Estado y prevención del cáncer digestivo en el norte de Chile / Status and prevention of digestives cancer in the north of Chile

In Chile, the cancer has become the main cause of death; the Northern Regions of Chile do not escape to this rea- lity. Both nationally and in the North of Chile, digestives cancers constitute the main cause of death over cancers of other organs. There is currently a National Cancer Law and a National Cancer Plan that provide the legal and technical framework for the implementation of preventive strategies that include the establishment of screening tests according to the local reality of each health service, however, there is still a limitation in the resources avai- lable for its implementation. Local experiences, such as the one carried out in the Region of Antofagasta , have shown in Colorectal Cancer (CRC) that by using a quantitative fecal immunochemcal test for occult blood in stools (FIT) as a screening method, asymptomatic patients carrying CRC can be detected in early stages of their disease, it also allows us to detect patients with CRC precursor lesions (adenomas with high and/or low grade dysplasias). It is important to continue advancing for the moment with the support of Regional Governments in obtaining fi- nancial resources to implement the different screening tests with clinical evidence for the main digestive cancers that affect the population of the Northern Macrozone of Chile.

En Chile el cáncer se ha convertido en la principal causa de muerte, las Regiones del Norte de Chile no escapan a esta realidad. Tanto a nivel Nacional como en el Norte de Chile, los cánceres digestivos en grupo constituyen la principal causa de muerte por sobre los cánceres de otros órganos. Existe actualmente una Ley Nacional del Cáncer y un Plan Nacional del Cáncer que dan el marco legal y técnico para la implementación de estrategias preventivas que incluyen la instauración de test de tamizajes o cribados según la realidad local de cada servicio de salud, sin embargo, aún existe limitación en los recursos disponibles para su implementación. Experiencias locales como la realizada en la Región de Antofagasta, han demostrado que en Cáncer Colorrectal (CCR), mediante el uso de un test inmunoquímico de sangre oculta en deposiciones cuantitativo (TSODi) como método de tamizaje, se pueden detectar pacientes asintomáticos portadores de CCR en etapas precoces de su enfermedad, además, permite detectar pacientes portadores de lesiones precursoras del CCR (adenomas con displasias de alto y/o bajo grado). Es importante seguir avanzando por el momento con apoyo de Gobiernos Regionales en la obtención de los recursos financieros para implementar los distintos test de tamizajes con evidencia clínica para los principales cánceres digestivos que afectan a la población de la Macrozona Norte de Chile

Automated extraction of information from free text of Spanish oncology pathology reports.

Background: Pathology reports are stored as unstructured, ungrammatical, fragmented, and abbreviated free text with linguistic variability among pathologists. For this reason, tumor information extraction requires a significant human effort. Recording data in an efficient and high-quality format is essential in implementing and establishing a hospital-based-cancer registry. Objective: This study aimed to describe implementing a natural language processing algorithm for oncology pathology reports. Methods: An algorithm was developed to process oncology pathology reports in Spanish to extract 20 medical descriptors. The approach is based on the successive coincidence of regular expressions. Results: The validation was performed with 140 pathological reports. The topography identification was performed manually by humans and the algorithm in all reports. The human identified morphology in 138 reports and by the algorithm in 137. The average fuzzy matching score was 68.3 for Topography and 89.5 for Morphology. Conclusions: A preliminary algorithm validation against human extraction was performed over a small set of reports with satisfactory results. This shows that a regular-expression approach can accurately and precisely extract multiple specimen attributes from free-text Spanish pathology reports. Additionally, we developed a website to facilitate collaborative validation at a larger scale which may be helpful for future research on the subject.

Introducción: Los reportes de patología están almacenados como texto libre sin estructura, gramática, fragmentados o abreviados, con variabilidad lingüística entre patólogos. Por esta razón, la extracción de información de tumores requiere un esfuerzo humano significativo. Almacenar información en un formato eficiente y de alta calidad es esencial para implementar y establecer un registro hospitalario de cáncer. Objetivo: Este estudio busca describir la implementación de un algoritmo de Procesamiento de Lenguaje Natural para reportes de patología oncológica. Métodos: Desarrollamos un algoritmo para procesar reportes de patología oncológica en Español, con el objetivo de extraer 20 descriptores médicos. El abordaje se basa en la coincidencia sucesiva de expresiones regulares. Resultados: La validación se hizo con 140 reportes de patología. La identificación topográfica se realizó por humanos y por el algoritmo en todos los reportes. La morfología fue identificada por humanos en 138 reportes y por el algoritmo en 137. El valor de coincidencias parciales (fuzzy matches) promedio fue de 68.3 para Topografía y 89.5 para Morfología. Conclusiones: Se hizo una validación preliminar del algoritmo contra extracción humana sobre un pequeño grupo de reportes, con resultados satisfactorios. Esto muestra que múltiples atributos del espécimen pueden ser extraídos de manera precisa de texto libre de reportes de patología en Español, usando un abordaje de expresiones regulares. Adicionalmente, desarrollamos una página web para facilitar la validación colaborativa a gran escala, lo que puede ser beneficioso para futuras investigaciones en el tema.

Two national mammography quality certification programs in Brazil: Framework and main outcomes between 2017 and 2021.

BACKGROUND: This study aims to provide an academic medical overview of the framework and key outcomes of two mammography quality certification programs in Brazil. METHODS: These programs assess radiation dose and phantom image quality in mammography units through a postal system. Each unit that passes this initial assessment is required to submit a sample of copies of five complete examinations. The quality of the patient images and reports is then reviewed by radiologists and medical physicist experts. Additionally, the number of mammography units and mammography coverage in the target population, were assessed. RESULTS: During the study period, 1007 units applied to the certification programs, and 934 (92.8%) successfully passed the assessment of radiation dose and phantom image quality. Out of these, 556 (59.5%) also passed the review of clinical image quality and reports, earning certification. The main issues related to mammogram and report quality were associated with the performance of radiographers (in terms of positioning) and radiologists (in terms of interpretation). On average, there are more than two mammography units/10,000 women in the target group. The screening mammography coverage in this group is 26.3% for women relying exclusively on the public healthcare and 58.1% for women with private healthcare plans. CONCLUSION: This study demonstrates the suitability of the framework adopted by national mammography quality certification programs in a middle-income country. These programs are carried out by relatively small workforce and at reasonable costs, utilizing postal resources to cover the large number of existing mammographic units and the vast distances within the country. POLICY STATEMENT: All mammography services in Brazil must adhere to the quality requirements for examinations and reference values for radiation dose to women established by the Ministry of Health. This ensures standardized conditions for early detection of breast cancer and minimizes the risk associated with x-rays.

