Scielo RSS <![CDATA[Revista Panamericana de Salud Pública]]> http://www.scielosp.org/rss.php?pid=1020-498920110007&lang=en vol. 30 num. 1 lang. en <![CDATA[SciELO Logo]]> http://www.scielosp.org/img/en/fbpelogp.gif http://www.scielosp.org <![CDATA[<b>Impact of the fortification of food with folic acid on neural tube defects in Costa Rica</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892011000700001&lng=en&nrm=iso&tlng=en OBJETIVO: Evaluar el impacto de la fortificación de alimentos con ácido fólico en las tendencias de las prevalencias de los defectos del tubo neural (DTN) y la tasa de mortalidad infantil (TMI) por este trastorno en Costa Rica. MÉTODOS: Se analizaron los datos de vigilancia del Centro de Registro de Enfermedades Congénitas y el Centro Centroamericano de Población. Se consideraron defectos del tubo neural la anencefalia, la espina bífida y el encefalocele. Se examinaron las tendencias durante 1987-2009, así como las diferencias de tasas (intervalo de confianza [IC] 95%) de prevalencia y mortalidad antes de la fortificación de alimentos con ácido fólico y hasta 12 años después de su implementación. Se determinó el aporte de la fortificación al descenso en la TMI general. RESULTADOS: En 1987-1997, previo al período de fortificación de alimentos con ácido fólico, la prevalencia de DTN fue de 12/10 000 nacidos (IC95%: 11,1-12,8), mientras que en 2009 fue de 5,1/10 000 nacidos (3,3-6,5). La TMI por DTN en 1997 fue de 0,64/1 000 nacimientos (46-0,82) y en 2009 de 0,19/1 000 (0,09-0,3). La TMI por DTN y su prevalencia disminuyeron en forma significativa, 71% y 58% respectivamente (P < 0,05). La TMI general disminuyó de 14,2/1 000 nacidos en 1997 a 8,84/1 000 en 2009 (P < 0,05). El descenso en la TMI por DTN contribuyó a una caída de 8,8% en la TMI general entre 1997 y 2009. CONCLUSIONES: La fortificación de alimentos con ácido fólico provocó una reducción de DTN al nacimiento y de la TMI por esta malformación durante el período 1997-2009, así como también el descenso de la TMI general. Existe relación de temporalidad entre el inicio de las políticas de fortificación y el descenso de la prevalencia y mortalidad por DTN. Se debe pro-mover esta intervención en los países de América Latina y el Caribe donde todavía no ha sido implementada.<hr/>OBJECTIVE: Evaluate the impact of the fortification of food with folic acid on prevalence trends for neural tube defects (NTD) and the infant mortality rate (IMR) associated with this disorder in Costa Rica. METHODS: The surveillance data from the Congenital Disease Registry Center and the Central American Population Center were analyzed. The neural tube defects considered were anencephaly, spina bifida, and encephalocele. The trends from 1987-2009, as well as the differences in prevalence and mortality rates prior to and up to 12 years after food fortification with folic acid, were examined (95% confidence interval [CI]). The contribution of fortification to the decrease in the overall IMR was determined. RESULTS: During 1987-1997, prior to the period of food fortification with folic acid, NTD prevalence was 12/10 000 births (95% CI: 11.1-12.8), whereas in 2009 prevalence was 5.1/10 000 births (3.3-6.5). The IMR associated with NTD was 0.64/1 000 births (46-0.82) in 1997 and 0.19/1 000 births (0.09-9.3) in 2009. There were significant decreases in the IMR associated with NTD and the prevalence of NTD: 71%, and 58%, respectively (P < 0.05). The overall IMR decreased from 14.2/1 000 births in 1997 to 8.84/1 000 births in 2009 (P < 0.05). The decrease in the IMR associated with NTD contributed to an 8.8% decrease in the overall IMR from 1997 to 2009. CONCLUSIONS: Food fortification with folic acid caused a decrease in NTD at birth and the IMR associated with this malformation during the 1997-2009 period. It also led to a decrease in the overall IMR. There is a temporal relationship between the introduction of fortification policies and the decrease in prevalence and mortality associated with NTD. This intervention should be promoted in Latin American and Caribbean countries where it has not yet been implemented. <![CDATA[<b>Brazilian experience with rapid monitoring of vaccination coverage during a national rubella elimination campaign</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892011000700002&lng=en&nrm=iso&tlng=en OBJECTIVE: To describe an adapted version of the Pan American Health Organization (PAHO) methodology for rapid monitoring of vaccination coverage and its use as a supervisory tool to guide decision-making and strategies for end-stage vaccination activities ("mopup" operations) following a six-week national rubella elimination campaign in Brazil. METHODS: Vaccination coverage assessments modeled on a variation of PAHO's rapid house-to-house coverage monitoring methodology were conducted by Brazilian municipalities following mass immunization of adults and adolescents from August to December 2008. Results of monitoring assessments conducted in 3 658 (65.7%) of 5 564 municipalities were reported to Brazil's National Immunization Program. RESULTS: Information on vaccination against rubella was obtained from more than 1.5 million Brazilians (2.1% of the 70.1 million people targeted for immunization) during vaccination coverage monitoring. According to the assessment data, vaccination targets of 95% coverage were reached in 2 175 (59.5%) of the 3 658 municipalities that reported results. The percentage of municipalities that reached coverage targets was lower than administrative coverage estimates (number of vaccine doses administered divided by the immunization target population). These results informed targeted "mop-up" campaigns to reach unvaccinated populations. CONCLUSIONS: Rapid coverage monitoring implemented at the local level proved useful for deciding when to conclude vaccination activities and where to focus additional efforts to achieve desired coverage.