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1.

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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2.

Impacto de la inactividad física en la mortalidad y los costos económicos por defunciones cardiovasculares: evidencia desde Argentina/ Impact of physical inactivity on mortality and the economic costs of cardiovascular deaths: evidence from Argentina/ Impacto da inatividade física na mortalidade e custos econômicos por mortes cardiovasculares: evidências provenientes da Argentina

García, Christian Martín; González-Jurado, José Antonio
| Idioma(s): Español
Objetivo. Estimar la mortalidad y los costos económicos por enfermedades cardiovasculares atribuibles a la inactividad física en Argentina. Métodos. Se estimó la mortalidad atribuible (MA) a la inactividad física como el producto entre la fracción atribuible poblacional (FAP) y el número de muertes originadas por las enfermedades cardiovasculares asociadas. Se realizó una valoración del valor estadístico de la vida (VEV) siguiendo el enfoque del capital humano, bajo el cual el VEV se estimó mediante la productividad perdida por muerte prematura. Se calcularon los costos económicos empleando la MA y el VEV, estratificando por sexo, grupo de edad y nivel de actividad física. Se empleó un análisis de sensibilidad para evaluar cómo varían los costos en tres escenarios posibles. Resultados. La MA a la actividad física baja y moderada varió entre 33 (18 a 24 años) y 7 857 (> 84 años) defunciones anualmente en ambos sexos. El VEV se encontraba entre I$ 441 005 (dólares internacionales) (18 a 24 años) y I$ 4 121 (> 84 años). La valoración de los costos totales por sexo indica que las pérdidas económicas ascendieron a I$ 752,5 millones para los hombres y a I$ 444,5 millones para las mujeres. Conclusión. Las pérdidas económicas variaron entre 0,61% del PIB para el escenario mínimo, 0,85% para el escenario medio, y 1,48% para el escenario máximo. Se recomienda fortalecer el desarrollo de políticas públicas orientadas a la reducción del sedentarismo en Argentina. Objective. Estimate mortality and economic costs from cardiovascular diseases attributable to physical inactivity in Argentina. Methods. Attributable mortality (AM) from physical inactivity was estimated as the product of the population attributable fraction and the number of deaths caused by associated cardiovascular diseases. Value of statistical life (VSL) was calculated using the human capital approach, in which VSL was estimated through lost productivity from premature death. Economic costs were calculated using AM and VSL, stratifying by sex, age group, and physical activity level. A sensitivity analysis was used to evaluate how costs vary in three possible scenarios. Results. AM from low and moderate physical activity ranged from 33 (18 to 24 years) to 7 857 (>84 years) deaths annually in both sexes. VSL ranged from I$441 005 (international dollars) (18 to 24 years) to I$4,121 (>84 years). Assessment of total costs by sex indicates that economic losses amounted to I$752.5 million for men and I$444.5 million for women. Conclusion. Economic losses ranged from 0.61% of GDP for the minimum scenario, 0.85% for the average scenario, and 1.48% for the maximum scenario. Stronger public policy-making aimed at reduction of sedentary lifestyles in Argentina is recommended. Objetivo. Estimar a mortalidade e os custos econômicos por doenças cardiovasculares atribuíveis à inatividade física na Argentina. Métodos. Foi estimada a mortalidade atribuível à inatividade física como o produto entre a fração atribuível populacional (FAP) e o número de mortes por doenças cardiovasculares associadas. Foi realizada uma avaliação do valor estatístico da vida (VEV) segundo o enfoque do capital humano em que o VEV foi estimado pela produtividade perdida por morte prematura. Foram calculados os custos econômicos empregando a mortalidade atribuível e o VEV, estratificados por sexo, faixa etária e nível de atividade física. Foi feita uma análise de sensibilidade para avaliar a variação dos custos nos três cenários possíveis. Resultados. A mortalidade atribuível a um nível baixo e moderado de atividade física variou entre 33 (18 a 24 anos) e 7 857 (>84 anos) mortes ao ano em ambos os sexos. O VEV foi de 441 005 dólares internacionais (18 a 24 anos) a 4 121 dólares internacionais (>84 anos). A avaliação dos custos totais por sexo indicou que as perdas econômicas atingiram 752,5 milhões de dólares internacionais no sexo masculino e 444,5 milhões de dólares internacionais no sexo feminino. Conclusão. Os prejuízos econômicos variaram entre 0,61% do PIB no cenário mínimo, 0,85% no cenário intermediário e 1,48% no cenário máximo. Recomenda-se o reforço na elaboração de políticas públicas orientadas à redução do sedentarismo na Argentina.
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3.

