Female sex workers and police violence during the Covid-19 health crisis in 2020-2021: results from the EPIC multi-country community-based research program in Argentina.

BACKGROUND: Female sex workers (FSW) have been disproportionately impacted by the Covid-19 crisis. Data show increases of police violence toward key populations (KP), likely a consequence of their role in enforcing health government measures. This study aimed to identify factors associated with police violence experienced by FSW during the Covid-19 crisis in Argentina. METHODS: EPIC is a multi-country, cross-sectional, community-based research program evaluating the impact of Covid-19 among KP. In Argentina, the study was conducted in collaboration with FSW community-based organizations (CBO). Participants completed an online survey (October 2020-April 2021). Police violence was measured as having experienced episodes of violence (physical, verbal, psychological or sexual) by security forces since the start of the health crisis. Factors associated with police violence were assessed in logistic regression models. RESULTS: Among 173 respondents, median age was 34 [IQR 27-42], 39.3% were transgender women (TW), 78.1% declared sex work as their only income and 71.7% mentioned their financial situation has deteriorated with the health crisis. Nearly half of FSW (44.5%) reported experiencing police violence within the first year of the Covid-19 pandemic, and among them, 76.6% declared more frequent violence episodes since the beginning of the health crisis. After adjustment for age, being a TW (aOR [95% CI] = 2.71 [1.21;6.05]), reporting non-injection drug use (2.92 [1.02;8.36]), having a considerably deteriorated financial situation (3.67 [1.47;9.21]), having had a consultation with a CBO worker for medical care/treatments (5.56 [2.15;14.37]) and declaring fear or experiences of discrimination by physicians/other health workers (2.97 [1.21;7.29]), since the beginning of the Covid-19 health crisis, were independently associated with police violence. CONCLUSIONS: FSW in Argentina have experienced an increase in police violence since the beginning of the health crisis. Belonging to multiple KP (FSW, TW, people who use drugs) increases the likelihood of experiencing police violence, highlighting the need of an intersectional approach to develop interventions to reduce stigma and violence against FSW. CBOs have provided essential support and services during the crisis to FSWs, and other KPs, who may have avoided traditional healthcare structures due to fear or experiences of discrimination.

Encuesta sobre el impacto de la pandemia COVID-19 en el consumo de medicamentos, drogas recreativas y bebidas alcohólicas en Argentina / Survey on the impact of the COVID-19 pandemic on the consumption of medicines, recreational drugs and alcoholic beverages in Argentina

Objectives: The objective of the study was to evaluate the behavior in the use of medicines, recreational drugs and the consumption of alcoholic beverages in the Argentine population during the course of the ASPO (Social, Preventive and Mandatory Isolation) due to the COVID-19 pandemic.Methods: An online survey was designed ad hoc and was available between June 28 and July 9, 2020 through Surveymonkey© and was disseminated through social networks. Univariate and bivariate analyzes were performed.Results: 43.6% of the 2,906 participants reported using medications for chronic diseases. A significant difference (p= .000) was observed in the decrease in consumption between those who were treated in public health care providers (17.9%) and those who did it in private medicine (7.2%). Likewise, a significant difference was found in the decrease in access by the area of residence (p =.031), being lower in the City of Buenos Aires (6.8%) than in the rest of the national territory (10.6%). Of the total of individuals surveyed, 38.3% reported having self-medicated during the ASPO, of these 59.3% did not alter their self-medication routine, 15% decreased their consumption and 25.7% increased it.23.9% of the sample reported consuming recreational drugs. 47.8% of users reported having increased consumption. Likewise, 66.3% reported drinking alcohol regularly, and of these, 40.1% increased their consumption.Conclusions: It is important to continue the care of chronic diseases, mental health and substance use. In particular, strengthening the public health system and the provinces. (AU)

