RESUMO
BACKGROUND: Social determinants of health thoroughly explored in the literature include insurance status, race, and ethnicity. There are over 50 million self-identifying Hispanics in the United States. This, however, represents a heterogeneous population. We used a national registry to investigate for significant differences in outcomes of Hispanic patients with non-small cell lung cancer (NSCLC) in the Unites states, by geographic region of origin. MATERIALS AND METHODS: We identified a cohort of Hispanic patients in the Unites states with NSCLC for which region of origin was documented within the 2004 to 2016 National Cancer Database (NCDB) registry. This included patients from Cuba, Puerto Rico, Mexico, South and Central America, and the Dominican Republic. We performed multivariate logistic regression modeling to determine whether origin was a significant predictor of cancer staging at diagnosis, adjusting for age, sex, histology, grade, insurance status, and facility type. Race was not included due to a nonsignificant association with stage at diagnosis at the bivariate level in this cohort. Subsequently, we used Kaplan-Meier modeling to identify whether overall survival (OS) of Hispanic patients differed by origin. RESULTS: A total of 12,557 Hispanic patients with NSCLC were included in this analysis. The breakdown by origin was as follows: n = 2071 (16.5%) Cuban, n = 2360 (18.8%) Puerto Rican, n = 4950 (39.4%) Mexican, n = 2329 (18.5%) from South or Central America, and n = 847 (6.7%) from the Dominican Republic. After controlling for age, sex, histology, grade, insurance status and treating facility type, we found that geographic origin was a significant predictor of advanced stage at diagnosis (P = .015). Compared to Cubans, patients of Puerto Rican origin were less likely to present with advanced disease (68.4% vs. 71.9%; OR: 0.82; 95%CI: 0.69-0.98; P = .026). We also identified a significant (log-rank P-value<.001) difference in OS by geographic origin, even at early-stages of diagnosis. Dominican patients with NSCLC exhibited the highest 5-year OS rate (63.3%), followed by patients from South/Central America (59.7%), Puerto Rico (52.3%), Mexico (45.9%), and Cuba (43.8%). CONCLUSION: This study showed that for Hispanic individuals living in the Unites states, region/country of origin is significantly associated with outcomes, even after accounting for other known determinants of health. We suggest that region of origin should be studied further as a potential determinant of outcomes in patients with cancer.
Assuntos
Carcinoma Pulmonar de Células não Pequenas , Hispânico ou Latino , Neoplasias Pulmonares , Determinantes Sociais da Saúde , Humanos , Carcinoma Pulmonar de Células não Pequenas/epidemiologia , Carcinoma Pulmonar de Células não Pequenas/etnologia , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/patologia , América Central/etnologia , Cuba/etnologia , República Dominicana/etnologia , Hispânico ou Latino/estatística & dados numéricos , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , México/etnologia , Porto Rico/etnologia , Determinantes Sociais da Saúde/etnologia , Determinantes Sociais da Saúde/estatística & dados numéricos , América do Sul/etnologia , Estados Unidos/epidemiologiaRESUMO
OBJECTIVES: To analyze the geographic inequalities in life expectancy (LE) and the probability of survival up to 40 and 60 years in Brazil between 1991 and 2010, to partition the variance of these indicators by including municipalities, states, and macroregions in the analysis, and to test the association between municipal socio-economic and health services indicators with life expectancy. STUDY DESIGN: Multilevel analysis. METHODS: Census data from 1991, 2000, and 2010 were used to calculate the outcomes and the socio-economic variables. Municipalities were separated into centiles according to their values in each outcome. Absolute and relative differences were calculated for each year. Multilevel linear regression models were performed, taking into account three levels: regions, states, and municipalities. Municipal socio-economic and health services variables were included in the model with the 2010 data. RESULTS: All 5545 Brazilian counties showed improvement in the three indicators, but the magnitude varied significantly across the country. The highest gains in LE were observed in the North and Northeast regions. The gap in LE between the 1st and 99th percentile decreased from 19.6 years to 12.2 years. The relative difference also fell, from 1.37 to 1.18. Most counties' socio-economic and health services indicators were associated with the outcomes and explained 86.7%, 31.2%, and 32.4% of the variation in LE attributable to regions, states, and counties, respectively. CONCLUSIONS: The average life expectancy increased between 1991 and 2010. Concomitantly, a reduction in geographic disparities was observed. The counties' socio-economic and health services variables explained much of the variation of the outcomes in 2010.
