Microcephaly and Associated Risk Factors in Newborns: A Systematic Review and Meta-Analysis Study.

Congenital microcephaly is caused by a multitude of drivers affecting maternal−fetal health during pregnancy. It is a rare outcome in high-income industrial countries where microcephaly rates are in the range of 0.3−0.9 per 1000 newborns. Prevalence of microcephaly varies considerably across developing countries and can go as high as 58 cases per 1000 live births in pregnancies exposed to infection by Zika virus (ZIKV). Not only ZIKV-infected pregnancies, but other drivers can modulate the occurrence and severity of this outcome. Here, we sought to test the ZIKV−microcephaly association vs. competing hypotheses using a meta-analysis with 8341 microcephaly cases pooled from 10,250,994 newborns in the Americas, Africa, and Asia. Analysis of risk ratios (RR) showed teratogens the most likely microcephaly-associated risk factor (RR = 3.43; 95%-CI 2.69−4.38; p-value < 0.0001), while the statistical significance of the ZIKV−microcephaly association was marginal (RR = 2.12; 95%-CI 1.01−4.48; p-value = 0.048). Other congenital infections showed strong but variable associations with microcephaly (RR = 15.24; 95%-CI 1.74−133.70; p-value = 0.014). Microcephaly cases were associated with impoverished socioeconomic settings, but this association was statistically non-significant (RR = 2.75; 95%-CI 0.55−13.78; p-value = 0.22). The marginal ZIKV−microcephaly association and statistical significance of the competing hypotheses suggest maternal ZIKV infection might not be a cause of microcephaly alone.

Mapping the global distribution of Strongyloides stercoralis and hookworms by ecological niche modeling.

BACKGROUND: The WHO has established a control strategy for Strongyloides stercoralis in school-aged children as well as targets and to maintain control programs for Ascaris lumbricoides, Trichuris trichiura and hookworms. For an efficient development of control programs, it is necessary to know the target countries around the world, as well as the areas within each country where efforts should be focused. Therefore, maps that provide information on the areas at risk for soil-transmitted helminth (STH) infections on a national and sub-national scale would allow for a better allocation of resources. METHODS: We used the ecological niche models MaxEnt and Kuenm R library to estimate the global distribution of S. stercoralis and hookworms. We used occurrence points of both species extracted from surveys of two literature reviews and from the Global Atlas of Helminth Infection database, together with 14 raster maps of environmental variables. RESULTS: We obtained two raster maps with the presence probability of S. stercoralis and hookworm infections at a global level and then estimated the global population at risk to be 2.6 and 3.4 billion, respectively. The population at risk was also estimated at the country level using estimations for areas as small as 25 km2. A relationship was found between the probability of the presence of S. stercoralis and its prevalence, and a raster map was generated. Annual precipitation, annual temperature, soil carbon content and land cover were the main associated environmental variables. The ecological niches of Strongyloides stercoralis and hookworms had an overlap of 68%. CONCLUSIONS: Here we provide information that can be used for developing more efficient and integrated control strategies for S. stercoralis and hookworm infections. This information can be annexed to the study of other risk factors or even other diseases to assess the health status of a community. GRAPHICAL ABSTARCT.

Assessment of crab fishermen's exposure to rabies virus in a typical Amazonian community.

Outbreaks of human rabies transmitted by hematophagous bats occurred in 2018 in Pará state, Brazil, eastern Amazon, after 12 years of no record of the disease. Thus, it is necessary to understand the epidemiological characteristics of these attacks to protect the local population. This study aimed to characterize the bat bite populations in the municipality of São João da Ponta, Pará State, Brazil, in 2013-2015. The Notifiable Diseases Information System (SINAN) database was used to identify the five individuals who sought medical care during the study period (seeds). Other individuals who were attacked during the same period but did not seek medical care (n = 61) were reached by snowball sampling, and a descriptive analysis was performed based on information obtained from questionnaires. Majority of the interviewees were men (92.4%; 61/66) and adults aged 20-50 years (69.9%; 46/66) and had <4 years of formal school education (86.3%; 57/66). Additionally, most of them were rural residents (92.4%; 61/66) and crab fishermen (79.3%; 53/66). The interviewees (92.4%; 61/66) identified mangroves of the Mãe Grande de Curuçá extractive reserve, where groups of fishermen sometimes gather for several days for crab fishing, often living in improvised dwellings without walls and covered by tarps or straw (88.8%; 56/66), conducive to attacks by vampire bats. Overall, 42.4% (28/66) of the participants had been bitten more than four times throughout their life. The median number of attacks over the participant's lifetime was 3.11 (range, 1-23). Participants were unaware of the risk of contracting rabies from the bite (95.4%; 65/66). These results suggest that vampire bat attacks are essentially an occupational hazard in the study region. Moreover, for each reported attack, there were at least 12.2 unreported cases. Thus, the study highlights the need to develop strategies for prophylactic treatment of this population.

Estrés postraumático luego de siniestros viales: una revisión sistemática / Post-traumatic stress disorder after road traffic accidents: a systematic review

Resumen Las lesiones físicas y los trastornos psicológicos que se producen como consecuencia de un siniestro de tránsito (ST) constituyen un grave problema de salud pública. En este trabajo se realiza una revisión sistemática y actualización de estudios sobre prevalencia y variables predictoras de estrés postraumático (TEPT) luego de un ST. Se realizó una búsqueda en bases de datos incluyendo Medline, PsycINFO, Scopus, y Elsevier de artículos entre 2015 y 2019, siguiendo las directrices PRISMA. La búsqueda inicial mostró un total de 1062 artículos, de los cuales 28 cumplieron criterios de inclusión. La literatura disponible es heterogénea en cuanto a objetivos y metodología. La prevalencia oscila entre 2,39 y 62%. Entre los predictores más robustos de TEPT se incluyen: sexo femenino, percepción de riesgo de vida en el ST, falta de apoyo social, secuelas físicas, y problemas emocionales previos. Se destaca la importancia de la detección temprana para prevenir secuelas psicológicas.

