RESUMO
BACKGROUND/AIM: Argentina has one of the highest cigarette smoking rates among both men and women in the Americas and no legislated restrictions on tobacco industry advertising. The tobacco industry has traditionally expanded markets by targeting adolescents and young adults. The objective of this study was to determine whether and how the tobacco industry promotes cigarettes to adolescents in Argentina. METHODS: We conducted a systematic search of tobacco industry documents available through the internet dated between 1995 and 2004 using standard search terms to identify marketing strategies in Argentina. A selected review of the four leading newspapers and nine magazines with reported high readership among adolescents was completed. The selected print media were searched for tobacco images and these were classified as advertisements if associated with a commercial product or as a story if not. RESULTS: The tobacco industry used market segmentation as a strategy to target Argentinean consumers. British American Tobacco (BAT) undertook a young adult psychographic study and classified them as "progressives", "Jurassics" or "conservatives" and "crudos" or "spoiled brats". BAT marketed Lucky Strike to the "progressives" using Hollywood movies as a vehicle. The tobacco industry also targeted their national brands to the conservatives and linked these brands with "nationalistic values" in advertising campaigns. Philip Morris promoted Marlboro by sponsoring activities directed at young people and they launched the 10 cigarettes packet as a starter vehicle. CONCLUSIONS: The tobacco industry used psychographic segmentation of the population and developed advertising strategies focused on youth. Tobacco control researchers and advocates must be able to address these strategies in counter-marketing interventions.
Assuntos
Publicidade/estatística & dados numéricos , Fumar/epidemiologia , Indústria do Tabaco/estatística & dados numéricos , Adolescente , Adulto , Argentina , Humanos , Meios de Comunicação de Massa , Pessoa de Meia-Idade , Fumar/psicologiaRESUMO
OBJECTIVE: To evaluate the processes and outcomes of tobacco litigation in Argentina and to analyse the strategies of the tobacco industry to oppose litigation using tobacco industry documents. METHODS: A systematic search of tobacco industry documents on the internet dating from 1978 to 2002. Law library searches using Argentinean official and unofficial reports systems were combined with computerised online searches. RESULTS: There have been at least 15 failed litigation cases in Argentina and the tobacco industry presented a concerted defence in every claim regardless of cost. We categorised 11 cases as product liability and nicotine addiction, two as health care reimbursement, and two as criminal law and secondhand smoke. Industry strategies included hiring legal consultants from prestigious international and Argentinean law firms and developing litigation prevention programmes. Industry monitored legal academic meetings, controlled the development of new product liability legislation, obtained favourable opinions from experts, and closely observed the development of litigation in Argentina. CONCLUSION: The strategies used by the industry have been successful in preventing recovery for tobacco injuries through litigation. Argentinean health advocates and lawyers need to be aware of the roles and strategies of the tobacco industry in order to develop effective litigation in Argentina.
Assuntos
Fumar/legislação & jurisprudência , Indústria do Tabaco/legislação & jurisprudência , Argentina , Atitude Frente a Saúde , Compensação e Reparação/legislação & jurisprudência , Direito Penal , Escolaridade , Governo , Custos de Cuidados de Saúde/legislação & jurisprudência , Humanos , Responsabilidade Legal , Marketing/métodos , Nicotina/efeitos adversos , Fumar/efeitos adversos , Fatores de Tempo , Indústria do Tabaco/economia , Poluição por Fumaça de Tabaco/legislação & jurisprudência , Tabagismo/etiologiaRESUMO
OBJECTIVE: To evaluate how transnational tobacco companies, working through their local affiliates, influenced tobacco control policymaking in Argentina between 1966 and 2005. METHODS: Analysis of internal tobacco industry documents, local newspapers and magazines, internet resources, bills from the Argentinean National Congress Library, and interviews with key individuals in Argentina. RESULTS: Transnational tobacco companies (Philip Morris International, British American Tobacco, Lorillard, and RJ Reynolds International) have been actively influencing public health policymaking in Argentina since the early 1970s. As in other countries, in 1977 the tobacco industry created a weak voluntary self regulating code to avoid strong legislated restrictions on advertising. In addition to direct lobbying by the tobacco companies, these efforts involved use of third party allies, public relations campaigns, and scientific and medical consultants. During the 1980s and 1990s efforts to pass comprehensive tobacco control legislation intensified, but the organised tobacco industry prevented its enactment. There has been no national activity to decrease exposure to secondhand smoke. CONCLUSIONS: The tobacco industry, working through its local subsidiaries, has subverted meaningful tobacco control legislation in Argentina using the same strategies as in the USA and other countries. As a result, tobacco control in Argentina remains governed by a national law that is weak and restricted in its scope.