Valoración de algunos indicadores del programa de atención a la conducta suicida en adolescentes / Evaluation of Some Indicators of the Program of Attention to Suicidal Behavior in Adolescents

Introducción: El suicidio está entre las tres primeras causas de muerte en el grupo de adolescentes y adultos jóvenes, su incidencia no ha descendido en el presente siglo. Objetivo: Valorar algunos indicadores relevantes del programa de atención a la conducta suicida en adolescentes. Métodos: Investigación en sistema y servicios de salud con diseño de estudio observacional descriptivo en tres áreas de salud del municipio Cienfuegos: áreas V, VII y VIII, de enero a septiembre del 2019. El universo fue de 46 profesionales de los Equipos de Salud Mental y Equipo Básicos de Salud. Se utilizaron como instrumentos dos encuestas, diseñadas y validadas por criterio de experto. Fueron seleccionados 6 indicadores en las dimensiones estructura y proceso y 4 en resultado. Se utilizó una media ponderada para procesar los datos. Resultados: Los indicadores valorados de regular fueron: en la estructura: capacitación de los recursos humanos y capacidad técnica del personal; en el proceso: confección de las historias clínicas, diseminación del programa en las unidades de salud y su verificación y las modalidades terapéuticas; y en resultado: la participación del equipo de salud mental en las investigaciones relacionadas con la conducta suicida. Conclusiones: Existe un grupo de deficiencias que conlleva a que el cumplimiento del programa de atención a la conducta suicida en adolescentes sea valorado como regular, en las tres áreas de salud del municipio Cienfuegos estudiadas(AU)

Introduction: Suicide is among the first three causes of death in the group of adolescents and young adults; its incidence has not decreased in the present century. Objective: To assess some relevant indicators of the adolescent suicidal behavior care program. Methods: Research in health system and services with descriptive observational study design in health areas V, VII and VIII of Cienfuegos municipality from January to September 2019. The universe was 46 professionals of the Mental Health Teams and Basic Health Team. Two surveys were used as instruments, designed and validated by expert criteria. Six indicators were selected in the structure and process dimensions and four in outcome. A weighted average was used to process the data. Results: The indicators rated as fair were: in the structure: training of human resources and technical aptitude of personnel; in the process: preparation of clinical histories, dissemination of the program in health units and its verification and therapeutic modalities; and in the outcome: participation of the mental health team in research related to suicidal behavior. Conclusions: There is a group of deficiencies that leads to the fact that compliance with the program of attention to suicidal behavior in adolescents is valued as regular in the three health areas of the Cienfuegos municipality studied(AU)

Automated extraction of information from free text of Spanish oncology pathology reports

Background: Pathology reports are stored as unstructured, ungrammatical, fragmented, and abbreviated free text with linguistic variability among pathologists. For this reason, tumor information extraction requires a significant human effort. Recording data in an efficient and high-quality format is essential in implementing and establishing a hospital-based-cancer registry Objective: This study aimed to describe implementing a natural language processing algorithm for oncology pathology reports. Methods: An algorithm was developed to process oncology pathology reports in Spanish to extract 20 medical descriptors. The approach is based on the successive coincidence of regular expressions. Results: The validation was performed with 140 pathological reports. The topography identification was performed manually by humans and the algorithm in all reports. The human identified morphology in 138 reports and by the algorithm in 137. The average fuzzy matching score was 68.3 for Topography and 89.5 for Morphology. Conclusions: A preliminary algorithm validation against human extraction was performed over a small set of reports with satisfactory results. This shows that a regular-expression approach can accurately and precisely extract multiple specimen attributes from free-text Spanish pathology reports. Additionally, we developed a website to facilitate collaborative validation at a larger scale which may be helpful for future research on the subject.

Introducción: Los reportes de patología están almacenados como texto libre sin estructura, gramática, fragmentados o abreviados, con variabilidad lingüística entre patólogos. Por esta razón, la extracción de información de tumores requiere un esfuerzo humano significativo. Almacenar información en un formato eficiente y de alta calidad es esencial para implementar y establecer un registro hospitalario de cáncer. Objetivo: Este estudio busca describir la implementación de un algoritmo de Procesamiento de Lenguaje Natural para reportes de patología oncológica. Métodos: Desarrollamos un algoritmo para procesar reportes de patología oncológica en Español, con el objetivo de extraer 20 descriptores médicos. El abordaje se basa en la coincidencia sucesiva de expresiones regulares. Resultados: La validación se hizo con 140 reportes de patología. La identificación topográfica se realizó por humanos y por el algoritmo en todos los reportes. La morfología fue identificada por humanos en 138 reportes y por el algoritmo en 137. El valor de coincidencias parciales (fuzzy matches) promedio fue de 68.3 para Topografía y 89.5 para Morfología. Conclusiones: Se hizo una validación preliminar del algoritmo contra extracción humana sobre un pequeño grupo de reportes, con resultados satisfactorios. Esto muestra que múltiples atributos del espécimen pueden ser extraídos de manera precisa de texto libre de reportes de patología en Español, usando un abordaje de expresiones regulares. Adicionalmente, desarrollamos una página web para facilitar la validación colaborativa a gran escala, lo que puede ser beneficioso para futuras investigaciones en el tema.

COVID-19 and zoonoses in Brazil: Environmental scan of one health preparedness and response.

The emergence of the COVID-19 pandemic reinforced the central role of the One Health (OH) approach, as a multisectoral and multidisciplinary perspective, to tackle health threats at the human-animal-environment interface. This study assessed Brazilian preparedness and response to COVID-19 and zoonoses with a focus on the OH approach and equity dimensions. We conducted an environmental scan using a protocol developed as part of a multi-country study. The article selection process resulted in 45 documents: 79 files and 112 references on OH; 41 files and 81 references on equity. The OH and equity aspects are poorly represented in the official documents regarding the COVID-19 response, either at the federal and state levels. Brazil has a governance infrastructure that allows for the response to infectious diseases, including zoonoses, as well as the fight against antimicrobial resistance through the OH approach. However, the response to the pandemic did not fully utilize the resources of the Brazilian state, due to the lack of central coordination and articulation among the sectors involved. Brazil is considered an area of high risk for emergence of zoonoses mainly due to climate change, large-scale deforestation and urbanization, high wildlife biodiversity, wide dry frontier, and poor control of wild animals' traffic. Therefore, encouraging existing mechanisms for collaboration across sectors and disciplines, with the inclusion of vulnerable populations, is required for making a multisectoral OH approach successful in the country.

