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1.
Value Health ; 21(12): 1357-1364, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30502778

RESUMO

BACKGROUND: A recent cluster randomized trial evaluating a multicomponent intervention showed significant reductions in blood pressure in low-income hypertensive subjects in Argentina. OBJECTIVES: To assess the cost-effectiveness of this intervention. METHODS: A total of 1432 hypertensive participants were recruited from 18 primary health care centers. The intervention included home visits led by community health workers, physician education, and text messaging. Resource use and quality of life data using the three-level EuroQol five-dimensional questionnaire were prospectively collected. The study perspective was that of the public health care system, and the time horizon was 18 months. Intention-to-treat analysis was used to analyze cost and health outcomes (systolic blood pressure [SBP] change and quality-adjusted life-years [QALYs]). A 1 time gross domestic product per capita per QALY was used as the cost-effectiveness threshold (US $14,062). RESULTS: Baseline characteristics were similar in the two arms. QALYs significantly increased by 0.06 (95% confidence interval [CI] 0.04-0.09) in the intervention group, and SBP net difference favored the intervention group: 5.3 mm Hg (95% CI 0.27-10.34). Mean total costs per participant were higher in the intervention arm: US $304 in the intervention group and US $154 in the control group (adjusted difference of US $140.18; 95% CI US $75.41-US $204.94). The incremental cost-effectiveness ratio was $3299 per QALY (95% credible interval 1635-6099) and US $26 per mm Hg of SBP (95% credible interval 13-46). Subgroup analysis showed that the intervention was cost-effective in all prespecified subgroups (age, sex, cardiovascular risk, and body mass index). CONCLUSIONS: The multicomponent intervention was cost-effective for blood pressure control among low-income hypertensive patients.

2.
Rev Panam Salud Publica ; 42, sep. 2018. Special Issue Alma-Ata.
Artigo em Espanhol | PAHO-IRIS | ID: phr-49465

RESUMO

[RESUMEN]. Objetivo. Explorar las motivaciones y expectativas de los usuarios del Programa de Estaciones Saludables en la Ciudad Autónoma de Buenos Aires y evaluar su potencial impacto sanitario. Métodos. Se realizaron entrevistas en profundidad (n = 34) y una encuesta autoadministrada (n = 605) a usuarios del programa. Se desarrolló un modelo epidemiológico para estimar el impacto del programa sobre los eventos cardiovasculares y los años de vida ajustados por discapacidad (AVAD). Resultados. Los principales factores motivadores para el uso de las estaciones saludables fueron la accesibilidad geográfica, económica (servicios gratuitos) y la satisfacción con la atención recibida. El 14,4% (intervalos de confianza del 95% [IC95%] 10,3–18,5%) de los usuarios hipertensos y el 24,8% (IC95% 17,6–32,0%) de los diabéticos informó haberse enterado de sus valores alterados en las estaciones saludables. Más de la mitad de los encuestados reportó alguna mejora de conocimientos sobre los beneficios de realizar actividad física y una alimentación saludable; esto fue más frecuente entre los usuarios más jóvenes, de menor nivel educativo, usuarios del sistema público de salud, usuarios de estaciones saludables de la zona sur y los que tenían algún factor de riesgo cardiometabólico (p<0.05). Se estimó que debido a la existencia de estaciones saludables se evitarían 12,5 eventos cardiovasculares y cerebrovasculares por año en la población asistida (4,75 eventos/100 000 personas) y 47,75 AVAD por estas causas. Conclusiones. Las estaciones saludables resultan un espacio propicio para la implementación de acciones de promoción de la salud y prevención, contribuyendo en la detección y facilitando el monitoreo de los factores de riesgo, con potencialidad para prevenir eventos cardiovasculares y sus consecuencias.


