Removal efficiency for emerging contaminants in a WWTP from Madrid (Spain) after secondary and tertiary treatment and environmental impact on the Manzanares River.

The effluents from wastewater treatment plants (WWTPs) can be an important contamination source for receiving waters. In this work, a comprehensive study on the impact of a WWTP from Madrid on the aquatic environment has been performed, including a wide number of pharmaceuticals and pesticides, among them those included in the European Watch List. 24-h composite samples of influent (IWW) and effluent wastewater after secondary (EWW2) and after secondary + tertiary treatment (EWW3) were monitored along two campaigns. Average weekly concentrations in IWW and EWW2 and EWW3 allowed estimating the removal efficiency of the WWTP for pharmaceutical active substances (PhACs). In addition, the impact of EWW3 on the water quality of the Manzanares River was assessed, in terms of PhAC and pesticide concentrations, through analysis of the river water collected upstream and downstream of the discharge point. After a preliminary risk assessment, a detailed evaluation of the impact on the aquatic environment, including a toxicological study and screening of pharmaceutical metabolites, was made for the seven most relevant PhACs: sulfamethoxazole, azithromycin and clarithromycin (antibiotics), metoprolol (antihypertensive), diclofenac (anti-inflammatory/analgesic), irbesartan (antihypertensive), and the antidepressant venlafaxine. Among selected PhACs, irbesartan, clarithromycin and venlafaxine presented moderate or high risk in the river water downstream of the discharge. Albeit no acute toxicity was detected, more detailed studies should be carried out for these substances, including additional toxicological studies, to set up potential sublethal and chronic effects on aquatic organisms.

A robust GC-MS/MS method for the determination of chlorothalonil in fruits and vegetables.

Chlorothalonil is a non-systemic fungicide that is easily degraded in contact with plants and soil or even by the effect of light and pH. A method for the determination of chlorothalonil in courgettes, strawberries, oranges, leeks and tomato by solvent extraction followed by GC-MS/MS with a triple quadrupole analyser was developed. The causes of chlorothalonil degradation during sample treatment were studied and minimised. The final method was based on extraction with acetone in the presence of 0.1 M EDTA sodium salt solution, and clean-up by SPE using OASIS HLB cartridges. Isotope-labelled hexachlorobenzene (HCB-(13)C(6)) was added as an internal standard to the SPE extracts before analysis by GC-MS/MS (EI) (QqQ) analysis in order to correct for instrumental deviations. Quantification was performed by matrix-matched standard calibration using relative responses to the internal standard. Two MS/MS transitions were used for mass spectrometric determination of chlorothalonil to ensure reliable quantification and confirmation. The method was validated using blank samples (for all matrices) spiked at two levels. Recoveries between 77% and 110% and an RSD below 20% were obtained for 0.1 and 0.01 mg kg(-1) spiking levels (n = 5). The validated method was applied to treated and untreated samples collected from an experimental field where a chlorothalonil formulated was applied.

Tobacco use and cessation counselling: cross-country. Data from the Global Health Professions Student Survey (GHPSS), 2005-7.

BACKGROUND: Brief intervention by a health professional can substantially increase smoking cessation rates among patients. However, few studies have collected information on tobacco use and training to provide cessation counselling among health professional students. OBJECTIVE: To examine tobacco use prevalence and tobacco cessation training among students pursuing advanced degrees in health professions. METHODS: The Global Health Professions Student Survey (GHPSS) has been conducted among third-year students attending dental, medical, nursing and pharmacy schools. The GHPSS was conducted in schools during regular lectures and class sessions. GHPSS follows an anonymous, self-administered format for data collection. RESULTS: The GHPSS was completed by at least one of the four target disciplines in 31 countries between 2005 and 2007 for a total of 80 survey sites. In 47 of the 80 sites, over 20% of the students currently smoked cigarettes; and in 29 of 77 sites, over 10% of the students currently used other tobacco products. GHPSS data showed that the majority of health professional students recognised that they are role models in society, believed that they should receive training on counselling patients to quit using tobacco, but in 73 of 80 sites less than 40% of the students reported they received such training. CONCLUSIONS: Health professional schools, public health organisations and education officials should discourage tobacco use among health professionals and work together to design and implement programmes that train all health professionals in effective cessation counselling techniques. If the goal of the tobacco control community is to reduce substantially the use of tobacco products, then resources should be invested in improving the quality of education of health professionals with respect to tobacco control.

