The 2023 Latin America report of the Lancet Countdown on health and climate change: the imperative for health-centred climate-resilient development.

In 2023, a series of climatological and political events unfolded, partly driving forward the global climate and health agenda while simultaneously exposing important disparities and vulnerabilities to climate-related events. On the policy front, a significant step forward was marked by the inaugural Health Day at COP28, acknowledging the profound impacts of climate change on health. However, the first-ever Global Stocktake showed an important gap between the current progress and the targets outlined in the Paris Agreement, underscoring the urgent need for further and decisive action. From a Latin American perspective, some questions arise: How do we achieve the change that is needed? How to address the vulnerabilities to climate change in a region with long-standing social inequities? How do we promote intersectoral collaboration to face a complex problem such as climate change? The debate is still ongoing, and in many instances, it is just starting. The renamed regional centre Lancet Countdown Latin America (previously named Lancet Countdown South America) expanded its geographical scope adding Mexico and five Central American countries: Costa Rica, El Salvador, Guatemala, Honduras, and Panama, as a response to the need for stronger collaboration in a region with significant social disparities, including research capacities and funding. The centre is an independent and multidisciplinary collaboration that tracks the links between health and climate change in Latin America, following the global Lancet Countdown's methodologies and five domains. The Lancet Countdown Latin America work hinges on the commitment of 23 regional academic institutions, United Nations agencies, and 34 researchers who generously contribute their time and expertise. Building from the first report, the 2023 report of the Lancet Countdown Latin America, presents 34 indicators that track the relationship between health and climate change up to 2022, aiming at providing evidence to public decision-making with the purpose of improving the health and wellbeing of Latin American populations and reducing social inequities through climate actions focusing on health. This report shows that Latin American populations continue to observe a growing exposure to changing climatic conditions. A warming trend has been observed across all countries in Latin America, with severe direct impacts. In 2022, people were exposed to ambient temperatures, on average, 0.38 °C higher than in 1986-2005, with Paraguay experiencing the highest anomaly (+1.9 °C), followed by Argentina (+1.2 °C) and Uruguay (+0.9 °C) (indicator 1.1.1). In 2013-2022, infants were exposed to 248% more heatwave days and people over 65 years old were exposed to 271% more heatwave days than in 1986-2005 (indicator 1.1.2). Also, compared to 1991-2000, in 2013-2022, there were 256 and 189 additional annual hours per person, during which ambient heat posed at least moderate and high risk of heat stress during light outdoor physical activity in Latin America, respectively (indicator 1.1.3). Finally, the region had a 140% increase in heat-related mortality from 2000-2009 to 2013-2022 (indicator 1.1.4). Changes in ecosystems have led to an increased risk of wildfires, exposing individuals to very or extremely high fire danger for more extended periods (indicator 1.2.1). Additionally, the transmission potential for dengue by Aedes aegypti mosquitoes has risen by 54% from 1951-1960 to 2013-2022 (indicator 1.3), which aligns with the recent outbreaks and increasing dengue cases observed across Latin America in recent months. Based on the 2023 report of the Lancet Countdown Latin America, there are three key messages that Latin America needs to further explore and advance for a health-centred climate-resilient development. Latin American countries require intersectoral public policies that simultaneously increase climate resilience, reduce social inequities, improve population health, and reduce greenhouse gas (GHG) emissions. The findings show that adaptation policies in Latin America remain weak, with a pressing need for robust vulnerability and adaptation (V&A) assessments to address climate risks effectively. Unfortunately, such assessments are scarce. Up to 2021, Brazil is the only country that has completed and officially reported a V&A to the 2021 Global Survey conducted by the World Health Organization (WHO). Argentina, Guatemala, and Panama have also conducted them, but they have not been reported (indicator 2.1.1). Similarly, efforts in developing and implementing Health National Adaptation Plans (HNAPs) are varied and limited in scope. Brazil, Chile, and Uruguay are the only countries that have an HNAP (indicator 2.1.2). Moreover, self-reported city-level climate change risk assessments are very limited in the region (indicator 2.1.3). The collaboration between meteorological and health sectors remains insufficient, with only Argentina, Brazil, Colombia, and Guatemala self-reporting some level of integration (indicator 2.2.1), hindering comprehensive responses to climate-related health risks in the region. Additionally, despite the urgent need for action, there has been minimal progress in increasing urban greenspaces across the region since 2015, with only Colombia, Nicaragua, and Venezuela showing slight improvements (indicator 2.2.2). Compounding these challenges is the decrease in funding for climate change adaptation projects in Latin America, as evidenced by the 16% drop in funds allocated by the Green Climate Fund (GCF) in 2022 compared to 2021. Alarmingly, none of the funds approved in 2022 were directed toward climate change and health projects, highlighting a critical gap in addressing health-related climate risks (indicator 2.2.3). From a vulnerability perspective, the Mosquito Risk Index (MoRI) indicates an overall decrease in severe mosquito-borne disease risk in the region due to improvements in water, sanitation, and hygiene (WASH) (indicator 2.3.1). Brazil and Paraguay were the only countries that showed an increase in this indicator. It is worth noting that significant temporal variation within and between countries still persists, suggesting inadequate preparedness for climate-related changes. Overall, population health is not solely determined by the health sector, nor are climate policies a sole responsibility of the environmental sector. More and stronger intersectoral collaboration is needed to pave development pathways that consider solid adaptation to climate change, greater reductions of GHG emissions, and that increase social equity and population health. These policies involve sectors such as finance, transport, energy, housing, health, and agriculture, requiring institutional structures and policy instruments that allow long-term intersectoral collaboration. Latin American countries need to accelerate an energy transition that prioritises people's health and wellbeing, reduces energy poverty and air pollution, and maximises health and economic gains. In Latin America, there is a notable disparity in energy transition, with electricity generation from coal increasing by an average of 2.6% from 1991-2000 to 2011-2020, posing a challenge to efforts aimed at phasing out coal (indicator 3.1.1). However, this percentage increase is conservative as it may not include all the fossil fuels for thermoelectric electricity