Consultorio de Salud Ambiental en un Hospital Privado de Comunidad de la Ciudad de Buenos Aires / Environmental Health consulting office in a Private Community Hospital of the Buenos Aires City

En los últimos años surge el concepto de Una Sola Salud que reconoce la interdependencia sistémica al observar que los cambios en la salud humana se expresan de manera sincrónica e indivisible de la salud del ambiente. Nuevas enfermedades y daños crónicos inespecíficos ocurren a la par de la pérdida de biodiversidad y vitalidad. En las últimas décadas venimos observando el surgimiento de "adaptaciones sistémicas" que requieren un abordaje desde la clínica y la toxicología a nivel individual y desde la epidemiología de la complejidad a nivel poblacional. Luego de un largo recorrido de investigaciones, el Hospital Italiano formalizó el consultorio de Salud Ambiental con la intención de brindar respuesta a la demanda de pacientes que atribuyen síntomas y signos a la polución ambiental. (AU)

In recent years, the concept of One Health has emerged, recognizing the systemic interdependence and the changes in human health that are expressed synchronously and indivisible from the environment. New diseases and nonspecific chronic damage are occuring in parallel with the loss of biodiversity and vitality.In recent decades we have observed the appearance of "systemic adaptations" that require a clinical and toxicological approach at the individual level, and address the population level from an epidemiological and complexity science paradigm. After many years of research, the Hospital Italiano de Buenos Aires formalized the Environmental Health consulting office and the measurement of glyphosate levels, giving answer to the demand of patients who associate their signs and symptoms to environmental pollution. (AU)

[Parental risk perception of 0-3-year-old children exposure to household pesticides]. / Percepción del riesgo de toxicidad por exposición a plaguicidas domésticos en hogares con niños de 0 a 3 años.

The objective of this work was to know the practices and risk perception of household pesticides (HPs) of mothers and fathers of children in early developmental stages. SUBJECTS AND METHOD: Quali tative research carried out in 2015. We conducted interviews in 18 homes with mothers and fathers of children aged 0 to 3 years registered in the General Health Insurance Plan of the Hospital Italiano de Buenos Aires (Metropolitan Area of Buenos Aires). The analytical categories were identified, interpre tive analytical categories of higher-level abstraction were conceptualized, and finally, diagrams were constructed to represent and organize the findings. RESULTS: The interviews showed that mothers and fathers: 1) used HPs regularly, 2) showed low concern for the health hazards of HPs and other hou sehold chemicals, except for a small, more sensitized group of parents, 3) they were more concerned regarding mosquito bites than exposure of their children to HPs, 4) relied on fumigation services and the normative framework that regulates them, and 5) expressed interest and willingness to receive more information and orientation from the pediatrician about the safe use of chemical products at home. Other analytical categories showed a constant parental adjustment between toxicity, patho genicity, hygiene, and well-being. CONCLUSIONS: Since home exposures levels to HPs considered safe for adults may be toxicologically relevant for young children, government and health agencies should provide parents with tools to decode HPs marketing and publicity messages, as well as to conceptua lize the relationship between HPs use and childhood health disorders.

Enfoque de género en las residencias médicas de un hospital universitario / Gender approach in medical residences of a university hospital