Comparison of two quantitative GC-MS methods for analysis of tomato aroma based on purge-and-trap and on solid-phase microextraction.

Two analytical procedures, one based on purge-and-trap and the other on solid phase microextraction, both followed by GC-MS measurement using an ion-trap mass spectrometer in the electron impact mode, have been developed for determination and quantitation of up to 39 aroma compounds in fresh tomatoes. The method based on purge-and-trap for isolation of the volatile compounds uses Tenax as adsorbent and a hexane-diethyl ether mixture as solvent for elution. The method was validated for linearity, precision (better than 20% for most compounds), and limit of detection, which was approximately 1 ng g(-1). This method enabled identification of up to 30 compounds in real samples. Use of SPME was considered as an alternative, to simplify sample treatment while maintaining the information level for the samples (e.g. the number of compounds detected) and quality of quantitation. A procedure based on SPME using a Carboxen/polydimethylsiloxane fibre was developed and validated for determination of 29 aroma compounds; precision was better than 20% and limits of detection ranged from 4 to 30 ng g(-1).

Application of solid-phase microextraction for the determination of pyrethroid residues in vegetable samples by GC-MS.

A solid-phase microextraction (SPME) method has been developed for the determination of 7 pyrethroid insecticides (bifenthrin, lambda-cyhalothrin, permethrin, cyfluthrin, cypermethrin, fenvalerate, and tau-fluvalinate) in water, vegetable (tomato), and fruit (strawberry) samples, based on direct immersion mode and subsequent desorption into the injection port of a GC/MS. The SPME procedure showed linear behavior in the range tested (0.5-50 microg L(-1) in water and 0.01-0.1 mg kg(-1) in tomato) with r(2) values ranging between 0.97 and 0.99. For water samples limits of detection ranged between 0.1 and 2 microg L(-1 )with relative standard deviations lower than 20%. Detection limits for tomato samples were between 0.003 and 0.025 mg kg(-1) with relative standard deviations around 25%. Finally, the SPME procedure has been applied to vegetable (tomato) and fruit (strawberry) samples obtained from an experimental plot treated with lambda-cyhalothrin, and in both cases the analyte was detected and quantified using a calibration curve prepared using blank matrix. SPME has been shown to be a simple extraction technique which has a number of advantages such as solvent-free extraction, simplicity, and compatibility with chromatographic analytical systems. Difficulties with the correct quantification in a complex matrix are also discussed.

El consumo de sustancias adictivas en las Américas / Use of addictives substances in the Americas

El consumo de tabaco, alcohol y otras drogas está ligado a cerca de una cuarta parte de las defunciones anuales que se producen en las Américas. En el Cono Sur de América Latina, a los 15 años de edad ya fuma cerca del 40 por ciento de los jóvenes y la gran mayoría respira en casa el aire contaminado por el humo de tabaco de los demás. En América Latina cada persona consume en promedio 6 kilos de alcohol puro por año, lo que constituye la cifra más alta del mundo menos desarrollado. Aunque los datos sobre el consumo de drogas ilegales no son abundantes sabemos que la marihuana es la droga que mayor proporción de la población consume. Se estima que 45 millones de ciudadanos de las américas la consumen. Si bien la carga de enfermedad que genera el consumo de drogas ilegales no llega a la magnitud de la ocasionada por las drogas ilegales, las consecuencias sociales son mucho mayores. Las respuestas de los países de las Américas al consumo de sustancias adictivas han sido insuficientes. Los principales desafíos para el control del tabaquismo y del uso de alcohol en las Américas son dos: disminuir la asequibilidad de los productos y evitar la exposición de la población a las prácticas comerciales de promoción de los productos de las industrias tabacalera y alcoholera. Además, en el caso del tabacco, hay que proteger a los no fumadores del humo de los demás. En el caso de las sustancias ilegales, los resultados hasta ahora de un enfoque orientado al control de la oferta han sido limitados. El desafío es hacer hincapié en el control de la demanda, mediante intervenciones de prevención, desintoxicación, tratamiento y rehabilitación, así como de reducción de daño (AU)

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[Availability of condoms in Mexico City]. / Disponibilidad de condones en la ciudad de México.