Perfil de salud bucal de niños que concurrieron a Servicios Odontológicos Universitarios en Porto Alegre (Brasil) y Córdoba (Argentina)/ Oral health condition of children who attended University Dental Services in Porto Alegre (Brazil) and Córdoba (Argentina)

Carletto-Körber, FPM; Figueiredo, Marcia Cançado; Giménez, MG; Martínez, J; Cornejo, LS
;
| Idioma(s): Inglés; Español
OBJETIVO: Comparar las condiciones de salud bucal de niños en relación con aspectos socio-demográficos-culturales maternos y perinatales. MÉTODOS: Se realizó examen clínico odontológico a 92 niños ≤3 años, concurrentes a la Clínica Odontológica de la Facultad de Odontología, UNC Córdoba-Argentina (n=32) y a la Clínica del Bebé, Facultad Odontología, UFRG Porto Alegre-Brasil (n=60). Las madres dieron consentimiento informado por escrito. Se aplicó una entrevista semiestructurada diseñada ad-hoc, a las madres o acompañantes del niño, para indagar aspectos socio-demográficos-culturales, hábitos de higiene bucal, gestación, dieta, tipo de parto y lactancia. Se aplicó Chi2 de Pearson y Fisher para evaluar la significación (p<0,05) de las diferencias entre cohortes. La importancia de diversos factores en relación a experiencia de caries y cohorte, se evaluó aplicando regresión logística binaria. RESULTADOS: El motivo de consulta resultó significativamente diferente entre cohortes, 100% preventivo en Argentina frente 8,3% en Brasil (p<0,001), igualmente al considerar la experiencia de caries (p<0,05). El modelo de regresión logística binaria mostró que las variables cohorte y libre de caries resultaron los factores más significativamente asociados a la experiencia de caries. Nivel de estudios de la madre bajo, dieta cariogénica del bebé y tipo de parto indicaron mayor riesgo cariogénico. Respecto a las cohortes se destacaron como estadísticamente significativos, higiene, edad, dieta del bebé y tipo de parto. CONCLUSIÓN: El nivel de instrucción de la madre y la dieta cariogénica del bebé muestran mayor riesgo de actividad de caries para ambas cohortes. Higiene bucal, dieta del bebé y tipo de parto se diferencian significativamente entre las cohortes Objective: To compare the oral health condition of children in relation to social, demographic and cultural maternal and perinatal aspects. Methods: Dental clinical examinations were performed on 92 children aged ≤3. They attended the Dental Clinic of the School of Dentistry, UNC Córdoba, Argentina (n=32), and the Infant Clinic, School of Dentistry, UFRG Porto Alegre-Brazil (n=60). The mothers signed a written informed consent. A semi-structured interview designed ad hoc was conducted with mothers or companions of the child to consider social, demographic and cultural aspects, oral hygiene habits, gestation, diet and type of delivery and lactation. Pearson-Fisher Chi2 test was applied to evaluate the significance (p <0.05) differences between cohorts. The importance of various factors in relation to caries experience and cohort was evaluated using binary logistic regression. Results: The reason why patients seek consultation was significantly different between cohorts: 100% preventive in Argentina versus 8.3% in Brazil (p <0.001), also considering caries experience (p <0.05). The binary logistic regression model showed that cohort and caries-free variables were the factors most significantly associated with caries experience. Mother's low educational level, cariogenic diet in the baby and type of delivery indicate greater cariogenic risk. Regarding cohorts, the following factors appear as statistically significant: hygiene, age, baby's diet and type of delivery. Conclusion: Mothers' educational level and the baby's cariogenic diet show increased risk of caries activity for both cohorts. Oral hygiene, baby's diet and type of delivery differ significantly between cohorts.
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4.