Se observa un proceso de feminización de la profesión médica, sin embargo, el acceso masivo de las mujeres se asocia a nuevas desigualdades de género, denominadas segregación horizontal y vertical. La segregación horizontal se manifiesta en la desigual distribución de hombres y mujeres en ciertas especialidades médicas y la segregación vertical, en la escasa representación de las mujeres en la mayoría de los altos cargos profesionales. El objetivo de este estudio fue determinar cómo se distribuyen hombres y mujeres en las distintas instancias del proceso que implica el ingreso al sistema de residencias médicas de un hospital universitario de Buenos Aires, Argentina y analizar la segregación horizontal y vertical de género en el proceso de ingreso a las residencias médicas. A partir de datos de postulantes a un hospital universitario, en el período 2015-2017, se realizó un análisis de regresión logística múltiple para ajustar el odds ratio de ser hombre o mujer con potenciales confundidores. No se observó asociación entre ser hombre o mujer y la realización del examen, su aprobación y el ingreso a entrevista. El odds ratio ajustado para el ingreso a la residencia de los hombres con respecto a las mujeres fue 2.03 (1.44-2.85). Para las residencias quirúrgicas fue 2.75 (1.54-4.92) y para las clínicas fue 1.89 (1.17-3.00). En la inscripción, las mujeres optaron mayormente por residencias clínicas, y los hombres por quirúrgicas. Se observó segregación horizontal y vertical en el proceso de ingreso a la residencia. Visibilizar la segregación de género permitirá generar una sociedad equitativa.

A process of feminization of the medical profession is observed, however, the massive access of women is associated with new gender inequalities named horizontal and vertical segregation. Horizontal segregation manifests itself in the unequal distribution of men and women in certain medical specialties and vertical segregation, in the limited representation of women in most high professional positions. The objective of this study was to determine how men and women are distributed in the different stages of the process that involves entering the medical residency system of an universitary hospital from Buenos Aires, Argentina, and to analyze the horizontal and vertical segregation of gender in the process of admission to medical residencies. Based on data from applicants to an universitary hospital, in the 2015-2017 period, a multiple logistic regression analysis was conducted to adjust the odds ratio of being male or female with potential confounders. There was no association between being man or woman and the performance of the exam, its approval and the admission to the interview. The adjusted odds ratio for the admission to the residency of men with respect to women was 2.03 (1.44-2.85). For the surgical residencies it was 2.75 (1.54-4.92) and for clinical it was 1.89 (1.17-3.00). In the inscription, women opted mainly for clinical residencies, and men for surgical purposes. Horizontal and vertical segregation was observed in the process of the residency. Making gender segregation visible will allow generating an equitable society.

[Gender approach in medical residences of a university hospital]. / Enfoque de género en las residencias médicas de un hospital universitario.

A process of feminization of the medical profession is observed, however, the massive access of women is associated with new gender inequalities named horizontal and vertical segregation. Horizontal segregation manifests itself in the unequal distribution of men and women in certain medical specialties and vertical segregation, in the limited representation of women in most high professional positions. The objective of this study was to determine how men and women are distributed in the different stages of the process that involves entering the medical residency system of an universitary hospital from Buenos Aires, Argentina, and to analyze the horizontal and vertical segregation of gender in the process of admission to medical residencies. Based on data from applicants to an universitary hospital, in the 2015-2017 period, a multiple logistic regression analysis was conducted to adjust the odds ratio of being male or female with potential confounders. There was no association between being man or woman and the performance of the exam, its approval and the admission to the interview. The adjusted odds ratio for the admission to the residency of men with respect to women was 2.03 (1.44-2.85). For the surgical residencies it was 2.75 (1.54-4.92) and for clinical it was 1.89 (1.17-3.00). In the inscription, women opted mainly for clinical residencies, and men for surgical purposes. Horizontal and vertical segregation was observed in the process of the residency. Making gender segregation visible will allow generating an equitable society.