Assuntos
Prevenção do Hábito de Fumar , Fumar/legislação & jurisprudência , Indústria do Tabaco/legislação & jurisprudência , Publicidade/legislação & jurisprudência , Argentina , HumanosRESUMO
According to Pan American Health Organization nearly 50% of women suffer chronic domestic violence in Latin America. We evaluated the prevalence of gender based violence (GBV) in women assisted in a University Outpatient Clinic in Buenos Aires. We used a survey originally developed by the International Planned Parenthood Federation (IPPF) in Spanish. The survey was distributed to a consecutive sample of women more than 18 years of age who attended the clinic. Participants were randomized to fill out the questionnaire anonymously (self-administered) or during an interview with the physician in order to test the sensitivity of these two different modalities of data collection. Of 360 eligible women 270, (75%) completed the questionnaire. The respondents had a median age of 45.4 years, only 33% had more than 7 years of formal education and 48% did not live with a partner. Of the 270 respondents, 120 (44%) women reported mistreatment at least once during their lifetime. Of these, 108 (40%) reported psychological GBV, 53 physical GBV and 45 reported sexual GBV. Most of the respondents suffered more than one type of violence. 46 (17%) women reported sexual abuse during childhood, 219 (81%) of participants never had been asked by their physician about domestic violence. Women interviewed by the physician reported GBV more frequently than those completing the self-administered survey (p <0.005). The survey developed by the IPPF is considered a useful tool for screening in a clinical setting.
De acuerdo a la Organización de la Salud, en América Latina cerca del 50% de las mujeres sufren violencia doméstica crónica. Se realizó esta investigación con el objetivo de estimar la prevalencia de violencia basada en género (VBG) en las mujeres que se atienden en el Programa de Medicina Interna General (PMIG) y comparar la frecuencia de detección de VBG bajo diferentes modalidades de encuesta. Se utilizó una muestra consecutiva de mujeres mayores de 18 años de edad que concurren al PMIG y aceptaron participar. Se utilizó la encuesta para detección de VBG desarrollada por la International Planning Parenthood Foundation. La mitad de la población completó la encuesta en forma anónima y a solas, y a la otra mitad el médico tratante le entregó el cuestionario al final de la consulta. Se repartieron 360 encuestas, se recuperaron 270. La edad promedio de la población fue 45.4 años, el 33 % poseía mas de 7 años de educación formal, el 48% no convivía en situación de pareja, el 56% tenía trabajo. Ciento veinte mujeres (44.4%) refirieron haber sufrido algún tipo de violencia en su vida. Ciento ocho informaron violencia psicológica, 53 violencia física y 45 violencia sexual. Cuarenta y seis mujeres (17.5%) relataron haber sufrido violencia sexual en la niñez. Cuarenta (14.8%) refirieron sufrir violencia en la actualidad. Las mujeres que respondieron la encuesta en forma anónima referían haber sufrido VBG con una frecuencia significativamente menor que las otras (P < 0.005). Al 93%de las encuestadas (219 mujeres) ningún médico les había preguntado sobre VBG en su vida. En conclusión,existe una alta prevalencia de VBG en la población encuestada.