Monitoramento do programa controle do tabagismo no contexto da pandemia de covid-19: experiência da Bahia / Monitoring the tobacco control program during the covid-19 pandemic: the Bahia experience / Seguimiento del programa de control del tabaco en el contexto de la pandemia por covid-19: la experiencia de Bahía

Com o advento da pandemia de Covid-19, tornou-se mais desafiante a manutenção das ações do Programa de Nacional de Controle do Tabagismo (PNCT), que tem como finalidade geral reduzir a prevalência de tabagistas no país por meio de ações individuais e, majoritariamente, atividades coletivas. O objetivo deste estudo é analisar a adesão dos municípios e a oferta e procura de atendimentos no Programa de Controle do Tabagismo na Bahia no contexto da pandemia da Covid-19. É um estudo transversal, de caráter descritivo, abordagem mista, composto por uma etapa qualitativa e outra quantitativa. Foram analisados os relatos e as informações fornecidas pelos gestores municipais quanto à adesão e ao monitoramento do PNCT por meio do preenchimento de formulário on-line, no período de 2018 a 2020. A análise das unidades de saúde cadastradas evidenciou o predomínio da oferta de tratamento na Atenção Básica quando comparada à Atenção Especializada. Com relação à adesão, observou-se diminuição no quantitativo de municípios cadastrados. Entre os fatores citados pelos coordenadores para diminuição ou interrupção dos atendimentos estão a pandemia de Covid-19 e a falta de insumos e de equipes qualificadas. Muitos pacientes deixaram de procurar atendimento por medo da infecção e alguns serviços tiveram suas atividades redirecionadas para o enfrentamento da pandemia. Perante o exposto, observamos que a pandemia acarretou uma diminuição da procura e da oferta de atendimentos do PNCT/BA, levando a um impacto direto na vida das pessoas assistidas, bem como na adesão de novos pacientes.Palavras-chave: Tabagismo; COVID-19; Programa Nacional de Controle de Tabagismo; Atenção básica.

With the advent of the COVID-19 pandemic, maintaining the actions within the National Program for Tobacco Control (NPTC), whose general goal is to reduce the prevalence of smokers in the country through individual and mostly collective practices, became more challenging. This study sought to analyze municipality adherence and the supply and demand for assistance of the Tobacco Control Program in Bahia (NPTC/BA) during the COVID-19 pandemic. This is a cross-sectional descriptive study with a mixed-method approach. Data consist of reports and information provided by municipal managers on the adherence to and monitoring of the NPTC, collected through online forms completed between 2018 to 2020. Analysis of the registered health units has shown a predominant treatment offer on the part of Primary Care when compared with Specialized Care. Regarding adherence, the number of municipalities registered in the program decreased during the period. The COVID-19 pandemic and the lack of supplies and qualified teams were some of the factors reported by coordinators for the decrease or interruption of care. Many patients stopped seeking care due to fear of contamination and some services had changed their activities to combat the pandemic. Results show that the pandemic led to a decrease in the demand and supply of NPTC/BA care, impacting the quality of life of assisted people as well as on the admission of new patients.

Con el advenimiento de la pandemia del COVID-19, se ha hecho más difícil mantener las acciones del Programa Nacional de Control del Tabaco (PNCT), cuya finalidad general es reducir la prevalencia de fumadores en el país, a través de acciones individuales y, en su mayoría, actividades colectivas. El objetivo de este estudio es analizar la adhesión de los municipios, la oferta y demanda de asistencia en el Programa Nacional de Control del Tabaco en Bahía (PNCT/BA) en el contexto de la pandemia del COVID-19. Se trata de un estudio descriptivo, transversal, con enfoque mixto, que consta de una etapa cualitativa y otra cuantitativa. Los informes y la información brindada por los gestores municipales fueron analizados para la adherencia y seguimiento del PNCT, mediante la cumplimentación del formulario online, en el período de 2018 a 2020. El análisis de las unidades de salud registradas mostró el predominio de la oferta de tratamiento en Atención Primaria frente a Atención Especializada. En cuanto a la adhesión, hubo una disminución en el número de municipios registrados en el período. Entre los factores mencionados por los coordinadores para la reducción o interrupción de la atención, se encuentra la pandemia del COVID-19, la falta de insumos y equipos calificados. Muchos pacientes dejaron de buscar atención por temor a la contaminación y algunos servicios tuvieron que reorientar sus actividades para enfrentar la pandemia. Dado lo anterior, observamos que la pandemia provocó una disminución en la demanda y oferta de atención del PNCT/BA, lo que generó un impacto directo en la calidad de vida de las personas atendidas, así como en la adherencia de nuevos pacientes.

Twenty Years of Neonatal Screening for Sickle Cell Disease in Brazil: The Challenges of a Continental Country with High Genetic Heterogeneity

Abstract Sickle cell disease (SCD) is the most common inherited hematological disease worldwide. The benefits of diagnosis and early intervention have led to the wide dissemination of public health programs worldwide. Through neonatal screening programs, it is possible to reduce morbidity and mortality in the first 5 years of life. The prophylactic use of penicillin, the anti-pneumococcal vaccine and other intensive care, increase the survival and quality of life of people with SCD. The aim of this study is to present the 20-year history of screening for hemoglobinopathies in Brazil and its challenges. From 2001 to 2019, an average of 2,400,000 children were screened per year nationwide, with the coverage being of 82,16%. The screening of 54,9% of newborns is collected up to their 5th day of life. The prevalence of SCD was 1:2,263 newborns; therefore, it was the second most-common disease detected by the program of Brazil, being only after hypothyroidism (1/2,175 live births). The healthcare system should provide the necessary infrastructure to confirm the diagnosis of newborns and to provide appropriate counseling and treatment. The early diagnosis and treatment, as well as the follow-up with a multidisciplinary team, are fundamental to the survival rate and the quality of life of patients.

Actualización del Programa Nacional y Normas de procedimiento para la prevención y control de la Tuberculosis en Cuba / Update of the National Program and Rules of Procedure for the prevention and control of tuberculosis in Cuba

El Programa Nacional y Normas de procedimiento para la Prevención y Control de la Tuberculosis en Cuba de 2013 constituye la guía de trabajo cotidiana del personal de salud para el manejo de la enfermedad. Este necesita ser actualizado para adecuarse a las nuevas condiciones y retos que plantea la tuberculosis a tono con las experiencias nacionales y las recomendaciones internacionales las cuales buscan estandarizar la atención. Deben modificarse términos en la clasificación de casos, incorporar nuevos métodos diagnósticos (imagenológicos, inmunológicos y genotípicos) y fundamentalmente en el tema de tratamiento con la incorporación de nuevas drogas, esquemas terapéuticos y la reorganización de los fármacos según su efectividad(AU)