generation, especially during climate-related events and when hydropower is affected (Panel 4). Yet, renewable energy sources have been growing, increasing by an average of 5.7% during the same period. Access to clean fuels for cooking remains a concern, with 46.3% of the rural population in Central America and 23.3% in South America lacking access to clean fuels in 2022 (indicator 3.1.2). It is crucial to highlight the concerning overreliance on fossil fuels, particularly liquefied petroleum gas (LPG), as a primary cooking fuel. A significant majority of Latin American populations, approximately 74.6%, rely on LPG for cooking. Transitioning to cleaner heating and cooking alternatives could also have a health benefit by reducing household air pollution-related mortality. Fossil fuels continue to dominate road transport energy in Latin America, accounting for 96%, although some South American countries are increasing the use of biofuels (indicator 3.1.3). Premature mortality attributable to fossil-fuel-derived PM2.5 has shown varied trends across countries, increasing by 3.9% from 2005 to 2020 across Latin America, which corresponds to 123.5 premature deaths per million people (indicator 3.2.1). The Latin American countries with the highest premature mortality rate attributable to PM2.5 in 2020 were Chile, Peru, Brazil, Colombia, Mexico, and Paraguay. Of the total premature deaths attributable to PM2.5 in 2020, 19.1% was from transport, 12.3% from households, 11.6% from industry, and 11% from agriculture. From emission and capture of GHG perspective, commodity-driven deforestation and expansion of agricultural land remain major contributors to tree cover loss in the region, accounting for around 80% of the total loss (indicator 3.3). Additionally, animal-based food production in Latin America contributes 85% to agricultural CO2 equivalent emissions, with Argentina, Brazil, Panama, Paraguay, and Uruguay ranking highest in per capita emissions (indicator 3.4.1). From a health perspective, in 2020, approximately 870,000 deaths were associated with imbalanced diets, of which 155,000 (18%) were linked to high intake of red and processed meat and dairy products (indicator 3.4.2). Energy transition in Latin America is still in its infancy, and as a result, millions of people are currently exposed to dangerous levels of air pollution and energy poverty (i.e., lack of access to essential energy sources or services). As shown in this report, the levels of air pollution, outdoors and indoors, are a significant problem in the wholeregion, with marked disparities between urban and rural areas. In 2022, Peru, Chile, Mexico, Guatemala, Colombia, El Salvador, Brazil, Uruguay, Honduras, Panama, and Nicaragua were in the top 100 most polluted countries globally. Transitioning to cleaner sources of energy, phasing out fossil fuels, and promoting better energy efficiency in the industrial and housing sectors are not only climate mitigation measures but also huge health and economic opportunities for more prosperous and healthy societies. Latin American countries need to increase climate finance through permanent fiscal commitments and multilateral development banks to pave climate-resilient development pathways. Climate change poses significant economic costs, with investments in mitigation and adaptation measures progressing slowly. In 2022, economic losses due to weather-related extreme events in Latin America were US$15.6 billion -an amount mainly driven by floods and landslides in Brazil-representing 0.28% of Latin America's Gross Domestic Product (GDP) (indicator 4.1.1). In contrast to high-income countries, most of these losses lack insurance coverage, imposing a substantial financial strain on affected families and governments. Heat-related mortality among individuals aged 65 and older in Latin America reached alarming levels, with losses exceeding the equivalent of the average income of 451,000 people annually (indicator 4.1.2). Moreover, the total potential income loss due to heat-related labour capacity reduction amounted to 1.34% of regional GDP, disproportionately affecting the agriculture and construction sectors (indicator 4.1.3). Additionally, the economic toll of premature mortality from air pollution was substantial, equivalent to a significant portion of regional GDP (0.61%) (indicator 4.1.4). On a positive note, clean energy investments in the region increased in 2022, surpassing fossil fuel investments. However, in 2020, all countries reviewed continued to offer net-negative carbon prices, revealing fossil fuel subsidies totalling US$23 billion. Venezuela had the highest net subsidies relative to current health expenditure (123%), followed by Argentina (10.5%), Bolivia (10.3%), Ecuador (8.3%), and Chile (5.6%) (indicator 4.2.1). Fossil fuel-based energy is today more expensive than renewable energy. Fossil fuel burning drives climate change and damages the environment on which people depend, and air pollution derived from the burning of fossil fuels causes seven million premature deaths each year worldwide, along with a substantial burden of disease. Transitioning to sustainable, zero-emission energy sources, fostering healthier food systems, and expediting adaptation efforts promise not only environmental benefits but also significant economic gains. However, to implement mitigation and adaptation policies that also improve social wellbeing and prosperity, stronger and solid financial systems are needed. Climate finance in Latin American countries is scarce and strongly depends on political cycles, which threatens adequate responses to the current and future challenges. Progress on the climate agenda is lagging behind the urgent pace required. While engagement with the intersection of health and climate change is increasing, government involvement remains inadequate. Newspaper coverage of health and climate change has been on the rise, peaking in 2022, yet the proportion of climate change articles discussing health has declined over time (indicator 5.1). Although there has been significant growth in the number of scientific papers focusing on Latin America, it still represents less than 4% of global publications on the subject (indicator 5.3). And, while health was mentioned by most Latin American countries at the UN General Debate in 2022, only a few addressed the intersection of health and climate change, indicating a lack of awareness at the governmental level (indicator 5.4). The 2023 Lancet Countdown Latin America report underscores the cascading and compounding health impacts of anthropogenic climate change, marked by increased exposure to heatwaves, wildfires, and vector-borne diseases. Specifically, for Latin America, the report emphasises three critical messages: the urgent action to implement intersectoral public policies that enhance climate resilience across the region; the pressing need to prioritise an energy transition that focuses on health co-benefits and wellbeing, and lastly, that need for increasing climate finance by committing to sustained fiscal efforts and engaging with multilateral development banks. By understanding the problems, addressing the gaps, and taking decisive action, Latin America can navigate the challenges of climate change, fostering a more sustainable and resilient future for its population. Spanish and Portuguese translated versions of this Summary can be found in Appendix B and C, respectively. The full translated report in Spanish is available in Appendix D.