Assuntos
Disparidades nos Níveis de Saúde , Expectativa de Vida/tendências , Adulto , Brasil/epidemiologia , Censos , Cidades/epidemiologia , Feminino , Geografia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multinível , Fatores SocioeconômicosRESUMO
BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) sets residency performance standards for the American Board of Family Medicine Certification Examination. This study aims are to describe the compliance of residency programs with ACGME standards and to determine whether residency pass rates depend on program size and location. METHODS: In this retrospective cohort study, residency performance from 2007 to 2011 was compared with the ACGME performance standards. Simple linear regression was performed to see whether program pass rates were dependent on program size. Regional differences in performance were compared with χ(2) tests, using an α level of 0.05. RESULTS: Of 429 total residency programs, there were 205 (47.8%) that violate ACGME performance standards. Linear regression showed that program pass rates were positively correlated and dependent on program size (P < .001). The median pass rate per state was 86.4% (interquartile range, 82.0-90.8. χ(2) Tests showed that states in the West performed higher than the other 3 US Census Bureau Regions (all P < .001). CONCLUSIONS: Approximately half of the family medicine training programs do not meet the ACGME examination performance standards. Pass rates are associated with residency program size, and regional variation occurs. These findings have the potential to affect ACGME policy and residency program application patterns.
Assuntos
Certificação/estatística & dados numéricos , Medicina de Família e Comunidade/educação , Internato e Residência/normas , Acreditação , Avaliação Educacional , Humanos , Internato e Residência/estatística & dados numéricos , Modelos Lineares , Porto Rico , Estudos Retrospectivos , Conselhos de Especialidade Profissional/normas , Estados UnidosRESUMO
We investigated the influence of nutritional status, as determined from anthropometric measurement, and of helminthic infections on the immune response of children of low socioeconomic status in two rural communities in Venezuela: El Cardón in the state of Nueva Esparta and San Daniel in the state of Miranda. A total of 125 boys and girls between 2 and 15 years old participated in the study. Their socioeconomic stratum was determined by a modified Graffar method. A physical examination was performed, as was also an anthropometric evaluation that took into account three indicators--weight-for-height, weight-for-age, and height-for-age--according to parameters established by the World Health Organization. Other examinations included feces, secretory IgA in saliva, total serum IgE, and anti-Ascaris-specific immunoglobulins. The children in both of the communities were in strata IV and V of the of Graffar scale, with a significantly greater number of stratum V inhabitants in San Daniel (P < 0.001). The results suggest that exposure level and individual susceptibility to the parasites are determining factors in parasitic infection and immune system behavior. The intensity of the parasitic burden plays an important role in stimulating polyclonal IgE, which diminishes the effectiveness of the specific response to those infections. On the other hand, nutritional deficiencies could change the immune mechanisms of the mucous membranes, negatively influence the synthesis of secretory IgA, and stimulate the production of polyclonal IgE. Poor sanitary and socioeconomic conditions promote more exposure to gastrointestinal parasites and a deficient nutritional status, which modulates the immune response and affects serum IgE and secretory IgA production mechanisms.
Assuntos
Ascaríase/imunologia , Estado Nutricional , Tricuríase/imunologia , Adolescente , Formação de Anticorpos , Antígenos de Helmintos/imunologia , Criança , Pré-Escolar , Feminino , Humanos , Imunoglobulina A/imunologia , Imunoglobulina E/imunologia , Lactente , Masculino , População Rural , Fatores Socioeconômicos , VenezuelaRESUMO
BACKGROUND: The seventh cholera pandemic has been ongoing in Mexico since 1991 and threatens to become endemic. This paper aims to determine the geographical pattern of cholera in Mexico to define areas at high risk of endemic cholera. METHODS: Ecologic research was conducted based upon the cartography of disease incidence. The 32 Mexican states were grouped into five strata according to the value of the 1991-1996 cumulative incidence rate of cholera. Rate ratios were computed for strata of states classified by geographical situation, urbanization, and poverty level. RESULTS: Cholera incidence was 2.47 times higher in coastal states than in the interior (95% CI : 2.42-2.52). The disease was negatively associated with urbanization. Incidence in the least urbanized stratum was four times as high as in the most urban stratum (95% CI : 3.9-4.12). The poorest stratum showed the most remarkable incidence, i.e. 5.9 times higher than the rate in the least poor stratum (95% CI : 5.73-6.04). CONCLUSIONS: This ecologic research suggests that high poverty level, low urbanization, and southern location are the most important predictors of endemic cholera in Mexican states. It is hypothesized that the natural environment of the coastal plains in southern states may also play a significant role in cholera incidence. Poor communities residing in the southern, predominantly rural, coastal states should be prioritized when it comes to investing in safe water supply facilities, adequate excreta disposal systems and cholera surveillance.