The 2013 National Program and Rules of Procedure for the Prevention and Control of Tuberculosis in Cuba constitutes the daily work guide of health personnel for the management of the disease. This Program and Rules of Procedure needs to be updated to meet the new conditions and challenges posed by tuberculosis in line with local experiences and international recommendations seeking to standardize care. Modificatins are needed for terms of case classification, new diagnostic methods need to be included (imaging, immunological and genotypic) and basically on the subject of treatment with the integration of new drugs, therapeutic forms and the reorganization of drugs according to their effectiveness(AU)

Programa nacional de inmunizacion en Chile: pasado, presente y futuro / National immunization program in Chile: past, present and future

El Programa Ampliado de Inmunizaciones (PAI) a nivel mundial nace en 1974 como iniciativa de la Organización Mundial de la Salud (OMS) y la Organización Panamericana de la Salud (OPS). En Chile, el actual Programa Nacional de Inmunizaciones (PNI) se origina en el Plan Ampliado de Inmunizaciones (PAI) establecido en el año 1978. En sus inicios, el PAI se basó en disposiciones legales definidas en 1975, que establecía las Enfermedades Trasmisibles de Vacunación Obligatoria. Desde el año 2010, el Decreto Exento N°6 promulgado el 29 de enero, se dispone la vacunación obligatoria contra enfermedades inmunoprevenibles de la población del país. Posteriormente se han realizado modificaciones al decreto exento N°6 reflejando la incorporación de nuevas vacunas al calendario, modificaciones en los grupos objetivo y/o cambios en las estrategias de vacunación, entre otros. En estas disposiciones también se establece que el Ministerio de Salud debe asegurar el acceso gratuito a vacunaciones seguras y efectivas para toda la población objetivo. El objetivo del artículo, es describir la evolución de las iniciativas de vacunación en nuestro país, desde antes de la creación del PAI, la sistematización de las estrategias de vacunación una vez que se establece el programa hasta las modificaciones realizadas en la última década.

The Expanded Program on Immunization (EPI) worldwide was created in 1974 as an initiative of the World Health Organization (WHO) and the Pan American Health Organization (PAHO). In Chile, the current National Immunization Program (PNI) originates from the Extended Inmunization Plan (EPI) established in 1978. In its beginnings, the EPI was based on legal provisions defined in 1975, which established the Communicable Diseases of Compulsory Vaccination. Since 2010, the Exempt Decree No. 6 promulgated on January 29, provides the Mandatory Vaccination against Immune preventable Diseases of the Population of the Country. Subsequently there have been modifications to the Exempt Decree No. 6 reflecting the incorporation of new vaccines to the calendar, modifications in the target groups and /or changes in vaccination strategies, among others. These provisions also state that the Ministry of Health must ensure free access to safe and effective vaccinations for the entire target population. The aim oh this article is to describe evolution of vaccination initiatives in our country, from before the creation of the EPI, the systematization of vaccination strategies once the program is established, until the modifications made in the last decade.

Análisis de los Resultados nacionales obtenidos por grupos estatales de investigación del el cáncer ruso. Programa de Cribado de Enfermedades de la Mucosa Oral y Borde Bermellón / Analysis of The Results Obtained by National Research Groups with The Russian State Cancer Program for The Screening of Diseases of The Oral Mucosa and The Vermillion Border

This article analyzes the results obtained by national research groups in the implementation of the Russian State Cancer Program. From 2015 to the first half of 2019, specialists studied the epidemiology and structure of oncological and precancerous diseases of the oral mucosa and the vermillion border in 486,059 persons aged 18-92 years living in Tula, the Tula region, Moscow and Noyabrsk as a result of screening and medical aid appealability. In this period, the productivity of the research group from Tula grew by the factor of 18.92. The results of the research confirm low cancer alertness of practicing dentists. An individual patient registration card has been developed to systematize data and create a diagnostic register for the screening of cancer and precancerous diseases of the oral mucosa and the vermillion border.

Government Policy, Clean Fuel Access, and Persistent Fuel Stacking in Ecuador.

After more than three decades of access to low-cost liquefied petroleum gas (LPG) financed by large direct government subsidies, more than 90% of Ecuadorian households cook primarily with LPG. Due to the large fiscal burden of the LPG subsidy, increases in electricity from hydropower, and other sociopolitical factors, the Government of Ecuador launched a major induction stove program (PEC) to reduce the demand for LPG. We assess the effects of the LPG subsidies and PEC using government records, interviews, academic literature, newspaper reports, household surveys, and focus groups. Household surveys, conducted in rural, northern Ecuadorian households (n=383), characterized cooking patterns and fuel access. Focus groups (n=6) were carried out with a subset of surveyed households to better characterize survey findings. The LPG subsidy was developed as part of broad social support reforms in the early 1970s, without specific aims to reduce the health impacts of household air pollution from woodfuel or provide economic benefits as part of the transition to a clean cooking fuel. Nonetheless, the subsidy has resulted in nearly all Ecuadorian households cooking primarily with LPG. PEC has generated the sale of 740,000 induction stoves since its inception in 2014, short of the goal of 3.5 million. Among the rural households surveyed, LPG use, acceptance, and satisfaction was high, however, more than three-quarters of those surveyed reported weekly woodfuel use. Induction stove ownership (17%) and use as a primary cooking fuel (1%) was low among the rural households surveyed; furthermore, households owning induction stoves reported very low satisfaction with the stoves. Here we show that nationally-representative surveys reporting only "primary cooking fuef" use may underestimate solid fuel use as a supplemental household cooking energy, particularly in rural areas where fuel availability issues play a stronger role in decisions about what fuels to use.

Fatores emocionais associados ao hábito de fumar em usuários de um programa antitabagismo / Emotional factors associated with smoking in individuals enrolled in a tobacco cessation program / Factores emocionales asociados con el hábito de fumar de usuarios de un programa de cesación de tabaquismo

Objetivo: Caracterizar a população atendida por um programa de tratamento do tabagismo e identificar os fatores emocionais associados ao hábito de fumar. Métodos: Estudo transversal, realizado em 2016, com dados secundários extraídos dos registros do programa de tratamento do fumante do município de Água Clara, Mato Grosso do Sul, Brasil. Os dados analisados referem-se a 173 participantes que realizaram a entrevista inicial do programa, de janeiro de 2012 a setembro de 2015. Foram estudadas as variáveis: sexo, idade, história tabagística, grau de dependência da nicotina, fatores emocionais e outras condições de saúde-doença. Analisaram-se os dados por meio de estatística descritiva, e a associação do grau de dependência aos fatores emocionais foi analisada pelo teste exato de Fisher. Resultados: Verificou-se a predominância do sexo feminino (63,6%, n=110); com idade média de 45,99 anos; média de idade de início do hábito de fumar de 14,38 anos; e média de tempo de uso do cigarro de 31,62 anos. Dos sintomas apresentados, predominaram os transtornos emocionais (75,1%, n=130), com confirmação de 38,2% (66) para depressão. Com relação ao grau de dependência da nicotina, 68,2% (118) apresentaram grau "elevado ou muito elevado", sendo observada associação entre nível "elevado e muito elevado" de dependência e fatores emocionais, como ansiedade e depressão (p<0,05). Conclusão: Os participantes do programa são mulheres em idade adulta, com tempo prolongado de uso do cigarro e decorrente presença de comprometimentos na saúde. Foi observada associação entre fatores emocionais como ansiedade e depressão e o maior grau de dependência da nicotina.