Se observa un proceso de feminización de la profesión médica, sin embargo, el acceso masivo de las mujeres se asocia a nuevas desigualdades de género, denominadas segregación horizontal y vertical. La segregación horizontal se manifiesta en la desigual distribución de hombres y mujeres en ciertas especialidades médicas y la segregación vertical, en la escasa representación de las mujeres en la mayoría de los altos cargos profesionales. El objetivo de este estudio fue determinar cómo se distribuyen hombres y mujeres en las distintas instancias del proceso que implica el ingreso al sistema de residencias médicas de un hospital universitario de Buenos Aires, Argentina y analizar la segregación horizontal y vertical de género en el proceso de ingreso a las residencias médicas. A partir de datos de postulantes a un hospital universitario, en el período 2015-2017, se realizó un análisis de regresión logística múltiple para ajustar el odds ratio de ser hombre o mujer con potenciales confundidores. No se observó asociación entre ser hombre o mujer y la realización del examen, su aprobación y el ingreso a entrevista. El odds ratio ajustado para el ingreso a la residencia de los hombres con respecto a las mujeres fue 2.03 (1.44-2.85). Para las residencias quirúrgicas fue 2.75 (1.54-4.92) y para las clínicas fue 1.89 (1.17-3.00). En la inscripción, las mujeres optaron mayormente por residencias clínicas, y los hombres por quirúrgicas. Se observó segregación horizontal y vertical en el proceso de ingreso a la residencia. Visibilizar la segregación de género permitirá generar una sociedad equitativa.

Representation of People's Decisions in Health Information Systems.* A Complementary Approach for Understanding Health Care Systems and Population Health.

OBJECTIVES: In this study, we aimed: 1) to conceptualize the theoretical challenges facing health information systems (HIS) to represent patients' decisions about health and medical treatments in everyday life; 2) to suggest approaches for modeling these processes. METHODS: The conceptualization of the theoretical and methodological challenges was discussed in 2015 during a series of interdisciplinary meetings attended by health informatics staff, epidemiologists and health professionals working in quality management and primary and secondary prevention of chronic diseases of the Hospital Italiano de Buenos Aires, together with sociologists, anthropologists and e-health stakeholders. RESULTS: HIS are facing the need and challenge to represent social human processes based on constructivist and complexity theories, which are the current frameworks of human sciences for understanding human learning and socio-cultural changes. Computer systems based on these theories can model processes of social construction of concrete and subjective entities and the interrelationships between them. These theories could be implemented, among other ways, through the mapping of health assets, analysis of social impact through community trials and modeling of complexity with system simulation tools. CONCLUSIONS: This analysis suggested the need to complement the traditional linear causal explanations of disease onset (and treatments) that are the bases for models of analysis of HIS with constructivist and complexity frameworks. Both may enlighten the complex interrelationships among patients, health services and the health system. The aim of this strategy is to clarify people's decision making processes to improve the efficiency, quality and equity of the health services and the health system.

[Clinical research in internal medicine residencies in Argentina. Supporters and detractors]. / La investigación clínica en residencias de medicina interna de la Argentina. Facilitadores y barreras.

Several academic and government organizations have strongly recommended the inclusion of specific competences in clinical research. So far, the current state of research within this framework has not been modified in our country. The main goal of this study was to provide a thorough description of the research activities in medical residencies, which could be used as an indicator of the acquisition of such competences and to identify the supporters and detractors to achieve them. A cross section study was carried out and several levels were analyzed in order to consider residencies as a cluster; 382 residents from 24 different residencies were included. the study showed a preponderance of women. the average age was 29 years old. A 71% of the residents asserted doing research. Half of those residents have stated being authors of papers presented in congresses; only 9% have published their experience. Factors which predict the development of research assignments were: to belong to a large residency, oR 16.99 (IC 95%, 2.096-137.87), being in the 3rd year of the residency, oR 9.95 (IC 95%, 2.84-34.82), completion of a research course, oR 2.78 (IC 95%, 1.10-7.04). Variables which reduce the chance to do research: location in Buenos Aires, oR 0.25 (IC 95%, 0.0072-0.91), being a woman, oR 0.34 (IC 95%, 0.14-0.79) and patients assistance workload, OR 0.97 (IC 95%, 0.95-0.99). We believe that the identification of factors which influence the possibility of doing research will lead to a improvement in the training of medical residents.