INTRODUCTION: At the beginning of 1999, Mexico occupied third place, after USA and Brazil, in the number of accumulated cases of AIDS (38,390 notified cases) in America. More than 80% of the cases corresponded to men between 20 and 44 years old. The transmission by sexual route has increased in both sexes, the proportion of men infected by sexual contact increased from 85% in 1991 to 90% in 1998 and in women this proportion increased from 41% in 1991 to 57% in 1998. The ratio male/female of cases of AIDS has varied from 17:1 in 1983 to 6:1 in 1998. Condom use is considered an effective method for the prevention of the transmission of STI's/HIV and therefore the availability is of paramount importance to promote use with the finality of combating these diseases. METHOD: A simple randomized sampling was done in 612 establishments that included: drugstore, bars and nightclubs, hotels and motels, self-service shops and health centers in Mexico City, where am cross sectional study was performed during June and July of 1995, to evaluate the availability of condoms considering three important items: a) percent per capita required to buy an annual endowment of 100 condoms in comparison with this same indicator reported in other countries; b) physical availability, on behalf of the Secretaría de Salud, Mexico City, that considers the volume of existing condoms to be utilized for a year by the public sector in this city; c) physical availability of condoms in different evaluated locations. RESULTS: In order to purchase an annual supply of condoms an individual needs the assign $500 (Pesos) which represents 2.3 to 2.6% of the annual GNP per capita for 1998 and 1997 respectively. The physical availability of condoms, on behalf of the Secretaría de Salud, Mexico City, was 94.9% in health centers. In drugstores, hotels and motels, self-service shops, bars and nightclubs the availability of condoms was 100%, 82.9%, 75% and 1.2%, respectively. CONCLUSIONS: It has been documented that the adequate use of condom is an effective strategy for the prevention of STI's/HIV, therefore the availability of this method of prevention is important to decrease the incidence of these diseases The results of this study indicate that the price for this method of prevention represents an important expense for the homes, which is a limiting factor for condom use, especially for those populations that include adolescents and young adults. It then becomes necessary for Government Institutions to implement programs that will subsidize this method of prevention. Availability is less in self-service shops and practically non-existent in bars and nightclubs. It is suggested that the availability of condom should be mandatory in public places, like bars and nightclubs, where the risk to start casual sexual contact is eminent.

[Analysis of participation in surveys in 5 countries: the importance for public health research]. / Análisis de la participación en encuestas de cinco países: relevancia para la investigación en salud pública.

This study compares participation rates and reasons for nonresponse in surveys conducted in five countries of Latin America and the Caribbean. The objective of the surveys was to measure the prevalence of risk behaviors affecting the transmission of human immunodeficiency virus. The surveys were based on probability samples of the population of both sexes between 15 and 49 years old, except in Mexico, where only men were included. Proportions of three components of participation were estimated: residences interviewed, interviewed residences with eligible persons, and eligible persons who completed the interview. In addition, an overall index that combined the three components was calculated. The overall response rate ranged from 35.6% in Mexico to 81.4% in Chile. The component with the greatest variability was the participation of eligible persons, which ranged from 50% in Mexico to 95% in Cuba. These values were lower than what had been expected, especially among men, and will serve to guide future surveys, since rejection rates higher than the ones expected in the protocol should be considered. The results make it possible to infer the validity of the prevalence estimates for the various observed risk behaviors. The results also establish a benchmark to calculate the sample size in future surveys and to improve research methodology.

Underestimation of Mycobacterium tuberculosis infection in HIV-infected subjects using reactivity to tuberculin and anergy panel.