Spatio-temporal multidisciplinary analysis of socio-environmental conditions to explore the COVID-19 early evolution in urban sites in South America.

This study aimed to analyse how socio-environmental conditions affected the early evolution of COVID-19 in 14 urban sites in South America based on a spatio-temporal multidisciplinary approach. The daily incidence rate of new COVID-19 cases with symptoms as the dependent variable and meteorological-climatic data (mean, maximum, and minimum temperature, precipitation, and relative humidity) as the independent variables were analysed. The study period was from March to November of 2020. We inquired associations of these variables with COVID-19 data using Spearman's non-parametric correlation test, and a principal component analysis considering socio economic and demographic variables, new cases, and rates of COVID-19 new cases. Finally, an analysis using non-metric multidimensional scale ordering by the Bray-Curtis similarity matrix of meteorological data, socio economic and demographic variables, and COVID-19 was performed. Our findings revealed that the average, maximum, and minimum temperatures and relative humidity were significantly associated with rates of COVID-19 new cases in most of the sites, while precipitation was significantly associated only in four sites. Additionally, demographic variables such as the number of inhabitants, the percentage of the population aged 60 years and above, the masculinity index, and the GINI index showed a significant correlation with COVID-19 cases. Due to the rapid evolution of the COVID-19 pandemic, these findings provide strong evidence that biomedical, social, and physical sciences should join forces in truly multidisciplinary research that is critically needed in the current state of our region.

Mortality risk during heat waves in the summer 2013-2014 in 18 provinces of Argentina: Ecological study.

Increased frequency of heat waves (HWs) is one of the prominent consequences of climate change. Its impact on human health has been mostly reported in the northern hemisphere but has been poorly studied in the southern hemisphere. The aim of this study was to analyze the effects of the HWs waves occurred in the warm season 2013-14 on mortality in the center-north region of Argentina, where 22 million people live. It was carried out an observational study of ecological-type contrasting the mortality occurred during the HWs of the summer 2013-14 with the mortality in the summers 2010-11 to 2012-13, free from HWs. The mortality was analyzed according to the following variables: place of residence, age, sex and cause of death. During the HWs of the summer 2013-14, 1877 (RR=1.23, 95%CI 1.20-1.28) deaths in excess were registered. Moreover, the death risk significantly increased in 13 of the 18 provinces analyzed. The mortality rates by sex revealed heterogeneous behaviour regarding both the time and spatial scale. The death risk increased with age; it was particularly significant in four provinces for the 60-79 years group and in six provinces in people of 80 years and over. The death causes that showed significantly increments were respiratory, cardiovascular, renal diseases and diabetes.