La investigación clínica en residencias de medicina interna de la Argentina: Facilitadores y barreras / Clinical research in internal medicine residencies in Argentina: Supporters and detractors

En el proceso de formación de los residentes de medicina interna, distintas organizaciones académicas y gubernamentales han recomendado incluir competencias específicas en investigación clínica. El estado actual de la investigación en este contexto no ha sido todavía relevado en nuestro país. El objetivo de este trabajo fue describir las actividades de investigación en las residencias de medicina interna como indicador de la adquisición de dichas competencias e identificar los facilitadores y barreras para la misma. Se realizó un estudio de corte transversal, se analizaron múltiples niveles para considerar las residencias como conglomerados. Se incluyeron 382 residentes de 24 residencias. Predominaron las mujeres, la mediana de edad fue 29 años. El 71% de los residentes informaron actividades de investigación. La mitad de ellos habían participado como autores de trabajos en congresos, solo el 9% había publicado su experiencia. Los factores predictores de desarrollar tareas de investigación fueron pertenecer a una residencia numerosa, OR 16.99 (IC 95%, 2.096-137.87), pertenecer al tercer año de residencia, OR 9.95 (IC 95%, 2.84-34.82), y haber realizado un curso de investigación, OR 2.78 (IC 95%, 1.10-7.04). Las variables que disminuyen la probabilidad de realizar investigación fueron la localización en el Gran Buenos Aires o Capital Federal, OR 0.25 (IC 95%, 0.0072-0.91), ser mujer, OR 0.34 (IC 95 0.14-0.79) y la carga asistencial, OR 0.97 (IC 95%, 0.95-0.99). Conocer los factores que influyen en la investigación contribuye a mejorar la formación de los residentes de medicina interna.(AU)

Several academic and government organizations have strongly recommended the inclusion of specific competences in clinical research. So far, the current state of research within this framework has not been modified in our country. The main goal of this study was to provide a thorough description of the research activities in medical residencies, which could be used as an indicator of the acquisition of such competences and to identify the supporters and detractors to achieve them. A cross section study was carried out and several levels were analyzed in order to consider residencies as a cluster; 382 residents from 24 different residencies were included. The study showed a preponderance of women. The average age was 29 years old. A 71% of the residents asserted doing research. Half of those residents have stated being authors of papers presented in congresses; only 9% have published their experience. Factors which predict the development of research assignments were: to belong to a large residency, OR 16.99 (IC 95%, 2.096-137.87), being in the 3rd year of the residency, OR 9.95 (IC 95%, 2.84- 34.82), completion of a research course, OR 2.78 (IC 95%, 1.10-7.04). Variables which reduce the chance to do research: location in Buenos Aires, OR 0.25 (IC 95%, 0.0072-0.91), being a woman, OR 0.34 (IC 95%, 0.14-0.79) and patients assistance workload, OR 0.97 (IC 95%, 0.95-0.99). We believe that the identification of factors which influence the possibility of doing research will lead to a improvement in the training of medical residents.(AU)

La investigación clínica en residencias de medicina interna de la Argentina: Facilitadores y barreras / Clinical research in internal medicine residencies in Argentina: Supporters and detractors

En el proceso de formación de los residentes de medicina interna, distintas organizaciones académicas y gubernamentales han recomendado incluir competencias específicas en investigación clínica. El estado actual de la investigación en este contexto no ha sido todavía relevado en nuestro país. El objetivo de este trabajo fue describir las actividades de investigación en las residencias de medicina interna como indicador de la adquisición de dichas competencias e identificar los facilitadores y barreras para la misma. Se realizó un estudio de corte transversal, se analizaron múltiples niveles para considerar las residencias como conglomerados. Se incluyeron 382 residentes de 24 residencias. Predominaron las mujeres, la mediana de edad fue 29 años. El 71% de los residentes informaron actividades de investigación. La mitad de ellos habían participado como autores de trabajos en congresos, solo el 9% había publicado su experiencia. Los factores predictores de desarrollar tareas de investigación fueron pertenecer a una residencia numerosa, OR 16.99 (IC 95%, 2.096-137.87), pertenecer al tercer año de residencia, OR 9.95 (IC 95%, 2.84-34.82), y haber realizado un curso de investigación, OR 2.78 (IC 95%, 1.10-7.04). Las variables que disminuyen la probabilidad de realizar investigación fueron la localización en el Gran Buenos Aires o Capital Federal, OR 0.25 (IC 95%, 0.0072-0.91), ser mujer, OR 0.34 (IC 95 0.14-0.79) y la carga asistencial, OR 0.97 (IC 95%, 0.95-0.99). Conocer los factores que influyen en la investigación contribuye a mejorar la formación de los residentes de medicina interna.

