Revista Panamericana de Salud Pública/Pan American Journal of Public Health

Objectives. To measure device-associated infection (DAI) rates, microbiological profiles, bacterial resistance, extra length of stay, and attributable mortality in intensive care units (ICUs) in three Brazilian hospitals that are members of the International Nosocomial Infection Control Consortium (INICC).
Methods. Prospective cohort surveillance of DAIs was conducted in five ICUs in three city hospitals in Brazil by applying the definitions of the U.S. Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System (CDC-NNIS).
Results. Between April 2003 and February 2006, 1 031 patients hospitalized in five ICUs for an aggregate 10 293 days acquired 307 DAIs, a rate of 29.8% or 29.8 DAIs per 1 000 ICUdays. The ventilator-associated pneumonia (VAP) rate was 20.9 per 1 000 ventilator-days; the rate for central venous catheter-associated bloodstream infections (CVC-BSI) was 9.1 per 1 000 catheter-days; and the rate for catheter-associated urinary tract infections (CAUTI) was 9.6 per 1 000 catheter-days. Ninety-five percent of all Staphylococcus aureus DAIs were caused by methicillin-resistant strains. Infections caused by Enterobacteriaceae were resistant to ceftriaxone in 96.7% of cases, resistant to ceftazidime in 79.3% of cases, and resistant to piperacillintazobactam in 85.7% of cases. Pseudomonas aeruginosa DAIs were resistant to ciprofloxacin in 71.3% of cases, resistant to ceftazidime in 75.5% of cases, and resistant to imipenem in 27.7% of cases. Patients with DAIs in the ICUs of the hospitals included in this study presented extra mortality rates of 15.3% (RR 1.79, P = 0.0149) for VAP, 27.8% (RR 2.44, P = 0.0004) for CVC-BSI, and 10.7% (RR 1.56, P = 0.2875) for CAUTI.
Conclusion. The DAI rates were high in the ICUs of the Brazilian hospitals included in this study. Patient safety can be improved through the implementation of an active infection control program comprising surveillance of DAIs and infection prevention guidelines. These actions should become a priority in every country.

Tasa de infecciones asociadas a aparatos en unidades de cuidados intensivos de hospitales brasileños: datos de la Comunidad Científica Internacional de Control de Infecciones Nosocomiales

Objetivos. Determinar las tasas de infección asociadas a aparatos (IAA), los perfiles microbiológicos, la resistencia bacteriana, la estancia hospitalaria adicional y la mortalidad atribuible en las unidades de cuidados intensivos (UCI) de tres hospitales brasileños miembros de la Comunidad Científica Internacional de Control de Infecciones Nosocomiales (INICC).
Métodos. Se realizó una vigilancia prospectiva de cohorte de las IAA en cinco UCI de tres hospitales urbanos de Brasil, según las definiciones del Sistema Nacional de Vigilancia de Infecciones Nosocomiales de los Centros para el Control y la Prevención de Enfermedades (CDC-NNIS) de los Estados Unidos de América.
Resultados. Entre abril de 2003 y febrero de 2006 se hospitalizaron 1 031 pacientes en las cinco UCI estudiadas, con un total de 10 293 días en los que se adquirieron 307 IAA, para una tasa de 29,8% (29,8 IAA por 1 000 días-UCI). Las tasas fueron: de 20,9 casos por 1 000 díasventilador en neumonía asociada a respiradores (NAR); de 9,1 por 1 000 días-catéter en infecciones circulatorias asociadas con cateterismo venoso central (IC-CVC); y de 9,6 por 1 000 días-catéter en infecciones urinarias asociadas con el uso de catéteres (IUAC). De las IAA causadas por Staphylococcus aureus, 95% se debieron a cepas resistentes a la meticilina. De las infecciones causadas por Enterobacteriaceae, 96,7% fueron resistentes a la ceftriaxona, 79,3% a la ceftazidima y 85,7% a la combinación piperacilina-tazobactam. De las IAA causadas por Pseudomonas aeruginosa, 71,3% resultaron resistentes a la ciprofloxacina, 75,5% a la ceftazidima y 27,7% al imipenem. Los pacientes con IAA en las UCI estudiadas presentaron tasas de mortalidad adicional de 15,3% (riesgo relativo [RR] = 1,79; P = 0,0149) por NAR, 27,8% (RR = 2,44; P = 0,0004) por IC-CVC y 10,7% (RR = 1,56; P = 0,2875) por IUAC.
Conclusiones. Las tasas de IAA en las UCI de los hospitales brasileños estudiados fueron elevadas. Se puede mejorar la seguridad de los pacientes mediante la implementación de un programa de control activo de las infecciones, que contemple la vigilancia de las IAA y directivas para la prevención de las infecciones. Estas acciones deben ser una prioridad en todos los países.