Assuntos
Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Instituições de Assistência Ambulatorial , Mulheres Maltratadas/estatística & dados numéricos , Violência Doméstica/estatística & dados numéricos , Argentina/epidemiologia , Prevalência , Atenção Primária à Saúde , Inquéritos e QuestionáriosRESUMO
According to Pan American Health Organization nearly 50% of women suffer chronic domestic violence in Latin America. We evaluated the prevalence of gender based violence (GBV) in women assisted in a University Outpatient Clinic in Buenos Aires. We used a survey originally developed by the International Planned Parenthood Federation (IPPF) in Spanish. The survey was distributed to a consecutive sample of women more than 18 years of age who attended the clinic. Participants were randomized to fill out the questionnaire anonymously (self-administered) or during an interview with the physician in order to test the sensitivity of these two different modalities of data collection. Of 360 eligible women 270, (75%) completed the questionnaire. The respondents had a median age of 45.4 years, only 33% had more than 7 years of formal education and 48% did not live with a partner. Of the 270 respondents, 120 (44%) women reported mistreatment at least once during their lifetime. Of these, 108 (40%) reported psychological GBV, 53 physical GBV and 45 reported sexual GBV. Most of the respondents suffered more than one type of violence. 46 (17%) women reported sexual abuse during childhood, 219 (81%) of participants never had been asked by their physician about domestic violence. Women interviewed by the physician reported GBV more frequently than those completing the self-administered survey (p <0.005). The survey developed by the IPPF is considered a useful tool for screening in a clinical setting.(AU)
De acuerdo a la Organización de la Salud, en América Latina cerca del 50% de las mujeres sufren violencia doméstica crónica. Se realizó esta investigación con el objetivo de estimar la prevalencia de violencia basada en género (VBG) en las mujeres que se atienden en el Programa de Medicina Interna General (PMIG) y comparar la frecuencia de detección de VBG bajo diferentes modalidades de encuesta. Se utilizó una muestra consecutiva de mujeres mayores de 18 años de edad que concurren al PMIG y aceptaron participar. Se utilizó la encuesta para detección de VBG desarrollada por la International Planning Parenthood Foundation. La mitad de la población completó la encuesta en forma anónima y a solas, y a la otra mitad el médico tratante le entregó el cuestionario al final de la consulta. Se repartieron 360 encuestas, se recuperaron 270. La edad promedio de la población fue 45.4 años, el 33 % poseía mas de 7 años de educación formal, el 48% no convivía en situación de pareja, el 56% tenía trabajo. Ciento veinte mujeres (44.4%) refirieron haber sufrido algún tipo de violencia en su vida. Ciento ocho informaron violencia psicológica, 53 violencia física y 45 violencia sexual. Cuarenta y seis mujeres (17.5%) relataron haber sufrido violencia sexual en la niñez. Cuarenta (14.8%) refirieron sufrir violencia en la actualidad. Las mujeres que respondieron la encuesta en forma anónima referían haber sufrido VBG con una frecuencia significativamente menor que las otras (P < 0.005). Al 93%de las encuestadas (219 mujeres) ningún médico les había preguntado sobre VBG en su vida. En conclusión,existe una alta prevalencia de VBG en la población encuestada.(AU)
Assuntos
Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Instituições de Assistência Ambulatorial , Mulheres Maltratadas/estatística & dados numéricos , Violência Doméstica/estatística & dados numéricos , Argentina/epidemiologia , Prevalência , Atenção Primária à Saúde , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Evidence shows that social relationships play an important role in health and health behavior. We examined the relationship between social networks and cancer screening among four U.S. Hispanic groups. METHODS: We used telephone surveys to collect data in eight U.S. regions that have concentrations of diverse Hispanic-origin populations. We interviewed 8903 Hispanic adults, for a response rate of 83%; analysis was restricted to the 2383 women aged > or =40. As a measure of social integration, we formed a social network index from items on the number of close relatives and friends, frequency of contact, and church membership. We used logistic regression to estimate the effects of social integration on screening, adjusting for sociodemographic factors. RESULTS: Among Mexican, Cuban, and Central-American women, the effect of social integration on mammography screening was slight. The odds ratios (OR) per unit change in social integration category ranged from 1.16 to 1.22 with confidence intervals (CI) that overlapped with the null. For Pap smear screening, the effect was strongest among Mexican-American women (OR=1.44, 95% CI=1.21 to 1.72), but also evident among Central-American women (OR=1.22, 95% CI=0.72 to 2.06) and Cuban women (OR = 1.25, 95% CI = 0.81 to 1.93). Among Puerto Rican women, social integration had no effect on either mammography (OR=1.03) or Pap smear screening (OR=1.08). CONCLUSIONS: Independent of socioeconomic factors, social integration appears to influence cancer screening participation of Hispanic women. The modest effect is not universal across Hispanic groups and was stronger for Pap smear than for mammography screening behavior. Researchers should recognize Hispanic group differences in social network characteristics and the potential of social networks to change screening behavior.