Objective: To characterize the population enrolled in a smoking treatment program and to identify the emotional factors associated with smoking. Methods: Cross-sectional study carried out in 2016 using secondary data extracted from the records of a smoking treatment program in the municipality of Água Clara, Mato Grosso do Sul, Brazil. The data analyzed refer to 173 participants who had undergone the initial interview of the program from January 2012 to September 2015. The following variables were studied: gender, age, smoking history, degree of nicotine dependence, emotional factors and other health-disease conditions. The data were analyzed using descriptive statistics, and the association between the degree of dependence and emotional factors was analyzed using Fisher's exact test. Results: There was a predominance of women (63.6%, n=110), with a mean age of 45.99 years, mean age of onset of smoking of 14.38 years and mean time of cigarette use of 31.62 years. Of the symptoms presented, emotional disorders were predominant (75.1%, n=130), with a 38.2% (66) rate of depression. Regarding the degree of nicotine dependence, 68.2% of the participants presented high or very high levels, with an association between high and very high levels of dependence and emotional factors such as anxiety and depression (p<0.05). Conclusion: The program participants are adult women with a long time of cigarette use and consequently compromised health. There was an association between emotional factors and a greater degree of nicotine dependence.

Objetivo: Caracterizar la población asistida por un programa para tratamiento del tabaquismo e identificar los factores emocionales asociados al hábito de fumar. Métodos: Estudio transversal realizado en 2016 con los datos secundarios de registros del programa de tratamiento para fumadores del municipio de Agua Clara, Mato Grosso do Sul, Brasil. Los datos analizados son de 173 participantes que realizaron la entrevista inicial del programa entre enero de 2012 y septiembre de 2015. Se estudiaron las variables sexo, edad, historia de tabaco, grado de dependencia de nicotina, factores emocionales y otras condiciones de salud-enfermedad. Se analizaron los datos a través de la estadística descriptiva. La asociación del grado de dependencia y los factores emocionales ha sido analizada por el test exacto de Fisher. Resultados: Se verificó la predominancia del sexo femenino (63,6%, n=110) con la media de edad de 45,99 años; la media de edad del inicio del hábito de fumar de 14,38 años; y la media del tiempo de consumo de cigarro de 31,62 años. Entre los síntomas presentados hubo predominancia para los trastornos emocionales (75,1%, n=130) y la confirmación del 38,2% (66) de depresión. Respecto el grado de dependencia de nicotina el 68,2% (118) presentaron grado "elevado o muy elevado" con asociación entre el nivel "elevado y muy elevado" de dependencia y los factores emocionales como la ansiedad y la depresión (p<0,05). Conclusión: Los participantes del programa son mujeres en edad adulta con largo uso del cigarro y la presencia de problemas de salud. Se observó la asociación entre los factores emocionales y el mayor grado de dependencia de nicotina.

Trajetória da política de controle do tabaco no Brasil de 1986 a 2016 / History of Brazil's tobacco control policy from 1986 to 2016 / Trayectoria de la política de control al tabaco en Brasil de 1986 a 2016

O estudo analisa a política brasileira de controle do tabaco entre 1986 e 2016, buscando caracterizar a trajetória da política e discutir os seus avanços, limites e desafios. Adotaram-se a perspectiva da economia política e contribuições do referencial de análise de políticas públicas. Realizou-se análise bibliográfica, documental, de dados secundários e de entrevistas semiestruturadas com atores envolvidos na política. Fatores relacionados ao contexto nacional e internacional, ao processo político e ao conteúdo da política influenciaram a institucionalidade do controle do tabaco no país. Ressaltam-se a consolidação da rejeição social ao tabagismo, a estruturação governamental da política, a atuação da sociedade civil e o prestígio do Brasil no cenário internacional. Medidas intersetoriais de controle do tabaco, como o aumento de preços e impostos de cigarros, a promoção de ambientes livres do fumo e a adoção de advertências sobre os malefícios do tabagismo contribuíram para a expressiva redução da prevalência de fumantes no período. A implementação da Convenção-Quadro para Controle do Tabaco da Organização Mundial da Saúde no Brasil, a partir de 2006, contribuiu para a expansão e consolidação da política nacional. No entanto, interesses econômicos relacionados ao tabaco limitaram a implementação de algumas ações estratégicas. Entre os desafios, destacam-se a sustentabilidade do controle do tabaco a médio e longo prazos e a superação das barreiras relacionadas à diversificação em áreas plantadas de fumo, ao combate ao comércio ilícito de cigarros e à interferência da indústria do fumo na política.

This study analyzes Brazil's tobacco control policy from 1986 to 2016, seeking to describe the policy's history and discuss its achievements, limits, and challenges. The study adopted a political economics approach and contributions from public policy analysis. Data were based on a search of the literature, documents, and secondary sources and semi-structured interviews with stakeholders involved in the policy. Factors related to the domestic and international contexts, the political process, and the policy's content influenced the institutional characteristics of tobacco control in the country. The study emphasizes the consolidation of Brazil's social rejection of smoking, government structuring of the policy, action by civil society, and Brazil's prestige in the international scenario. Inter-sector tobacco control measures like price and tax increases on cigarettes, the promotion of smoke-free environments, and the enforcement of health warnings contributed to the important reduction in prevalence of smoking. Implementation of the World Health Organization Framework Convention on Tobacco Control in Brazil, beginning in 2006, contributed to the expansion and consolidation of the national policy. However, tobacco-related economic interests limited the implementation of some strategic measures. The challenges feature the medium- and long-term sustainability of tobacco control and the solution to barriers involving crop diversification on current tobacco-growing areas, the fight against the illegal cigarette trade, and interference in the policy by the tobacco industry.