Assuntos
Cólera/epidemiologia , Clima , Surtos de Doenças/prevenção & controle , Características de Residência , Urbanização , Altitude , Cólera/prevenção & controle , Comportamento Alimentar , Humanos , Incidência , México/epidemiologia , Fitoplâncton , Áreas de Pobreza , Fatores de Risco , Saneamento , Microbiologia da ÁguaRESUMO
PIP: This article asks how family relationships affect the living conditions of low-income elderly people in urban Mexico. The existence of so many elderly women living alone in the country is at odds with cultural beliefs portraying mothers as the archetypal recipients of family charity. It is evident that there is little state provision of accommodation for the elderly, forcing older people to rely on their families for care. Living with family is usually thought to be a better option for older people. Yet many poorer families cannot afford to provide care, and some are not willing to do so. In addition, families treat elderly men and women differently, with significant consequences for housing conditions and well-being of men and women in later life.^ieng
Assuntos
Idoso , Relações Familiares , Habitação , Pesquisa , Fatores Sexuais , Adulto , Fatores Etários , América , Demografia , Países em Desenvolvimento , Características da Família , Geografia , América Latina , México , América do Norte , População , Características da População , Características de ResidênciaRESUMO
BACKGROUND: American cutaneous leishmaniasis (ACL) is endemic in many rural areas of Brazil where different transmission patterns of the disease have been described. This ecological study was carried out in a municipality located in Southeast Brazil and aimed to investigate the space-temporal patterns of the disease and environmental risk factors from 1966 to 1996. METHODS: Incident ACL cases were defined by clinical diagnosis, confirmed by a positive skin test and/or parasitological examination. Age-adjusted morbidity rate of ACL was calculated by year for this municipality and their different census enumeration districts. The homogeneity chi2 test, Moran and empirical Bayes index and Knox procedure were employed for testing the significance of clusters in time, space and in time-space, respectively. A Poisson regression model was used to identify environmental factors related to rate variability. RESULTS: A total of 1712 new ACL cases were reported with a yearly incidence rate of 48/100000 inhabitants. Higher incidence rates were detected in 1968, 1974, and 1988 (100, 160, and 190 cases/100000, respectively) with evidence of spatial clustering from 1986 to 1993. Significant space-time clustering with epidemic peaks followed by low incidence in subsequent periods was observed. The incidence rates of ACL were independently associated with rural areas; areas lacking sanitary installations and with higher proportion of exposed garbage (P < 0.01). CONCLUSIONS: This study suggests that ACL rates vary across space and time. Rural areas and some environmental factors could explain part of this variation. Environmental modifications in the vicinity of households over time and accumulation of susceptible individuals are discussed as possible factors responsible for variability.
PIP: This paper presents the results of an ecological study on American cutaneous leishmaniasis (ACL) cases carried out in Caratinga municipality, Southeast Brazil. The study aimed to estimate the incidence rates of ACL from 1966 to 1996, to test for space and temporal patterns in the rates and to correlate them to sociogeographic factors. Findings of the study showed an increase in the incidence rates of reported ACL cases. A total of 1712 ACL cases were reported in Caratinga during 1966-96, with a yearly incidence rate of 48/100,000 inhabitants. Evidence of spatial clustering was noted during 1986-93. Higher incidence rates were detected in 1968 (100 cases/100,000 inhabitants), 1974 (160/100,000), and 1988 (190/100,000). In addition, an observation noted that explosive outbreaks of ACL are followed with very low incident rate cases in the subsequent period. This observation indicates a lifelong resistance for treated individuals following clinically apparent infection. Moreover, prevalence of ACL infection was associated with rural areas, lack of sanitary disposal, and exposed garbage.
Assuntos
Leishmaniose Cutânea/epidemiologia , Modelos Estatísticos , Adulto , Distribuição por Idade , Brasil/epidemiologia , Feminino , Humanos , Incidência , Leishmaniose Cutânea/diagnóstico , Masculino , Distribuição de Poisson , Vigilância da População , Fatores de Risco , População Rural , Distribuição por Sexo , Conglomerados Espaço-TemporaisRESUMO
This article examines geographical differences in AIDS knowledge and attitudes. Data from a survey of 900 adolescent girls in the Caribbean nation of Jamaica indicate significant differences across geography in AIDS knowledge and attitude. Adolescent girls in more central areas have access to different and more sources of information than those in more remote areas. They are also more likely to know persons with AIDS, be more knowledgeable about the clinical manifestations of AIDS, and be more realistic in assessing their susceptibility of HIV. The implications of geographical differences for AIDS education efforts are discussed.
PIP: This paper examines geographical differences in AIDS knowledge and attitudes among adolescent girls in Jamaica. A total of 900 respondents aged 14-17 were chosen; 714 of them were from urban areas, and 186 were from rural areas. Questions covered awareness of AIDS existence, information sources, the number of persons with AIDS the respondent was aware of, knowledge of AIDS transmission, and knowledge of risks. Findings showed that geography influenced the levels of knowledge and attitudes of adolescent girls toward AIDS. Young women who lived in more central areas were had an advantage over girls in remote areas with respect to access to AIDS information. It was concluded that efforts toward the dissemination of AIDS information to adolescents in rural areas should be implemented and that these should incorporate the development of educational resources for AIDS education. The results of this survey suggest generally that geographic type should be considered in educational efforts.