Abstract Physical injuries and psychological disorders following a road traffic accident (RTAs) are a serious public health problem. The objective of this work was to conduct a systematic review and update of studies on the prevalence and predictive variables of post-traumatic stress disorder (PTSD) after RTAs. A systematic search was performed in databases including Medline, PsycINFO, Scopus and Elsevier, of articles published between January 2015 and August 2019, following PRISMA guidelines. Initial search showed a total of 1062 articles, and 28 met inclusion criteria. The available literature is heterogeneous in regards to aims and methodology. Prevalence rates ranged from 2,39 % to 62%. The most robust predictors of PTSD include: female gender, perceived threat to life, lack of social support, persistent physical problems and previous emotional problems. The importance of early detection to prevent psychological sequelae is highlighted.

Epilepsia y Variables. Departamento de Neurología, Hospital de Clínicas del año 2016 al 2018 / Epilepsy and Variables. Department of Neurology, Hospital de Clínicas from 2016 to 2018

En el mundo hay unos 50 millones de personas con epilepsia. En países de ingresos bajos y medianos sugieren una proporción mucho mayor, entre 7 y 14 por 1000 personas. Las poblaciones pobres y las que viven en situaciones de vulnerabilidad, en particular en los países de ingresos bajos y medianos, soportan una carga desproporcionadamente alta; lo que supone una amenaza para la salud pública y el desarrollo económico y social. 1 Por el que el propósito de estudio fue conocer la característica epidemiológica de esta población. Se analizaron 281 fichas de pacientes con epilepsia, en un periodo de dos años, comprendidos entre 16 y 91 años. Resultados: 51.9% corresponde al sexo masculino y el 48.1% al femenino. El 63,34% presentó crisis focal. El 59,2 de los casos de epilepsia, se acompañan de trastornos psiquiátricos. Solo el 5% ha afirmado haber padecido algún efecto adverso a la medicación. Se desconoce la causa de epilepsia en un 58,58%. Dentro las causas de epilepsia secundaria; el Accidente Cerebro Vascular (ACV) se encuentra en un 22.4%. Llamativamente el 30.2% de los pacientes no cuenta con estudio de imagen de encéfalo. El 41.93% presentó crisis con el tratamiento, pero el 50% de los pacientes realiza tratamiento de forma irregular. El 53,73% presentaba tratamiento con un único fármaco anticonvulsivante, siendo la Carbamacepina la más utilizada. Conclusión: La Epilepsia tiene una alta prevalencia dentro de los desórdenes neurológicos. Afecta al sexo masculino de forma más importante, siendo la crisis focal la más frecuente. La baja asociación con trastornos psiquiátricos encontrados; nos obliga a hacer hincapié a ser más exhaustivos en la búsqueda de estos. En un alto porcentaje se desconoce la causa. Las causas más frecuentes de epilepsia secundaria fueron ACV y Traumatismo de Cráneo. Un porcentaje considerable continúan con crisis por incumpliendo del tratamiento. La Carbamacepina, el Ácido Valproico y la Fenitoína son los más utilizados, debidos a los costos y accesibilidad de los mismos, se deben establecer esfuerzos para proponer estrategias de intervención, para facilitar el seguimiento de los pacientes y que estos se puedan también beneficiar de nuevos fármacos anticonvulsivantes.

In the world there are about 50 million people with epilepsy. In low and middle income countries they suggest a much higher proportion, between 7 and 14 per 1000 people. Poor populations and those living in vulnerable situations, particularly in low and middle income countries, carry a disproportionately high burden; which poses a threat to public health and economic and social development. 1 Whereby the purpose of the study was to know the epidemiological characteristic of this population. Were analyzed 281 records of patients with epilepsy, over a period of two years, between 16 and 91 years. Results: 51.9% correspond to the male sex and 48.1% to the female. 63.34% presented focal crisis. 59.2 of epilepsy cases are accompanied by psychiatric disorders. Only 5% have claimed to have suffered any adverse effect to the medication. The cause of epilepsy in 58.58% is unknown. Within the causes of secondary epilepsy; Stroke is 22.4%. Notably, the 30.2% of patients do not have a brain imaging study; 41.93% presented a crisis with treatment, but 50% of patients performed irregular treatment. 53.73% had treatment with a single anticonvulsant drug, with Carbamazepine being the most used. Conclusion: Epilepsy has a high prevalence within neurological disorders. It affects the male sex more importantly, with the focal crisis being the most frequent. The low association with psychiatric disorders found; it forces us to emphasize being more exhaustive in the search for these. The cause is unknown in a high percentage. The most frequent causes of secondary epilepsy were CVA and Skull Trauma. A considerable percentage continue with crisis due to non-compliance with treatment. Carbamazepine, Valproic Acid and Phenytoin are the most used, due to their costs and accessibility, efforts should be established to propose intervention strategies, to facilitate the monitoring of patients and so that they can also benefit from new anticonvulsant drugs.