Mortality risk during heat waves in the summer 2013-2014 in 18 provinces of Argentina: Ecological study / Risco de mortalidade durante ondas de calor no verão 2013-2014 em 18 províncias da Argentina: Estudo ecológico

Abstract Increased frequency of heat waves (HWs) is one of the prominent consequences of climate change. Its impact on human health has been mostly reported in the northern hemisphere but has been poorly studied in the southern hemisphere. The aim of this study was to analyze the effects of the HWs waves occurred in the warm season 2013-14 on mortality in the center-north region of Argentina, where 22 million people live. It was carried out an observational study of ecological-type contrasting the mortality occurred during the HWs of the summer 2013-14 with the mortality in the summers 2010-11 to 2012-13, free from HWs. The mortality was analyzed according to the following variables: place of residence, age, sex and cause of death. During the HWs of the summer 2013-14, 1877 (RR=1.23, 95%CI 1.20-1.28) deaths in excess were registered. Moreover, the death risk significantly increased in 13 of the 18 provinces analyzed. The mortality rates by sex revealed heterogeneous behaviour regarding both the time and spatial scale. The death risk increased with age; it was particularly significant in four provinces for the 60-79 years group and in six provinces in people of 80 years and over. The death causes that showed significantly increments were respiratory, cardiovascular, renal diseases and diabetes.

Resumo O aumento da frequência das ondas de calor (OsC) é uma das consequências proeminentes das alterações climáticas. O seu impacto na saúde humana tem sido relatado principalmente no hemisfério norte, mas tem sido mal estudado no hemisfério sul. O objetivo deste estudo foi analisar os efeitos das OsC ocorridas no verão de 2013-14 sobre a mortalidade na região centro-norte da Argentina, onde 22 milhões de pessoas vivem. Foi realizado um estudo observacional de tipo ecológico que contrasta a mortalidade ocorrida durante as OsC do verão 2013-14 com a mortalidade nos verões 2010-11 a 2012-13. A mortalidade foi analisada de acordo com local de residência, idade, sexo e causa de morte. Durante as OsC do verão de 2013-14, registaram-se 1.877 (RR=1.23, 95%IC 1.20-1.28) mortes em excesso. O risco de morte (RM) aumentou significativamente em 13 das 18 províncias analisadas. As taxas de mortalidade por sexo revelaram um comportamento heterogêneo tanto no tempo como na escala espacial. O RM foi aumentado com a idade; este aumento foi particularmente significativo em quatro províncias para o grupo de 60-79 anos e em seis províncias em pessoas com mais de 80 anos. As causas de morte que mostraram significativamente incrementos foram: doenças respiratórias, cardiovasculares, renais e diabetes.

Política de salud en la agenda climática Argentina / Health policy in the Argentine climate agenda

INTRODUCCIÓN: El cambio climático es un determinante estructural de la salud y una amenaza para la salud pública global. Por ello, la Asamblea Mundial de la Salud de 2008 llamó a elaborar planes de acción para minimizar los impactos sanitarios del cambio climático. El objetivo de este trabajo fue sistematizar el proceso de desarrollo de una política sanitaria en la materia, que se plasma en el Plan de Acción Nacional en Salud y Cambio Climático. MÉTODOS: Para el diseño de la política de salud y cambio climático se conformó una Mesa de Trabajo al interior del Ministerio de Salud de la Nación, integrada por diferentes áreas con competencias en la temática. Esta mesa fue la responsable de llevar a cabo un diagnóstico de situación para la priorización de los temas a incluir en un plan de acción que puesto a consideración de otras áreas del Estado Nacional a través del Grupo de Trabajo de Salud al interior del Gabinete Nacional de Cambio Climático y de la sociedad civil. RESULTADOS: La política sanitaria en materia de cambio climático cuenta con tres instrumentos: un programa nacional, una mesa de trabajo y un plan de acción. El plan está organizado en 7 ejes de intervención y 21 medidas. DISCUSIÓN: El Ministerio de Salud ha trabajado en Salud y Cambio Climático desde 2008, pero fue a partir de la conformación de la Mesa de Trabajo que se logró la transversalización de la temática.

Accesibilidad a los servicios de salud en Concepción del Uruguay. Perfil socioeconómico de los usuarios / Accessibility to health services in Concepción del Uruguay. A users' socioeconomic profile

RESUMEN Objetivos Describir la accesibilidad a los servicios públicos de salud en la ciudad de Concepción del Uruguay, Provincia de Entre Ríos, y analizar la asociación existente entre las condiciones socioeconómicas de los usuarios y los servicios de salud elegidos para la atención habitual. Materiales y Métodos Estudio observacional de corte transversal, con datos obtenidos de fuentes primarias a partir de la aplicación de una encuesta diseñada ad hoc a partir de un muestreo probabilístico de dos etapas. Los datos fueron analizados a través de la confección de tablas de contingencia. La asociación entre las variables se midió a partir de pruebas de Chi2 y del análisis de correspondencias. Resultados Evidencia de asociación significativa entre el tipo de servicio de salud al que acude la población y el máximo nivel de instrucción alcanzado para α=0,05 (p<0,01). Existe una correspondencia entre las categorías "secundario incompleto" y "primaria completa" y la elección de los servicios de salud públicos, con una mayor fuerza para el caso del hospital provincial y los referentes de salud del hogar con secundario incompleto. También se halló una fuerte evidencia respecto a la asociación entre la condición de ocupación referida por los referentes de salud de los hogares y el servicio de atención elegido por estos, para α=0,05 (p<0,01). Conclusión Se observa una brecha en la accesibilidad en la que, a medida que mejora la posición social de los usuarios, disminuye la elección de la atención primaria y aumenta la elección de servicios privados.