[ABSTRACT]. Objective. To explore the motivations and expectations of the users of the Program for Healthy Centers in the Autonomous City of Buenos Aires and to evaluate its potential health impact. Methods. In-depth interviews were conducted (n = 34) and a self-administered survey was sent to users of the program (n = 605). An epidemiological model was developed to estimate the impact of the program on cardiovascular events (CVE) and disability-adjusted life years (DALYs). Results. The main motivating factors for using the healthy centers were geographic and economic accessibility (free services) and satisfaction with the care received. 14.4% (95% CI, 10.3-18.5%) of hypertensive users and 24.8% (95% CI, 17.6-32.0%) of diabetic users reported having learned of their altered values in the healthy center. More than half of the respondents reported some improvement in their knowledge about the benefits of physical activity and healthy eating; this was more frequent among those who were younger, of lower educational level, users of the public health system, users of a healthy center in the South zone and those who had a cardiometabolic risk factor (p<0.05). It was estimated that the healthy centers would prevent 12.5 cardiovascular and cerebrovascular events per year in the assisted population (4.75 events/100 000) and 47.75 DALYs due to these causes. Conclusions. The healthy centers are a favorable space for the implementation of health promotion and prevention actions, contributing to the detection of and facilitating the monitoring of risk factors, with a potential to prevent cardiovascular events and its consequences.


[RESUMO]. Objetivo. Explorar as motivações e expectativas dos usuários do Programa Estações Saudáveis na Cidade Autônoma de Buenos Aires e avaliar seu impacto potencial na saúde. Métodos. Foram realizadas entrevistas em profundidade (n = 34) e uma pesquisa auto-administrada (n = 605) a usuários do programa. Um modelo epidemiológico foi desenvolvido para estimar o impacto do programa em eventos cardiovasculares e anos de vida ajustados por incapacidade (DALY). Resultados. Os principais fatores motivadores para o uso do estações saudáveis foram a acessibilidade geográfica, econômica (serviços gratuitos) e a satisfação com o atendimento recebido. 14,4% (intervalo de confiança de 95% [IC95%] 10,3-18,5%) de usuários hipertensos e 24,8% (IC95% 17,6-32,0%) dos diabéticos relataram ter aprendido sobre seus valores alterados na estação saudável. Mais da metade dos entrevistados relataram alguma melhora no conhecimento sobre os benefícios da atividade física e da alimentação saudável, com maior freqüência entre os mais jovens, de menor escolaridade, usuários do sistema público de saúde, usuários de estações saudáveis na zona sul e aqueles que apresentaram algum fator de risco cardiometabólico (p<0,05). Estimou-se que, devido à existência de estações saudáveis, 12,5 eventos cardiovasculares e cerebrovasculares por ano seriam evitados na população atendida (4,75 eventos/100 000) e 47,75 DALY por essas causas. Conclusões. As estações saudáveis são um espaço propício para a implementação de ações de promoção e prevenção da saúde, contribuindo para a detecção e facilitação do monitoramento dos fatores de risco, com potencial para prevenir os eventos cardiovasculares e suas consequências.


Assuntos
Promoção da Saúde , Prevenção Primária , Estilo de Vida Saudável , Conhecimentos, Atitudes e Prática em Saúde , Doenças Cardiovasculares , Avaliação em Saúde , Argentina , Promoção da Saúde , Prevenção Primária , Estilo de Vida Saudável , Conhecimentos, Atitudes e Prática em Saúde , Doenças Cardiovasculares , Avaliação em Saúde , Promoção da Saúde , Prevenção Primária , Estilo de Vida Saudável , Conhecimentos, Atitudes e Prática em Saúde , Doenças Cardiovasculares , Avaliação em Saúde
3.
Salud Colect ; 14(1): 139-151, 2018 Jan-Mar.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30020356

RESUMO

Traffic accidents are an emerging problem in cities with high mobility and little urban planning. Evidence is lacking in Argentina regarding the relationship between the environment and accident occurrence; we therefore conducted a geospatial analysis and estimated the risk of accidents and their possible association with the characteristics of the physical environment in the city of Resistencia, Argentina occurring in 2012. Kernel density estimates were used for the spatial distribution of accidents and in parallel an observational, analytical study was carried out to analyze the factors associated with accident occurrence. The results show three critical areas (in the northwest, center and south of the city) with greater accident frequency. Environmental factors that were associated with the occurrence of accidents were the presence of street lighting (23% greater), the presence of a tree close to the road (47% greater), the presence of a traffic light (28% greater), and if the road was a major avenue (122% greater) and had curves (129% greater). This study shows the city of Resistencia to be in a situation of urban vulnerability due not only to its socioeconomic status but also to the unequal development compared to neighboring cities, a reality that fosters an unfavorable environment.

