factors among elderly people in Cataluña, Spain</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010000100006&lng=en&nrm=iso&tlng=en OBJETIVOS: Evaluar, a partir de una encuesta de salud poblacional, la proporción de personas que han sufrido lesiones por caídas no intencionadas en una muestra de personas de edad no institucionalizadas, y valorar los factores demográficos y condicionantes médicos asociados. MÉTODOS: Un total de 3 247 personas de 65 y más años de edad seleccionadas mediante un muestreo aleatorio polietápico participaron en la Encuesta de Salud de Cataluña (ESCA-2006), respondiendo un cuestionario administrado por un entrevistador que incluía preguntas sobre lesiones por caídas en los 12 meses previos a la encuesta y otros factores relevantes asociados. RESULTADOS: El 14,9% de los encuestados manifestaron haber sufrido lesiones por caídas. En el análisis multivariado, el sexo, la edad, vivir solo, estar tomando cinco o más medicamentos y padecer problemas de movilidad, diabetes o trastornos músculo-esqueléticos se asociaron a un mayor riesgo de lesiones por caídas. No se observó, en cambio, un efecto estadísticamente significativo de las discapacidades sensoriales y de la comunicación, las enfermedades cardiovasculares, las cataratas o el consumo de alcohol. CONCLUSIONES: Los servicios de salud, que suelen estar en contacto con las personas de edad, pueden identificar a quienes están expuestos a un mayor riesgo de sufrir caídas, desarrollando diferentes intervenciones preventivas de efectividad demostrada. Aun con ciertas limitaciones, las encuestas de salud poblacionales proporcionan información útil sobre la carga que representan las lesiones por caídas para la salud de las personas de edad, complementando datos que proporcionan otras fuentes.<hr/>OBJECTIVES: To assess, based on a population health survey, what proportion of individuals in a sample of non-institutionalized older persons suffered injuries from unintentional falls, and to evaluate the associated demographic and health-related factors. METHODS: A total of 3 247 individuals over 65 years of age, selected by multistage random sampling, participated in the Health Survey of Cataluña (ESCA-2006), answering an interviewer-administered questionnaire that included questions about injuries from falls, and any relevant associated factors, during the 12 months preceding the survey. RESULTS: Of the respondents, 14.9% reported having been injured by falling. Multivariate analysis indicated that sex, age, living alone, taking five or more medications, and suffering from mobility problems, diabetes, or musculoskeletal disorders were associated with an increased risk of injury from falls. However, no statistically significant effect was observed from sensory or communication impairment, cardiovascular disease, cataracts, or alcohol consumption. CONCLUSIONS: Health care services, which are often in contact with the elderly, can identify those who are at increased risk of falling and put into place a variety of proven, preventive interventions. Though somewhat limited, population health surveys provide useful information regarding the burden of fall-related injuries on elderly health and complement data provided by other sources. <![CDATA[<B>The PAHO Strategic Fund</B>: <B>a mechanism to facilitate access to medicines</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010000100007&lng=en&nrm=iso&tlng=en OBJETIVO: Descrever o funcionamento do Fundo Estratégico para medicamentos da Organização Pan-Americana da Saúde (OPAS). MÉTODO: Estudo retrospectivo, com recorte temporal de 2004 a 2007, fundamentado em levantamento bibliográfico e documental em arquivos dos escritórios da OPAS nos Estados Unidos, El Salvador, Guatemala, Honduras e Brasil. Foram levantados o volume total de recursos e os tipos de medicamentos movimentados por meio do Fundo Estratégico nos anos de 2004, 2005, 2006 e nos meses de janeiro a setembro de 2007. RESULTADOS: O levantamento revelou um fundo bem estruturado que movimentou recursos crescentes, de US$ 3 475 043,00 em 2004 a US$ 19 646 634,00 em 2007 (de janeiro a setembro). Houve um crescimento na participação dos antirretrovirais nesse dispêndio, de pouco menos de 8% do total em 2004 a 57,89% em 2007. Ainda em 2007, 66,63% da movimentação financeira do Fundo Estratégico foram destinados à compra de antirretrovirais para nove países (Brasil, Guatemala, El Salvador, Equador, Honduras, Haiti, Belize, Nicarágua e Bolívia) de um total de 17 países participantes. O país que mais movimentou recursos financeiros por meio do Fundo Estratégico foi o Brasil, com 63% dos gastos para compra de insumos estratégicos no período de janeiro a setembro de 2007. CONCLUSÃO: A proposta de unificar as compras de medicamentos de todos os países participantes para melhor negociação de preços e administração das compras permitirá economias de escala. O Fundo Estratégico pode contribuir para ampliar o acesso aos medicamentos e melhorar a gestão do sistema público de saúde da América Latina.