Methodology for the assessment of brucellosis management practices and its vaccination campaign: example in two Argentine districts.

BACKGROUND: In Argentina, vaccination with Brucella abortus Strain 19 vaccine is mandatory. The objective of the study was to develop and test a method for evaluating, in an innovative way, some farmers' and veterinarians' management practices in relation to brucellosis and to assess the vaccination campaign and coverage. The work took place in Brandsen and Navarro districts. Four questionnaires were designed (for officials from Local Sanitary Entities, vaccinators, vet practitioners and farmers). Responses were coded as "ideal" (0) and "not ideal" (1). To assess the relative weight of each question ("item"), experts ranked the items according to their impact on management practices and vaccination. A weighted score was then calculated. A higher weighted score was assigned to the worse practices. Farmers obtaining a global weighted score above the third quartile were classified as "inappropriately managed farms", to be compared per type of production system and district. To assess the immunization coverage, female calves were sampled 30 to 50 days post vaccination; they were expected to react positively to serological diagnostic tests (DT+). RESULTS: There were significantly more inappropriately managed farms and higher global scores among beef farmers and in Brandsen. Eighty three percent (83%) of female calves were DT+, significantly under the ideal immunization coverage (95%). Only 48% of farms were considered well vaccinated. DT+ results were positively associated with the Brandsen district (OR = 25.94 [4.60-1146.21] and with the farms having more than 200 cow heads ((OR = 78.34 [4.09-1500.00]). On the contrary, DT+ were less associated with vaccinators being veterinary practitioners (OR = 0.07 [0.006-0.78]). Farmers are well advised by their veterinary practitioners but they should improve some management practices. CONCLUSIONS: The vaccination campaign is globally well implemented, but the immunization coverage and some vaccinators' practices should be improved. This study leads to a better understanding of the most common used management and control practices regarding brucellosis, which affect its epidemiology. Any vaccination campaign should be periodically assessed to highlight possible fails. The described methodology can be extrapolated to other countries and different contexts.

Evaluation of Bone Mineral Density in Patients with Type 1 Gaucher Disease in Argentina.

The purpose of this study was to evaluate the frequency of osteoporosis (OP) in patients with Gaucher disease (GD) in Argentina. GD patients from 28 centers were consecutively included from April 2012 to 2014. Bone mineral density (BMD) was determined by dual X-ray absorptiometry in the lumbar spine and the femoral neck or the total proximal femur for patients ≥20 yr of age, and by whole-body scan in the lumbar spine in patients <20 yr of age. In children, mineral density was calculated using the chronological age and Z height. OP diagnosis was determined following adult and pediatric official position of the International Society for Clinical Densitometry. A total of 116 patients were included, of which 62 (53.5%) were women. The median age was 25.8 yr. All patients received enzyme replacement therapy, with a median time of 9.4 yr. Normal BMD was found in 89 patients (76.7%), whereas low bone mass (LBM) or osteopenia was found in 15 patients (13%) and OP in 12 patients (10.3%). The analysis of the pediatric population revealed that 4 patients (9.3%) had LBM and 3 (7%) had OP (Z-score ≤ -2 + fractures height-adjusted by Z), whereas in the adult population (n = 73), 11 patients (15%) had LBM or osteopenia and 9 (12.3%) had OP. Bone marrow infiltration and the presence of fractures were significantly correlated with the presence of OP (p = 0.04 and <0.001, respectively). This is the first study in Argentina and in the region describing the frequency of OP or LBM in GD patients treated with imiglucerase using the official position of the International Society for Clinical Densitometry.

Evaluación de la satisfacción con el rol laboral en mujeres y hombres / Work role satisfaction evaluation in women and men

Estudio en el que se presenta la validación del cuestionario de Satisfacción con el Rol Laboral (SRO), instrumento formado por 5 ítems de respuesta abierta que, mediante un sistema de codificación, se transforman en puntuaciones cuantitativas. El estudio es transversal y la muestra estuvo formada por 2618 hombres y 2600 mujeres con distintos tipos de empleo y edades entre 19 y 60 años, que participaron voluntariamente en el estudio. Se encontró que las respuestas al SRO se estructuraban, en mujeres y hombres, en una sola dimensión cuya consistencia interna fue satisfactoria. En ambos géneros la satisfacción con el rol laboral se asociaba de forma estadísticamente significativa, aunque con un tamaño del efecto moderado o bajo, con mayor satisfacción general con la vida y mayor autoestima, con menor neuroticismo y con menos sintomatología depresiva, de ansiedad, somática y disfunción social. Se concluye que el SRO es un instrumento válido para la evaluación de la satisfacción con el rol laboral de mujeres y hombres(AU)

