Reduciendo el impacto de COVID-19 sobre la radioterapia oncológica en países en desarrollo: revisión rápida y consenso de expertos / Reducing the impact of COVID-19 on radiation oncology units of developing countries: a rapid review and expert consensus

OBJETIVO: Establecer recomendaciones para la toma de decisiones de manejo en radioterapia durante la pandemia de COVID-19, adaptadas a un país con recursos de salud limitados. MÉTODOS: A través de una revisión rápida de la literatura se buscaron publicaciones que describieran medidas para reducir el riesgo de infección por COVID-19, así como también pautas de manejo para reducir la carga de trabajo en las unidades de radioterapia. Se incluyeron en el alcance de esta revisión las siguientes patologías: tumores ginecológicos, cáncer de mama, tumores gastrointestinales, tumores genitourinarios, tumores de cabeza y cuello, cáncer de piel, tumores del sistema nervioso central y linfomas. Un grupo de expertos discutió en línea los datos extraídos y redactó las recomendaciones. Mediante un método Delphi modificado, se evaluó el consenso entre 14 radio-oncólogos certificados. Se evaluó la calidad de la evidencia que sustentó las recomendaciones sobre esquemas de tratamiento. RESULTADOS: Se incluyeron un total de 57 documentos. De 25 trabajos se extrajeron las estrategias para reducir el riesgo de infección. De los restantes, se obtuvieron las recomendaciones para cada patología. Las recomendaciones están orientadas a establecer escenarios específicos donde se pueden omitir, diferir, priorizar y acortar los tratamientos. En el ítem de acortar se recomiendan esquemas de tratamiento para cada patología, priorizando los esquemas hipofraccionados cuando fue posible. CONCLUSIÓN: Se plantean estrategias para la gestión de los servicios de radioterapia con el objetivo de garantizar que los tratamientos de alta calidad para pacientes oncológicos sigan entregándose, pese a la crisis sanitaria ocasionada por COVID-19.

OBJECTIVE: To generate recommendations on the management of radiotherapeutic treatments during the pandemic, adapted to a country with limited health resources. METHODS: We did a rapid review of the literature, searching for papers that describe any measures to reduce the risk of COVID-19 infection, as well as management guidelines to reduce the workload, in radiotherapy units. The following conditions were included in the scope of this review: gynecological tumors, breast cancer, gastrointestinal tumors, genitourinary tumors, head and neck tumors, skin cancer, tumors of the central nervous system, and lymphomas. An expert group discussed online the extracted data and drafted the recommendations. Using a modified Delphi method, the consensus was reached among 14 certificated radio-oncologists. The quality of the evidence that supported the recommendations on treatment schedules was assessed. RESULTS: A total of 57 documents were included. Of these, 25 provided strategies to reduce the risk of infection. Recommendations for each condiction were extracted from the remaining documents. The recommendations aim to establish specific parameters where treatments can be omitted, deferred, prioritized, and shortened. Treatment schemes are recommended for each condition, prioritizing hypo-fractionated schemes whenever possible. CONCLUSIONS: We propose strategies for the management of radiotherapy services to guarantee the continuity of high-quality treatments despite the health crisis caused by COVID-19.

Comportamiento epidemiológico de la tuberculosis / Epidemiological behavior of tuberculosis

Introducción: la tuberculosis es la más antigua de las pandemias y causa alrededor de 1,7 millones de muertes y 9 millones de casos nuevos cada año. Objetivo: determinar el comportamiento epidemiológico de la tuberculosis en el municipio Matanzas. Materiales y métodos: se realizó un estudio observacional descriptivo retrospectivo en el período comprendido entre enero 2010 a diciembre del 2014. Se tomó como universo el total de 42 pacientes con diagnóstico de tuberculosis en todas sus formas. Se trabajó con el total del universo. Resultados: en cuanto a incidencia existió una tendencia a su disminución en el municipio de Matanzas, siendo el área de salud más afectada el área de Contreras con 11 casos para un 53,8 %. El mayor número de sintomáticos respiratorios de más de 14 días se encontró en el año 2011 con 2739 pacientes, el mayor número de ellos del área de salud de Policlínico Docente "José Jacinto Milanés" con 814. Conclusiones: predominó del número de casos de tuberculosis con baciloscopía positiva con un 61 %, de ellos más de la mitad fue diagnosticado en la atención secundaria, traduciendo una falla del programa. El 89,8 % de los pacientes presentó localización pulmonar con amplio predominio de la misma (AU).