Prevalence of hospital infections in adult intensive care units in Argentina

Objectives. To present consolidated results from two surveys of nosocomial infection incidence, within the framework of Argentina’s National Surveillance of Hospital Infections Program.
Methods. Two editions of the National Survey on the Incidence of Hospital Infections in Argentina were used, those of 2004 and 2005. Of the 68 hospitals, 53 reported data from adult intensive care units (in 2004, 26 units; in 2005, 27), for a total of 359 patients (in 2004, 158 patients; in 2005, 201). The survey was designed as a multicenter, observational, cross-sectional, and descriptive study. Data analysis was performed with several statistics programs, combining and standardizing variables and both time periods in order to include all the hospitals from the two surveys.
Results. The prevalence of hospital infection among patients was 24%. Of the 127 illnesses, the most frequently occurring was pneumonia (43.3%), which in 85% of the cases was associated with use of a respirator. Primary bloodstream infections took second place, at 20.5%, with 61% of these cases being associated with a central catheter. Patients given respiratory therapy were at greatest risk (P < 0.001) of developing pneumonia; this was not observed among patients with central or urinary catheters.
Conclusions. The prevalence of hospital infections, the distribution of primary infection sites, and the associations with risk factors were similar to those observed by other authors in several countries. It is important to understand the local and national issues prior to initiating a surveillance program. Surveys such as these, with a national scope and administered by the State, are one way of motivating, raising awareness, and building capacity.

Objetivos. Presentar resultados consolidados de dos encuestas de prevalencia de infecciones nosocomiales, realizadas en el marco del Programa Nacional de Vigilancia de Infecciones Hospitalarias de Argentina.
Métodos. Se realizaron dos ediciones de la Encuesta Nacional de Prevalencia de Infecciones Hospitalarias de Argentina, en 2004 y 2005. De 68 hospitales, 53 notificaron datos de unidades de cuidados intensivos de adultos polivalente (26 en 2004 y 27 en 2005), con un total de 359 pacientes (158 en 2004 y 201 en 2005). La encuesta se diseñó como un estudio multicéntrico, observacional, transversal y descriptivo. El análisis de los datos se realizó utilizando distintos paquetes estadísticos, con variables y tiempos unificados y estandarizados para permitir la incorporación de los hospitales de ambos períodos.
Resultados. La prevalencia de pacientes con infección hospitalaria fue de 24%. Sobre 127 episodios, el más frecuente fue la neumonía (43,3%), que en 85% de los casos se asoció a asistencia respiratoria mecánica. En segundo lugar, se encontró la infección primaria de la sangre con 20,5%; en 61% de los casos se la asoció a catéter central. Los pacientes expuestos a asistencia respiratoria mecánica presentaron mayor riesgo (P < 0,001) de desarrollar neumonía; esto no se observó en pacientes con catéter central o urinario.
Conclusiones. La prevalencia de infección hospitalaria, la distribución por sitios primarios y la asociación a factores de riesgo, fueron similares a lo observado por otros autores de distintos países. Es fundamental conocer la problemática local y nacional antes de iniciar un programa de vigilancia. Estas encuestas, de carácter nacional y administradas por el Estado, son un factor de motivación, concienciación y capacitación.

Health-related quality of life among people with intellectual disabilities in Spain

