Revista Panamericana de Salud Públicahttps://www.scielosp.org/feed/rpsp/2006.v20n4/2018-01-01T00:02:00ZUnknown authorVol. 20 No. 4 - 2006WerkzeugEvaluación del impacto económico de la vacuna antirrotavírica en VenezuelaS1020-498920060009000012018-01-01T00:02:00Z2018-01-01T00:02:00ZConstenla, DagnaPérez-Schael, IreneRheingans, Richard D.Antil, LynnSalas, HansYarzábal, Juan Pablo
<em>Constenla, Dagna</em>;
<em>Pérez-Schael, Irene</em>;
<em>Rheingans, Richard D.</em>;
<em>Antil, Lynn</em>;
<em>Salas, Hans</em>;
<em>Yarzábal, Juan Pablo</em>;
<br/><br/>
OBJETIVO: El objetivo de este estudio fue evaluar el costo de la atención médica de la gastroenteritis por rotavirus y la relación costo-efectividad de la vacuna antirrotavírica en la población venezolana menor de 5 años de edad. MÉTODOS: Se utilizó un modelo económico que integra la información epidemiológica, la eficacia de la vacuna y los costos de atención médica de la gastroenteritis por rotavirus, desde la perspectiva de la sociedad. Para determinar la efectividad de la vacuna, se estimó el número de casos de hospitalización, de consultas médicas y de muertes evitados después de su administración. La relación costo-efectividad de la vacuna se evaluó partiendo del número de años de vida ajustados por discapacidad (AVAD) y de casos evitados. RESULTADOS: En Venezuela, los servicios de salud invierten, aproximadamente, 4,2 millones de dólares estadounidenses (US$) por año para cubrir los costos de atención médica causados por el rotavirus. Un programa de vacunación antirrotavírica evitaría aproximadamente el 52% (186) de las muertes, el 54% (7 232) de las hospitalizaciones y el 50% (55 168) de las consultas ambulatorias durante los primeros cinco años de vida, en una cohorte vacunada. Para un precio estimado de US$ 24 por régimen de vacuna, se genera una relación costo-efectividad de US$ 1 352 por AVAD. CONCLUSIONES: Los resultados de este estudio apuntan a que la vacunación antirrotavírica es una estrategia costoefectiva en la prevención de la gastroenteritis por rotavirus en Venezuela, ya que puede evitar muertes y años de vida ajustados por discapacidad en la población menor de cinco años de edad.Sexually transmitted infections and private physicians in Peru, 2003S1020-498920060009000022018-01-01T00:02:00Z2018-01-01T00:02:00ZHsieh, Evelyn J.Blas, Magaly M.La Rosa Roca, SaydaGarcia, Patricia J.
<em>Hsieh, Evelyn J.</em>;
<em>Blas, Magaly M.</em>;
<em>La Rosa Roca, Sayda</em>;
<em>Garcia, Patricia J.</em>;
<br/><br/>
OBJECTIVES: To analyze demographic and practice characteristics of private physicians in 10 cities of Peru, and to shed light on the role of private practice in the delivery of medical care to patients with sexually transmitted infections (STIs). METHODS: As part of an interventional trial designed to improve physician management of STIs in 10 cities in Peru, detailed information was compiled regarding numbers of physicians in each city. A door-to-door survey was then conducted within each city of all private and public medical offices and institutions. Each physician encountered who had a private practice was asked to answer a questionnaire regarding demographic information, medical education, specialty, type of private and public practices currently engaged in, number of STI cases seen per month, and average earnings per consultation. RESULTS: Of 2 060 physicians working in the 10 cities, 507 reported having a private practice, either exclusively or concurrently with other clinical positions. Almost all the private physicians (97.4%) reported managing cases of STIs. Regional differences among private physicians were found in physician density, gender, and place of medical training. In addition, significant variations by gender were seen in rates of specialization, earnings per consultation, and numbers of female patients with STIs seen per month. CONCLUSIONS: Studies of the physician workforce can provide meaningful insights for potential use in addressing public health problems. This study provides valuable information that can help understand the important role of private physicians in managing STIs in Peru.Soroepidemiologia da hepatite B e C em índios Kaingang do Sul do BrasilS1020-498920060009000032018-01-01T00:02:00Z2018-01-01T00:02:00ZFerreira, AlineGreca, DanielTavares, EryMoriya, YatiyoSpelling, FloriseBoeira, MaristelaSantos, Sidneis dosMessias-Reason, Iara de
<em>Ferreira, Aline</em>;
<em>Greca, Daniel</em>;
<em>Tavares, Ery</em>;
<em>Moriya, Yatiyo</em>;
<em>Spelling, Florise</em>;
<em>Boeira, Maristela</em>;
<em>Santos, Sidneis Dos</em>;
<em>Messias-Reason, Iara De</em>;
<br/><br/>
OBJETIVO: Investigar a prevalência de infecção pelo vírus da hepatite B e C na população indígena Kaingang da reserva de Mangueirinha, no Estado do Paraná, Brasil. MÉTODO: A presença dos marcadores sorológicos anti-HBc, anti-HBs, AgHBs e anti-VHC foi investigada em amostras de sangue de 214 voluntários (81 do sexo masculino e 133 do sexo feminino) usando técnicas imunoenzimáticas. Os participantes responderam a um questionário sobre os aspectos sociodemográficos, as condições de vida, os hábitos e o histórico de doenças e de vacinação. RESULTADOS: A média de idade foi de 29,85 anos (1 a 90 anos). Foi observada uma positividade de 71,02% para o marcador anti-HBs e de 15,42% para o anti-HBc. Nenhum caso foi positivo para o marcador AgHBs. Somente um participante, uma mulher de 30 anos, apresentou positividade para anti-VHC. CONCLUSÃO: Os resultados mostram baixa prevalência de infecção pelo VHB e pelo VHC na população Kaingang estudada. A alta prevalência de anti-HBs nas faixas etárias mais baixas indica uma boa abrangência da imunização ativa artificial. Na população adulta, é provável que a imunidade contra o VHB tenha sido adquirida principalmente de forma natural, pelo contato com o vírus.Arsenic in drinking water in the Los Altos de Jalisco region of MexicoS1020-498920060009000042018-01-01T00:02:00Z2018-01-01T00:02:00ZHurtado-Jiménez, RobertoGardea-Torresdey, Jorge L.