Introduction: tuberculosis is the eldest of the pandemic diseases and causes almost 1.7 million deaths and nine millions of new cases every year. Objective: to determine the epidemiologic behavior of tuberculosis in the municipality of Matanzas. Materials and methods: a retrospective, descriptive, observational study was carried out in the period from January 2010 to December 2014. The universe were the total of 42 patients with diagnosis of tuberculosis in all its forms. All of them were included in the study. Results: It was found a tendency to a decrease of tuberculosis in the municipality of Matanzas, being the most affected health area the Contreras one, with 11 cases, for 52.8 %. The highest number of symptomatic patients of more than 14 days was found in 2011, with 2 739, most of them from the health area of the Teaching Policlinic "José Jacinto Milanés", with 814 patients. Conclusions: the number of tuberculosis cases with positive sputum smears predominated for 61 %. More than half of them were diagnosed in the secondary health care, showing a program failure. 89.8 % of the patients had pulmonary location with a wide predominance of it (AU).

Cáncer: magnitud del problema en el mundo y en Uruguay, aspectos epidemiológicos / Cancer: magnitude of the problem in the world and in Uruguay, epidemiological aspects / Câncer: magnitude do problema no mundo e no Uruguay, aspectos epidemiológicos

El problema del cáncer es uno de los desafíos más relevantes de nuestra época. Como consecuencia de la transición demográfico-epidemiológica, el cáncer es actualmente una de las principales causas de muerte en el mundo y en Uruguay. Debido a que esta transición está aún en curso y con diferentes dinámicas alrededor del mundo, el problema del cáncer está cambiando en su escala y perfil. Se estima que el número de casos nuevos anuales pasará de alrededor de 14 millones en 2012 a más de 20 millones en 2030, y que casi dos tercios de esos casos ocurrirán en los países menos desarrollados. En tanto que estos últimos no cuentan con recursos similares a aquellos de los países desarrollados para enfrentar la enfermedad, esta situación plantea un desafío dramático para gobiernos y autoridades sanitarias. En Uruguay se diagnostican unos 13000 casos nuevos de cáncer (exceptuando al cáncer de piel distinto al melanoma), y más de 8000 pacientes mueren por esta enfermedad anualmente. Se examina, en particular, la situación epidemiológica de los cuatro tipos de cáncer más importantes: el cáncer de mama femenino, y los de próstata, pulmón y colo-recto, éstos dan cuenta de la mitad del total. Se analizan, además: el cáncer cervico-uterino y el cáncer de esófago. Las tasas estandarizadas por edad de mortalidad por cáncer (todos los sitios reunidos) muestran un descenso sostenido en las últimas décadas. No obstante, Uruguay exhibe en general tasas de incidencia comparables al conjunto de los países desarrollados, pero tasas de mortalidad más elevadas.

The burden of cancer is one of the most relevant challenges of our time. As a consequence of the demographic-epidemiologic transition, cancer is currently one of the leading causes of death, globally and in Uruguay. This transition is still in progress but with different dynamics around the world; therefore, the burden of cancer is changing its scale and profile. The projections indicate that the number of new cases will grow from 14 million in 2012 to more than 20 million in 2030, and that almost two thirds of them will take place in developing countries. Since less developed countries don`t have similar resources as those of developed countries to face the problem, this situation poses a dramatic challenge to governments and health authorities. In Uruguay, a Around 13000 new cancer cases (any sites, except for non-melanoma skin cancer) are diagnosed and more than 8000 patients die due to this cause annually. The epidemiological situation of the four most frequent cancers is analysed in this article as they account for almost half of the total (female breast, prostate, lung and colo-rectum). Cervical and oesophageal cancers are also analysed. Uruguay shows a sustained decline in age- standardized mortality rates for all sites combined during the last two decades. In general, Uruguay exhibits comparable values of incidence rates to more developed countries, but higher values of mortality rates.

O problema do câncer é um dos desafios mais relevantes de nosso tempo. Como consequência da transição demográfico-epidemiológica, o câncer é atualmente uma das principais causas de morte no mundo e no Uruguai. Devido a que essa transição ainda está em desenvolvimento e com diferentes dinâmicas ao redor do mundo, o problema do câncer está mudando na sua escala e no seu perfil. Estima-se que o número anual de novos casos vai aumentar de ao redor de 14 milhões em 2012 para mais de 20 milhões em 2030, e que quase dois terços desses casos ocorrerão nos países menos desenvolvidos. Enquanto esses últimos não contarem com recursos similares àqueles dos países desenvolvidos para enfrentar a doença, essa situação colocará um desafio dramático para os governos e as autoridades sanitárias. No Uruguai, diagnosticam-se aproximadamente 13000 casos novos de câncer (excetuando-se o câncer de pele diferente do melanoma), e mais de 8000 pacientes morren dessa doença anualmente. Examina-se, particularmente, a situação epidemiológica dos quatro tipos de câncer mais importantes: o câncer de mama feminino, e os de próstata, pulmão e colo-reto, estes constituindo a metade do total. Analisam-se, também, o câncer cérvico-uterino e o câncer de esôfago. As taxas padronizadas por idade de mortalidade por câncer (todas as localizações reunidas) mostran uma diminuição persistente nas últimas décadas. Porém, o Uruguai exibe em geral taxas de incidência comparáveis ao conjunto dos países desenvolvidos, embora as taxas de mortalidade sejam mais elevadas.

