Higiene social y organización de la salud pública como ciencia y asignatura de la enseñanza. Breve historia del desarrollo de la higiene social y la organización de la salud pública (fragmento) / Social hygiene and public health organization as science and curricula subject. Brief history of the development of social hygiene and public health organization (fragment)

La revolución científico-técnica, los colosales éxitos de la ciencia médica y los logros de la práctica de salud pública han contribuido al cambio radical de los tipos de patología, al proceso activo de especialización y de integración en la ciencia médica y la salud pública y al perfeccionamiento del trabajo de los órganos y las instituciones de salud pública. El análisis desde el punto de vista de la higiene social es una tarea importantísima que incumbe a los científicos y pedagogos de las cátedras de higiene social y de organización de salud pública. La higiene social y la organización de salud pública como una ciencia médica independiente es una de las asignaturas más complejas de la enseñanza médica. La misma tiene una gran importancia en la formación del futuro médico que busca solución a los problemas de la salud pública socialista y de la protección de la salud de la población de la Unión Soviética. Para asimilar los conocimientos en esta rama, a esta misma le debe preceder una sólida preparación de los estudiantes en disciplinas teóricas, médico-biológicas, sociales y clínicas. Precisamente por eso la higiene social y la organización de salud pública se enseña en los cursos superiores de los centros de enseñanza...(AU)

A direct comparison of popular models of normal memory loss and Alzheimer's disease in samples of African Americans, Mexican Americans, and refugees and immigrants from the former Soviet Union.

OBJECTIVES: To understand how people differentiate normal memory loss from Alzheimer's disease (AD) by investigating cultural models of these conditions. DESIGN: Ethnographic interviews followed by a survey. Cultural consensus analysis was used to test for the presence of group models, derive the "culturally correct" set of beliefs, and compare models of normal memory loss and AD. SETTING: Chicago, Illinois. PARTICIPANTS: One hundred eight individuals from local neighborhoods: African Americans, Mexican Americans, and refugees and immigrants from the former Soviet Union. MEASUREMENTS: Participants responded to yes-or-no questions about the nature and causes of normal memory loss and AD and provided information on ethnicity, age, sex, acculturation, and experience with AD. RESULTS: Groups held a common model of AD as a brain-based disease reflecting irreversible cognitive decline. Higher levels of acculturation predicted greater knowledge of AD. Russian speakers favored biological over psychological models of the disease. Groups also held a common model of normal memory loss, including the important belief that "normal" forgetting involves eventual recall of the forgotten material. CONCLUSION: Popular models of memory loss and AD confirm that patients and clinicians are speaking the same "language" in their discussions of memory loss and AD. Nevertheless, the presence of coherent models of memory loss and AD, and the unequal distribution of that knowledge across groups, suggests that clinicians should include wider circles of patients' families and friends in their consultations. These results frame knowledge as distributed across social groups rather than simply the possession of individual minds.

Time for healing: somatization among chronically mentally ill immigrants.

In a cross-sectional study, we examined demographic factors and acculturation level with somatization among chronically mentally ill groups of immigrants (Russians and Latinos). Ninety Russian and 90 Latino patients attending a university affiliated Day Treatment Program were assessed on somatoform symptoms and acculturation by the 12-item somatization subscale of the SCL-90-R and by a 12- items short acculturation scale, respectively. Higher somatization was significantly associated to women, Russian ethnicity, high school or above level of education, shorter length of residence in the U.S., and lower acculturation. Interaction by ethnic group showed that somatization was influenced by the length of residence in the U.S. among Russians but not among Hispanics. In a multivariate model, higher somatization corresponds to female, Russian, and shorter residence in the U.S. (only among Russians). Length of stay in the host country rather than the level of acculturation influence the frequency of somatic complaints, modified by ethnicity.

Incidence of stroke and stroke subtypes in Malmö, Sweden, 1990-2000: marked differences between groups defined by birth country.

BACKGROUND AND PURPOSE: The proportion of immigrants has increased in Sweden markedly during the last decades, as in many other Western countries. Incidence of stroke has increased during this period. However, it is primarily unknown whether incidence of stroke and stroke subtypes in Sweden is related to country of birth. METHODS: Incidence of first-ever stroke was followed during 10 years in a cohort consisting of all 40- to 89-year-old inhabitants in the city of Malmö, Sweden (n=118,134). Immigrants from 12 different countries were compared with native-born Swedes. RESULTS: Adjusted for age, sex, marital status, and socioeconomic indicators, the incidence of stroke (all subtypes) was significantly higher among immigrants from former Yugoslavia (relative risk [RR], 1.31; 95% CI, 1.1 to 1.6) and Hungary (RR, 1.33; CI, 1.02 to 1.7). A significantly increased incidence of intracerebral hemorrhage was observed in immigrants from Peoples Republic of China or Vietnam (RR, 4.2; CI, 1.7 to 10.4) and the former Soviet Union (RR, 2.7; CI, 1.01 to 7.3). Immigrants from Finland had a significantly higher incidence of subarachnoid hemorrhage (RR, 2.8; CI, 1.1 to 6.8). A significantly lower incidence of stroke was observed in the group from Romania (RR, 0.14; CI, 0.04 to 0.6). Immigrants from Denmark, Norway, Germany, Chile, Czechoslovakia, and Poland had approximately the same risk as citizens born in Sweden. CONCLUSIONS: In this urban population from Sweden, there are substantial differences in stroke incidence and stroke subtypes between immigrants from different countries. To what extent this could be accounted for by exposure to biological risk factors remains to be explored.

