Fibrilación auricular en pacientes con ictus isquémico en Hospital Universitario Comandante Faustino Pérez. 2017 / Atrial fibrillation in patients with ischemic stroke in the University Hospital Comandante Faustino Pérez. 2017

Introducción: se realizó un estudio observacional transversal en pacientes con fibrilación auricular ingresados con ictus isquémico en la sala de neurología en el Hospital Universitario Comandante Faustino Pérez el año 2017. Objetivo: caracterizar la fibrilación auricular en estos pacientes en relación con edad y sexo, factores de riesgo, tipo de fibrilación y factores de riesgo de embolismo. Materiales y métodos: el universo del estudio fue de 40 pacientes con fibrilación auricular e ictus isquémico. Durante el ingreso a los pacientes y/o sus familiares se les aplicó una encuesta para la obtención de la información. Resultados: predominó el grupo de edades de 75-84 años y el sexo masculino con el 50 % y 70 % respectivamente. Los factores de riesgo más frecuentes en los pacientes con fibrilación auricular e ictus isquémico fueron la hipertensión arterial y edad mayor de 75 años con 85 % y la insuficiencia cardiaca con 70 %. La fibrilación auricular más frecuente fue la diagnosticada por primera vez con 55 %. Según la respuesta ventricular predominó la fibrilación auricular con respuesta ventricular rápida con 75 %. Los factores de riesgo de embolismo predominantes fueron la hipertensión arterial y la edad ≥ 75 años con 85 % seguida de la insuficiencia cardiaca con 70 %. Conclusiones: la fibrilación auricular en los pacientes con ictus isquémico predominó en hombres mayores de 75 años, hipertensos con insuficiencia cardiaca y en la mayoría de los pacientes se realizó el diagnóstico de la fibrilación auricular durante el ingreso con ictus isquémico (AU).

Introduction: it was carried out a transversal observational study in the in-patients with atrial fibrillation and ischemic stroke in the neurology ward of the Faustino Pérez Hospital in 2017. Objective: to characterize the atrial fibrillation in these patients taking into account age, sex, risk factors, fibrillation type and embolic risk. Materials and methods: the universe of the study was 40 patients with atrial fibrillation and ischemic stroke. During the hospitalization, a survey was applied to patients and/or their relatives for collecting the information. Results: The 75-84 age group predominated and male patients predominated. With 50 % and 70 % respectively. The most frequent risk factors in patients with atrial fibrillation and ischemic stroke were arterial hypertension and being more than 75 years old with 85 % and heart failure with 70 %. The most frequent atrial fibrillation was the one diagnosed for the first time with 55 %. According to the ventricular answer, atrial fibrillation with fast ventricular answer predominated, with 75 %. The predominant embolic risk factors were arterial hypertension and patients aged ≥ 75 years with 85 %, followed by heart failure with 70 %. Conclusions: atrial fibrillation in in-patients with ischemic stroke was predominant in male hypertensive patients aged 75 years and more with cardiac failure; in most of the patients the atrial fibrillation was made during the hospitalization with ischemic stroke (AU).

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.

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.

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.

Tobacco use among the elderly: a systematic review and meta-analysis / Uso de tabaco entre idosos: revisão sistemática e meta-análise

The aim of this study was to combine the results of identified surveys on the prevalence of tobacco use in old age to estimate world prevalence of tobacco use and possible factors related to such behavior among the elderly. The literature search included electronic databases such as MEDLINE, LILACS, and Biological Abstracts, hand-searching of specialist journals and cited reference searches. The combined global prevalence was estimated using the random effects model. The total number of elderly subjects included in all surveys was 140,058, with data available from all the continents. Overall prevalence of tobacco use was 13 percent in both genders (22 percent male and 8 percent female). The prevalence rates were heterogeneous among surveys and were associated with smoking definition, questionnaire application, and country economic status. Few epidemiological studies assessed tobacco use among the elderly. A higher prevalence rate of tobacco use in males who live in higher income countries could be found, although additional evidence regarding elderly samples is still required.