El estudio analiza la política brasileña de control al tabaco entre 1986 y 2016, procurando determinar la trayectoria de la política en este sentido, además de discutir sus avances, límites y desafíos. Se adoptaron la perspectiva de la economía política y contribuciones dentro del marco referencial del análisis a las políticas públicas. Se realizó un análisis bibliográfico, documental, de datos secundarios y de entrevistas semiestructuradas con actores involucrados en la política. Los factores relacionados con el contexto nacional e internacional, proceso político y contenido de la política influenciaron la institucionalidad del control al tabaco en el país. Se resaltan la consolidación del rechazo social al tabaquismo, la estructuración gubernamental de la política, la actuación de la sociedad civil y el prestigio de Brasil en el escenario internacional. Las medidas intersectoriales de control al tabaco, como el aumento de precios e impuestos de cigarrillos, la promoción de ambientes libres de tabaco y la adopción de advertencias sobre los perjuicios del tabaquismo contribuyeron a una expresiva reducción de la prevalencia de fumadores durante el período. La implementación de la Convención-Marco para el Control del Tabaco de la Organización Mundial de la Salud, en Brasil, a partir de 2006, contribuyó a la expansión y consolidación de la política nacional. No obstante, los intereses económicos, relacionados con el tabaco, limitaron la implementación de algunas acciones estratégicas. Entre los desafíos, se destacan la sostenibilidad del control al tabaco a medio y largo plazo y la superación de las barreras relacionadas con la diversificación en áreas plantadas con tabaco, el combate al comercio ilícito de cigarrillos y la interferencia de la industria del tabaco en la política.

A Convenção-Quadro para o Controle do Tabaco da Organização mundial da Saúde na agenda política brasileira, 2003-2005 / El Convenio Marco para el Control del Tabaco en la Organización Mundial de la Salud em la agenda política brasileña, 2003-2005 / The World Health Organization Framework Convention on Tobacco Control in the Brazilian political agenda, 2003-2005

Resumo: Este estudo analisa a criação de uma agenda política de controle do tabaco no Brasil a partir da participação do país na Convenção-Quadro para o Controle do Tabaco da Organização Mundial da Saúde (CQCT-OMS). Tal processo se estendeu entre as negociações diplomáticas para a participação do Brasil nesse Tratado, em 2003, e a sua ratificação pelo Congresso Nacional, em 2005, e foi marcado por longas controvérsias que colocaram frente a frente atores da saúde pública, que são os responsáveis pelas atividades de controle do tabaco, o alto escalão da diplomacia brasileira, os emissários da indústria tabaqueira, os representantes dos pequenos plantadores de fumo da Região Sul do país, deputados, senadores e ministros. O estudo toma como base as contribuições de John W. Kingdon sobre o processo de configuração de agenda no âmbito da formulação de políticas públicas. Sua construção baseou-se em bibliografia secundária, fontes legislativas e institucionais no período de 1995 a 2005. Conclui-se que a convergência da capacidade técnica da burocracia da saúde e suas ações para o controle do tabaco, o envolvimento do alto escalão do Ministério das Relações Exteriores (fluxo de políticas), a iniciativa de criação do CQCT_oms (fluxo de problemas) e a existência de um ambiente favorável, tanto no Executivo quanto no Legislativo (fluxo político), possibilitaram a abertura de uma janela de oportunidade para a ratificação da CQCT-OMS e sua ascensão à agenda de decisão governamental.

Resumen: Este estudio analiza la creación de una agenda política de control al tabaco en Brasil, a partir de la participación del país en el Convenio Marco para el Control del Tabaco de la Organizaciòn Mundial de la Salud (CQCT-OMS por sus siglas en portugués). Tal proceso se extendió entre las negociaciones diplomáticas para la participación de Brasil en ese tratado, en 2003, y su ratificación por el Congreso Nacional, en 2005, que estuvo marcado por largas controversias que pusieron frente a frente a actores de la salud pública, quienes son responsables de las actividades de control al tabaco; el alto escalón de la diplomacia brasileña, los emisarios de la industria tabaquera, los representantes de los pequeños agricultores del tabaco de la región sur del país, diputados, senadores y ministros. El estudio toma como base las contribuciones de John W. Kingdon sobre el proceso de configuración de agenda en el ámbito de la formulación de políticas públicas. Su construcción se basó en bibliografía secundaria, fuentes legislativas e institucionales durante el período de 1995 a 2005. Se concluyó que la convergencia de la capacidad técnica de la burocracia de la salud y sus acciones para el control el tabaco, la participación del alto escalafón del Ministerio de Asuntos Exteriores (flujo de políticas), la iniciativa de creación del CQCT-OMS (flujo de problemas) y la existencia de un ambiente favorable, tanto en el Ejecutivo como en el Legislativo (flujo político), posibilitaron la apertura de una ventana de oportunidad para la ratificación del CQCT-OMS y su ascensión a la agenda de decisión gubernamental.

Abstract: This study analyses the development of a tobacco-control agenda in Brazil following the country's participation in the World Health Organization Framework Convention on Tobacco Control (WHO-FCTC). This process started with the diplomatic negotiations for the participation of Brazil in the treaty, in 2003, and its ratification by the National Congress, in 2005, and was marked by substantial controversies between public health players, who are accountable for tobacco-control actions, and the high echelon of Brazilian diplomacy, emissaries of the tobacco industry, representatives of small tobacco farmers from the Southern region of the country, congress representatives, senators and ministers. The study is based on the contributions of John W. Kingdon on the development of an agenda for the formulation of public policies. It took into account secondary references, legislative and institutional sources from the 1995 to 2005 period. It concluded that the association of tobacco-related healthcare actions by technically skilled officials, the involvement of the high echelon of the Ministry of Foreign Affairs (policy flow), the initiative for the establishment of the WHO-FCTC (problem flow), and the existence of a favorable environment in both, executive and legislative (political flow), opened a window of opportunity for WHO-FCTC ratification and its inclusion in the government decision agenda.

Conocimiento y actitudes de los padres en relación a la vacunación de sus hijos / Knowledge and attitudes of the parents in relation to the vaccination of their children

Introduction: Vaccination, a health action that has allowed to decrease mortality and to eradicate many diseases, may be at risk as a result of misinformation of parents and campaigns led by movements against vaccines. Objective: To describe and analyze the knowledge and attitudes of parents of newborns and children of 2 and more months of age against the application of vaccines. Method: Exploratory study performed by application of a questionnaire to parents attending the UC CHRISTUS health network. Results: Knowledge and attitude of parents of newborns is rated as very good. 32.5% think that the vaccines can cause damage or claim not to know and have wrong knowledge; vaccination is considered a measure in favor of their childrens' health, but manifest that scarce information does not allow to make right decisions and suspect economic interests behind them. The parents of older children have no precise knowledge of the existing calendar, nor of the name of vaccines. They think that the existing information does not allow them to be sure of the real benefits, with some of them even feeling forced to vaccinate their children. Discussion: It is urgent to educate and answer questions about the importance and safety of vaccines and to perform studies at a national level.