Objective. To measure health-related quality-of-life (HRQL) among people with intellectual disabilities in the province of Salamanca, Spain.
Methods. A population-based, cross-sectional descriptive study. The SF-36 Health Survey, adapted and validated for the Spanish population, was selected and administered to 265 people with intellectual disabilities in the province of Salamanca, Spain. Personal interviews were also conducted with the participants in the presence of their parents, tutors, or close family. Eight quality-of-life scales were explored: general health, physical functioning, role–physical, bodily pain, role–emotional, social functioning, vitality, and mental health, based on questions on sociodemographic and lifestyle variables, health services utilization, support needs, and health status and HRQL.
Results. Of the 265 people studied, 69.8% were men and 30.2% were women (median age: 35 years; minimum: 16; maximum: 72). The highest number of points pertained to role–physical and physical functioning (more than 85 points), and the lowest, to general health and vitality (less than 70 points). No significant differences were found between men and women for any of the eight components. The independent variables, age, family income, level of education, and support needs showed the greatest number of independent associations with the general health, physical functioning, and social functioning components. Of the participants, 41.5% indicated that they felt their health was good.
Conclusions. The study participants perceived their HRQL to be good, especially on the role–physical and physical functioning scales. Additional studies should be designed to evaluate HRQL in people with different degrees of intellectual disability to further contribute to intervention efforts and health and social programs designed specifically for this population group and to evaluate the interventions and program already underway.

Objetivo. Establecer la calidad de vida relacionada con la salud (CVRS) percibida por las personas con discapacidad intelectual en la provincia de Salamanca, España.
Métodos. Estudio descriptivo transversal de base poblacional. Se aplicó el cuestionario de salud SF-36, adaptado y validado para la población española, a 265 personas con discapacidad intelectual de la provincia de Salamanca, España. Se realizaron entrevistas personales a los participantes en presencia de sus padres, tutores o familiares cercanos. Se exploraron ocho dimensiones de la calidad de vida: salud general, función física, rol físico, rol emocional, función social, dolor corporal, vitalidad y salud mental a partir de variables sociodemográficas y de estilo de vida, utilización de servicios de salud, necesidades de apoyo, y estado de salud y CVRS.
Resultados. De las 265 personas estudiadas, 69,8% eran hombres y 30,2% eran mujeres (edad media: 35 años; mínima: 16; máxima: 72). Las puntuaciones máximas obtenidas correspondieron a las dimensiones rol físico y función física (por encima de 85 puntos) y las mínimas, a salud general y vitalidad (por debajo de 70 puntos). No se observaron diferencias significativas entre los hombres y las mujeres en ninguna de las ocho dimensiones. Las variables independientes edad, ingresos familiares, nivel educacional y necesidad de apoyo presentaron la mayor cantidad de asociaciones independientes con las dimensiones salud general, función física y función social. De los participantes, 41,5% manifestó que su salud percibida era buena.
Conclusiones. Los participantes en este estudio percibieron su CVRS como buena, especialmente en las dimensiones rol físico y función física. Se deben diseñar estudios para evaluar la CVRS en personas con diferentes grados de discapacidad intelectual para contribuir a elaborar intervenciones y programas sanitarios y sociales específicos para esta población y para evaluar las intervenciones y los programas en marcha.

Participatory development of descriptors for evaluation of violence and accident prevention centers in Brazil

Objective. To explain the participatory model used to develop descriptors for evaluating the Accident and Violence Prevention Centers created by the Ministry of Health of Brazil to initiate and follow-up on public policies that reduce morbidity and mortality due to external causes.
Method. The nominal group technique was the main strategy employed. Participants included 13 representatives from centers in the states of Rio de Janeiro and Espírito Santo.
Results. Eleven descriptors were identified for evaluation, with five being selected as priorities: situation analysis; intra- and intersectoral processes; monitoring of municipal accident and mortality data; political, financial, and administrative support (autonomy); and establishment of a work team (composition, dedication, and technical skills).
Conclusions. The participatory model revealed both a step toward identity-developing for the centers, as well as the history of the health sector’s actions in this area. The process also highlighted old barriers that must be overcome if effective actions against violence are to be taken by the country.

Objetivo. Descrever o processo de construção participativa de descritores para a avaliação dos Núcleos de Prevenção de Acidentes e Violência instituídos pelo Ministério da Saúde brasileiro, cuja missão é o acompanhamento e a mobilização de políticas públicas voltadas para a redução da morbimortalidade por causas externas.
Método. A técnica de grupo nominal foi a estratégia central empregada. Participaram 13 representantes dos núcleos dos estados do Rio de Janeiro e Espírito Santo.
Resultados. Foram produzidos 11 descritores para avaliação e foram eleitos cinco como prioritários: construção do diagnóstico situacional, articulação intra e intersetorial, monitoramento dos dados de mortalidade de acidentes e violência no município, apoio político, financeiro e administrativo (autonomia) e formação de equipe de trabalho (composição, dedicação e capacitação técnica).
Conclusões. Os descritores escolhidos revelam tanto a trajetória de construção de identidade desses núcleos e a maturidade de atuação do setor saúde nessa área como também antigos obstáculos a serem superados para a realização de ações mais efetivas de enfrentamento da violência no País.