Assuntos
Comportamentos Relacionados com a Saúde/etnologia , Hispânico ou Latino , Mamografia/estatística & dados numéricos , Teste de Papanicolaou , Apoio Social , Esfregaço Vaginal/estatística & dados numéricos , Adulto , América Central/etnologia , Cuba/etnologia , Feminino , Humanos , Americanos Mexicanos , Porto Rico/etnologia , Estados UnidosRESUMO
Despite the fact that approximately 50% of Argentine women are estimated to experience domestic violence (DV) at some point in their lives, clinicians have historically not been formally trained in detecting and evaluating women at risk for DV. We surveyed general practitioners to assess their level of knowledge and practice styles regarding DV and their perception of need for training in this area. We surveyed 291 internists from 11 medical centers in 4 regions of the country. We used a 10 point scale to asses their knowledge of DV. Knowledge items were derived from McCauley's article on Battering Syndrome. We asked them about the frequency with which they discuss DV with their patients and had them rate their need for further training. A total of 175 surveys were completed (60% response), 66% were men, mean age was 46 yr and the average number of women patients seen per month was 143. The mean knowledge score was 4.6 (+/- 1.8)/10. On average, the respondents had discussed DV during the last month in 1.2 (+/- 0.22) opportunities and DV was diagnosed in 0.8 (+/- 0.18). 78% of physicians reported no previous training about DV; 65% considered themselves not properly equipped to diagnose or treat DV victims; 47% showed an interest in undergoing some type of formal training and 70% wanted written material. In conclusion, practicing clinicians in Argentina score poorly on knowledge assessment of domestic violence and perceive a need for additional training in this area.
Assuntos
Violência Doméstica , Papel do Médico , Relações Médico-Paciente , Mulheres Maltratadas , Estudos de Coortes , Estudos Transversais , Educação Médica , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Despite the fact that approximately 50
of Argentine women are estimated to experience domestic violence (DV) at some point in their lives, clinicians have historically not been formally trained in detecting and evaluating women at risk for DV. We surveyed general practitioners to assess their level of knowledge and practice styles regarding DV and their perception of need for training in this area. We surveyed 291 internists from 11 medical centers in 4 regions of the country. We used a 10 point scale to asses their knowledge of DV. Knowledge items were derived from McCauleys article on Battering Syndrome. We asked them about the frequency with which they discuss DV with their patients and had them rate their need for further training. A total of 175 surveys were completed (60
response), 66
were men, mean age was 46 yr and the average number of women patients seen per month was 143. The mean knowledge score was 4.6 (+/- 1.8)/10. On average, the respondents had discussed DV during the last month in 1.2 (+/- 0.22) opportunities and DV was diagnosed in 0.8 (+/- 0.18). 78
of physicians reported no previous training about DV; 65
considered themselves not properly equipped to diagnose or treat DV victims; 47
showed an interest in undergoing some type of formal training and 70
wanted written material. In conclusion, practicing clinicians in Argentina score poorly on knowledge assessment of domestic violence and perceive a need for additional training in this area.