Assuntos
Síndrome da Imunodeficiência Adquirida/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Síndrome da Imunodeficiência Adquirida/epidemiologia , Síndrome da Imunodeficiência Adquirida/transmissão , Adolescente , Adulto , Fatores Etários , Feminino , Educação em Saúde , Humanos , Jamaica/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , População Rural , Fatores Sexuais , Inquéritos e Questionários , População UrbanaRESUMO
In a field study carried out in three rural communities in Paraguay in a zone endemic for Chagas disease, we implemented three different vector control interventions--spraying, housing improvement, and a combination of spraying plus housing improvement--which effectively reduced the triatomine infestation. The reduction of triatomine infestation was 100% (47/47) in the combined intervention community, whereas in the community where housing improvement was carried out it was 96.4% (53/55). In the community where fumigation alone was used, the impact was 97.6% (40/41) in terms of domiciliary infestation. In all the houses where an intervention was made, an 18-month follow-up showed reinfestation rates of less than 10%. A serological survey of the population in the pre- and post-intervention periods revealed a shift in positive cases towards older age groups, but no significant differences were observed. The rate of seroconversion was 1.3% (three new cases) in the community with housing improvement only, but none of these cases could have resulted from vector transmission. The most cost-effective intervention was insecticide spraying, which during a 21-month follow-up period had a high impact on triatomine infestation and cost US$ 29 per house as opposed to US$ 700 per house for housing improvement.
PIP: Chagas disease is most commonly spread by vectors in areas where inadequate housing, crowding, and poor hygienic conditions facilitate the proliferation of triatomines and help to maintain their domestic cycle. Chagas disease is widely distributed in America, from the southern US to southern Argentina, with a prevalence of 5-60%. In 3 rural communities in Paraguay in a zone endemic for Chagas disease, insecticide spraying, housing improvement, and a combination of spraying plus home improvement were implemented in a field study to control the vectors of Chagas disease. The insecticide applied was lambdacyhalothrin in a wettable powder formulation, while houses were modified to have smooth, flat, crack-free walls and ceiling surfaces, as well as better ventilation and illumination. Each intervention effectively reduced the vector of Chagas disease, with triatomine infestation reduced by 100% in the combined intervention community, 96.4% in the community in which only houses were improved, and 97.6% in terms of domiciliary infestation where only fumigation was used. In all houses in which an intervention was made, an 18-month follow-up showed reinfestation rates of less than 10%. A serological survey of the population during the pre- and post-intervention periods showed a shift in positive cases toward older age groups, but no significant differences were observed. The rate of seroconversion was 1.3% (3 new cases) in the community with housing improvement only, but none of those cases could have resulted from vector transmission. Insecticide spraying was the most cost-effective intervention: US$29 per house compared to US$700 per house for housing improvement.
Assuntos
Doença de Chagas/prevenção & controle , Doenças Endêmicas/prevenção & controle , Controle de Insetos/métodos , Triatoma/parasitologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Animais , Doença de Chagas/epidemiologia , Doença de Chagas/parasitologia , Doença de Chagas/transmissão , Criança , Pré-Escolar , Análise Custo-Benefício , Doenças Endêmicas/estatística & dados numéricos , Feminino , Humanos , Lactente , Controle de Insetos/economia , Masculino , Pessoa de Meia-Idade , Paraguai/epidemiologia , Avaliação de Programas e Projetos de Saúde , Saúde da População Rural , Estudos SoroepidemiológicosRESUMO
BACKGROUND: Reinvasion by Aedes aegypti of cities in the Americas poses a threat of urbanisation of yellow fever. After detection of yellow-fever infection in a resident of the city of Santa Cruz, Bolivia, in December, 1997, we investigated all subsequent suspected cases. METHODS: We introduced active surveillance of yellow fever in the Santa Cruz area. Hospitals and selected urban and rural health centres reported all suspected cases. Patients were serologically screened for yellow fever, dengue, hepatitis A and B, and leptospirosis. We collected clinical and epidemiological information from patients' records and through interviews. We also carried out a population-based serosurvey in the neighbourhood of one case. FINDINGS: Between December, 1997, and June, 1998, symptomatic yellow-fever infection was confirmed in six residents of Santa Cruz, five of whom died. Five lived in the southern sector of the city. Two had not left the city during the incubation period, and one had visited only an area in which sylvatic transmission was deemed impossible. Of the 281 people covered in the serosurvey 16 (6%) were positive for IgM antibody to yellow fever. Among five people for whom this result could not be explained by recent vaccination, there were two pairs of neighbours. INTERPRETATION: Urban transmission of yellow fever in Santa Cruz was limited in space and time. Low yellow-fever immunisation coverage and high infestation with A. aegypti in the city, and the existence of endemic areas in the region present a risk for future urban outbreaks. We recommend immediate large-scale immunisation of the urban population, as well as tightened surveillance and appropriate vector control.