O objetivo deste estudo foi combinar os resultados de pesquisas identificadas sobre a prevalência do tabagismo em idosos, para estimar sua prevalência mundial e possíveis fatores relacionados a este tipo de comportamento entre eles. A revisão da literatura incluiu busca nas bases de dados eletrônicas como MEDLINE, LILACS e Biological Abstracts, busca manual em jornais especializados e nas referências citadas. A prevalência global combinada foi estimada usando-se o modelo de efeitos randômicos. O número total de idosos incluídos em todos os levantamentos foi 140.058, com dados disponíveis em todos os continentes. A prevalência de tabagismo foi de 13 por cento em ambos os sexos (22 por cento homens e 8 por cento mulheres). As taxas de prevalência foram heterogêneas e estiveram associadas com a definição de tabagismo, aplicação do questionário e com a economia de cada país. A maior taxa de prevalência foi encontrada entre idosos do sexo masculino que vivem em países de renda mais alta.

Cataract prevalence in Central-West region of São Paulo State, Brazil / Prevalência de catarata na região centro-oeste do Estado de São Paulo, Brasil

PURPOSE: Cataract is considered the main preventable cause of blindness and visual impairment mainly in poor countries. This study was done to evaluate if cataract is still an important cause of blindness in Central-West region of State of São Paulo, Brazil. METHODS: A cross-sectional study was conducted with a systematically randomized sample of households in five cities located in Central-West region of São Paulo State, Brazil. The sample consisted of 4,229 individuals (8,458 eyes) of all ages. All household members were considered eligible. They were submitted to a complete ophthalmological examination (visual acuity with and without visual correction, biomicroscopy, fundoscopy, tonometry, and refractometry). Cataract diagnosis was given to eyes presenting lens opacity in biomicroscopy exam, according to Lens Opacities Classification System II (LOCS II). Eye with a best correction, presenting visual deficiency or blindness caused by cataract was considered after excluded other pathologies that decrease visual acuity (VA). We considered as visual deficiency eyes with 0.05 < VA < 0.3 and as blind eyes with VA < 0.05. Visual impairment was considered for individuals with 0.05 < VA < 0.3 in the best eye, with the best correction and blindness for individuals with VA < 0.05 in the best eye, with the best correction. We considered the number of eyes with cataract, the number of eyes with visual deficiency and blindness and the number of individuals with visual deficiency and blindness. Occurrence frequency was evaluated for eyes separately and together. RESULTS: Cataract frequency in this population was 4.94 percent (209 individuals), affecting mainly people over 50'ths (92.34 percent) and females (61.11 percent). Cataract was the cause of visual impairment for 0.96 percent and blindness for 0.52 percent of the total population. CONCLUSION: Our results showed that cataract prevalence in studied region population of the is similar to developed countries.

OBJETIVO: A catarata é a principal causa tratável de cegueira e deficiência visual em países subdesenvolvidos. Este estudo foi realizado para avaliar se a catarata continua sendo uma importante causa de cegueira no centro-oeste do Estado de São Paulo. MÉTODOS: Um estudo transversal, de caráter observacional, realizado em cinco cidades da região centro-oeste do Estado de São Paulo, para as quais o centro de referência é a cidade de Botucatu. A amostra estabelecida para este estudo, de forma aleatória, seria composta por 5.555 indivíduos, sendo que foram examinados 4.229 indivíduos (8.458 olhos), ou seja, 78 por cento da amostra pretendida. Os indivíduos foram submetidos a um exame oftalmológico completo que consistia em avaliação da acuidade visual (com e sem correção), tonometria, biomicroscopia, fundoscopia e exame refracional. O diagnóstico de catarata foi dado aos indivíduos que apresentassem opacidade de cristalino na biomicroscopia, de acordo com o Sistema de Classificação de Opacidade do Cristalino II (LOCS II). Olhos apresentando deficiência visual ou cegueira, com a melhor correção e causados por catarata, foram considerados após excluir outras patologias que pudessem causar baixa da acuidade visual (AV). Olhos com deficiência visual foram considerados quando 0,05 < AV < 0,3 e olhos cegos quando AV < 0,05. Indivíduos com deficiência visual foram considerados quando 0,05 < AV < 0,3 e indivíduos cegos quando AV < 0,3, no melhor olho com a melhor correção. Foi considerado o número de olhos com catarata, o número de olhos com deficiência visual e cegueira e o número de indivíduos com deficiência visual e cegueira. RESULTADOS: A prevalência de catarata na população estudada foi de 4,94 por cento (209 indivíduos), afetando principalmente indivíduos com mais de 50 anos (92,34 por cento) e do sexo feminino (61,11 por cento). A catarata foi a causa de deficiência visual para 0,96 por cento e a causa de cegueira para 0,52 por cento de toda ...