Importancia de la inmunización anti virus de Hepatitis B en estudiantes de Enfermería / Importance of immunization against Hepatitis B virus in nursing students

La hepatitis B constituye un problema de salud pública, con alta morbilidad asociada a daño hepático agudo, crónico y cáncer. Esta situación agrava por deficiencias en los programas de vacunación en niños y poblaciones de alto riesgo. Los profesionales y estudiantes de la salud están expuestos a riesgo biológico y la prevalencia de infección puede llegar a 11.1%, siendo hasta tres veces mayor que en la población general. La profesión de enfermería está expuesta a riesgos biológicos, siendo superior durante el proceso de formación por la escasa experiencia, que eleva el peligro de accidentes en sus prácticas y estancias hospitalarias. La vacunación es la forma más eficaz de prevención. En este artículo se analizala necesidad de que los estudiantes de salud, en específico los de enfermería, reciban el esquema de vacunación, tomando en cuenta que aún cumplido, puede no generarse inmunidad al virus y aumentar su exposición y susceptibilidad

Hepatitis B is a public health problem, with high morbidity associated with acute, chronic liver damage and cancer. This situation is aggravated by deficiencies in vaccination programs in children and high-risk populations. Professionals and students of health are exposed to biological risk and the prevalence of infection can reach 11.1%, being up to three times higher than in the general population. The nursing profession is exposed to biological risks, being superior during the training process due to thescarce experience, which increases the risk of accidents in their practices and hospital stays. Vaccination is the most effective form of prevention. This article analyzes the need for health students, specifically nursing students, to receive the vaccination schedule, taking into account that even when it is completed, immunity to the virus cannotbe generated and its exposure and susceptibility increased

Population profiles associated with severe functional difficulties and disability among 5-17 years-old children in México / Perfiles poblacionales asociados con dificultades funcionales y discapacidad severa en niños de 5-17 años en México

Abstract: Objectives: To report the prevalence of severe functional difficulties and disability (SFD) in a nationally representative sample of children ages 5 to 17 in Mexico, to identify factors associated with SFD, and population profiles predictive of SFD. Materials and methods: Using data from the National Survey on Children and Women we estimated prevalence and 95% confidence intervals of SFD and risk factors. We fitted bivariate and multivariate logistic regression models. We then examined which combinations of the sociodemographic factors best predicted SFD. Results: The prevalence of SFD was 11.2%. The most prevalent SFD were on the socioemotional dimension (8.3%). The associated risk factors in the three dimensions were: living in a poor household, being a boy, having a mother with basic education or less, and non-indigenous background or living in an urban area. Conclusions: Identifying groups of the population at higher risk for SFD provides useful information for targeted intervention implementation.

Resumen: Objetivos: Reportar la prevalencia de dificultades funcionales y discapacidad severa (SFD) en una muestra nacional representativa de niños de 5 a 17 años en México; identificar los factores asociados con SFD; documentar los perfiles poblacionales que predicen SFD. Material y métodos: Se utilizaron los datos de la Encuesta Nacional de Niñas, Niños y Mujeres en México; se estimaron prevalencias e intervalos de confianza al 95%. Se ajustaron modelos bivariados y multivariados. Se examinaron las combinaciones de factores sociodemográficos que mejor predecían la SFD. Resultados: La prevalencia de SFD fue de 11.2%. Las SFD más prevalentes fueron en la dimensión socioemocional (8.3%). Los factores de riesgo asociados en las tres dimensiones fueron pobreza, ser hombre, tener una madre con educación primaria o menor, no ser indígena o vivir en zonas urbanas. Conclusiones: Identificar a los grupos con mayor riesgo de SFD dentro de la población proporciona información útil para el desarrollo de intervenciones.

Early warning signal for dengue outbreaks and identification of high risk areas for dengue fever in Colombia using climate and non-climate datasets.

BACKGROUND: Dengue has been prevalent in Colombia with high risk of outbreaks in various locations. While the prediction of dengue epidemics will bring significant benefits to the society, accurate forecasts have been a challenge. Given competing health demands in Colombia, it is critical to consider the effective use of the limited healthcare resources by identifying high risk areas for dengue fever. METHODS: The Climate Risk Factor (CRF) index was constructed based upon temperature, precipitation, and humidity. Considering the conditions necessary for vector survival and transmission behavior, elevation and population density were taken into account. An Early Warning Signal (EWS) model was developed by estimating the elasticity of the climate risk factor function to detect dengue epidemics. The climate risk factor index was further estimated at the smaller geographical unit (5 km by 5 km resolution) to identify populations at high risk. RESULTS: From January 2007 to December 2015, the Early Warning Signal model successfully detected 75% of the total number of outbreaks 1 ~ 5 months ahead of time, 12.5% in the same month, and missed 12.5% of all outbreaks. The climate risk factors showed that populations at high risk are concentrated in the Western part of Colombia where more suitable climate conditions for vector mosquitoes and the high population level were observed compared to the East. CONCLUSIONS: This study concludes that it is possible to detect dengue outbreaks ahead of time and identify populations at high risk for various disease prevention activities based upon observed climate and non-climate information. The study outcomes can be used to minimize potential societal losses by prioritizing limited healthcare services and resources, as well as by conducting vector control activities prior to experiencing epidemics.

Coinfección por el virus de la hepatitis C y el virus de la inmunodeficiencia humana en una población de riesgo / Co-infection due to the hepatitis C virus and the human immunodeficiency virus in a population at risk

Se realizó un estudio descriptivo, prospectivo y transversal de 25 pacientes con coinfección por el virus de la hepatitis C y el de la inmunodeficiencia humana, quienes habían sido remitidos al Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" en Santiago de Cuba, en el período de enero del 2012 a igual mes del 2014, a fin de determinar las características epidemiológicas, clínicas y humorales en ellos. En la serie se obtuvo que la infección por ambos virus fuera más frecuente en el grupo etario de 3039 años (36,0 %), en el sexo masculino (96,0 %) y en los integrantes del grupo de múltiples riesgos (64,0 %). La mayoría de los pacientes habían sido diagnosticados con la coinfección en un período inferior a los 3 años, referían más de una manifestación clínica y presentaron resultados elevados en las pruebas funcionales hepáticas.