PIP: Until recently, urban yellow fever had not been reported from the Americas since 1954, but jungle yellow fever increasingly affects forest dwellers in Bolivia, Brazil, Colombia, Ecuador, and Peru. The reinvasion by Aedes aegypti of cities in the Americas now threatens to urbanize yellow fever. After yellow fever infection was identified in a resident of Santa Cruz, Bolivia, in December 1997, all subsequent suspected cases were investigated. Active surveillance of yellow fever was introduced in the Santa Cruz area, with hospitals and selected urban and rural health centers reporting all suspected cases. Patients were serologically screened for yellow fever, dengue, hepatitis A and B, and leptospirosis; clinical and epidemiological data were collected from patients' records and through interviews; and a population-based serosurvey was conducted in the neighborhood of one case. Between December 1997 and June 1998, symptomatic yellow fever infection was confirmed in 6 residents of Santa Cruz, of whom 5 died. 5 lived in the southern sector of the city. 2 cases did not leave the city during their incubation period, and 1 had visited only an area in which sylvatic transmission was deemed impossible. Of the 281 people covered in the serosurvey, 16 (6%) were positive for IgM antibody to yellow fever. Among 5 people for whom that result could not be explained by recent vaccination, there were 2 pairs of neighbors. This instance of urban yellow fever transmission was limited in both time and space.
Assuntos
Saúde da População Urbana , Febre Amarela/epidemiologia , Adulto , Aedes/virologia , Animais , Bolívia/epidemiologia , Criança , Pré-Escolar , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/tendências , Transmissão de Doença Infecciosa/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância da População/métodos , Estudos Soroepidemiológicos , Febre Amarela/diagnósticoRESUMO
PIP: "Although Mexican migration to the United States dates back over a century, reliable statistics documenting its geographical distribution have only recently become available. This new information, together with the creation of a Geographical Data System and the recent development of multilevel analysis, have allowed one to examine the regional context of Mexican migration to the U.S.... This paper draws on two new tools for context analysis and examines how they can be used to study international migration: first, the Geographical Data systems, which measure physical factors (aridity, isolation, land use, environmental degradation), together with socioeconomic statistics and familial organization and reproduction." (EXCERPT)^ieng
Assuntos
Coleta de Dados , Demografia , Emigração e Imigração , Geografia , Estatística como Assunto , América , Países Desenvolvidos , Países em Desenvolvimento , América Latina , México , América do Norte , População , Dinâmica Populacional , Pesquisa , Estados UnidosRESUMO
PIP: Findings from the Bolivia Demographic and Health Survey in 1998 indicate that large fertility and reproductive health disparities based on education level and geographic location still persist in the country. Despite substantial improvement in the overall education level of Bolivian women in the past 5 years, urban women are almost 5 times more likely to attend high school than rural women are. Major differences in education level also exist between provinces. Total fertility rate is at 4.2 children per woman, with women without education having more than 3 times the number of children compared to those with higher education. At such rates, rural women will have an average of 6.3 children, which are 2.5 children more than their urban counterparts. Moreover, nearly 80% of women in union know of a modern method of contraception and 45% of them are using some form of family planning. The highest levels of contraceptive use are among women with higher education and women in urban areas. There is also a notable increase in the number of women who receive assistance from a trained medical professional during delivery. Infant and child mortality rates remain among the highest in Latin America although both rates have declined since the 1994 survey findings. Infant mortality rates are still 80% higher in rural areas than urban areas.^ieng
Assuntos
Demografia , Escolaridade , Geografia , Mortalidade Infantil , Medicina Reprodutiva , Pesquisa , População Rural , População Urbana , Mulheres , América , Bolívia , Países em Desenvolvimento , Economia , Saúde , América Latina , Mortalidade , População , Características da População , Dinâmica Populacional , Classe Social , Fatores Socioeconômicos , América do SulRESUMO
BACKGROUND: A number of studies have reported associations between indoor biofuel air pollution in developing countries and chronic obstructive lung disease (COLD) in adults and acute lower respiratory infection (ALRI) in children. Most of these studies have used indirect measures of exposure and generally dealt inadequately with confounding. More reliable, quantified information about this presumed effect is an important pre-requisite for prevention, not least because of the technical, economic and cultural barriers to achieving substantial exposure reductions in the world's poorest households, where ambient pollution levels are typically between ten and a hundred times higher than recommended standards. This study was carried out as part of a programme of research designed to inform the development of intervention studies capable of providing quantified estimates of health benefits. METHODS: The association between respiratory symptoms and the use of open fires and chimney woodstoves ('planchas'), and the distribution of confounding factors, were examined in a cross-sectional study of 340 women aged 15-45 years, living in a poor rural area in the western highlands of Guatemala. RESULTS: The prevalence of reported cough and phlegm was significantly higher for three of six symptom measures among women using open fires. Although this finding is consistent with a number of other studies, none has systematically examined the extent to which strong associations with confounding variables in these settings limit the ability of observational studies to define the effect of indoor air pollution adequately. Very strong associations (P < 0.0001) were found between the type of fire and a number of household and socioeconomic factors including the arrangement of rooms, floor type, and possession of a radio and television. The spouse's economic activity type was also significantly associated (P < 0.05). Thus, while 82% of open fire users had dirt floors and only 18% cement or tile floors, the situation was reversed for plancha users, only 16% of whom had dirt floors. CONCLUSIONS: Confounding presents a substantial problem for observational studies of indoor air pollution and health, although there is a reasonable case for believing that the observed association is causal. Intervention studies are required for stronger evidence of this association, and more importantly, to determine the size of health benefit achievable through feasible exposure reductions.