<em>Hurtado-Jiménez, Roberto</em>;
<em>Gardea-Torresdey, Jorge L.</em>;
<br/><br/>
OBJECTIVE: To establish the degree of contamination by arsenic in drinking water in the Los Altos de Jalisco (LAJ) region of west-central Mexico, and to estimate the levels of exposure that residents of the area face. METHODS: Total arsenic concentration (the sum of all arsenic forms, organic and inorganic) was determined for 129 public water wells in 17 municipal capitals (cabeceras municipales) of the LAJ region, using inductively coupled plasma-optical emission spectroscopy. For most of the wells, water samples were taken in both November 2002 and October 2003. The levels of exposure to arsenic were estimated for babies (10 kg), children (20 kg), and adults (70 kg). RESULTS: Mean concentrations of arsenic higher than the Mexican national guideline value of 25 µg/L were found in 44 (34%) of the 129 wells. The mean concentration of total arsenic for the 129 wells ranged from 14.7 µg/L to 101.9 µg/L. The highest concentrations were found in well water samples collected in the cities of Mexticacán (262.9 µg/L), Teocaltiche (157.7 µg/L), and San Juan de los Lagos (113.8 µg/L). Considering the global mean concentration for all the wells in each of the 17 cities, the mean concentration of arsenic exceeded the Mexican guideline value in 7 of the cities. However, the global mean concentration in all 17 cities was higher than the World Health Organization guideline value of 10 µg/L for arsenic. The range of the estimated exposure doses to arsenic in drinking water was 1.1-7.6 µg/kg/d for babies, 0.7-5.1 µg/kg/d for children, and 0.4-2.7 µg/kg/d for adults. CONCLUSIONS: At the exposure doses estimated in the LAJ region, the potential health effects from chronic arsenic ingestion include skin diseases, gastrointestinal effects, neurological damage, cardiovascular problems, and hematological effects. While all the residents may not be affected, an important fraction of the total population of the LAJ region is under potential health risk due to the ingestion of high levels of arsenic. Epidemiological studies to determine the arsenic levels in the blood, hair, and nails of humans should be conducted in the LAJ region to help assess the relationship between the prevalence of health problems and the chronic ingestion of arsenic.Relación costo-efectividad de la vacuna contra Haemophilus influenzae tipo b en niños menores de dos años de edad en ColombiaS1020-498920060009000052018-01-01T00:02:00Z2018-01-01T00:02:00ZGuzmán, Nelson AlvisDe La Hoz Restrepo, FernandoConsuelo, David Vivas
<em>Guzmán, Nelson Alvis</em>;
<em>De La Hoz Restrepo, Fernando</em>;
<em>Consuelo, David Vivas</em>;
<br/><br/>
OBJETIVOS: Las vacunas conjugadas contra Haemophilus influenzae tipo b (Hib) son la herramienta más importante para prevenir la mayoría de las enfermedades invasoras producidas por dicho patógeno, pero debido a su costo, aún no se han introducido mundialmente de manera masiva. En el presente estudio se determinó la relación costo-efectividad de una vacuna contra Hib para prevenir la neumonía y la meningitis bacterianas en niños menores de 2 años en Colombia. MÉTODOS: Se estimaron los costos directos e indirectos de la neumonía y la meningitis hospitalaria y siguiendo las recomendaciones de la Organización Mundial de la Salud (OMS), la relación costo-efectividad de los programas de vacunación contra Hib. Se estimaron también las razones de costos por caso evitado de enfermedad invasora por Hib y el costo por año de vida salvado en dos situaciones hipotéticas: con vacunación contra Hib (cobertura vacunal: 90%) y sin vacunación. RESULTADOS: El costo medio del tratamiento hospitalario de un caso de neumonía fue de 611,5 dólares estadounidenses (US$) (intervalo de confianza del 95% [IC95%]: 532,2 - 690,8), el costo medio del tratamiento hospitalario de un caso de meningitis fue de US$ 848,9 (IC95%: 716,8 - 981,0) y el costo por caso evitado de enfermedad invasora por Hib, de US$ 316,7 (IC95%: 294,2 - 339,2). La relación costo-efectividad en la hipótesis con vacunación fue de 2,38, frente a 3,81 en la hipótesis sin vacunación. CONCLUSIÓN: La aplicación de un programa adecuado de vacunación contra Hib en Colombia puede prevenir cerca de 25 000 casos de enfermedad invasora por año, lo que representa un ahorro de por lo menos US$ 15 millones anuales. Además, puede evitar cerca de 700 defunciones y salvar anualmente 44 054 años de vida.Associations between dengue and combinations of weather factors in a city in the Brazilian AmazonS1020-498920060009000062018-01-01T00:02:00Z2018-01-01T00:02:00ZRosa-Freitas, Maria GoretiSchreiber, Kathleen V.Tsouris, PantelisWeimann, Ellem Tatiani de SouzaLuitgards-Moura, José Francisco