This study presents the validation of the Work Role Satisfaction Inventory (WRS), an instrument consisting of 5 open-response items whereby qualitative responses are transformed into quantitative scores by means of a coding system. The study is cross-sectional and the sample included 2618 men and 2600 women in different types of employment, ages 19 to 60 years, who voluntarily participated in the study. Results revealed that, in both men and women, the WRS responses conformed a single dimension whose internal consistency was satisfactory. In both genders, work role satisfaction was significantly associated, although with a small to moderate effect size, with higher overall life satisfaction and self-esteem, with less neuroticism and fewer depressive, anxiety and somatic symptoms, and with less social dysfunction as well. We conclude that the WRS is a valid instrument for the evaluation of women’s and men’s satisfaction with their work role(AU)

Salud mental en mujeres maltratadas por su pareja. Un estudio con muestras de México y España / Mental health in women abused by their partners. A study with samples from Mexico and Spain

ANTECEDENTES: La violencia contra las mujeres se reconoce internacionalmente como un fenómeno social que representa un problema de salud pública y de derechos humanos. Su forma más común es la violencia de pareja, que afecta a corto y largo plazos la salud física y mental de las víctimas. OBJETIVO: Analizar el maltrato a la mujer por parte de su pareja en la población general mediante un estudio comparativo de mujeres de México y España. Para ello se estudiaron el impacto en la salud mental y la relevancia de los factores socioculturales en dicha violencia. MÉTODO: Estudio transversal con 101 mujeres mexicanas y 101 españolas de la población general evaluadas mediante siete pruebas psicológicas de maltrato de la pareja, salud mental, autoestima, apoyo social y actitudes hacia los roles de género. RESULTADOS: La mayoría de las mujeres mexicanas y más de la mitad de las españolas sufrían violencia por parte de su pareja; el maltrato psicológico era el tipo de violencia más frecuente. Esto se asociaba con peor salud mental, menor apoyo social y actitudes más tradicionales hacia los roles de género. DISCUSIÓN Y CONCLUSIÓN: Los resultados del presente trabajo indican que la violencia de pareja, sobre todo la psicológica, es un problema común entre las mujeres de la población general, lo que coincide con los informes sobre la prevalencia de la misma en ambos países y parece estar influida por patrones socioculturales. El maltrato por parte de la pareja es una amenaza para la salud mental de las mujeres que requiere de atención poniendo énfasis en los factores socioculturales que la sostienen.

BACKGROUND: Violence against women is internationally recognized as a social phenomenon representing a public health and a human rights problem. Partner abuse is its most common form and it affects the victim's physical and mental health in the short- and long-term. OBJECTIVE: To analyze partner abuse in women from the general population based on a comparative study with women from Mexico and Spain. Another goal was to study the impact of this type of abuse on women's mental health and the relevance of socio-cultural risk factors. METHOD: Transversal study with 101 Mexican women and 101 Spaniard women from the general population evaluated in seven psychological tests on partner abuse, mental health, self-esteem, social support and attitudes towards gender roles. RESULTS: Most Mexican women and more than half of the Spaniards suffered abuse from their partners. Psychological maltreatment was the most frequent form of abuse. This was associated with worst mental health, less social support and more traditional attitudes towards gender roles. DISCUSSION AND CONCLUSION: The results of this study indicate that partner abuse, especially psychological is a common problem among women from the general population, coinciding with reports related to its prevalence in both countries, and it seems to be influenced by socio-cultural patterns. Partner abuse, especially psychological, is a threat for women's mental health that needs to be attended focusing on the socio-cultural risk factors underlying it.

Prevalence and spatial distribution of bovine brucellosis in San Luis and La Pampa, Argentina.

BACKGROUND: Bovine brucellosis (BB) is a zoonotic disease caused by Brucella abortus. BB is endemic in Argentina, where vaccination with Brucella abortus strain 19 is compulsory for 3-to-8 month-old heifers. The objectives of this study were to quantify the prevalence of BB and to identify factors associated with its occurrence, along with the spatial distribution of the disease, in the provinces of La Pampa and San Luis. A two-stage random sampling design was used to sample 8,965 cows (3,513 in La Pampa and 5,452 in San Luis) from 451 farms (187 in La Pampa and 264 in San Luis). RESULTS: Cow and herd prevalence were 1.8 % (95 % CI: 1.3-2.2; n = 157) and 19.7 % (95 % CI: 17.0-22.4; n = 89), respectively. Both cow-level and herd-level prevalence in La Pampa (2.4 and 26.0 %, respectively) were significantly higher than in San Luis (1.4 and 15.5 %, respectively). There were not differences between the proportions of reactive cattle compared to that obtained in a survey conducted in 2005. However, herd prevalence in La Pampa was significantly (P < 0.05) higher compared to that study. Disease was found to be spatially clustered in west La Pampa. The lower the bovine density and the calf/cow ratio, the higher odds of belonging to the cluster. CONCLUSIONS: The increase of farm prevalence in the last five years suggests that the disease is spreading and that control measures should be applied in the region. The cluster of infected farms was located in the west region of La Pampa. There, farms have lower animal densities and smaller cow/calf indices compared to the rest of the province. Although western La Pampa has more infected herds, within-farm prevalence was not higher, which suggests that the control program has been relatively successful in controlling the disease at the farm level, and/or that low animal density inherently results in low disease prevalence. Our results provide baseline information on the epidemiology of BB and its potential pattern of transmission in Argentina, which will ultimately help to improve BB control programs in the country.