Breast cancer screening in developing countries

Developing countries have limited healthcare resources and use different strategies to diagnose breast cancer. Most of the population depends on the public healthcare system, which affects the diagnosis of the tumor. Thus, the indicators observed in developed countries cannot be directly compared with those observed in developing countries because the healthcare infrastructures in developing countries are deficient. The aim of this study was to evaluate breast cancer screening strategies and indicators in developing countries. A systematic review and the Population, Intervention, Comparison, Outcomes, Timing, and Setting methodology were performed to identify possible indicators of presentation at diagnosis and the methodologies used in developing countries. We searched PubMed for the terms “Breast Cancer” or “Breast Cancer Screening” and “Developing Country” or “Developing Countries”. In all, 1,149 articles were identified. Of these articles, 45 full articles were selected, which allowed us to identify indicators related to epidemiology, diagnostic intervention (diagnostic strategy, diagnostic infrastructure, percentage of women undergoing mammography), quality of intervention (presentation of symptoms at diagnosis, time to diagnosis, early stage disease), comparisons (trend curves, subpopulations at risk) and survival among different countries. The identification of these indicators will improve the reporting of methodologies used in developing countries and will allow us to evaluate improvements in public health related to breast cancer.

Income inequality and adolescent fertility in low-income countries / Desigualdad de renta y fertilidad en la adolescencia en países de baja renta / Desigualdade de renda e fertilidade na adolescência em países de baixa renda

Abstract: The well-known socioeconomic gradient in health does not imply that income inequality by itself has any effect on well-being. However, there is evidence of a positive association between income inequality and adolescent fertility across countries. Nevertheless, this key finding is not focused on low-income countries. This study applies a multilevel logistic regression of country-level adolescent fertility on country-level income inequality plus individual-level income and controls to the Demographic and Health Surveys data. A negative association between income inequality and adolescent fertility was found among low-income countries, controlling for income (OR = 0.981; 95%CI: 0.963-0.999). Different measures and different subsamples of countries show the same results. Therefore, the international association between income inequality and adolescent fertility seems more complex than previously thought.

Resumen: El conocido gradiente socioeconómico en la salud no significa que la desigualdad de renta, por sí sola, tenga algún efecto sobre el bienestar. Existen evidencias de una asociación positiva entre desigualdad de renta y fertilidad en la adolescencia en diversos países, pero este importante descubrimiento requiere más investigaciones en los países de baja renta. El estudio aplica la regresión logística multivariada al análisis de la fertilidad en la adolescencia y la desigualdad de renta, ambas a nivel nacional, además de la renta individual y controles, utilizando datos de las Encuestas de Demografía y Salud. Se encontró una asociación negativa entre desigualdad de renta y fertilidad en la adolescencia en países de baja renta, después de ajustar por renta (OR = 0,981; IC95%: 0,963-0,999). Los mismos resultados fueron constatados para medidas diferentes y sub-muestras diferentes de estos países. Por tanto, la asociación internacional entre desigualdad de renta y fertilidad en la adolescencia parece ser más compleja de lo que se pensaba anteriormente.

Resumo: O conhecido gradiente socioeconômico na saúde não significa que a desigualdade de renda, por si só, tenha qualquer efeito sobre o bem-estar. Há evidência de uma associação positiva entre desigualdade de renda e fertilidade na adolescência em diversos países, mas esse importante achado requer mais averiguação nos países de baixa renda. O estudo aplica a regressão logística multivariada à análise da fertilidade na adolescência e a desigualdade de renda, ambas em nível nacional, além da renda individual e controles, utilizando dados dos Inquéritos de Demografia e Saúde. Foi encontrada uma associação negativa entre desigualdade de renda e fertilidade na adolescência em países de baixa renda, depois de ajustar para renda (OR = 0,981; IC95%: 0,963-0,999). Os mesmos resultados foram constatados para medidas diferentes e sub-amostras diferentes dos países. Portanto, a associação internacional entre desigualdade de renda e fertilidade na adolescência parece ser mais complexa do que se pensava anteriormente.

Prostate cancer in Brazil and Latin America: epidemiology and screening

ABSTRACT Introduction: Prostate cancer is one of the tumors with higher incidence and mortality among men in the World. Epidemiological data are influenced by life expectancy of population, available diagnostic methods, correct collection of data and quality of health services. Screening of the disease is not standardized around the World. Up till now there is no consensus about the risks versus benefits of early detection. There are still missing data about this pathology in Latin America. Objective: to revise current epidemiologic situation and early diagnosis policies of prostate cancer in Brazil and Latin America. Materials and Methods: Medline, Cochrane Library and SciELO databases were reviewed on the subject of epidemiology and screening of prostate cancer. Screening research was performed in websites on national public health organizations and Latin America. Screening recommendations were obtained from those governmental organizations and from Latin American urological societies and compared to the most prominent regulatory agencies and societies of specialists and generalists from around the World. Results: Brazil and Latin America have a special position in relation to incidence and mortality of prostate cancer. In Brazil, it occupies the first position regarding incidence of cancer in men and the second cause of mortality. Central America has the highest rate of mortality of the continent with lower incidence/mortality ratios. Screening recommendations are very distinct, mainly among regulatory organs and urological societies. Conclusion: prostate cancer epidemiology is an important health public topic. Data collection related to incidence and mortality is still precarious, especially in less developed countries. It is necessary to follow-up long term screening studies results in order to conclude its benefits.

