Detección de eventos adversos en la sala clínica de un hospital a través de metodología activa / Adverse Event Detection in a Hospital Clinic Ward through an Active Methodology

INTRODUCCIÓN: Los eventos adversos (EA) hospitalarios expresan deficiencias en la seguridad de los pacientes internados. Aunque es un tema ampliamente abordado en otros ámbitos, no se han desarrollado suficientes líneas de investigación a nivel nacional. Los objetivos del trabajo fueron medir la frecuencia de EA y sus consecuencias en la sala de clínica de un hospital de alta complejidad de la provincia de Buenos Aires, y cuantificar el subregistro de EA en la historia clínica (HC). MÉTODOS: Se realizó un estudio descriptivo con una metodología activa para la detección de EA. Mediante recorridas diarias por la sala, observación directa del proceso de atención y entrevistas a profesionales de la salud y a los pacientes, se detectaron los EA y demás variables. RESULTADOS: Se observó una alta ocurrencia de casos (70%), en parte por la metodología utilizada y la definición más sensible de EA. Las consecuencias de mayor frecuencia en los pacientes fueron las molestias físicas (65,6%), mientras que para el sistema hospitalario fue el uso adicional de recursos terapéuticos (48,9%). La tasa de letalidad por EA fue de 5,3%. Apenas el 39,7% de los casos estaba registrado en la HC. CONCLUSIONES: Las metodologías habituales para el estudio de los EA no parecen ser efectivas para identificar la totalidad de los casos. Tanto las definiciones tradicionales de EA como el subregistro de casos en la HC subestiman este problema de la seguridad hospitalaria

Ingesta alimentaria en la población adulta de dos ciudades de la Provincia de Buenos Aires: su adecuación a las necesidades nutricionales / FOOD INTAKE OF AN ADULT POPULATION IN TWO CITIES IN THE PROVINCE OF BUENOS AIRES: ITS ADEQUACY TO NUTRITIONAL RECOMMENDATIONS

Introducción: frecuentemente la ingesta alimentaria de las personas no coincide con las recomendaciones de salud. Objetivos: comparar la ingesta alimentaria de la población estudiada con las recomendaciones de las guías nacionales como base para definir los contenidos del plan de educación nutricional de un programa de prevención primaria de diabetes. Materiales y métodos: evaluamos la ingesta alimentaria de personas de 45 a 75 años, atendidas en el sector público de salud de La Plata y Berisso, entre marzo de 2015 y marzo de 2016. Utilizamos una encuesta de ingesta de alimentos estructurada y autoadministrada basada en un listado de alimentos de consumo habitual de nuestra población (NutriQuid). Los participantes completaron la encuesta durante dos días hábiles y un día de fin de semana. Verificamos el porcentaje de adecuación de la ingesta energética y nutrientes a las recomendaciones nutricionales del Ministerio de Salud de la Nación. En un subgrupo analizamos la relación entre el índice de masa corporal e ingesta energética y el consumo de sodio en hipertensos/normotensos. La evaluación estadística incluyó ANOVA y el test de t. Resultados: evaluamos las encuestas realizadas a 142 personas: 50% o más de la población encuestada siguió un plan de alimentación que no cumple con las recomendaciones del Ministerio de Salud de la Nación respecto de energía, proteínas, lípidos, sodio, ácidos grasos saturados, colesterol y azúcares refinados. Más del 80% de los participantes consumió cantidades insuficientes de fibra, potasio, frutas y verduras. Sólo un 27% de los hipertensos y un 14% de los normotensos consumieron las cantidades de sodio recomendadas. El 35% de los hipertensos y el 48% de los normotensos declararon consumir más del doble del valor recomendado. Conclusiones: consideramos que nuestros resultados apoyan la iniciativa de implementar un programa de educación alimentaria basado en las recomendaciones nutricionales.

Diabetes primary prevention program: New insights from data analysis of recruitment period.

BACKGROUND: Primary Prevention of Diabetes Program in Buenos Aires Province evaluates the effectiveness of adopting healthy lifestyle to prevent type 2 diabetes (T2D) in people at high risk of developing it. We aimed to present preliminary data analysis of FINDRISC and laboratory measurements taken during recruitment of people for the Primary Prevention of Diabetes Program in Buenos Aires Province in the cities of La Plata, Berisso, and Ensenada, Argentina. METHODS: People were recruited through population approach (house-to-house survey by FINDRISC in randomized areas) and opportunistic approach (FINDRISC completed by participants during consultations for nonrelated prediabetes/diabetes symptoms in public and private primary care centres of cities involved). In people with FINDRISC score ≥ 13 points, we evaluated blood concentrations of HbA1c , creatinine, lipids, and an oral glucose tolerance test (OGTT). RESULTS: Approximately 3415 individuals completed the FINDRISC populational survey and 344 the opportunistic survey; 43% of the 2 groups scored over 13 points; 2.8 and 75.4% of them, respectively, took the prescribed OGTT. Approximately 53.7% of the OGTT showed normal values and 5.2% unknown T2D. The remaining cases showed 69.5% impaired fasting glucose, 13.6% impaired glucose tolerance, and 16.9% both impairments. HbA1c values showed significant differences compared with normal glucose tolerance (4.96 ± 0.43%), prediabetes (5.28 ± 0.51%), and T2D (5.60 ± 0.51%). Participants with prediabetes and T2D showed a predominant increase in low-density lipoprotein-cholesterol values. In prediabetes, >50% showed insulin resistance. CONCLUSIONS: People with prediabetes/T2D had dyslipidemia associated with insulin resistance, which promotes the development of T2D and cardiovascular disease. Thus, it merits its appropriate treatment.