RESUMO
PIP: The strategy of the Cuban government to control HIV consists of examining the whole adult population and quarantining all seropositive persons in local institutions. Between 1986 and 1990, a total of 8,832,726 HIV tests were done using domestic ELISA and Western blot methods. 497 persons (362 men and 135 women) were found to be HIV-positive. 122 infections were directly attributed to Cuban intervention in Africa. 150 infected men were homosexuals and bisexuals. Infected blood products caused 9 cases, and neonatal transmission produced 3 infections. 63 AIDS cases were reported since December 1989. Compulsory testing would be more acceptable if HIV infected persons would get zidovudine (AZT) for secondary prevention. It is estimated that this policy has prevented 4000 new infections. The violation of human rights by quarantining people with false positive results is real: 23-53 such people are estimate to be quarantined. Tourists are not examined because of the economic need for more revenue from tourism, thus HIV transmission could continue despite quarantines. The cost of testing is high, although health care already made up 12% of the budget in 1989, increasing from 7.8% in 1983. Tracing sexual contacts requires 450 nurses and 200 epidemiologist. The public education campaign about AIDS involved 30 television programs and several hundred radio programs by groups of experts discussing transmission, AZT treatment, and treatment of opportunistic infections. Since 1988, schools have also included AIDS education from the 5th grade on. Condom use is stressed, but machismo often hinders its acceptance. While AIDS is a menace, the rate of syphilis increased from 7.2/100,000 in 1970 to 84.3/100,000 in 1987. Stressing personal responsibility in preventing HIV infection skirts the need for modification of high risk behavior and lulls the public into a false sense of security because of the belief that full protection from AIDS is provided by the quarantine.^ieng
Assuntos
Sorodiagnóstico da AIDS , Síndrome da Imunodeficiência Adquirida , Adulto , Educação , Estudos de Avaliação como Assunto , Programas Governamentais , Infecções por HIV , População , Fatores Etários , América , Região do Caribe , Técnicas de Laboratório Clínico , Cuba , Demografia , Países em Desenvolvimento , Diagnóstico , Doença , América Latina , América do Norte , Organização e Administração , Características da População , VirosesRESUMO
To evaluate possible misclassification of smokers and nonsmokers, we compared self-reported cigarette consumption and serum cotinine levels in a sample of 743 Mexican American participants in the Hispanic Health and Nutrition Examination Survey (HHANES). The study sample was stratified by sex and self-reported cigarettes consumed per day (0, 1 to 9, 10 to 19, and greater than or equal to 20) and selected from those with available serum. We defined biochemical smokers as persons with serum cotinine levels greater than or equal to 0.084 microM/L (14 ng/ml). Misclassification was defined as a discrepancy between self-reported smoking and the serum cotinine level used to define a biochemical smoker. Of 189 self-reported nonsmokers, 12 (6.3%) were defined as biochemical smokers and possibly misclassified by self-report. Among 124 never smokers only 5 (4%) were biochemical smokers compared with 7 of 65 (10.8%) self-reported former smokers. Only 1 of the 12 misclassified nonsmokers reported living with a current smoker. In 9 of the 12 misclassified nonsmokers, serum cotinine levels were consistent with light smoking. Among the 547 self-reported smokers, 66 (12.1%) were found to have serum cotinine levels less than or equal to 0.084 microM/L (14 ng/ml) and possibly misclassified by self-report. Of these, one person reported 20 or more cigarettes per day. We conclude that self-reported cigarette consumption may be an insufficient measure of the risks associated with tobacco use and measurement of serum cotinine may be important to assess the magnitude of misclassification of smoking status in epidemiologic studies.
Assuntos
Autorrevelação , Fumar , Adulto , Idoso , Cotinina/sangue , Feminino , Hispânico ou Latino , Humanos , Masculino , México/etnologia , Pessoa de Meia-Idade , Fumar/sangue , Fumar/etnologia , Fumar/psicologiaRESUMO
The purpose of this study was to estimate the prevalence of diagnosed and undiagnosed diabetes among Mexican Americans, Cubans, and Puerto Ricans in the United States and compare these estimates to data from prior surveys for U.S. non-Hispanic whites and blacks. Data for this study are from the Hispanic Health and Nutrition Examination Survey, a multipurpose cross-sectional survey of three U.S. Hispanic populations conducted in 1982-1984. The interviewed sample of people aged 20-74 yr included 3935 Mexican Americans in the southwest, 1134 Cubans in Florida, and 1519 Puerto Ricans in the New York City area. The diabetes component consisted of interview questions on diabetes diagnosis and treatment and an oral glucose tolerance test administered to a subsample. The prevalence of diabetes was two to three times greater for Mexican Americans and Puerto Ricans than for non-Hispanic whites surveyed in 1976-1980. In Cubans, the prevalence was similar to that for non-Hispanic whites. In men and women 45-74 yr of age, the prevalence of diabetes was extremely high for both Mexican Americans (23.9%) and Puerto Ricans (26.1%) compared with Cubans (15.8%) or non-Hispanic whites (12%). The total prevalence of diabetes was not significantly different for Mexican Americans and Puerto Ricans but was significantly lower for Cubans. The relatively lower prevalence of diabetes among Cubans and the high prevalence in both Mexican Americans and Puerto Ricans may be related to socioeconomic, genetic, behavioral, or environmental factors.
