{"title":"Health of indigenous peoples initiative.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75654,"journal":{"name":"Bulletin of the Pan American Health Organization","volume":"29 4","pages":"369-72"},"PeriodicalIF":0.0,"publicationDate":"1995-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19585347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K J Lassner, C H Chen, L A Kropsch, M W Oberle, I M Lopes, L Morris
{"title":"Comparative study of safety and efficacy of IUD insertions by physicians and nursing personnel in Brazil.","authors":"K J Lassner, C H Chen, L A Kropsch, M W Oberle, I M Lopes, L Morris","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>To assess whether trained nursing personnel could provide IUD services as safely and effectively as physicians in Brazil, an experimental study was conducted at the main clinic of the Center for Research on Integrated Maternal and Child Care in Rio de Janeiro. From November 1984 through April 1986, a total of 1,711 women who requested IUD insertion at the clinic were randomly assigned to have a Copper-T 200 IUD inserted by one of the clinic's 11 physicians or 13 nurses. All of the physicians and nursing staff members who provided these services had taken the Center's standard clinical family planning training course. Of 860 insertions attempted by the physicians and nurses, 1.3% and 3.3%, respectively, were unsuccessful. Statistically, this difference was very significant (P < 0.01). Also, mainly because the cervix was small and undilated, nulliparous women had a relatively high insertion failure rate of 8.0%, as compared to 1.5% for primiparas and 1.0% for multiparas. The overall rate of complications at insertion was 1.8%, these complications including diaphoresis, vomiting, syncope, cervical laceration, and one case of perforation of the uterus; no significant difference was found between the complication rates for insertions performed by physicians as compared to nurses. However, 9.0% of the study subjects reported severe pain during IUD insertion, with significantly higher percentages reporting pain if the IUD was inserted by a physician, or if the subject was nulliparous, had preinsertion symptoms, or had a history of pelvic inflammatory disease (PID) or sexually transmitted disease (STD). It was also found that the nurses had a dramatically high insertion failure rate (11.6%) with nulliparous subjects, while the physicians' failure rate with such subjects was a significantly lower 3.4%. No significant difference was found in the groups served by nurses and physicians with regard to postinsertion complaints or termination of use within 12 months of insertion. These findings suggest that future training, besides preparing nursing personnel in IUD insertion, should emphasize preparation in taking the client's medical history and diagnosing existing medical symptoms that could be associated with IUD insertion complications. In addition, if a nulliparous woman requests an insertion, it should be performed by a physician or more experienced nursing staff member with close medical supervision. Because of high rates of reported pain at insertion, such women, as well as those with medical symptoms associated IUD insertion complications and those with a history of PID or STD, should be considered candidates for extra care and counseling.(ABSTRACT TRUNCATED AT 400 WORDS)</p>","PeriodicalId":75654,"journal":{"name":"Bulletin of the Pan American Health Organization","volume":"29 3","pages":"206-15"},"PeriodicalIF":0.0,"publicationDate":"1995-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19501390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J E Gómez Marín, L Rigouts, L E Villegas Londoño, F Portaels
{"title":"Restriction fragment length polymorphism (RFLP) analysis and tuberculosis epidemiology.","authors":"J E Gómez Marín, L Rigouts, L E Villegas Londoño, F Portaels","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In order to study polymorphisms of the DNA insertion sequence 6110 (IS6110) in Mycobacterium tuberculosis strains isolated from Colombian patients, together with resistance to antituberculous medications in the Department of Quindío, Colombia, a prospective study was conducted using a consecutive sample of 59 patients with symptomatic pulmonary tuberculosis whose cases had been confirmed by bacilloscopy, both with and without a history of treatment. The patients, who were participating in the Tuberculosis Control Program of the Regional Health Institute of Quindío in Armenia, included all individuals attending local health centers and hospitals between March and July 1993 who were referred to the regional institute. Sputum specimens from each patient were cultured and subjected to drug sensitivity tests. Subsequently, restriction fragment length polymorphisms (RFLP) of IS6110 from 27 patients were analyzed. The patients' treatment histories were used to classify their cases according to WHO criteria. Forty-five cultures were found positive, 44 for M. tuberculosis and 1 for M. africanum. Initial drug resistance was observed in 4 of 42 new cases, or 9.5% (95% CI: 0.6, 18), 2 showing resistance to isoniazid (INH) and 2 to isoniazid plus streptomycin (INH-SM). Acquired resistance was observed in 2 of the 3 chronic cases and relapses, the bacteria being resistant to isoniazid, rifampicin, and streptomycin (INH-RM-SM) in one case and to isoniazid, ethambutol, rifampicin, and streptomycin (INH-EMB-RM-SM) in the other. In those 27 strains subjected to RFLP analysis, the number of copies of IS6110 ranged from 6 to 17. Similarity coefficients revealed five distinct groups of strains. Overall, the RFLP analysis permitted most of the strains to be distinguished from one another, implying that the polymorphisms involved are sufficient to permit effective employment of this technique, which appears to have considerable potential for use in epidemiologic studies and in work designed to provide a basis for tuberculosis control program decision-making.</p>","PeriodicalId":75654,"journal":{"name":"Bulletin of the Pan American Health Organization","volume":"29 3","pages":"226-36"},"PeriodicalIF":0.0,"publicationDate":"1995-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19502593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Periconceptional folic acid and neural tube defects: public health issues.","authors":"R Pérez-Escamilla","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This review examines evidence linking periconceptional folic acid intake to neural tube defects (NTDs) and related public health issues in the United States and developing countries. Sources of information were identified through on-line searches (Medline, UCAT-University of Connecticut) and by contacting researchers in the field. The distribution of NTDs varies across regions. Recurrent NTDs can be prevented with high-dosage folic acid supplementation during periconception, but it is not clear if such a protective effect can be achieved with lower dosages or in low-NTD-risk populations. Overall, it appears that women with a previous NTD pregnancy should receive folic acid supplementation during periconception under medical guidance. Dietary counseling regarding foods rich in folate should be given to all women of childbearing age. However, primary prevention of NTDs through widespread food fortification with folic acid seems unwarranted in both the United States and developing countries due to the low prevalence of NTDs relative to other problems and a potentially unfavorable benefit/risk ratio.