Upper gastrointestinal bleeding in children in southern Iran.

Objective. To find out whether the causes of upper GI bleeding in our center in a developing country differed from developed countries. Methods. Children presenting to our center with upper GI bleeding from March 2002 to March 2007, were retrospectively evaluated. Informations were retrieved from patient’s history and physical examination and results of upper GI endoscopy regarding etiology of bleeding, managements, use of medications which might predispose patient to bleeding, and the mortality rate. Results. From 118 children (67 boys; with age of 7.7±4.7 yrs) who underwent upper GI endoscopies, 50% presented with hematemesis, 14% had melena and 36% had both. The most common causes of upper GI bleeding among all patients were gastric erosions (28%), esophageal varices (16%), duodenal erosions (10%), gastric ulcer (8.5%), Mallory Weiss syndrome tear (7.8%), duodenal ulcer (6.8%), esophagitis (1.7%) and duodenal ulcer with gastric ulcer (0.8%). The causes of bleeding could not be ascertained in 20.5% of cases. No significant pre-medication or procedure related complications were observed. Endoscopic therapy was performed in 13.5% of patients. In 14.4% of patients, there was a history of consumption of medications predisposing them to upper GI bleeding. Two deaths occurred (1.7%) too. Conclusion. The findings in the present study showed that half of upper GI bleedings in pediatric patients from south of Iran, were due to gastric and duodenal erosions and ulcers. This study concludes that the causes of upper GI bleeding in children in our center of a developing country, are not different from those in developed ones.

The Association Between Public Social Expenditure and Suicides: Evidence from OECD Countries / 예방의학회지

OBJECTIVES: This study aimed to examine the association between public social expenditure (PSE) and suicides in the 27 countries of the Organization for Economic Cooperation and Development (OECD) from 1980 to 2003. METHODS: The age-standardized suicide rates and their annual change (%) were obtained from the OECD Health Data 2007. As a measure of social protection, the PSE (% GDP) was used. The covariates included the annual divorce rate (/100,000 population), fertility rate (number of children/woman aged 15 to 49 years), GDP per capita (US$PPP), male unemployment rate (%), life expectancy (years) and alcohol consumption (liter/capita) for each country, which were all obtained from the OECD Health Data 2007 and the OECD Social Indicators 2006. Using hierarchical linear models that included these covariates, the effects of PSE on suicides (Model 1) and the annual percent change (Model 2) were examined (Model 3). Also, sub-sample analyses were done for six countries that experienced political/economic transition. RESULTS: We could not find significant effects of PSE on suicides (Model 1), but we observed significantly negative effects on the annual percent change for men and women (Model 2). Such findings were replicated in the sub-sample analysis, and moreover, the effect size was much larger (Model 3). CONCLUSIONS: Our finding suggests that social welfare protection can be a pivotal factor for suicide epidemiology, and especially in countries experiencing a social crisis or transition.

HIV, syphilis, and hepatitis B and C prevalence among patients with mental illness: a review of the literature / Prevalência de infecção por HIV, sífilis e hepatite B e C entre portadores de doenças mentais crônicas

A limited number of studies worldwide have investigated the prevalence of HIV, syphilis, and hepatitis B and C infection among psychiatric patients. However, prevalence of these infections in the population with chronic mental illness has not been clearly established. Most of the published papers are from developed countries and have derived from relatively small and non-representative samples. We performed a systematic review of the published literature to identify studies on these infectious diseases within psychiatric populations in Brazil and other developing countries. Overall, prevalence rates varied from 0 percent to 29 percent for HIV; 1.6 percent to 66 percent for HBV; 0.4 percent to 38 percent for HCV; and 1.1 percent to 7.6 percent for syphilis. Several risk factors were identified and discussed, although sampling limitations restrict the generalization of study findings. This review highlights the lack of information on the prevalence of sexually transmitted diseases and their associated factors among persons with chronic mental illness and identifies gaps in the knowledge base in both developing and developed countries.