<hr/>OBJECTIVE: To describe the medicine procurement activities of the PAHO Strategic Fund. METHOD: This is a retrospective study covering the period from 2004 to 2007, based on a bibliographic and document survey of Pan American Health Organization (PAHO) archives in the United States, El Salvador, Guatemala, Honduras, and Brazil. The volume of resources and the types of drugs procured by the fund were determined for the years 2004, 2005, and 2006 and for the period of January to September 2007. RESULTS: The survey revealed a well-structured fund handling increasing resources, from US$ 3 475 043.00 in 2004 to US$ 19 646 634.00 in 2007 (January to September). The participation of antiretroviral drugs in this expenditure has grown from less than 8% of the total in 2004 to 57.89% in 2007. Still, in 2007, 66.63% of the financial resources managed by the Strategic Fund were allocated to the purchase of antiretroviral drugs for nine countries (Brazil, Guatemala, El Salvador, Ecuador, Honduras, Haiti, Belize, Nicaragua, and Bolivia) out of a total of 17 participating countries. Brazil was the country using the most resources through the Strategic Fund, accounting for 63% of the expenditure for the purchase of strategic supplies between January and September 2007. CONCLUSION: The proposal to unify the purchase of medications for all participating countries to improve pricing and purchasing management will result in large-scale savings. The Strategic Fund can contribute to increasing access to medicines and improving the management of the public health care system in Latin America. <![CDATA[<B>Adjusted clinical groups use at a Spanish primary care center</B>: <B>a retrospective, population-based study</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010000100008&lng=en&nrm=iso&tlng=en OBJETIVOS: Evaluar los resultados de la aplicación del sistema de clasificación mediante grupos clínicos ajustados (GCA) en un centro de atención primaria de salud (APS) de una población española. MÉTODOS: Estudio transversal retrospectivo a partir de los registros médicos informatizados de los pacientes atendidos ambulatoriamente durante 2007 en el centro de salud La Roca, administrado por una empresa de gestión de servicios de salud en La Roca del Vallès, Barcelona, España. Los GCA se conformaron según la Clasificación Internacional de Enfermedades, 9.ª revisión, modificación clínica. Se calcularon los pesos relativos medios en dólares estadounidenses de cada GCA respecto al costo medio total y, a partir de ellos, se crearon las bandas de utilización de recursos. Se determinaron los índices de riesgo (IR) y eficiencia (IE) con respecto a 2006 y se estimó el poder explicativo de la clasificación empleada. RESULTADOS: Se estudiaron 8 294 pacientes, para una cobertura de 82,7%, con una media de 4,1 episodios por paciente, 6,9 visitas por paciente y 5,7 visitas por habitante al año. A siete GCA correspondió 51,0% de los pacientes atendidos. El IR fue de 1,015, el IE en las visitas de 0,975 y el poder explicativo de la clasificación en GCA fue de 53,4% para las visitas y de 74,8% para los episodios. CONCLUSIONES: El sistema de GCA permitió agrupar a los pacientes de una población según su estado clínico y puede ayudar, entre otros aspectos, en la asignación de recursos y la evaluación de la eficiencia de los equipos de APS.<hr/>OBJECTIVES: To evaluate the results of implementing a classification system based on adjusted clinical groups (ACG) at a primary health care (PHC) in a Spanish population. METHODS: A retrospective, cross-sectional study based on the computerized medical records of outpatients seen in 2007 by the La Roca clinic, administered by a health services management company in La Roca del Vallès, Barcelona, Spain. The ACGs were formed according to the International Classification of Diseases, 9th Revision, Clinical Modification. The relative weight of each ACG's total average cost was calculated (in U.S. dollars) and based on these, the resources usage levels were established. The risk index (RI) and efficiency index (EI) for 2006 and the classification's explanatory power were determined. RESULTS: A total of 8 294 patients were studied (82.7% coverage), with an average of 4.1 incidents per patient, 6.9 visits per patient, and 5.7 visits per person per year. Seven GCAs accounted for 51.0% of patients seen. The RI was 1.015, the EI was 0.975 visits, and the explanatory power of the ACG classification was 53.4% for visits and 74.8% for incidents. CONCLUSIONS: The ACG system allowed this patient population to be grouped by clinical status, which can help to, among other things, allocate resources and evaluate PHC team efficiency. <![CDATA[<B>Smoking and exposure to tobacco smoke among pregnant women in Ecuador</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010000100009&lng=en&nrm=iso&tlng=en OBJETIVOS: Determinar la frecuencia de tabaquismo y exposición ambiental al humo de tabaco en mujeres embarazadas de Ecuador y describir los perfiles sociodemográficos asociados con esos factores de riesgo perinatal. MÉTODOS: Estudio descriptivo transversal mediante una encuesta aplicada a mujeres de 18 a 46 años con más de 3 meses de embarazo que asistieron entre octubre de 2004 y septiembre de 2005 a sus consultas de seguimiento en siete servicios de maternidad de seis ciudades de Ecuador. Se analizaron los datos demográficos