4.
Salud colect ; 14(1): 139-151, mar. 2018. tab, graf
Artigo em Espanhol | LILACS-Express | ID: biblio-962407

RESUMO

RESUMEN Los accidentes de tránsito constituyen un problema emergente en ciudades con alta movilidad y baja planificación urbana. No existe suficiente evidencia en Argentina acerca de la relación entre el entorno y la ocurrencia de accidentes. Por ello, realizamos un análisis espacial de ocurrencia y estimamos el riesgo de ocurrencia de accidentes en el año 2012 y su posible asociación con las características del entorno físico en la ciudad de Resistencia, provincia del Chaco, Argentina. Para el análisis espacial de los accidentes se utilizó la estimación de densidad kernel. Luego, a través de un estudio observacional y analítico se procedió a analizar los factores asociados a la ocurrencia de los accidentes. Los resultados muestran que existen tres zonas críticas (noroeste, centro y sur) con mayor frecuencia de accidentes. Los factores del entorno que estuvieron asociados con la ocurrencia de accidentes fueron la presencia de iluminación vial (23% menor), árbol próximo a la calzada (47% mayor), la presencia de semáforo (28% mayor), avenidas (122% mayor) y disposición curva de la calzada (129% mayor). Este estudio ubica a la ciudad de Resistencia en una situación de vulnerabilidad urbana, no solo por el contexto socioeconómico donde se encuentra sino por el desigual desarrollo territorial que presenta respecto a las ciudades vecinas, que propicia un entorno desfavorable.


ABSTRACT Traffic accidents are an emerging problem in cities with high mobility and little urban planning. Evidence is lacking in Argentina regarding the relationship between the environment and accident occurrence; we therefore conducted a geospatial analysis and estimated the risk of accidents and their possible association with the characteristics of the physical environment in the city of Resistencia, Argentina occurring in 2012. Kernel density estimates were used for the spatial distribution of accidents and in parallel an observational, analytical study was carried out to analyze the factors associated with accident occurrence. The results show three critical areas (in the northwest, center and south of the city) with greater accident frequency. Environmental factors that were associated with the occurrence of accidents were the presence of street lighting (23% greater), the presence of a tree close to the road (47% greater), the presence of a traffic light (28% greater), and if the road was a major avenue (122% greater) and had curves (129% greater). This study shows the city of Resistencia to be in a situation of urban vulnerability due not only to its socioeconomic status but also to the unequal development compared to neighboring cities, a reality that fosters an unfavorable environment.

5.
Rev. panam. salud pública ; 42: e150, 2018. tab
Artigo em Espanhol | LILACS | ID: biblio-961831

RESUMO

RESUMEN Objetivo Explorar las motivaciones y expectativas de los usuarios del Programa de Estaciones Saludables en la Ciudad Autónoma de Buenos Aires y evaluar su potencial impacto sanitario. Métodos Se realizaron entrevistas en profundidad (n = 34) y una encuesta autoadministrada (n = 605) a usuarios del programa. Se desarrolló un modelo epidemiológico para estimar el impacto del programa sobre los eventos cardiovasculares y los años de vida ajustados por discapacidad (AVAD). Resultados Los principales factores motivadores para el uso de las estaciones saludables fueron la accesibilidad geográfica, económica (servicios gratuitos) y la satisfacción con la atención recibida. El 14,4% (intervalos de confianza del 95% [IC95%] 10,3-18,5%) de los usuarios hipertensos y el 24,8% (IC95% 17,6-32,0%) de los diabéticos informó haberse enterado de sus valores alterados en las estaciones saludables. Más de la mitad de los encuestados reportó alguna mejora de conocimientos sobre los beneficios de realizar actividad física y una alimentación saludable; esto fue más frecuente entre los usuarios más jóvenes, de menor nivel educativo, usuarios del sistema público de salud, usuarios de estaciones saludables de la zona sur y los que tenían algún factor de riesgo cardiometabólico (p<0.05). Se estimó que debido a la existencia de estaciones saludables se evitarían 12,5 eventos cardiovasculares y cerebrovasculares por año en la población asistida (4,75 eventos/100 000 personas) y 47,75 AVAD por estas causas. Conclusiones Las estaciones saludables resultan un espacio propicio para la implementación de acciones de promoción de la salud y prevención, contribuyendo en la detección y facilitando el monitoreo de los factores de riesgo, con potencialidad para prevenir eventos cardiovasculares y sus consecuencias.