<hr/>Describir una versión adaptada de la metodología de la Organización Panamericana de la Salud (OPS) para el monitoreo rápido de la cobertura de vacunación. Exponer su uso como herramienta de supervisión para guiar la toma de decisiones y las estrategias para las actividades de vacunación finales (campañas "de barrido") después de una campaña nacional de eliminación de la rubéola de 6 semanas de duración en el Brasil. MÉTODOS: Los municipios brasileños llevaron a cabo una evaluación de la cobertura de vacunación basada en una variante de la metodología de monitoreo rápido "casa por casa" de la OPS, después de una campaña masiva de vacunación de adultos y adolescentes efectuada entre agosto y diciembre del 2008. Los resultados de las evaluaciones de seguimiento realizadas en 3 658 (65,7%) de 5 564 municipios se comunicaron al Programa Nacional de Vacunación del Brasil. RESULTADOS: Mediante el monitoreo de la cobertura de vacunación se obtuvo información sobre la vacunación antirrubeólica de más de 1,5 millones de brasileños (2,1% de los 70,1 millones de destinatarios de la inmunización). Según estos datos, se alcanzó la meta de vacunación (cobertura del 95%) en 2 175 (59,5%) de los 3 658 municipios que presentaron resultados. El porcentaje de municipios que alcanzaron la meta de cobertura fue menor que las estimaciones de cobertura administrativa (cantidad de dosis de vacuna administradas dividida por la población destinataria de la inmunización). Estos resultados se usaron para las campañas de vacunación "de barrido" a fin de alcanzar a las poblaciones no vacunadas. CONCLUSIONES: El monitoreo rápido de la cobertura de vacunación en el nivel local resultó útil para decidir cuándo concluir las actividades de vacunación y en qué aspectos se debían concentrar los esfuerzos posteriores para lograr la cobertura deseada. <![CDATA[<b>Child mortality from cancer in Colombia, 1985-2008</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892011000700003&lng=en&nrm=iso&tlng=en OBJETIVO: Determinar la magnitud de la mortalidad por cáncer infantil en Colombia y evaluar las tendencias en su evolución entre 1985 y 2008. MÉTODOS: Se analizó durante dicho período la mortalidad en la población colombiana de 0 a 14 años provocada por cáncer en todas las localizaciones -leucemias, tumores malignos del sistema nervioso central (SNC), linfomas no Hodgkin, linfomas Hodgkin, tumores óseos y tumores renales. Se calculó el cambio promedio en las variaciones de las tendencias de mortalidad por cáncer en dicho grupo etario. RESULTADOS: Las muertes por cáncer constituyeron el 3,5% de la mortalidad en menores de 15 años. Entre los períodos 1985-1989 y 2005-2008 las tasas de mortalidad por cáncer mostraron un descenso en ambos sexos, pasando de 54,4 muertes por millón a 44,8 muertes por millón en niños y de 40,9 muertes por millón a 37,9 muertes por millón en niñas. La mortalidad por leucemias y linfomas registró un descenso estadísticamente significativo, mientras que la mortalidad por cánceres del SNC, contrariamente, aumentó también de manera significativa. CONCLUSIONES: Pese a leves tendencias a la baja en la mortalidad por leucemias y linfomas no Hodgkin, las tasas de mortalidad por cáncer infantil en Colombia permanecen altas y requieren esfuerzos importantes en los tratamientos para obtener mayores logros.<hr/>OBJECTIVE: Determine the magnitude of child mortality from cancer in Colombia and evaluate the trends in its evolution from 1985 to 2008. METHODS: Mortality in the Colombian population aged 0-14 years from cancer in any site (e.g., leukemia, malignant tumors of the central nervous system (CNS), nonHodgkin's lymphoma, Hodgkin's lymphoma, bone tumors, kidney tumors) during this period was analyzed. The mean change in the variations of cancer mortality trends in this age group was calculated. RESULTS: Deaths from cancer accounted for 3.5% of mortality in children under 15 years of age. During the periods 1985-1989 and 2005-2008 there was a decrease in mortality from cancer in both sexes, with figures dropping from 54.4 deaths per million to 44.8 deaths per million in boys and from 40.9 deaths per million to 37.9 deaths per million in girls. There was a statistically significant decrease in leukemia- and lymphoma-related mortality, whereas mortality associated with cancers of the CNS increased significantly. CONCLUSIONS: In spite of slight downward trends in mortality from leukemia and non-Hodgkin's lymphoma, childhood cancer mortality rates in Colombia remain high. Significant work on treatments for childhood cancer is required to obtain greater success. <![CDATA[<b>Influence of family environment and social group on smoking among Brazilian youth aged 15 to 24 years</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892011000700004&lng=en&nrm=iso&tlng=en OBJETIVO: Estimar a prevalência do tabagismo em jovens brasileiros, analisando fatores individuais, familiares e do grupo social associados a esse hábito. MÉTODOS: Foram analisados dados de jovens de 15 a 24 anos vivendo em 17 capitais brasileiras e no Distrito Federal, obtidos pelo Inquérito Domiciliar sobre Fatores de Risco para Doenças Crônicas e Morbidade Referida realizado em 2002 e 2003 pelo Instituto Nacional do Câncer. Foram analisadas variáveis individuais (sexo, idade, escolaridade, consumo de álcool, autoavaliação de saúde, prática de atividade física, estar estudando), variáveis da família (idade e escolaridade do chefe da família e fumo do pai, da mãe e dos irmãos) e variáveis do grupo social (fumo do melhor amigo, da maioria dos amigos, ou do namorado). Para avaliar os fatores associados ao tabagismo foi utilizado o método de estimação generalized estimating