Prevención primaria de diabetes tipo 2 en Argentina: estudio piloto en la provincia de Buenos Aires / Primary prevention of type 2 diabetes in Argentina: Pilot study in the province of Buenos Aires

Intervenciones: Sobre estilo de vida, previenen el desarrollo de diabetes tipo 2 (DMT2) en personas con tolerancia a la glucosa o glucemia de ayunas alterada (TGA y GAA, respectivamente), aisladas o combinadas. Objetivo: Evaluar la efectividad de adoptar estilo de vida saludable sobre la manifestación clínica de DMT2 en personas con riesgo de desarrollarla. Metodología: Estudio prospectivo en participantes de 3 municipios de provincia de Buenos Aires (La Plata, Berisso y Ensenada), mediante cuestionario FINDRISC; quienes superen su puntaje de riesgo (≥ 13), realizarán prueba de tolerancia oral a la glucosa. El estudio incluirá a todas las personas con TGA/GAA que deseen participar y firmen un consentimiento informado, distribuidas en 2 grupos: a) intervención autoadministrada, y b) intervención intensificada (talleres de modalidad grupal mensuales sobre plan de alimentación saludable y práctica regular de actividad física 3 veces por semana). Ambos grupos tendrán un seguimiento de 2 años. Se utilizarán cuestionarios para evaluar bienestar, hábitos alimentarios y actividad física de cada participante al inicio del estudio y cada 6 meses durante el seguimiento. En ambos grupos se realizarán individualmente mediciones antropométricas y análisis de laboratorio a los 0, 12 y 24 meses. Igualmente, se evaluará la coste-efectividad de las estrategias implementadas. Resultados y conclusiones: Los resultados del estudio permitirán: a) demostrar la factibilidad y el costo de este tipo de programas: b) identificar genotipos de personas en riesgo facilitando intervenir en ellas precoz y eficientemente; c) definir si estas intervenciones también mejoran otros FRCV presentes; d) cuantificar las lesiones de microangiopatía (microaneurismas retinianos) en población con TGA/GAA, y e) identificar barreras y alianzas estratégicas interdisciplinarias e intersectoriales para la implementación efectiva de este tipo de programas.

Lifestyle interventions: Prevent/delay the development of type 2 diabetes (T2DM) in people with impaired glucose tolerance or impaired fasting blood glucose (IGT and IFG, respectively), alone or combined. Objective: To evaluate the effectiveness of adopting a healthy lifestyle on the clinical manifestation of T2DM in people at risk of its development. Methodology: A prospective study will be conducted, using the FINDRISC questionnaire, on participants selected from three municipalities of the Province of Buenos Aires (La Plata, Berisso and Ensenada). An oral glucose tolerance test will be performed on those participants who exceed their risk score (≥ 13). The study will include all people with IGT/ IFG who wish to participate and sign an informed consent form. They will be randomly divided into two groups: a) self-administered intervention and b) Intensified Intervention (monthly group sessions on healthy meal plan and weekly sessions of physical activity). Both groups will be followed-up for two years. Questionnaires will be used to assess welfare (WHO-5), eating habits, and physical activity of each participant at baseline and every six months of followup. Individual anthropometric measurements and laboratory analysis will be performed in both groups at 0, 12 and 24 months. The cost-effectiveness of the strategies implemented will also be assessed. Results and conclusions: The results of the study will allow to: a) demonstrate the feasibility and cost of such programs, b) identify genotypes of people at risk that would facilitate early implementation of effective prevention strategies; c) define whether these interventions would also improve other associated cardiovascular risk factors, d) Identify and quantify microangiopathy lesions (retinal micro-aneurysms) in a population with IGT/IFG, and e) identify barriers and interdisciplinary strategic alliances for effective implementation of such programs.

Evaluación de calidad de atención en centro de atención primara de salud / Evaluation of care quality in primary health care centers

INTRODUCCIÓN: la calidad de la atención como política sanitaria es considerada una estrategia para el logro de la equidad en salud. OBJETIVOS: Evaluar las características y la calidad de atención de los centros de atención primaria de la salud (CAPS). MÉTODOS: Se realizó un estudio transversal evaluativo, que involucró a 89 CAPS de las provincias de Buenos Aires y Entre Ríos, que se autoevaluaron bajo la supervisión de un equipo docente de la Facultad de Ciencias Médicas de la Universidad Nacional de La Plata. Se evaluaron 200 estándares,agrupados en las siguientes dimensiones: Conducción y gestión (CG), Recursos humanos (RH), Registros e información (RI), Actividades de organización (AO), Normas de atención (N), Actividades del equipo de salud sobre la comunidad (AC), Participación social (PS), ReferenciaContrarreferencia (RF), Planta física (PF), Recursos materiales (RM) e Insumos (I). RESULTADOS: Sólo el 18% de los CAPS cuentan con unequipo de salud básico. El nivel de calidad global fue de 58±14%. Encuanto a las dimensiones, el ranking fue: I 87%, RM 70%, AO 66%, AC63%, PF 61%, CG 55%, RF 55%, N 47%, RH 43%, RI 41%, PS 32%.CONCLUSIONES: Estos resultados permiten establecer un diagnósticode situación en cada CAPS para sustentar planes de mejora específicosy un diagnóstico integral para respaldar la definición de ejes estratégicosen las políticas sanitarias.