Several academic and government organizations have strongly recommended the inclusion of specific competences in clinical research. So far, the current state of research within this framework has not been modified in our country. The main goal of this study was to provide a thorough description of the research activities in medical residencies, which could be used as an indicator of the acquisition of such competences and to identify the supporters and detractors to achieve them. A cross section study was carried out and several levels were analyzed in order to consider residencies as a cluster; 382 residents from 24 different residencies were included. The study showed a preponderance of women. The average age was 29 years old. A 71% of the residents asserted doing research. Half of those residents have stated being authors of papers presented in congresses; only 9% have published their experience. Factors which predict the development of research assignments were: to belong to a large residency, OR 16.99 (IC 95%, 2.096-137.87), being in the 3rd year of the residency, OR 9.95 (IC 95%, 2.84- 34.82), completion of a research course, OR 2.78 (IC 95%, 1.10-7.04). Variables which reduce the chance to do research: location in Buenos Aires, OR 0.25 (IC 95%, 0.0072-0.91), being a woman, OR 0.34 (IC 95%, 0.14-0.79) and patients assistance workload, OR 0.97 (IC 95%, 0.95-0.99). We believe that the identification of factors which influence the possibility of doing research will lead to a improvement in the training of medical residents.

[Gaps between prescription of anti-hypertensive and hypertension control in older adults of Buenos Aires suburbs]. / Brechas entre la prescripción de antihipertensivos y el control de la hipertensión en adultos mayores de los CAPS del conurbano bonaerense.

BACKGROUND: Medications delivered to primary care centers (PCC) all over the country through the Remediar program (RP) covers 80% of the most prevalent diseases. Among them, the prevalence of hypertension is 77% of 65 years or older. OBJECTIVE: To describe the pharmacological treatment and its appropriateness, and to understand needs and barriers among hypertensive beneficiaries of RP at Buenos Aires suburbs. Method Qualitative-quantitative triangulation: cross-sectional study with revision of medical records (MR) and in-depth interviews between December/2008 and February/2009 to hypertensive patients of 65 years or older and CAPS's staff. Prevalence of correct treatment (CT); appropriate Indication (AI); Optimal control (OC) were analyzed. RESULTS: The following PCCs were selected: Moreno, Tigre, Lomas de Zamora, Lanus and San Isidro. Prevalence of: CT: (10.2%; 95%CI 6,7-15,1); AI: (84.8%; 95% CI 80-89 ), and OC: 11,6% (95%CI 7-16) and OC among patients with good registry: 35.7% (95%CI 24,9-48,1). Eighty two % of patients received a prescription for enalapril. Deficient registry was detected in MR. Interviewees expressed difficulties in accessing treatment, lack of medication and use of alternative circuits to get them. Both, staff and patients were exposed to barriers generated by CAPSs and RP. CONCLUSIONS: A low degree of blood pressure control was observed, even with adequate prescription. Multifactorial problems explain several barriers to access and maintain hypertension treatment.

[Internal Medicine Residencies in Argentina, 2008]. / Formación en las residencias de clínica médica en la Argentina, 2008.