ABSTRACT Objective To explore the motivations and expectations of the users of the Program for Healthy Centers in the Autonomous City of Buenos Aires and to evaluate its potential health impact. Methods In-depth interviews were conducted (n = 34) and a self-administered survey was sent to users of the program (n = 605). An epidemiological model was developed to estimate the impact of the program on cardiovascular events (CVE) and disability-adjusted life years (DALYs). Results The main motivating factors for using the healthy centers were geographic and economic accessibility (free services) and satisfaction with the care received. 14.4% (95% CI, 10.3-18.5%) of hypertensive users and 24.8% (95% CI, 17.6-32.0%) of diabetic users reported having learned of their altered values in the healthy center. More than half of the respondents reported some improvement in their knowledge about the benefits of physical activity and healthy eating; this was more frequent among those who were younger, of lower educational level, users of the public health system, users of a healthy center in the South zone and those who had a cardiometabolic risk factor (p<0.05). It was estimated that the healthy centers would prevent 12.5 cardiovascular and cerebrovascular events per year in the assisted population (4.75 events/100 000) and 47.75 DALYs due to these causes. Conclusions The healthy centers are a favorable space for the implementation of health promotion and prevention actions, contributing to the detection of and facilitating the monitoring of risk factors, with a potential to prevent cardiovascular events and its consequences.


RESUMO Objetivo Explorar as motivações e expectativas dos usuários do Programa Estações Saudáveis na Cidade Autônoma de Buenos Aires e avaliar seu impacto potencial na saúde. Métodos Foram realizadas entrevistas em profundidade (n = 34) e uma pesquisa auto-administrada (n = 605) a usuários do programa. Um modelo epidemiológico foi desenvolvido para estimar o impacto do programa em eventos cardiovasculares e anos de vida ajustados por incapacidade (DALY). Resultados Os principais fatores motivadores para o uso do estações saudáveis foram a acessibilidade geográfica, econômica (serviços gratuitos) e a satisfação com o atendimento recebido. 14,4% (intervalo de confiança de 95% [IC95%] 10,3-18,5%) de usuários hipertensos e 24,8% (IC95% 17,6-32,0%) dos diabéticos relataram ter aprendido sobre seus valores alterados na estação saudável. Mais da metade dos entrevistados relataram alguma melhora no conhecimento sobre os benefícios da atividade física e da alimentação saudável, com maior freqüência entre os mais jovens, de menor escolaridade, usuários do sistema público de saúde, usuários de estações saudáveis na zona sul e aqueles que apresentaram algum fator de risco cardiometabólico (p<0,05). Estimou-se que, devido à existência de estações saudáveis, 12,5 eventos cardiovasculares e cerebrovasculares por ano seriam evitados na população atendida (4,75 eventos/100 000) e 47,75 DALY por essas causas. Conclusões As estações saudáveis são um espaço propício para a implementação de ações de promoção e prevenção da saúde, contribuindo para a detecção e facilitação do monitoramento dos fatores de risco, com potencial para prevenir os eventos cardiovasculares e suas consequências.


Assuntos
Prevenção Primária , Doenças Cardiovasculares , Estilo de Vida Saudável , Promoção da Saúde/organização & administração , Argentina/epidemiologia , Avaliação em Saúde
6.
BMJ Open ; 7(1): e014420, 2017 01 31.
Artigo em Inglês | MEDLINE | ID: mdl-28143840

RESUMO

INTRODUCTION: Hypercholesterolaemia is estimated to cause 2.6 million deaths annually and one-third of the cases of ischaemic heart disease. In Argentina, the prevalence of hypercholesterolaemia increased between 2005 and 2013 from 27.9% to 29.8%. Only one out of four subjects with a self-reported diagnosis of coronary heart disease is taking statins. Since 2014, statins (simvastatin 20 mg) are part of the package of drugs provided free-of-charge for patients according to cardiovascular disease (CVD) risk stratification. The goal of this study is to test whether a complex intervention targeting physicians and pharmacist assistants improves treatment and control of hypercholesterolaemia among patients with moderate-to-high cardiovascular risk in Argentina. METHODS AND ANALYSIS: This is a cluster trial of 350 patients from 10 public primary care centres in Argentina to be randomised to either the intervention or usual care. The study is designed to have 90% statistical power to detect a 0.7 mmol/L reduction in low-density lipoproteins cholesterol from baseline to 12 months. The physician education programme consists of a 2-day initial intensive training and certification workshop followed by educational outreach visits (EOVs) conducted at 3, 6 and 9 months from the outset of the study. An on-site training to pharmacist assistants during the first EOV is performed at each intervention clinic. In addition, two intervention support tools are used: an app installed in physician's smartphones to serve as a decision aid to improve prescription of statins according to patient's CVD risk and a web-based platform tailored to send individualised SMS messages to patients. ETHICS AND DISSEMINATION: Ethical approval was obtained from an independent ethics committee. Results of this study will be presented to the Ministry of Health of Argentina for potential dissemination and scale-up of the intervention programme to the entire national public primary care network in Argentina. TRIAL REGISTRATION NUMBER: NCT02380911.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Países em Desenvolvimento , Educação Médica Continuada , Educação em Farmácia , Hipercolesterolemia/tratamento farmacológico , Técnicos em Farmácia/educação , Adulto , Idoso , Argentina , Técnicas de Apoio para a Decisão , Estilo de Vida Saudável , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Adesão à Medicação , Pessoa de Meia-Idade , Aplicativos Móveis , Padrões de Prática Médica , Projetos de Pesquisa , Medição de Risco , Fatores de Risco , Mensagem de Texto
7.
Rev. esp. cardiol. (Ed. impr.) ; 69(11): 1051-1060, nov. 2016. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-157511

