Cultural components of behavioural epidemiology: implications for primary health care.

In this article we discuss the association of culturally linked behaviour and epidemiology: that patterns of disease are significantly related to cultural sets of normative beliefs and behaviour. The literature on this is vast and includes much of what is written under the headings of Medical Anthropology as well as, for example, Cross-cultural Psychiatry and Medical Geography. A comprehensive review is obviously impossible, but as this is presented primarily as a background paper, basic issues are raised, and related to examples from the literature, to stimulate discussion. The article is divided into four subsections which give an indication of our focus: culture, disease and illness causation; utilization and provision of health resources; health, illness and normative socio-political and economic behaviour and primary health care, community participation and culture--implications for the future.

[Satisfaction among patients of a homeopathic clinic].

The use of unconventional medicine has been increasing in recent decades. We surveyed 102 patients treated in the homeopathic clinic of a large medical center (42 men and 62 women aged 1-71 years, mean 22.7), and compared them with 72 patients treated in the outpatient clinics (42 men and 32 women mean 38 years). The majority of respondents were children and young adults suffering mainly from chronic illnesses, in whom conventional treatment had been ineffective. Although standard medical insurance does not cover complementary medical treatment, the great majority of homeopathic patients maintained their insurance and continued follow-up with their conventional physician. Medical conditions diagnosed at the homeopathy clinic were different from the general distribution of medical conditions and causes of death in Israel. The 3 most frequent medical conditions treated were allergy, recurrent upper respiratory tract infections and dermatological problems. We assume that the public prefers to treat life-threatening diseases by conventional means, turning to homeopathic treatment only in the case of conditions that reduce the quality of life. More than 80% of the responders were greatly satisfied by the approach of the therapist and half felt that their principal medical condition was improved. There was no difference between reports of satisfaction by the patients of our homeopathic and conventional outpatient clinics. We believe that homeopathic medicine complements conventional medicine, and is not an alternative. We hope that this study will contribute to defining legislation regarding the status of homeopathic health services.

Encefalopatia espongiforme bovina atípica: uma revisão / Atypical bovine spongiform encephalopathy: a review

Bovine spongiform encephalopathy (BSE), caused by an infectious prion, emerged in the 1980s in Europe as a new disease in cattle and, since then, several actions are being taken for its prevention and control. Restricting the feeding of ruminants with animal by-products and the removal and destruction of specific risk materials (SRM) for the condition of carcasses in slaughterhouses have been proven effective to control the disease, in addition to the reduction of human exposure to the agent, as this is an important zoonosis. However, in 2004 the first atypical cases of BSE were diagnosed, in which the causative agents showed different molecular weights in Western blot (WB), compared to the classical form of the agent. In addition to the molecular differences, clinical presentations proved to be differentiated in atypical forms, affecting mainly cattle older than eight years. Because it is a new form of the disease, many studies are being conducted to elucidate the pathogenesis, epidemiology and zoonotic potential of atypical BSE. The aim of this study was to review the main aspects of atypical BSE emphasizing its etiology, epidemiology, clinical signs, diagnosis and control and prevention measures.

A encefalopatia espongiforme bovina (EEB), causada por um príon infectante, surgiu na década de 1980 na Europa como uma nova doença nos rebanhos bovinos e, desde então, estão sendo tomadas várias ações para sua prevenção e controle. A restrição da alimentação de ruminantes com subprodutos de origem animal e a remoção e destruição dos materiais de risco específico para a doença das carcaças em frigoríficos se mostraram efetivas medidas para o controle da doença, além de reduzirem a exposição humana ao agente, pois se trata de uma importante zoonose. No entanto, em 2004 os primeiros casos atípicos de EEB foram diagnosticados, nos quais os agentes causais apresentavam alterações de peso molecular na prova de Western blot, em relação ao agente da forma clássica. Além das diferenças moleculares dos agentes, as apresentações clínicas mostraram-se diferenciadas nas formas atípicas, acometendo principalmente bovinos com idade superior a oito anos. Por se tratar de uma nova forma da doença, muitos estudos estão sendo conduzidos buscando elucidar a patogenia, epidemiologia e seu potencial zoonótico. Objetivou-se neste estudo revisar os principais aspectos relacionados às EEB atípicas enfatizando sua etiologia, epidemiologia, sinais clínicos, diagnóstico e medidas de controle.