Assuntos
Diabetes Mellitus/epidemiologia , Inquéritos Epidemiológicos , Hispânico ou Latino/genética , Inquéritos Nutricionais , Adulto , Idoso , Estudos Transversais , Cuba/etnologia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/genética , Feminino , Humanos , Masculino , México/etnologia , Pessoa de Meia-Idade , Prevalência , Porto Rico/etnologia , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Cuba's response to the human immunodeficiency virus (HIV) epidemic has been to conduct mass testing of the population to ascertain seroprevalence, to enforce mandatory relative quarantine of persons testing positive, and to implement educational interventions using media and school-based programs. METHODS: Interview with the Vice-Minister of Health and review of available data. RESULTS: Reports to date show a very low seroprevalence rate without evidence of a widespread epidemic. Sexual contact with foreign-born persons is the primary risk factor. Possible advantages of Cuba's policy include rapid reduction in the risk of HIV transmission by infected blood products, an opportunity for focused education and secondary prevention, and limitation of new infections. Possible disadvantages include the restriction of individual freedom in those who are not guilty of any illegal act, quarantine of persons with false positive HIV tests, and ongoing transmission because of the incomplete nature of the quarantine. The policy is expensive and may displace other public health priorities. The content of the media-based educational interventions has emphasized rational medical information in unimaginative formats with a limited focus on prevention. CONCLUSIONS: The issue of personal responsibility for behavioral change versus government imposed regulations is at the core of Cuba's HIV policy. The quarantine policy may paradoxically permit most Cubans to feel that they are personally invulnerable to the HIV epidemic.
Assuntos
Síndrome da Imunodeficiência Adquirida/prevenção & controle , Surtos de Doenças/prevenção & controle , Quarentena , Adulto , Cuba/epidemiologia , Feminino , Comportamentos Relacionados com a Saúde , Educação em Saúde/métodos , Política de Saúde , Humanos , Disseminação de Informação , Masculino , Programas de Rastreamento , Alocação de Recursos , Justiça SocialRESUMO
To determine the accuracy of self-report of cigarette consumption among Mexican American smokers, we compared self-reported cigarette use and serum cotinine concentrations in a sample of 547 participants in the Hispanic Health and Nutrition Examination Survey (HHANES). We defined underreporting of cigarette use as a cotinine to cigarette-per-day ratio of greater than 0.142 microM/l which represented a substantial discrepancy between self-reported consumption and serum cotinine. Of the 98 men and 97 women who reported smoking one to nine cigarettes/day, 20.4 percent and 24.7 percent, respectively, underreported their cigarette consumption. Underreporting was less common among men and women smoking 10 to 19 cigarettes/day (8.3 percent and 10.8 percent, respectively) and 20 or more cigarettes/day (2.2 percent and 2.9 percent, respectively). Comparison of underreporters to other smokers by demographic characteristics within sex and cigarettes/day categories showed no differences. Differences in cotinine metabolism and extremely efficient smoking are alternative explanations that can not be ruled out with these data. We believe, however, that a proportion of Mexican American light smokers may underreport the quantity of cigarettes smoked per day, and may truly be moderate or heavy smokers.
Assuntos
Inquéritos Epidemiológicos , Hispânico ou Latino/psicologia , Autorrevelação , Fumar/psicologia , Adulto , Idoso , Cotinina/sangue , Feminino , Humanos , Masculino , México/etnologia , Pessoa de Meia-Idade , Fumar/sangue , Fumar/etnologia , Sudoeste dos Estados UnidosRESUMO
In the Hispanic Health and Nutrition Examination Survey (HHANES) of 3,928 Mexican Americans ages 20-74 years, the age-adjusted prevalence of self-reported diabetes was 6.8 percent among men and 7.6 percent among women. Comparable age-adjusted rates for the US population in a national survey were 2.9 percent in men and 3.8 percent in women. The prevalence of diabetes in Mexican Americans is greater in older age groups, was similar in men and women, and among women only was inversely associated with education.