RESUMO

Introducción y objetivos: La insuficiencia cardiaca es un grave problema de salud pública. El objetivo de la revisión es estimar la carga de insuficiencia cardiaca en Latinoamérica. Métodos: Revisión sistemática y metanálisis, tras búsqueda en MEDLINE, EMBASE, LILACS y CENTRAL desde enero de 1994 a junio de 2014, sin restricción de idioma. Se incluyeron estudios experimentales y observacionales con al menos 50 participantes de edad ≥ 18 años. Resultados: Se incluyeron 143 de las 4.792 referencias recuperadas. La mayoría de los estudios se realizaron en Sudamérica (92%), principalmente en Brasil (64%). La media de edad era 60 ± 9 años y la fracción de eyección media, del 36 ± 9%. La incidencia de insuficiencia cardiaca en el único estudio poblacional identificado fue de 199/100.000 personas-años; la prevalencia, del 1% (intervalo de confianza del 95% [IC95%], 0,1-2,7%); las tasas de rehospitalización, del 33, el 28, el 31 y el 35% a 3, 6, 12 y 24-60 meses de seguimiento respectivamente, y la mediana de estancia hospitalaria, 7,0 días. La tasa de mortalidad al año fue del 24,5% (IC95%, 19,4-30,0%). La mortalidad intrahospitalaria fue del 11,7% (IC95%, 10,4-13,0%), y aumentaba en pacientes con fracción de eyección reducida, cardiopatía isquémica y enfermedad de Chagas. Conclusiones: Pocos estudios han evaluado la incidencia y la prevalencia de insuficiencia cardiaca en Latinoamérica. Se hallaron altas tasas de mortalidad y de hospitalización, y la heterogeneidad es su principal limitación. Este estudio brinda la información epidemiológica disponible para la toma de decisiones sobre esta enfermedad. Se requieren más estudios con metodologías estandarizadas y en poblaciones representativas (AU)


Introduction and objectives: Heart failure is a major public health concern. The aim of this review was to estimate the burden of heart failure in Latin America. Methods: Systematic review and meta-analysis following a search in MEDLINE, EMBASE, LILACS, and CENTRAL for articles published between January 1994 and June 2014, with no language restrictions. We included experimental and observational studies with at least 50 participants aged ≥ 18 years. Results: In total, 143 of the 4792 references retrieved were included in the study. Most studies had been conducted in South America (92%), and mainly in Brazil (64%). The mean age of the patients was 60 ± 9 years, and mean ejection fraction was 36% ± 9%. The incidence of heart failure in the single population study providing this information was 199 cases per 100 000 person-years. The prevalence of heart failure was 1% (95% confidence interval [95%CI], 0.1%-2.7%); hospital readmission rates were 33%, 28%, 31%, and 35% at 3, 6, 12, and 24 to 60 months of follow-up, respectively; and the median duration of hospitalization was 7.0 days. The 1-year mortality rate was 24.5% (95%CI, 19.4%-30.0%). In-hospital mortality was 11.7% (95%CI, 10.4%-13.0%), and the rate was higher in patients with a reduced ejection fraction, ischemic heart disease, or Chagas disease. Conclusions: Few studies have evaluated the incidence and prevalence of heart failure in Latin America. High mortality and hospitalization rates were found, and the main limitation was heterogeneity between studies. The results presented provide useful epidemiologic information for decision-making related to this disease. Further studies with standardized methods and representative populations are needed in this line (AU)


