n is emphasized.  Material
on administration and the rural economy are incorporated.The school in the fulfillment of all its functions emphasizes the fields of action of
veterinary public health and management as axes of the professional activities of the veterinarian in the search for social transformation for health
and development.56. The school prepares the veterinarian to occupy a position on the health or agricultural team.  It discusses his role within
a multidisciplinary context in a limited way.The school of veterinary medicine considers the veterinarian as an independent professional member
of a multidisciplinary team.  This concept is made viable through its theoretical and practical content.The school considers multidisciplinary
teamwork and the capacity to make decisions with professional independence as basic; it participates actively in searching, planning, and
implementation that demonstrate these qualities and elements.57. In its teaching the school utilizes the results of research carried out by various
health professionals, but the actual research activities are minimal.The instructors, students, and graduates question the models of animal health
care, carrying out research on related problems.The instructors, students, and graduates of the school, forming interdisciplinary teams, participate
through the results of their research in the prevention and solution of the priority problems in veterinary public health.58. The school, through
its instructors, students, and graduates, participates in discussions (for example, scientific days) that tend to define the functions and bases of
the profession.The school, through its instructors, students, and graduates, organizes activities to discuss the nature of the profession,
using the existing theories as a basis.  The professional profile responds partially to the needs of the country.The school, through its instructors,
students, and graduates and with the help of the various social actors, assumes a significant role in research and other activities that tend to
define the profile of the veterinarian to include contributing to the resolution of problems related to health, food protection, the environment,
animal production and health, and the development of biomedical models.59. The school treats the subjects related to working conditions in the
profession very lightly, both in the theory and in the practice.The responsibility for improving working conditions in the profession is assumed
by the school as a line of action in the institutions where the students practice; the latter participate in a limited way in the discussion of the
curriculum.The school assumes a significant role in the improvement of working conditions in the profession.  It prepares the veterinarians to
take an active part in the search for the strategies and mechanisms that are conducive to good professional performance.The graduate of the
school in the society

60. The graduates of the school have knowledge, abilities, and skills in their field of work.  In the labor market they demonstrate their limitations
in analysis and research.

The graduates of the school demonstrate knowledge and abilities in the practice while at the same time conducting applied research to improve
the services.  Their critical attitudes are limited to their participation in review and improvement committees in their places of work.

The graduates of the school demonstrate knowledge, abilities, and professional aptitudes and perform efficiently.  They develop critical and
analytical aptitudes in their occupation in order to identify, through applied research and other activities, new ways to promote health and
development.61. The graduates accept the ethical values of the institution where they work.The graduates consciously apply professional values
in considering the environment.The graduates of the school have an ethical social conscience which they apply to social transformation.62. The
graduates of the school enter the labor market where they follow the existing lines of authority and standards.  They demonstrate a personal
interest but participate only in the application of some specific regional and local health programs.When they enter the labor market, the
graduates of the school demonstrate qualities of leadership, striving for the improvement of veterinary care and veterinary personnel.The
graduates of the school demonstrate capacities of leadership and management that are conducive to the transformation of health and
development.63. The graduates of the school see veterinary medicine as a dependent profession and a source of relatively secure
employment.The graduates of the school are identified with their profession and become leaders in its promotion.The graduates of the school
are fully identified with the profession, promoting its development in all areas.

     TOBACCO OR HEALTH


















ANALYSIS OF THE SITUATION

.    At least 90% of the deaths from
     lung cancer, 75% of those
     caused by chronic bronchitis,
     and 25% resulting from ischemic
     heart disease can be traced to
     smoking.

.    It is estimated that in the
     Americas smoking is associated
     with more than half a million
     avoidable premature deaths
     every year. 

.    In Canada and the United States
     of America, which have had
     prevention and control programs
     for more than two decades, a
     sustained decline in tobacco
     use has been observed, owing in
     large measure to the fact that
     many adults have given up the
     habit. 

.    In Latin America and the
     Caribbean, where only a few
     countries have national
     programs for prevention and
     control, it is estimated that
     tobacco use is increasing in
     some population groups,
     especially among adolescents
     and young women with stable
     incomes who live in urban
     areas.

PAHO PROGRAM ON TOBACCO OR HEALTH

The Governing Bodies of PAHO/WHO
have adopted a number of resolutions
urging the Governments and the
nongovernmental agencies to assume
a more active role in the fight
against the use of tobacco.

Activities in this regard have
included the convening of panels of
experts, the organization of
workshops, and the promotion of
policies, plans, and programs for
the prevention and control of
smoking in the countries.

The Organization cooperates in the
analysis of existing legislation and
in the promotion of legal measures
aimed at reducing the use of tobacco
and protecting the population
against its harmful effects.

As the culmination of this process,
PAHO/WHO has established a program
on "Tobacco or Health," the plan of
action for which is based on
Resolution XII of the XXXIV meeting
of the Directing Council (1989) and
is supported by the Ministers of
Health of the Region.