<em>Rosa-Freitas, Maria Goreti</em>;
<em>Schreiber, Kathleen V.</em>;
<em>Tsouris, Pantelis</em>;
<em>Weimann, Ellem Tatiani De Souza</em>;
<em>Luitgards-Moura, José Francisco</em>;
<br/><br/>
OBJECTIVES: Dengue has become the most important endemic disease in Brazil. The Amazonian state of Roraima has one of the highest incidence rates of dengue in the country. The objective of this study was to determine whether significant temporal relationships exist between the number of reported dengue cases and short-term climate measures for the city of Boa Vista, the capital of Roraima. If such relationships exist, that suggests that it may be possible to predict dengue case numbers based on antecedent climate, thus helping develop a climate-based dengue early-warning system for Boa Vista. METHODS: Seasonal Pearson product-moment correlations were developed between 3-week running averages of daily numbers of reported dengue cases for September 1998-December 2001 and certain meteorological variables (thermal, hydroclimatic, wind, atmospheric pressure, and humidity) up to 25 weeks before. Two-sample t tests were also applied to test for statistically significant differences between samples of daily dengue cases with above-average values and samples with below-average values for three-variable meteorological combinations. These multivariate combinations consisted of the three climate measures that together explained the greatest portion of the variance in the number of dengue cases for the particular season. RESULTS: The strength of the individual averaged correlations varied from weak to moderate. The correlations differed according to the period of the year, the particular climatic variable, and the lag period between the climate indicator and the number of dengue cases. The seasonal correlations in our study showed far stronger relationships than had daily, full-year measures reported in previous studies. Two-sample t tests of multivariate meteorological combinations of atmospheric pressure, wind, and humidity values showed statistically significant differences in the number of reported dengue cases. CONCLUSIONS: Relationships between climate and dengue are best analyzed for short, relevant time periods. Climate-based multivariate temporal stochastic analyses have the potential to identify periods of elevated dengue incidence, and they should be integrated into local control programs for vector-transmitted diseases.Efecto del tamaño de las agujas en la inmunogenicidad y reactogenicidad de dos vacunas aplicadas a lactantesS1020-498920060009000072018-01-01T00:02:00Z2018-01-01T00:02:00ZConfirman la gran diversidad de Leishmania en el estado de Acre, BrasilS1020-498920060009000082018-01-01T00:02:00Z2018-01-01T00:02:00ZReflexiones sobre el desarrollo de capacidades para la promoción de salud en PerúS1020-498920060009000092018-01-01T00:02:00Z2018-01-01T00:02:00ZSeroprevalencia y factores de riesgo de la infección por el VIH en trabajadoras sexuales de América del SurS1020-498920060009000102018-01-01T00:02:00Z2018-01-01T00:02:00ZLos determinantes sociales de la salud, la posición socioeconómica y la inequidad en saludS1020-498920060009000112018-01-01T00:02:00Z2018-01-01T00:02:00ZEfecto independiente de la exposición pasiva prenatal y posnatal al tabacoS1020-498920060009000122018-01-01T00:02:00Z2018-01-01T00:02:00ZChile: protección social de la saludS1020-498920060009000132018-01-01T00:02:00Z2018-01-01T00:02:00ZUrriola, Rafael
<em>Urriola, Rafael</em>;
<br/><br/>
Errata: Robilotta, "A tomografia por emissão de pósitrons: uma nova modalidade na medicina nuclear brasileira" (Rev Panam Salud Publica. 2006;20(2/3):134-42.)S1020-498920060009000142018-01-01T00:02:00Z2018-01-01T00:02:00Z