ABSTRACT Objective Describe accessibility to public health services in the city of Concepción del Uruguay, Entre Ríos, and analyze the association between socioeconomic conditions of users and the health services chosen for routine care. Materials and Methods Observational cross-sectional study, with data obtained from primary sources from the application of a survey designed ad hoc from a two-stage probabilistic sampling. The data was analyzed through the preparation of contingency tables. The association between variables was measured using Chi2 tests and correspondence analysis. Results Evidence of a significant association between the type of health service the population attends and the highest level of education attained for α=0,05 (p<0,01). There is a correspondence between the categories "Incomplete Secondary" and "Complete Primary" and the choice of public Health Services, with greater force in the case of the Provincial Hospital and the Home health Referents with "Incomplete Secondary". Strong evidence was also found regarding the association between the occupation condition reported by the household health referents and the care service chosen by these households, for α=0,05 (p<0,01). Conclusion There is a gap in accessibility, where as the social position of users improves, the choice of primary care decreases and the choice of private services increases.

Condiciones de trabajo y de salud de las personas recuperadoras de residuos del Ecoparque Gualeguaychú / Working and health conditions of the people who recover waste from the Gualeguaychú Ecopark

INTRODUCCIÓN La gestión de los residuos es uno de los principales problemas de salud ambiental local. Las personas recuperadoras de residuos son un actor clave, aunque poco se conoce de sus condiciones de salud. OBJETIVOS El objetivo fue describir las condiciones de trabajo y de salud autopercibida por las personas recuperadoras de residuos del Ecoparque Gualeguaychú. METODOLOGÍA Se realizó un estudio descriptivo observacional de corte transversal. Para relevar las condiciones ambientales se aplicó una lista de verificación y se realizaron 48 encuestas de autopercepción a las personas recuperadoras, sobre condiciones de trabajo y proceso de salud - enfermedad ­ atención. Se efectuó un análisis de frecuencia general de las variables y estratificadas por género y grupos de edad. RESULTADOS El 85% de los recuperadores dijo estar conforme o muy conforme con su trabajo y en las mujeres asciende al 100%. Entre los factores de riesgo autopercibidos se destacan; contacto con pañales desechables, papel higiénico, toallas higiénicas, gasas y algodones (90%); contacto con agujas, metales y vidrios (>90%); exposición a calor o frío extremo (90%); movimientos repetitivos (88%); ruidos molestos (73%) y levantar cargas pesadas (58%) valor que asciende 77% en los varones. En relación a las medidas de protección 94% señalo usarlas de manera permanente y 73% que los elementos son provistos por la Cooperativa. Los principales problemas de salud referidos fueron; osteomusculares (58%), neurológicos (42%), oculares (27%), dérmicos (23%), respiratorios (21%) y digestivos (17%). 75% de las personas recuperadoras solo tiene cobertura del sistema público de salud y el 90% concurre a un efector público cuando tiene un problema; las mujeres con más frecuencia a un centro de atención primaria y los hombres al hospital. DISCUSIÓN La organización de las personas recuperadas en una Cooperativa permite generar ciertos estándares mínimos en las condiciones de trabajo.

Mortalidad Asociada a Eventos Extremis de Frio en Argentina, 2005-2015 / Mortality Associated to Extreme Cold Events in Argentina, 2005-2015

La mortalidad guarda relación con las temperaturas diarias y los eventos extremos. Este estudio buscó analizar los efectos de las bajas temperaturas sobre la mortalidad en las principales ciudades de Argentina en el período 2005-2015. MÉTODOS: Se realizó un estudio de series temporales con modelos aditivos generalizados, modelando la relación entre bajas temperaturas y mortalidad para 21 ciudades de Argentina entre 2005 y 2015. Se analizó la mortalidad general y por grupos de sexo, edad y causa de muerte, en días fríos y días de olas de frío, así como los rezagos de 7 y 14 días posteriores a dichos eventos. RESULTADOS: En los 7 días posteriores a un día frío, el riesgo de muerte aumenta en la mitad de las ciudades entre un 1,04 [IC95%: 1,00-1,08] y un 1,14 [IC95%: 1,06-1,23] según la ciudad. El grupo de 65 años y más es el que muestra mayor impacto, con un incremento de hasta el 1,20 [IC95%: 1,05-1,39]. Las olas de frío se asocian con un aumento más pronunciado en el riesgo de morir en los siguientes 7 días en 8 ciudades (1,05 [IC95%: 1,03-1,08] a 1,30 [IC95%: 1,03-1,65]), y en 10 ciudades en los siguientes 14 días, aunque con valores algo más bajos. CONCLUSIONES: Con diferencias en magnitud y robustez estadística según las ciudades, la población de las áreas urbanas presenta un riesgo aumentado de muerte durante los 7 y 14 días posteriores a un evento de frío extremo

[Mortality from heat waves in the city of Buenos Aires, Argentina (2005-2015)]. / Mortalidad por olas de calor en la ciudad de Buenos Aires, Argentina (2005-2015).