BACKGROUND: This study aimed to evaluate purified protein derivative (PPD) reactivity and its interrelationship with anergy panel and CD4+ lymphocytes in HIV-infected subjects as compared to PPD reactivity in HIV-uninfected individuals in a tuberculosis endemic and high Bacillus Calmette-Guérin (BCG) coverage environment. METHODS: Clients of four Mexico City HIV detection centres were screened for HIV-1 antibodies (ELISA or haemagglutination, Western Blot); reactivity to PPD (Mantoux PPD, 5TU RT-23), Candida (1:1000, 0.1 ml), and tetanus toxoid (10Lf, 0.1 ml); and CD4+ T cells. Active tuberculosis was excluded. Informed consent was obtained. RESULTS: From 5130 clients 1168 subjects were enrolled; of these 801 (68.6%) were HIV positive. Reactivity to PPD among HIV-positive subjects was found in 174 (22%), 261 (32.6%), and 296 (37%), at PPD cutoff levels of > or =10 mm, > or =5 mm, and > or =2 mm as compared to 224 (61%) of 367 HIV-negative individuals' reactors to PPD (> or =10 mm) (P < 0.001). After exclusion of anergic individuals using two cutoff levels for cutaneous allergens (< or =2 mm and < or =5 mm), PPD reactivity between HIV-infected and uninfected individuals continued to be significantly different. Only HIV-infected individuals with CD4+ T cells > or =500 cells/mm3 had similar reactivity to PPD as HIV-uninfected individuals. Variables associated with PPD reactivity were CD4+ T cell counts, BCG scar, HIV infection and age. CONCLUSIONS: PPD reactivity was useful to diagnose tuberculosis infection only among HIV-infected individuals with CD4+ counts > or =500 cells/mm3. Among individuals with lower counts, lowering cutoff levels or using anergy panel did not permit comparable reactivity as that observed among HIV-uninfected individuals.

[Myths about the prevention and control of non-communicable diseases in Latin America]. / Mitos sobre la prevención y el control de las enfermedades no transmisibles en América Latina.

Given the increase of the burden of non-communicable diseases (NCD) and the possibility to avoid it, it is urgent to implement or strengthen NCD preventive programs in Latin America. However, many myths hinder the implementation of NCD programs. Myths on NCD include: a) NCD are degenerative and incurable; b) they are diseases of the elderly; c) they are diseases of the rich. Like wise there are myths about NCD preventive programs are: a) difficult to implement, b) expensive, and c) ineffective. We present data that demonstrate how these myths are untrue and discuss the challenges to find a balanced health policy that emphasizes the importance of NCD without overlooking other diseases.

[Prevalence of hypertension in Valparaíso. Results of the base survey of the CARMEN project (Set of measures for the multifactorial reduction of non-transmissible diseases)]. / Prevalencia de hipertensión arterial en Valparaíso. Resultados de la encuesta de base del programa CARMEN (conjunto de acciones para la reducción multifactorial de las enfermedades no transmisibles).

BACKGROUND: There is little information about the real prevalence of hypertension in Chile. AIM: To assess the adjusted prevalence of hypertension and its main therapeutic measures among adults living in Valparaiso, Chile. MATERIALS AND METHODS: A random sample of dwellings in Valparaiso was chosen. Among these, an individual of 25 to 64 years old was randomly surveyed for risk factors for chronic diseases and sociodemographic parameters. Blood pressure, weight, height, oral glucose tolerance test, fasting cholesterol and triglycerides were also measured. Prevalence was pondered according to age, sex, and probability of selection in the dwelling interior. RESULTS: Three thousand one hundred twelve individuals were studied. The adjusted prevalence of hypertension was 11.4% (11.6% among females and 10.6% among men). The prevalence increased along with age from 3 and 1.9% in men and women of 25 to 34 years old respectively, to 18.2 and 27.4% among men and women of 55 to 64 years old (p < 0.01). People of low socioeconomic level had a higher prevalence of hypertension than those of high socioeconomic level (14.2 and 9.3% respectively, P < 0.05). Diabetes, obesity and hypercholesterolemia were significantly more frequent in subjects with hypertension than in the general population. Forty-four percent of diagnosed hypertensives were receiving medications (angiotensin converting enzyme inhibitors 40%, calcium antagonists 34%, beta blockers 22%). Twenty five percent of patients were treated with a combination of medications. Of those treated, only 22% had normal blood pressure levels at the moment of examination. CONCLUSIONS: High blood pressure is an important public health problem that requires more efficient detection and treatment programs.

[Characteristics of sex behavior of men in Mexico City]. / Características de comportamiento sexual en hombres de la Ciudad de México.