Infección oculta por el virus de la hepatitis B Aspectos clínicos epidemiológicos y moleculares / Occult hepatitis B virus infection Clinical epidemiological and molecular aspects

Resumen Propósito: La infección oculta por el virus de la hepatitis B se caracteriza por la presencia del genoma viral en muestras de suero y/o tejido hepático pero sin detección de antígeno de superficie. Los mecanismos de patogénesis no se conocen completamente. El propósito del presente artículo es discutir y describir los aspectos clínicos, epidemiológicos y moleculares más importantes de este tipo de infección. Metodología: Se realizó una búsqueda de literatura en la base de datos PUBMED, de trabajos originales y revisiones de tema publicados entre 1979 y 2012. La búsqueda se realizó utilizando las palabras claves "Occult HBV infection, Epidemiology, clinical implications, mechamisms y outcome". Artículos relevantes citados en las publicaciones seleccionadas también fueron consultados. Conclusiones: La identificación de casos de infección oculta por el virus de la hepatitis B y la descripción de la prevalencia es de importancia para la prevención de la transmisión de la infección y del desarrollo de hepatopatías terminales. La disponibilidad de métodos sensibles y específicos para la detección del genoma viral ha permitido explorar la epidemiologia. No obstante, aún son materia de estudio los mecanismos de patogénesis. (Acta Médica Colombiana 2013; 38: 143-153).

Abstract Objective: occult hepatitis B virus infection is characterized by the presence of the viral genome in serum and / or liver tissue samples but without surface antigen detection. The mechanisms of pathogenesis are not fully known. The purpose of this article is to discuss and describe the most important clinical, epidemiological and molecular aspects of this type of infection. Methods: we performed a literature search in PUBMED database of original works and reviews of the subject published between 1979 and 2012. The search was performed using the keywords "occult HBV infection, epidemiology, clinical implications, mechanisms and outcome". Relevant articles cited in the selected publications were also consulted. Conclusions: the identification of cases of occult hepatitis B virus infection and the description of its prevalence is important in preventing transmission of the infection and the development of terminal hepatic diseases. The availability of sensitive and specific methods for the detection of viral genome has allowed us to explore the epidemiology. However, the mechanisms of pathogenesis are still under examination. (Acta Médica Colombiana 2013; 38: 143-153).

Reunião com expertos em hepatotoxicidade da Sociedade Brasileira de Hepatologia: analgésicos, antitérmicos, insumos vegetais, fitoterápicos, homeopáticos e AINEs / Meeting with Society's Hepatotoxic Experts Brazilian Institute of Hepatology: Analgesics, Antipyretics, Vegetable, Phytotherapic, Homeopathic and AINS

No dia 05 de agosto de 2010, no Hotel Blue Tree, no bairro do Morumbi em São Paulo, a Sociedade Brasileira de Hepatologia realizou uma reunião de expertos para discutir alguns assuntos importantes referentes à toxicidade hepática. Esta reunião foi de responsabilidade exclusiva da Sociedade Brasileira de Hepatologia (SBH), sem interferência de agências ou da indústria farmacêutica. Dentre os assuntos discutidos, três deles mereceram destaque pelo volume de solicitações de esclarecimentos encaminhadas diretamente à Sociedade Brasileira de Hepatologia. O site da SBH recebe com frequência tais solicitações de outras sociedades ou diretamente de colegas, assim como do público não-médico, por questões pertinentes a estes assuntos: 1. papel do acetaminofen/paracetamol nas alterações hepáticas da dengue; 2. eficácia e segurança da medicina alternativa (homeopatia, medicina natural, fitoterápicos); 3. alterações hepáticas induzidas por analgésicos, antitérmicos e anti-inflamatórios não-esteroides com foco no seu uso na dengue.Dentro deste contexto, a Sociedade Brasileira de Hepatologia organizou uma sessão durante todo o dia 05 de agosto para discutir unicamente estes temas.

Scientific foundations of hormesis. Part 2. Maturation, strengths, limitations, and possible applications in toxicology, pharmacology, and epidemiology.