equations (GEE). RESULTADOS: Considerando o efeito do plano amostral, a prevalência de tabagismo foi de 12,8%, variando de 6,8% em Aracaju a 24,1% em Porto Alegre. Como preditores do tabagismo foram observados o sexo masculino, maior idade, menor escolaridade, não estar estudando no momento da pesquisa, pior percepção de saúde e consumo de álcool. Foram associados ao tabagismo fatores relacionados ao fumo entre os pares (amigos/namorados) e características ligadas ao hábito de fumar entre membros da família (pai/mãe e irmãos). Houve um efeito da coorte de nascimento dos pais no tabagismo do jovem, com maior prevalência de tabagismo entre os jovens cujos pais e mães nasceram na década de 1930. CONCLUSÕES: Características individuais e a influência dos pares e da família mostraram-se relevantes para o fumo do jovem. A intensificação do diálogo entre adolescentes, escola, colegas, amigos e pais poderia gerar uma redução do consumo de substâncias entre os jovens.<hr/>OBJECTIVE: To estimate the prevalence of smoking among Brazilian youth, examining individual, family, and social group factors associated with this habit. METHODS: Data from youth aged 15 to 24 years living in 17 Brazilian state capitals and the Federal District, obtained from the Household Survey on Risk Factors for Chronic Diseases and Reported Morbidity carried out in 2002 and 2003 by the National Cancer Institute was analyzed. Individual variables (sex, age, schooling, alcohol consumption, self-rated health, physical activity, current school attendance), family variables (age and education of head of household and father, mother, or sibling smoking), and social group variables (best friend smoking, most friends smoking, boyfriend/girlfriend smoking) were analyzed. Generalized estimating equations (GEE) approach to evaluate the factors associated with smoking were used. RESULTS: Considering the effect of the sampling design, smoking prevalence was 12.8%, ranging from 6.8% in Aracaju to 24.1% in Porto Alegre. The following factors were predictors of smoking: male sex, older age, less schooling, not attending school at the time of the survey, poorer health perception, and alcohol consumption. Peer smoking (friends or boyfriend/girlfriend) and smoking among family members (father/mother or sibling) were associated with smoking. There was an effect of parental birth cohort on smoking, with a higher prevalence of smoking among youth whose parents were born in the 1930s. CONCLUSIONS: Individual characteristics and the influence of peers and family were relevant for smoking by the youth. Increasing the dialogue among teenagers, school, schoolmates, friends, and parents could lead to a reduction of substance use among youth. <![CDATA[<b>Epidemiology and registry of congenital heart disease in Costa Rica</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892011000700005&lng=en&nrm=iso&tlng=en OBJETIVO: Caracterizar la población de niños que nacen con cardiopatías congénitas (CC) en Costa Rica y evaluar sus procesos de registro. MÉTODOS: Estudio observacional exploratorio que incluyó a todos los niños con CC diagnosticadas en el Hospital Nacional de Niños entre el 1 de mayo de 2006 y el 1 de mayo de 2007. Tomando en cuenta los niños menores de 1 año y su respectiva cohorte de nacimientos, se estimaron prevalencias con intervalos de confianza de 95% (IC95%) según sexo, tipo de cardiopatía, edad al diagnóstico, edad materna, residencia habitual y malformaciones extracardiacas asociadas. Se compararon los datos con el Centro de Registro de Enfermedades Congénitas (CREC). RESULTADOS: Durante el período estudiado se diagnosticaron 534 casos con CC. Los casos en menores de 1 año fueron 473 dentro de una cohorte de nacimientos de 77 140 -prevalencia de 0,6% (IC95%: 0,5-0,7). Con base en datos del CREC, se demostró que al nacimiento no se detectan 71% de los casos. La edad promedio al diagnóstico en niños menores de 1 año fue de 46,6 días. No hubo diferencias por sexo. La prevalencia de CC en hijos de madres de 35 años o más fue significativamente mayor, aunque al excluir las cromosomopatías este riesgo perdió su significancia estadística. Las provincias del país con puertos marítimos fueron las de mayor riesgo en hijos de madres adolescentes. Las CC más frecuentes fueron los defectos del tabique interventricular e interauricular, persistencia del conducto arterioso, estenosis valvular pulmonar, defectos del tabique aurículo ventricular, coartación de aorta y tetralogía de Fallot. El 34% de las CC fueron múltiples, 11,2% se asociaron a cromosomopatías y 19% tenían malformaciones congénitas asociadas. CONCLUSIONES: La prevalencia de CC en Costa Rica está dentro del rango informado a nivel mundial. Se halló que en el CREC había un importante subregistro de CC debido principalmente a los criterios de edad aplicados. Los resultados sugieren que la edad materna (menores de 20 años y mayores de 34 años) es un factor asociado a la ocurrencia de CC.