PIP: The authors investigated the association between respiratory symptoms and the use of open fires and chimney woodstoves, as well as the distribution of confounding factors, in a cross-sectional study of 340 women aged 15-45 years living in a poor rural area in the western highlands of Guatemala, and found a significantly higher prevalence of reported cough and phlegm for 3 of 6 symptom measures among women using open fires. When considering confounding factors, very strong associations were found between the type of fire and a number of household and socioeconomic factors including the arrangement of rooms, floor type, and possession of a radio and television. The spouse's economic activity type was also significantly associated. 82% of open fire users had dirt floors, with the remaining 18% having cement or tile floors, while only 16% of chimney woodstove users had dirt floors.
Assuntos
Poluição do Ar em Ambientes Fechados/efeitos adversos , Países em Desenvolvimento , Calefação , Pneumopatias Obstrutivas/epidemiologia , População Rural/estatística & dados numéricos , Madeira , Adolescente , Adulto , Poluição do Ar em Ambientes Fechados/estatística & dados numéricos , Causalidade , Feminino , Guatemala , Humanos , Pneumopatias Obstrutivas/etiologia , Pessoa de Meia-Idade , Pobreza/estatística & dados numéricos , Fatores de RiscoRESUMO
Estimates of the incidence of pulmonary tuberculosis in developing countries are based on case reporting from local health laboratories or the annual risk of tuberculin skin test conversion. Because these methods are problematic, the authors used a multiple case ascertainment method to estimate the incidence of pulmonary tuberculosis from 1989 to 1993 in a Peruvian shantytown of 34,000 inhabitants. Two methods, face-to-face interview of all local inhabitants and examination of local laboratory smear records, were used for case gathering. The number of missed cases was estimated by capture-recapture analysis. Survey cases with positive smears were matched to age- and sex-matched controls and interviewed about socioeconomic conditions. The average annual incidence per 100,000 population was 364 (95% confidence interval 293-528) by capture-recapture methods. For the city encompassing the shantytown, the Peruvian Ministry of Heath reported an average annual incidence of 134 cases per 100,000 population. The authors conclude that, in Peru, alarming clusters of pulmonary tuberculosis are masked by government reports that pool zones of disparate incidence. Existing estimators of pulmonary tuberculosis incidence based on tuberculin conversion rates may be invalid in such areas. Within these hyperendemic areas, persons suitable for intensive prophylaxis efforts cannot be reliably identified by housing and socioeconomic risk factors.
PIP: A multiple case ascertainment method was used to estimate the incidence of pulmonary tuberculosis in 1989-93 in a shantytown with 34,000 residents near Lima, Peru. Face-to-face interviews with all residents yielded 191 reports of smear-positive tuberculosis diagnoses at shantytown laboratories and 97 diagnoses from out-of-town laboratories during the study period. Local laboratory smear records identified 354 positive smears, confirming the oral reports of 139 residents (73%) who reported diagnoses at local laboratories. The number of missed cases was estimated by capture-recapture analysis. An average annual incidence of 364 pulmonary tuberculosis cases per 100,000 population was calculated. In contrast, an average annual incidence of 134 cases/100,000 was reported by the Peruvian Ministry of Health for the city (South Lima) encompassing the shantytown. For hyperendemic areas such as shantytowns, various household and socioeconomic factors have been proposed as screening tools to identify those at risk of tuberculosis and in need of chemoprophylaxis. Survey cases with positive smears were matched with controls by age and sex and interviewed about socioeconomic conditions. Logistic regression analysis identified three socioeconomic factors that were protective against pulmonary tuberculosis: a longer residence in the shantytown (odds ratio (OR), 0.91/year; 95% confidence interval (CI), 0.82-0.99), a larger number of doors in the home (OR, 0.80/door; 95% CI, 0.70-0.93), and recent consumption of alcohol (OR, 0.61; 95% CI, 0.29-1.01). The positive predictive value of a model comprised of these three factors was below 1%, however. These findings indicate that clusters of tuberculosis cases in areas such as shantytowns may be masked by their proximity to areas of lower incidence in the absence of special case finding efforts.