A descriptive, prospective and cross-sectional study of 25 patients with diagnosis of co-infection due to hepatitis C virus and that of the human immunodeficiency who had been referred to "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba, was carried out from January, 2012 to the same month in 2014, in order to determine the epidemiological, clinical and humoral characteristics in them. In the series it was obtained that the infection due to both viruses was more frequent in the 30-39 age group (36.0%), in male sex (96.0%) and in the members of the multiple risks group (64.0%). Most of the patients had been diagnosed with the co-infection in less than the 3 years, they stated more than one clinical feature and presented high results in the liver functional tests.

Fatores de risco peridomiciliares e conhecimento sobre leishmaniose visceral da população de Formiga, Minas Gerais / Peridomiciliary risk factors and knowledge concerning visceral leishmaniasis in the population of formiga, Minas Gerais, Brazil

RESUMO: Introdução: As leishmanioses representam uma importante carga de doença nos países tropicais, apresentando índices significativos de morbimortalidade nos locais onde ocorrem, incluindo o Brasil. Nesse contexto, a participação popular nas ações profiláticas pode ser determinante para o êxito das estratégias de controle. Objetivo: Por isso, o presente estudo teve o objetivo de investigar o conhecimento da população sobre as leishmanioses e a ocorrência de fatores de risco peridomiciliares associados à população no município de Formiga, Minas Gerais. Métodos: Foi realizado um inquérito domiciliar com uma amostra de 427 indivíduos entre maio e julho de 2011. Resultados: Apenas 7,5% dos moradores mostraram conhecimento sobre as leishmanioses, sendo principalmente as mulheres (OR = 3,15; IC95% 1,30 - 7,65). A prevalência de riscos peridomiciliares foi de 95%. Associação estatisticamente significativa foi encontrada entre maior escolaridade e menos fatores de risco peridomiciliares (OR = 0,45; IC95% 0,28 - 0,72) e entre o local de residência e maior número desses fatores de risco (OR = 1,84; IC95% 1,19 - 2,85). Conclusão: Os resultados demonstram que há baixo nível de conhecimento sobre as leishmanioses por parte da população. Além disso, a maioria dos respondentes está sujeita a algum fator de risco peridomiciliar, fato que pode contribuir para a manutenção do ciclo da doença no município.

ABSTRACT: Introduction: Leishmaniasis represents an important burden of diseases in tropical countries, with significant levels of morbidity and mortality where they occur, including in Brazil. In this context, popular participation in prophylactic actions can be decisive for the success of the control strategies. Objective: For this reason, this study aimed at investigating the population's knowledge concerning leishmaniasis and the occurrence of peridomiciliary risk factors associated with the population of Formiga, Minas Gerais. Methods: A household questionnaire with a sample of 427 individuals was conducted between May and July 2011. Results: Only 7.5% of the residents presented knowledge regarding leishmaniasis, most of them being women (OR = 3.15; 95%CI 1.30 - 7.65). The prevalence of peridomiciliary risks was 95%. A statistically significant association was found between higher education levels and less peridomiciliary risk factors (OR = 0.45; 95%CI 0.28 - 0.72) and between the place of residence and a higher number of risk factors (OR = 0.84; 95%CI 1.19 - 2.85). Conclusion: The results demonstrate that the population has low levels of knowledge about leishmaniasis. Moreover, the majority of respondents are subject to some peridomiciliary risk factor, which may contribute to the maintenance of the disease cycle in the city.

Fatores associados à prática do binge drinking entre estudantes da área da saúde / Factors associated with practice of binge drinking among students of health

OBJETIVO: identificar a prevalência do consumo de álcool e a de fatores associados ao binge drinking entre acadêmicos da saúde de uma instituição de ensino superior. MÉTODOS: trata-se de uma pesquisa transversal e analítica, cujo instrumento de coleta foibaseadono Alcohol Use Disorders Identification Test. A associação entre o binge drinking e demais variáveis foi investigada pela análise bivariada e Regressão Logística. RESULTADOS: a prevalência de uso de álcool foi de 135 estudantes (74,9%) e do binge drinking foi de 44 (15,3%). O binge drinking foi associado ao sexo masculino e ao tipo de religião. Quanto aos prejuízos para a vida acadêmica, o beber problemático esteve associado às faltas escolares, ao baixo desempenho em avaliações, ao envolvimento em brigas ou eventos fora da lei. CONCLUSÃO: houve alta prevalência de consumo de álcool e prejuízos relativos ao desempenho acadêmico estiveram associados ao binge drinking. .

PURPOSE: identifying the prevalence of alcohol consumption and the factors associated with binge drinking among academics of health of a higher education institution. METHODS: this is a cross-sectional analytical study; whose instrument of data collection was based on the Alcohol Use Disorders Identification Test. The association between binge drinking and other variables was assessed by bivariate analysis and logistic regression. RESULTS: the prevalence of alcohol use was of 135 students (74,9%) and binge drinking was 44 (15,3%). The binge drinking was associated with male gender and with the type of religion. Regarding the harms to the academic life, problematic drinking was associated with school absences, low performance on assessments, and involvement in fights or events outside the law. CONCLUSION: there was a high prevalence of alcohol consumption and losses related to academic performance were associated with binge drinking. .