The notion of hormesis has undergone numerous modifications in the course of the 20th century. Because of its unfortunate association with homeopathy, hormesis did not gain acceptance among biomedical professionals. The lack of a plausible mechanism for its occurrence may have contributed much to the rejection of this concept. This treatise outlines the conceptual struggle for an understanding of the widespread occurrence of low dose effects that appear to be opposite to those caused by high doses as also seen in hormesis. An incomplete conceptualization of time as a fundamental variable of effects (in addition to dose) is identified as one of the major reasons why hermetic responses were not observed more frequently than was reported by Calabrese and Baldwin. The definition of hormesis as an (over)compensation response to an inhibitory signal lacks a designation for (over)compensation responses to stimulatory signals in the other direction. Hormoligosis, which was coined by Luckey for all low-dose stimulatory responses of toxins, is suggested as a suitable term for generalizing the latter types of effects. Both types of effects are recognized as originating in a homeostatic overcompensation response that optimizes the ability of an organism to meet challenges beyond the limits of normal (unexercised) adaptation. Thus, repeated biochemical/physiologic/immunological, etc. exercises like physical exercise make an organism more fit and hence both hormetic and hormoligotic effects will have life-prolonging consequences. A more complete generalization was developed by linking hormesis/hormoligosis with the vast literature on Selye's general adaptation syndrome to stress. According to this broader view, stress is just one type of homeostatic exercise making organisms more fit for future biochemical/physiological/immunological, etc.challenges. Therefore, both hormesis and hormoligosis are manifestations of two nonmutational evolutionary principles--homeostasis and optimization.

The case for a new system for oversight of research on human subjects.

The increasing emphasis on evidence-based clinical practice has thrown into sharp focus multiple deficiencies in current systems of ethical review. This paper argues that a complete overhaul of systems for ethical oversight of studies involving human subjects is now required as developments in medical, epidemiological and genetic research have outstripped existing structures for ethical supervision. It shows that many problems are now evident and concludes that sequential and piecemeal amendments to present arrangements are inadequate to address these. At their core present systems of ethical review still rely on the integrity and judgment of individual investigators. One possible alternative is to train and license research investigators, make explicit their responsibilities and have ethics committees devote much more of their time to monitoring research activity in order to detect those infringing the rules.

Malaria antes y después de la cura radical masiva en el estado Sucre Venezuela / Malaria before and after massive radical cure in Sucre state Venezuela

La transmisión de la malaria es producto de varios factores relacionados con el hospedero (socioeconómicos y geográficos), y con el parásito. También ha sido reconocido que su transmisión es sensible al clima y el ambiente, percibiéndose como la enfermedad metaxénica más propensa a ser afectada por los cambios climáticos globales. Datos recientes de Venezuela indican que la malaria se podía incrementar en, aproximadamente, un tercio en el año siguiente al evento de El Niño. La administración masiva de medicamentos antimaláricos como medida profiláctica ha generado cuestionamientos por susfracasos en la interrupción de la transmisión, dadas las bajas coberturas de tratados y la alta probabilidad de dispersión de parásitos resistentes a las drogas. En el estado Sucre la implementación de la cura radical masiva en 2002, cubrió 76,5% de la población en los municipios intervenidos, nivel suficiente para disminuir la semilla malárica y por ende, la incidencia de laenfermedad. Por lo tanto la solución delproblema no se logrará por una sola actividad o medida independiente, es importante el manejo de las variables humanas y técnicas, en lo particular el desarrollo social, que permita una relación armónica consigo mismo y su entorno, evitando el deterioro en la salud y calidad de vida de la población, concomitantemente con el desarrollo de nuevas herramientas para el control del vector y el parásito.

Improving homeopathic prescribing by applying epidemiological techniques: the role of likelihood ratio

A committee of the Dutch Association of Homeopathic Physicians is trying to validate materia medica by evaluating successful cases. These cases are presented and assessed by a group of experienced homeopathic... (AU)

Epidemiología y Homeopatía: son compatibles? Podemos hacer estadísticas en Homeopatía? / Epidemiology and Homeopathy: are compatibles?

