Trabajar en salud durante la pandemia: Experiencias de vinculación con la comunidad relativas a la producción social del cuidado en Mar del Plata, Argentina / Work in health during the pandemic: Experiences of linking with the community related to the social production of care in Mar del Plata, Argentina

Resumen En este artículo proponemos visibilizar las estrategias de vinculación comunitaria de trabajadores/as de salud pública relativas a la producción del cuidado en el contexto crítico de la pandemia de la covid-19, signado por la profundización de la pobreza, la restricción de los servicios de salud y las tensiones del sistema sanitario en Argentina. Con un diseño metodológico cualitativo y enfoque etnográfico, entrevistamos a trabajadoras/es de distintas disciplinas, ocupaciones y géneros que se desempeñan en centros de salud y hospitales públicos en Mar del Plata y zonas rurales circundantes, entre los meses de marzo y diciembre de 2021. A partir de sus narrativas, analizamos las dimensiones de acceso a la alimentación, medicación y terapias holísticas, las dificultades encontradas y su contribución a la producción social del cuidado en salud. Concluimos que las estrategias generadas conllevan el potencial instituyente para la reorientación de los servicios públicos de salud de acuerdo con los desafíos del derecho a la salud desde la perspectiva de género y derechos en el tránsito a la postpandemia.

Abstract In this article we propose to make visible the strategies of community engagement of public health workers related to the production of care in the critical context of the covid-19 pandemic, marked by the deepening of poverty, the restriction of health services and the tensions of the health system in Argentina. With a qualitative methodological design and ethnographic approach, we interviewed workers from different disciplines, occupations and genders, who work in health centers and public hospitals in Mar del Plata and surrounding rural areas, between the months of March and December 2021. Based on their narratives, we analyze the dimensions of access to food, medication and holistic therapies, the difficulties encountered and their contribution to the social production of health care. We conclude that the strategies generated carry the instituting potential for the reorientation of public health services in accordance with the challenges of the right to health from the perspective of gender and rights in the transition to the post-pandemic.

Guía de manejo obstétrico y del recién nacido en madre aloinmunizada / Guidelines for the obstetric management of an alloimmune mother and her newborn / Guia de manejo obstétrico e neonatal em mães aloimunizadas

Resumen: La aloinmunización es una respuesta biológica frente a la exposición de antígenos no propios. La gestación, las transfusiones de hemocomponentes, los trasplantes de órganos sólidos y células hematopoyéticas, así como el consumo de drogas intravenosas exponen a las pacientes al desarrollo de aloanticuerpos antieritrocitarios. El hallazgo de los mismos debe cumplir con las instancias diagnósticas para identificar la probabilidad de estar asociados a enfermedad hemolítica feto neonatal (EHFN) y su oportuna derivación a policlínica de alto riesgo obstétrico (ARO) para su correcto seguimiento. Es fundamental que sean los laboratorios de inmunohematología de los servicios de hemoterapia y medicina transfusional los encargados de los estudios diagnósticos de aloinmunización eritrocitaria(1). En este sentido hemos elaborado esta guía con el objetivo de protocolizar de manera multidisciplinaria el manejo de las embarazadas aloinmunizadas y sus recién nacidos.

Abstract: Alloimmunization is the biological response to exposure to non-HLA antigens. Pregnancy, transfusion of blood components, solid organ and hematopoietic cell transplantation, as well as intravenous drug use expose patients to the development of anti-erythrocyte antibodies. When the latter are found, they must match diagnostic criteria to identify the potential association to hemolytic disease of the fetus and newborn (HDFN) and its timely referral to the high-risk obstetric risk polyclinic for due follow-up. It is of the essence for erythrocyte alloimmunization diagnostic tests to be carried out by the immunohematology laboratories of the Hemotherapy and Transfusional Medicine services. To that end, we have prepared these guidelines with the purpose of providing a multidisciplinary protocol for the handling of maternal alloimmunization and alloimmunization of the newborn.