<hr/>OBJECTIVE: Characterize the population of children born with congenital heart disease (CHD) in Costa Rica and evaluate the country's registry processes. METHODS: Exploratory observational study that included all children with CHD diagnosed at the National Children's Hospital between 1 May 2006 and 1 May 2007. Considering children under 1 year of age and their respective birth cohort, prevalence was estimated by sex, type of heart disease, age at diagnosis, maternal age, habitual residence, and associated extracardiac malformations, with 95% confidence intervals (95% CI). The data was compared with those of the Congenital Disease Registry Center (CREC). RESULTS: During the period studied, 534 cases with CHD were diagnosed. There were 473 cases in children under 1 year of age in a birth cohort of 77 140 children. Prevalence was 0.6% (95% CI: 0.5-0.7). Based on CREC data, it was demonstrated that 71% of the cases were not detected at birth. The average age of diagnosis in infants under 1 year of age was 46.6 days. There were no differences by sex. Prevalence of CHD in children of mothers aged 35 years or over was significantly higher. However, when chromosomal abnormalities were excluded, the risk was no longer statistically significant. The provinces in the country with maritime ports were the areas with the highest risk in children of adolescent mothers. The most common CHDs were ventricular and atrial septal defects, patent ductus arteriosus, pulmonary valve stenosis, atrioventricular septal defects, coarctation of the aorta, and tetralogy of Fallot. Thirtyfour percent of the cases of CHD were multiple, 11.2% were associated with chromosomal abnormalities, and 19% had associated congenital malformations. CONCLUSIONS: CHD prevalence in Costa Rica is within the range reported globally. Significant underreporting of CHD was found in the CREC, primarily due to the age criteria applied. The results suggest that maternal age (under 20 and over 34) is a factor associated with CHD. <![CDATA[<b>Bioelectrical impedance values among indigenous children and adolescents in Rio Grande do Sul, Brazil</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892011000700006&lng=en&nrm=iso&tlng=en OBJECTIVE: To describe the nutritional status of indigenous children and adolescents in Rio Grande do Sul, Brazil, through bioelectrical values, and to compare the nutritional classifications of the anthropometric method to those of the body composition method. METHODS: A cross-sectional survey was conducted of 3 204 subjects at 35 schools in the 12 Kaingang indigenous lands of Rio Grande do Sul, Brazil. Following World Health Organization recommendations, the weight and height (H) of each subject was measured twice and the body mass index/age (BMI/A) was classified. Body composition was assessed by Bioelectrical Impedance Vector Analysis (BIVA). Resistance (R) and reactance (Xc) were estimated using a bioelectrical impedance analyzer. Divergences between these two methods were performed on RXc graph. RESULTS: Of the sample, 56.8% were adolescents and 50.6% were males. The mean values of phase angle were higher in adolescents, in males, and in individuals overweight by BMI/A. Mean values of R, Xc, R/H, and Xc/H were higher among children and among those with BMI/A < +2 z scores. Divergences in overweight classification were: male children, 94.6%; male adolescents, 77.1%; female children, 85.4%; and female adolescents, 94.8%. CONCLUSIONS: The mean values of bioelectrical measures observed among the Kaingang children and adolescent were similar to those found for different populations in other studies. For both gender and age groups, differences were observed between nutritional classifications by BMI/age and by BIVA. These results reinforce the importance of employing multiple techniques, such as anthropometry and BIVA, when conducting nutritional assessments of a population.<hr/>OBJETIVO: Describir el estado nutricional de niños y adolescentes indígenas en Rio Grande do Sul, Brasil, mediante los valores de impedancia bioeléctrica y comparar las clasificaciones nutricionales del método antropométrico con las del método de composición corporal. MÉTODOS: Se llevó a cabo un estudio transversal en 3 204 participantes de 35 escuelas de los 12 territorios indígenas habitados por el pueblo kaingang (o guayaná) del estado de Rio Grande do Sul (Brasil). Según las recomendaciones de la Organización Mundial de la Salud, se midió el peso y la talla (T) de cada participante en dos oportunidades y se clasificó el índice de masa corporal (IMC) según la edad. La composición corporal se evaluó mediante análisis vectorial de impedancia bioeléctrica. La resistencia (R) y la reactancia (Xc) se calcularon con un analizador de impedancia bioeléctrica. Las divergencias entre estos dos métodos se analizaron con un gráfico RXc. RESULTADOS: De la muestra, 56,8% eran adolescentes y 50,6% eran varones. Los valores medios del ángulo de fase fueron mayores en los adolescentes, en los varones y en los individuos con sobrepeso según el IMC/edad. Los valores medios de R, Xc, R/T y Xc/T fueron mayores en los niños y en las personas con puntajes z de IMC/edad < +2. Se observaron las siguientes divergencias en la clasificación del sobrepeso: 94,6% para los niños, 77,1% para los adolescentes, 85,4% para las niñas y 94,8% para las adolescentes. CONCLUSIONES: Los valores medios de las medidas de impedancia bioeléctrica observados en niños y adolescentes kaingang fueron similares a los encontrados en diferentes poblaciones en otros estudios. Se observaron diferencias entre las clasificaciones nutricionales por IMC/edad y por análisis vectorial de impedancia bioeléctrica en ambos sexos y grupos etarios. Estos resultados destacan la importancia de emplear múltiples técnicas, como la antropometría y el análisis vectorial de impedancia bioeléctrica, cuando se efectúan evaluaciones nutricionales de una determinada población. <![CDATA[<b>Prevalence of bacterial vaginosis in Chilean sex workers</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892011000700007&lng=en&nrm=iso&tlng=en OBJETIVO: Determinar la prevalencia de vaginosis bacteriana (VB) en trabajadoras sexuales chilenas y relacionar los hallazgos con variables sociodemográficas, sexuales y clínicas. MÉTODO: Se estudió una muestra de 379 trabajadoras sexuales que asistían para control a Unidades de Atención y Control de Salud Sexual de Chile. A todas se las entrevistó para obtener antecedentes sociodemográficos y sexuales, se les realizó evaluación clínica que incluyó características del flujo vaginal, pH y prueba de aminas, y se les tomó una muestra vaginal para