"Virei um mendigo": vivências de ex-moradores de rua acolhidos por uma instituição confessional brasileira / "Me torné un mendigo": vivencias de antiguos sin techo acogidos en una institución confesional brasileña / "I became a beggar": life experience reports of former homeless people sheltered in a brazilian confessional institution

Objetivo: analisar as vivências de ex-moradores de rua usuários de álcool acolhidos por uma Instituição Confessional. Método:fundamentado nométodo clínico-qualitativo, de agosto de 2007 a maio de 2008 foram realizadas entrevistas semi estruturadas com moradores de uma organização filantrópica do interior do Estado de São Paulo. O critério de saturação definiu a amostra de oito participantes. Resultados: três categorias foram constituídas com a técnica de análise de conteúdo temática: Você fica com vergonha: expressa tendência ao isolamento ou formação de grupos; Virei um mendigo: apresenta a ruptura da vida social e perda da identidade; O que passou não volta mais: demonstra a tentativa de livrar-se da imagem de si mesmo, negação social e identificação com os novos papéis. Conclusão: para sobreviver, o ex-morador nega elementos centrais da sua identidade e vivencia a reconstrução da nova identidade. Para retornar ao antigo lar/sociedade necessita reconfigurar a identidade perdida.

Aim: to analyze the life experiences of former homeless alcohol users sheltered in a Confessional Institution. Method: the study is based on the clinical-qualitative method. FromAugust 2007 to May 2008, semi-structured interviews were carried out with residents of a philanthropic organization in the state of São Paulo. The saturation criterion defined a sample of eight participants. Results: three categories were composed through the content analysis technique: You get embarrassed: expresses tendency to isolation or forming groups; I became a beggar: shows the breakdown of social life and loss of identity; The past will not return: demonstrates an attempt to get rid of their self-image, social denial and identification with the new roles. Conclusion:to survive, the former homeless person denies central elements of their identity and experiences the reconstruction of a new identity. In order to return to the former home/society, itis necessary to recompose the lost identity.

Objetivo:analizar las experiencias de vida de antiguos sin-techo alcoholicos acogidos en institución confesional. Método: basado en el método clínico-cualitativo, entre Agosto/2007 y mayo/2008 se realizaron entrevistas semi-estructuradas con residentes de una organización filantrópica del estado de São Paulo (Brasil). El criterio de satuaração definió la muestra de ocho participantes. Resultados: la técnica de análisis de contenido constituyó tres categorías: “Estás avergonzado”: expresa una tendencia al aislamiento o formación de grupos; “Me torné un mendigo”: presenta una ruptura de la vida social con pérdida de identidad; "El pasado no volverá": muestra intento de deshacerse de la imagen de sí mismo, negación social e identificación con los nuevos roles. Conclusión: para sobrevivir, ellos niegam elementos centrales de su identidad y experimentan la reconstrucción de la nueva identidad. Para volver al antiguo hogar/sociedad necesita reconfigurar la identidad pérdida.

Orphans of the Mexican drug war: insights on a public health challenge / Huérfanos víctimas de la lucha contra el narcotráfico en México: apreciaciones sobre un reto en materia de salud pública

OBJECTIVE: To describe how the Government of Mexico and other direct stakeholders perceive children orphaned by the drug war; to determine the current measures addressing this as a public health problem; and to compare these measures to international frameworks so that relevant recommendations can be identified. METHODS: This was an exploratory, descriptive case study using qualitative methods. Semi-structured interviews were performed with key informants at the federal, state, and municipal government levels in Mexico, as well as non-governmental organizations, and other institutes working with orphans. Participants were identified with a purposive snowball sample. RESULTS: No official definition of "orphan" was identified; nor was there a shared perception among the key informants of what constitutes being an orphan. An official, collective definition is important because it modifies the quantity of children categorized as such within the target population. Although most of the interviewees perceive that the number of orphans and vulnerable children (OVC) has increased in the last 6 years, they acknowledged there is no reliable data to prove it. The increase, they believe, is due not to the drug war, but to a loss of family cohesion. Stakeholders recommend improving public policies, currently identified as the most difficult barrier to overcome due to a perceived inability to modify existing laws. However, the General Law for Victims was recently passed by the Government of Mexico and addresses many of the challenges identified. CONCLUSIONS: When compared to the international frameworks, there are three major issues in Mexico's current situation: coordination among and within stakeholders; emphasis on using community solutions; and putting in place preventive programs. For two of these problems, the General Law of Victims offers solutions.

OBJETIVO: Describir cómo el Gobierno de México y otros interesados directos perciben el tema de los niños huérfanos como consecuencia de la lucha contra el narcotráfico; determinar las iniciativas actuales que abordan este tema como un problema de salud pública; y comparar estas iniciativas con los marcos internacionales con objeto de poder determinar las recomendaciones pertinentes. MÉTODOS: Se trata de un estudio de casos exploratorio y descriptivo que utilizó métodos cualitativos. Se llevaron a cabo entrevistas semiestructuradas con informantes clave a escalas federal, estatal y municipal del gobierno de México, así como con organizaciones no gubernamentales y otras instituciones que colaboraban con los huérfanos. Los participantes fueron seleccionados mediante un muestreo intencionado de bola de nieve. RESULTADOS: No se encontró ninguna definición oficial de "huérfano"; ni existía entre los informantes clave una percepción compartida de lo que constituye ser un huérfano. Es importante que exista una definición oficial y colectiva porque modifica la cantidad de niños clasificados como tales entre la población examinada. Aunque la mayor parte de los entrevistados perciben que el número de niños huérfanos y vulnerables (NHV) ha aumentado en los seis últimos años, también reconocen que no existen datos fidedignos que lo demuestren. Creen que el aumento no se debe a la lucha contra el narcotráfico sino a una pérdida de la cohesión familiar. Los interesados directos recomiendan mejorar las políticas públicas, que actualmente se consideran como la barrera más difícil de superar, dada la incapacidad percibida para modificar las leyes existentes. Sin embargo, el Gobierno de México aprobó recientemente la Ley General de Víctimas, que aborda muchos de los retos señalados. CONCLUSIONES: En comparación con los marcos internacionales, existen tres asuntos principales en la situación actual de México: la coordinación entre y dentro de los distintos grupos de interesados directos; el énfasis en el empleo de soluciones comunitarias; y la implantación de programas preventivos. La Ley General de Víctimas ofrece una solución para dos de estos problemas.

