Tuberculosis en Argentina: desigualdad social y de género / Tuberculosis in Argentina: social and gender inequality

Este artículo se propone describir la distribución de la tuberculosis en Argentina y analizar la desigualdad social y de género de la distribución en el período 1990-2011. Para ello, se emplearon las cifras oficiales de notificación de casos de tuberculosis del país, se calcularon tasas por 100.000 habitantes por jurisdicción y departamentos, por grupos de edad y por sexo. La desigualdad en la distribución se analizó mediante el índice de Gini y su asociación con las condiciones sociales mediante el índice de concentración y el índice de efecto; la tendencia se estudió mediante regresión exponencial. Los resultados muestran que las tasas de tuberculosis son mayores entre los 20 y 34 años de edad y son superiores en varones. Existe una marcada desigualdad entre jurisdicciones (índice de Gini = 0,273) y es mayor por departamentos (índice de Gini = 0,391), superior en mujeres (0,411) que en varones (0,394). La distribución de la tuberculosis se asoció a peores condiciones sociales (índice de efecto = -0,212), y esta asociación fue mayor en las mujeres (índice de efecto = 11,4; 6,4; 16,4). La tendencia del problema al descenso entre 1990 y 2011 no ha contribuido a reducir las brechas entre jurisdicciones y departamentos ni tampoco a reducir la desigualdad en la distribución de la tuberculosis asociada a las desfavorables condiciones sociales de la población.

This article seeks to describe the distribution of tuberculosis in Argentina and analyze the social and gender inequality of the distribution within the period of 1990-2011. In order to accomplish this, the official data from tuberculosis case notifications in the country was used, and the rates were calculated per 100,000 inhabitants by jurisdiction and department, by age group and by sex. The inequality in the distribution was analyzed using the Gini index and the association with social conditions using the concentration index and the effect index; the trend was studied using exponential regression. The results demonstrate that tuberculosis rates are higher between 20 and 34 years of age and are greater in males. There is a marked inequality among jurisdictions (Gini index = 0.273) which is even greater among departments (Gini index = 0.391) and is higher in females (0.411) than in males (0.394). The distribution of tuberculosis was associated with worse social conditions (effect index = -0.212) and this association was stronger in females (effect index = 11.4, 6.4, 16.4). The downward trend in tuberculosis rates observed between 1990 and 2011 has not contributed to reducing the gaps among jurisdictions and departments nor has it reduced the inequality in the distribution of tuberculosis associated with the unfavorable social conditions of the population.

Retrospective comparison of filgrastim plus plerixafor to other regimens for remobilization after primary mobilization failure: clinical and economic outcomes.

We performed a retrospective analysis to evaluate clinical and economic outcomes in patients receiving remobilization therapy after primary mobilization failure. Our primary endpoint was to compare filgrastim plus plerixafor to other regimens in their ability to collect a target cell dose of at least 2 million CD34+ cells/kg (cumulative). Of 96 consecutive patients who failed their primary mobilization therapy and in whom a second mobilization was attempted, remobilization consisted of filgrastim plus plerixafor (n = 38), filgrastim with or without sargramostim (n = 43), or chemotherapy plus filgrastim (n = 15), 84% of filgrastim/plerixafor patients were able to collect at least 2 million CD34+ cells/kg from both mobilizations, compared to 60% of patients mobilized with chemotherapy/filgrastim and 79% of the filgrastim ± sargramostim patients (P = 0.17). However, when combined with cells collected from the first mobilization, 53% of filgrastim/plerixafor patients reached the target of 2 million CD34+ cells in one apheresis, compared to 20% of those receiving chemotherapy/filgrastim and 28% of those receiving filgrastim ± sargramostim (P = 0.02). Resource utilization, mobilization drug costs, clinical care costs, and total costs were significantly different. We conclude that while filgrastim/plerixafor is the most efficient remobilization strategy, those clinical benefits may not translate into lower cost, especially when multiple days of plerixafor administration are required.