Resumo: A aloimunização é uma resposta biológica à exposição a antígenos não próprios. A gravidez, as transfusões de hemocomponentes, os transplantes de órgãos sólidos e células hematopoiéticas, bem como o uso de drogas intravenosas expõem os pacientes ao desenvolvimento de anticorpos antieritrocitários. O achado destes deve obedecer a critérios diagnósticos para identificar a doença e a probabilidade de estarem associados a doença hemolítica feto neonatal (DHPN) e seu encaminhamento oportuno para uma unidade de alto risco obstétrico para acompanhamento adequado. É fundamental que os laboratórios de imuno-hematologia dos serviços de Hemoterapia e Medicina Transfusional se encarreguem dos estudos diagnósticos da aloimunização eritrocitária. Elaboramos este guia com o objetivo de estabelecer um protocolo multidisciplinar para o manejo de gestantes aloimunizadas e seus recém-nascidos.

[The emergence of diabetes in a Tapiete community of Salta: gender, ethnicity and relations with the health system]. / La emergencia de la diabetes en una comunidad tapiete de Salta: género, etnicidad y relaciones con el sistema de salud.

In Argentina, the presence of diabetes and other chronic diseases among indigenous populations has not yet been sufficiently studied. This article is the result of an ethnographic study of the sociocultural and gender determinants that are involved in diabetes care and prevention processes among the Tapiete people in the province of Salta. The research combined participant observation and interviews both with adult men and women diagnosed with diabetes and with nurses and doctors at a primary care center in Misión Los Tapietes and at a hospital in Tartagal between August and September of 2019. The growing presence of diabetes has been observed in the community, along with a lack of articulation of social and health interventions with native practices of health-disease-care, as well as problems in communicating diagnosis and treatment options, intensified by difficulties regarding access to the healthcare system. The article examines the complexity of the epidemiological transition, meanings of chronic disease for men and women, the traumatic emergence of diabetes, and difficulties in exercising the right to health among indigenous populations.

En Argentina, la ocurrencia de diabetes y otras enfermedades crónicas en población indígena aún no ha sido suficientemente estudiada. Este trabajo es resultado de una exploración etnográfica de las determinaciones socioculturales y de género de los procesos de atención y prevención de diabetes en indígenas tapietes de la provincia de Salta. La investigación combinó observación participante con entrevistas a varones y mujeres de edad adulta y con diagnóstico de diabetes, y entrevistas a enfermeras y médicas de un centro de atención primaria de Misión Los Tapietes y de un hospital de Tartagal, entre los meses de agosto y septiembre de 2019. En la comunidad se ha observado la creciente presencia de diabetes, junto con la falta de articulación de las intervenciones sociosanitarias con las prácticas nativas de salud-enfermedad-atención; los problemas en la comunicación del diagnóstico y tratamiento; y las dificultades de acceso al sistema de salud. El artículo discute la complejidad de la transición epidemiológica, los sentidos de la enfermedad crónica para los varones y las mujeres, la emergencia traumática de la diabetes y las dificultades en el ejercicio del derecho a la salud de los pueblos originarios.

La emergencia de la diabetes en una comunidad tapiete de Salta: género, etnicidad y relaciones con el sistema de salud / The emergence of diabetes in a Tapiete community of Salta: gender, ethnicity and relations with the health system

RESUMEN En Argentina, la ocurrencia de diabetes y otras enfermedades crónicas en población indígena aún no ha sido suficientemente estudiada. Este trabajo es resultado de una exploración etnográfica de las determinaciones socioculturales y de género de los procesos de atención y prevención de diabetes en indígenas tapietes de la provincia de Salta. La investigación combinó observación participante con entrevistas a varones y mujeres de edad adulta y con diagnóstico de diabetes, y entrevistas a enfermeras y médicas de un centro de atención primaria de Misión Los Tapietes y de un hospital de Tartagal, entre los meses de agosto y septiembre de 2019. En la comunidad se ha observado la creciente presencia de diabetes, junto con la falta de articulación de las intervenciones sociosanitarias con las prácticas nativas de salud-enfermedad-atención; los problemas en la comunicación del diagnóstico y tratamiento; y las dificultades de acceso al sistema de salud. El artículo discute la complejidad de la transición epidemiológica, los sentidos de la enfermedad crónica para los varones y las mujeres, la emergencia traumática de la diabetes y las dificultades en el ejercicio del derecho a la salud de los pueblos originarios.