Biliary liver flukes (Opisthorchiasis and Clonorchiasis) in immigrants in the United States: often subtle and diagnosed years after arrival.

BACKGROUND: Biliary liver flukes are extremely common parasites in some regions of the world where consumption of raw fresh-water fish is a cultural practice. Clonorchis sinensis and Opisthorchis spp. are the major biliary liver flukes associated with human disease. Some of these parasites are highly associated with cholangiocarcinoma. It was noted that several cases presenting at our center had been in the US for prolonged periods. This prompted us to retrospectively review cases of liver fluke infection diagnosed at our facility. METHODS: All cases of biliary liver fluke infection over a 6-year period were retrospectively investigated at a clinic serving international patients, to determine the prevalence and risk factors for infection in a nonendemic area. Cases were identified through review of stool ova and parasite (O&P) records maintained at Regions Hospital/HealthPartners microbiology laboratory. All O&P samples positive for Opisthorchis spp. or Clonorchis sinensis were included in the review. RESULTS: Seventeen cases were identified during the study period. Our center performed approximately 1,800 stool O&P examinations per year on approximately 1,100 individuals per year during the study period. Biliary liver flukes were uncommon, accounting for 1.3% of individuals infected with organisms considered to be potentially pathogenic. Infections were predominantly found in migrants from Laos, Cambodia and Thailand. Cases were also identified in migrants from the former Soviet Union and South America. It is of note that 25% of patients were detected after 5 years of residence in the US. Often, the only clinical clue to infection was a mild absolute eosinophilia (500 to 1000 microL). CONCLUSIONS: Although biliary liver fluke is an infrequent cause of infection in immigrants to the US, because of the potential long-term consequences of chronic infection, educational information highlighting routes of infection and the fact that asymptomatic infection is common and may eventually lead to cancer should be aimed at high-risk community members and those who have been visiting friends and relatives in endemic areas.

Hepatitis B virus genotypes and HBsAg subtypes in refugees and injection drug users in the United States determined by LiPA and monoclonal EIA.

Hepatitis B virus (HBV) genotyping and hepatitis B surface antigen (HBsAg) subtyping were carried out on sera from 196 HBsAg-positive patients, including 151 refugees entering the United States and 45 injection drug users in Seattle. HBsAg subtyping was performed by enzyme immunoassay (EIA) using a panel of monoclonal antibodies and the HBV genotype was determined by polymerase chain reaction (PCR) followed by detection of amplified HBV DNA by a reverse-phase hybridization line probe assay (LiPA) using genotype-specific probes. HBV DNA was detected by PCR in 155 (79%) of the 196 sera and all 155 were genotyped by LiPA. Samples from Southeast Asia were predominantly genotype B/subtype ayw1 and genotype C/adr; samples from the former Soviet Union and eastern Europe were mostly genotype D/ayw2 and genotype D/ayw3; samples from east Africa were mainly genotype A/adw2 and genotype D/ayw2; and samples from injection drug users were mostly genotype D/ayw3 and genotype A/adw2. Some strains of ayw3 gave atypical monoclonal antibody reactivity patterns in the subtyping assay due to a Val/Ala instead of a Thr at amino acid residue 118 and a Thr instead of a Met at residue 125. A strain of ayw2 also gave an atypical monoclonal antibody reactivity pattern due to an Ala instead of a Thr at amino acid residue 123. LiPA genotyping and monoclonal EIA subtyping can provide useful information for epidemiological studies.

[Acute psychiatric hospitalization due to alcoholism, 1978-1988].

We examined the records of 81 alcoholic patients hospitalized a total of 260 times (3.2 per patient) during 1978-1988. Hospitalizations were of the acute type, and not for weaning purposes. Only 1 of the patients was born in Israel. The prevalence of hospitalizations involving alcoholism among immigrants from the former Soviet Union, North Africa, and South America was similar, 0.07%. However, in immigrants from India and Pakistan it was 0.4%. 10% of hospitalizations were ordered by court or district psychiatrists. There were 69 men and 12 women (M/F ratio 5.8). In 1171 of the hospitalizations, one-third were later found not to be of alcohol-related. We therefor emphasize the need for better clinical diagnosis. The relationship between age on immigration and age on first psychiatric hospitalization for alcoholic psychosis indicated a group of "imported" alcoholics. In light of the continuing immigration from countries with a high incidence of alcoholism to Israel, an appropriate system should be set up to prevent and to treat alcoholism.

[Incidence of acute myocardial infarction among Soviet specialists after long-term work in the tropics]. / Zabolevaemost' ostrym infarktom miokarda Sovetskikh spetsialistov, dlitel'no rabotaiushchikh v tropikakh.

The paper presents the results of epidemiological survey of acute myocardial infarction morbidity rates among the Soviet specialists who worked in the Republic of Cuba. A total of 54,765 individuals aged 20-59 years were examined within 10 years. There were 48 cases of acute myocardial infarction (AMI). The morbidity rate in males and females was 1.44 and 0.08 per 1,000, respectively. The morbidity rate was 22.9%; death rate in males and females was 0.28 and 0.08 per 1,000, respectively. The incidence of major risk factors in AMI patients and the relation of the morbidity rates of the specialists to the specific features of their adaptation to an emergency of the tropics were considered. Some trends of practical measures were defined to reduce AMI morbidity rates in specialists moving to the tropics to work.