Prevalencia de retinopatía diabética en comunas dependientes del Servicio de Salud Metropolitano Occidente (SSMOC) / Prevalence of diabetic retinopathy in districts of the Servicio de Salud Metropolitano Occidente (SSMOC)

La retinopatía diabética (RD) es una microangiopatía progresiva que se caracteriza por lesiones y oclusión de vasos retinales pequeños en personas con diabetes mellitus. En relación a su prevalencia en Chile, contamos con pocos trabajos descritos en la literatura, cabe mencionar que en el trabajo de Verdaguer en el año 2001 se encontró una prevalencia de 28,5 por ciento durante la campaña "Día de la diabetes". Presentamos un estudio retrospectivo de prevalencia, cuyo objetivo es determinar la prevalencia de la RD y sus tipos en la población diabética en 10 comunas del Servicio de Salud Metropolitano Occidente (SSMOC). La muestra consiste en el análisis de los resultados de fotografías retinales tomadas a 4600 pacientes diabéticos. Se encuentra una prevalencia de RD de 20 por ciento de los pacientes diabéticos estudiados, 17 por ciento tenía hallazgos compatibles con una RDNP leve a moderada y 3 por ciento presentaba características de RDNP severa y RDP.

Diabetic retinopathy (DR) is a progressive microangiopathy characterized by lesions and occlusion of small retinal vessels in people with diabetes mellitus. In relation to their prevalence in Chile, we have few studies reported in the literature, it is noteworthy that in the work of Verdaguer in 2001 found a prevalence of 28.5 percent during the "Day of diabetes". A retrospective study of prevalence, which aims to determine the prevalence of diabetic retinopathy and their rates in the diabetic population in 10 districts of the Western Metropolitan Health Service (SSMOc). The sample consists of the analysis of the results of retinal photographs taken in 4600 diabetic patients. Is a DR prevalence of 20 percent of diabetic patients studied. 17 percent had findings consistent with a mild to moderate no proliferative DR and 3 percent had features of severe no proliferative DR and proliferative DR.

Use of steel bands in sternotomy closure: implications in high-risk cardiac surgical population.

A retrospective-prospective descriptive and comparative study of two sternal closure techniques in a population of 621 patients divided into: group A, steel band closure (n=300) and group B, conventional technique closure (n=321), was carried out between January 2005 and December 2007 in order to describe and compare the results of both techniques in high-risk patients for sternal dehiscence and mediastinitis. Differences between both groups and association with risk factors were obtained using non-parametric tests for statistical analysis. No complications or mortality related to the use of the steel sternal bands were found. A statistically significant difference was found in the frequency of sternal dehiscence between both groups (P=0.022) in favor of group A. Although the frequency of mediastinitis was higher in group B, a statistically significant difference could not be established in terms of this complication. Sternal dehiscence was found to be a risk factor for mediastinitis. This study demonstrates that the use of steel bands for median sternotomy closure is a safe, reliable and reproducible technique. The frequency of sternal dehiscence significantly decreases with this technique in high-risk patients.

Programa especial para investigación y adiestramiento en enfermedades tropicales (TDR) / Special programme in research and training in tropical diseases

A description of the six tropical diseases involved in the programme and the achierement of research goals are evaluated. The author points out the important accomplishment of these aims in the impact in the malaria and filiariasis control, in the elimination of leprosy and the future erradication of Chagas disease in the Americas. At the same time the relevance of the manpower training were imphasized in the strenghtening on the research infrastructure of the member countries

Infección humana por trypanosoma cruzi en Chile: algunas estimaciones epidemiológicas y de los costos de la atención y tratamiento del paciente chagásico / Trypanosoma cruzi human infection in Chile: some estimates on epidemiology and care and treatment costs of the chagasic patient

