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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.

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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3.

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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4.

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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5.

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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6.

Trypanosoma cruzi genetic diversity: Something new for something known about Chagas disease manifestations, serodiagnosis and drug sensitivity.

Zingales, Bianca
| Idioma(s): Inglés
The genetic diversity of Trypanosoma cruzi, the protozoan agent of Chagas disease, is widely recognized. At present, T. cruzi is partitioned into seven discrete typing units (DTUs), TcI-TcVI and Tcbat. This article reviews the present knowledge on the parasite population structure, the evolutionary relationships among DTUs and their distinct, but not exclusive ecological and epidemiological associations. Different models for the origin of hybrid DTUs are examined, which agree that genetic exchange among T. cruzi populations is frequent and has contributed to the present parasite population structure. The geographic distribution of the prevalent DTUs in humans from the southern United States to Argentina is here presented and the circumstantial evidence of a possible association between T. cruzi genotype and Chagas disease manifestations is discussed. The available information suggests that parasite strains detected in patients, regardless of the clinical presentation, reflect the principal DTU circulating in the domestic transmission cycles of a particular region. In contrast, in several orally transmitted outbreaks, sylvatic strains are implicated. As a consequence of the genotypic and phenotypic differences of T. cruzi strains and the differential geographic distribution of DTUs in humans, regional variations in the sensitivity of the serological tests are verified. The natural resistance to benznidazole and nifurtimox, verified in vivo and in vitro for some parasite stocks, is not associated with any particular DTU, and does not explain the marked difference in the anti-parasitic efficacy of both drugs in the acute and chronic phases of Chagas disease. Throughout this review, it is emphasized that the interplay between parasite and host genetics should have an important role in the definition of Chagas disease pathogenesis, anti-T. cruzi immune response and chemotherapy outcome and should be considered in future investigations.
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7.

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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8.

Valoración de la exposición a plaguicidas en cultivos extensivos de Argentina y su potencial impacto sobre la salud/ Pesticide Exposure Assessment in Argentinian Extensive Crops and its Potential Health Impact

Butinof, Mariana; Fernández, Ricardo; Muñoz, Sonia; Lerda, Daniel; Blanco, Marcelo; Lantieri, María Josefina; Antolini, Luciana; Gieco, Marbela; Ortiz, Pablo; Filippi, Iohanna; Franchini, Germán; Eandi, Mariana; Montedoro, Franco; Díaz, María del Pilar
| Idioma(s): Español
INTRODUCCIÓN: Los plaguicidas configuran un aspecto central de las prácticas agrícolas. OBJETIVOS: Describir la distribución espacial de la exposición a plaguicidas en Argentina y su asociación con indicadores de carga de cáncer, construir índices de exposición global y validar índices de exposición individual con biomarcadores de efecto en sujetos laboralmente expuestos. MÉTODOS: Se construyeron dos índices globales (de exposición a plaguicidas [IEP] y de impacto ambiental total [IIAT]), se estudiaron sus distribuciones espaciales y mediante un estudio ecológico a nivel nacional se estimó la asociación con las tasas de mortalidad de cáncer total, mama y próstata, usando los departamentos como nivel de desagregación (n=564). Dos índices de exposición, construidos con información (individual) de agroaplicadores de Córdoba, se validaron mediante biomarcadores (actividad de butirilcolinesterasa y genotoxicidad). RESULTADOS: El área pampeana agrupa un IEP mayor al promedio nacional y los IIAT superiores, correspondientes al 2,4-D y clorpirifos. El aumento en ambos índices de exposición se asoció a incrementos en las tasas de mortalidad por cáncer a nivel departamental. El daño genotóxico en aplicadores no se asoció a los niveles de exposición; sí la disminución de la actividad de butirilcolinesterasa. CONCLUSIONES: Los instrumentos ­índices­ y resultados alcanzados brindan valiosos elementos para vigilar la exposición a plaguicidas en Argentina. INTRODUCTION: Pesticides are a key factor of agricultural practices. OBJECTIVES: To describe the spatial distribution of pesticide exposure in Argentina and its association with cancer burden indicators, build global exposure indices, and validate individual exposure indices with biomarkers of effect in occupationally exposed subjects. METHODS: Two global indices were developed (pesticide exposure [PEI] and total environmental impact [TEII]), their spatial distribution was studied and, by means of a nationwide ecological study, the association with total, breast and prostate cancer mortality rates was estimated, using departments as level of spatial disaggregation (n=564). Two exposure indices, built with (individual) information of pesticide applicators in Córdoba, were validated using biomarkers (butyrylcholinesterase and genotoxicity). RESULTS: The Pampas have a PEI which is higher than national average as well as the highest TEII, corresponding to 2.4-D and chlorpyrifos. The increase in both exposure indices was associated to increases in the mortality rates due to cancer at the departmental level. Genotoxic damage in applicators was not associated to levels of exposure; what was associated was the reduction of butyrylcholinesterase activity. CONCLUSIONS: The instruments ­indices­ and results obtained provide valuable elements for the surveillance of pesticide exposure in Argentina.
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9.