ABSTRACT In Argentina, the presence of diabetes and other chronic diseases among indigenous populations has not yet been sufficiently studied. This article is the result of an ethnographic study of the sociocultural and gender determinants that are involved in diabetes care and prevention processes among the Tapiete people in the province of Salta. The research combined participant observation and interviews both with adult men and women diagnosed with diabetes and with nurses and doctors at a primary care center in Misión Los Tapietes and at a hospital in Tartagal between August and September of 2019. The growing presence of diabetes has been observed in the community, along with a lack of articulation of social and health interventions with native practices of health-disease-care, as well as problems in communicating diagnosis and treatment options, intensified by difficulties regarding access to the healthcare system. The article examines the complexity of the epidemiological transition, meanings of chronic disease for men and women, the traumatic emergence of diabetes, and difficulties in exercising the right to health among indigenous populations.

Compliance with the 2009 Royal College of Obstetricians and Gynaecologists guidelines for venous thromboembolic disease prophylaxis in pregnancy and postpartum period in Uruguay.

: Venous thromboembolism remains as one of the leading causes of maternal death. Prevention of venous thromboembolism in the obstetric population is challenging as recommendations for prophylaxis have low grade of evidence. Risk factors and prophylaxis guidelines have been highlighted by Royal College of Obstetricians and Gynaecologists. In 2014, we developed a written alert following this guidelines to guide thromboprophylaxis. The aim of this study is to assess recommendations compliance. This study was conducted at University-Hospital in Uruguay from January 2014 to December 2016. A total of 1035 women were enrolled and stratified in high, intermediate or low risk based on Royal College of Obstetricians and Gynaecologists guidelines. Thromboprophylaxis was recommended for women at intermediate and high risk. Women were followed up to assess symptomatic thromboembolism or haemorrhagic complications. A total of 309 were pregnant and 731 puerperal. Median age was 24 (19-29) years old. Of them, 3.0% (n = 31) were at high risk and 35.4% (n = 366) at intermediate risk. All high-risk women received prophylaxis with low-molecular-weight heparin. Of the 366 intermediate-risk women, 52.7% received prophylaxis. Venous thromboembolism was developed in only one woman of the intermediate group, who had received prophylaxis. Bleeding complications were not observed. Awareness of the thrombotic risk, as conferred by an easy and suitable risk assessment, has the potential to improve venous thromboembolism prophylaxis in pregnant and puerperal women. We have a good guidelines compliance with the written alert in the high-risk women group. However, we have to improve low-molecular-weight heparin indication in intermediate-risk group, especially in postcaesarean women.

[Does geographic context matter in diabetes-related mortality? Spatial and time trends in Argentina, 1990-2012]. / ¿El contexto geográfico importa en la mortalidad por diabetes mellitus? Tendencias espacio-temporales en Argentina, 1990-2012.

The aim of this study was to identify spatial-temporal clusters of high and low diabetes-related mortality from 1990 to 2012 in Argentina. This was a spatial-temporal retrospective ecological study in the population older than 34 years living in Argentina, according to sex, from 1990 to 2012. The spatial units of analysis consisted of the country's departments (subdivisions of the provinces) plus the Autonomous City of Buenos Aires. Spatial-temporal exploration technique was used to detect clusters with high and low mortality. Areas with high mortality from diabetes mellitus were found in the Central-West of the country, and areas with low mortality were found in the coastal region of the province of Buenos Aires and Patagonia. Clusters with high mortality occupied a period from 1995 to 2008; clusters with low mortality shifted towards the years 2002 to 2012. The recent drop in mortality from diabetes was not geographically homogeneous, but displayed a marked decrease in the eastern area of the Province of Buenos Aires and the Autonomous City of Buenos Aires.

