San Francisco de Laishí, Argentina
San Francisco de Laishí, Argentina

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Linetzky B.,Ministerio de Salud de la Nacion | Mejia R.,University of Buenos Aires | Ferrante D.,Ministerio de Salud de la Nacion | De Maio F.G.,DePaul University | Diez Roux A.V.,University of Michigan
Nicotine and Tobacco Research | Year: 2012

Introduction: The relationship between poverty and tobacco consumption among adolescents has not been extensively studied, and what evidence exists has come almost entirely from developed countries. Moreover, the impact of contextual factors-such as school-level poverty-remains unclear. Methods: We obtained information about smoking behavior from the Global Youth Tobacco Survey in Argentina in 2007. School-level characteristics were derived by matching schools to census areas from the 2001 Census. Additional school-level information was obtained from the Ministry of Education. Random intercept models were used to evaluate the associations of school-level variables (poverty in the census area of the school, school receipt of social assistance, and public or private status) with current smoking, intention to quit, secondhand smoke exposure outside the home, support for smoke-free laws, purchase of single cigarettes among smokers, and susceptibility to smoking in 5 years among nonsmokers. Results: After controlling for age and sex, students attending schools receiving social assistance were more likely to smoke (odds ratio [OR] 1.35, 95% CI 1.02-1.80) and to purchase loose cigarettes (OR 1.66, 95% CI 1.08-2.54), whereas school poverty was signifi cantly associated with secondhand smoke exposure (OR 1.27, 95% CI 1.04-1.58). Conclusion: This study shows that an association exists between unfavorable contextual school characteristics and tobacco consumption and related measures among youth in Argentina. Efforts to prevent smoking may need to address the school-level factors that place youth at higher risk. © The Author 2012. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved.

Tobar F.,University of Buenos Aires | Drake I.,Ministerio de Salud de la Nacion | Martich E.,Escola Nacional de Saude Publica ENSP
Revista Panamericana de Salud Publica/Pan American Journal of Public Health | Year: 2012

Latin America is adopting regulations that bear on medicinal costs and spending. The regulations have four main goals: i) to guarantee a competitive market, ii) to ensure affordability for individual consumers (commercial channel), iii) to contain public spending on medicines (institutional channel), and iv) to guarantee efficient spending on medicines. The experience of Latin America differs from that of countries in developed regions. In the latter, the countries tend to have similar policies, both in promoting generic medicines and in price control strategies, and in optimizing and containing pharmaceutical expense. In contrast, in Latin America, certain institutional weaknesses impede the consolidation and application of an effective regulatory policy. This paper reviews the experience gained through the adoption of economic regulations aimed at reducing spending and improving access to medicines, suggests lessons learned at the international level, and offers recommendations for the countries of Latin America. Its purpose is to offer key elements to decision-makers and the authorities of the countries concerned in pursuing economic regulation of medicines.

Uruena A.,Ministerio de Salud de la Nacion | Pippo T.,Ministerio de Salud de la Nacion | Betelu M.S.,Ministerio de Salud de la Nacion | Virgilio F.,Ministerio de Salud de la Nacion | And 7 more authors.
Vaccine | Year: 2011