Uma casa sem teto: influência da família na vida das pessoas em situação de rua / House without a roof: the family influence in the life of street people / Casa sin techo: influencia de la familia en la vida de personas en situación de calle

Objetivou-se com este estudo identificar os principais motivos apontados pela população em situação de rua que a levaram a essa condição e analisar a influência da família diante desse cenário. Trata-se de um estudo descritivo-exploratório de natureza qualitativa. Os dados foram coletados no período de agosto de 2010 a junho de 2011, nas dependências de um albergue, junto a 19 pessoas que se encontravam em situação de rua no município de Maringá - PR. Identificou-se que a família tem forte influência na condição de situação de rua, pela ausência de laços familiares, pelo rompimento desses laços por desavenças, brigas, dependência química, separação conjugal, perda dos membros familiares pelo evento de morte, falta de condições financeiras para acolhimento ou outros motivos. Identificou-se também, na maioria dos casos, um grande desejo de reconstruir ou formar uma nova família. Conclui-se que este é um fenômeno complexo e multifatorial, que exige intervenções intersetoriais, e que a Enfermagem deve atentar para as necessidades afetadas dessa população, que padece nas ruas das cidades.

The objective of this study was to identify the reasons given by street people which led them to this condition, as well as analyze the influence of their families in this scenario. It is a descriptive exploratory study of qualitative nature. Data were collected between August 2010 and June 2011, at a hostel; 19 street people who were living in the streets of Maringá-PR were interviewed. It was found that families play a major role in the street condition, whether through the absence of one, or because family ties were disrupted because of fights, quarrels, drug addiction, divorce, loss of family members due to death, lack of financial resources, among others. However, the will to rebuild or build a new family is in a great desire. It can be concluded that this is a complex and multifactor phenomenon, which requires cross-section interventions, and that nursing must address the needs of this population, who is suffering in the streets.

Este estudio tuvo el objetivo de identificar los principales motivos señalados por la población en situación de calle que le llevaron a esta condición y analizar la influencia de la familia delante de este escenario. Se trata de un estudio descriptivo-exploratorio de naturaleza cualitativa. Los datos fueron recolectados en el período de agosto de 2010 a junio de 2011, en las dependencias de un albergue, junto a 19 personas que se encontraban en situación de calle en el municipio de Maringá - PR. Se identificó que la familia tiene fuerte influencia en la condición de situación de calle, por la ausencia de lazos familiares, por la ruptura de estos lazos por desavenencias, peleas, dependencia química, separación conyugal, pérdida de los miembros familiares por el evento de muerte, falta de condiciones financieras para acogimiento u otros motivos. Se identificó también, en la mayoría de los casos, un gran deseo de reconstruir o formar una nueva familia. Se concluye que éste es un fenómeno complexo y multifactorial, que exige intervenciones intersectoriales, y que la Enfermería debe atentar para las necesidades afectadas de esta población, que padece en las calles de las ciudades.

Viral hepatitis in Latin America and the Caribbean: a public health challenge / Las hepatitis víricas en América Latina y el Caribe: un reto para la salud pública

Viral hepatitis (VH) is an emergent concern in public health agendas worldwide. More than one million people die annually from hepatitis and 57% and 78% of global cirrhosis and hepatocellular carcinoma cases, respectively, are caused by VH. The burden of disease caused by hepatitis in Latin America and the Caribbean (LAC) is high. Data on hepatitis has been collected in several countries, but more accurate and comparable studies are needed. Hepatitis B vaccination and screening of donated blood are routine practices in the region. However, integrated policies covering prevention and control of disease caused by all types of hepatitis viruses are scarce. Existing preventive measures need to be reinforced. Attention must be paid to at-risk populations, awareness campaigns, and water and food safety. Affordable access to diagnosis and treatment, population screening, referral to health services and monitoring of positive cases are among the main challenges currently posed by VH in LAC. The World Health Organization framework and Pan American Health Organization regional strategy, defined in response to resolution WHA63.18 of the World Health Assembly, may help to overcome these difficulties. Successful experiences in the fight against hepatitis in some LAC countries may also provide very interesting solutions for the region.

Las hepatitis víricas (HV) constituyen una preocupación emergente en los programas de salud pública a escala mundial. Más de un millón de personas mueren anualmente por hepatitis. Las HV causan el 57% de los casos de cirrosis y el 78% de los casos de carcinoma hepatocelular en el mundo. La carga de morbilidad causada por las hepatitis en América Latina y el Caribe (ALC) es alta. Se han recopilado datos sobre las hepatitis en varios países, pero se requieren estudios más minuciosos y comparables. La vacunación contra la hepatitis B y el tamizaje de la sangre donada son prácticas corrientes en la región. Sin embargo, son escasas las políticas integradas que abarquen la prevención y el control de las enfermedades ocasionadas por todos los tipos de virus causantes de hepatitis. Es preciso reforzar las medidas preventivas existentes y prestar atención a las poblaciones en situación de riesgo, a las campañas de sensibilización y a la inocuidad del agua y los alimentos. El acceso asequible al diagnóstico y el tratamiento, el tamizaje de la población, la derivación a los servicios de salud y la vigilancia de los casos positivos constituyen algunos de los principales retos planteados actualmente por las HV en ALC. El marco de la Organización Mundial de la Salud y la estrategia regional de la Organización Panamericana de la Salud, definidos en respuesta a la resolución WHA63.18 de la Asamblea Mundial de la Salud, pueden ayudar a superar estas dificultades. Las experiencias exitosas en la lucha contra las hepatitis en algunos países de ALC también pueden proporcionar soluciones muy interesantes para la región.