Control of cervical cancer in Colombia: the perspective of the health system

Objectives. To characterize the health system stakeholder’s perspective on the basics of the political, economic, and sanitary context, as well as the ways in which control activities are being realized in four of Colombia’s health departments.
Methods. This was a qualitative study of four Colombian health departments chosen for their differing cervical cancer mortality rates and their planned disease control efforts (Boyacá, Caldas, Magdalena, and Tolima). Semistructured interviews were conducted of health care managers, insurance coordinators, and public and private health institutions at the departmental and municipals levels. Focus groups comprised of professionals from health insurance companies and health care services providers were convened. Data analysis was based on the grounded theory with open codes related to the roles of health care managers, insurance companies, and heath care services provided. The technical reports were compared to the testimonies of interviewees.
Results. Thirty-eight interviews and 14 focus groups (70.9% response rate) were conducted and 12 technical reports reviewed. Cervical cancer is not perceived to be a public health priority. Interest centers on the flow of financial resources within the health system. Findings indicated unsatisfactory communication among the stakeholders and no consensus on the subject. Planning is limited to meeting the status quo. Staffing is inadequate. Cases with positive outcomes are lost to follow-up due to the fragmentation that results from affiliation with different health care systems.
Conclusions. The financial situation, normative planning, and the challenges of decentralization affect the skill-building, at-risk coverage, and the control activities needed for effective screening programs. What is needed is an integrated, more efficiently organized program in which all the health system stakeholders participate.

Objetivo. Caracterizar, desde la perspectiva de los actores del sistema de salud, los elementos del contexto político, económico y sanitario, así como la forma en que se articulan las actividades para el control del cáncer cervicouterino en cuatro departamentos de Colombia.
Métodos. Estudio cualitativo en cuatro departamentos colombianos seleccionados por sus diferentes niveles de mortalidad por cáncer cervicouterino y de organización de las actividades de control de esta enfermedad (Boyacá, Caldas, Magdalena y Tolima). Se realizaron entrevistas semiestructuradas a funcionarios, directores de aseguradoras y de instituciones de salud públicas y privadas a niveles departamental y municipal. Se conformaron grupos focales con profesionales de las empresas aseguradoras y prestadoras de servicios. El análisis de la información se basó en la teoría fundamentada con codificaciones abiertas relacionadas con las funciones de las direcciones de salud, de las empresas aseguradoras y las acciones de los servicios de salud. Los informes técnicos se contrastaron con los testimonios.
Resultados. Se realizaron 38 entrevistas y se trabajó con 14 grupos focales (70,9% de respuesta) y 12 informes técnicos. El cáncer cervicouterino no es percibido como una prioridad de la salud pública. El interés se centra en el flujo de dinero dentro del sistema. No se encontró una adecuada articulación entre los actores y no hay rectoría en el tema. La planificación se limita al cumplimiento de las normas. Los recursos humanos son inadecuados. No hay seguimiento de los casos positivos por la fragmentación de la población según su afiliación al sistema de salud.
Conclusiones. La orientación financiera, la planificación normativa y las dificultades de la descentralización afectan al desarrollo de las competencias, la cobertura de la población de alto riesgo y las actividades de control necesarias para el adecuado funcionamiento de los programas de tamizaje. Se requiere un programa integrado y mejor organizado en el que participen los diferentes actores del sistema de salud.