Os portadores de doenças mentais crônicas encontram-se em risco para a infecção pelo HIV e outras infecções sexualmente transmissíveis. Entretanto, a prevalência dessas infecções entre portadores de doença mental crônica ainda não está claramente estabelecida nesta população. A maioria dos trabalhos sobre o tema foi conduzida em países desenvolvidos, com amostras relativamente pequenas e não representativas. Foi realizada uma revisão sistemática da literatura para identificar estudos sobre a prevalência do HIV, sífilis, hepatite B e C entre pacientes com doença mental crônica no Brasil e no mundo. De um modo geral, as prevalências variaram de 0 por cento a 29 por cento, 3 a 66 por cento, 0,4 a 38 por cento e 3,3 por cento a 7,6 por cento para HIV, hepatite B, hepatite C e sífilis, respectivamente. Vários fatores de risco foram identificados e discutidos, embora a literatura atual não demonstre achados significativos gerados por estudos representativos. Tal revisão destaca a escassez de informação sobre a prevalência de infecções sexualmente transmitidas e seus fatores associados entre portadores de doenças mentais crônicas e identifica lacunas no conhecimento atual em países desenvolvidos bem como nos em desenvolvimento.

The JICA training course, community-based cancer prevention for the Asian and Pan-Pacific countries, fiscal year 2006 (epidemiological approach).

Communicable diseases are still major causes of deaths in developing countries. Cancer incidence, however, increased 19% between 1990 and 2000, mainly in this same developing world (Stewart and Kleihaus, 2003), and malignant neoplasms are now the second leading cause of mortality in these countries (WHO, 2003). Limitations of medical facilities and equipment mean that prevention is indispensable for cancer control (Mikheev et al., 1994). However, human resources concerning cancer prevention are also limited, and encouragement of their development should be taken as a first priority. To assist in this aim, the present training course was designed by the Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Japan, and has been annually conducted since 1999, supported by the Japan International Cooperation Agency (JICA) (Takezaki, 2001; 2002; 2003; Wakai, 2004; 2006). The course targets doctors and public health workers who are responsible for community-based cancer prevention in developing countries to promote the introduction of comprehensive procedures, focusing mainly on primary prevention but also including screening for secondary prevention of cancer.

Eat dirt and avoid atopy: the hygiene hypothesis revisited.

The explosive rise in the incidence of atopic diseases in the Western developed countries can be explained on the basis of the so-called "hygiene hypothesis". In short, it attributes the rising incidence of atopic dermatitis to reduced exposure to various childhood infections and bacterial endotoxins. Reduced exposure to dirt in the clean environment results in a skewed development of the immune system which results in an abnormal allergic response to various environmental allergens which are otherwise innocuous. This article reviews the historical aspects, epidemiological and immunological basis of the hygiene hypothesis and implications for Indian conditions.

Biomedical publications in south Asian countries.

By and large, biomedical research is not a priority sector in south Asian countries, land of world's one-fifth population. The total number of studies published during 1990-98 from each of the south Asian countries were elicited based on MEDLINE database. The number of studies were normalised by population and physician size, and gross domestic products. The results showed that the following countries are more productive: India and Sri Lanka, when publications were normalised to population; India, Sri Lanka and Nepal when normalised to GDP; Nepal and Sri Lanka when normalised to physician number.

An epidemiological assessment of increasing incidence and trends in breast cancer in Mumbai and other sites in India, during the last two decades.