Análisis del gasto de los hogares en salud en Argentina, como componente de la cobertura universal de salud/ Analysis of household expenditure on healthcare in Argentina, as a component of universal health coverage

Abeldaño, Roberto Ariel
| Idioma(s): Español
Resumen El Informe Mundial de Salud 2010 de la OMS delineó un marco conceptual para analizar los componentes de la Cobertura Universal de Salud, sugiriendo tres dimensiones: cobertura del servicio, cobertura financiera y cobertura de la población. A partir de ese marco, se analizan los gastos relacionados a la salud en los hogares argentinos en el año 2012/13. Para el análisis se utilizó como fuente de datos la Encuesta Nacional de Gastos de Hogares 2012/13. Se construyeron indicadores de gasto en salud de los hogares siguiendo la propuesta de Sherri (2012) y se definieron modelos multivariados para identificar determinantes del gasto de los hogares. Los resultados evidencian que la situación de gasto catastrófico en compromete al 2,3% de los hogares del país, mientras que el empobrecimiento debido al gasto en salud se encontró en el 1,7% de los hogares. Abstract The 2010 World Health Report of WHO established a conceptual framework for the analysis of the components of Universal Health Coverage; three dimensions were suggested: services coverage, financial coverage, and population coverage. Within this framework, health-related spending of argentine households for the year 2012-2013 are analyzed. The analysis was performed on data retrieved from the National Survey of Household Expenditure 2012-2013. Household healthcare expenditure indicators were built following Sherri’s proposal (2012) and multivariate models were defined to identify determiners of household spending. Results indicate that catastrophic spending situations affect 2.3% of the country households, whereas impoverishment resulting from spending on healthcare was detected in 1.7% of them.
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5.

Oral health of youth housed in socio-educational centers of the Juvenile Penal Area of the Province of Cordoba, Argentina

Barnetche, María M; Cornejo, Lila Susana
| Idioma(s): Inglés
The purpose of this research was to analyze the oral health status of youth housed in socioeducational centers of the Juvenile Penal Area of the Province of Córdoba, Argentina of corrections by considering clinical evaluation and the main sociodemographic data. Sociodemographics, healthy and unhealthy habits of selfcare, and dental clinical profile were assessed for this purpose. An exploratory crosssectional study was carried out on 70 14to 18yearolds who had been institutionalized for at least six months. A clinical examination was conducted and the WHO Oral Health Survey was applied. Centralization and dispersion measurements, relative frequency, multiple correspondence analysis and generalized linear models were used to describe the data. The results showed: males 94%, mean age 16.91 ± 1.11, complete primary schooling 34%, from Córdoba City 69% and belonging to nuclear families 29%. Regarding healthy habits, 71% had frequent sugar intake, and 46% brushed teeth daily; while among unhealthy habits, 80% smoked tobacco, 63% drankalcohol and 73% used psychoactive substances. Sixtythree percent had visited a dentist once, and in 80% of the cases reason for the visit was pain. Clinical examination showed high prevalence of deterioration of the oral health component (DMFT = 8.94 ± 4.75, SiC = 14.26 ± 2.15, IPC3 = 56%, MO = 53%). Clinical profile showed marked prevalence of a very high level of caries severity, gingival disease and malocclusion, but not of initial stages of caries, alterations of enamel or temporo mandibular dysfunction. The sociodemographic characteristics revealed conditions of social, educational and health vulnerability, a situation which interferes with the inclusion of these youths in the productive system and their access to better living conditions (AU) El propósito de esta investigación fue analizar la situación de salud bucal de jóvenes alojados en centros socioeducativos del Área Penal Juvenil de la Provincia de Córdoba, a través de la evaluación clínica teniendo en cuenta los principales datos sociodemográficos. Para tal fin se valoraron las características sociodemográfica; los hábitos saludables, no saludables, de autocuidado y el perfil clínico odontológico. Se desarrolló un estudio transversal exploratorio en 70 jóvenes, de 14 a 18 años de edad, alojados por un período no menor a seis meses. Se realizó examen clínico y se aplicó la Encuesta de Salud Bucal de la OMS. Para la descripción de los datos se aplicaron medidas de centralización y de dispersión, frecuencia relativa, análisis de correspondencia múltiples y modelos lineales generalizados. Los resultados mostraron el siguiente perfil sociodemográfico: 94% son varones con una edad media de 16,91 ±1.11 que tienen primario completo 34%, son procedentes de la Ciudad de Córdoba 69% y pertenecen a familias nucleares 29%. Respecto a los hábitos saludables el 71% de los jóvenes tienen una alta frecuencia de consumo de azucares, el 46% presenta frecuencia diaria de cepillado dental; entre los hábitos no saludables el 80% consume tabaco, 63% bebidas alcohólicas, y 73% SPA, el 63% concurrió al odontólogo alguna vez por dolor (80%). El exámen clínico mostró una alta prevalencia del deterioro del componente bucal de la salud (CPOD= 8,94 ± 4,75; SIC=14,26 ± 2,15; IPC3 56%; MO 53). El perfil clínico mostró una marcada prevalencia del nivel muy alto de severidad de caries, enfermedad gingival y maloclusión, no así de los estadios iniciales de caries, alteraciones de esmalte y disfunción temporomandibular. Las características sociode mo gráficas halladas ponen de manifiesto condiciones de vulnerabilidad social, educativa y sanitaria, las cuales inter fieren en su incorporación al sistema de producción y acceso a mejores condiciones de vida (AU)
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6.