PAHO, in addition to promoting
awareness of the risks of smoking
and encouraging the implementation
of control measures in the
countries, provides technical
advisory services, identifies
critical areas and deficiencies,
collaborates with the countries in
the development of programs, and
cooperates in training and research.
OBJECTIVES OF THE PROGRAM

1. To promote public health measures
at  the Regional, subregional, and
national levels in order to reduce
the incidence and prevalence of
smoking and protect the health of
non-smokers, working to see that
their rights are upheld.

2. To ensure that future societies
and generations will remain "smoke-
free."




STRATEGIES AND PRIORITIES

The attainment of the ultimate
objectives of the program will be
facilitated by the adoption of
strategies for implementation of the
Regional Plan of Action for the
Prevention and Control of Smoking. 
This plan recommends concrete
control measures, including:

*    Promoting the development of
     policies, plans, and programs
     for the prevention and control
     of smoking.

*    Facilitating the mobilization
     of public opinion, the
     encouragement of appropriate
     political action, and the
     utilization of resources for
     prevention and control of the
     habit.

*    Facilitating the production,
     collection, and distribution of
     pertinent technical
     information.











LINES OF ACTION


1.  Development of policies, plans,
and programs

Promotion of policies, plans, and
programs on smoking.  Efforts in
this regard are aimed at raising
awareness of the health risks posed
by tobacco in the general public,
opinion groups, and decision-making
circles in order to promote the
adoption of clear-cut policies on
the problem.

2.  Mobilization of resources

Identification and mobilization of
all possible resources that could
contribute to execution of the
program:  mobilization of public
opinion, identification of
preeminent experts and centers,
determination of sources of
financing, utilization of social
networks, cooperation with involved
community groups.


3.  Dissemination of information

Collection, production,
dissemination, and exchange of
educational/informative material on
smoking.  Use of the mass media as
an instrument for prevention.


4.  Training

The Program supports short-term
training activities for personnel in
charge of formulating and
implementing programs for the
prevention and control of smoking.


5.  Research

The Program encourages and supports
research on the causes and
prevalence of smoking, as well as on
the effectiveness and impact of
prevention and control activities.


6.  Direct technical cooperation

Technical advisory services are
provided to the countries that
request them for the development of
national programs that are
compatible with the Program's lines
of action.  The Program arranges for
the services of experts and
cooperates in working group meetings
and activities of planning and
evaluation.
4.    Epidemiological Research on Malaria

      4.1   Introduction

      The need for epidemiological research on malaria can vary
greatly not just between countries but also from one locality to the
next.  The incidence of malaria as well as mortality from the disease
vary both geographically and with the social composition of
populations.  For example, in 1986, although just 3.8% of the
population of the Region of the Americas was living in the subregion
comprising Central America, Panama, and Belize, this area accounted for
123,000 cases of malaria, or 20% of the total number of cases in the
Region.  Within this subregion, Costa Rica and Panama had only 2% of
the cases, while 98% were concentrated in the five remaining countries
(PAHO, 1988:5).  Within these countries, it is possible to identify the
localities and population groups which account for the majority of
malaria cases and in which the probability of occurrence of the illness
is greater than in others places or groups.  It is therefore of vital
importance to identify the set of characteristics or factors in such
localities and groups that explain the increased probability of
becoming ill or dying of malaria.

      Recognition of the risk factors for malaria, and of the relative
importance of each of them, in each of the localities and population
groups during a specific period can be accomplished through
epidemiological research studies.  Epidemiological research seeks to
collect and organize information on the risk factors associated with
a higher risk of becoming ill with a disease, thereby contributing to
more complete knowledge of the epidemiological situation of that
disease.  In addition, it facilitates the establishment of a
population's risk profile and the selection of interventions aimed
specifically at modifying or eliminating this profile in high-
risk localities and groups. 

      The three basic assumptions that provide the rationale for
malaria research based on the epidemiological risk approach can be
stated as follows: 
      (1)   Within the malarious areas selected, it is possible to
identify, through indicators based on risk factors, certain
subgroups of the population in which the probability of
contracting malaria is greater than in the rest of the
population.

      (2)   Such subgroups account for a substantial proportion of the
morbidity from malaria that occurs in the total population.

      (3)   It is possible to increase the effectiveness and efficiency
of the general health services in the management of malaria
prevention and control interventions by rechanneling
activities and resources toward:
a.   the causal risk factors identified; and
b.   the individuals and groups that are at greatest risk
of contracting malaria.


      These three premises facilitate the formulation of research
objectives and hypotheses that will establish the correlation between
malaria and the various risk factors under study.

      4.2   Definition of Purposes and Objectives

      In all situations in which an epidemiological study of malaria
risk is to be carried out, it is fundamental that the purposes and
objectives of the research be rationally defined.

      One of the general objectives of epidemiological research on
malaria is to identify those individuals and social groups in malarious
areas who, by reason of their social, economic, or environmental living
conditions, are at very high risk of becoming ill or dying of malaria.