INTRODUCTION: the quality of care as health policy is considered a strategy to attain health equity. OBJECTIVES: Toevaluate the characteristics and care quality in primary health care centers (PHCC). METHODS: An evaluative cross-sectional study was conducted. It involved 89 PHCC from the provinces ofBuenos Aires and Entre Ríos. A self-assessment of care quality was performed under supervision of an advisory team from the Faculty of Medical Sciences of the National University of La Plata. Two hundred (200) standards were evaluated according to the following dimensions: Leadership and Management (LM), Human Resources (HR), Records and Information (RI), OrganizationActivities (OA), Norms and Guides (NG), Community Activities (CA), Social Participation (SP), Referral system (RS), Physical plant (PP), Material resources (MR) and Supplies (S). RESULTS: Only 18% of PHCC have a basic health team. The overall qualitylevel was 58±14%. In regard to the dimensions, the ranking was: S 87%, MR 70%, OA 66%, CA 63%, PP 61%, LM 55%, RS 55%, NG 47%, HR 43%, RI 41%, SP 32%. CONCLUSIONS: These results allow to perform a situational diagnosis of each PHCC to support specific improvement plans and a comprehensive diagnosis to define strategic priorities for health policies.

Short-term evaluation of the impact of a fortified food aid program on the micronutrient nutritional status of Argentinian pregnant women.

We studied the impact of a food supplementation program (Plan Más Vida (PMV)) on the micronutrient nutritional condition of pregnant women from low-income families 1 year after its implementation. The food program provided supplementary diet (wheat and maize--fortified flour, rice or sugar, and fortified soup). We performed a prospective, nonexperimental, cross-sectional study in the province of Buenos Aires, Argentina, evaluating pregnant women at baseline (n = 164) and 1 year after PMV implementation (n = 108). Biochemical tests (hemogram, ferritin, vitamin A, zinc, and folic acid), anthropometric assessments (weight and height), and dietary surveys (24 h recall) were performed at the two study points. One year after PMV implementation, no significant changes in anthropometric values were observed. Folic acid deficiency and the risk of vitamin A deficiency (retinol, 20-30 µg/dl) decreased significantly (35.8 to 6.1 % and 64 to 41 %, respectively; p < 0.000). Anemia and prevalence of iron and zinc deficiency values did not change. Diet survey results showed that although nutrient intake increased significantly, it was still below recommendations. Implementation of the PMV and of the government nutritional strategies had a high impact on the prevalence of folic acid deficiency. We also observed a decrease in the risk of vitamin A deficiency, and no impact on iron and zinc nutritional status. Adherence to the specific fortified food (soup) was not good and intra-family dilution and distribution of food was high.

Evaluation of the impact of a food program on the micronutrient nutritional status of Argentinean lactating mothers.

This study was conducted to evaluate the impact of a food aid program (Plan Más Vida, PMV) on the micronutrient nutritional condition of lactating mothers 1 year after its implementation. The food program provided supplementary diets (wheat- and maize-fortified flour, rice or sugar, and fortified soup) to low-income families from the province of Buenos Aires, Argentina. A prospective, non-experimental study was carried out to evaluate the micronutrient nutritional status of lactating mothers (n = 178 at baseline and n = 151 after 1 year). Biochemical tests (hemoglobin, ferritin, zinc, vitamin A, and folic acid), anthropometric assessments (weight and height) and dietary surveys (24-h recall) were performed. We found no significant changes in anthropometric values 1 year after the intervention. The risk for vitamin A (retinol 20-30 µg/dl) and folate deficiency significantly decreased 1 year after PMV implementation (56.3 vs. 29.9 and 50.3 vs. 3.4 %, respectively; p < 0.001). Anemia was seen in 25.8 % of lactating mothers at baseline, without statistically significant differences 1 year after (p = 0.439). The nutritional data obtained after assessing the early impact of PMV actions may be useful to provincial health authorities to perform periodic evaluations in the future.

Short-term evaluation of the impact of a food program on the micronutrient nutritional status of Argentinean children under the age of six.

This study was undertaken to evaluate the impact of Plan Más Vida (PMV) on the micronutrient nutritional condition of children aged 1 to 6 years 1 year after PMV implementation. The food program was intended for low-income families from the province of Buenos Aires, Argentina and provided supplementary diets. A prospective, nonexperimental study was carried out. Children (472 at baseline and 474 after 1 year) were divided into two groups (1-2 and 2-6 years of age). Biochemical tests (hemogram, ferritin, zinc, vitamin A, and folic acid), anthropometric assessments (weight and height), and dietary surveys (24-h recall) were performed. Chronic growth retardation (-2 height/age Z-score) was present in 2.8% and 8.7% of 1-2- and 2-6-year-old children, respectively; 14.4% in the former and 8.8% in the latter group had overweight/obesity. No significant changes were recorded 1 year after PMV implementation. Whereas anemia values decreased (55.3% to 39.1%, p = 0.003) and serum zinc values increased in 1-2-year-old children, the risk for vitamin A deficiency decreased significantly in both age groups. The evaluation of the early impact of PMV actions provided important nutritional data that should be used by provincial health authorities to conduct future evaluations.

