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1.

Respuesta doméstica a las recomendaciones sanitarias de intervención sobre ambiente y perros en una localidad con transmisión de leishmaniasis visceral (Pto. Iguazú, Argentina, 2014­2016)/ Domestic response to intervention based on health recommendations on the environment and dogs in a locality with transmission of visceral leishmaniosis (Pto. Iguazú, Argentina, 2014-2016)

Mastrangelo, Andrea Verónica; Santini, María Soledad; Quintana, María Gabriela; Salomón, Oscar Daniel
| Idioma(s): Español
Introducción: La leishmaniasis visceral (LV) es una enfermedad parasitaria emergente en Argentina. En Puerto Iguazú, frontera con Brasil y Paraguay, en 2010 se registró presencia del vector y casos caninos; y en 2014-2015 dos casos humanos. Objetivo: Este artículo tiene como objetivo analizar los cambios en el nivel micro escala después de dar a conocer a los convivientes el diagnóstico de LV canina (LVC), informándoles estrategias de manejo ambiental para reducir el contacto con el vector. Método: Es una investigación descriptiva, que indagó en dos momentos (2014 y 2016) una muestra no probabilística distribuida en base al criterio de mejor escenario para la presencia del vector (n = 55) en la que se seleccionaron, luego de un primer rastrillaje entomológico y de diagnóstico veterinario, puntos de muestreo con presencia de vectores y al menos un perro con LVC (n = 6/55). Resultados: Un único hogar implementó las modificaciones sugeridas. Esos cambios no resultaron suficientes para controlar la transmisión. La hipótesis es que las medidas de control requieren intervención a meso escala (el vecindario y no el domicilio), atendiendo al radio real de dispersión de vectores. Conclusiones: El riesgo de infección humana por LV se relaciona con el modo de vida, incluyendo las relaciones interespecie. Las relaciones humano-perro combinan especismo y poshumanismo, acotando la efectividad de la "tenencia responsable" como modelo de vínculo saludable. Introduction: Visceral leishmaniasis (VL) is an emerging parasitic disease in Argentina. In Puerto Iguazú, border with Brazil and Paraguay, vector and canine cases were registered in 2010; and in 2014 and 2015 there were two human cases. Objective: The objective of this article is to analyze changes at the micro-scale level after informing the cohabitants of the diagnosis of canine LV (LVC), letting them know the environmental management strategies to reduce contact with the vector. Method: It is a descriptive researh, which investigated in two moments (2014 and 2016) a non-probabilistic sample distributed based on the criterion of the best scenario for the presence of the vector (n = 55). Sampling points with the presence of vectors and at least one dog with LVC (n = 6/55) were selected, after a first entomological and veterinary diagnosis raking. Results: A single household implemented the suggested modifications. The changes were not enough to control the transmission. The hypothesis is that the control measures require intervention at a meso-scale (the neighborhood instead of the home), taking into account the real radius of vector dispersion. Conclusions: The risk of human infection due to VL is related to the way of life, including interspecies relationships. The human-dog relationships combine speciesism and post-humanism, which limits the effectiveness of "responsible ownership" as model of a healthy bond.
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2.

Costos médicos directos de las Internaciones por Insuficiencia Cardiaca en el Plan de Salud del Hospital Italiano de Buenos Aires./ [Direct medical costs of hospitalization due to heart failure in the health plan of the Hospital Italiano de Buenos Aires.]

Waisman, Gabriel Dario; Tortella, Juan Jose; Garfi, Leonardo Guillermo; Izbizky, Gustavo Hernan
| Idioma(s): Español
Introduction: It is undeniable that costs of medical care in chronic diseases has increased. There are multiple reasons: population aging, associated pathologies late complications, available high cost health technologies. Heart failure is one of the main causes of global death and morbidity, being the final consequence of cardiac diseases and hypertension, fulfilling criteria of becoming a high costs pathology. We are going to evaluate direct medical costs of hospitalization due to heart failure from the vision of those who manage health resources. Materials and Methods: Observational, retrospective cohort using secondary databases from the Hospital Italiano de Buenos Aires. Adult population with diagnosed heart failure that required hospitalization with discharge diagnosis of heart failure between 2007 and 2011. Results: The main cost component was attributable to hospital bed, diagnostic and therapeutic interventions. The average incidence of hospitalizations during the period was 11.4 per 10,000 patients / year. Overall mortality in the episode rate was 0.25% per year and 28.8 % overall 60% Conclusion: The most important decision seems decide whether management can be done on an outpatient basis or not, using heart failures guidelines to optimize time of admission, auxiliary diagnostic methods and medications used.
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3.