This study aimed to analyze mortality during heat waves in the city of Buenos Aires, Argentina, in 2005-2015. We used a time series design with generalized additive models, linking mortality to days of heat waves throughout the period, and to days of the heat wave in 2013, the longest wave since 1906, controlling for time variables, mean temperature, and humidity. Risk of death from natural causes increased by 14% (RR = 1.140; 95%CI: 1.108-1.173) during heat waves when compared to the other days in the hot season. The increase occurred in both sexes and in all age groups, and individuals under 15 years of age were more affected (RR = 1.167; 95%CI: 1.019-1.335) as were those over 84 years (RR = 1.201; 95%CI: 1.098-1.313). The heat wave in December 2013 showed an increase of 43% (RR = 1.428; 95%CI: 1.399-1.457) in total daily deaths, increasing to 51% in individuals over 84 years (RR = 1.515; 95%CI: 1.372-1.674) and 65% (RR = 1.647; 95%CI: 1.367-1.986) for renal causes. We conclude that heat waves pose a significant risk of death, differing according to sex and age in the population of Buenos Aires.

El objetivo de este trabajo es analizar la mortalidad durante las olas de calor en la ciudad de Buenos Aires, Argentina, para el período 2005-2015. Utilizamos un diseño de series temporales con modelos aditivos generalizados, vinculando mortalidad con días de ola de calor en todo el período, y con días de la ola de calor de 2013, la más prolongada desde el año 1906, controlando por variables temporales, temperatura media y humedad. Encontramos que el riesgo de muerte por causas naturales se incrementa en un 14% (RR = 1,140; IC95%: 1,108-1,173) durante las olas de calor, respecto al resto de los días del semestre cálido. El incremento se da en ambos sexos y en todos los grupos de edad, siendo más afectados los menores de 15 (RR = 1,167; IC95%: 1,019-1,335) y los mayores de 84 años (RR = 1,201; IC95%: 1,098-1,313). En la ola de calor de diciembre de 2013 aumentaron 43% (RR = 1,428; IC95%: 1,399-1,457) las muertes diarias totales, valor que sube al 51% para el grupo de mayores de 84 años (RR = 1,515; IC95%: 1,372-1,674) y al 65% (RR = 1,647; IC95%: 1,367-1,986) para las causas renales. Concluimos que las olas de calor constituyen un factor significativo de riesgo de muerte, diferente según sexo y edad, para la población de la ciudad de Buenos Aires.

O objetivo deste trabalho é analisar a mortalidade durante as ondas de calor na cidade de Buenos Aires, Argentina, no período de 2005-2015. Foi usado um desenho de séries temporais com modelos aditivos generalizados, vinculando a mortalidade com dias de onda de calor em todo o período, e com dias da onda de calor em 2013, a mais prolongada desde o ano de 1906, controlando através de variáveis temporais, temperatura media e umidade. Encontramos que o risco de morte por causas naturais teve um incremento de 14% (RR = 1,140; IC95%: 1,108-1,173) durante as ondas de calor, ao respeito do resto dos dias do semestre cálido. O incremento se produz em ambos os sexos e em todos os grupos de idade, sendo mais afetados os menores de 15 (RR = 1,167; IC95%: 1,019-1,335) e os maiores de 84 anos (RR = 1,201; IC95%: 1,098-1,313). Na onda de calor que ocorreu em dezembro de 2013 aumentaram um 43% (RR = 1,428; IC95%: 1,399-1,457) as mortes diárias totais, valor que sobe a 51% para o grupo de pessoas maiores de 84 anos (RR = 1,515; IC95%: 1,372-1,674) e a 65% (RR = 1,647; IC95%: 1,367-1,986) para as causas renais, Concluímos que as ondas de calor constituem um fator significativo de risco de morte, diferente segundo o sexo e idade, para a população da cidade de Buenos Aires.

Mortalidad por olas de calor en la ciudad de Buenos Aires, Argentina (2005-2015) / Mortality from heat waves in the city of Buenos Aires, Argentina (2005-2015) / Mortalidade por ondas de calor na cidade de Buenos Aires, Argentina (2005-2015)

Resumen: El objetivo de este trabajo es analizar la mortalidad durante las olas de calor en la ciudad de Buenos Aires, Argentina, para el período 2005-2015. Utilizamos un diseño de series temporales con modelos aditivos generalizados, vinculando mortalidad con días de ola de calor en todo el período, y con días de la ola de calor de 2013, la más prolongada desde el año 1906, controlando por variables temporales, temperatura media y humedad. Encontramos que el riesgo de muerte por causas naturales se incrementa en un 14% (RR = 1,140; IC95%: 1,108-1,173) durante las olas de calor, respecto al resto de los días del semestre cálido. El incremento se da en ambos sexos y en todos los grupos de edad, siendo más afectados los menores de 15 (RR = 1,167; IC95%: 1,019-1,335) y los mayores de 84 años (RR = 1,201; IC95%: 1,098-1,313). En la ola de calor de diciembre de 2013 aumentaron 43% (RR = 1,428; IC95%: 1,399-1,457) las muertes diarias totales, valor que sube al 51% para el grupo de mayores de 84 años (RR = 1,515; IC95%: 1,372-1,674) y al 65% (RR = 1,647; IC95%: 1,367-1,986) para las causas renales. Concluimos que las olas de calor constituyen un factor significativo de riesgo de muerte, diferente según sexo y edad, para la población de la ciudad de Buenos Aires.