According to the gathered information from the 1992 Chile census and an extensive epidemiological field study of Chagasïdisease in rural-periurban sections of the seven most northern regions where this malady is endemic, the following epidemiological outline arises: Total population in the country 13,348,401. Population in endemic regions 8,824,205 (urban 8,050,700 rural 773,505). Number of infected 142,000 (16,7 percent). Total number of cardiopathies 26,554 (18,7 percent). In considering the regime of fees for health attentions of the National Health Funds- including hospitalization, laboratory test and surgical interventions- in its minimal prices plus the value of medicaments, it is posible to produce some estimates onf the cost of attention and treatment, in U.S. dollars, of the chagasic patient. Average annual cost of a patient with chronic chagasic cardiopathy U.S.$ 439,29 to U.S.$ 584,25 If these values are multiplied by 26,554 give rise to a figure ranging from U.S.$ 11,644,906 to U.S.$ 15,514,474

Evaluación de un programa de erradicación del triatoma infestans en viviendas rurales de la IV Región de Chile mediante serología para la enfermedad de Chagas en niños de 0 a 10 años de edad / Triatoma infestans eradication program assessment in rural dwellings from the IV Region of Chile by serology for Chagas' disease in children 0 to 10 years of age

The present study deals with the evaluation of the effectiveness of the measures employed in the control of triatoma infestans, the vector of trypanosoma cruzi infection (Chagas' disease), in the IV Region of Chile through a serological follow up program. For this reason, a serological survey has been carried out in 2,783 chidren, from 0 to 10 years, who live in rural high endemic areas of the region. The sera were tested using an indirect hemagglutination test (IHAT) and ELISA techniques with results agreeing in 99,9 for percent of the samples. In children with positive serology xenodiagnosis was perfomed and blood samples from the corresponding mothers were submitted to serology for Chagas's disease. These addicional tests should allow to distinguish between congenital infection and vectorial transmission. It was observed that vectorial transmission of T. cruzi was interrupted in some localities where entomological control has been applied for 10 years, or lowered in those which have been submitted to desinsectations in the last 5 years. On the other hand, a relatively high prevalence of the infection has been detected in some localities. These results suggest an apparent increase of vectorial transmision, indicating the need of readjusting the dwellings insecticide sprayings activities to improve the measures against the vector

El Token economy: resultados de su utilización en una comunidad terapéutica / Token economy: results of its use in a therapeutic community

Se plantea la hipótesis de que con la aplicación de una variante del sistema de reforzamiento por fichas, podría incrementarse la participación de los pacientes en las actividades desarrolladas en una comunidad terapéutica para psicóticos y alcohólicos, y de que su aplicación era factible dentro de la estructura organizativa mantenida en los tres últimos años de trabajo. Para lograr estos objetivos se llevó a cabo una investigación desarrollada en tres etapas de tres meses cada una, y se controló durante las mismas el comportamiento de los pacientes en cuanto a: asistencia diaria a la reuníon matutina: cumplimiento del horario establecido para levantarse; y otros indicadores utilizados como control por no contemplarse en el sistema de gratificaciones. Durante la primera etapa se mantuvo la estructura anterior, basada exclusivamente en gratificaciones morales; durante la segunda, se ensayaron diferentes tipos de premios, donde se incluyeron excursiones, premios en efectivo y artículos de artesanía, así como pases especiales a los pacientes destacados. En la tercera etapa se estableció el otorgamiento del pase de fin de semans mediante la acumulación de puntos ganados por conductas positivas y anotados mediante gomígrafo en una tarjeta individual que se renovaría semanalmente. Los resultados evidenciaron un incremento importante de los indicadores contemplados en el sistema de gratificaciones, y poca modificación en aquellos que se utilizaron como controles y para valorar la influencia indirecta de otras conductas positivas. Se consideró que sus resultados apoyan las dos hipótesis planteadas, y que el pase de fin de semana otorgado mediante puntos acumulados contituye el premio de interés general más adecuado. Se concluye que la experiencia acumulada hizo incorporar dicho sistema a la estructura comunitaria del servicio docente "Rogelio Paredes", del Hospital Psiquiátrico de La Habana, y añadirlo al sistema previo de estimulaciones morales, exclusivamente