¿El contexto geográfico importa en la mortalidad por diabetes mellitus? Tendencias espacio-temporales en Argentina, 1990-2012 / Does geographic context matter in diabetes-related mortality? Spatial and time trends in Argentina, 1990-2012 / É importante o contexto geográfico na mortalidade por diabetes mellitus? Tendências espaço-temporais na Argentina, 1990-2012

Resumen: El objetivo de esta investigación fue identificar conglomerados espacio-temporales de alta y baja mortalidad por diabetes mellitus durante el período 1990-2012 en Argentina. Se realizó un estudio ecológico retrospectivo espacio-temporal. Se consideró la población mayor de 34 años residente en Argentina, según sexo, durante el período 1990-2012. Las unidades espaciales de análisis estuvieron conformadas por departamentos más la Ciudad Autónoma de Buenos Aires. Se empleó la técnica de exploración espacio-temporal para la detección de conglomerados de alta y baja mortalidad. Se encontraron áreas de elevada mortalidad por diabetes mellitus en el centro-oeste del país, y zonas de baja mortalidad en la región costera de la provincia de Buenos Aires y Patagonia. Los conglomerados de alta mortalidad ocuparon un período comprendido entre 1995 y 2008; los de baja mortalidad se desplazaron hacia los años 2002-2012. El descenso reciente en la mortalidad por diabetes mellitus no fue geográficamente homogéneo, con una disminución marcada en el este de la Provincia de Buenos Aires y la Ciudad Autónoma de Buenos Aires.

Abstract: The aim of this study was to identify spatial-temporal clusters of high and low diabetes-related mortality from 1990 to 2012 in Argentina. This was a spatial-temporal retrospective ecological study in the population older than 34 years living in Argentina, according to sex, from 1990 to 2012. The spatial units of analysis consisted of the country's departments (subdivisions of the provinces) plus the Autonomous City of Buenos Aires. Spatial-temporal exploration technique was used to detect clusters with high and low mortality. Areas with high mortality from diabetes mellitus were found in the Central-West of the country, and areas with low mortality were found in the coastal region of the province of Buenos Aires and Patagonia. Clusters with high mortality occupied a period from 1995 to 2008; clusters with low mortality shifted towards the years 2002 to 2012. The recent drop in mortality from diabetes was not geographically homogeneous, but displayed a marked decrease in the eastern area of the Province of Buenos Aires and the Autonomous City of Buenos Aires.

Resumo: O objetivo desta pesquisa foi identificar conglomerados espaço-temporais de alta e baixa mortalidade por diabetes mellitus durante o período 1990-2012 na Argentina. Foi realizado um estudo ecológico retrospectivo espaço-temporal, considerando a população maior de 34 anos, residente na Argentina, segundo o sexo, durante o período de 1990-2012. As unidades espaciais de análises foram constituídas pelos departamentos, junto com a Cidade Autônoma de Buenos Aires. Foi empregada a técnica de exploração espaço-temporal para a detecção de conglomerados de alta e baixa mortalidade. Foram encontradas áreas de elevada mortalidade por diabetes mellitus no Centro-oeste do país, e zonas de baixa mortalidade na região costeira da província de Buenos Aires e Patagônia. Os conglomerados de alta mortalidade ocuparam um período compreendido entre 1995 e 2008; os de baixa mortalidade foram no período de 2002-2012. A diminuição recente na mortalidade por diabetes mellitus não foi geograficamente homogênea, com destaque para o leste da província de Buenos Aires e a Cidade Autônoma de Buenos Aires.

Diffusion of aniline blue injected into the thyroarytenoid muscle as a proxy for botulinum toxin injection: an experimental study in cadaver larynges

Endolaryngeal injection of botulinum toxin into the thyroarytenoid (TA) muscle is one of the methods for treatment of focal laryngeal dystonia. However, after treatment, there is variation in laryngeal configuration as well as the side effects reported by patients. As a consequence of the functional variability of results, it was hypothesized that botulinum toxin diffuses beyond the limits of the muscle into which it is injected. OBJECTIVES: After injection of botulinum toxin into the TA muscle for the treatment of focal laryngeal dystonia, patients differ in terms of laryngeal configuration and side effects. We hypothesized that this toxin diffuses from the target muscle to adjacent muscles. METHOD: The TA muscles of 18 cadaver larynges were injected with aniline blue (0.2 mL). After fixation in formaldehyde and nitric acid decalcification, the larynges were sectioned in the coronal plane and the intrinsic muscles were analyzed. RESULTS: We found diffusion of aniline blue to the lateral cricoarytenoid muscle, cricothyroid muscle, and posterior cricoarytenoid muscle in 94.3%, 42.9%, and 8.6% of the cases, respectively. In terms of the degree of diffusion to adjacent muscles, we found no differences related to the size (height and width) of the TA muscle or to gender. CONCLUSIONS: Our findings suggest that diffusion of botulinum toxin from its injection site in the TA muscle to the lateral cricoarytenoid muscle is likely in most cases. On the other hand, diffusion to the cricothyroid muscle occurs in approximately half of cases and diffusion to the posterior cricoarytenoid muscle occurs in very few cases...