</p>","PeriodicalId":75654,"journal":{"name":"Bulletin of the Pan American Health Organization","volume":"29 3","pages":"250-63"},"PeriodicalIF":0.0,"publicationDate":"1995-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19502598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Irradiation for the prevention of foodborne diseases.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75654,"journal":{"name":"Bulletin of the Pan American Health Organization","volume":"29 3","pages":"279-81"},"PeriodicalIF":0.0,"publicationDate":"1995-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19502602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Biotechnology research training grants program.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75654,"journal":{"name":"Bulletin of the Pan American Health Organization","volume":"29 3","pages":"283-5"},"PeriodicalIF":0.0,"publicationDate":"1995-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19502604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Correct case management of childhood diarrhea: a survey of nine state capitals in northeast Brazil.","authors":"H da C Ribeiro Júnior, C J Drasbek","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The National Program for Maternal and Child Health (COSMI) of the Ministry of Health (MOH) of Brazil conducted a survey in nine state capitals from 29 March to 30 April 1993 to assess how well health facilities were managing diarrhea cases in patients under 5 years of age. One of seven PAHO/WHO health facility surveys performed in Latin America and the Caribbean in 1992-1993, the Brazilian survey took place in the Northeast Region where most diarrheal morbidity and mortality occur. Like the other six surveys, it used a new PAHO/WHO methodology designed to collect data on certain principal indicators through observation, interviews, and review of clinical records. Overall, 475 cases of patients with diarrhea were observed in 192 facilities, and 463 health workers and 474 caretakers were interviewed. The results indicated that few diarrhea patients received care that strictly followed the PAHO/WHO/Ministry of Health treatment guidelines. In terms of these guidelines, the correct procedure was used to assess the patient's hydration status only 8% of the time, and only 1% of the health workers provided correct advice to the caretaker on prevention and home care aspects of diarrheal diseases. The procedure used to rehydrate patients with oral rehydration salts (ORS) was correct in only 6% of the cases. Of those patients with bloody stools, 24% were treated appropriately with antibiotics. Besides collecting information on correct case management, the survey provided a basis for developing two-year operational plans of action in each of the nine participating states to strengthen efforts directed at controlling and preventing diarrheal diseases, including cholera.</p>","PeriodicalId":75654,"journal":{"name":"Bulletin of the Pan American Health Organization","volume":"29 3","pages":"237-49"},"PeriodicalIF":0.0,"publicationDate":"1995-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19502595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Strategies and causes of reduced infant and young child diarrheal disease mortality in Cuba, 1962-1993.","authors":"R L Riverón Corteguera","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75654,"journal":{"name":"Bulletin of the Pan American Health Organization","volume":"29 3","pages":"285"},"PeriodicalIF":0.0,"publicationDate":"1995-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19502605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Trends in relative mortality from cerebrovascular diseases in Brazilian state capitals, 1950-1988.","authors":"I Lessa","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This article seeks to describe trends in relative mortality from cerebrovascular diseases (CVDs) in Brazilian state capitals from 1950 through 1988. Absolute numbers of deaths from all causes; from CVDs; and from ill-defined signs, symptoms, and afflictions were obtained from official Brazilian mortality statistics. In calculating relative CVD mortality, deaths from ill-defined signs, symptoms, and afflictions were excluded. The collected data permitted calculation of relative CVD mortality in most state capitals for 1950, 1955, 1960, 1961-1965, 1966-1970, 1971-1975, 1977-1980, 1981-1985, and 1986-1988. During the study period CVD mortality was found to play an increasing role in overall mortality in all the state capitals. Regional grouping of data showed greater relative CVD mortality in the South and Southwest Regions toward the start of the study period. However, over the course of this period the part that CVD mortality played in overall mortality grew most rapidly in the less-developed North, Northeast, and Center-West Regions. In general, relative CVD mortality data in nearly all the state capitals demonstrate the attention that needs to be devoted to CVDs within the context of adult public health. In particular, there is a clear need to greatly strengthen and improve the marginal existing programs for detection and control of hypertension and diabetes in Brazil. This should be done by assessing international experience with programs of this type and adapting that experience to Brazilian conditions. Beyond that, it will be important to support health promotion and protection efforts that can deal with risk factors and secure prevention through lifestyle modification--something that can provide benefits in dealing not only with CVDs but also with diabetes, obesity, and certain neoplasias.</p>","PeriodicalId":75654,"journal":{"name":"Bulletin of the Pan American Health Organization","volume":"29 3","pages":"216-25"},"PeriodicalIF":0.0,"publicationDate":"1995-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19501391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Prospects and challenges for health in the Americas.","authors":"G Alleyne","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75654,"journal":{"name":"Bulletin of the Pan American Health Organization","volume":"29 3","pages":"264-71"},"PeriodicalIF":0.0,"publicationDate":"1995-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19502599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}