y de exposición medioambiental (variables independientes) y su relación con el hábito de fumar cigarrillos y la exposición ambiental al humo de tabaco. RESULTADOS: De las 746 mujeres analizadas, 53,3% había fumado ocasionalmente y 4,3% había fumado habitualmente; de estas, 75,0% había dejado de fumar antes o durante el embarazo. De las encuestadas, 12,9% estuvo expuesta con frecuencia o siempre al humo de tabaco en ambientes cerrados. Tener mayor educación (11 años o más) y un nivel socioeconómico medio o alto, ser caucásica y considerar aceptable que las mujeres de su comunidad fumen se asoció significativa y directamente con el hábito de fumar cigarrillos (P < 0,001). En general, 12,9% de las mujeres estuvo expuesta al humo de tabaco y esto se asoció significativamente con ser soltera y cohabitar con fumadores o trabajadores vinculados con la industria del tabaco (P < 0,001). CONCLUSIONES: Se deben diseñar e implementar medidas específicas dirigidas no solo a estimular el abandono de este hábito en las embarazadas, sino también a prevenir que las mujeres en edad reproductiva comiencen a fumar y controlar el entorno fumador en el hogar.<hr/>OBJECTIVES: To determine the frequency of smoking and second-hand smoke exposure among pregnant women in Ecuador and to describe the sociodemographic profiles associated with these perinatal risk factors. METHODS: A cross-sectional descriptive study using a survey of women 18-46 years of age who were more than three months pregnant and attended follow-up consultations in seven maternity clinics in six cities in Ecuador between October 2004 and September 2005. Demographics and environmental exposure (independent variables) data and their relationship to cigarette smoking and secondhand-smoke exposure were analyzed. RESULTS: Of the 746 women studied, 53.3% had smoked occasionally, and 4.3%, regularly; of these, 75% had quit smoking before or during pregnancy. Of the respondents, 12.9% were frequently or always exposed to secondhand smoke indoors. Having more education (11 or more years), being in the middle or upper socioeconomic classes, being Caucasian, and it being considered acceptable for women in the community to smoke were significantly and directly associated with cigarette smoking (P < 0.001). Overall, 12.9% of women were being exposed to secondhand smoke and this was significantly associated with being single and cohabiting with smokers or employees connected to the tobacco industry (P < 0.001). CONCLUSIONS: Specific measures must be designed and implemented to not only encourage smoking cessation during pregnancy, but also to prevent women of reproductive age from taking up smoking and to limit smoking in the home environment. <![CDATA[<B>Susceptibility of <I>Aedes aegypti</I> to DDT, deltamethrin, and lambda-cyhalothrin in Colombia</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010000100010&lng=en&nrm=iso&tlng=en OBJETIVOS: Evaluar el estado de susceptibilidad a insecticidas piretroides deltametrina y lambdacialotrina y al organoclorado DDT, e identificar los mecanismos bioquímicos asociados con resistencia en 13 poblaciones naturales de Aedes aegypti recolectadas en localidades de Colombia donde el dengue es un grave problema de salud pública. MÉTODOS: Se recolectaron y criaron en condiciones controladas formas inmaduras de diferentes criaderos naturales del vector para cada localidad. Con la generación F2 se realizaron bioensayos utilizando las metodologías OMS 1981 (papeles impregnados) y CDC 1998 (botellas impregnadas). En las poblaciones con mortalidades compatibles con disminución de la susceptibilidad, se midieron los niveles de esterasas no específicas (ENE), oxidasas de función mixta (OFM) y acetilcolinesterasa modificada (ACEM) mediante pruebas colorimétricas. RESULTADOS: Todas las poblaciones del mosquito evaluadas evidenciaron resistencia al organoclorado DDT. En cuanto a los piretroides, se encontró resistencia generalizada a lambdacialotrina pero no a deltametrina. Los mecanismos bioquímicos de resistencia evaluados permitieron encontrar 7 de 11 poblaciones con ENE elevadas y una población con OFM incrementadas. CONCLUSIONES: Se descarta la resistencia cruzada de tipo fisiológico entre el DDT y lambdacialotrina en las poblaciones de A. aegypti evaluadas. La resistencia fisiológica a lambdacialotrina parece asociarse con el incremento de las ENE. El comportamiento diferencial en los niveles de susceptibilidad y los valores enzimáticos entre poblaciones se asociaron con la variabilidad genética y presión de selección química a nivel local.