Knowledge, attitudes and practices (KAP) regarding leptospirosis among residents of riverside settlements of Santa Fe, Argentina.

Ricardo, Tamara; Bergero, Laura C; Bulgarella, Esteban P; Previtali, M Andrea
| Idioma(s): Inglés
BACKGROUND: Leptospirosis is a global and re-emerging zoonotic disease caused by Leptospira spirochetes that are shed into the environment by infected animals. Humans can get infected via contact with animal hosts or contaminated environment. In Argentina, the highest annual incidences were reported in the province of Santa Fe, where epidemic outbreaks occurred during flooding events. This study examined the knowledge, attitudes and practices (KAP) regarding leptospirosis among residents of riverside slum settlements from Santa Fe after a major flood. METHODS AND FINDINGS: A cross-sectional questionnaire was administered to 113 residents of 3 riverside settlements from Santa Fe. The influence of knowledge and attitudes regarding leptospirosis on the likelihood that an individual will use preventive practices were evaluated using linear mixed-effects models. The majority of respondents (83.2%) had previously heard about leptospirosis; however specific knowledge about leptospirosis was limited. The results of the modeling efforts, show that the likelihood of using preventive practices was associated with having greater knowledge score, but not with more positive attitudes. We also found that females were more likely to use safer practices than males. CONCLUSIONS: Even though the majority of respondents had heard about leptospirosis, a high percentage of them had limited knowledge regarding the severity of the disease and its prevalence in the region. Our results suggest that public health interventions in these riverside communities should focus on educating the public on the multiple dimensions of leptospirosis in order to attain greater adherence to preventive practices instead of intending to change the perceptions or attitudes towards the disease, which did not have a significant influence. The key challenge lies in identifying effective strategies to reach the high risk group for leptospirosis here that is male fishermen, who spend most of the time in precarious campsites on the river islands.
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4.

Reproductive endpoints of Rhinella arenarum (Anura, Bufonidae): Populations that persist in agroecosystems and their use for the environmental health assessment.

Babini, María Selene; de Lourdes Bionda, Clarisa; Salinas, Zulma Anahí; Salas, Nancy Edith; Martino, Adolfo Ludovico
| Idioma(s): Inglés
Degradation of the environment by agriculture affects the persistence and health of the amphibian populations. Characteristics related to reproduction of anuran can be used to evaluate the status of populations and as endpoints in environmental health assessment. In this in situ study the aspects related to the amplexus and ovipositions of the bioindicator species Rhinella arenarum that inhabits agroecosystems were analyzed. The hypothesis of this study is that perturbations of agroecosystems have a negative impact on the size of reproductive adults, on the size of ovipositions and eggs, and on the survival of eggs and embryos. Study area is located in the rural landscape of central Argentina. Four sampling sites were selected: C1, C2 and C3 are ponds on agroecosystems; and SM is a reference site that is not affected by agriculture or livestock. Abundance of amplexus pairs, oviposition and tadpoles per site was recorded. Individuals´ snout-vent length (SVL) in amplexus was measured. The fecundity was calculated like number of eggs per oviposition. The eggs' Gosner stage, the diameter eggs and the frequency of dead and abnormal eggs were recorded by oviposition. Killing-power between egg-embryo and egg-tadpole was calculated. The higher phosphate concentration was detected in all agroecosystems and nitrate was detected in C1 and C2. Conductivity, salinity and SDT were higher in C1 site Male SVL from the SM site was lower than the other sites while the largest SVL was of female from the C3 site. The higher frequencies of sprouted eggs and of dead eggs were recorded in the C2 site. Egg diameter was associated with SM and correlated negatively to SVL of the male and female. No correlation between female SVL and oviposition size was recorded. Killing-power in the passage from egg to tadpole classes was higher in the three agroecosystems. The hypothesis of this study was corroborated in part. Reproductive adults in agroecosystems did not have smaller body size. However, in the agroecosystem ponds, the eggs with smaller diameter were registered, the oviposition had higher frequency of abnormal eggs and the higher mortality was registered. This confirms the high sensitivity of the early stages to environmental disturbances and sustains their use as endpoints for the environmental health assessment.
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5.