Brazilian-Portuguese translation and validation of the HIV/AIDS-Targeted Quality of Life Instrument

Objectives. To translate the HIV/AIDS-Targeted Quality of Life Instrument (HATQoL) into Brazilian Portuguese, culturally adapt it, and evaluate its psychometric properties (validity and reliability) as a Brazilian version.
Methods. This cross-sectional study was carried out at the laboratory of infectious diseases at Escola Paulista de Medicina (Universidade Federal de Sao Paulo). Data were collected on clinical and sociodemographic characteristics of 106 HIV-infected individuals who answered the HAT-QoL and the SF-36R. Pearsonfs correlation coefficient was used to measure construct validity. Reliability was assessed using Cronbachfs alpha and intraclass correlation coefficients.
Results. The sample was 70.8% male. The mean age was 39.9 years, with 40.5% of the participants being homosexual or bisexual. Eleven (10.4%) patients had a CD4 cell count . 200 cells/mm3. A substantial ceiling effect was observed in 7 of 9 HAT-QoL domains (overall function, life satisfaction, health worries, medication worries, HIV acceptance, provider trust, and sexual function). Sexual function was the domain with the highest ceiling effect (63.2%). A substantial floor effect (30.2%) was observed for financial worries. Statistically significant associations were observed between the HAT-QoL domains and clinical and sociodemographic characteristics, as well as with SF-36 domains. Internal consistency was satisfactory (Cronbachfs alpha = 0.73.0.90). Inter- and intraobserver reproducibility was very high (0.87.0.98 and 0.82.0.97, respectively).
Conclusion. The Brazilian Portuguese version of the HAT-QoL is valid, reliable, and may contribute to evaluating the impact of HIV infection on the quality of life of patients in Brazil.

Objetivo. Traduzir para portugues brasileiro, adaptar culturalmente e avaliar as propriedades psicometricas (validade e confiabilidade) de um questionario de qualidade de vida (HIV/AIDS-Targeted Quality of Life Instrument, HAT-QoL) especifico para pacientes infectados pelo HIV.
Metodo. Estudo transversal realizado no ambulatorio de infectologia da Escola Paulista de Medicina da Universidade Federal de Sao Paulo. Coletaram-se caracteristicas sociodemograficas e clinicas de 106 individuos infectados pelo HIV, que responderam os questionarios de qualidade de vida HAT-QoL e SF-36. O coeficiente de correlacao de Pearson aferiu a validade de construto. Para avaliar a confiabilidade foram calculados o alfa de Cronbach e o coeficiente de correlacao intraclasse.
Resultados. A proporcao de homens na amostra foi de 70,8%. A media de idade foi 39,9 anos. Dos participantes, 40,5% eram homo ou bissexuais. Onze (10,4%) pacientes tinham contagem de celulas CD4 . 200 celulas/mm3. Entre os nove dominios do HAT-QoL, sete (funcao geral, satisfacao com a vida, preocupacoes com a saude, preocupacoes com a medicacao, aceitacao do HIV, confianca no profissional e funcao sexual) apresentaram efeito teto substancial. O dominio gfuncao sexualh foi o que apresentou efeito teto mais alto (63,2%). O dominio preocupacoes financeiras apresentou efeito chao substancial (30,2%). Associacoes estatisticamente significativas foram observadas entre os dominios do HAT-QoL e caracteristicas sociodemograficas e clinicas e dominios do questionario SF-36. A consistencia interna foi satisfatoria (alfa de Cronbach = 0,73 a 0,90). A reprodutibilidade inter e intraobservador foi muito alta (0,87 a 0,98 e 0,82 a 0,97, respectivamente).
Conclusao. O HAT-QoL em portugues brasileiro e um instrumento valido, confiavel e que pode contribuir para avaliar o impacto da infeccao pelo HIV sobre a qualidade de vida de pacientes brasileiros.

Objective. In spite of long-term endemicity and repeated government and private efforts, effective, sustained community participation for dengue prevention remains a challenge in Puerto Rico. This study explored differences found in interviews conducted in 2001 in attitudes toward dengue and its prevention by respondents' gender and whether they had a prior dengue infection. Findings may be used to develop messages to promote Aedes aegypti control practices.
Methods. From September to October 2003, 11 focus groups were conducted in San Juan, Puerto Rico. Fifty-nine persons (35 women, 24 men), . 18 years of age, who had been identified through the Puerto Rico dengue surveillance system participated in the focus groups. Analysis was based on grounded theory.
Results. Women considered dengue important because of its economic, emotional, and health impact, and they were concerned more often than men about insufficient garbage removal and water disposal. Participants with a previous dengue diagnosis were more concerned about risk of the disease, were more knowledgeable about dengue and its prevention, and recommended use of repellents more often than their counterparts without a previous dengue diagnosis. Barriers to sustained dengue prevention included misconceptions from outdated educational materials, “invisibility” of dengue compared with chronic diseases, and lack of acceptance of responsibility for dengue prevention.
Conclusions. Suggested strategies to motivate residents' actions included working with government agencies to address structural problems that increase mosquito populations, improving access to information on garbage collection and water disposal through telephone hotlines, increasing publicity and information about dengue by mass media campaigns, and educating health professionals.