<hr/>OBJECTIVES: To assess the susceptibility status of 13 natural populations of Aedes aegypti (collected from sites in Colombia where dengue is a serious public health problem) to the pyrethroids, deltamethrin and lambda-cyhalothrin, and to the organochlorine, DDT, and to identify any biochemical mechanisms associated with resistance. METHODS: Immature forms of the vector were collected from natural breeding spots at each site and then raised under controlled conditions. Using the F2 generation, bioassays were performed using the World Health Organization's 1981 methodology (impregnated paper) and United States Centers for Disease Control and Prevention's 1998 methodology (impregnated bottles). In populations where mortality rates were consistent with decreased susceptibility, levels of nonspecific esterases (NSE), mixed-function oxidases (MFO), and acetylcholinesterase (AChE) were measured using colorimetric tests. RESULTS: All of the mosquito populations that were tested showed resistance to the organochlorine DDT. In the case of the pyrethroids, widespread resistance to lambda-cyhalothrin was found, but not to deltamethrin. Assessing the biochemical resistance mechanisms showed that 7 of the 11 populations had elevated NSE, and one population, increased MFO. CONCLUSIONS: Physiological cross-resistance between DDT and lambda-cyhalothrin in the A. aegypti populations tested was dismissed. Physiological resistance to lambda-cyhalothrin appears to be associated with increased NSE. The differences in susceptibility levels and enzyme values among the populations were associated with genetic variations and chemicals in use locally. <![CDATA[<B>Concepts and determination of reference values for human biomonitoring of environmental contaminants</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010000100011&lng=en&nrm=iso&tlng=en Human biomonitoring (HBM) of environmental contaminants plays an important role in estimating exposure and evaluating risk, and thus it has been increasingly applied in the environmental field. The results of HBM must be compared with reference values (RV). The term "reference values" has always been related to the interpretation of clinical laboratory tests. For physicians, RV indicate "normal values" or "limits of normal"; in turn, toxicologists prefer the terms "background values" or "baseline values" to refer to the presence of contaminants in biological fluids. This discrepancy leads to the discussion concerning which should be the population selected to determine RV. Whereas clinical chemistry employs an altered health state as the main exclusion criterion to select a reference population (that is, a "healthy" population would be selected), in environmental toxicology the exclusion criterion is the abnormal exposure to xenobiotics. Therefore, the choice of population to determine RV is based on the very purpose of the RV to be determined. The present paper discusses the concepts and methodology used to determine RV for biomarkers of chemical environmental contaminants. <![CDATA[<B>El programa epidat</B>: <B>usos y perspectivas</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010000100012&lng=en&nrm=iso&tlng=en Human biomonitoring (HBM) of environmental contaminants plays an important role in estimating exposure and evaluating risk, and thus it has been increasingly applied in the environmental field. The results of HBM must be compared with reference values (RV). The term "reference values" has always been related to the interpretation of clinical laboratory tests. For physicians, RV indicate "normal values" or "limits of normal"; in turn, toxicologists prefer the terms "background values" or "baseline values" to refer to the presence of contaminants in biological fluids. This discrepancy leads to the discussion concerning which should be the population selected to determine RV. Whereas clinical chemistry employs an altered health state as the main exclusion criterion to select a reference population (that is, a "healthy" population would be selected), in environmental toxicology the exclusion criterion is the abnormal exposure to xenobiotics. Therefore, the choice of population to determine RV is based on the very purpose of the RV to be determined. The present paper discusses the concepts and methodology used to determine RV for biomarkers of chemical environmental contaminants. <![CDATA[<B>FE DE ERRATA "Participación comunitaria en el control de las parasitosis intestinales en una localidad rural de Argentina" (<I>Rev Panam Salud Publica.</I> 2009;26(6):471-7)</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010000100013&lng=en&nrm=iso&tlng=en Human biomonitoring (HBM) of environmental contaminants plays an important role in estimating exposure and evaluating risk, and thus it has been increasingly applied in the environmental field. The results of HBM must be compared with reference values (RV). The term "reference values" has always been related to the interpretation of clinical laboratory tests. For physicians, RV indicate "normal values" or "limits of normal"; in turn, toxicologists prefer the terms "background values" or "baseline values" to refer to the presence of contaminants in biological fluids. This discrepancy leads to the discussion concerning which should be the population selected to determine RV. Whereas clinical chemistry employs an altered health state as the main exclusion criterion to select a reference population (that is, a "healthy" population would be selected), in environmental toxicology the exclusion criterion is the abnormal exposure to xenobiotics. Therefore, the choice of population to determine RV is based on the very purpose of the RV to be determined. The present paper discusses the concepts and methodology used to determine RV for biomarkers of chemical environmental contaminants.