Assuntos
Surtos de Doenças , Mycobacterium tuberculosis , Classe Social , Tuberculose Pulmonar/epidemiologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Peru/epidemiologia , Fatores Socioeconômicos , Conglomerados Espaço-TemporaisRESUMO
The spatial and temporal distributions of dengue cases reported during a 1991-1992 outbreak in Florida, Puerto Rico (population = 8,689), were studied by using a Geographic Information System. A total of 377 dengue cases were identified from a laboratory-based dengue surveillance system and georeferenced by their residential addresses on digital zoning and U.S. Geological Survey topographic maps. Weekly case maps were generated for the period between June and December 1991, when 94.2% of the dengue cases were reported. The temporal evolution of the epidemic was rapid, affecting a wide geographic area within seven weeks of the first reported cases of the season. Dengue cases were reported in 217 houses; of these 56 (25.8%) had between two and six reported cases. K-function analysis was used to characterize the spatial clustering patterns for all reported dengue cases (laboratory-positive and indeterminate) and laboratory-positive cases alone, while the Barton and David and Knox tests were used to characterize spatio-temporal attributes of dengue cases reported during the 1991-1992 outbreak. For both sets of data significant case clustering was identified within individual households over short periods of time (three days or less), but in general, the cases had spatial pattern characteristics much like the population pattern as a whole. The rapid temporal and spatial progress of the disease within the community suggests that control measures should be applied to the entire municipality, rather than to the areas immediately surrounding houses of reported cases. The potential for incorporating Geographic Information System technologies into a dengue surveillance system and the limitations of using surveillance data for spatial studies are discussed.
PIP: Through use of the Geographic Information System (GIS), the spatial and temporal distributions of dengue cases reported during a 1990-91 outbreak in Florida, Puerto Rico, were reviewed. The GIS, a computer system that can store, assemble, manipulate, and analyze geographically referenced material, offers a new approach to the study of disease patterns. A total of 377 dengue cases were identified from a laboratory-based dengue surveillance system and georeferenced by their residential addresses on digital zoning and US Geological Survey topographic maps. Weekly case maps were generated for the period June-December 1991, when 94.2% of dengue cases were reported. The epidemic's temporal evolution was rapid, affecting a wide geographic region within 7 weeks of the first reported cases of the season. Cases were reported in 217 houses, 56 (25.8%) of which had 2-6 cases each. Both K-function analysis, and the Barton and David-Knox tests, revealed significant case clustering within individual households over a period of 3 days or less. In general, however, cases had spatial pattern characteristics similar to the population pattern as a whole. The rapid spatial and temporal progress of dengue cases within the community suggests that vector control measures (e.g., source reduction) should be applied to the entire municipality, rather than to the areas immediately surrounding houses of reported cases.
Assuntos
Dengue/epidemiologia , Surtos de Doenças , Adolescente , Adulto , Aedes/fisiologia , Distribuição por Idade , Animais , Anticorpos Antivirais/sangue , Criança , Bases de Dados Factuais , Dengue/transmissão , Vírus da Dengue/imunologia , Feminino , Geografia , Humanos , Incidência , Insetos Vetores/fisiologia , Masculino , Vigilância da População , Porto Rico/epidemiologia , Estudos Retrospectivos , Estações do Ano , Distribuição por Sexo , Conglomerados Espaço-TemporaisRESUMO
PIP: This article illustrates the success of two cities--Portland, Oregon, and Curitiba, Brazil--in managing urban growth and the problems that accompany growth (traffic congestion, pollution, psychological stress, and chaotic development). The world's 14 megacities are home to 7.6% of the global urban population, while the 195 mid-sized cities are inhabited by 31% of the global urban population. The above two cities (1-2.5 million inhabitants) resisted the destruction of old neighborhoods for new highways. Portland and Curitiba are global models of successful management and livability and demonstrate economic viability, social cohesiveness, and environmental health. These cities used unique approaches to social and economic inequities. In Curitiba, the poor have the same purchasing power as in Sao Paulo, but life is bearable because of its level of services. Portland has avoided a concentration of poor in the central city. Both cities have active streets with a mix of shops, factories, offices, and houses. Cities deteriorate when geographic layouts reduce social interaction between rich and poor, people and services, and internal building viability vs. external building decay. Both cities enhance public space and cut urban sprawl. Transportation and other systems accommodate fringe settlements and restrict growth in environmentally sensitive areas. Parks and trees make each city visually attractive. Portland has laws limiting housing growth. Planning minimizes private car use and maximizes pedestrian welfare. Portland's political system was key to planning. Curitiba suffers from lack of coordination with other cities and is at the mercy of state and federal funding. Curitiba has succeeded by making practical policy decisions.^ieng