Introducción: La vacunación, acción sanitaria que ha permitido disminuir la mortalidad y erradicar muchas enfermedades, puede estar en riesgo como resultado de la desinformación de los padres y campañas del movimiento anti vacunas. Objetivo: Describir y analizar conocimiento y actitudes de padres de recién nacidos y niños de dos y más meses de edad, en relación a la aplicación de vacunas. Método: Estudio exploratorio, descriptivo, mediante la aplicación de un cuestionario a padres asistentes a la Red de Salud UC CHRISTUS. Resultados: El conocimiento y actitud de los padres de RN es catalogado como muy bueno. El 35,2%, piensa que las vacunas pueden causar daño y declara no saber y tiene conocimientos errados. Señalan que la información existente no les permite tomar decisiones correctas y sospechan intereses económicos detrás de los programas de vacunación. Los padres de niños mayores, no tienen conocimiento preciso del calendario vigente, ni del nombre de las vacunas. Opinan que la información existente no les permite estar seguros de los reales beneficios, sintiéndose algunos, obligados a vacunar a sus hijos. Discusión: Es urgente educar y aclarar dudas en torno a la importancia y seguridad de las vacunas y realizar estudios nacionales.

Analysis of poultry transit, notification systems and legislation in the state of Sergipe, 2008-2012 / Análise do trânsito de aves, dos sistemas de notificação e da legislação no estado de Sergipe entre 2008 e 2012

The purpose of this study was to assess the transit of poultry, as well as the inspection on the outbreak of diseases, by addressing the issues concerning the system of the National Program on Poultry Sanity and its legal resolutions. The data on the animal transportation and the occurrence of the diseases were collected from the official services. A legislation-based assessment was also carried out for the period from 2008 to 2012 in the state of Sergipe, Brazil. Results showed an intense transit of poultry in just about all towns of the state in the period under study, especially in chicken farms where less number of poultry is bred: from 5,000 to 15,000. Besides, 64% of poultry transportation was found to be intermunicipal. The state of Sergipe has received poultry particularly from the states of Pernambuco (49.87%), Bahia (20.85%), Minas Gerais (5.94%), Paraíba (5.16%), and Goiás (5.05%). The number of transit indicates an increase in transit over the years. In addition, three of six municipalities which saw these diseases (Estância, São Cristóvão and Itaporanga d'Ajuda) are responsible for a great part of the poultry transit. Results also showed that the majority of activities of the State Program on Poultry Sanity would be carried out in the municipalities where a larger poultry marketing flow takes place, thereby seeking to record a greater number of notifications on the diseases and, then, carry out the surveillance activities. Therefore, regarding the poultry transit, it is recommended to do a mapping of the risk regions for poultry diseases, as well as studies about the epidemiological characterization of the municipalities of the state of Sergipe.(AU)

O objetivo deste estudo foi avaliar o trânsito de aves, sua fiscalização e o surgimento de enfermidades, abordando questões referentes ao sistema do Programa Nacional de Sanidade Avícola e suas determinações legais. Dessa forma, compilaram-se dados do serviço oficial sobre o trânsito dos animais e a ocorrência de doenças, realizando-se também uma avaliação da legislação vigente entre 2008 e 2012, no estado do Sergipe. Observou-se no período averiguado um intenso trânsito de aves em quase toda a totalidade dos municípios, principalmente entre granjas que alojam pequenas quantidades de aves (5.000 a 15.000), e 64% do total do transporte de aves ocorreu entre municípios do Estado. Os estados fornecedores de aves para Sergipe foram sobretudo Pernambuco (49,87%), Bahia (20,85%), Minas Gerais (5,94%), Paraíba (5,16%) e Goiás (5,05%). O número de guias de trânsito emitidas aponta um crescimento do trânsito ao longo dos anos. Verificaram-se que três municípios (Estância, São Cristóvão e Itaporanga d'Ajuda), dos seis acometidos por enfermidades, são aqueles responsáveis por grande parte do trânsito realizado. O estudo mostrou que para os municípios sergipanos, nos quais acontece maior fluxo de comercialização avícola, seriam indicadas mais das ações do Programa Estadual de Sanidade Avícola, com a finalidade de registrar maior número de notificações de enfermidades e, consequentemente, exercer ações de vigilância. Assim, quanto ao trânsito animal, recomendam-se a adoção de um mapeamento das regiões de risco sanitário para as enfermidades de aves e a realização de estudos sobre a caracterização epidemiológica dos municípios de Sergipe.(AU)

Analysis of poultry transit, notification systems and legislation in the state of Sergipe, 2008-2012 / Análise do trânsito de aves, dos sistemas de notificação e da legislação no estado de Sergipe entre 2008 e 2012

The purpose of this study was to assess the transit of poultry, as well as the inspection on the outbreak of diseases, by addressing the issues concerning the system of the National Program on Poultry Sanity and its legal resolutions. The data on the animal transportation and the occurrence of the diseases were collected from the official services. A legislation-based assessment was also carried out for the period from 2008 to 2012 in the state of Sergipe, Brazil. Results showed an intense transit of poultry in just about all towns of the state in the period under study, especially in chicken farms where less number of poultry is bred: from 5,000  to  15,000. Besides, 64% of poultry transportation was found to be intermunicipal. The state of Sergipe has received poultry particularly from the states of Pernambuco (49.87%), Bahia (20.85%), Minas Gerais (5.94%), Paraíba (5.16%), and Goiás (5.05%). The number of transit indicates an increase in transit over the years. In addition, three of six municipalities which saw these diseases (Estância, São Cristóvão and Itaporanga dAjuda) are responsible for a great part of the poultry transit. Results also showed that the majority of activities of the State Program on Poultry Sanity would be carried out in the municipalities where a larger poultry marketing flow takes place, thereby seeking to record a greater number of notifications on the diseases and, then, carry out the surveillance activities. Therefore, regarding the poultry transit, it is recommended to do a mapping of the risk regions for poultry diseases, as well as studies about the epidemiological characterization of the municipalities of the state of Sergipe.

O objetivo deste estudo foi avaliar o trânsito de aves, sua fiscalização e o surgimento de enfermidades, abordando questões referentes ao sistema do Programa Nacional de Sanidade Avícola e suas determinações legais. Dessa forma, compilaram-se dados do serviço oficial sobre o trânsito dos animais e a ocorrência de doenças, realizando-se também uma avaliação da legislação vigente entre 2008 e 2012, no estado do Sergipe. Observou-se no período averiguado um intenso trânsito de aves em quase toda a totalidade dos municípios, principalmente entre granjas que alojam pequenas quantidades de aves (5.000 a 15.000), e 64% do total do transporte de aves ocorreu entre municípios do Estado. Os estados fornecedores de aves para Sergipe foram sobretudo Pernambuco (49,87%), Bahia (20,85%), Minas Gerais (5,94%), Paraíba (5,16%) e Goiás (5,05%). O número de guias de trânsito emitidas aponta um crescimento do trânsito ao longo dos anos. Verificaram-se que três municípios (Estância, São Cristóvão e Itaporanga dAjuda), dos seis acometidos por enfermidades, são aqueles responsáveis por grande parte do trânsito realizado. O estudo mostrou que para os municí- pios sergipanos, nos quais acontece maior fluxo de comercialização avícola, seriam indicadas mais das ações do Programa Estadual de Sanidade Avícola, com a finalidade de registrar maior número de notificações de enfermidades e, consequentemente, exercer ações de vigilância. Assim, quanto ao trânsito animal, recomendam-se a adoção de um mapeamento das regiões de risco sanitário para as enfermidades de aves e a realização de estudos sobre a caracterização epidemiológica dos municípios de Sergipe.