Significados e práticas de saúde e doença entre a população em situação de rua em Salvador, Bahia, Brasil / Meanings and practices associated with health and illness among the homeless in Salvador, Bahia State, Brazil

O objetivo deste trabalho foi analisar práticas e significados atribuídos à saúde e à doença pela população em situação de rua em Salvador, Bahia, Brasil. Trata-se de um estudo qualitativo de enfoque antropológico com realização de observação participante e entrevistas semi-estruturadas com 13 indivíduos entre 30 e 66 anos. Os resultados apontam que as condições de vida e saúde deste grupo são muito precárias, sendo a violência sobressalente nas narrativas. Os principais problemas de saúde foram o abuso de substâncias psicoativas, HIV/AIDS, transtornos mentais, problemas odontológicos, dermatológicos e gastrointestinais. A saúde foi associada, entre outros significados, à capacidade de resistir ao cotidiano de dificuldades, enquanto a doença vinculou-se ao estado de debilidade impeditivo de lutar pela sobrevivência. Os serviços de saúde são procurados em situações graves e urgentes. Conclui-se pela necessidade de políticas específicas visando garantir condições de vida adequadas e acesso à saúde para esta população.

This article aimed to analyze the practices and meanings associated with health and illness among homeless people in Salvador, Bahia State, Brazil. A qualitative anthropological study was conducted with participant observation and semi-structured interviews with 13 subjects 30 to 66 years of age. The results point to extremely precarious living and health conditions among the homeless. The narratives emphasize frequent violence. The main health problems were substance abuse, HIV/AIDS, mental disorders, and dental, dermatological, and gastrointestinal problems. Among other meanings, health was associated with the capacity to cope with everyday difficulties. Meanwhile, illness was identified as a state of weakness that hindered the struggle for survival. Homeless people only turned to health services when their health problems were serious and urgent. In conclusion, the study showed the need for specific policies to improve living conditions and access to healthcare for this population.

O critério utilitarista será adequado para situação de risco? / Is the utilitarian criterion appropriate for situations of risk?

O utilitarismo difere das teorias éticas que fazem o caráter de bom ou mau de uma ação depender do agente, pois, de acordo com o utilitarismo, é possível que uma ação boa venha resultar de uma motivação ruim no indivíduo. Antes de Jeremy Benthan, fundador do utilitarismo, e Stuart Mill, um dos maiores defensores desta teoria, darem forma ao utilitarismo, o pensamento utilitarista já existia na filosofia antiga inspirado na formulação do princípio da utilidade. Partilhavam a ideia de construir uma ciência positiva dos fatos sociais, afastando-se de qualquer pretensão de encontrar princípios ou verdades absolutas.

Utilitarianism differs from ethical theories in which good or evil depend on the agent, since, according to utilitarian thinkers, a good action may result from bad intentions. Before Jeremy Bentham, the founder of the theory, and John Stuart Mill, its strongest advocate, gave utilitarianism its modern form, such kinds of thinking based on the principle of utility had already existed in the philosophy of the ancients. They shared the idea of building up a positive science of social facts, devoid of any quest for first principles or absolute truths.

Comportamento de risco para HIV e DST entre professores universitários / Risk behavior to STD and HIV infection among university professors

Há aumento da infecção pelo HIV entre casais heterossexuais, mesmo em relações estáveis e fiéis. Objetivo: avaliar o comportamento sexual e de risco para doenças sexualmente transmissíveis (DST) e infecção pelo vírus da imunodeficiência humana (HIV) entre professores universitários. Métodos:estudo transversal. Foram incluídos professores universitários da área da saúde de universidade do Sul do Brasil. Foi utilizado questionário auto aplicável e anônimo, com dados sociodemográficos, comportamentais e sexuais para infecção pelo HIV e DST, além de fatores de risco para doenças por via venosa. A análise estatística foi realizada com o uso do SPSS, versão 16.0. Resultados: foram estudados 184 docentes, sendo 55,4% mulheres. A média de idade foide 40,5 (DP ± 9,1) anos. Prática de sexo anal, maior número de parceiros, maior frequência de relações sexuais e infidelidade foram associados ao gênero masculino. Dos entrevistados, 31% se declararam infiéis; nas relações conjugais, apenas 19,8% utilizavam preservativo, e nas extraconjugais, 39,3%. O usode preservativo esteve associado à infidelidade. Entre outros fatores de risco, 39,1% compartilham objetos de higiene e uso pessoal, 3,8% submeteram-se a transfusão de sangue, 11,4% tinham tatuagem ou piercing e 31% sofreram acidente com material perfurocortante. Conclusão: a amostra estudada apresentarisco similar ao da população geral de contrair HIV e outras DST, por apresentar os fatores de risco: pouca adesão ao uso de preservativo, alta prevalênciade relações extraconjugais, uso de álcool antes das relações, prática de sexo anal, múltiplos parceiros durante a vida e ainda a ocorrência de acidentes perfurocortantes, devido à vulnerabilidade da profissão.