Abortion as empowerment: reproductive rights activism in a legally restricted context.

McReynolds-Pérez, Julia
| Idioma(s): Inglés
BACKGROUND: This paper analyzes the strategies used by activist health professionals in Argentina who justify providing abortion despite legal restrictions on the procedure. These "insider activists" make a case for abortion rights by linking pregnancy termination to a woman's ability to exert agency at a key point in her reproductive life, and argue that refusing women access to the procedure constitutes a grievous health risk. This argument frames pregnancy termination as an issue of empowerment and also as a medical necessity. METHODS: This article is based on ethnographic research conducted in Argentina in 2013 and 2015, which includes in-depth interviews with abortion activists and health professionals and ethnographic observation at activist events and in clinics. RESULTS: During the period of my field research, the medical staff in one clinic shifted from abortion counseling, based on a harm reduction model, to legal pregnancy termination, a new mode of abortion provision where they directly provided abortions based on the legal health exception. These insider activists formalized the latter approach by creating a diagnostic instrument that frames women's "bio-psycho-social" reasons for wishing to terminate a pregnancy as medically justified. CONCLUSIONS: The clinical practice analyzed in this article raises important questions about the potential for health professionals to take on an activist role by making safe abortion accessible, even in a context where the procedure is highly restricted.
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10.

Domoic acid in a marine pelagic food web: Exposure of southern right whales Eubalaena australis to domoic acid on the Península Valdés calving ground, Argentina.

D'Agostino, Valeria C; Degrati, Mariana; Sastre, Viviana; Santinelli, Norma; Krock, Bernd; Krohn, Torben; Dans, Silvana L; Hoffmeyer, Mónica S
| Idioma(s): Inglés
The gulfs that surround Península Valdés (PV), Golfo Nuevo and Golfo San José in Argentina, are important calving grounds for the southern right whale Eubalaena australis. However, high calf mortality events in recent years could be associated with phycotoxin exposure. The present study evaluated the transfer of domoic acid (DA) from Pseudo-nitzschia spp., potential producers of DA, to living and dead right whales via zooplanktonic vectors, while the whales are on their calving ground at PV. Phytoplankton and mesozooplankton (primary prey of the right whales at PV and potential grazers of Pseudo-nitzschia cells) were collected during the 2015 whale season and analyzed for species composition and abundance. DA was measured in plankton and fecal whale samples (collected during whale seasons 2013, 2014 and 2015) using liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS). The genus Pseudo-nitzschia was present in both gulfs with abundances ranging from 4.4×10 and 4.56×10 cell l . Pseudo-nitzschia australis had the highest abundance with up to 4.56×10 cell l . DA in phytoplankton was generally low, with the exception of samples collected during a P. australis bloom. No clear correlation was found between DA in phytoplankton and mesozooplankton samples. The predominance of copepods in mesozooplankton samples indicates that they were the primary vector for the transfer of DA from Pseudo-nitzschia spp. to higher trophic levels. High levels of DA were detected in four whale fecal samples (ranging from 0.30 to 710µgg dry weight of fecal sample or from 0.05 and 113.6µgg wet weight assuming a mean water content of 84%). The maximum level of DA detected in fecal samples (710µg DA g dry weight of fecal sample) is the highest reported in southern right whales to date. The current findings demonstrate for the first time that southern right whales, E. australis, are exposed to DA via copepods as vectors during their calving season in the gulfs of PV.
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