Mapear la salud: una propuesta de comunicación participativa y educación sanitaria

Organización Panamericana de la Salud
| Idioma(s): Español
Este manual busca fortalecer las capacidades de los equipos que desarrollan acciones de comunicación, educación y promoción de salud en el sistema sanitario público de las diferentes regiones y provincias de Argentina, desde una perspectiva comunicacional y educativa que pretende recuperar los diversos determinantes de la salud, utilizando el mapeo colectivo como herramienta metodológica
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7.

Financiamiento, organización, costos y desempeño de los servicios de los subsistemas de salud argentinos./ [Financing, organization, costs and services performance of the Argentinean health sub-systems.]

Yavich, Natalia; Báscolo, Ernesto Pablo; Haggerty, Jeannie
| Idioma(s): Español
Objective:: To analyze the relationship between health system financing and services organization models with costs and health services performance in each of Rosario's health sub-systems. Materials and methods:: The financing and organization models were characterized using secondary data. Costs were calculated using the WHO/SHA methodology. Healthcare quality was measured by a household survey (n=822). Results:: Public subsystem:Vertically integrated funding and primary healthcare as a leading strategy to provide services produced low costs and individual-oriented healthcare but with weak accessibility conditions and comprehensiveness. Private subsystem: Contractual integration and weak regulatory and coordination mechanisms produced effects opposed to those of the public sub-system. Social security: Contractual integration and strong regulatory and coordination mechanisms contributed to intermediate costs and overall high performance. Conclusion:: Each subsystem financing and services organization model had a strong and heterogeneous influence on costs and health services performance.
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8.

Asociación de cobertura de vacunación con factores sociodemográficos, en trabajadores de centros de salud de primer nivel de atención, Córdoba-Argentina./ Association of vaccination coverage with sociodemographic factors in workers of primary health care centers of Cordoba, Argentina.

Acevedo, Gabriel; López, Laura; Willington, Ana; Burrone, Soledad; Farias, Alejandra; Sánchez, Julieta
| Idioma(s): Inglés
INTRODUCTION: The activities performed by the health personnel have specific occupational risks making it more susceptible to get infectious diseases. Therefore, all healthcare workers must be properly immunized against vaccinepreventable diseases. AIMS: Assessing the proportion of healthcare workers from the public subsector who are vaccinated and relating the sociodemographic factors with the proportion of the Meningitis vaccination condition of the workers from the primary care level of the city of Córdoba Methods: An observational analytical cross-sectional study was carried out with a sample of 157 workers of the municipal district of Cordoba. A self-administered survey was conducted and univariate and bivariate analyses were performed. For the evaluation of factors related with the vaccination a Chi-Square Test was implemented. RESULTS: The measures of immunization coverage found were: hepatitis B vaccine 67,5%, anti flu vaccine 66,25%, trabadouble bacterial vaccine 60,51% and triple or double viral vaccine 50,32%. The overall analysis showed higher levels of coverage among those workers with a higher level of education and less seniority. This was also evident among the youngest and the physicians. With important differences depending on the educational level for hepatitis B vaccine, for triple or double viral among the youngest workers and double bacterial for those with less seniority. CONCLUSION: The health personnel studied on this research has a vaccination status that is lower than that of the internationally recommended vaccination status. Although, this status is similar to the one reported in several countries it shows that the under-coverage of vaccination among these workers is an extended problem which must be prioritized by health authorities; given the implications for the health of workers and the population these workers assist.
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9.