En este artículo se hace una reflexión acerca de la posibilidad de utilizar métodos estadísticos en Homeopatía. Se presenta aquí una propueta para realizar un trabajo de investigación utilizando métodos estadísticos y epidemiológicos, en Homeopatía

Protocolo de tratamento homeopático das lesöes provocadas pelo Papiloma vírus humano / Homeopathic treatment protocol of the injuries caused by Human Papilloma Virus

O presente trabalho destaca a manutençäo de resultados de publicaçäo feita em 1993, a qual abrangia, na ocasiäo, um universo de 200 pacientes. No decorrer dos anos, fomos sentindo a necessidade de sistematizar o uso desse medicamento, a fim de atender uma demanda crescente de pacientes só evidentes numa epidemia. Na metade do ano de 1998, o número de casos tratados atinge a marca de aproximadamente 1000 pacientes. Apresentamos o protocolo de tratamento utilizado em nossos ambulatórios sobre o medicamento Thuya occidentalis nas lesöes em genitais masculinos e femininos provocadas pelo papiloma vírus humano.

Vacina: agressao isopatica ou cura homeopatica por antecipacao? / Vaccine: isopathic agression or homeopathic cure in advance?

O preconceito de que a homeopatia e contraria a vacinaca moderna levou os autores a uma analise do problema, objetivando a formulacao de que um conceito doutrinario a partir dos principios estabelecidos por Hahnemann. Concluiram que a vacinacao e uma especie de cura homeopatica por antecipacao, explicada pela extrema semelhanca entre a vacina e seu respectivo agente infeccioso natural

Vacina: agressao isopatica ou cura homeopatica por antecipacao? / Vaccine: isopathic agression or homeopathic cure in advance?

O preconceito de que a homeopatia e contraria a vacinaca moderna levou os autores a uma analise do problema, objetivando a formulacao de que um conceito doutrinario a partir dos principios estabelecidos por Hahnemann. Concluiram que a vacinacao e uma especie de cura homeopatica por antecipacao, explicada pela extrema semelhanca entre a vacina e seu respectivo agente infeccioso natural

Aislamiento de poblaciones de Serratia marcescens de origen clínico en dos institutos pediátricos / Isolation of populations of Serratia marcescens of clinical origin in two pediatrics institutions

Introudcción. Serratia marcescens es un patógeno oportunista en hospederos inmunocomprometidos y se asocia fundamentalmente a brotes intrahospitalarios con tasas de letalidad elevadas. El propósito del presente estudio fue tipificar 2 poblaciones de S. marcescens de origen clínico aisladas en 2 institutos pediátricos semejantes. Material y métodos. Se empleó el sistema de biotipificación propuesto por Grimont para la caracterización de 65 cepas del Hospital Infantil de México, originalmente clasificadas como Enterobacter sp y 35 cepas del Instituto Nacional de Pediatría aisladas en un brote intrahospitalario. Reesultados. El biogrupo más numeroso en ambas poblaciones fue el A 5/8 y de éste los biotipos A8a y A8b; se observaron variaciones en las proporciones de los biotipos identificados acordes al hospital de aislamiento, así como en los biotipos y patrones de resistencia a los antibióticos en cepas aisladas del mismo pacientes en muestras diferentes. Conclusiones. Del presente estudio se concluye que es importante que en los hospitales se realicen estudios epidemiológicos particulares de sus poblaciones de S. marcescens, pero es más importante aún que se lleve a cabo una correcta identificación de esta bacteria para valorar adecuadamente su importancia como patógeno oportunista en nuestro medio

El novedoso tratamiento del cólera realizado por un médico mexicano en el siglo XIX / A novel therapy for cholera designed by a Mexican physician during the 19th century

En la epidemia de cólera que padeció la Ciudad de México en 1850, el doctor Felipe Castillo, entonces director del hospital de San Pablo, utilizó "agua salada" en el tratamiento de coléricos que se atendieron en el hospital. Considerando que en esa época se ignoraba la etiopatogenia de la enfermedad, el proceder de Castillo fue innovador. Este estudio está basado en un informe inédito, clasificado como anónimo, que presentó el doctor Castillo al Gobernador de la Ciudad durante la epidemia

Inflamacion e infeccion (Bloque 2.6) / ssss

El bloque permite al medico en formacion ampliar su analisis y comprension del medelo economico social vigente y su relacion con estos procesos en cada caso problema se hara emfasis en evidenciar la relacion de estos procesos (infeccion e inflamacion) con los factores etiologicos o de riesgo de origen biogeneticos, psicologicos y sociales asociados a cada sistema organico correlacionandolas con la patogenia y fisiopatologia...