Analysis of poultry transit, notification systems and legislation in the state of Sergipe, 2008-2012 / Análise do trânsito de aves, dos sistemas de notificação e da legislação no estado de Sergipe entre 2008 e 2012

The purpose of this study was to assess the transit of poultry, as well as the inspection on the outbreak of diseases, by addressing the issues concerning the system of the National Program on Poultry Sanity and its legal resolutions. The data on the animal transportation and the occurrence of the diseases were collected from the official services. A legislation-based assessment was also carried out for the period from 2008 to 2012 in the state of Sergipe, Brazil. Results showed an intense transit of poultry in just about all towns of the state in the period under study, especially in chicken farms where less number of poultry is bred: from 5,000  to  15,000. Besides, 64% of poultry transportation was found to be intermunicipal. The state of Sergipe has received poultry particularly from the states of Pernambuco (49.87%), Bahia (20.85%), Minas Gerais (5.94%), Paraíba (5.16%), and Goiás (5.05%). The number of transit indicates an increase in transit over the years. In addition, three of six municipalities which saw these diseases (Estância, São Cristóvão and Itaporanga dAjuda) are responsible for a great part of the poultry transit. Results also showed that the majority of activities of the State Program on Poultry Sanity would be carried out in the municipalities where a larger poultry marketing flow takes place, thereby seeking to record a greater number of notifications on the diseases and, then, carry out the surveillance activities. Therefore, regarding the poultry transit, it is recommended to do a mapping of the risk regions for poultry diseases, as well as studies about the epidemiological characterization of the municipalities of the state of Sergipe.(AU)

O objetivo deste estudo foi avaliar o trânsito de aves, sua fiscalização e o surgimento de enfermidades, abordando questões referentes ao sistema do Programa Nacional de Sanidade Avícola e suas determinações legais. Dessa forma, compilaram-se dados do serviço oficial sobre o trânsito dos animais e a ocorrência de doenças, realizando-se também uma avaliação da legislação vigente entre 2008 e 2012, no estado do Sergipe. Observou-se no período averiguado um intenso trânsito de aves em quase toda a totalidade dos municípios, principalmente entre granjas que alojam pequenas quantidades de aves (5.000 a 15.000), e 64% do total do transporte de aves ocorreu entre municípios do Estado. Os estados fornecedores de aves para Sergipe foram sobretudo Pernambuco (49,87%), Bahia (20,85%), Minas Gerais (5,94%), Paraíba (5,16%) e Goiás (5,05%). O número de guias de trânsito emitidas aponta um crescimento do trânsito ao longo dos anos. Verificaram-se que três municípios (Estância, São Cristóvão e Itaporanga dAjuda), dos seis acometidos por enfermidades, são aqueles responsáveis por grande parte do trânsito realizado. O estudo mostrou que para os municí- pios sergipanos, nos quais acontece maior fluxo de comercialização avícola, seriam indicadas mais das ações do Programa Estadual de Sanidade Avícola, com a finalidade de registrar maior número de notificações de enfermidades e, consequentemente, exercer ações de vigilância. Assim, quanto ao trânsito animal, recomendam-se a adoção de um mapeamento das regiões de risco sanitário para as enfermidades de aves e a realização de estudos sobre a caracterização epidemiológica dos municípios de Sergipe.(AU)

Prevención de leptospirosis humana en la comunidad / Prevention of human leptospirosis in the community

La leptospirosis es endémico-epidémica en Cuba; centenares de casos se han informado desde la década de los 80 hasta la actualidad. Se realizó una revisión de las principales acciones de prevención y control de la leptospirosis en la comunidad y su tratamiento. Se efectuó una búsqueda bibliográfica en las bases de datos MEDLINE, EBSCO y SciELO; se tuvo en cuenta además, la Guía de la Organización Mundial de la Salud para el diagnóstico, vigilancia y control de la leptospirosis humana vigente desde el 2003 y el Programa Nacional de Prevención y Control de la Leptospirosis Humana vigente desde 1997. Se analizan acciones preventivas como: eliminar reservorio de la enfermedad (incluye desratización, saneamiento canino, vacunación animal, detección y tratamiento de animales domésticos portadores y enfermos); evitar la contaminación de medios infectantes (abarca vertimiento sanitario de la excreta animal, drenaje de charcos y terrenos bajos, higienización comunitaria, desinfección del hábitat animal, tratamiento sanitario de piscinas, protección física de fuentes de agua y alimentos); evitar el contagio humano con medios infectantes (implica prohibición sanitaria de ingestión de carnes y leches de animal enfermo o portador, desinfección de frutas y verduras, uso de medios físicos de protección, prohibición sanitaria de inmersión en fluviales contaminadas); quimioprofilaxis y vacunación. Se establecen las principales acciones desarrolladas, tanto por el Ministerio de Salud Pública de Cuba como por la Organización Mundial de la Salud(AU)

Leptospirosis is endemic-epidemic in Cuba. Hundreds of cases have been reported from the 80s to the present. A review of the main actions for prevention and control of leptospirosis in the community and its treatment was performed. A literature search was conducted in MEDLINE, EBSCO and SciELO databases. The World Health Organization Guide for the diagnosis, monitoring and control of human leptospirosis in force since 2003 and the National Program for Prevention and Control of Human Leptospirosis in force since 1997 were taken into account also. Preventive actions are analyzed such as: removing reservoir of this disease (including rodent control, canine sanitation, animal vaccination, screening and treatment of carriers and sick pets); avoiding contamination of infective media (covering health dumping of animal excreta, drainage ponds and lowlands, community sanitation, disinfection of animal habitat, pool-health treatment, physical protection of water sources and food); preventing human infection with infective means (involving ingesting health prohibition of meat and milk from sick animals or carrier, disinfection of fruits and vegetables, using physical means of protection, health ban immersion in contaminated river); chemoprophylaxis and vaccination. The main actions are set by both the Ministry of Public Health of Cuba as the World Health Organization(AU)