Abstract: This study aimed to analyze mortality during heat waves in the city of Buenos Aires, Argentina, in 2005-2015. We used a time series design with generalized additive models, linking mortality to days of heat waves throughout the period, and to days of the heat wave in 2013, the longest wave since 1906, controlling for time variables, mean temperature, and humidity. Risk of death from natural causes increased by 14% (RR = 1.140; 95%CI: 1.108-1.173) during heat waves when compared to the other days in the hot season. The increase occurred in both sexes and in all age groups, and individuals under 15 years of age were more affected (RR = 1.167; 95%CI: 1.019-1.335) as were those over 84 years (RR = 1.201; 95%CI: 1.098-1.313). The heat wave in December 2013 showed an increase of 43% (RR = 1.428; 95%CI: 1.399-1.457) in total daily deaths, increasing to 51% in individuals over 84 years (RR = 1.515; 95%CI: 1.372-1.674) and 65% (RR = 1.647; 95%CI: 1.367-1.986) for renal causes. We conclude that heat waves pose a significant risk of death, differing according to sex and age in the population of Buenos Aires.

Resumo: O objetivo deste trabalho é analisar a mortalidade durante as ondas de calor na cidade de Buenos Aires, Argentina, no período de 2005-2015. Foi usado um desenho de séries temporais com modelos aditivos generalizados, vinculando a mortalidade com dias de onda de calor em todo o período, e com dias da onda de calor em 2013, a mais prolongada desde o ano de 1906, controlando através de variáveis temporais, temperatura media e umidade. Encontramos que o risco de morte por causas naturais teve um incremento de 14% (RR = 1,140; IC95%: 1,108-1,173) durante as ondas de calor, ao respeito do resto dos dias do semestre cálido. O incremento se produz em ambos os sexos e em todos os grupos de idade, sendo mais afetados os menores de 15 (RR = 1,167; IC95%: 1,019-1,335) e os maiores de 84 anos (RR = 1,201; IC95%: 1,098-1,313). Na onda de calor que ocorreu em dezembro de 2013 aumentaram um 43% (RR = 1,428; IC95%: 1,399-1,457) as mortes diárias totais, valor que sobe a 51% para o grupo de pessoas maiores de 84 anos (RR = 1,515; IC95%: 1,372-1,674) e a 65% (RR = 1,647; IC95%: 1,367-1,986) para as causas renais, Concluímos que as ondas de calor constituem um fator significativo de risco de morte, diferente segundo o sexo e idade, para a população da cidade de Buenos Aires.

Mortalidad asociada a bajas temperaturas en la República Argentina (2005-2015) / Mortality associated with low temperatures in the República Argentina (2005-2015)

INTRODUCCIÓN Diversos estudios muestran el vínculo entre las temperaturas diarias y eventos extremos sobre la morbilidad y mortalidad humana. El impacto de las temperaturas altas ha sido más estudiado que el de eventos fríos y bajas temperaturas. OBJETIVO analizar y caracterizar los efectos de las bajas temperaturas sobre la mortalidad en las principales áreas urbanas de la República Argentina en el período 2005-2015. MÉTODOS Se realizó un estudio de series temporales con Modelos Aditivos Generalizados modelando la relación entre temperaturas extremas y mortalidad para 21 ciudades de Argentina en el período 2005-2015. Se analizó la mortalidad total y por grupos de sexo, edad y causa de muerte, y se consideraron las temperaturas diarias y la presencia de eventos de temperatura extrema;día frío y ola de frío. Para evaluar los efectos diferidos se analizaron rezagos de 7 y 14 días posteriores al evento. RESULTADOS El estudio mostró una asociación entre los eventos de temperatura extrema y la mortalidad en algunas de las ciudades analizadas, impacto que se verifica durante los siete y catorce días posteriores al evento. En los siete días posteriores a un día frío el riesgo de muerte aumenta en la mitad de las ciudades analizadas, entre un 4,1% [IC95%; 0-8,4] y un 13,9% [IC 95%; 5,8-22,6] según la ciudad. El grupo de 65 años y más fue el que mostró el mayor impacto, con un incremento de entre 4,5% [IC95%; 0-9,4] al 19,7% [IC95%; 9,5-31]. Las olas de frío se asocian con un aumento en el riesgo en los siete días posteriores en ocho ciudades, pero el efecto es más pronunciado, con valores entre 5,5% [CI95% 2,8-8,2] en CABA y 30,3 [CI95% 3,1- 64,6] en Santa Rosa. Los valores del riesgo se modifican con el aumento del rezago considerado, persistiendo hasta 14 días en la mayoría de las ciudades estudiadas. DISCUSIÓN Con diferencias en magnitud y robustez estadística según las ciudades, la población de las áreas urbanas analizadas presenta un riesgo aumentado de muerte durante los 7 y 14 días posteriores a un evento de frío extremo