The acquisition of medical competence in the Internal Medicine Residencies (IMR) is a complex process. In Argentina there are not current data available on the number, organization and the way the residencies work. The objective of this study was to survey the IMR in Argentina and categorize their academic and general structure. From June 2007 to June 2008 we identified all the IMR using a combined searching strategy. We contacted them looking for structural and organizational data. Academic data were collected in a sample of 24 residencies using questionnaires. We also gathered data using qualitative measurements, in a subsample of 15 residencies, by means of direct observation and in-depth interviews. We identified 162 ongoing residencies and a total of 2012 residents. The majority of them (87%) were located in big cities, with a preponderance of public residencies (66%); 13% of these didn't have a residency instructor or coordinator. Most of these didn't have Institutional Internet available. The residents median age was 29 years old (Intercuartil range 2.7), with a 64.5% of women; 24% were under the regimen called "concurrente". From the sample, 230 residents were interviewed; 13% of them (CI95% 9-18.7) did not receive any remuneration. The rest received a monthly payment (in Arg $) ranging from US$ 140 to 552. A 58% (13/22) was involved in Specialist courses. Medians for weekly working hours and for "on duty" were respectively 50 and 8 per month, with no difference between public or private institutions. These findings evidence the need to certify the formative and academic process of IMR.

Formación en las residencias de clínica médica en la Argentina, 2008 / Internal Medicine residencies in Argentina, 2008

La adquisición de las competencias médicas de las Residencias de Clínica Médica (RCM) es un proceso complejo. En la Argentina no contamos con datos actualizados de su identificación, organización y funcionamiento. El objetivo del estudio fue censar las RCM de Argentina y caracterizar su estructura general y formativa. Entre junio 2007 y junio 2008 todas las instituciones con RCM del país fueron relevadas mediante estrategias de búsqueda, y contactadas para datos estructurales y de organización. Se recabaron datos académicos en una muestra de 24 residencias mediante cuestionarios, y en una submuestra de 15 con técnicas cualitativas de observación directa y entrevistas. Relevamos 162 RCM activas distribuidas en su mayoría (87%) en ciudades grandes y 2012 residentes. La mayoría pertenecen al sector público (66%). Un 13% no cuentan con coordinador o instructor y la mayoría no posee acceso a Internet institucional. Según el censo, la mediana de edad de los residentes es de 29 años (intervalo intercuartil 2.7), siendo 64.5% mujeres y 24% concurrentes. De los encuestados, 13% (IC 95% 9-18.7) refirió no recibir remuneración, en el resto la misma varió entre $520 y $ 2100 mensuales; 58% (13/22) realiza curso de especialista. Las medianas de horas trabajadas semanales y de guardias mensuales fueron 50 y 8 respectivamente, sin diferencias entre los centros públicos y privados. Estos hallazgos muestran la necesidad de reconsiderar la certificación del proceso formativo de las RCM.

The acquisition of medical competence in the Internal Medicine Residencies (IMR) is a complex process. In Argentina there are not current data available on the number, organization and the way the residencies work. The objective of this study was to survey the IMR in Argentina and categorize their academic and general structure. From June 2007 to June 2008 we identified all the IMR using a combined searching strategy. We contacted them looking for structural and organizational data. Academic data were collected in a sample of 24 residencies using questionnaires. We also gathered data using qualitative measurements, in a subsample of 15 residencies, by means of direct observation and in-depth interviews. We identified 162 ongoing residencies and a total of 2012 residents. The majority of them (87%) were located in big cities, with a preponderance of public residencies (66%); 13% of these didn't have a residency instructor or coordinator. Most of these didn't have Institutional Internet available. The residents median age was 29 years old (Intercuartil range 2.7), with a 64.5% of women; 24% were under the regimen called "concurrente". From the sample, 230 residents were interviewed; 13% of them (CI95% 9-18.7) dide not receive any remuneration. The rest received a monthly payment (in Arg $) ranging from US$ 140 to 552. A 58% (13/22) was involved in Specialist courses. Medians for weekly working hours and for "on duty" were respectively 50 and 8 per month, with no difference between public or private institutions. These findings evidence the need to certify the formative and academic process of IMR.