RESUMEN
OBJECTIVES: To estimate the prevalence of posttraumatic stress disorder (PTSD) and to assess the relationships between PTSD and demographic and disaster-related factors. METHODS: Five months after a magnitude 8.0 earthquake struck the city of Pisco, Peru, we conducted a cross-sectional study using demographic questions, the PTSD Checklist, and a translated version of the Harvard Trauma Questionnaire. We used stratified sampling to randomly enroll subjects in Pisco and its annexes. We then used bivariate and multivariate analyses to find correlations between PTSD and demographic and disaster-related factors. RESULTS: We interviewed 298 adult earthquake survivors and detected 75 cases of PTSD (prevalence 25.2%; 95% confidence interval, 20.2%-30.1%). In the bivariate analysis, PTSD was significantly associated with female sex, loss of church, food and water shortages immediately after the earthquake, joblessness, injuries, loss of a relative or friend, lack of clean drinking water or appropriate sleeping conditions 5 months after the earthquake, and low levels of perceived support from family and friends. In the multivariate analysis, only female sex, food and water shortages, loss of church, injuries, and low levels of perceived support from family and friends were independently associated with PTSD. CONCLUSIONS: PTSD affected about a quarter of Pisco's population. Its impact was moderate to severe when compared with other disasters worldwide and in Latin America.
Asunto(s)
Desastres , Terremotos , Trastornos por Estrés Postraumático/epidemiología , Sobrevivientes/estadística & datos numéricos , Adulto , Lista de Verificación , Estudios Transversales , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Perú/epidemiología , Prevalencia , Escalas de Valoración Psiquiátrica , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Factores Socioeconómicos , Encuestas y Cuestionarios , Sobrevivientes/psicologíaRESUMEN
In 2001, Peru changed its treatment policy for uncomplicated Plasmodium falciparum malaria on the northern Pacific Coast to sulfadoxine-pyrimethamine with atresunate (SP-AS). Because Peru was the first country in the Americas to adopt this combination therapy, we established a surveillance system in the region to assess the frequency of new or worsening symptoms after starting therapy. Over a period of two years, 1,552, or approximately two-thirds of all patients with uncomplicated P. falciparum malaria who had received SP-AS on the northern coast were followed up. Of these, 8.8% reported at least one adverse effect, with the most common being vomiting, nausea, headache, abdominal pain, dizziness, and fever; no severe adverse effects related to SP-AS therapy were identified. Treatment of uncomplicated malaria with SP-AS was associated with a low frequency of mild adverse effects in Peru, and therefore should be considered as a first-line therapy in areas of the Americas where SP efficacy is still high.
Asunto(s)
Antimaláricos/uso terapéutico , Artemisininas/uso terapéutico , Quimioterapia Combinada , Malaria Falciparum/tratamiento farmacológico , Malaria Falciparum/epidemiología , Pirimetamina/uso terapéutico , Sulfadoxina/uso terapéutico , Antimaláricos/administración & dosificación , Antimaláricos/efectos adversos , Artemisininas/administración & dosificación , Artemisininas/efectos adversos , Artesunato , Combinación de Medicamentos , Humanos , Perú/epidemiología , Pirimetamina/administración & dosificación , Pirimetamina/efectos adversos , Sulfadoxina/administración & dosificación , Sulfadoxina/efectos adversosRESUMEN
High levels of Plasmodium falciparum resistance to both chloroquine (CQ) and sulfadoxine-pyrimethamine (SP) have been documented throughout the Amazon Basin of South America. Because of reports about the persistent efficacy of both of these drugs in the northwestern Peruvian Amazon region, we carried out an evaluation of the therapeutic efficacy of chloroquine (25 mg/kg) and SP (25 mg/kg of the sulfadoxine component) for the treatment of uncomplicated P. falciparum infections at two sites: Ullpayacu and Pampa Hermoza/Alianza. A total of 111 patients were enrolled. Only 5 (14.3%) of the 35 patients who received CQ had an adequate clinical and parasitologic response (ACPR). Six subjects (17%) had early treatment failure, 1 (2.9%) had late clinical failure, and 23 (65.7%) had late parasitologic failure (LPF). Of the subjects treated with SP, 92.3% had ACPR and 7.7% had LPF. Based on these findings, it is clear that there are at least limited areas within the Peruvian Amazon region where P. falciparum strains continue to be sensitive to SP.
Asunto(s)
Antimaláricos/farmacología , Resistencia a Medicamentos/genética , Malaria Falciparum/epidemiología , Malaria Falciparum/parasitología , Plasmodium falciparum/efectos de los fármacos , Adolescente , Adulto , Animales , Niño , Preescolar , Cloroquina/farmacología , Combinación de Medicamentos , Femenino , Humanos , Malaria Falciparum/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Perú/epidemiología , Pirimetamina/farmacología , Sulfadoxina/farmacologíaRESUMEN
Reports from several sites in South America suggest the presence of isolated cases of chloroquine-resistant Plasmodium vivax malaria. To investigate the possibility of chloroquine-resistant P. vivax in Peru, we conducted 28-day in vivo drug efficacy trials at three sites in the Amazon region and one site on the northern Pacific Coast between 1998 and 2001. A total of 242 patients between the ages of 2 and 60 years were enrolled (177 from the Amazon region and 65 from the northern coast). All subjects received directly observed therapy with chloroquine, 25 mg/kg, over a three-day period. On enrollment, 49% had a documented fever and 96% had a history of fever; their geometric mean parasite density was 5,129 parasites/microL. A total of 212 (88%) of the 242 subjects completed their 28-day follow-up. Four of the 177 patients from the Amazon region had a recurrence of P. vivax parasitemia on days 21 and 28 after treatment was initiated. Two of these patients had chloroquine-resistant infections, based on polymerase chain reaction-single-stranded conformational polymorphism genotyping and chloroquine-desethylchloroquine blood levels, which were > or = 97 ng/mL at the time of the reappearance of parasitemia. None of the subjects studied on the northern Pacific Coast had recurrent parasitemia.
Asunto(s)
Antimaláricos/farmacología , Cloroquina/farmacología , Resistencia a Medicamentos , Malaria Vivax/epidemiología , Plasmodium vivax/efectos de los fármacos , Adolescente , Adulto , Animales , Niño , Preescolar , ADN Protozoario/análisis , Femenino , Humanos , Malaria Vivax/parasitología , Malaria Vivax/patología , Masculino , Persona de Mediana Edad , Perú/epidemiología , Plasmodium vivax/genética , Reacción en Cadena de la Polimerasa , RecurrenciaRESUMEN
Objetivos: Determinar si existiò relaciòn entre caracterìsticas maternas, prácticas hospitalarias y pérdida de peso neonatal con el mantenimiento de la lactancia materna exclusiva (LME) hasta 6 meses en los niños nacidos sanos en el Centro Médico Naval en 1998. Materiales y métodos: Se revisó las historias clínicas de los niños nacidos en 1998, evaluando si existió relación entre el mantenimiento de la LME hasta 6 meses y la edad y paridad de la madre, la jerarquía militar del familiar miembro de la institución, sexo del lactante, pérdida de peso neonatal. Resultados: Se brindo LME hasta los 6 meses al 36.7 por ciento de la población estudiada (40 de 109). Los factores asociados fueron la jeraquía militar y el consumo de fórmula durante el período neonatal. Conclusiones: La jerarquía miliatar inferior del familiar de la institución y el no consumir fórmula durante el período neonatal estuvieron asociados al mantenimiento de la LME hasta 6 meses en los niños nacidos sanos en esta institución