Factores asociados a la utilización de servicios de salud odontológicos./ [Factors associated with the use of dental health services].

Dho, María Silvina
| Idioma(s): Español
This paper seeks to analyze the factors associated with the use of dental health services (UDHS) by adults in the city of Corrientes, Argentina. A cross-sectional study was conducted. Information concerning the study variables was collected via a home survey. The sample size was established with a 95% confidence interval level (381 individuals). A simple random sampling design was used, which was complemented with a non-probability quota sampling. The data was analyzed using SPSS version 21.0 and Epidat version 3.1 softwares. Socio-economic level, dental health coverage, perception of oral health care, perception of oral health, knowledge about oral health, and oral hygiene habits were significantly associated with the UDHS over the last twelve months. These same factors, excluding dental health coverage and knowledge about oral health, were associated with the UDHS for routine dental check-ups. Measures should be implemented to increase the UDHS for prevention purposes in men and women of all socio-economic levels, particularly in less-privileged individuals.
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6.

Application of a health risk assessment model for cattle exposed to pesticides in contaminated drinking waters: A study case from the Pampas region, Argentina.

Dubny, Sabrina; Peluso, Fabio; Masson, Ignacio; Othax, Natalia; González Castelain, José
| Idioma(s): Inglés
Using the USEPA methodology we estimated the probabilistic chronic risks for calves and adult cows due to pesticide exposure through oral intake of contaminated surface and ground waters in Tres Arroyos County (Argentina). Because published data on pesticide toxicity endpoints for cows are scarce, we used threshold levels based on interspecies extrapolation methods. The studied waters showed acceptable quality for cattle production since none of the pesticides were present at high-enough concentrations to potentially affect cow health. Moreover, ground waters had better quality than surface waters, with dieldrin and deltamethrin being the pesticides associated with the highest risk values in the former and the latter water compartments, respectively. Our study presents a novel use of the USEPA risk methodology proving it is useful for water quality evaluation in terms of pesticide toxicity for cattle production. This approach represents an alternative tool for water quality management in the absence of specific cattle pesticide regulatory limits.
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7.

Evaluaciones económicas en un sistema de salud fragmentado: oportunidades y desafíos metodológicos para Argentina/ Economic Evaluations in a Fragmented Health System: Opportunities and Methodological Challenges for Argentina

Lamfre, Laura; Hutter, Florencia; Álvarez, Jorgelina; Sanguine, Verónica; Altuna, Juan; Hasdeu, Santiago; Montero, Guadalupe; Freiberg, Andrés
| Idioma(s): Español
Introducción: La particularidad del sistema de salud argentino, que se encuentra fragmentado en tres subsistemas y con más de 900 financiadores, lleva a reflexionar sobre cuál es la posibilidad de desarrollar evaluaciones económicas (EE) en forma global y que sirvan de modo eficiente al proceso de toma de decisiones. Objetivos: Identificar y discutir los desafíos metodológicos que implican el diseño de EE en un sistema de salud caracterizado por la fragmentación, la no integración en la prestación de servicios y la presencia de múltiples financiadores. Analizar los aspectos claves de la formulación de las EE y su aplicabilidad en nuestro contexto, así como también la generalización y transferibilidad de sus resultados hacia el sistema de salud en su conjunto. Métodos: Se realizó una búsqueda sistemática de la literatura en las principales fuentes bibliográficas. Se relevaron indicadores a nivel provincial y sectorial. Asimismo, se citan ejemplos de estudios de EE que demuestran las diferencias intersectoriales en los principales elementos metodológicos que componen una EE. Conclusiones: Las características de nuestro sistema de salud fragmentado implican diferencias en términos de estructuras de costos, perspectiva de análisis y umbrales de disponibilidad a pagar según la entidad involucrada. Ello tiene repercusiones metodológicas en la elaboración y en los resultados de las EE y, por tanto, condiciona la aplicabilidad o generalización de los resultados a nivel nacional.
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8.