tinción de Gram. Para el diagnóstico de VB se empleó el criterio de Nugent. Los datos fueron analizados con EPI-INFO 3.4.1 y BioStat, utilizándose un grado de significación de P < 0,005. RESULTADOS: La prevalencia de VB fue de 69,1%. El síndrome no se asoció a las variables sociodemográficas edad y escolaridad. Las mujeres que vivían (casadas o no) con su pareja tuvieron menos frecuencia de VB en comparación con las mujeres solteras (P < 0,001). No hubo variables sexuales asociadas a VB, en tanto que el empleo del dispositivo intrauterino (DIU) sí lo estuvo (P < 0,0001). La presencia de descarga vaginal, pH vaginal alterado y prueba de aminas positiva se asociaron a la infección (P < 0,0001). CONCLUSIONES: En coincidencia con otros estudios realizados distintos países, el presente trabajo observó que las trabajadoras sexuales chilenas tienen una alta prevalencia de VB, con mayor riesgo para aquellas que usan DIU como método de anticoncepción o que no conviven (casadas o no) con su pareja.<hr/>OBJECTIVE: To determine the prevalence of bacterial vaginosis (BV) in Chilean sex workers and relate the findings to sociodemographic, sexual, and clinical variables. METHODS: A sample of 379 sex workers seen in Chilean Sexual Health Monitoring and Care Units for check-ups was studied. All of them were interviewed to obtain their sociodemographic and sexual history. A clinical examination was performed that included the characteristics of vaginal discharge, pH, and amine test. A vaginal sample was taken for Gram stain. The Nugent criteria were used for the diagnosis of BV. The data was analyzed with EPI-INFO 3.4.1 and BioStat, using a degree of significance of P < 0.005. RESULTS: BV prevalence was 69.1%. The syndrome was not associated with the sociodemographic variables, age or education. BV was less common in women (married or unmarried) who lived with their partners than in single women (P < 0.001). There were no sexual variables associated with BV, whereas use of intrauterine devices was related (P < 0.0001). The presence of vaginal discharge, abnormal vaginal pH, and positive amine test were associated with infection (P < 0.0001). CONCLUSIONS: Like other studies conducted in different countries, this study observed that Chilean sex workers have a high prevalence of BV, with greater risk for women who use IUDs for birth control or women (married or unmarried) who do not live with their partners. <![CDATA[<b>Nutrition and health in children from former slave communities (quilombos) in the state of Alagoas, Brazil</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892011000700008&lng=en&nrm=iso&tlng=en OBJETIVO: Descrever as condições de nutrição e saúde das crianças de 6 a 59 meses de 39 comunidades remanescentes dos quilombos no Estado de Alagoas. MÉTODOS: Para este estudo transversal, coletaram-se dados antropométricos, demográficos, socioeconômicos e de saúde. O escore Z < -2 foi utilizado para definir o déficit para os índices peso para idade (PI), peso para estatura (PE) e estatura para idade (EI). O sobrepeso foi definido por um escore Z &gt; 2 para o índice PE. Utilizou-se o padrão antropométrico de 2006 da Organização Mundial da Saúde. A anemia foi diagnosticada por um nível de hemoglobina (HemoCue) menor que 11 g/dL. RESULTADOS: Foram avaliadas 973 crianças (50,4% meninos). A maioria das famílias (60,8%) pertencia à classe E (a mais pobre) e era assistida pelo Programa Bolsa Família (76,0%). Os chefes de família apresentavam escolaridade < 4 anos de estudo (75,9%) e 57,1% dos domicílios tinham mais do que 5 moradores. As prevalências de déficits de PI, PE, EI (déficit estatural) e sobrepeso foram, respectivamente, 3,4, 2,0, 11,5 e 7,1%. A anemia foi identificada em 52,7% das crianças, não diferindo entre aquelas portadoras de déficit estatural ou sobrepeso (P = 0,43). CONCLUSÕES: O déficit estatural, indicativo de desnutrição crônica, foi o desvio antropométrico mais prevalente, seguido pelo sobrepeso, apesar do perfil de pobreza predominante. A anemia foi um grave problema, acometendo de forma intensa tanto crianças com déficit estatural como aquelas com sobrepeso. O conjunto desses achados indica que o direito humano à alimentação adequada não vem sendo garantido às crianças quilombolas alagoanas, devendo o poder público adotar as medidas necessárias para reverter tal situação.<hr/>OBJECTIVE: To describe the nutrition and health status of children aged 6 to 59 months from 39 former slave communities in the state of Alagoas. METHODS Data on anthropometric, demographic, socioeconomic, and health variables were collected for this cross-sectional study. Deficits in weight-for-age (WFA), weight-for-height (WFH), and height-for-age (HFA) were defined as a Z score < -2. Overweight was defined as a Z score &gt; 2 for WFH. The 2006 World Health Organization growth standards were used as reference. Anemia was diagnosed based on hemoglobin levels (HemoCue) < 11 g/dL. RESULTS We assessed 973 children (50.4% boys). Most families (60.8%) belonged to social class E (lowest), and most (76.0%) were assisted by the federal welfare program Bolsa Família. Heads of family had < 4 years of schooling (75.9%), and more than 5 people lived in the house in 57.1% of the households. The prevalence of WFA, WFH, and HFA (stunting) deficits and overweight was, respectively, 3.4, 2.0, 11.5, and 7.1%. Anemia was diagnosed in 52.7% of the children, without differences between the stunting and overweight groups (P = 0.43). CONCLUSIONS Stunting, an indicator of chronic malnutrition, was the most prevalent anthropometric deviation, followed by overweight, despite the disadvantaged socioeconomic profile. Anemia was a severe problem, affecting children with both stunting and overweight. Taken together, these findings suggest that the human right to adequate