Diffusion of aniline blue injected into the thyroarytenoid muscle as a proxy for botulinum toxin injection: an experimental study in cadaver larynges.

INTRODUCTION: Endolaryngeal injection of botulinum toxin into the thyroarytenoid (TA) muscle is one of the methods for treatment of focal laryngeal dystonia. However, after treatment, there is variation in laryngeal configuration as well as the side effects reported by patients. As a consequence of the functional variability of results, it was hypothesized that botulinum toxin diffuses beyond the limits of the muscle into which it is injected. OBJECTIVES: After injection of botulinum toxin into the TA muscle for the treatment of focal laryngeal dystonia, patients differ in terms of laryngeal configuration and side effects. We hypothesized that this toxin diffuses from the target muscle to adjacent muscles. METHOD: The TA muscles of 18 cadaver larynges were injected with aniline blue (0.2 mL). After fixation in formaldehyde and nitric acid decalcification, the larynges were sectioned in the coronal plane and the intrinsic muscles were analyzed. RESULTS: We found diffusion of aniline blue to the lateral cricoarytenoid muscle, cricothyroid muscle, and posterior cricoarytenoid muscle in 94.3%, 42.9%, and 8.6% of the cases, respectively. In terms of the degree of diffusion to adjacent muscles, we found no differences related to the size (height and width) of the TA muscle or to gender. CONCLUSIONS: Our findings suggest that diffusion of botulinum toxin from its injection site in the TA muscle to the lateral cricoarytenoid muscle is likely in most cases. On the other hand, diffusion to the cricothyroid muscle occurs in approximately half of cases and diffusion to the posterior cricoarytenoid muscle occurs in very few cases.

[False diagnosis of tuberculosis by culture]. / Falso diagnostico de tuberculosis por cultivo.

A remarkable input to the epidemiology of tuberculosis was not the only benefit of the molecular tools developed in the early nineties for Mycobacterium tuberculosis intra-species differentiation. These genotyping methods served also to unveil specimen cross-contamination, which was until then overlooked in laboratories culturing mycobacteria. This error consists in the accidental carry-over of bacilli from a specimen with high bacterial load to that, or those, processed subsequently. The ensuing detection of falsely positive cultures can result in a wrong diagnosis of tuberculosis and the initiation of a long-lasting treatment with potentially toxic drugs. This series of errors implies the mismanagement of patients, the distraction of public health system resources, and the distortion of epidemiological data. M. tuberculosis laboratory cross-contamination was detected wherever investigated systematically, with a median rate of 3% of all positive cultures. The confirmation of this error requires a critical appraisal of bacteriological, clinical, epidemiological and genotyping results. We present here a review of national and international information on laboratory cross-contamination and describe measures recommended for minimizing the risk, surveying the occurrence, and avoiding clinical consequences of this laboratory error that raises a question on the reliability of a positive culture.

Falso diagnóstico de tuberculosis por cultivo / False diagnosis of tuberculosis by culture

Las herramientas de genotipificación intra-especie de Mycobacterium tuberculosis desarrolladas durante los años 90 no sólo dieron un impulso notable a la epidemiología de la tuberculosis, también pusieron de manifiesto un fenómeno hasta entonces soslayado en los laboratorios de tuberculosis: la contaminación cruzada de muestras. Este error consiste en la transferencia accidental de bacilos de una muestra con alta carga bacilar a la o las procesadas subsecuentemente. La consiguiente aparición de falsos cultivos positivos puede inducir al diagnóstico erróneo de tuberculosis y la instauración de tratamientos prolongados con drogas potencialmente tóxicas. Esa secuencia de errores conduce al mal manejo de los pacientes involucrados, la distracción de los recursos del sistema de salud y la distorsión de los resultados de análisis epidemiológicos. Se detectó contaminación cruzada en todos los laboratorios donde fue investigada sistemáticamente, con tasas de alrededor del 3% de los cultivos positivos. La confirmación requiere confrontar resultados bacteriológicos, clínicos, epidemiológicos y de genotipificación. Realizamos aquí una revisión de la información nacional e internacional sobre el tema y describimos las medidas recomendadas para minimizar el riesgo, vigilar la ocurrencia y evitar las consecuencias clínicas de este error de laboratorio que vulnera la certeza de un cultivo positivo.(AU)