Objetivos: El objetivo del estudio fue evaluar el comportamiento en el uso de medicamentos, drogas recreativas y el consumo de bebidas alcohólicas en la población argentina durante el transcurso del ASPO (Aislamiento Social, Preventivo y Obligatorio) por la pandemia de la Covid-19.Métodos: Se diseñó ad hoc una encuesta on-line disponible entre el 28 de junio y el 9 de julio del 2020 mediante Surveymonkey© difundida por redes sociales. Se realizaron análisis univariados y bivariados.Resultados: El 43,6% de los 2.906 participantes reportó utilizar medicamentos para enfermedades crónicas. Se observó una diferencia significativa (p=,000) en la disminución del consumo entre quienes se atienden en efectores públicos (17,9%) y quiénes lo hacen en la medicina privada (7,2%). Asimismo, se encontró una diferencia significativa en la disminución del acceso por la zona de residencia (p=,031), siendo menor en Ciudad de Buenos Aires (6,8%) que en el resto del territorio nacional (10,6%). Del total de individuos encuestados, el 38,3% refiere haberse automedicado durante el ASPO, de estos el 59,3% no alteró su rutina de auto-medicación, el 15% disminuyó su consumo y el 25,7% lo aumentó.El 23,9% de la muestra manifestó consumir drogas recreativas. El 47,8% de los usuarios informó haber aumentado el consumo. Asimismo, el 66,3% informó tomar alcohol regularmente, y de éstos, el 40,1% aumentó su consumo.Conclusiones: Es importante continuar la atención de las enfermedades crónicas, la salud mental y el uso de sustancias. En particular reforzando el sistema público de salud y del interior del país. (AU)

Metaanálisis de fracturas de cadera, vertebrales y de muñeca en mujeres posmenopáusicas con indicaciones preventivas o de tratamiento para osteoporosis con risedronato o raloxifeno / Meta-analysis of hip, vertebral and wrist fractures in postmenopausal women undergoing preventive therapy or treatment for osteoporosis with risedronate and raloxifene

Fundamento: Se presenta una revisión sistemática con metaanálisis de los efectos del uso de risedronato y raloxifeno en las fracturas y en la densidad mineral ósea (DMO), de cadera, vértebra y muñeca en las mujeres con osteoporosis posmenopáusica. Material y método: Se revisaron los ensayos clínicos publicados desde 1966 hasta septiembre de 2002 en MEDLINE, Cochrane Library, EMBASE, Pascal Biomed y publicaciones de la Sociedad Española de Reumatología, Sociedad Española de la Investigación Ósea y del Metabolismo Mineral y Fundación Hispana de Osteoporosis y Enfermedades Metabólicas Óseas. Resultados y discusión: Se incluyeron 8 ensayos clínicos con risedronato y 6 con raloxifeno. A las dosis recomendadas (5 mg de risedronato y 60 mg de raloxifeno) con seguimiento de 2 o más años, el riesgo relativo (RR) de fracturas de cadera fue de 0,74 (intervalo de confianza [IC] del 95 por ciento, 0,59-0,94) y 1,13 (IC del 95 por ciento, 0,66-1,96) con risedronato y raloxifeno, respectivamente; en fracturas vertebrales fue de 0,61 (IC del 95, por ciento 0,50-0,75) y 0,65 (IC del 95 por ciento, 0,53-0,79), respectivamente, y en fracturas de muñeca de 0,67 (IC del 95 por ciento, 0,42-1,07) y 0,88 (IC del 95 por ciento, 0,67-1,14), respectivamente. El incremento de la DMO para risedronato y raloxifeno vertebral fue del 4,32 por ciento (IC del 95 por ciento, 3,78-4,88) y del 2,62 por ciento (IC del 95 por ciento, 2,40-2,82); femoral del 2,77 por ciento (IC del 95 por ciento, 2,37-3,17) y 1,39 por ciento (IC del 95 por ciento, 1,03-1,75), y en el trocánter del 3,94 por ciento (IC del 95 por ciento, 3,29-4,58) y 1,72 por ciento (IC del 95 por ciento, 0,602,85), respectivamente. Risedronato disminuyó el riesgo de fractura en cadera, no así en muñeca, mientras raloxifeno no mostró un efecto reductor de fracturas ni en cadera ni en muñeca. La reducción del riesgo de fractura vertebral se produjo en ambos fármacos. En trocánter, fémur y vértebra, ambos fármacos produjeron aumentos en la DMO (AU)

Análisis farmacoeconómico del tratamiento de la osteoporosis postmenopaúsica con risedronato o alendronato / Pharmacoeconomic analysis of the treatment of postmenopausal osteoporosis with risedronate of alendronate

Se realizó un análisis coste-efectividad del tratamiento de la osteoporosis postmenopáusica con risedronato o alendronato semanal, utilizándose un modelo de Markov y costes españoles. La reducción del riesgo de sufrir fractura de cadera fue, en pacientes con o sin fractura vertebral previa, del 60 por ciento y 40 por ciento con risedronato y del 51 por ciento y 21 por ciento con alendronato. La reducción del riesgo de fractura vertebral fue, en pacientes con fractura vertebral previa del 45 por ciento y del 55 por ciento con risedronato y alendronato respectivamente. El coste por fractura de cadera evitada (en mujeres tratadas a partir de los 70 años, con o sin fractura vertebral previa, y después de 10 años de tratamiento) osciló con risedronato entre 54.134 y 84.287 euros; con alendronato los costes fueron mayores: 67.853 y 173.748 euros. El coste por año de vida ajustado por calidad (AVAC) fue, así mismo, menor con risedronato (43.601-61.064 euros) que con alendronato (49.48388.634) en pacientes con o sin fractura vertebral previa. Risedronato es más coste-efectivo que alendronato de administración semanal. (AU)

Relation between clinical and therapeutic variables and quality of life in hypertension.