Creencias y prácticas comunitarias relacionadas con el dengue en Puerto Rico

Objetivo. A pesar de la prolongada endemia y los reiterados esfuerzos gubernamentales y privados, la participación efectiva y sostenida de la comunidad en las tareas de prevención del dengue sigue siendo un reto en Puerto Rico. A partir de entrevistas realizadas en 2001 se analizaron las diferencias en las actitudes hacia el dengue y su prevención según el sexo de los encuestados y sus antecedentes de haber sufrido esta enfermedad. Estos resultados pueden servir para desarrollar mensajes dirigidos a promover prácticas de control de Aedes aegypti.
Métodos. Entre septiembre y octubre de 2003 sesionaron 11 grupos focales en San Juan, Puerto Rico. Participaron 59 personas (35 mujeres y 24 hombres) de 18 años o más, identificados a través del sistema de vigilancia de dengue de Puerto Rico. El análisis se basó en la teoría fundamentada o inductiva.
Resultados. Las mujeres consideraban importante el dengue por su impacto económico, emocional y sanitario y más mujeres que hombres estaban preocupadas por la insuficiente recolección de basura y disposición de aguas residuales. Los participantes con diagnóstico previo de dengue estaban más preocupados por los riesgos de la enfermedad, conocían más sobre el dengue y su prevención y con mayor frecuencia aconsejaron el uso de repelentes que sus pares sin diagnóstico previo de dengue. Entre las barreras para la prevención sostenida del dengue estaban: conceptos erróneos por materiales educativos obsoletos, la “invisibilidad” del dengue en comparación con las enfermedades crónicas y la falta de aceptación de responsabilidad por la prevención del dengue.
Conclusiones. Las estrategias sugeridas para motivar la acción de los residentes comprenden: trabajar con las agencias gubernamentales para resolver los problemas estructurales que incrementan las poblaciones de mosquitos, mejorar el acceso a la información sobre la recolección de basura y la disposición de las aguas residuales mediante líneas telefónicas de asistencia directa, aumentar la propaganda y la información sobre el dengue mediante campañas por los medios masivos de información y educar a los profesionales de la salud.

Objectives. Low-income residents of northern Mexico rely on unvented heaters during the winter, a practice that puts them at elevated risk for carbon monoxide intoxication. The goal of this study is to develop a communication protocol for carbon monoxide intoxication risks among the primarily low socioeconomic status population of Ciudad Juárez, Chihuahua, Mexico.
Methods. The mental models risk communication approach was used to identify important gaps in public understanding. This approach consists of step-by-step assessment of information needs and effectiveness of risk communication efforts by using interviews and surveys.
Results. The mental models process uncovered a key technical misunderstanding, the subject population’s belief that carbon monoxide can be seen or smelled, which may result in a risk-prone behavior: failure to use a carbon monoxide detector. A communication protocol was designed to address this and other knowledge gaps, and it produced significant improvements in subjects’ knowledge in a pretest/posttest evaluation.
Conclusions. The mental models process was successful in developing a communication instrument capable of improving knowledge in the subject population. Future research needs include assessing the extent to which this instrument succeeds in changing behavior and reducing the risk of carbon monoxide intoxication. Future interventional efforts may focus on encouraging people to use carbon monoxide detectors.

Aplicación del enfoque de los modelos mentales al riesgo por monóxido de carbono en el norte de México