Prevalence of signs and symptoms of temporomandibular disorders in children in the state of Puebla, Mexico, evaluated with the research diagnostic criteria for temporomandibular disorders (RDC/TMD)

The aim of this work was to describe the prevalence of signs and symptoms of temporomandibular disorders (TMD) in children of the State of Puebla, Mexico. A descriptive observational study was performed. After calculating sample size, children who met the following selection criteria were included: registered at an official elementary school, either sex, ages between 8 and 12 years, who accept to participate in the study and whose parents have signed the informed consent forms. The Research Diagnostic Criteria for Temporomandibular Disorders were used by calibrated researchers (Kappa.90) under the same conditions. Descriptive statistics were applied by using SPSSv15 software. The study included 235 children, 129 (54.9%) female and 106 (45.1%) male, of average age 9.31+1.2 years. Prevalence of signs and symptoms was 33.2%, and predominately muscular (82%), 48.1% showed signs of muscular pain and 19.1% joint pain. 63.4% showed signs of alteration in the mouth opening pattern, 39.1% presented joint sounds on opening or closing the mouth and 20.4% on mandibular excursions. The high prevalence of signs and symptoms related to temporomandibular disorders, in particular in children with mixed dentition, shows the importance of TMD evaluation during this period, when morphological changes associated to growth and craniofacial development prevail.

El objetivo del presente trabajo fue describir la prevalencia de signos y sintomas de los trastornos temporomandibulares (TTM) en ninos del estado de Puebla, Mexico. Se realizo un estudio observacional descriptivo. Previo calculo de tamano de muestra, se incluyeron ninos que cumplieron con criterios previos de seleccion: inscriptos en escuela primaria oficial, de cualquier sexo, en edades de 8 a 12 anos, que aceptaron participar en el estudio y cuyos padres firmaron el consentimiento informado. Se utilizaron los Criterios de Investigacion Diagnostica para los TTM, aplicados por investigador estandarizado (Kappa .90) bajo las mismas condiciones. Se calculo estadistica descriptiva con el programa SPSS v15. Se incluyeron 235 ninos, 129 (54.9%) mujeres y 106 (45.1%) varones con promedio de edad de 9.31}1.2 anos. La prevalencia de signos y sintomas de TTM fue del 33.2% predominantemente musculares (82%), 48.1% presentaron dolor muscular y 19.1% articular. El 63.4% presento alteraciones en el patron de apertura bucal, 39.1% presento ruidos articulares en apertura o cierre y 20.4% a las excursiones mandibulares. Las altas prevalencias de los signos y sintomas relacionadas con los Trastornos Temporomandibulares, particularmente en ninos con denticion mixta, demuestran la importancia de la evaluacion de los TTM durante este periodo, donde prevalecen los cambios morfologicos asociados al crecimiento y al desarrollo craneofacial.

Evaluación de sistemas de salud y la estrategia de APS / Evaluation of health care systems and primary health care strategy

OBJETIVO: evaluar la calidad de los sistemas de salud y la estrategia de Atención Primaria de la Salud (APS) en distintas áreas geográficas del país. MÉTODO: estudio de corte transversal con abordaje metodológico triangular que involucró:a) encuestas a las personas que demandan la atención, b) entrevistas a referentes claves del equipo de salud y c) grupos focales con los equipos de salud. Los componentes de estructura, proceso y resultados de los sistemas de salud basados en APS se evaluaron por medio de indicadores específicos. RESULTADOS:el análisis de la información muestra un déficit evidente de la integración del equipo profesional, principalmente en la actividad comunitaria y social, la carencia de normativas adecuadas y problemas de accesibilidad estructural para población discapacitada. Se destaca, además, el alto porcentaje de personal que desconoce los programas en ejecución dentro de la institución, así como la falta de un sistema de información adecuado sobre la población del área y de registros de los procesos de gestión en la mayoría de las unidades analizadas. CONCLUSIÓN: a pesar de los esfuerzos para definir y ejecutar la estrategia de APS, los centros de salud continúan realizando sus actividades en base al modelo tradicional de atención exclusiva de la demanda

OBJECTIVE: the aim of this project was to evaluate the quality of health care systems based on the strategy of Primary Health Care in different areas of the country. METHOD: cross-sectional study with a triangular approach, including a) a survey to the population demanding care, b) interviews to key referents of the health team, and c)health team focus groups. The components of structure, process and outcomes of the health system based on PHC were evaluated by specific indicators. RESULTS: the analysis of the information shows an evident deficit of the integration of the professional team, mainly in the activities towards community, the lack of norms and lack of facilities for disable people. It must be noted also the high percentage of the health care team that does not know about current institutional health programs and the lack of an adequate information system for the area population and for the administrative process in most of the sites studied. CONCLUSION: in spite of the efforts to implement the PHC strategy, most of health centers evaluated are still providing care based on the traditional model oriented to the demands of care

Prevalence of signs and symptoms of temporomandibular disorders in children in the State of Puebla, Mexico, evaluated with the research diagnostic criteria for temporomandibular disorders (RDC/TMD).