Objective: Since the 10-valent pneumococcal conjugate vaccine (PCV-10) and 13-valent pneumococcal conjugate vaccine (PCV-13) were recently licensed for use in Argentina, both vaccines were evaluated to estimate the costs, health benefits and cost-effectiveness of adding a PCV to the routine child immunization schedule. Methodology: The integrated TRIVAC vaccine cost-effectiveness model from Pan American Health Organization's ProVac Initiative (Version 1.0.65) was used to assess the health outcomes of 20 successive cohorts from birth to 5 years of age. PCV-10 and PCV-13 were each compared to a scenario assuming no PCV vaccination. A 3 + 1 (three doses + booster) schedule and a vaccination price of US$ 20.75 per dose was assumed in the base case for both vaccines. Results: Introduction of PCV-13 rather than PCV-10 would increase the number of life years gained (LYG) by at least 10%. The number of LYG (and LYG after adjustment for DALY morbidity weights) was 56,882 (64,252) for PCV-10 compared to 65,038 (71,628) for PCV-13. From the health system perspective, the cost per DALY averted was US$ 8973 and US$ 10,948 for PCV-10 and PCV-13 respectively, and US$ 8546 and US$ 10,510 respectively, after incorporating costs saved by households. When PCV13 was compared to PCV10 directly, the additional benefits of PCV-13 was conferred at a cost of US$ 28,147 per DALY averted. Cost-effectiveness was influenced mainly by vaccine price, serotype replacement, pneumonia mortality and discount rate. Conclusion: Routine vaccination against S. pneumoniae in Argentina would be cost-effective with either PCV-10 or PCV-13. PCV-13, with higher coverage of local serotypes, would prevent more cases of pneumonia, invasive pneumococcal disease, sequelae and deaths with a higher number of LYG and DALYs averted, but PCV-10, due its higher impact in the prevention of AOM, would save more costs to the healthcare system. © 2011 Elsevier Ltd.

Schoj V.,Hospital Italiano Of Buenos Aires | Alderete M.,Hospital Italiano Of Buenos Aires | Ruiz E.,Hospital Provincial Of Neuquen Dr E Castro Rendon | Hasdeu S.,Hospital Centenario Dr Natalio Burd | And 2 more authors.
Tobacco Control | Year: 2010

Objectives: The objective of this study was to evaluate the impact of 100% smoke-free environment legislation on respiratory and sensory irritation symptoms and respiratory function among bar and restaurant workers from the city of Neuquén, Argentina. Methods: Pre-ban and post-ban studies without a comparison group in an Argentinean city were conducted. A baseline survey and spirometric measurements were performed with a total of 80 bar and restaurant workers 1 month before (October 2007) and 3 months after (March 2008) the implementation of the new 100% smoke-free legislation. Results: A significant reduction in secondhand smoke exposure was observed after the enactment and enforcement of the new legislation, and an important reduction in respiratory symptoms (from a pre-ban level of 57.5% to a post-ban level of only 28.8%). The reduction of sensory irritation symptoms was even higher. From 86.3% of workers who reported at least one sensory irritation symptom in October 2007, only 37.5% reported the same symptoms in March 2008. Also, data obtained by spirometry showed a significant forced vital capacity increase. Conclusions: Consistent with other studies, 100% smoke-free legislation improved short-term health outcomes in the sample and should be implemented nationwide. Furthermore, undertaking this study has been highly important in promoting 100% smoke-free environment legislation at the workplace as a legitimate right of hospitality workers, and in reducing social acceptance of designated smoking areas in bars and restaurants.

Pedranti M.S.,National University of Cordoba | Barbero P.,Ministerio de Salud de la Provincia de Cordoba | Wolff C.,Ministerio de Salud de la Nacion | Ghietto L.M.,National University of Cordoba | And 2 more authors.
Epidemiology and Infection | Year: 2012

The contribution of parvovirus B19 (B19V) as a causative agent of febrile exanthema (FE) in Cordoba, Argentina, was analysed by detection of viral DNA, and specific IgM and IgG. Serum from 141 patients with FE who were negative for measles and rubella, collected during 2005-2009, plus serum from 31 healthy individuals, were assayed. B19V was the aetiological agent in 14·9% of all FE cases, and in 39·1% in an epidemic year (2007). B19V DNA was detected in 47·6% of IgM-positive FE patients, 30·2% of IgM-negative/IgG-positive FE patients, and 9·7% of healthy controls, indicating B19V long-term infection in ∼10% of immunocompetent individuals. Persistent B19V DNA was significantly more frequent in children than adults and in males than females. All patients with acute B19V infection had rash and fever, 85·7% had adenopathy, and only 14·3% had arthropathy. This is the first follow-up study of markers of infection and immunity for B19V infection in Argentina. © 2011 Cambridge University Press.