A remarkable input to the epidemiology of tuberculosis was not the only benefit of the molecular tools developed in the early nineties for Mycobacterium tuberculosis intra-species differentiation. These genotyping methods served also to unveil specimen crosscontamination, which was until then overlooked in laboratories culturing mycobacteria. This error consists in the accidental carry-over of bacilli from a specimen with high bacterial load to that, or those, processed subsequently. The ensuing detection of falsely positive cultures can result in a wrong diagnosis of tuberculosis and the initiation of a long-lasting treatment with potentially toxic drugs. This series of errors implies the mismanagement of patients, the distraction of public health system resources, and the distortion of epidemiological data. M. tuberculosis laboratory cross-contamination was detected wherever investigated systematically, with a median rate of 3% of all positive cultures. The confirmation of this error requires a critical appraisal of bacteriological, clinical, epidemiological and genotyping results. We present here a review of national and international information on laboratory crosscontamination and describe measures recommended for minimizing the risk, surveying the occurrence, and avoiding clinical consequences of this laboratory error that raises a question on the reliability of a positive culture.(AU)

Falso diagnóstico de tuberculosis por cultivo / False diagnosis of tuberculosis by culture

Las herramientas de genotipificación intra-especie de Mycobacterium tuberculosis desarrolladas durante los años 90 no sólo dieron un impulso notable a la epidemiología de la tuberculosis, también pusieron de manifiesto un fenómeno hasta entonces soslayado en los laboratorios de tuberculosis: la contaminación cruzada de muestras. Este error consiste en la transferencia accidental de bacilos de una muestra con alta carga bacilar a la o las procesadas subsecuentemente. La consiguiente aparición de falsos cultivos positivos puede inducir al diagnóstico erróneo de tuberculosis y la instauración de tratamientos prolongados con drogas potencialmente tóxicas. Esa secuencia de errores conduce al mal manejo de los pacientes involucrados, la distracción de los recursos del sistema de salud y la distorsión de los resultados de análisis epidemiológicos. Se detectó contaminación cruzada en todos los laboratorios donde fue investigada sistemáticamente, con tasas de alrededor del 3% de los cultivos positivos. La confirmación requiere confrontar resultados bacteriológicos, clínicos, epidemiológicos y de genotipificación. Realizamos aquí una revisión de la información nacional e internacional sobre el tema y describimos las medidas recomendadas para minimizar el riesgo, vigilar la ocurrencia y evitar las consecuencias clínicas de este error de laboratorio que vulnera la certeza de un cultivo positivo.

A remarkable input to the epidemiology of tuberculosis was not the only benefit of the molecular tools developed in the early nineties for Mycobacterium tuberculosis intra-species differentiation. These genotyping methods served also to unveil specimen crosscontamination, which was until then overlooked in laboratories culturing mycobacteria. This error consists in the accidental carry-over of bacilli from a specimen with high bacterial load to that, or those, processed subsequently. The ensuing detection of falsely positive cultures can result in a wrong diagnosis of tuberculosis and the initiation of a long-lasting treatment with potentially toxic drugs. This series of errors implies the mismanagement of patients, the distraction of public health system resources, and the distortion of epidemiological data. M. tuberculosis laboratory cross-contamination was detected wherever investigated systematically, with a median rate of 3% of all positive cultures. The confirmation of this error requires a critical appraisal of bacteriological, clinical, epidemiological and genotyping results. We present here a review of national and international information on laboratory crosscontamination and describe measures recommended for minimizing the risk, surveying the occurrence, and avoiding clinical consequences of this laboratory error that raises a question on the reliability of a positive culture.

[Drug consumption and health equity in the Metropolitan Area of Buenos Aires, Argentina]. / Consumo de medicamentos y equidad en materia de salud en el Area Metropolitana de Buenos Aires, Argentina.