The aim of this work was to describe the prevalence of signs and symptoms of temporomandibular disorders (TMD) in children of the State of Puebla, Mexico. A descriptive observational study was performed. After calculating sample size, children who met the following selection criteria were included: registered at an official elementary school, either sex, ages between 8 and 12 years, who accept to participate in the study and whose parents have signed the informed consent forms. The Research Diagnostic Criteria for Temporomandibular Disorders were used by calibrated researchers (Kappa 90) under the same conditions. Descriptive statistics were applied by using SPSSv15 software. The study included 235 children, 129 (54.9%) female and 106 (45.1%) male, of average age 9.31 + 1.2 years. Prevalence of signs and symptoms was 33.2%, and predominately muscular (82%), 48.1% showed signs of muscular pain and 19.1% joint pain. 63.4% showed signs of alteration in the mouth opening pattern, 39.1% presented joint sounds on opening or closing the mouth and 20.4% on mandibular excursions. The high prevalence of signs and symptoms related to temporomandibular disorders, in particular in children with mixed dentition, shows the importance of TMD evaluation during this period, when morphological changes associated to growth and craniofacial development prevail.

[A personalised health care programme (PANDELAS) operating in Buenos Aires , Argentina , during 2006]. / Programa de Atención Personalizada y Nominal de la Salud-PANDELAS Buenos Aires, Argentina, 2006.

OBJECTIVE: Identifying families having health risks using GIS technology to plan health care action which would include the whole community and not just that part of the population demanding attention. METHODS: 48,800 inhabitants from Ensenada county near Buenos Aires, Argentina were registered and questioned regarding socio-economic-sanitary aspects and their data was georeferenced to cadastral maps (using Arc-GIS-ESRI-2002 software). Health teams (HT) from each local health centre (LHC) were instructed in how to identify the population at risk and plan and carry out preventative health action using the software. Variables such as the quality of attention received, knowledge of the area and its inhabitants, the effectiveness of LHC action, the amount of extramural activities engaged in, community participation and the degree of satisfaction were evaluated pre- and post-PANDELAS. RESULTS: PANDELAS led to focusing attention on homes having structural disadvantages (i.e. the absence of drinking water or drains), vulnerable inhabitants having special characteristics or sick people suffering from a chronic pathology. Children aged <1 year, patients affected by chronic disease, the aged, pregnant women and people lacking routine controls (such as Papanicolau, etc) were georeferenced. Controls were increased by 300 % based on this information. LHC tripled their knowledge of the area for which they were responsible and the needs of their target population; outdoor community activities increased 6-fold and community participation increased from 0 ,1 % to 3,9 %. LHC satisfaction and that of the community with the work done was reflected in 89 % and 85 % favourable answers, respectively. CONCLUSIONS: PANDELAS brought greater LHC commitment towards their community, planning their activities on the basis of preventative action and increasing accessibility to the heath care system.

Programa de Atención Personalizada y Nominal de la Salud-PANDELAS Buenos Aires, Argentina, 2006 / A personalised health care programme (PANDELAS) operating in Buenos Aires, Argentina, during 2006

Objetivo Cuidar selectivamente la salud identificando y georrefenciando la totalidad de la población, y no sólo para aquellos que demandan atención. Métodos Un total de 48 800 habitantes de Ensenada, Buenos Aires-Argentina; fueron censados en aspectos socio-económico-sanitarios y sus datos georreferenciados en mapas catastrales (software Arc-GIS-ESRI-2002). Equipos de Salud (EDS) identificaron población en riesgo y efectuaron acciones de prevención. Variables como calidad de atención, conocimiento del área, efectividad, cantidad de actividades extramuros, participación comunitaria, y grado de satisfacción, fueron evaluadas pre y post-PANDELAS. Resultados PANDELAS permitió focalizar hogares con inconvenientes estructurales (ausencia de agua potable, cloacas); individuos vulnerables, con características especiales o enfermos con patología crónica. Se georreferenciaron niños < 1 año, embarazadas, individuos con controles incompletos. Con esta información se incrementaron estos controles en 300 por ciento. El EDS triplicó el conocimiento del área e información de las necesidades de la población; sextuplicó actividades comunitarias extramuros e incrementó la participación comunitaria del 0,1 por ciento al 3,9 por ciento. La satisfacción comunitaria y del EDS con la labor realizada tuvo 85 por ciento y 89 por ciento respuestas favorables respectivamente. Conclusiones PANDELAS logró mayor compromiso del EDS para con su comunidad, planificando actividades en base a acciones preventivas e incrementando la cantidad de destinatarios de las mismas.

Objective Identifying families having health risks using GIS technology to plan health care action which would include the whole community and not just that part of the population demanding attention. Methods 48 800 inhabitants from Ensenada county near Buenos Aires, Argentina were registered and questioned regarding socio-economic-sanitary aspects and their data was georeferenced to cadastral maps (using Arc-GIS-ESRI-2002 software). Health teams (HT) from each local health centre (LHC) were instructed in how to identify the population at risk and plan and carry out preventative health action using the software. Variables such as the quality of attention received, knowledge of the area and its inhabitants, the effectiveness of LHC action, the amount of extramural activities engaged in, community participation and the degree of satisfaction were evaluated pre- and post-PANDELAS. Results PANDELAS led to focusing attention on homes having structural disadvantages (i.e. the absence of drinking water or drains), vulnerable inhabitants having special characteristics or sick people suffering from a chronic pathology. Children aged <1 year, patients affected by chronic disease, the aged, pregnant women and people lacking routine controls (such as Papanicolau, etc) were georeferenced. Controls were increased by 300 percent based on this information. LHC tripled their knowledge of the area for which they were responsible and the needs of their target population; outdoor community activities increased 6-fold and community participation increased from 0 ,1 percent to 3,9 percent. LHC satisfaction and that of the community with the work done was reflected in 89 percent and 85 percent favourable answers, respectively. Conclusions PANDELAS brought greater LHC commitment towards their community, planning their activities on the basis of preventative action and increasing accessibility to the heath care system.