Vizzotti C.,Ministerio de Salud de la Nacion | Gonzalez J.,INEI ANLIS Dr. Carlos Malbran | Gentile A.,Sociedad Argentina de Pediatria | Rearte A.,Ministerio de Salud de la Nacion | And 5 more authors.
Pediatric Infectious Disease Journal | Year: 2014

BACKGROUND: After a country wide outbreak occurred during 2003-2004, 1 dose of hepatitis A vaccine was introduced into Argentinian regular immunization schedule for all children aged 12 months in June 2005. The aim of this study was to assess the impact of this novel intervention. METHODS: A longitudinal analysis was done of hepatitis A virus (HAV) infection rates reported to the National Epidemiological Surveillance System from 2000 to 2011. Occurrence of fulminant hepatic failure (FHF) and liver transplantation cases up to 2011 were also assessed. Incidence rates and clinical impact were compared between pre- and postvaccination periods (2000-2002 vs. 2006-2011). Notification rates were also compared by age groups and geographical regions. RESULTS: Since 2006, an abrupt decline was observed in HAV infection rates, as well as in FHF and liver transplantation cases. The mean incidence rate of 7.9/100,000 in the postvaccination period represents a reduction of 88.1% (P < 0.001) when compared with the prevaccination period. Neither FHF nor liver transplantation due to HAV infection were observed since March 2007. Decline in incidence rates was evident in all geographical regions and all age groups but was higher in the prevaccination most affected areas and in young children. Although an absolute decrease was observed for cases and rates in all age groups, since 2006, a higher proportion of cases was observed in people >14 years of age. CONCLUSIONS: The single-dose vaccination strategy has been highly effective for controlling HAV infection in all age groups till now in Argentina. Long-term surveillance will be critical to document the sustained success of this unique intervention. Copyright © 2013 by Lippincott Williams & Wilkins.

De Maio F.G.,DePaul University | Konfino J.,Ministerio de Salud de la Nacion | Ondarsuhu D.,Instituto Nacional Of Estadistica Y Censos | Goldberg L.,Ministerio de Salud de la Nacion | And 2 more authors.
Tobacco Control | Year: 2015

Objective To examine social gradients in tobacco use in Argentina and Uruguay, using newly available directly comparable data sets. Methods Secondary analysis of Global Adult Tobacco Survey data from Argentina (N=6645) and Uruguay (N=5581). Social gradients in current tobacco use, exposure to secondhand smoke, and cessation attempt were examined with sex-stratified and age-adjusted logistic regression. Results Among men, there is evidence of higher odds of being a current smoker among respondents with lower levels of education, but the association is only statistically significant for respondents with less than primary education in Uruguay (OR=2.15, 95% CI 1.22 to 3.77). Similarly, women with lower levels of education have higher odds of being a current smoker in Uruguay. The association between education and exposure to secondhand smoke is broadly similar for both sexes in both countries, with generally higher odds among groups with low education, though the relationship is only statistically significant among men in Uruguay (OR=1.77, 95% CI 1.08 to 2.92). In both countries, respondents with lower levels of education in general have higher odds of having attempted to quit smoking in the past year, although these associations did not attain statistical significance. Conclusions Social gradients in tobacco use, exposure to secondhand smoke and cessation attempts are broadly similar in both countries. Efforts to evaluate the long-term effects of tobacco control efforts in these countries should monitor how policies affect national averages, and the social gradients that are embedded in aggregate data. © 2015, BMJ Publishing Group. All rights reserved.

De Maio F.G.,DePaul University | Linetzky B.,Ministerio de Salud de la Nacion | Ferrante D.,Ministerio de Salud de la Nacion
Public Health | Year: 2012