OBJECTIVE: To determine the major features of sexual behavior in men from Mexico City, such as the number of sexual partners, history of sexually transmitted disease (STD) and beliefs on AIDS. MATERIAL AND METHODS: A transversal epidemiologic study was conducted in 1995 based on multistage sampling with conglomerates. A total of 1,377 males from 15 to 49 years of age was interviewed by means of a structured questionnaire. Statistics such as Student's test and chi 2 were applied to determine significance. RESULTS: Subject mean age was 17.7 years (SD = 2.8 years) Overall proportion of condom use in the last intercourse was 24.6% depending on the type of partner: 18.8% used it with regular partners and 62.5% with multiple partners. Symptoms suggesting gonococcal uretritis were found in 2%. Finally, 97.5% understood the meaning of AIDS and knew some protective measures against infection. CONCLUSIONS: Some risky characteristics of sexual behavior were identified concerning the transmission of STD such as multiple sexual partners, not using condom and STD antecedents.

Factors associated with condom use in the male population of Mexico City.

Sexually transmitted diseases (STDs) are an important public health problem, due to their medical, social and economic repercussions. Therefore, more knowledge is needed about the sexual behaviour that promotes their spread, in order to improve control and prevention strategies. Our aim was to determine the frequency of male condom use associated with sexual behaviour factors, a history of and knowledge about STDs in a sample of the male population in Mexico City. During 1994 a cross-sectional epidemiological study was carried out, using multi-stage sampling with conglomerates, in 1377 men from 15 to 49 years old. The mean age was 34.5 years (SD 7.5 years). Mean age at first sexual relations was 17.7 years (SD 2.8 years). The global proportion of condom use during the last sexual relation was 24.6%; use according to type of female sex partner in the last year was 18.8% with regular partners and 62.5% with occasional partners. The principal predictors of male condom use, identified through statistical modelling, were: younger age (<25 years), middle and high education level (>9 years), middle and high socioeconomic level and type of sexual partners (occasional and regular). This population has risk factors for acquiring and transmitting some STDs, such as occasional sexual partners and a history of STDs. Characteristics which are important in relation to male condom use were identified, such as age (younger than 35), education (complete junior high school or more) and type of sexual partners (occasional and regular).

PIP: A cross-sectional epidemiological study was conducted in 1994 to determine the frequency of condom use in Mexico City among sexually active men aged 15-49 years old, and the association with sexual behavior and a history of or knowledge about STDs. The 1377 men interviewed were of mean age 34.5 years, and experienced their first sexual intercourse at mean age 17.7 years. 47% of the men reported using a condom at least once in their lives and 81.6% were married. 79.4% reported having a formal partner, 14.6% had relations with occasional partners, and 6.1% with both regular and informal partners. 26.4% used a condom during their most recent sexual intercourse, 18.8% with formal partners and 62.5% with casual partners. Condom use with formal partners was largely to prevent pregnancy, while condom use with casual partners was to prevent the transmission of STDs. Young and single men were almost twice as likely to use condoms as older married men. The main predictors of male condom use were therefore being under 25 years old, having more than 9 years of formal education, being of middle to high socioeconomic status, and type of sex partners.

[Risk factors for non communicable diseases: methods and global results of the CARMEN program basal survey]. / Factores de riesgo para las enfermedades no transmisibles: metodología y resultados globales de la encuesta de base del programa CARMEN (Conjunto de Acciones para la Reducción Multifactorial de las Enfermedades no Transmisibles).

BACKGROUND: In the last decades, chronic non communicable diseases are becoming the main cause of disability and mortality among adults. The risk factor surveillance and management is the most efficient mean of reducing the impact of these diseases. AIM: To report the results of a non communicable disease risk factor surveillance program in Valparaiso, Chile. MATERIAL AND METHODS: A random samples of people aged 25 to 64 years old living in Valparaiso, Chile was studied. Subjects were questioned about smoking and physical activity habits. Blood pressure, height and weight were measured using standardized techniques at their homes and blood samples were obtained to measure serum lipid levels and oral glucose tolerance test at the nearest outpatient clinic. RESULTS: Of the initial 3852 homes selected, 752 individuals did no agree to answer the inquiry, therefore 3120 subjects were finally interviewed. Of these, 40.6% were smokers, 15% drank alcohol in two or more occasions per month, 84.6% were physically inactive, 19.7% had a body mass index over 30 kg/m2, 11.1% had high blood pressure, 3.9% were diabetic and 46.9% had high serum cholesterol levels. CONCLUSIONS: The basal survey for the CARMEN program shows a high prevalence of cardiovascular risk factors among Chileans.