Migraciones en países de América Latina: Características de la población pediátrica / Migrations in Latin American countries: Characteristics of the pediatric population Abstract

Introducción: Las migraciones constituyen un fenómeno creciente en América Latina (AL), pero hay poca información sobre la magnitud en población pediátrica y asociación con variables sociodemográficas. Objetivo: Estudiar la asociación de variables sociodemográficas con la tasa de inmigración de población pediátrica en países de AL. Material y métodos: Se buscó información sobre migraciones en países de AL en: Organización Internacional para Migraciones, Organización Panamericana de la Salud y Programa de Naciones Unidas para el Desarrollo. Se efectuaron correlaciones o comparación entre países de variables económicas y demográficas: ingreso nacional bruto per cápita (INB), índice de desarrollo humano (IDH), coeficiente de desigualdad Gini (CG) y tasa de alfabetización (% adultos alfabetizados, TA), con tasa neta de migración por país (TNM) y de niños < 15 años (IN15). Resultados: La TNM fue positiva para Costa Rica, Panamá, Venezuela, Chile y Argentina. No observamos asociación entre TNM con: INB, IDH, CG y TA. Hubo una asociación de IN15 con CG (r = 0,668, p = 0,01), con INB (r = -0,720; p = 0,01), con TA (r = -0,755; p = 0,01) y con IDH (r = -0,799; p = 0,01). La IN15 fue más baja en países de AL con mayor INB vs. aquellos con menor INB (Fisher, p < 0,0001). Conclusiones: Hay una asociación inversa entre INB per cápita, IDH, TA y directa del CG, con la proporción de IN15 de cada país. No observamos una asociación entre TNM con IDH, TA, CG. Debe analizarse el impacto en salud de estas migraciones infantiles.

Introduction: Migration is a growing phenomenon among Latin American countries (LAC) as well as others; however, scarce information is available studying its impact on paediatric groups and its association with socioeconomic variables. Objective: To study the association among socioeconomic variables and the immigration rate of paediatric population in LAC. Material and methods: Official rates of migration of LAC were obtained from: International Organization for Migration, Pan American Health Organization, and United Nations Development Programme. Demographic and socioeconomic information was also obtained for: gross domestic product (GDP), human development index (HDI), Gini coefficient of inequality (GC), alphabetization rate for adults (AA), net migration rate (NMR), and immigration of children < 15 years (IM15). Description, linear correlations and analysis of differences between groups of countries were assessed. Results: The NMR was positive for Costa Rica, Panama, Venezuela, Chile and Argentina. No association among NMR and GDP, HDI, GC, AA was found. A correlation of IM15 was found with: GC (r = 0.668, P = .01), with GDP (r = -0.720; P = .01), AA (r = -0.755; P = .01) and with HDI (r = -0.799; P = .01). Rate of IM15 was lower in LA countries with advanced/medium development (GDP> median) vs those with low development (Fisher, P < .0001). Conclusions: There is a direct inverse association between GDP per capita, HDI, AA and GC and the proportion of each country IN15. We did not observe an association between NMR and HDI, AA, and GC. The health impact of these migrations should be analysed.

A cooperação internacional da Fiocruz na formação de recursos humanos em saúde: os programas de pós-graduação / Fiocruz international cooperation in training human resources in health: the graduate programs

A cooperação técnica internacional é importante instrumento de desenvolvimento eauxilia países a promoverem mudanças estruturais, como forma de superar restrições queprejudicam seu crescimento e desenvolvimento. A formação de recursos humanosqualificados em saúde é um dos maiores desafios destes países, assim como a retenção eeducação permanente destes profissionais. Uma das estratégias para diminuir estes efeitos,é a formação rápida e em larga escala de recursos humanos especializados na área dasaúde, principalmente em nível de Pós-Graduação, que sejam capacitados para a inovaçãoe pesquisa em saúde. As parcerias do Brasil com a África e América do Sul são frequentese este estudo exploratório-descritivo buscou analisar os cursos de Pós-Graduaçãorealizados pela Fundação Oswaldo Cruz (Fiocruz) com parceira internacional. Foipesquisada a trajetória da Cooperação Internacional da Instituição na área de formação empós-graduação, modalidade mestrado, realizada com instituições em Angola, Argentina,Moçambique e Peru. Foi realizada pesquisa bibliográfica sobre formação de recursoshumanos em saúde, ensino e avaliação da Pós-Graduação no Brasil e CooperaçãoInternacional. Também foi realizada coleta de dados com estratégia e análise documentalpara consecução parcial dos objetivos propostos. Os perfis dos egressos e títulos dasdissertações foram objeto de análise. As iniciativas pesquisadas apontam que sãoprogramas heterogêneos, que apesar de apresentarem alto índice de conclusão, háexperiências exitosas e outras que devem ser aprendizado para as iniciativas que terãocontinuidade e para as que podem surgir no futuro.

