RESUMO
PIP: This article describes the objectives and content of a workshop held in Managua, Nicaragua, during November 1995, on screening for cervical cancer. The aims were to discuss cost-effective models of screening in countries with a high incidence of cervical cancer and to reach a consensus on principles for screening that is balanced with a country's resources. The workshop aimed to develop a planning framework and to identify program strengths and weaknesses by country. In 1990 there were 25,000 deaths due to cervical cancer in Central America; even so, most countries attach a low priority to cervical cancer screening. Workshop plenary sessions were devoted to discussions about the natural history of cancer of the cervix and the implications for screening, the high costs of human papillomavirus (HPV) tests, approaches to national registries of cervical cancer, screening issues in Central America, downstaging, laboratory quality control issues, treatment of abnormalities, recruitment of women, and IEC. This report includes individual country program reports for Nicaragua, Panama, Haiti, the Dominican Republic, Guatemala, Honduras, and St. Vincent and the Grenadines. Participants concluded that priority should be placed on education about cancer and cancer of the cervix and education of primary health care professionals. It was agreed that all participating countries should begin pilot programs adapted to resource availability, with the idea of a later nationwide expansion. Health care professionals who treat women during the prime reproductive years should use the opportunity to identify women at high risk of invasive cancer. There is overcoverage of women aged under 35 years and insufficient coverage of women aged 35-64 years. Health programs need to enlist the help of women's groups in creating a need and demand in communities. Cytology laboratories need to provide quality services.^ieng
Assuntos
Programas de Rastreamento/organização & administração , Neoplasias do Colo do Útero/prevenção & controle , Adolescente , Adulto , Idoso , América Central , Análise Custo-Benefício , Técnicas Citológicas/normas , Feminino , Educação em Saúde , Humanos , Programas de Rastreamento/economia , Pessoa de Meia-Idade , Papillomaviridae/isolamento & purificação , Controle de Qualidade , Neoplasias do Colo do Útero/patologiaAssuntos
Atenção à Saúde , Mortalidade Infantil , Pobreza , Adulto , Criança , Feminino , Serviços de Saúde/estatística & dados numéricos , Honduras , Humanos , Lactente , Recém-Nascido , Masculino , População Rural , População UrbanaRESUMO
Traffic accidents are a major cause of death and injury in Costa Rica. The present study describes their epidemiology on the basis of data obtained from various sources, including compulsory motor vehicle insurance reports, hospital discharges, and death statistics. The use of several sources of information made it possible to characterize the problem from different perspectives and to include in the analysis the greatest possible number of reported accidents. Incidence, mortality, and hospital discharge rates were calculated on the basis of population figures, and the age and type of license of drivers involved in accidents were analyzed. In addition, case-fatality rates were determined for different types of accidents. The study showed that in Costa Rica the population groups aged 20-39 and over 70 were involved in more motor vehicle accidents than other age groups. However, case-fatality is higher for those under age 10 and over age 40. Incidence and fatality rates are high in provinces where the terrain is relatively flat, making it possible to drive at high speeds. With regard to the characteristics of the drivers, it was observed that those under age 20 have more accidents than older drivers, and that the accident rates for bus and taxi drivers are much higher than those for drivers of private cars. Finally, case-fatality is higher when the accident involves a vehicle and a pedestrian. These findings have implications for the definition of policies on traffic accident control in Costa Rica. The problem needs urgent attention, and measures should be adopted to improve the situation in those parts of the country where traffic accident incidence and fatality are especially high. Our study also demonstrates the importance of knowing how to use available data to generate different types of information.