Factores que inciden en la provisión de tratamientos de reproducción asistida / Factors that affect the provision of assisted reproduction treatments

INTRODUCCIÓN La Ley 26862 garantiza el acceso a las técnicas de reproducción asistida (TRA) sin distinción de edad, orientación sexual o situación conyugal. OBJETIVOS Conocer los factores objetivos (FO) y subjetivos (FS) que inciden en la provisión de TRA en el ámbito público de la Ciudad Autónoma de Buenos Aires. MÉTODOS Se realizó un estudio cualitativo, con entrevistas en profundidad a profesionales y funcionarios encargados de diagnosticar y garantizar las condiciones de provisión de TRA en salud pública. Resultados FO Las condiciones edilicias, el equipamiento tecnológico y los recursos humanos no constituyen barreras para la provisión de TRA. Las obras sociales y empresas de medicina prepaga cubren tratamientos, pero las personas sin cobertura médica sólo acceden mediante pago. FS A) Tipo de tratamiento: No se observan reticencias al uso de inseminación artificial, fertilización in vitro o inyección intracitoplasmática de espermatozoide. La mayoría acuerda con implementar donación de gametos para garantizar el acceso de los sujetos previstos por ley (lesbianas, mujeres sin pareja o de mayor edad). Se aboga por un sistema altruista sin pago de gametos. Hay actitudes favorecedoras de la implementación de lo estipulado en la ley. B) Acceso por parte de los sujetos definidos por la ley: La mayoría de los entrevistados está de acuerdo con el acceso por parte de parejas del mismo sexo y mujeres sin pareja (actitudes favorecedoras de implementación de la ley y los sujetos previstos). La mayoría de los participantes considera que debe establecerse un límite de edad para el acceso a las TRA con óvulos propios. DISCUSIÓN Las barreras objetivas más importantes son el cobro de los tratamientos a las personas sin seguro médico y la inexistencia de un servicio de donación de gametos. Las barreras subjetivas están vinculadas a la necesidad de actitudes facilitadoras en general, con la excepción de las mujeres mayores de 42 años, por razones médicas.

Factors associated with migration in individuals affected by leprosy, maranhão, Brazil: an exploratory cross-sectional study.

In Brazil, leprosy is endemic and concentrated in high-risk clusters. Internal migration is common in the country and may influence leprosy transmission and hamper control efforts. We performed a cross-sectional study with two separate analyses evaluating factors associated with migration in Brazil's Northeast: one among individuals newly diagnosed with leprosy and the other among a clinically unapparent population with no symptoms of leprosy for comparison. We included 394 individuals newly diagnosed with leprosy and 391 from the clinically unapparent population. Of those with leprosy, 258 (65.5%) were birth migrants, 105 (26.6%) were past five-year migrants, and 43 (10.9%) were circular migrants. In multivariate logistic regression, three independent factors were found to be significantly associated with migration among those with leprosy: (1) alcohol consumption, (2) separation from family/friends, and (3) difficulty reaching the healthcare facility. Separation from family/friends was also associated with migration in the clinically unapparent population. The health sector may consider adapting services to meet the needs of migrating populations. Future research is needed to explore risks associated with leprosy susceptibility from life stressors, such as separation from family and friends, access to healthcare facilities, and alcohol consumption to establish causal relationships.

Investigation of a scabies outbreak in a kindergarten in Constance, Germany.

In industrialized countries, scabies occurs sporadically or in the form of protracted epidemics, typically in nursing homes for elderly people. Outbreaks of scabies in a kindergarten are very rare. The main goal of our study was to investigate an outbreak of scabies in a kindergarten and to identify risk factors for the infestation with the ectoparasitosis. We investigated an outbreak of scabies in a kindergarten in the City of Constance, southern Germany, with a particular pedagogical concept. Risk factors indicating a transmission of Sarcoptes mites through body contact or via fomites were assessed using questionnaires and by following the daily routine in the kindergarten. A total of 16 cases were identified. The attack rate was significantly higher in nursery teachers (risk ratio 42.1) compared to children (risk ratio 10.5). In all cases, scabies had developed rather recently, with minimal clinical manifestations. In nursery teachers, the probability of scabies was 4.4 times higher in those teachers who hugged children regularly. Children who preferably played with their own soft toys had a lower probability of developing scabies [risk ratio 0.14, 95 % confidence interval (CI) 0.05-0.42; p = 0.04]. It seems conceivable that the particular pedagogical concept of the kindergarten favored the spread of Sarcoptes mites. We were unable to show whether transmission had preferably occurred through body contact or via fomites.

A simple method for rapid community assessment of tungiasis.

OBJECTIVE: To evaluate a rapid assessment method to estimate the overall prevalence of tungiasis and severity of disease in endemic communities. METHODS: We analysed data from 10 population-based surveys on tungiasis, performed in five endemic communities in Brazil and Nigeria between 2001 and 2008. To assess the association between occurrence of tungiasis on six defined topographic areas of the feet and the true prevalence/prevalence of severe disease, linear regression analyses were performed. Estimated prevalences were calculated for each of the 10 surveys and compared to true prevalences. We then selected the most useful topographic localization to define a rapid assessment method, based on the strength of association and operational aspects. RESULTS: In total, 7121 individuals of the five communities were examined. Prevalence of tungiasis varied between 21.1% and 54.4%. The presence of periungual lesions on the toes was identified as the most useful rapid assessment to estimate the prevalence of tungiasis (absolute errors: -4% to +3.6%; R(2 )=96%; P < 0.0001). Prevalence of severe tungiasis (>20 lesions) was also estimated by the method (absolute errors: -3.1% to +2.5%; R(2 )=76%; P = 0.001). CONCLUSION: Prevalence of tungiasis and prevalence of severe disease can be reliably estimated in communities with distinct cultural and geographical characteristics, by applying a simple and rapid epidemiological method. This approach will help to detect high-risk communities and to monitor control measures aimed at the reduction of tungiasis.

Prevalence and risk factors of hookworm-related cutaneous larva migrans in a rural community in Brazil.

The epidemiology of hookworm-related cutaneous larva migrans (HrCLM) in endemic communities is not well understood. To describe the prevalence of HrCLM and to identify environmental and behavioural risk factors for the infestation, two cross-sectional surveys were conducted in a small village in an endemic area of north-eastern Brazil - one in the rainy season and the other in the dry season. The members of each household were examined clinically for the presence of HrCLM, and information on possible risk factors was collected. HrCLM, which was diagnosed in 45 individuals in the rainy-season survey and in 17 in the dry-season survey, was significantly more prevalent in the rainy season (4.4% v. 1.7%; P<0.001). The age-specific prevalences peaked, at 14.9%, in infants and children aged < or = 4 years. In a logistic regression analysis, the independent risk factors for current infestation or infestation in the preceding 6 months were identified as young age (odds ratio = 0.96; 95% confidence interval = 0.94-0.98), living in a house without a solid floor (odds ratio = 1.99; 95% confidence interval = 1.22-3.23), and walking barefoot (odds ratio = 1.77; 95% confidence interval = 1.12-2.80). In the study area, therefore, HrCLM is a common parasitic skin disease in children, is associated with behavioural and environmental risk factors, and shows marked seasonality in its prevalence. Local control of HrCLM should be based primarily on the health education of mothers and the elder girls who take care of their younger siblings.