      4.3   Formulation of the Research Hypothesis

      Epidemiological research is conducted with a view to answering
certain specific questions, or hypotheses, relating to the frequency,
distribution, and determinants of malaria in various social groups.

      Thus, an initial step in epidemiological research is the
formulation of relevant questions that can be the subject of research. 
Such questions are presented in the form of one or more hypotheses. 
These hypotheses express the probable correlation that exists in the
study population between exposure to one or more risk factors and the
occurrence of an impairment to health, in this case malaria.

      RESEARCH HYPOTHESIS:

      An assumption or conjecture that is advanced to account
      for certain facts or events and is used as a basis for
      research which seeks to prove or disprove the hypothesis.
      (OMS/OPS, 1986:47)


      Well-formulated hypotheses lead to better-structured research. 
An example of a hypothesis for epidemiological research on malaria
might be the following:

      The individuals in locality "x" who lack regular access to
      medical care will have greater morbidity from malaria than those
      who have regular access to health services.


      The number of hypotheses will depend on the objectives and scope
of the research as well as on the number of risk factors under study. 
Most research hypotheses are stated in negative terms.  This way of
stating a hypothesis is known as a null hypothesis.

      NULL HYPOTHESIS:

      The statistical hypothesis that one variable has no
      association with another variable or set of variables...
      In simplest terms, the null hypothesis states that the
      results observed in a study, experiment, or test are no
      different from what might have occurred as a result of
      the operation of chance alone (Last:90).
      

      The basic reason for formulating a research hypothesis as a null
hypothesis is that the tests of statistical significance utilized in
the analysis of the hypothesis can only reject (or not reject) it when
they measure the probability that the results obtained in a study might
have occurred by chance.

      The null hypothesis corresponding to the research hypothesis
proposed above is as follows:

      There is no difference in terms of morbidity from malaria
      between the individuals of locality "x" who do not have regular
      access to medical care and those who do have regular access to
      health services.


       The formulation of research hypotheses facilitates selection
of the research design, the methodology to be used, the variables that
will be included, and the way in which the data will be analyzed. 
Moreover, it avoids confusion, loss of time, and unnecessary data
collection.
EXERCISE 1


      Malaria has been defined as a priority problem in Malarialand,*
and a group of investigators from the general health services of that
country have therefore decided to carry out a series of epidemiological
studies on the risk of malaria in the malarious areas of the country. 
Annex I presents general information about the country and its four
malarious areas. Using the information that you have at your disposal,
start your research with the following activities:


STEP  1:  Of the four malarious areas in Malarialand, select the one
that can be defined as having the highest priority.  Also identify,
within this area, the locality or localities in which research will
be initiated, specifying the criteria you applied or the reasoning
behind your selection of the particular region and locality or
localities.

STEP  2:  Formulate the general objectives of the epidemiological
research on the risk of malaria.

STEP  3:  State six hypotheses that the research will seek to prove
or disprove with a view to studying the role of six probable risk
factors that might account for the increased incidence of malaria in
the localities selected.

STEP  4:  Formulate a null hypothesis corresponding to each of the
six research hypotheses.

STEP  5:  Prepare a preliminary list of the information that you will
need to collect in order to prove the research hypotheses.








     4.4 Selection of the Research Design

      Like all scientific research, the epidemiological study of
malaria should be carried out on the basis of a structure, plan, or
design.  The research design makes it possible to structure the
theoretical frame of reference in accordance with the research
hypotheses.  Moreover, it facilitates selection of the number and type
of characteristics or factors to be studied and of the methods for
organizing, analyzing, and interpreting the data. 

      RESEARCH DESIGN

      The procedures and methods, predetermined by an
      investigator, to be adhered to in conducting a research
      project (Last:114).


      The selection and planning of the research design implies
identification of the variables or characteristics to be investigated
and definition of the procedures for selecting the groups that will be
studied, as well as the plan for randomization, if the design is
experimental.  As was pointed out in the Chapter 3, the most frequently
used epidemiological research designs are: 
(a) cross-sectional; (b) retrospective (case-control);
(c) prospective (cohort); and (d) controlled clinical trial.

      The research hypotheses and objectives must be taken into
account in selecting the research design.  In addition, it is necessary
to bear in mind existing limitations on information and resources. 
Finally, consideration should be given to whether or not a particular
research design will provide the structure needed in order to
adequately analyze the basic questions to be studied.

      4.5   Analysis of the Correlation between Malaria and the
Probable Risk Factors to be Studied

      4.5.1 Introduction

      After the research design has been selected, the next step is
to actually carry out the study.  Once all the epidemiological
information has been collected and sorted, it is broken down into the
corresponding contingency tables.  This is followed by calculation of
the basic measures for study and application of the statistical test
that has been selected for analysis of the study hypotheses. 

      The analysis and interpretation of epidemiological studies is
based on the results obtained in the tests of statistical significance. 
One of the most frequently used tests in epidemiology, and one that
exemplifies the use of contingency tables, is the chi-square test.

      4.5.2 Chi-Square Test

      In epidemiological research, one of the analytical strategies
for interpre