Incidence of HIV and HTLV-1 infection among sexually transmitted disease clinic attenders in Jamaica.

Of 970 sexually transmitted disease (STD) patients enrolled at the Comprehensive Health Centre, Kingston, Jamaica, between November 1990 and January 1991, 710 (73%, 333 men and 377 women) were reexamined between January 1992 and July 1993 to estimate the incidence of HIV and HTLV-I infection and to identify risk factors for infection. Of those reexamined, 20% were recruited passively when they returned to the clinic of their own accord, and 80% were recruited actively through field visits to their homes. Passively recruited persons were significantly more likely than active recruits to have had a sexually transmitted disease since enrollment or at their follow-up visit. Seven men and one woman became HIV positive during the period of follow-up. The overall HIV incidence rate was 0.7 per 100 person years (95% confidence interval [CI] = 0.3 to 1.4), 1.4 (CI = 0.6 to 2.8) for men and 0.2 (CI = 0.004 to 0.9) for women. Four of 270 men and 4 of 318 women were HTLV-I positive, an overall incidence of 0.9 per 100 person years (CI = 0.4 to 1.7), 1.0 for men and 0.8 for women. HTLV-I infection was associated with an age of 30 years or older (p < 0.01). The presumed lower transmission probability for HTLV-I may combine with a higher prevalence of HTLV-I in sexual partners to produce similar overall incidence rates for the two infections. The HIV and HTLV-I incidence rates may have been underestimated, because the study subjects who did not return to the clinic may have had a somewhat higher risk. On univariate analysis, there were significant associations between HIV infection in men and drinking alcohol before sex, cocaine use, total number of sex partners, sex with a prostitute since enrollment, ever accepting money for sex, the average number of sex partners per month, bruising during sex, and genital ulcers found on follow-up examination. This analysis needs to be interpreted with caution in view of the small number of seroconverters, which did not allow testing for independent effects in a logistic regression model.

Opportunistic infections in pediatric HIV infection: a study of 74 autopsy cases from Latin America. The Latin American AIDS Pathology Study Group.

The present report describes opportunistic infections found at 74 autopsies of pediatric HIV/AIDS patients performed at several hospitals in Latin American countries. Fungal infections were the most common (53 cases), Candida sp. (39.18%) and Pneumocystis carinii (20.27%) being the most frequently recognized. Other fungal diseases included histoplasmosis, aspergillosis, and cryptococcosis. Viral infections were present in 31 cases, 38.7% being due to cytomegalovirus. Other viruses recognized included herpes simplex and adenovirus. Additional opportunistic infections were due to Mycobacterium avium-intracellulare, toxoplasmosis, and tuberculosis. Nonspecific bacterial bronchopneumonia was present in 11 cases. Cytomegalovirus and P. carinii coinfection was the most common association found. In this series patients died at a younger age (72% at or younger than 1 year old) and there was a slightly higher number of cases of histoplasmosis and brain toxoplasmosis than in other previously published series of infants and children.

Trends in cervical cancer mortality in the Americas.

This article presents an assessment of cervical cancer mortality trends in the Americas based on PAHO data. Trends were estimated for countries where data were available for at least 10 consecutive years, the number of cervical cancer deaths was considerable, and at least 75% of the deaths from all causes were registered. In contrast to Canada and the United States, whose general populations had been screened for many years and where cervical cancer mortality has declined steadily (to about 1.4 and 1.7 deaths per 100,000 women, respectively, as of 1990), most Latin American and Caribbean countries with available data have experienced fairly constant levels of cervical cancer mortality (typically in the range of 5-6 deaths per 100,000 women). In addition, several other countries (Chile, Costa Rica, and Mexico) have exhibited higher cervical cancer mortality as well as a number of noteworthy changes in this mortality over time. Overall, while actual declining trends could be masked by special circumstances in some countries, cervical cancer mortality has not declined in Latin America as it has in developed countries. Correlations between declining mortality and the intensity of screening in developed countries suggest that a lack of screening or screening program shortcomings in Latin America could account for this. Among other things, where large-scale cervical cancer screening efforts have been instituted in Latin America and Caribbean, these efforts have generally been linked to family planning and prenatal care programs serving women who are typically under 30; while the real need is for screening of older women who are at substantially higher risk.