OBJECTIVE: To assess the level of equity in drug consumption patterns in the Metropolitan Area of Buenos Aires, Argentina, given the transformation of the Argentine pharmaceutical market since the deregulation of the country's economy in 1991. METHODOLOGY: For this study, data from secondary statistical sources were processed and analyzed. The secondary sources used were two household surveys that contained a module on the utilization of health services and the associated expenditures. The surveys had been designed by the Ministry of Health and were applied in the Metropolitan Area of Buenos Aires in 1989 and 1995. RESULTS: There was a socially regressive increase in out-of-pocket expenditures on drugs between 1989 and 1995, in a market where average drug prices doubled in the midst of relaxed price controls and more open imports. The regressive character of drug expenditures was shown in the growth in direct spending for drug purchases, the increase in the proportion of private health expenditures devoted to drugs, and the unequal increase among the different economic strata in the proportion of family income going toward drugs. CONCLUSIONS: Out-of-pocket expenditures on drugs are an efficient indicator of equity for studying the financial protections that urban Argentines have when they become ill. This kind of indicator of financial equity could help improve the regulatory framework of the pharmaceutical market by incorporating social evaluation criteria along with analyses of pharmaceutical safety and therapeutic efficacy.

Consumo de medicamentos y equidad en materia de salud en el Area Metropolitana de Buenos Aires, Argentina / Drug consumption and health equity in the Metropolitan Area of Buenos Aires, Argentina

OBJETIVO: Medir la equidad manifestada por los patrones de consumo de medicamentos en el Area Metropolitana de Buenos Aires, Argentina, a la luz de las transformaciones operadas en el mercado farmacéutico argentino después de la desregulación de la economía en 1991. METODOLOGíA: Se procesaron y analizaron fuentes estadísticas secundarias: se utilizaron dos encuestas domiciliarias que contenían un módulo sobre la utilización de servicios de salud y gastos asociados diseñado por el Ministerio de Salud y aplicado al Area Metropolitana de Buenos Aires en 1989 y 1995. RESULTADOS: Se constató un aumento del carácter socialmente regresivo del gasto de bolsillo en medicamentos entre 1989 y 1995, en un mercado farmacéutico que ha duplicado sus precios medios en el nuevo contexto de liberación de precios y apertura de las importaciones. Esta regresión se manifestó en el crecimiento del gasto directo de la compra de medicamentos, el aumento de la parte correspondiente a los medicamentos en la estructura del gasto privado para la salud y el incremento desigual del peso relativo de dicho gasto en los ingresos familiares. CONCLUSIONES: El gasto de bolsillo en medicamentos resulta un indicador eficiente de equidad financiera para el estudio de la protección de la población urbana argentina frente al riesgo de enfermar, y puede contribuir a la adecuación del marco regulador del mercado farmacéutico, mediante la incorporación de criterios sociales de evaluación a la ecuación farmacológica de seguridad y eficacia terapéutica

Objective. To assess the level of equity in drug consumption patterns in the Metropolitan Area of Buenos Aires, Argentina, given the transformation of the Argentine pharmaceutical market since the deregulation of the country's economy in 1991. Methodology. For this study, data from secondary statistical sources were processed and analyzed. The secondary sources used were two household surveys that contained a module on the utilization of health services and the associated expenditures. The surveys had been designed by the Ministry of Health and were applied in the Metropolitan Area of Buenos Aires in 1989 and 1995. Results. There was a socially regressive increase in out-of-pocket expenditures on drugs between 1989 and 1995, in a market where average drug prices doubled in the midst of relaxed price controls and more open imports. The regressive character ofdrug expenditures was shown in the growth in direct spending for drug purchases, the increase in the proportion of private health expenditures devoted to drugs, and the unequal increase among the different economic strata in the proportion of family income going toward drugs. Conclusions. Out-of-pocket expenditures on drugs are an efficient indicator of equity for studying the financial protections that urban Argentines have when they become ill. This kind of indicator of financial equity could help improve the regulatory framework of the pharmaceutical market by incorporating social evaluation criteria along with analyses of pharmaceutical safety and therapeutic efficacy.