Análisis de las normativas de residuos biopatogenicos en la Republica Argentina / Analysis of biopathogenic waste regulations in the Argentine Republic

Esta publicación tiene como objetivo analizar la situación de la normativa relacionada con la gestión interna de los residuos biopatogénicos en los establecimientos de atención de la salud. Se realizó una revisión comparativa de las leyes provinciales y de sus decretos reglamentarios a fin de identificar los criterios empleados como base para proponer una adecuación de la normativa nacional con un criterio integrador. La descripción de situaciones particulares obedece a la necesidad de poner de manifiesto las diversidades y coincidencias o los hallazgos en algunas jurisdicciones que son interesantes de replicar en otras o que por el contrario ameritan una revisión local en el contexto del avance del conocimiento y de la disponibilidad de tecnologías. La omisión de una jurisdicción en una descripción no implica necesariamente la ausencia de ese tema su marco legislativo.

Mortalidad por olas de calor en la República Argentina (verano 2013-2014) / Mortality due to heat waves in the Argentine Republic (summer 2013-2014)

INTRODUCCIÓN Las olas de calor son un período prolongado inusualmente caluroso, con apreciable impacto en la salud. Durante éstas se presentan incrementos en la mortalidad. En Argentina se ha observado un incremento en la frecuencia de las olas de calor en el período 1960-2010. OBJETIVO analizar y caracterizar los efectos de las olas de calor del semestre cálido (octubre a marzo) 2013-2014 sobre la mortalidad en la región centro-norte de la Argentina. MÉTODOS se realizó un estudio observacional de tipo ecológico comparando la mortalidad ocurrida durante las olas de calor del semestre cálido de 2013-2014 con el promedio de la mortalidad del mismo período de los años comprendidos entre 2010-2011 y 2012-2013. La mortalidad durante las olas de calor fue analizada por grupos de edad, sexo, causa de muerte y jurisdicción. RESULTADOS Durante las olas de calor del verano 2013-2014 se registraron 1877 defunciones en exceso, asimismo se observó que el riesgo de morir se incrementó significativamente en 13 de las 19 jurisdicciones analizadas. Entre Ríos fue la jurisdicción con mayor tasa de mortalidad general ajustada por edad (36,7 cada 100.000 habitantes) y con mayor duración de la ola de calor (16 días). La mortalidad por sexo mostró heterogeneidad en la escala temporal y espacial, en diciembre el comportamiento fue similar para ambos sexos (6 jurisdicciones con RR>1 en mujeres y 5 con RR>1 en varones), mientras que en enero y febrero el riesgo fue mayor para los varones. El riesgo de morir se incrementó con la edad, éste fue significativo en cuatro jurisdicciones para el grupo de 60-79 años y en seis jurisdicciones en mayores de 80 años. Las causas de defunción con riesgo significativamente incrementado fueron; las enfermedades respiratorias, cardiovasculares, cerebrovasculares, insuficiencia renal y diabetes. DISCUSIÓN La mortalidad durante las olas de calor del verano 2013-2014 mostró incrementos en tasas generales y específicas por edad, sexo y causa de defunción

Normativas para la gestión de residuos biopatogénicos en Argentina / Regulations on bio-pathogenic waste management in Argentina

INTRODUCCIÓN: la gestión de los residuos de establecimientos de atención de la salud plantea variados problemas técnicos y es influida por las circunstancias culturales, sociales yeconómicas. En Argentina, la operación está inmersa en un complejo escenario legal donde coexisten 18 marcos legislativos diferentes para residuos biopatogénicos. OBJETIVOS: Proveer las herramientas para la construcción colectiva y federal de presupuestos mínimos en la materia. MÉTODOS: Se realizó una revisión comparativa de las leyes provinciales y sus decretos reglamentarios, cotejándolas con la ley nacional para cada aspecto y siguiendo las sucesivas etapas de la gestión interna de los residuos generados en establecimientos de atención de la salud. RESULTADOS: Se relevaron 67 normas: 5 nacionales, 40 leyes provinciales y 22 decretos provinciales. En la mayoría de los ítems comparados se observó una gran diversidad de criterios y diferente nivel de profundización. CONCLUSIONES: Argentina necesita poner en agenda la actualización de las normativas de residuos de establecimientos de atención de la salud con un enfoque inclusivo de la salud ambiental y laboral, para construir presupuestos mínimos en la temática de manera colectiva y federal.

INTRODUCTION: health care waste management poses various technical problems and is influenced by cultural,social and economic contexts. In Argentina, this takes place in a complex legal scenario with the coexistence of 18 different legalframeworks for bio-pathogenic waste. OBJECTIVES: To provide the tools for the collective federal construction of mínimum agreements in this field. METHODS: A comparative review wasperformed on provincial laws and their regulatory decrees. It involved a comparison with the national law for every aspect, following the successive stages of internal health care wastemanagement. RESULTS: The review included 67 legal dispositions: 5 at national level, 40 provincial laws and 22 provincial decrees. Most of the items showed a great diversity of criteria and different depth level. CONCLUSIONS: Argentina needs toupdate the regulations on health care waste management with an inclusive approach to environmental and occupational health, in order to develop the collective federal construction of minimum agreements.