International technical cooperation is an important tool for development and supportscountries to promote structural changes as a way to overcome constraints that impair theirgrowth and development. The training of qualified human resources for health is one ofthe biggest challenges in these countries, as well as the retention and continuing educationof these professionals. One of the strategies to lessen these effects is the rapid and largescaletraining of specialized human resources in health, especially in graduate level, whoare trained on health innovation and research. Brazil's partnerships with Africa and SouthAmerica are frequent and this descriptive exploratory study investigates the graduateprograms conducted by the Oswaldo Cruz Foundation (Fiocruz) with internationalpartnership. The path of the Institution on International Cooperation on master's trainingperformed with institutions in Angola, Argentina, Mozambique and Peru was searched.Literature review on training of human resources for health, education, evaluation ofBrazilian graduate studies and International Cooperation was held. Data collection withdocumental strategy and analysis for partial achievement of the proposed objectives wasalso performed. The profile of graduates and titles of the thesis were also analyzed. Theinitiatives surveyed indicate successful programs, high completion rates and continuity ofsome of the initiatives. The initiatives researched indicate that they are heterogeneousprograms, which despite their high completion rate, there are successful experiences butalso others that should be a lesson learnt for the initiatives to be continued and those thatmay arise in the future.

Factors that influence a career choice in primary care among medical students from high-, middle-, and low-income countries: a systematic review / Factores que influyen en la elección de una carrera en atención primaria entre estudiantes de medicina de países de ingresos altos, medianos y bajos: una revisión sistemática

OBJECTIVE: To determine which factors influence a medical student's decision to choose a career in primary care; and to establish if these factors are similar or different among students in high-, middle- and low-income countries. METHODS: An extensive search was done of PubMed, Google Scholar, and Virtual Library of Health for articles on primary care careers published in 2003-2013 in English, Spanish, and/or Portuguese. Initially, 600 records were identified; 74 full-text articles were assessed for eligibility and 55 were selected (42 from high-income countries; 13 from middle- and low-income). These were assessed to identify intrinsic and extrinsic factors that influence career choice among medical students from high-, middle-, and low-income countries. RESULTS: A comparison framework with common and specific factors that influence career choice in primary care among medical students from high-, middle- and low-income was developed. Factors were classified as extrinsic or intrinsic, and as facilitators or barriers. Several factors common to all countries were identified: facilitators were exposure to rural location, role models, working conditions; barriers were low income, prestige, and medical school environment. Some factors specific to middle- and low-income countries were: understanding of rural needs and intellectual challenge. Other factors specific to high-income countries were: attitude towards social problems, voluntary work, influence of family, and length of residency. CONCLUSIONS: Further studies on the subject are needed, especially in low- and middle-income countries. Identifying factors as barriers or facilitators for career choice will promote a better understanding of the reasons behind the shortage of primary care professionals and will contribute to policy building, improved training, and recruitment and retention of these professionals.

OBJETIVO: Determinar los factores que influyen en la decisión de un estudiante de medicina de dedicarse profesionalmente a la atención primaria; y establecer si estos factores son similares o diferentes entre estudiantes de países de ingresos altos, medianos y bajos. MÉTODOS: Se llevó a cabo una extensa búsqueda en PubMed, en Google Académico y en la Biblioteca Virtual en Salud de artículos sobre selección de carrera en atención primaria publicados entre 2003 y 2013 en inglés, español o portugués. Inicialmente, se seleccionaron 600 registros; se evaluó la idoneidad de 74 artículos de texto completo, y de estos se seleccionaron 55 (42 de países de ingresos altos, 13 de países de ingresos medianos y bajos). Se evaluaron los artículos con el objeto de determinar cuáles eran los factores intrínsecos y extrínsecos que influían en la elección profesional de los estudiantes de medicina de países de ingresos altos, medianos y bajos. RESULTADOS: Se elaboró un marco de comparación de los factores comunes y específicos que influyen en la elección profesional de atención primaria por parte de los estudiantes de medicina de países de ingresos altos, medianos y bajos. Los factores se clasificaron como extrínsecos o intrínsecos, y como facilitadores o barreras. Se determinaron varios factores comunes a todos los países: la exposición a un entorno rural, los modelos a imitar y las condiciones laborales actuaban como facilitadores; los ingresos bajos, el escaso prestigio y el entorno propio de las facultades de medicina actuaban como barreras. Algunos factores específicos de países de ingresos medianos y bajos fueron la comprensión de las necesidades rurales y el desafío intelectual. Otros factores específicos de países de ingresos altos fueron la actitud hacia los problemas sociales, el haber trabajado como voluntario, la influencia de la familia y la duración del período de residencia. CONCLUSIONES: Se requieren nuevos estudios sobre el tema, especialmente en países de ingresos medianos y bajos. Determinar si estos factores actúan como barreras o facilitadores de la elección profesional ayudará a comprender los motivos de la escasez de profesionales de atención primaria y contribuirá a la elaboración de políticas, a mejorar la capacitación, y a captar a estos profesionales y garantizar su permanencia.