[Population study of the prevalence of anaemia in the adult population of Buenos Aires, Argentina]. / Estudio poblacional de prevalencia de anemia en población adulta de Buenos Aires, Argentina.

OBJECTIVE: To determine the prevalence and causes of anaemia among adults in Buenos Aires, Argentina. DESIGN: Community-based, cross-sectional, quantitative study, with descriptive and analytic stages. SETTING: Study conducted in La Plata, Buenos Aires, Argentina. PARTICIPANTS: Rigorous selection from randomised sampling, with 3-stage stratification: geographical area, health aspects, and social/economic status. Adults >18 years old. RESULTS AND MAIN MEASUREMENTS: Social-economic and nutritional data and blood samples were obtained from each participant. If anaemia was detected, either treatment was given until complete recovery or further studies were conducted until definitive diagnosis was reached. Weight, height, haemoglobin, erythrocytes, haematocrit, transferrin, iron and ferritin levels, daily intake of calories, carbohydrates, lipids, proteins, calcium, iron, and vitamin C were measured. One thousand and thirty-six patients out of 1200 selected were analyzed. The prevalence of anemia in adults was 26.3%. Variables such as low social/economic status, nutritional questions, and frequency of doctor's consultation were associated with risk of anaemia. However, basic unsatisfied needs--a variable consisting of precarious housing and low educational level--, female sex, and living in slums were significant in the multivariate analysis (OR>2.5). CONCLUSIONS: One in 4 adults has anaemia, with iron deficiency as the major cause. Anaemia diagnosis is mainly associated with social and gender questions and the area of residence. This information, if used by the State to plan appropriate and focused preventive measures, could benefit not just adults but the entire community that depends on them.

Estudio poblacional de prevalencia de anemia en población adulta de Buenos Aires, Argentina / Population study of the prevalence of anaemia in the adult population of Buenos Aires, Argentina

Objetivo. Establecer la prevalencia de anemia en población adulta y determinar los factores asociados. Diseño. Estudio poblacional de corte transversal, con etapa descriptiva y analítica. Emplazamiento. Estudio realizado en La Plata, Argentina. Participantes. Muestra aleatoria, con estratificación trietápica considerando área geográfica, aspectos sanitarios y nivel socioeconómico de adultos mayores de 18 años. Resultados y mediciones principales. Encuestas socioeconómica y nutricional, estudios hematológico y sérico. A quienes se detectó anemia, se les aseguró un tratamiento completo o estudios ulteriores hasta el diagnóstico de certeza. Se valoró: peso y talla, hemoglobina, hematíes, hematocrito, ferremia, transferrina, ferritina, ingesta diaria de calorías, hidratos de carbono, lípidos, proteínas, calcio, hierro y vitamina C. Se analizó a 1.136 pacientes de los 1.200 seleccionados. La prevalencia de anemia en adultos fue del 26,3%. Numerosas variables, como nivel socioeconómico, aspectos nutricionales o frecuencia de consulta médica, se asocian al riesgo de anemia. Sin embargo, las necesidades básicas insatisfechas --variable compuesta por vivienda precaria y bajo nivel de instrucción--, sexo femenino y residencia en suburbios mantienen la significación en el análisis multivariable (odds ratio > 2,5). Conclusiones. Una de cada 4 personas adultas presenta anemia, y la ferropenia es la causa más importante. El diagnóstico de anemia se asoció, predominantemente, a aspectos sociales, el sexo o el área geográfica de residencia. Dicha información, utilizada por el Estado para planificar las medidas preventivas, oportunas y focalizadas, podrá lograr beneficios no sólo en los adultos, sino en toda la comunidad que depende económicamente de ellos

Objective. To determine the prevalence and causes of anaemia among adults in Buenos Aires, Argentina. Design. Community-based, cross-sectional, quantitative study, with descriptive and analytic stages. Setting. Study conducted in La Plata, Buenos Aires, Argentina. Participants. Rigorous selection from randomised sampling, with 3-stage stratification: geographical area, health aspects, and social/economic status. Adults >18 years old. Results and main measurements. Social-economic and nutritional data and blood samples were obtained from each participant. If anaemia was detected, either treatment was given until complete recovery or further studies were conducted until definitive diagnosis was reached. Weight, height, haemoglobin, erythrocytes, haematocrit, transferrin, iron and ferritin levels, daily intake of calories, carbohydrates, lipids, proteins, calcium, iron, and vitamin C were measured. One thousand and thirty-six patients out of 1200 selected were analyzed. The prevalence of anemia in adults was 26.3%. Variables such as low social/economic status, nutritional questions, and frequency of doctor's consultation were associated with risk of anaemia. However, basic unsatisfied needs--a variable consisting of precarious housing and low educational level--, female sex, and living in slums were significant in the multivariate analysis (OR>2.5). Conclusions. One in 4 adults has anaemia, with iron deficiency as the major cause. Anaemia diagnosis is mainly associated with social and gender questions and the area of residence. This information, if used by the State to plan appropriate and focused preventive measures, could benefit not just adults but the entire community that depends on them

Acquisition of visuomotor abilities and intellectual quotient in children aged 4-10 years: relationship with micronutrient nutritional status.