Objetivos. Los residentes de bajos ingresos del norte de México dependen durante el invierno de calefactores no ventilados, una práctica que los pone en mayor riesgo de intoxicación por monóxido de carbono. Se elaboró un protocolo de comunicación sobre los riesgos de intoxicación por monóxido de carbono en la población fundamentalmente de bajo nivel socioeconómico de Ciudad Juárez, Chihuahua, México.
Métodos. Se utilizó el enfoque de comunicación de riesgos de los modelos mentales para identificar importantes brechas en la comprensión pública. Este enfoque consiste en la evaluación paso a paso de las necesidades de información y la eficacia de los esfuerzos de comunicación de riesgos, mediante entrevistas y encuestas.
Resultados. El proceso basado en los modelos mentales descubrió un malentendido técnico clave: la población estudiada cree que el monóxido de carbono se puede ver u oler. Esto puede llevar a un comportamiento proclive al riesgo: no utilizar detectores de monóxido de carbono. Se diseñó un protocolo de comunicación para atender esta y otras brechas en el conocimiento que, según las evaluaciones previa y posterior, mejoró significativamente el nivel de conocimiento de las personas.
Conclusiones. El proceso basado en modelos mentales permitió desarrollar exitosamente un instrumento de comunicación capaz de mejorar el nivel de conocimiento en la población estudiada. Investigaciones futuras deben evaluar en qué grado este instrumento logra modificar el comportamiento y reducir el riesgo de intoxicación por monóxido de carbono. Nuevas intervenciones podrían centrarse en estimular el uso de detectores de monóxido de carbono.

Human rabies transmitted by vampire bats reached new heights in Latin America in 2005. A total of 55 human cases were reported in several outbreaks, 41 of them in the Amazon region of Brazil. Peru and Brazil had the highest number of reported cases from 1975 to 2006. In Peru, outbreaks involving more than 20 cases of bat-transmitted human rabies were reported during the 1980s and 1990s. During this period, a smaller number of cases were reported from outbreaks in Brazil. A comparison of data from field studies conducted in Brazil in 2005 with those from the previous decade suggests similar bat-bite situations at the local level. The objective of this study was to review the epidemiological situation and, on the basis of this information, discuss possible factors associated with the outbreaks. Prevention and control measures already recommended for dealing with this problem are also reviewed, and some further suggestions are provided.

La rabia transmitida por murciélagos vampiros a humanos: ¿una zoonosis emergente en América Latina?

La rabia en humanos transmitida por murciélagos vampiros aumentó en América Latina en 2005. Se notificaron varios brotes con un total de 55 personas enfermas, 41 de ellas en la región amazónica de Brasil. Perú y Bolivia acumularon el mayor número de casos notificados entre 1975 y 2006. En Perú se informaron brotes de más de 20 personas con rabia transmitida por murciélagos en las décadas de 1980 y 1990. En ese período se informó un número menor de casos en los brotes de Brasil. Al comparar los datos de estudios de campo realizados en Brasil en 2005 con los obtenidos en décadas anteriores se observaron situaciones similares en cuanto a los casos de mordidas por murciélagos a nivel local. En este estudio se presenta una revisión de la situación epidemiológica y, a partir de esa información, se discuten los posibles factores asociados con los brotes. Se revisan también las medidas de prevención y control ya recomendadas para hacer frente a este problema y se ofrecen algunas recomendaciones adicionales.

Canine population dynamics: the potential effect of sterilization campaigns

Objective. To analyze, through mathematical modeling, the potential ability of sterilization campaigns to reduce the population density of pet dogs.
Methods. Mathematical models were constructed to simulate the canine population dynamics and project the results of control strategies based on several sterilization rates.
Results. Even at high sterilization rates (for example, 0.80 year–1), it would take approximately 5 years to reduce density by 20%. Even so, other sources of population growth, such as the importing of dogs from other geographic areas, could outweigh the effects of a sterilization program.
Conclusions. A program’s effectiveness is contingent upon not only on the sterilization rate, but also the rate of population growth. Sterilization campaigns may potentially reduce population density, but this reduction may not be immediately evident.

Objetivo. Analisar, por meio de modelos matemáticos, os potenciais impactos das campanhas de esterilização na redução da densidade populacional de cães domiciliados.
Métodos. Foram elaborados modelos matemáticos para simular a dinâmica populacional de cães domiciliados e projetar os resultados de estratégias de controle para diferentes taxas de esterilização.
Resultados. Mesmo para altas taxas de esterilização (por exemplo, 0,80 ano–1), seriam necessários cerca de 5 anos de campanhas para possibilitar uma redução de 20% na densidade. No entanto, outras fontes de crescimento populacional, como a importação de cães de outras áreas, poderiam reduzir a efetividade dos programas de esterilização.
Conclusões. A efetividade de um programa depende não apenas da taxa de esterilização, mas também da taxa de crescimento populacional. As campanhas de esterilização podem potencialmente reduzir a densidade populacional, embora a redução nem sempre possa ser notada de imediato.