Sociodemographic determinants of complicated unsafe abortions in a semi-urban Nigerian town: a four-year review / Determinantes sociodemográficas de abortos inseguros complicados en un poblado semiurbano de Nigeria: una revisión de cuatro anos

BACKGROUND: Abortions performed by persons lacking the requisite skills or in environments lacking minimal medical standards or both are considered unsafe. It is estimated that over 20 million unsafe abortions are performed annually and about 70 000 women die globally as a result, with the majority occurring in the developing world. This study aims to determine the sociodemographic factors involved in complicated unsafe abortions. SUBJECTS AND METHODS: The study is a four-year retrospective evaluation of all cases of complicated unsafe abortions managed at the Niger Delta University Teaching Hospital, Okolobiri, Bayelsa state, Nigeria between January 1, 2007 and December 31, 2010. RESULTS: The incidence of unsafe complicated abortions over the study period was 4.10% of total deliveries and contributed 14.0% of gynaecological admissions: 34.92% occurred in adolescents less than 20 years of age, of which the majority (55.55%) were secondary school students. There were 55.45% of patients who were nulliparae, 60.32% were unemployed and 69.80% were unmarried. A total of 87.30% had never used any form of contraceptive. Abortion mortality rate was 256/100 000 deliveries and the case fatality was 4.76%. It constituted 30.0% of all gynaecological deaths and 17.64% of maternal deaths during the study period. The commonest cause of death was septicaemia (66.66%). CONCLUSION: Unfavourable sociodemographic factors are major determinants of the high incidence of unsafe abortion in the Niger Delta despite strict abortion laws. Concrete measures must be put in place to address these, as unsafe abortion and its complications are a major cause ofmaternal morbidity and mortality in the environment.

ANTECEDENTES: Los abortos realizados por personas que no poseen las habilidades requeridas o en circunstancias en las quefaltan las normas médicas mínimas, o ambas, son considerados inseguros. Se estima que se realizan encima de 20 millones de abortos inseguros anualmente y aproximadamente 70 000 mujeres mueren globalmente como resultado, presentándose la mayoría de estos casos en el mundo en vías de desarrollo. Este estudio se propone determinar los factores sociodemográficos involucrados en los abortos inseguros complicados. SUJETOS Y MÉTODOS: El estudio es una evaluación retrospectiva de cuatro anos de todos los casos de abortos inseguros complicados tratados en el Hospital Docente Universitario de Niger Delta, Okolobiri, estado de Bayelsa, Nigeria, entre el 1ero de enero de 2007y el 31 de diciembre de 2010. RESULTADOS: La incidencia a lo largo del periodo de estudio fue 4.10% y contribuyó el 14.0% de los ingresos ginecológicos: 34.92% ocurrieron en los adolescentes de menos de 20 anos de edad, de los cuales la mayor parte (55.55%) eran estudiantes de escuela secundaria. Hubo 55.45% pacientes nulí-paras, 60.32% desempleadas y 69.80% solteras. Un total de 87.30% nunca había usado contraceptivo alguno. La mortalidad por aborto fue 256/100 000 partos, y la fatalidad de casos fue 4.76%. Ello constituyó el 30.0% de todas las muertes ginecológicas. La causa más común de las muertefue la septicemia (66.66%). CONCLUSIÓN: Los factores sociodemográficos desventajosos constituyen determinantes principales de la alta incidencia del aborto inseguro en Niger Delta, a pesar de sus estrictas leyes en contra del aborto. Deben tomarse medidas concretas para abordarlos, ya que el aborto inseguro y sus complicaciones constituyen una de las mayores causas de morbosidad maternal y mortalidad en el ambiente.