Assuntos
Qualidade de Vida , Planejamento Social , Urbanização , América , Brasil , Demografia , Países Desenvolvidos , Países em Desenvolvimento , Economia , Geografia , América Latina , América do Norte , População , Pesquisa , Seguridade Social , América do Sul , Estados Unidos , População UrbanaRESUMO
PIP: The author discusses possible future trends in economic development and urbanization in the city of Monterrey, Mexico. Information is provided on metropolitan growth from 1940 to 1995; population size and growth rate; extension of the urban area; deconcentration; and projections according to land use.^ieng
Assuntos
Agricultura , Economia , Previsões , Geografia , Densidade Demográfica , Urbanização , América , Conservação dos Recursos Naturais , Demografia , Países em Desenvolvimento , Meio Ambiente , América Latina , México , América do Norte , População , Dinâmica Populacional , Pesquisa , Estatística como Assunto , População UrbanaRESUMO
PIP: Following the reintroduction of measles virus in Central America through an outbreak in Costa Rica in 1997, El Salvador's Ministry of Health, in October 1997, reviewed the vaccination coverage levels of children under 1 year of age in all of its 262 districts to determine which districts had not achieved coverage levels of at least 90%. The ministry subsequently organized a mop-up measles vaccination campaign for November-December 1997 in the 84 districts identified as being at high risk, targeting children under age 5 years. House-to-house vaccination was conducted, using the current routine vaccination schedule. Including first doses and boosters, 36,560 doses of measles vaccines and 8637 doses of MMR were administered. 91,115 children under 1 year old live in the districts. 69,552 houses were visited, of which 52,494 were found occupied, and 41,597 children under age 5 years were identified in the households. This mop-up vaccination campaign against measles reduced from 84 to 61 the number of districts at risk for measles. Recommendations are presented.^ieng
Assuntos
Geografia , Imunização , Sarampo , Pesquisa , América , América Central , Atenção à Saúde , Países em Desenvolvimento , Doença , El Salvador , Saúde , Serviços de Saúde , América Latina , América do Norte , População , Atenção Primária à Saúde , VirosesRESUMO
PIP: 3.5 million people lived in Costa Rica as of mid-1997. There were 24 births and 4 deaths per 1000 population, respectively, contributing to the annual natural increase rate of 2.0%. Each woman in Costa Rica bears an average of 2.8 children during her reproductive lifespan and men and women were expected to live for 73 and 78 years, respectively. Costa Rica's low infant mortality rate and high literacy and life expectancy rates set it apart from the rest of Central America. Costa Rica is also the only country in the region which maintains no standing army. About 96% of the population is White or Mestizo, 3% is Black, and 1% is indigenous Indian. More than half of the country lives in San Jose and its metropolitan area, 6% of the country's total land area. Unemployment has run near 5% over the past 2 years, but much of the labor force is underemployed. Costa Rica's economy depends upon tourism and agricultural exports such as coffee, beef, and bananas. A large Intel factory opened in 1997. The government and Costa Rican environmentalists are planning a joint campaign to reconvert 80% of Costa Rica's pasture back to forest and tree crops. About 20% of the government's budget is spent upon education and the 93% literacy rate is the highest in the region. Government health services provide low-cost contraceptives to more than 75% of users and 75% of women use some form of family planning.^ieng
Assuntos
Coeficiente de Natalidade , Comportamento Contraceptivo , Demografia , Escolaridade , Expectativa de Vida , Mortalidade , Densidade Demográfica , Crescimento Demográfico , Árvores , Desemprego , América , América Central , Conservação dos Recursos Naturais , Anticoncepção , Costa Rica , Países em Desenvolvimento , Economia , Emprego , Meio Ambiente , Serviços de Planejamento Familiar , Fertilidade , Geografia , América Latina , Longevidade , América do Norte , População , Dinâmica Populacional , Classe Social , Fatores SocioeconômicosRESUMO
PIP: "The purpose of this paper is to produce indicators of income insufficiency at geographically disaggregated levels by combining information from the Continuous Household Survey (CHS) and the Population and Housing Censuses (PHC) of Uruguay, 1985.... Estimates allowed [us] to construct a hierarchy of the geographical areas according to the proportion of poor households and other income distribution indicators, including measures of distance within the income distribution and of the intensity of poverty...." (EXCERPT)^ieng