Assuntos
Diabetes Mellitus/etnologia , Hispânico ou Latino , Adulto , Fatores Etários , Idoso , Estudos Transversais , Diabetes Mellitus/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , México/etnologia , Pessoa de Meia-Idade , Sudoeste dos Estados UnidosRESUMO
Because of the concern that we were underestimating the prevalence of tuberculosis within the Latino community in San Francisco, we undertook a community-based screening program directed largely towards recent immigrants. Of 1,871 intermediate-strength (5 TU) tuberculin tests applied and read, 37 per cent of the reactions were greater than or equal to 10 mm. Significant reactions were found in 53 per cent of foreign-born persons compared to 7 per cent of those born in the United States. Persons older than 20 years of age were more likely to have significant reactions compared to younger Latinos. Among the foreign-born, the frequency of significant reactions was not influenced by the length of stay in the US or a history of BCG (bacille Calmette-Guérain) vaccination. Two foreign-born children were found to have current tuberculosis. The prevalence of tuberculin reactors among US-born Latino children was 3 per cent, which suggests that undetected transmission of tuberculosis may be occurring. We conclude that Latino immigrants should be systematically screened for tuberculosis.
Assuntos
Hispânico ou Latino , Tuberculose/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Vacina BCG , California , América Central/etnologia , Criança , Pré-Escolar , Emigração e Imigração , Métodos Epidemiológicos , Feminino , Humanos , Lactente , Masculino , México/etnologia , Pessoa de Meia-Idade , Teste Tuberculínico , Tuberculose/diagnóstico , Tuberculose/imunologia , Estados UnidosRESUMO
The rate of positive tuberculin skin tests for Latino children was examined to help define high risk groups. We reviewed 330 charts of subjects, 18 years of age or younger, with one or more tuberculin (5 tuberculin units, purified protein derivative) skin test readings in a 5-year period. Overall 9% of United States-born and 53% of foreign-born Latinos had positive tuberculin tests (P less than 0.01). Repeat applications identified 35 converters and a greater proportion of United States-born Latinos were in this group (P less than 0.05). Radiographic changes on chest films consistent with active tuberculous disease were found in four of the foreign-born converters. The calculated tuberculin conversion rate of these Latinos is 15 to 30 times that of the United States general population. Unsuspected transmission of tuberculosis may be one possible explanation. We recommend that: clinicians should perform routine tuberculin skin tests in healthy Latino children whether born in the United States or in a foreign country; and active screening for tuberculosis of Latino immigrants by local health departments be conducted with appropriate funding support.
Assuntos
Hispânico ou Latino , Teste Tuberculínico , Tuberculose/epidemiologia , Adolescente , Brasil/etnologia , California , Criança , Pré-Escolar , Emigração e Imigração , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Programas de Rastreamento , Tuberculose/prevenção & controle , Estados UnidosRESUMO
The 25 years of revolution in Cuba have brought about great changes in the health care system. The health status of the population has been transformed from that of a developing country to one approximating the developed countries. The delivery of primary care at the community level has evolved over the past 15 years as a result of critical evaluations of the new implementations. The community polyclinic has been the basis for all health planning since 1975. This model has the health of the community as its main concern and the mechanism for involving the community in healthcare decisions has been established. The history of the community polyclinic and the evolution of the guidelines by which it functions are reviewed. In practice, many problems persist and the strategy for resolution of current conflicts will provide for interesting developments in the near future.
Assuntos
Centros Comunitários de Saúde/organização & administração , Continuidade da Assistência ao Paciente , CubaRESUMO
Tuberculosis is a significant public health problem in developing countries, despite the fact that the means for effective control have been available for more than 35 yr. Cuba is a developing country that has achieved control of tuberculosis comparable to that of the United States. The history of tuberculosis control in Cuba prior to 1959 is reviewed. The achievement of effective control during the past 24 yr results from the implementation of ambulatory, supervised chemotherapy at the primary care level and the priority set by the government. Case-finding strategies, chemotherapeutic regimens, prevention, and economic implications are discussed. A wider application of the successful Cuban experience is possible by providing an overall improvement in living conditions, a significant but modest investment in human resources, and a political commitment to improved health care.