PIP: Each year, approximately 52,000 new cases of cervical carcinoma occur in Latin America and the Caribbean. In contrast to developed countries, where the incidence of cervical cancer has declined over the past 30 years, there has been no such trend in Latin America. This study used Pan American Health Organization (PAHO) data to estimate cervical cancer mortality trends in the 14 countries in the Americas for which data were available for at least 10 consecutive years, the number of cervical cancer deaths was substantial, and at least 75% of deaths from all causes were registered. Marked declines in cervical cancer mortality in the US and Canada have occurred in all age groups (especially the 40-64 year group) since 1960; by 1990, the mortality rates from this cause were 1.4 and 1.7/100,000 women, respectively. In the Latin American and Caribbean countries with available data, cervical cancer mortality has remained fairly constant since 1960 at about 5-6 deaths/100,000 women. In Mexico, Chile, and Costa Rica, cervical cancer mortality has increased over time, largely among women over 40 years of age, as a result of the concentration of screening efforts on younger women attending prenatal or family planning clinics. In some Latin American countries, declining cervical cancer mortality rates may be masked by improvements in death registration and the accuracy of death certification. In general, Latin American countries exhibit large within-country variation in cervical cancer incidence and mortality, reflecting differential access to cervical cancer screening and treatment.

Risk factors for HTLV-I among heterosexual STD clinic attenders.

Human T-cell lymphotropic virus type 1 (HTLV-I) status was assessed in 994 patients attending a sexually transmitted disease (STD) clinic in Kingston, Jamaica, between November 1990 and January 1991 for a new STD complaint. Of 515 heterosexual men, 36 (7.0%) were HTLV-I seropositive, as were 38 (7.9%) of 479 women. HTLV-I seroprevalence increased with age in women. A history of blood transfusion was associated with HTLV-I in both sexes, significantly so in men [odds ratio (OR) 4.7, confidence interval (CI) 1.1-17 for men; OR 1.9, CI 0.6-5.0 for women]. Further analysis excluded all persons reporting a transfusion. On multiple logistic regression analysis, independent associations with HTLV-I infection in men were shown for marital status (OR 3.5, CI 1.2-10 for married/common law vs. single/visiting unions), agricultural occupation (OR 9.0, CI 2.0-41), bruising during sex (OR 2.9, CI 1.0-8.1), > or = 15 years at first sexual intercourse (OR 2.9, CI 1.0-8.2), and a positive test for hepatitis B surface antigen (OR 7.3, CI 1.2-52). In women, associations were shown for two or more sex partners in the 4 weeks prior to complaint (OR 4.9, CI 1.8-13), 11 or more lifetime sexual partners (OR 5.9, CI 1.3-27), aged < 15 years at first sexual intercourse (OR 2.3, 1.0-5.4), bruising during sex (OR 2.7, CI 1.1-6.6), microhaemagglutination-Treponema pallidum positivity (OR 3.6, CI 1.6-8.4), and human immunodeficiency virus infection (OR 14, CI 2.1-92).(ABSTRACT TRUNCATED AT 250 WORDS)

HIV/AIDS and its interaction with tuberculosis in Latin America and the Caribbean.

At present, human immunodeficiency virus (HIV) is thought to have infected over 17 million people worldwide, over 1 million in North America and roughly 2 million in Latin America and the Caribbean. By comparison, infection with the tuberculosis (TB) agent Mycobacterium tuberculosis is far more common, current estimates indicating that roughly one-third of the world's population is infected. These two infections tend to aggravate each other. That is, HIV leads to a progressive immune system depression that favors reactivation of TB in people with latent tuberculous infections; it promotes progression of TB primary infections or reinfections to full-blown tuberculous disease; and it fosters TB transmission, because those simultaneously infected with HIV and M. tuberculosis tend to develop a bacilliferous and contagious TB that can be transmitted to other susceptible individuals, even though the latter are HIV-negative. In addition, this coinfection tends to promote circulation of drug-resistant M. tuberculosis and to produce peculiar manifestations that complicate TB diagnosis, treatment, and control. Overall, it seems clear that the growing threat posed by these associated agents demands effective action in the form of well-coordinated measures involving throughgoing participation by all countries.