Objectives: To identify changes in the social gradients for Pap smears and mammograms in Argentina. Study design: Secondary analysis of the 2005 and 2009 Argentine National Risk Factor Surveys. Methods: Logistic regression analysis was used to examine social gradients by income and education, adjusting for age and health insurance. Results: The proportion of women who received a Pap smear in the previous 2 years increased from 51.6% in 2005 to 60.5% in 2009 (χ2 = 344.8, P < 0.001). A significant increase was also seen in the receipt of a mammogram in the previous 2 years by women aged ≥50 years, with an increase from 39.6% in 2005 to 52.6% in 2009 (χ2 = 279.6, P < 0.001). In 2005, low-income women were most likely not to have received a Pap test [odds ratio (OR) = 3.27, 95% confidence interval (CI) = 2.70-3.98], followed by medium-income women (OR = 1.73, 95% CI = 1.41-2.12), compared with high-income women. The gradient by education was of a similar magnitude, and both income and education gradients remained stable from 2005 to 2009. Restricting the analysis to eight provinces that have been deemed to be high priority due to their high levels of mortality from cervical cancer reveals an increasing income-based gradient in Pap smears. In contrast, inequalities in mammography diminished across the country, with a significant reduction in the social gradient measured either by income or education. In contrast to high-income women, low-income women experienced higher odds of not having a mammogram, but the gap diminished over time [OR = 4.14 (95% CI = 2.96-5.78) in 2005 vs OR = 2.37 (95% CI = 1.81-3.11) in 2009]. Conclusion: Social gradients in cancer screening are changing in Argentina. There are signs of a reduction in inequalities in mammograms, although this is attenuated by indications that inequalities in Pap smear utilization in priority provinces are growing. Surveillance of population indicators is needed to verify whether these short-term changes persist over time. © 2012 The Royal Society for Public Health.

Navoni J.A.,University of Buenos Aires | De Pietri D.,Ministerio de Salud de la Nacion | Garcia S.,Ministerio de Salud de la Nacion | Lepori E.C.V.,University of Buenos Aires
Revista Panamericana de Salud Publica/Pan American Journal of Public Health | Year: 2012

Objective: To analyze the concentration of arsenic in water collected in localities of the province of Buenos Aires, Argentina, and the epidemiological relationship of that concentration to factors of susceptibility and associated pathologies. Methods: In 152 samples from 52 localities of Buenos Aires from 2003-2008, the concentration of arsenic was quantified through the generation of hydride spectrophotometry of atomic absorption. A composite index of health (CIH) was constructed using the content of arsenic and the percentages of households with unmet basic needs and dwellings without access to the potable water. Through the CIH, risk areas associated with mortality from malignant neoplasms related to arsenic were defined. Results: Concentrations of arsenic spanned a broad range from 0.3 to 187 mg/L, with a median of 40 mg/L. Of the samples, 82% presented levels of arsenic higher than the acceptable limit of 10 mg/L, and more than half of those came from households with potable water connections. In the departments studied, the average mortality (deaths/100 000 inhabitants) from tumors was greater in men than in women: respiratory tract (310 versus 76), urinary tract (44 versus 11), and skin (21 versus 11), respectively. The regions with greater concentrations of arsenic and of poverty, together with the lack of potable water connections, had a two-to-four times greater risk. Conclusions: The findings from the composite index of health summarized the health risk from exposure to arsenic for lower socioeconomic levels of the population for a broad area of the province of Buenos Aires.

de Maio F.G.,DePaul University | Linetzky B.,Ministerio de Salud de la Nacion | Ferrante D.,Ministerio de Salud de la Nacion | Fleischer N.L.,University of Michigan
Global Public Health | Year: 2012

A consensus on income inequality as a social determinant of health is yet to be reached. In particular, we know little about the cross-sectional versus lagged effect of inequality and the robustness of the relationship to indicators that are sensitive to varying parts of the income spectrum. We test these issues with data from Argentina's 2005 and 2009 National Risk Factor Surveys. Inequality was operationalised at the provincial level with the Gini coefficient and the Generalised Entropy (GE) index. Population health was defined as the age-standardised percentage of adults with poor/fair self-rated health by province. Our crosssectional results indicate a significant relationship between inequality (Gini) and poor health (r=0.58, p<0.01) in 2005. Using the GE index, a gradient pattern emerges in the correlation, and the r values increase as the index becomes sensitive to the top of the distribution. The relationship between 2005 inequality and 2009 health displays a similar pattern, but with generally smaller correlations than the 2005 cross-sectional results. Further advances in the income inequality and health literature require new theoretical models to account for how inequalities in different parts of the income spectrum may influence population health in different ways. © 2012 Taylor & Francis.

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