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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.

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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8.

Desigualdades en salud, su impacto sobre la prevalencia de factores de riesgo cardiovascular y el desarrollo de sus complicaciones crónicas en Argentina: estudio sobre Encuesta Nacional de Factores de Riesgo./ Desigualdades en salud, su impacto sobre la prevalencia de factores de riesgo cardiovascular y el desarrollo de sus complicaciones crónicas en Argentina: estudio sobre Encuesta Nacional de Factores de Riesgo./ Health inequalities and the impact on the prevalence of cardiovascular risk factors and chronic complications in Argentina: a study on national risk factors surveys.

Asteazaran, Santiago; Gagliardino, Juan Jose; Elgart, Jorge Federico
| Idioma(s): Español; Inglés
BACKGROUND: In Argentina, there is evidence of health inequalities, measured both at the general level and also using income as a parameter of social status. However, few studies address the issue of health equality in chronic diseases such as cardiovascular risk factors. OBJECTIVE: To describe health inequalities, using cardiovascular risk factors as a tracer for chronic diseases in different areas of the country and over time. In addition, we aim to identify differences in the quality of care provided to people with cardiovascular risk factors, between 2005 and 2009. METHODS: This is an observational study, which used descriptive and quantitative methods. Data from the National Risk Factors Survey from 2005 and 2009 in the cohorts who have chronic diseases (hypertension, diabetes, dyslipidemia and overweight/obesity) were analyzed to assess associations between health status and several demographic, epidemiological and socioeconomic variables. Additionally, clinical and metabolic characteristics of people with diabetes and other cardiovascular risks factors were analyzed in 2005 and 2009 using the database Quality of Diabetes Care (QUALIDIAB). RESULTS: Cardiovascular risk factors are more frequent in people with lower socioeconomic status, regardless of the indicator. The inequalities detected showed the worst indicators in strata with lower education and income, with the same results both nationwide and separated by region. This inequalities were more pronounced in 2009, and their magnitude changed by region and cardiovascular risk factor. From 2005 to 2009, body mass index, blood glucose and HbA1c value increased. In contrast, both systolic blood pressure and triglycerides decreased, with no significant changes in total cholesterol and diastolic blood pressure. CONCLUSION: Cardiovascular risk factors present inequalities attributed to social status manifesting at both national and regional levels.
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9.

Morphology and size of blood cells of Rhinella arenarum (Hensel, 1867) as environmental health assessment in disturbed aquatic ecosystem from central Argentina.

Salinas, Zulma Anahí; Baraquet, Mariana; Grenat, Pablo Raúl; Martino, Adolfo Ludovico; Salas, Nancy Edith
| Idioma(s): Inglés
Four populations of Rhinella arenarum from aquatic environments with different degrees of disturbance in central Argentina were compared to assess the ability of cytomorphology and cytomorphometry of blood cells as a hematological biomarker. A total of 93 specimens of R. arenarum (adults sexually mature) were captured during the spring. From the analysis of cell, no variations were found in terms of morphology, whereas in nuclear and cell areas and Price-Jones curves, we observed a smaller size in erythrocytes of individuals inhabiting the site most altered, "Villa Dalcar," as well as for leukocytes, lymphocytes, neutrophils, and eosinophils for the same site. This could be caused by presence of different pollutants in the lake. Furthermore, this was confirmed by the high levels of environmental variables (conductivity, total dissolved solids, and salinity) show that Villa Dalcar is the site most affected by human activities.
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10.

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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