Epidemiological characteristics and HIV-related oral lesions observed in patients from a Southern Brazilian city / Características epidemiológicas e das lesões bucais associadas ao HIV observadas em pacientes de uma cidade sul-brasileira

PURPOSE: To assess the epidemiological characteristics and associated oral lesions of HIV adult carriers in a southern Brazilian city. METHODS: A retrospective survey was conducted to review the medical records of 534 patients treated at 5 referral health centers. RESULTS: Nearly 52% of the patient sample was male, 88.2% were older than 30 years of age, 58% had been diagnosed with an advanced stage of HIV disease and 78.1% presented rapid rates of HIV progression to AIDS. Harmful habits were common (31.9%), and 35% of the patients were unemployed. Approximately 60% of the subjects used highly active antiretroviral therapy. Tuberculosis was the most commonly observed systemic illness (18.5%), and oral candidiasis was the most prevalent lesion in the oral cavity (50%). A higher risk for tuberculosis onset was associated to illicit drugs use and oral candidiasis and hairy leukoplakia. CONCLUSION: The high prevalence of concurrent diseases and the rapid progression to AIDS highlight the need for early diagnosis and access to treatment. Professionals must be made aware about the onset of HIV-related oral lesions that would be helpful to diagnose HIV or serve as indicators of a worsening condition.

OBJETIVO: Avaliar o perfil epidemiológico de portadores do HIV com manifestações estomatológicas em uma cidade sul brasileira. METODOLOGIA: Conduziu-se um estudo transversal, retrospectivo em 534 prontuários médicos de pacientes atendidos em 5 centros de referência. RESULTADOS: Cerca de 52% dos pacientes eram do gênero masculino; 88,2% eram maiores de 30 anos, 58% foram diagnosticados no estágio avançado da doença e 78,1% apresentaram rápida progressão para AIDS. A prática de hábitos nocivos foi comum (39,1%) e 35% estavam desempregados. Aproximadamente 60% dos sujeitos usavam terapia antirretroviral composta. A tuberculose foi a doença sistêmica mais comumente observada (18,5%) e a candidíase bucal a manifestação estomatológica mais prevalente (50%). Um maior risco para a ocorrência de tuberculose foi observado nos portadores de candidíase bucal e leucoplasia pilosa que faziam uso de drogas ilícitas. CONCLUSÃO: A elevada prevalência de doenças oportunistas e a rápida progressão para AIDS suscitam maior atenção para o diagnóstico precoce e acesso ao tratamento. Os profissionais devem ser alertados sobre a ocorrência de lesões bucais associadas ao HIV, pois podem sugerir a presença de infecção pelo vírus ou indicar uma pior condição de saúde do paciente.

How many low birthweight babies in low- and middle-income countries are preterm? / Quantos dos recém-nascidos de baixo peso de países emergentes são pré-termo? / Cuantos de los recién nacidos de bajo peso de países emergentes son pre-término?

OBJECTIVE: To assess the prevalence of preterm birth among low birthweight babies in low and middle-income countries. METHODS: Major databases (PubMed, LILACS, Google Scholar) were searched for studies on the prevalence of term and preterm LBW babies with field work carried out after 1990 in low- and middle-income countries. Regression methods were used to model this proportion according to LBW prevalence levels. RESULTS: According to 47 studies from 27 low- and middle-income countries, approximately half of all LBW babies are preterm rather than one in three as assumed in studies previous to the 1990s. CONCLUSIONS: The estimate of a substantially higher number of LBW preterm babies has important policy implications in view of special health care needs of these infants. As for earlier projections, our findings are limited by the relative lack of population-based studies.

OBJETIVO: Estimar a prevalência de recém-nascidos pré-termo entre os recém-nascidos de baixo peso ao nascer de países de renda média ou baixa. MÉTODOS: Em consulta a bases de dados (PubMed, LILACS, Google Scholar) foram procurados estudos sobre a prevalência de recém-nascidos a termo e pré-termo entre aqueles de baixo peso ao nascer conduzidos após 1990 em países emergentes. Modelos de regressão foram usados para avaliar a proporção de acordo com as prevalências de baixo peso. RESULTADOS: Com base em 47 estudos de 27 países emergentes, aproximadamente metade de todos os recém-nascidos com baixo peso seriam prematuros, em vez de um a cada três, como estimado em estudos anteriores à década de 1990. CONCLUSÕES: A estimativa de números substancialmente mais altos de prematuros com baixo peso tem importantes reflexos no planejamento em saúde, uma vez que esses recém-nascidos demandam cuidados especiais. Todavia, os achados são limitados pela falta de estudos populacionais.

OBJETIVO: Estimar la prevalencia de recién nacidos pre-término entre los recién nacidos de bajo peso al nacer de países de renta media o baja. MÉTODOS: En consulta a bases de datos (PubMed, LILACS, Google Scholar) fueron procurados estudios sobre la prevalencia de recién nacidos a término y pre-término entre aquellos de bajo peso al nacer conducidos posteriores a 1990 en países emergentes. Modelos de regresión fueron usados para evaluar la proporción de acuerdo con las prevalencias de bajo peso. RESULTADOS: Con base en 47 estudios de 27 países emergentes, aproximadamente la mitad de todos los recién nacidos con bajo peso serían prematuros, y no uno de cada tres, como se estimó en estudios anteriores a la década de 1990. CONCLUSIONES: La estimación de números sustancialmente más altos de prematuros con bajo peso tiene importantes consecuencias en la planificación de salud, ya que tales recién nacidos demandan cuidados especiales. Aún, los resultados son limitados por la falta de estudios poblacionales.