food is not guaranteed for the children from former slave communities from Alagoas. Therefore, the government should take the necessary measures to revert this situation. <![CDATA[<b>Assessment of core capacities for enforcement of the International Health Regulations at points of entry in Uruguay</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892011000700009&lng=en&nrm=iso&tlng=en OBJETIVO: Describir las características y resultados de la evaluación de capacidades básicas para cumplir el Reglamento Sanitario Internacional (RSI) en puntos de entrada de Uruguay, mediante la aplicación simultánea de los instrumentos de la Organización Mundial de la Salud (OMS) y el MERCOSUR, así como también las fortalezas y debilidades identificadas en ambos al ser aplicados en el terreno. MÉTODOS: Se realizó un estudio descriptivo y transversal mediante la aplicación de los instrumentos OMS y MERCOSUR de evaluación de capacidades básicas para el RSI. Se seleccionaron dos puntos de entrada (PDE 1 y 2) escogidos como muestra de conveniencia por presentar el mayor volumen de tráfico de pasajeros y bienes del país. Ambos instrumentos fueron caracterizados individual y cualitativamente en términos de fortalezas y debilidades. RESULTADOS: El valor promedio de implementación de capacidades básicas fue de 69% (OMS) y 67,4% (MERCOSUR) para el PDE 1 y de 68% (OMS) y 63,9% (MERCOSUR) para el PDE 2; se registró una diferencia promedio entre instrumentos de 1,6% para el PDE 1 y 4,1% para el PDE 2. Ambos instrumentos examinaron factores no mensurables, sujetos al juicio del evaluador, sin utilizar definiciones operacionales de las variables relevadas. CONCLUSIONES: La aplicación simultánea de los instrumentos de la OMS y del MERCOSUR arrojó niveles de implementación semejantes en los dos puntos de entrada evaluados. Estos procesos de evaluación se verían enriquecidos por el intercambio de las fortalezas y la mejora de las debilidades observadas en ambos instrumentos y registradas en el presente trabajo.<hr/>OBJECTIVE: To describe the characteristics and results of the assessment of core capacities for enforcement of the International Health Regulations (IHR) at points of entry in Uruguay through simultaneous application of the World Health Organization (WHO) and MERCOSUR instruments, and indicate the strengths and weaknesses identified in both instruments when applied in the field. METHODS: A descriptive cross-sectional study was conducted through the application of the WHO and MERCOSUR instruments to assess core capacities for the enforcement of the IHR. Two points of entry (POE 1 and 2) were selected as a convenience sample because they had the highest volume of passenger and goods traffic in the country. Both instruments were characterized individually and qualitatively in terms of strengths and weaknesses. RESULTS: The average values for the implementation of core capacities were 69% (WHO) and 67.4% (MERCOSUR) for POE 1 and 68% (WHO) and 63.9% (MERCO-SUR) for POE 2. The average differences recorded between the instruments were 1.6% for POE 1 and 4.1% for POE 2. Both instruments examined nonmeasurable factors that are subject to the evaluator's judgment, without using operational definitions of the relevant variables. CONCLUSIONS: Simultaneous application of the WHO and MERCOSUR instruments yielded similar levels of implementation at the two points of entry assessed. The assessment processes of the two instruments would be enhanced by capitalizing on each other's strengths and addressing the weaknesses observed and recorded in this study. <![CDATA[<b>Structural actions toward HIV/AIDS prevention in Cartagena, Colombia</b>: <b>a qualitative study</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892011000700010&lng=en&nrm=iso&tlng=en OBJECTIVE: To obtain a thorough understanding of the complexity and dynamics of the social determination of HIV infection among inhabitants of Cartagena, Colombia, as well as their views on necessary actions and priorities. METHODS: In a five-year ethnography of HIV/AIDS in collaboration with 96 citizens of Cartagena, different methods and data collection techniques were used. Through 40 in-depth interviews and 30 life histories of inhabitants, the scenario of HIV vulnerability was summarized in a diagram. This diagram was evaluated and complemented through group discussions with key representatives of local governmental and nongovernmental organizations and with people who were interested in the epidemic or affected by it. RESULTS: The diagram illustrates the dynamic and complex interrelationships among structural factors (i.e., social determinants) of HIV infection, such as machismo; lack of work, money, and social services; local dynamics of the performance of the state; and international dynamics of the sexual tourism industry. On the basis of the diagram, groups of key representatives proposed prioritizing structural actions such as reducing socioeconomic inequalities and providing access to health care and education. CONCLUSIONS: The social determinants displayed in the diagram relate to historic power forces that have shaped vulnerable scenarios in Cartagena. Collaboration between participants and researchers generates conceptual frameworks that make it possible to understand and manage the complexity of HIV's social determination. This way of understanding effectively connects local inequalities with international flows of power such as sexual tourism and makes evident the strengths and limitations of current approaches to HIV prevention.