Abstract in Spanish:
La relación entre la drepanocitosis y los diferentes haplotipos del gen que codifica la subunidad betas de la globina ha permitido llegar a entender mejor las manifestaciones clínicas de aquella enfermedad. El uso de mejores técnicas de laboratorio permite descartar la presencia de otros factores hereditarios capaces de ocultar el verdadero genotipo hemoglobínico. La heterogeneidad clínica de la drepanocitosis, afección caracterizada por la presencia de una hemoglobina anormal denominada HbS, depende de las concentraciones de hemoglobina fetal (HbF), la razón de cadenas Ggamma a cadenas Agamma en la molécula de globina, las concentraciones de 2,3-difosfoglicerato, la presencia de mutaciones ligadas, los haplotipos del gen betas, la presencia simultánea de alfa-talasemia, y factores ambientales. En particular, los polimorfismos Senegal y árabe-saudí o indio del conglomerado de genes que codifican la subunidad betas se asocian con una evolución clínica menos grave, mientras que los haplotipos de la República Centroafricana (CAR) o Bantú, Camerún y Benín se asocian con drepanocitosis grave. De todos, el haplotipo CAR es el de peor pronóstico (concentraciones de HbF de menos de 12% y razón de Ggamma:Agamma propia de la edad adulta). Estos polimorfismos del ácido desoxirribonucleico, una vez caracterizados, adquieren enorme importancia como marcadores antropológicos y genéticos. En las Américas, los haplotipos betas permiten entender mejor las raíces ancestrales africanas de las poblaciones de raza negra. Se ha comprobado la presencia de variedad genética no solo entre las diferentes poblaciones negras de las Américas, sino también dentro de un mismo país, como se observa en Costa Rica.Abstract in English:
The link between betas-gene haplotypes and sickle cell anemia has permitted a better understanding of the biological manifestations of this disease. The use of better laboratory methods can help rule out other hereditary factors that can camouflage the real hemoglobin genotype. The clinical heterogeneity of sickle cell disease, which is characterized by the presence of S hemoglobin, can be explained in terms of fetal hemoglobin (HbF) levels, ratio of Ggamma chains to Agamma chains, 2,3-diphosphoglycerate levels, linked mutations, betas haplotypes, coexistence of alpha-thalassemia, and environmental factors. The inheritance of Sen and Arab/Indian beta-gene cluster polymorphisms is associated with a milder clinical course, whereas the Central African Republic (CAR) or Bantu, Cameroon, and Benin haplotypes are linked with severe sickle cell disease. The CAR haplotype carries the worst prognosis of all (less than 12% HbF levels and adult-type Ggamma:Agamma ratio). Once characterized, these DNA polymorphisms also assume great importance as anthropologic and genetic markers. In America, betas haplotypes are contributing to a better understanding of Black American roots and their African ancestry. There is ample evidence of genetic variability not only between different Black populations in America, but also within the same country, as is the case in Costa Rica.Abstract in Spanish:
Se llevó a cabo una intervención destinada a mejorar la salud materna e infantil en una provincia aislada de Bolivia con acceso limitado a instalaciones de salud modernas. La intervención se centró en la creación y el fortalecimiento de organizaciones para mujeres, en el desarrollo de habilidades entre las mujeres, en la identificación de problemas y la determinación de prioridades y en el adiestramiento de habitantes de la comunidad en la aplicación de técnicas seguras para la atención del parto. Para evaluar su impacto se compararon las tasas de mortalidad perinatal y las prácticas obstétricas de 409 mujeres antes y después de la intervención. La mortalidad perinatal bajó de 117 defunciones por 1 000 nacimientos antes de la intervención a 43,8 defunciones por 1 000 nacimientos después de ella. Se produjo un aumento significativo del número de mujeres que participaron en organizaciones femeninas después de la intervención, así como del número de dichas organizaciones. Asimismo, hubo un aumento significativo de la proporción de mujeres que recibieron atención prenatal y que iniciaron la lactancia materna desde el primer día después del parto. El número de neonatos atendidos inmediatamente después del alumbramiento también aumentó, pero el cambio no fue estadísticamente significativo. Este estudio demuestra que la organización comunitaria puede mejorar la salud materna e infantil en lugares aislados.Abstract in English:
An intervention to improve maternal and child health was conducted in a remote Bolivian province with limited access to modern medical facilities. The intervention focused on initiating and strengthening women's organizations, developing women's skills in problem identification and prioritization, and training community members in safe birthing techniques. Its impact was evaluated by comparing perinatal mortality rates and obstetric behavior among 409 women before and after the intervention. Perinatal mortality decreased from 117 deaths per 1 000 births before the intervention to 43.8 deaths per 1 000 births after. There was a significant increase in the number of women participating in women's organizations following the intervention, as well as in the number of organizations. The proportion of women receiving prenatal care and initiating breast-feeding on the first day after birth was also significantly larger. The number of infants attended to immediately after delivery likewise increased, but the change was not statistically significant. This study demonstrates that community organization can improve maternal and child health in remote areas.Abstract in Spanish:
El presente estudio se realizó en México en una población vecina a una planta recicladora de cinc y de otros polvos metálicos ante la posibilidad de que estas sustancias entraran en contacto con la población y produjeran diferentes efectos nocivos sobre la salud. La planta se sitúa en un municipio cercano a Monterrey, que es la tercera ciudad más poblada de México y la segunda más industrializada. Se aplicó un diseño transversal comparativo para llevar a cabo la investigación, que duró de septiembre a noviembre de 1994. Mediante un muestreo por cuotas se seleccionaron viviendas en dos zonas --una zona expuesta por vecindad a la planta y otra no expuesta que sirvió de control-- hasta lograr el tamaño muestral deseado (621 individuos, a un promedio de cinco por vivienda). En cada domicilio un estudiante de psicología adiestrado aplicó un cuestionario a un familiar mayor de edad para recoger datos sobre la presencia de afecciones agudas y crónicas, trastornos del embarazo y enfermedades congénitas en los integrantes del hogar. En la población expuesta se aplicaron 127 cuestionarios, que arrojaron información sobre 596 personas, y en la población no expuesta se administraron 147, que proporcionaron datos sobre 743 personas. Las distribuciones por sexo y edad fueron semejantes en las dos poblaciones y el tiempo de residencia en la zona fue ligeramente mayor en los individuos no expuestos. Los problemas de salud más frecuentes en la población expuesta fueron irritación ocular y de vías respiratorias superiores, alergias, trastornos del sueño, bronquitis, cansancio excesivo, problemas cutáneos, otitis y anemias. Las razones de prevalencias fueron significativas en el caso de erupciones y otras enfermedades cutáneas, cansancio excesivo, trastornos del sueño, infecciones respiratorias superiores, otitis, bronquitis y alergias. Cuando se compararon los dos grupos de mujeres no se encontraron diferencias significativas en las prevalencias de problemas obstétricos, abortos espontáneos o hijos con malformaciones congénitas o bajo peso al nacer. La sensibilidad del cuestionario utilizado para detectar problemas de salud es pobre y podría haber causado una subestimación de algunas afecciones. No obstante, diferentes sesgos de información fueron controlados y ello permite concluir que la población expuesta tiene un mayor riesgo de padecer ciertas enfermedades y trastornos que la población no expuesta.Abstract in English:
This study was conducted in Mexico among residents of an area near a recycling plant for zinc and other metallic dusts to find out if these substances produce various adverse health effects in the population that may come in contact with them. The plant is in a municipality close to Monterrey, which is Mexico's third most populous and second most industrialized city. A cross-sectional comparative design was used for the research, which took place from September to November 1994. By means of quota sampling, houses were selected in two areas-one exposed, by virtue of its proximity to the plant, and the other unexposed, which served as a control-until the desired sample size was reached (621 individuals, an average of five per household). In each dwelling, a trained psychology student administered a questionnaire to one of the older family members to gather data on the presence of acute and chronic illnesses, problems during pregnancy, and congenital illnesses among the household members. In the exposed population, 127 questionnaires were completed, providing information on 596 persons; in the unexposed population, data on 743 persons were gathered via 147 questionnaires. The sex and age distributions were similar in the two populations, and the length of residence in their respective area was slightly longer among unexposed individuals. The most frequently reported health problems in the exposed population were irritation of the eyes and upper respiratory tract, allergies, sleep disturbances, bronchitis, fatigue, skin problems, ear infections, and anemia. The prevalence ratios for the exposed versus unexposed populations were significant with regard to skin eruptions and other skin diseases, fatigue, sleep disturbances, upper respiratory infections, ear infections, bronchitis, and allergies. Women from the two groups did not show significant differences in the prevalence of obstetric problems, miscarriages, or children born with congenital deformities or low birthweight. The sensitivity of the questionnaire used to detect health problems was poor, which could have resulted in an underestimation of some disorders. Nevertheless, various types of information bias were controlled, permitting the conclusion that the exposed population had a greater risk of suffering certain diseases and disorders than the unexposed population.Abstract in Portuguese:
O Triatoma sordida é uma espécie predominantemente peridomiciliar e, atualmente, a mais capturada no Brasil. Para melhor compreender a resposta deste triatomíneo às atividades de controle, uma pesquisa de infestação triatomínica foi realizada em outubro de 1993 em 12 localidades rurais do município de Porteirinha, MG, Brasil. Foram capturados 772 exemplares de T. sordida, dos quais 3,6% estavam infectados pelo Trypanosoma cruzi. Dentre as 406 unidades domiciliares pesquisadas, 34,9% estavam infestadas. Dos 695 ecótopos peridomiciliares estudados, 27,6% foram positivos para a presença de T. sordida. O estudo revelou um peridomicílio simples, com poucos ecótopos positivos por unidade domiciliar e baixa densidade triatomínica (colônias de no máximo cinco insetos). O estudo constatou uma associação entre presença de triatomíneos e ecótopos de madeira: 72,8% dos triatomíneos foram capturados neste tipo de ecótopo. Entre as unidades domiciliares positivas, 62,9% ficavam próximas do ambiente silvestre (12 a 299 m); 92,3% dos ecótopos infestados ficavam a menos de 20 m das casas. O censo de animais peridomiciliares revelou que as galinhas correspondiam a 82,7% dos animais. As unidades domiciliares infestadas foram imediatamente borrifadas com deltametrina (25 mg i.a./m²). Novas pesquisas de infestação foram feitas 7 meses (pesquisa 2) e 1 ano (pesquisa 3) após a borrifação. Na pesquisa 2 o número de triatomíneos correspondeu a 52,5% da população original e, na pesquisa 3, a 79,1% da mesma. A redução do número de triatomíneos capturados na pesquisa 2 incidiu principalmente sobre as ninfas. A grande proporção de adultos capturados nessa ocasião confirma a existência de apenas um ciclo anual do T. sordida na região. Na pesquisa 3 o aumento do número de ninfas demonstrou crescimento desta população, utilizando-se da grande disponibilidade de galinhas para alimentação. Apesar das dificuldades de borrifação e da baixa permanência do inseticida no peridomicílio, a existência de apenas um ciclo anual do triatomíneo e a lentidão na reconstituição da população original sugerem que uma borrifação anual é suficiente para controle do T. sordida. Maior eficiência poderá ser obtida com a eliminação dos esconderijos, através da substituição do material usado na construção dos anexos, principalmente a madeira.Abstract in English:
Triatoma sordida, a predominantly peridomestic species, is currently the triatomine species most frequently collected in Brazil. To evaluate the effectiveness of control activities against this species, a survey to determine infestation rates was carried out in October 1993 in 12 rural localities in the municipality of Porteirinha, State of Minas Gerais, Brazil. In the survey, 772 T. sordida were captured, of which 3.6% were infected with Trypanosoma cruzi. Of the 406 dwellings investigated, 34.9% were infested, and 27.6% of 695 peridomiciliar ecotopes contained T. sordida. The area around the dwellings was relatively uniform, with few positive ecotopes per household and low triatomine densities (a maximum of five insects per colony). The study found an association between the presence of insects and wood: 72.8% of the insects were captured in this type of ecotope. The majority of the positive households (62.9%) were close to forests (12 to 299 m); 92.3% of the infested ecotopes were less than 20 m from the house. A census of peridomestic animals revealed that chickens were the most abundant (82.7%). All positive households found in the survey were sprayed immediately with deltamethrin (25 mg a.i./m²). New surveys were carried out 7 months (survey 2) and 12 months (survey 3) after spraying. In survey 2, the number of insects collected corresponded to 52.5% of the original total, and in survey 3, 79.1%. The decrease in population observed in survey 2 was mainly due to a reduction in the population of nymphs. The large proportion of adults captured in that survey supports the idea that T. sordida produces only a single generation per year in this region. In survey 3 the increase in the number of nymphs, attributable to the great availability of chickens as a source of food, resulted in population growth. Despite the difficulties of spraying and the short persistence of the insecticide, the slow population response of T. sordida suggests that one annual spraying is sufficient for effective control of this species. Higher effectiveness could be obtained by eliminating peridomestic hiding places, for example, by replacing wooden annexes with structures made from other materials.Abstract in Spanish:
La epidemiología genética es una disciplina relativamente reciente que estudia la interacción entre los factores genéticos y ambientales que dan origen a las enfermedades del ser humano. Valiéndose de marcadores genéticos desarrollados a través de la biología molecular, de complejos algoritmos almacenados en computadoras y de amplias bases de datos, la epidemiología genética se ha desarrollado notablemente durante los últimos 10 años. El presente artículo describe los objetivos de la epidemiología genética y su metodología, empleando ejemplos concretos tomados de la literatura científica reciente.Abstract in English:
Genetic epidemiology is a relatively new discipline that studies the interaction between genetic and environmental factors in the production of human diseases. Taking advantage of the genetic markers provided by molecular biological research, complex computerized algorithms, and large databases, the field of genetic epidemiology has undergone notable development in the past 10 years. This article describes the objectives and methodology of genetic epidemiology, using concrete examples from the recent scientific literature.Abstract in Spanish:
En octubre de 1995 el Ministerio de Salud Pública y Población de Haití inspeccionó 42 establecimientos de salud para determinar la prevalencia y distribución de la infección por malaria. Se examinaron 1 803 frotis de sangre periférica obtenidos de pacientes con sospecha de tener esa enfermedad; la tasa general de positividad de los frotis fue de 4,0% (con un recorrido de 0,0 a 14,3%). La tasa más baja (1,6%) se ob-servó en el grupo de niños de 1 a 4 años y la más alta en personas de 15 años de edad o mayores (5,5%). Los diagnósticos clínico y microscópico de la malaria fueron poco confiables; la sensibilidad general del diagnóstico microscópico fue de 83,6% y su especificidad de 88,6%, y el valor predictivo de un frotis positivo fue de 22,2%. Es preciso mejorar los diagnósticos microscópicos y reestablecer una vigilancia adecuada a fin de identificar las zonas donde la transmisión es más intensa. La frecuencia relativamente baja de la malaria es un dato alentador y sugiere que el refuerzo de las iniciativas de control dirigidas a las zonas de mayor prevalencia podría mitigar aun más el efecto de la malaria en Haití.Abstract in English:
In October 1995 the Ministry of Public Health and Population in Haiti surveyed 42 health facilities for the prevalence and distribution of malaria infection. They examined 1 803 peripheral blood smears from patients with suspected malaria; the overall slide positivity rate was 4.0% (range, 0.0% to 14.3%). The rate was lowest among 1- to 4-year-old children (1.6%) and highest among persons aged 15 and older (5.5%). Clinical and microscopic diagnoses of malaria were unreliable; the overall sensitivity of microscopic diagnosis was 83.6%, specificity was 88.6%, and the predictive value of a positive slide was 22.2%. Microscopic diagnoses need to be improved, and adequate surveillance must be reestablished to identify areas where transmission is most intense. The generally low level of malaria is encouraging and suggests that intensified control efforts targeted to the areas of highest prevalence could further diminish the effect of malaria in Haiti.Abstract in Spanish:
La 4.ª Conferencia Internacional sobre la Promoción de la Salud, que tuvo lugar en Jakarta, Indonesia, del 21 al 25 de julio de 1997 bajo el patrocinio de la OMS y del Gobierno de ese país, ha sentado un antecedente por haber sido la primera de su género en celebrarse en un país en desarrollo y en contar con la participación del sector privado. De forma similar la Declaración de Jakarta, fruto de la Conferencia, plantea conceptos innovadores que se proyectan hacia el futuro siglo. En la Declaración se insta a la comunidad mundial a adoptar determinadas estrategias clave encaminadas a favorecer actividades para la promoción de la salud en el ámbito internacional, reiterándose que dichas actividades rendirán los frutos deseados únicamente si se basan en un común esfuerzo por parte de todos los sectores sociales, especialmente del sector privado y de la propia población que se busca servir. Se subraya, asimismo, que cualquier inversión en la promoción de la salud redundará en abundantes beneficios para todos.Abstract in English:
This report presents a set of indicators to aid in the assessment of reproductive health and its associated programs in developing countries. The indicators basically stem from the accords ratified at the International Conference on Population and Development (ICPD), which was held in 1994 for the purpose of improving the reproductive health status of women, men, and adolescents throughout the world. However, working drafts and ways of approaching the subject were developed in 1996 at several meetings of representatives of the United Nations Population Fund (UNFPA), bilateral agencies, and nongovernmental organizations. The indicators are not in their definitive and final form, and it is expected that comments received from users will allow them to be improved. The indicators deal with the monitoring of progress toward the goals of the ICPD, managerial policies and procedures, family planning, maternal health, infections of the reproductive system and sexually transmitted diseases, abortion and infertility, and other demographic, social, and economic factors.