Análisis de tendencia de la desigualdad en la mortalidad materno-infantil, Argentina, 1990-2010/ Trend Analysis on Maternal and Child Mortality Inequality, Argentina, 1990-2010

Marro, María Jimena; Fattore, Gisele Lorena
| Idioma(s): Español
INTRODUCCION: La salud materno-infantil constituye un escenario donde las desigualdades se manifiestan sensiblemente, ostentando diferenciales en el riesgo de morir. OBJETIVOS: Analizar la tendencia de la desigualdad en la situación de salud maternoinfantil de Argentina en el período 1990-2010. METODOS: Se recurrió a un diseño agregado-observacional-longitudinal con nivel de agregación provincial. Se utilizó tasa de mortalidad infantil, tasa de mortalidad en menores de 5 años y razón de mortalidad materna para los trienios 1989-1991, 2000-2002 y 2009-2011. Se estimaron medidas de desigualdad basadas en el concepto de regresión, desproporcionalidad y rango. RESULTADOS: La tendencia de la desigualdad fue diferente según el método empleado. La mortalidad infantil y en menores de 5 años disminuyó a lo largo de la fase, fundamentalmente a expensas del período 2000-2010. La desigualdad en la mortalidad materna mostró una tendencia ligeramente descendente, aunque la situación para ciertas provincias no fue mejor a la que presentaban al inicio de la etapa. Según las medidas basadas en rangos, para el trienio 2000-2002 hubo aumento del riesgo para los tres indicadores de mortalidad. CONCLUSIONES: La reducción de la brecha en el eje infantil se produjo fundamentalmente durante 2000-2010, mientras que la mortalidad materna configuró un escenario relativamente estable. Se destaca la necesidad de utilizar distintos métodos para medir las desigualdades en salud
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9.

Programa Nacional de Salud Escolar: una politica de cuidado de niñas, niños y adolescentes en edad escolar de Argentina/ National School Health Program: a Policy for the Care of Girls, Boys and Adolescents of School Age in Argentina

Codarini, Gabriela; Andracchio, María Ángeles; Viggiani, Fernanda; González, Patricia; Lev, Débora
| Idioma(s): Español
La población escolar se caracteriza por presentar un perfil de salud con una baja tasa de mortalidad y una baja frecuencia de internaciones en comparación con otros grupos etarios, lo cual contribuye a que sea percibida como una población sana. Sin embargo, esta población no es inmune a la alta carga de morbilidad por enfermedades crónicas no transmisibles (ECNT) que se observa globalmente. Existen diversas iniciativas para la aplicación de políticas y programas dirigidos a la población escolar con el objetivo de reducir el impacto de los principales factores de riesgo de ECNT. Estas intervenciones tienen como principales escenarios a la escuela y a los centros de salud locales, donde se desarrollan acciones de promoción de la salud y se propicia el acceso al control anual de salud. El Programa Nacional de Salud Escolar (PROSANE) tiene como objetivo propiciar y fortalecer la implementación de políticas de cuidado de la población en edad escolar de Argentina. El artículo describe esta estrategia, su modalidad de implementación y sus resultados. La implementación del PROSANE ha permitido visibilizar a esta población, elaborar un análisis sanitario y promover su acceso al sistema de salud
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10.

Promover la salud en la escuela: ¿cómo construir una escuela promotora de salud?

Organización Panamericana de la Salud
| Idioma(s): Español
[Prólogo]. Esta publicación tiene como objetivo proveer insumos conceptuales y didácticos que faciliten la implementación de este enfoque en las escuelas. Se espera que contribuya a la comprensión del marco conceptual y operativo de las escuelas promotoras de salud, y a la vez, permita recrearlo según las características de cada contexto. Por otra parte, dado que habitualmente no resulta claro cómo pasar de la teoría a la acción en este tema, se presenta una propuesta metodológica, que lejos de ser una receta, plantea ser un disparador de la imaginación y creatividad de quienes la lean para mejorar la concreción de este enfoque en el ámbito escolar.
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