Adolescent injuries in Argentina, Bolivia, Chile, and Uruguay: Results from the 2012-2013 Global School-based Student Health Survey (GSHS).

Beck, Naja I; Arif, Issra; Paumier, Michelle F; Jacobsen, Kathryn H
| Idioma(s): Inglés
OBJECTIVES: The goals of this study were to identify the proportion of early adolescents in southern South America who were injured in the past year, to identify risk behaviours and other exposures associated with injuries, and to evaluate the most common types and causes of injury in this population. METHODS: We used complex samples analysis to examine cross-sectional data from more than 35,000 students from all four countries in South America that participated in the Global School-based Student Health Survey (GSHS) in 2012-2013. RESULTS: The proportion of students reporting at least one injury in the past year that required medical treatment or caused at least one full day of missed school or usual activities was 27.1% in Argentina, 29.5% in Uruguay, 30.9% in Chile, and 36.8% in Bolivia. Significantly more boys than girls reported injuries. Injured students were more likely than non-injured students to report anxiety-induced insomnia, being physically attacked, being in a physical fight, and being lonely in the past year, and they were also more likely to report being bullied, using tobacco, drinking alcohol, and missing school in the past month. For both boys and girls, the most common type of injury reported was a broken bone or dislocated joint and the most common injury cause was the student falling. However, most students were not able to provide a specific answer to either question. CONCLUSION: The GSHS has been conducted in 100 low- and middle-income countries and territories around the world, and new waves of data collection are currently being planned and implemented. The utility of the injury data from the GSHS would be improved if the injury type and cause response items were updated to better capture information about self-harm, sports injuries, and other statistics that will provide a stronger foundation for evidence-based injury prevention interventions in adolescent populations.
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10.

Economic impact of expanded use of biologic therapy for the treatment of rheumatoid arthritis and Crohn's disease in Argentina, Brazil, Colombia, and Mexico.

Tundia, Namita; Kotze, Paulo Gustavo; Rojas Serrano, Jorge; Mendes de Abreu, Mirhelen; Skup, Martha; Macaulay, Dendy; Signorovitch, James; Chaves, Leonardo; Chao, Jingdong; Bao, Yanjun
| Idioma(s): Inglés
OBJECTIVES: To estimate economic impact resulting from increased biologics use for treatment of rheumatoid arthritis (RA) and Crohn's disease (CD) in Argentina, Brazil, Colombia, and Mexico. METHODS: The influence of increasing biologics use for treatment of RA during 2012-2022 and for treatment of CD during 2013-2023 was modeled from a societal perspective. The economic model incorporated current and projected medical, indirect, and drug costs and epidemiologic and economic factors. Costs associated with expanded biologics use for RA were compared with non-expanded use in Argentina, Brazil, Colombia, and Mexico. A similar analysis was conducted for CD in Brazil, Colombia, and Mexico. RESULTS: Accounting for additional costs of biologics and medical and indirect cost offsets, the model predicts that expanded use of biologics for patients with RA from 2012 to 2022 will result in cumulative net cost savings of ARS$2.351 billion in Argentina, R$9.004 billion in Brazil, COP$728.577 billion in Colombia, and MXN$18.02 billion in Mexico; expanded use of biologics for patients with CD from 2013 to 2023 will result in cumulative net cost savings for patients with CD of R$0.082 billion in Brazil, COP$502.74 billion in Colombia, and MXN$1.80 billion in Mexico. Indirect cost offsets associated with expanded biologics use were a key driver in reducing annual per-patient net costs for RA and CD. LIMITATIONS: Future economic projections are limited by the potential variance between projected and actual future values of biologic prices, wages, medical costs, and gross national product for each country. CONCLUSIONS: Increasing biologics use to treat RA and CD may limit cost growth over time by reducing medical and indirect costs. These findings may inform policy decisions regarding biologics use in Argentina, Brazil, Colombia, and Mexico.
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