A great deal is known on the epidemiology of breast cancer. In this paper an attempt has been made to discuss the epidemiology and trends in incidence of breast cancer in various populations of India with special reference to the data available at Mumbai Cancer Registry. For discussing descriptive epidemiology of breast cancer the data collected for most recent year, 1999, by Mumbai Cancer Registry has been utilized. For studying time trends in breast cancer the data collected for the Mumbai Cancer Registry for the years 1982-99 and for Bangalore and Chennai 1982-96 and for Barshi, Bhopal and Delhi for the years 1988-96 has been employed. A linear regression model based on the logarithms of the various incidence rates, a method frequently used for studying time trends, was applied to the entire dataset. Age specific incidence rates for breast cancer for most of the urban population in India were found to show steep increase till menopause years, after which the curves plateau. Most of the registries data indicate that Christians in India have the greatest risk of breast risk and Muslims have the lowest rate. In all the populations breast cancer was found to be less prevalent at the lower education level and the incidence increased with the education level. The trends for increase in breast cancer incidence over time for most of the populations in India were found to be statistically significant.

Prevalência e características associadas à depressäo: revisäo de estudos epidemiológicos com base populacional / Prevalence and associated characteristics of depression: a review of population-based epidemiological studies

Neste trabalho é apresentada uma revisäo da prevalência e dos fatores associados à depressäo observados em estudos epidemiológicos de base populacional. Os artigos foram obtidos a partir de pesquisas na Medline e Lilacs, nos últimos cinco anos, nas línguas inglesa, portuguesa e espanhola. Também foram utilizados artitos referenciados. As principais palavras-chave utilizads na pesquisa foram: epidemiologia, distribuiçäo, prevalência, depressäo maior, transtorno depressivo, transtornos afetivos, transtornos de humor, estudo populacional, estudo de comunidade e CIDI (Composite International Diagnostic Interview). Foram considerados para o presente trabalho os artigos relativos a estudos que investigaram amostras da populaçäo geral e que utilizaram critérios diagnósticos padronizados, assim como as classificações diagnósticas da CID ou do DSM. Os aspectos enfatizados säo a prevalência da depressäo e as características associadas à mesma, a saber: sexo, idade, estado civil, escolaridade, raça/etnia, trabalho, renda e status socioeconômico, urbanizaçäo, tabagismo e outros fatores, incluindo-se o uso de serviços de saúde, e suicídio. Os episódios depressivos e o transtorno depressivo recorrente tiveram prevalências significativas em todos os países ocidentais. Nestes países, as prevalências de episódios depressivos nos últimos 30 dias, no último ano e durante a vida, de acordo com o DSM (III a IV), variaram de 2,2 por cento a 5,4 por cento, 3,5 por cento a 10,3 por cento e 3,7 por cento a 15,7 por cento, respectivamente. O fator descrito como mais consistentemente associado à depressäo foi o sexo feminino. Associações entre depressäo e os demais fatores acima mencionados foram encontrados em alguns trabalhos, mas näo em todos. Na presente revisäo ficou evidente a carência de estudos epidemiológicos sobre depressäo em países menos desenvolvidos. Estes estudos säo importantes para se estabelecer a carga da depressäo na comunidade e os seus determinantes e, desta forma, subsidiar políticas e programas de saúde pública

Spectrum of genetic disorders and the impact on health care delivery: an introduction

Until recently, infectious diseases and malnutrition-related disorders constituted the major cause of ill health and mortality in the world population. However, advances in treatment of such disorders and increased understanding of the molecular basis of heredity have led to genetically transmitted conditions becoming a major cause of morbidity and mortality. Several disorders, including chromosomal [Down syndrome, Turner syndrome], single-gene [sickle-cell disease, thalassaemia, glucose-6-phosphate dehydrogenase deficiency, haemophilia, inborn errors of metabolism] and multifactorial disorders [coronary artery disease, arteriosclerosis, diabetes mellitus, hypertension, obesity] are common and becoming increasingly important. As there is no agreed-upon definitive cure with acceptable risk, these disorders are a significant burden on the health care delivery system. This is because the chronic nature of genetic diseases requires lifelong medical attention, expensive supportive and symptomatic therapy and specialist care. This review outlines the genetic disorders, their impact on health care delivery systems and the general framework required to prevent and control these disorders

Nutritional deficiencies and subsequent effects on mental and behavioral development in children.

Nutritional deficiencies at all stages of growth, both pre- and post-natal, can affect a child's physical, mental and behavioral development. In this paper, we review literature about how mental development is affected by the following nutritional conditions: low birth weight, mild, moderate, and severe protein-energy malnutrition, iodine deficiency, and iron deficiency.