OBJECTIVE: Study the relation between quality of life (QoL) and various clinical, therapeutic and sociodemographic variables in treated hypertensive patients. MATERIAL AND METHODS: A prospective study was carried out in 92 primary care centres in Spain. A total of 269 hypertensive patients were selected and 106 healthy normotensive individuals were included as controls. At the time of inclusion a wide range of clinical variables was documented. QoL was assessed at baseline and 1 month after the intensification of antihypertensive therapy, using a self-administered, specific hypertension, 56-item questionnaire in addition to the generic EuroQoL-5D. RESULTS: QoL was poorer among the hypertensive subjects than among the normotensive individuals, even adjusting for the differences observed between the groups (age, sex, education and working status). The same was found with the EuroQol-5D. In the hypertensive subjects, after applying a multiple regression equation, only four variables significantly retained their negative impact on QoL: sex (female), greater organ damage and higher heart rate and weight. After the intensification of antihypertensive therapy with irbesartan, QoL improved significantly. Neither the presence of side-effects during the month of follow-up, nor the degree of BP reduction showed a significant impact on QoL, although the latter came close to statistical significance. CONCLUSIONS: Hypertensive patients have significantly poorer QoL than normotensive subjects, even with adjustment for differences. In hypertensives, QoL is affected by some clinical variables that might help us to identify those with worse QoL. Intensification of antihypertensive therapy produced a positive impact on QoL.

Reducción del riesgo en la hipertensión arterial asociada a factores de riesgo cardiovascular. proyecto hydra

En este artículo se presenta el proyecto HYDRA que pretende evaluar y comparar el efecto que producen, sobre la reducción del riesgo cardiovascular, un betabloqueante y un antagonista AT1 en pacientes con hipertensión arterial y alto riesgo cardiovascular. La edad, el sexo, el colesterol total, el colesterol HDL, la diabetes mellitus, el tabaquismo, la hipertrofia de ventrículo izquierdo y los niveles de la presión arterial son variables que cuantifican la determinación del riesgo cardiovascular. También se estudia la evolución de la proteinuria y la presión del pulso. El estudio se realizará sobre un total de 284 individuos pertenecientes a cinco comunidades autónomas y tendrá una duración de 52 semanas (AU)

[Diet and cardiovascular risk in Spain. Description of the evolution of cardiovascular prolile]. / Dieta y riesgo cardiovascular en España (DRECE II). Descripción de la evolución del perfil cardiovascular.

BACKGROUND: To describe the evolution of cardiovascular profile in a sample of the Spanish general population. PATIENTS AND METHODS: Study cohort of 1,800 subjects from the Diet and Cardiovascular Risk in Spain study (DRECE I) with and without cardiovascular risk according to Spanish Society of Arteriosclerosis guidelines (CRSSA) followed during five years. RESULTS: Mean follow up was 4.8 years. High blood pressure (>= 140/90 mmHg), total cholesterol > 200 mg/dl, triglycerides > 150 mg/dl and HDLc < 35 mg/dl were present in a 55.6, 85.8. 42.9 and 13.4%, respectively of the individuals with CRSSA. A 31% of those without CRSSA developed hypercholesterolemia and a 11.5% hypertension. Stroke, transient isquemic attack, angor and acute myocardial infarction appeared in 4, 3, 12 and 12 cases in the group with CRSSA and 5, 0, 1 and 1 in the grup without CRSSA. The incidence of acute myocardial infarction was 3.3 and 1.2/1,000 persons-year in the groups with/without CRSSA, respectively. Triglycerides were associated to the presence of acute myocardial infarction (OR = 10.08; IC95%; 2.1-46.4). CONCLUSIONS: There is a worsening of the cardiovascular risk profile in the cohort. Individuals with CRSSA have a worse cardiovascular risk profile than those without CRSSA. The cardiovascular risk factors tend to be grouped in the same subjects.