Perfil epidemiológico e estratégias para o diagnóstico de SMSL em um país em desenvolvimento / Epidemiological profile and strategies for diagnosing SIDS in a developing country

OBJETIVO: Descrever o perfil epidemiológico, os fatores de risco e as melhores estratégias para diagnosticar a síndrome da morte súbita do lactente (SMSL) em um país em desenvolvimento. MÉTODOS: Estudo caso-controle populacional com crianças nascidas entre 01/01/2001 e 31/12/2003 em Porto Alegre (RS), divididas em três grupos: casos de SMSL (33) e controles - óbitos esclarecidos (192) e crianças vivas (192) -, que foram pareados por idade e sexo aos casos. As famílias com casos de lactentes menores de 1 ano que faleceram em casa foram identificadas, e as informações das certidões de óbito e autópsias foram comparadas para confirmar a SMSL. Os óbitos esclarecidos foram os ocorridos em hospitais, e os controles vivos foram selecionados na vizinhança dos casos de SMSL. Os pais foram entrevistados para obter informações sobre a saúde e os hábitos de sono da criança. Realizou-se uma análise multivariada para identificar fatores de risco na população estudada. RESULTADOS: A incidência da SMSL na população avaliada foi de 0,55/1.000 nascidos vivos. A análise revelou os seguintes fatores de risco: etnia (autorreferida como negra), prematuridade, baixo peso ao nascer, mãe adolescente, tabagismo na gravidez e renda familiar abaixo de um salário mínimo. Além disso, 94 por cento dos casos de SMSL foram mal-diagnosticados na certidão de óbito. CONCLUSÕES: Embora a SMSL tenha sido mal-diagnosticada, seu perfil epidemiológico é semelhante ao da literatura, assim como os fatores de risco, que poderiam ser reduzidos com campanhas preventivas. Investigar a SMSL em países em desenvolvimento requer estratégias especiais para evitar erros de diagnóstico.

OBJECTIVE: To describe the epidemiological profile, risk factors and best strategies for diagnosing sudden infant death syndrome (SIDS) in a developing country. METHODS: Population-based, case-control study with children born between January 1st, 2001, and December 31st, 2003, in Porto Alegre, southern Brazil, who were allocated into three groups: SIDS cases (33), explained death controls (192), and living controls (192). Children in the latter two groups were age- and sex-paired with SIDS cases. Families in which an infant had died at home within the first year of life were identified, and the information available on death certificates and autopsy reports was compared to confirm the diagnosis of SIDS. Explained death controls consisted of infants who had died at city hospitals, and living controls were selected in the same neighborhood as SIDS cases. All parents were interviewed to obtain information on children’s health and sleep habits. Multivariate analysis was performed to identify risk factors in the study population. RESULTS: The incidence of SIDS in the population assessed was 0.55/1,000 live births. The analysis revealed the following risk factors: ethnicity (characterized by self-reported black skin color), prematurity, low birth weight, adolescent mother, smoking during pregnancy, and family income of less than one minimum wage. Ninety-four percent of SIDS cases were misdiagnosed in the death certificate. CONCLUSIONS: Although SIDS was misdiagnosed in official death certificates, the epidemiological profile is similar to the literature, as well as risk factors, which could be reduced with preventive campaigns. Investigating SIDS in developing countries requires special strategies to avoid misdiagnosis.

Development and analysis of a low-cost screening tool to identify and classify hearing loss in children: a proposal for developing countries

OBJECTIVE: A lack of attention has been given to hearing health in primary care in developing countries. A strategy involving low-cost screening tools may fill the current gap in hearing health care provided to children. Therefore, it is necessary to establish and adopt lower-cost procedures that are accessible to underserved areas that lack other physical or human resources that would enable the identification of groups at risk for hearing loss. The aim of this study was to develop and analyze the efficacy of a low-cost screening tool to identify and classify hearing loss in children. METHODS: A total of 214 2-to-10 year-old children participated in this study. The study was conducted by providing a questionnaire to the parents and comparing the answers with the results of a complete audiological assessment. Receiver operating characteristic (ROC) curves were constructed, and discriminant analysis techniques were used to classify each child based on the total score. RESULTS: We found conductive hearing loss in 39.3 percent of children, sensorineural hearing loss in 7.4 percent and normal hearing in 53.3 percent. The discriminant analysis technique provided the following classification rule for the total score on the questionnaire: 0 to 4 points - normal hearing; 5 to 7 points - conductive hearing loss; over 7 points - sensorineural hearing loss. CONCLUSION: Our results suggest that the questionnaire could be used as a screening tool to classify children with normal hearing or hearing loss and according to the type of hearing loss based on the total questionnaire score.