<hr/>OBJETIVO: Explorar la comprensión de los habitantes sobre la determinación social de la infección por el VIH en Cartagena, Colombia, y sus criterios sobre las medidas necesarias y las prioridades. MÉTODOS: Se usaron diferentes métodos y técnicas de recolección de datos en una investigación etnográfica quinquenal de la infección por el VIH/sida en colaboración con 96 ciudadanos de Cartagena. Se resumió en un diagrama la situación de vulnerabilidad al VIH tras analizar la información obtenida en 40 entrevistas a profundidad y 30 historias de vida de los habitantes. Este diagrama se evaluó y se complementó por medio de análisis grupales con representantes clave de organizaciones gubernamentales y no gubernamentales locales y con personas interesadas en la epidemia o afectadas por ella. RESULTADOS: El diagrama ilustra las interrelaciones dinámicas y complejas que existen entre los factores estructurales (es decir, determinantes sociales) de la infección por el VIH, como el machismo; la falta de trabajo, dinero y servicios sociales; la dinámica local de la función del estado; y la dinámica internacional de la industria del turismo sexual. Sobre la base del diagrama, los grupos de representantes clave propusieron medidas estructurales prioritarias, como reducir las desigualdades socioeconómicas y proporcionar acceso a la atención de salud y la educación. CONCLUSIONES: Los determinantes sociales que se muestran en el diagrama se relacionan con las fuerzas de poder que históricamente han configurado situaciones de vulnerabilidad en Cartagena. La colaboración entre los participantes y los investigadores genera marcos conceptuales que permiten comprender y gestionar la complejidad de la determinación social de la infección por el VIH. Este enfoque permite relacionar las desigualdades locales con los flujos internacionales de poder, como el turismo sexual, y pone de manifiesto las ventajas y las limitaciones de los métodos actuales para la prevención de la infección por el VIH. <![CDATA[<b>Depression and self-perceived burden of care by hemodialysis patients and their caregivers</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892011000700011&lng=en&nrm=iso&tlng=en OBJETIVO: Determinar síntomas depresivos, apoyo social percibido y autopercepción de carga en pacientes en hemodiálisis crónica (HDC); identificar síntomas depresivos y grado de fatiga en cuidadores de pacientes en HDC, y evaluar -en el paciente- la asociación entre autopercepción de carga y apoyo social percibido, y entre autopercepción de carga y síntomas depresivos, y -en el cuidador- la relación entre el número de años de cuidado y el grado de fatiga alcanzado. MÉTODOS: Se tomó una muestra de 162 díadas paciente-cuidador, a quienes se les aplicaron los instrumentos "escala adaptada de percepción de apoyo social", "escala de autopercepción de carga", "escala de depresión del Centro de Estudios Epidemiológicos" y "escala de severidad de la fatiga". Los instrumentos fueron aplicados a los pacientes por ayudantes de investigación entrenados y, en el caso de los cuidadores, fueron autoaplicados. RESULTADOS: Del total de pacientes, 40% fueron mujeres, con un promedio de edad de 56 ± 14,9 años, mientras que entre los cuidadores principales, 75% fueron mujeres, cónyuges, con una edad promedio de 50 ± 16,1 años. Se observó que tanto los pacientes (40,74 %) como los cuidadores principales (43,82 %) presentaban síntomas de depresión. Se encontró una asociación positiva (r = 0,43, P < 0,001) entre la autopercepción de carga y la presencia de síntomas depresivos en los pacientes. CONCLUSIONES: Los cuidadores principales son en su mayoría mujeres y familiares de los pacientes. Se perciben fatigados con el cuidado, al igual que lo perciben los propios pacientes. La presencia de síntomas depresivos es similar en pacientes y cuidadores, y hay una asociación estadísticamente significativa entre autopercepción de carga y presencia de síntomas depresivos en los pacientes.<hr/>OBJECTIVE: To determine the depressive symptoms, perceived social support, and self-perceived burden in chronic hemodialysis (CHD) patients; identify depressive symptoms and degree of fatigue in caregivers of CHD patients; evaluate-in patients-the association between self-perceived burden and perceived social support, and between self-perceived burden and depressive symptoms; and evaluate-in caregivers-the relationship between the number of years of care and the degree of fatigue reached. METHODS: A sample of 162 patient-caregiver pairs was selected in which an adapted version of the Multidimensional Scale of Perceived Social Support, along with the Self-perceived Burden Scale, the Center for Epidemiologic Studies Depression Scale, and the Fatigue Severity Scale were applied. The instruments were administered to patients by trained research assistants and, in the case of the caregivers, were self-administered. RESULTS: Forty percent of the patients were women, with an average age of 56 ± 14.9 years, whereas 75% of the primary caregivers were female spouses, with an average age of 50 ± 16.1 years. It was observed that the patients (40.74%) as well as the primary caregivers (43.82%) had depressive symptoms. A positive association (r = 0.43, P < 0.001) was found between self-perceived burden and the presence of depressive symptoms in patients. CONCLUSIONS: The majority of the primary caregivers were women and relatives of the patients. They perceived themselves as fatigued with care, as did the patients themselves. The presence of depressive symptoms was similar in patients and caregivers. There was a statistically significant association between self-perceived burden and the presence of depressive symptoms in patients. <![CDATA[<b>Evidence of the contribution of elderly support programs to healthy aging in Brazil</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892011000700012&lng=en&nrm=iso&tlng=en OBJETIVO: Buscar na literatura evidências relativas à contribuição dos programas de promoção da saúde no processo de envelhecimento saudável no Brasil. MÉTODOS: Pesquisaram-se