Lethargy, poor attention, and the high rate and severity of infections in malnourished children affect their educational achievement. We therefore studied the association between visuomotor abilities and intelligence quotient (IQ) and their relationship with iron, zinc, and copper. A cross-sectional study was carried out on a sample of 89 healthy children (age range, 4-10 years). Evaluations of visuomotor ability and IQ were performed with the Developmental Test of Visual Motor Integration (VMI) and the Scale for Measurement of Intelligence for children aged 3-18 years, respectively. Nutritional status was assessed using anthropometry and biochemical assessments, which included serum ferritin, zinc and copper levels, and Hb. The sample was classified as having low or normal VMI scores: 47 children (52.8%, mean age 7 +/- 1.5 years) had low VMI, and 42 (47.2%, mean age 7 +/- 2.06 years) had normal VMI. There were no statistically significant differences in socioeconomic and cultural condition between both groups. We found significantly higher serum copper and ferritin levels in normal as compared to low VMI, but we did not find any differences with zinc. IQ was significantly higher in normal vs low VMI children. The fact that children with abnormal VMI presented low mean serum copper and ferritin concentrations could indicate that copper and iron deficiencies in this sample could be related with visuomotor abilities.

[The relationship between socioeconomic factors and maternal and infant health programs in 13 Argentine provinces]. / La relación entre los factores socioeconómicos y los programas sanitarios de salud maternoinfantil en 13 provincias argentinas.

OBJECTIVES: To analyze the relationship between maternal and infant health and socioeconomic, cultural, and sanitation factors in Argentina; to evaluate how health program quality affects the primary health indicators for mothers and infants. METHODS: This is a cross-sectional study with multiple variables. The authors studied six indicators for maternal and infant health: rates for maternal, infant, neonatal, and postneonatal mortality; the percentage of newborns with low birthweight; and the percentage of premature newborns. The study was conducted in 79 administrative units in 13 provinces that represent different geographic regions of Argentina. They included (1) the provinces of Salta and Jujuy in northwest Argentina; (2) the provinces of Córdoba, Santa Fe, and Buenos Aires in central Argentina; (3) the provinces of Entre Ríos and Misiones in the Mesopotamia or northeast region; (4) the provinces of San Luis, San Juan, and Mendoza in the Cuyo or northwest, Andean region; and (5) the provinces of Neuquén, Río Negro, and Chubut in the south. The explanatory variable in the study was the quality of health programs, controlled by socioeconomic, cultural, and sanitation factors in 1999 and 2000. The definition of program quality ("poor," "average," "good," and "very good") was based on quantitative and qualitative analysis of selected variables such as policies, organization, and procedures as determined by the investigators. Documentation was obtained from secondary official sources. The investigators interviewed 117 health system managers (including supervisors of provincial and local health programs, administrators of maternal and child health programs, and hospital directors), who provided information on characteristics and indicators of the health programs. RESULTS: There were marked geographic differences in the levels of maternal and infant health, medical care, and socioeconomic, cultural, and sanitation factors. Only 10.0% of health programs were classified as "very good," 35.4% as "good," 31.6% as "average," and 23.0% as "poor." There was a significant correlation (P < 0.05) between rates of infant and postneonatal mortality and adverse socioeconomic circumstances. There was also a significant correlation between the percentage of low birthweight infants and the quality of health programs. CONCLUSIONS: There are clear disparities in the level of maternal and infant health care in different administrative units in Argentina. The infant mortality rate was associated with variations in socioeconomic, cultural, and sanitation factors and with the quality of health programs. Health programs improved infant health when appropriately implemented, even in adverse socioeconomic and sanitation conditions.

La relación entre los factores socioeconómicos y los programas sanitarios de salud maternoinfantil en 13 provincias argentinas / The relationship between socioeconomic factors and maternal and infant health programs in 13 Argentine provinces