There is increased HIV infection among heterosexual couples, even in stable and faithful relationships. Objective: to assess sexual behaviorand risk to acquiring sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV) among health area faculty working at a university in southern Brazil. Methods: cross-sectional study conducted between December 2009 and March 2010. Health area faculty members working at a university in southern Brazil were included in the survey. Upon approval, anonymous and self-administered questionnaire was used, which included data on socio-demographic characteristics, risk sexual behavior for exposure to HIV and STDs, as well as additional risk factors to diseases acquired intravenously.Statistical analysis was performed using the SPSS, version 16.0. Results: a total of 184 faculty members was studied; 55.4% were women. Mean age was 40.5 (SD ± 9.1) years. Anal sex, larger number of partners, higher sex frequency, and infidelity was associated with being male. Of the interviewees, 31%reported infidelity; only 19.8% used condoms in marital relations and 39.3% in extramarital sex. Condom use was associated with infidelity. Among otherrisk factors, 39.1% reported having shared personal hygiene objects, 3.8% had undergone blood transfusion, 11.4% had a tattoo or piercing, and 31% hadalready had work-related needlestick accidents. Conclusion: the sample studied is at risk of contracting HIV and other STDs because of poor or inconsistent condom use, high prevalence of extramarital relationships, alcohol use before sexual intercourses, anal sex, multiple partners, and high rates of work-relatedneedlestick injuries

Behavior, knowledge and perception of risks about sexually transmitted diseases in a group of people over 50 years old / Comportamiento, conocimiento y percepción de riesgo sobre enfermedades sexualmente transmisibles en un grupo de personas con 50 o más años de edad / Comportamento, conhecimento e percepção de risco sobre doenças sexualmente transmissíveis em um grupo de pessoas com 50 anos e mais de idade

The goal was to analyze the behavior, knowledge and risk perception about sexually transmitted diseases / AIDS (STD/AIDS) in people over 50 years old. 165 public servants at a State Secretary in Mato Grosso, Brazil were interviewed. The chi-square test and logistic regression tests were used for the analysis of risk perception and the behavior and knowledge variables about STD/AIDS. Most of the respondents were female (60.6 percent), 63.2 had a fixed partner, 72.4 percent had sexual relations in the past six months, and only 13.3 percent always wore condoms, with 21.5 percent being male and 8 percent female. Perception of risk was associated with non-use of condoms in their last sexual relation (p<0.001) and answering that anyone may acquire a STD/AIDS (p=0.039). The challenge of public policies is to increase actions, directing them to promote the health of the adult and elderly populations, especially regarding sexuality and vulnerability to STD/AIDS.

El objetivo fue analizar aspectos de comportamiento, conocimiento y percepción de riesgo de las ETS/SIDA, en personas con 50 o más años de edad. Se entrevistaron 165 servidores de una Secretaría del estado de Mato Groso, Brasil. Se utilizó una prueba de Chi cuadrado y de regresión logística para analizar la percepción de riesgo y las variables de comportamiento y conocimiento sobre las ETS/SIDA. La mayoría de los entrevistados era del sexo femenino (60,6 por ciento); para el comportamiento un 63,2 por ciento tenía pareja fija y un 72,4 por ciento tuvo relación sexual en los últimos 6 meses; apenas el 13,3 por ciento utiliza siempre preservativo, el 21,5 por ciento de los hombres y el 8 por ciento de las mujeres. Se demostró que existe una asociación entre la percepción de riesgo y el uso de preservativo en la última relación sexual (p < 0,001); y, que cualquier persona puede contraer una ETS/SIDA (p =0,039). El actual desafío de las políticas públicas es incrementar las acciones que tienen como objetivo la promoción de la salud de la población adulta y de los adultos mayores, principalmente en lo que se refiere a la sexualidad y a la vulnerabilidad delante de las ETS/SIDA.

Objetivou-se analisar o comportamento, conhecimento e percepção de risco às doenças sexualmente transmissíveis/AIDS (DST/AIDS) em pessoas com 50 anos e mais de idade. Foram entrevistados 165 servidores de uma secretaria estadual de Mato Grosso, Brasil. Utilizou-se o teste de qui-quadrado e regressão logística para análise da percepção do risco e variáveis do comportamento e conhecimento sobre DST/AIDS. A maioria dos entrevistados é do sexo feminino (60,6 por cento), 63,2 por cento tem parceiro fixo e 72,4 por cento tiveram relação sexual nos últimos 6 meses e apenas 13,3 por cento utilizam sempre o preservativo, dos quais 21,5 por cento homens e 8 por cento mulheres. Houve associação entre percepção de risco e não uso de preservativo na última relação sexual (p<0,001) e responder que qualquer pessoa pode contrair uma DST/AIDS (p=0,039). O desafio das políticas públicas hoje é incrementar ações direcionando-as à promoção à saúde da população adulta e idosa, principalmente quanto à sexualidade e vulnerabilidade às DSTs/AIDS.

U.S. experts warn of Honduras AIDS risk to women. International.

Honduras, the Central American country hardest hit by AIDS, may suffer from a particularly aggressive strain of HIV that is especially dangerous to women, US experts said. "We are investigating the presence in Honduras of (HIV) sub-type B, which is more aggressive than others and could be the reason why it is worse in this country," Winslow Klaslala, professor at the University of Miami, Florida, said. According to the Health Ministry, 7664 Hondurans have been infected with HIV since 1985, and 995 have died. That is 60% of the total number of HIV sufferers in the six countries of Central America and the incidence in women is unusually high at 36%. A team of experts, including members from Harvard University and the WHO, have been taking blood samples, primarily from HIV infected women, Klaslala said. They will analyze the blood to look for sub-type B, described by Klaslala as highly "aggressive and adaptable." "If it is present," he said, "women are particularly at risk." Honduran health authorities were paying close attention to the investigations. "If they show that the sub-type that attacks in Honduras is more aggressive, we will have to redesign our campaign for combatting the disease," said Enrique Zelaya, a top Health Ministry official.