Assuntos
Humanos , Insuficiência Cardíaca/epidemiologia , Tempo de Internação/estatística & dados numéricos , Efeitos Psicossociais da Doença , América Latina/epidemiologia , Mortalidade Hospitalar , Volume Sistólico/fisiologia
8.
Rev Esp Cardiol (Engl Ed) ; 69(11): 1051-1060, 2016 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27553287

RESUMO

INTRODUCTION AND OBJECTIVES: Heart failure is a major public health concern. The aim of this review was to estimate the burden of heart failure in Latin America. METHODS: Systematic review and meta-analysis following a search in MEDLINE, EMBASE, LILACS, and CENTRAL for articles published between January 1994 and June 2014, with no language restrictions. We included experimental and observational studies with at least 50 participants aged ≥ 18 years. RESULTS: In total, 143 of the 4792 references retrieved were included in the study. Most studies had been conducted in South America (92%), and mainly in Brazil (64%). The mean age of the patients was 60 ± 9 years, and mean ejection fraction was 36% ± 9%. The incidence of heart failure in the single population study providing this information was 199 cases per 100000 person-years. The prevalence of heart failure was 1% (95% confidence interval [95%CI], 0.1%-2.7%); hospital readmission rates were 33%, 28%, 31%, and 35% at 3, 6, 12, and 24 to 60 months of follow-up, respectively; and the median duration of hospitalization was 7.0 days. The 1-year mortality rate was 24.5% (95%CI, 19.4%-30.0%). In-hospital mortality was 11.7% (95%CI, 10.4%-13.0%), and the rate was higher in patients with a reduced ejection fraction, ischemic heart disease, or Chagas disease. CONCLUSIONS: Few studies have evaluated the incidence and prevalence of heart failure in Latin America. High mortality and hospitalization rates were found, and the main limitation was heterogeneity between studies. The results presented provide useful epidemiologic information for decision-making related to this disease. Further studies with standardized methods and representative populations are needed in this line.


Assuntos
Insuficiência Cardíaca/epidemiologia , Antígua e Barbuda/epidemiologia , Argentina/epidemiologia , Brasil/epidemiologia , Cardiomiopatia Chagásica/epidemiologia , Chile/epidemiologia , Colômbia/epidemiologia , Cuba/epidemiologia , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Jamaica/epidemiologia , América Latina/epidemiologia , Tempo de Internação/estatística & dados numéricos , México/epidemiologia , Mortalidade , Readmissão do Paciente/estatística & dados numéricos , Peru/epidemiologia , Prevalência , Fatores de Risco , Volume Sistólico , Uruguai/epidemiologia
9.
Sci Total Environ ; 538: 802-16, 2015 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-26340583

RESUMO

Four million people in Argentina are exposed to arsenic contamination from drinking waters of several center-northern provinces. A systematic review to examine the geographical distribution of arsenic-related diseases in Argentina was conducted, searching electronic databases and gray literature up to November 2013. Key informants were also contacted. Of the 430 references identified, 47 (mostly cross-sectional and ecological designs) referred to arsenic concentration in water and its relationship with the incidence and mortality of cancer, dermatological diseases and genetic disorders. A high percentage of the water samples had arsenic concentrations above the WHO threshold value of 10µg/L, especially in the province of Buenos Aires. The median prevalence of arsenicosis was 2.6% in exposed areas. The proportion of skin cancer in patients with arsenicosis reached 88% in case-series from the Buenos Aires province. We found higher incidence rate ratios per 100µg/L increment in inorganic arsenic concentration for colorectal, lung, breast, prostate and skin cancer, for both genders. Liver and skin cancer mortality risk ratios were higher in regions with medium/high concentrations than in those with low concentrations. The relative risk of mortality by skin cancer associated to arsenic exposure in the province of Buenos Aires ranged from 2.5 to 5.2. In the north of this province, high levels of arsenic in drinking water were reported; however, removal interventions were scarcely documented. Arsenic contamination in Argentina is associated with an increased risk of serious chronic diseases, including cancer, showing the need for adequate and timely actions.


Assuntos
Arsênico , Doença Crônica/epidemiologia , Exposição Ambiental/estatística & dados numéricos , Poluentes Ambientais , Adulto , Argentina/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade
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