OBJETIVOS: Analizar la relación entre la salud maternoinfantil y los factores determinantes socioeconómicos, culturales y sanitarios y evaluar el efecto de la calidad de los programas de salud sobre los principales indicadores de salud maternoinfantil. MÉTODOS: Estudio analítico de corte transversal con múltiples variables. Se estudiaron seis indicadores maternoinfantiles: las tasas de mortalidad materna, infantil, neonatal y posneonatal y los porcentajes de bajo peso al nacer y de prematuros. El estudio se realizó en 79 unidades administrativas de 13 provincias argentinas distribuidas en las cuatro principales regiones del país: Norte (Salta, Jujuy y Misiones), Centro (Córdoba, Santa Fe y Buenos Aires), Litoral (Entre Ríos), Cuyo (San Luis, San Juan y Mendoza) y Sur (Neuquén, Río Negro y Chubut). Como variable explicativa se utilizó la calidad de los programas de salud, controlada por los factores determinantes socioeconómicos, culturales y sanitarios (período 1999-2000). La calidad de los programas (mala, regular, buena y muy buena) se basó en el análisis cuantitativo y cualitativo de variables seleccionadas de políticas, organización y procesos, según el juicio consensuado de los investigadores. La información documental se obtuvo de fuentes oficiales secundarias y las características e indicadores de los programas de salud se derivaron de las entrevistas a 117 referentes clave. RESULTADOS: Se encontraron marcadas diferencias geográficas en el nivel de salud maternoinfantil, la atención médica y los factores condicionantes de la salud. Solo 10,0 por ciento de los programas de salud fueron calificados como muy buenos, 35,4 por ciento como buenos, 31,6 por ciento como regulares y 23,0 por ciento como malos. Se encontró una correlación significativa (P < 0,05) entre las tasas de mortalidad infantil y posneonatal y la condición socioeconómica desfavorable y entre las tasas de mortalidad infantil y neonatal y el porcentaje de bajo peso...

OBJECTIVES: To analyze the relationship between maternal and infant health and socioeconomic, cultural, and sanitation factors in Argentina; to evaluate how health program quality affects the primary health indicators for mothers and infants. METHODS: This is a cross-sectional study with multiple variables. The authors studied six indicators for maternal and infant health: rates for maternal, infant, neonatal, and postneonatal mortality; the percentage of newborns with low birthweight; and the percentage of premature newborns. The study was conducted in 79 administrative units in 13 provinces that represent different geographic regions of Argentina. They included (1) the provinces of Salta and Jujuy in northwest Argentina; (2) the provinces of Córdoba, Santa Fe, and Buenos Aires in central Argentina; (3) the provinces of Entre Ríos and Misiones in the Mesopotamia or northeast region; (4) the provinces of San Luis, San Juan, and Mendoza in the Cuyo or northwest, Andean region; and (5) the provinces of Neuquén, Río Negro, and Chubut in the south. The explanatory variable in the study was the quality of health programs, controlled by socioeconomic, cultural, and sanitation factors in 1999 and 2000. The definition of program quality ("poor," "average," "good," and "very good") was based on quantitative and qualitative analysis of selected variables such as policies, organization, and procedures as determined by the investigators. Documentation was obtained from secondary official sources. The investigators interviewed 117 health system managers (including supervisors of provincial and local health programs, administrators of maternal and child health programs, and hospital directors), who provided information on characteristics and indicators of the health programs. RESULTS: There were marked geographic differences in the levels of maternal and infant health, medical care, and socioeconomic, cultural, and sanitation factors. Only 10.0 percent...

Diagnóstico del Estado Nutricional de Micronutrientes y Evaluación Antropométrica en una Población Infantil Suburbana de la Provincia de Buenos Aires / Diagnosis of Micronutrient Nutritional Status and Anthropometric in a Suburban Child Population in the Province of Buenos Aires

Objetivo: Determinar el estado nutricional evaluado por antropometría, y el estado nutricional de micro nutrientes en una población infantil.

Métodos: Se estudiaron 205 niños de 4 a 10 años de una comunidad suburbana de La Plata, Argentina. Se determino Peso/edad, Talla/edad y Peso/talla y se comparo las referencias. Para determinar las deficiencias de micro nutrientes y anemia se establecieron los siguientes puntos de cortes: Deficiencia de zinc y cobre < 70 mcg/dl (absorción atómica), hierro por ferritina < 12 ng/dl (quimioluminiscencia), hemoglobina < 11,5 g/dl (Coulter). Se realizó una encuesta social y de ingesta y de hábitos alimentarios. Los datos se analizaron con EpiInfo 6. Se utilizaron las correlaciones de Pearson y Spearman.

Resultados: La media de edad fue de 6,69 (± 2,04), 46,6 % de sexo femenino. El número de integrantes de familia fue de 6 (± 1,98), la dieta cubría las recomendaciones de proteínas, pero el 19,4 % no cubría las recomendaciones de calorías y 30,33 y 40 % de los niños no cubrieron las recomendaciones de hierro, zinc y vitamina A respectivamente. La prevalencia de insuficiente progresión de peso fue 4,5 % (Store Z < -2 de P/E) y por < Percentilo 10 de P/E 19,2 %; retraso crónico de crecimiento (<-2 score Z T/E) fue 5,6 %, y 23,2 % (< percentilo 10); por el indicador P/T la emaciación de primer grado alcanzó el 5%, sobrepeso y la obesidad llegó al 17,7 %. La prevalencia de anemia fue 21,6 %. El 6,8 % de los niños presento deficiencia de hierro, 5,1 % deficiencia de cobre y 11,3 % deficiencia de zinc. No se halló correlación significativa entre Peso/edad, peso/talla y Talla/ edad, con los niveles séricos de micro nutrientes y Hb, ni al comparar el estado nutricional y la prevalencia de deficiencia de cada micro nutrientes, excepto la prevalencia deficiencia de hierro en niños con retraso crónico de merecimiento que fue mayor que en el resto de los niños (p: 0,01).

Conclusión: La carencia de micro nutrientes afecta a todos los estados nutricionales estimados por antropometría en los niños estudiados. El sobrepeso y la obesidad aparecen como un problema nutricional emergente.