as bases de dados Science Direct, SciELO, LILACS, IBECS, Biblioteca Cochrane e MEDLINE em busca de artigos que enfocassem iniciativas voltadas para a população idosa e o envelhecimento saudável, que avaliassem multidimensionalmente a qualidade de vida do idoso e que tratassem de aspectos relativos às práticas profissionais específicas em promoção da saúde. Para definir a eficácia das iniciativas, adotaram-se os seguintes critérios: ter metas que incluíssem a melhoria da saúde e do bem-estar; ter foco na saúde holística; usar o empoderamento como mecanismo central; atender os pré-requisitos da saúde e realizar ações nas áreas prioritárias da Carta de Ottawa. RESULTADOS: Foram identificados 10 artigos que se referiam a cinco programas de promoção da saúde do idoso no Brasil. Pode-se afirmar que todos os programas apresentados demonstraram elementos que vão ao encontro da promoção da saúde no envelhecimento por abranger características que permitem a inserção dos idosos na sociedade por meio da criação do ambiente de suporte para prevenção de agravos, aumento da capacidade funcional e melhoria da qualidade de vida, tendo sido atendidos os critérios de eficácia. CONCLUSÕES: É preciso produzir evidências científicas acerca da efetividade, eficiência e eficácia dos programas para a terceira idade para que se possa avaliar o valor dessas ações na promoção da saúde no envelhecimento.<hr/>OBJECTIVE: To search the literature for evidence of the contribution of elderly health programs to the process of healthy aging in Brazil. METHODS: The databases Science Direct, SciELO, LILACS, IBECS, the Cochrane Library, and MEDLINE were searched to find articles focusing on initiatives developed for the elderly population and to promote healthy aging, providing a multidimensional evaluation of the quality of life of the elderly, and covering aspects relating to specific health promotion practices. The initiatives were considered effective if the following criteria were met: having goals that included the improvement of health and well-being, having a focus on holistic health, using empowerment as a central mechanism to improve health, and meeting the prerequisites for health and developing actions in the priority areas described in the Ottawa Charter. RESULTS: Ten articles referring to five elderly health promotion programs in Brazil were identified. All the programs met the efficacy criteria, and included elements that promoted healthy aging through characteristics that fostered the insertion of the elderly in society through the creation of a support environment for the prevention of injury, increase in functional capacity, and improvement of quality of life. CONCLUSIONS: Studies are required to produce scientific evidence on the efficacy, efficiency, and effectiveness of elderly health programs to determine the value of these actions to promote healthy aging. <![CDATA[<b>Prospective registration and results disclosure of clinical trials in the Americas</b>: <b>a roadmap toward transparency</b>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892011000700013&lng=en&nrm=iso&tlng=en The objective of this article is to propose a roadmap toward transparency of clinical trials in the Americas by their prospective registration and results disclosure. This will broaden access to more complete and accurate data and facilitate evidence-informed decision-making and participation in research. Consequently, it should have a positive impact on people's health and should promote trust in health research. Existing initiatives were identified, registration of trials was analyzed following the World Health Organization (WHO) standards on trial registration, and a roadmap is proposed to address the gaps in advancing transparency. The analysis shows that, in spite of numerous regional and country initiatives, clinical trials taking place in nonEnglish-speaking parts of the Americas are underregistered. A roadmap is proposed to enhance research governance and good research practice by improving the transparency of clinical trials. The proposed roadmap includes strategies for implementing WHO international standards for trial registration, for developing international standards of public disclosure of trial results, and for a potential role of the Pan American Health Organization.<hr/>El objetivo de este artículo es proponer una hoja de ruta que fomente la transparencia de los ensayos clínicos en la Región de las Américas mediante el registro prospectivo de los ensayos y la comunicación de sus resultados. Esto brindará un acceso más amplio a datos más completos y exactos, y facilitará la toma de decisiones fundamentada en datos probatorios y la participación en las investigaciones clínicas. En consecuencia, debería tener una repercusión positiva en la salud de la población y promover la confianza en la investigación médica. Después de identificar las iniciativas existentes y analizar los registros de ensayos clínicos según las normas de la Organización Mundial de la Salud (OMS) para el registro de ensayos, se propone una hoja de ruta para salvar las brechas y promover la transparencia. El análisis demuestra que, a pesar de las numerosas iniciativas regionales y de los distintos países, hay un subregistro de los ensayos clínicos que tienen lugar en zonas no anglohablantes de la Región de las Américas. Se propone una hoja de ruta para mejorar la gobernanza en la investigación y las buenas prácticas clínicas mediante una mayor transparencia en los ensayos clínicos. La hoja de ruta propuesta incluye estrategias para ejecutar las normas internacionales de la OMS sobre el registro de los ensayos clínicos, formular normas internacionales de comunicación pública de los resultados de los ensayos, y una función potencial de la Organización Panamericana de la Salud.