Bovine brucellosis in Argentina and bordering countries: update.

Bovine brucellosis is a zoonotic disease spread worldwide. The infection in cattle is predominantly caused by Brucella abortus and is usually detected in pregnant females through abortions. The disease is endemic in Argentina; however, infection in humans is underestimated and often not reported. The prevalence of bovine brucellosis in countries bordering Argentina is quite variable: 0.04% in Uruguay, 10.20% in the north and 0.06% in the south of Brazil, 0.2% in Chile, 3.15% in Paraguay and 2.27% in Bolivia. In 1999, the Argentine National Control and Eradication Program was implemented. Its strategies include identification of vaccinated animals, compulsory vaccination with B. abortus S19 of 100% of 3- to 8-month-old females, negative serological tests before animal movements and categorization of farms in terms of their brucellosis status. The epidemiological surveillance in milk is performed through the milk ring test and the indirect ELISA. The result of a national brucellosis survey performed in 2004 indicates that 12.4% (95% CI: 10.89-14.0) of Argentine beef farms are seropositive to Brucella and that the apparent prevalence in cattle is 2.10% (95% CI: 1.90-2.40). The official serological diagnostic tests are as follows: buffered plate antigen test, as screening, serum agglutination test, 2-mercaptoethanol and fluorescence polarization assay, competitive ELISA, as confirmatory tests, and complement fixation test, as definitive test. Santa Fe and a district in Córdoba have 'Outstanding Plans'. Tierra del Fuego is a 'Zone free from bovine brucellosis'. One question arising when studying the Argentine situation is why the disease remains endemic if good regulations exist to control and eradicate it. In future, some different aspects might be evaluated to understand it, and further studies should be performed to prioritize, select and refine control strategies.

Analysis of cattle movements in Argentina, 2005.

We describe the movement of cattle throughout Argentina in 2005. Details of farm-to-farm and farm-to-slaughter movements of cattle were obtained from the Sanitary Management System database (Sistema de Gestión Sanitaria, SGS), maintained by the National Service for Agrifood Health and Quality (SENASA). Movements were described at the regional and district level in terms of frequency, the number of stock transported, the district of origin and destination and Euclidean distance traveled. Social network analysis was used to characterize the connections made between regions and districts as a result of cattle movement transactions, and to show how these characteristics might influence disease spread. Throughout 2005 a total of 1.3 million movement events involving 32 million head of cattle (equivalent to approximately 57% of the national herd) were recorded in the SGS database. The greatest number of farm-to-farm movements occurred from April to June whereas numbers of farm-to-slaughter movement events were relatively constant throughout the year. Throughout 2005 there was a 1.1-1.6-fold increase in the number of farm-to-farm movements of cattle during April-June, compared with other times of the year. District in-degree and out-degree scores varied by season, with higher maximum scores during the autumn and winter compared with summer and spring. Districts with high in-degree scores were concentrated in the Finishing region of the country whereas districts with high out-degree scores were concentrated not only in the Finishing region but also in Mesopotamia, eastern Border and southern Central regions. Although movements of cattle from the Border region tended not to be mediated via markets, the small number of districts in this area with relatively high out-degree scores is a cause for concern as they have the potential to distribute infectious disease widely, in the event of an incursion.

Predictors of antibiotic prescription in respiratory tract infections by ambulatory care practitioners

El uso excesivo de antibióticos promueve la aparición ydiseminación de bacterias resistentes. Se ha encontrado una tasa de prescripción de antibióticos en infecciones respiratorias (resfrío común, rinosinusitis aguda y bronquitis aguda) del 50 al 70%, aunque la etiología sea viral en la mayoría de los casos. Esta investigación se condujo con el objetivo de identificar cuáles son los predictoresdel uso de antibióticos en las infecciones respiratorias agudas. Se realizó un estudio de corte transversal. Losparticipantes fueron médicos internistas generales y otorrinolaringólogos que atienden pacientes adultos en formaambulatoria en Buenos Aires. Se utilizó un cuestionario con 20 viñetas sobre casos clínicos, que incluían variablesimportantes en la toma de decisiones sobre el tratamiento antibiótico en infecciones respiratorias agudas.Las viñetas fueron construidas según un diseño factorial fraccionado con nueve variables clínicas. Se calculóel peso absoluto y relativo de cada variable clínica que predijo el uso de antibióticos, para cada médico, medianteregresión lineal múltiple. Los predictores con mayor peso para la decisión de prescribir antibióticos, fueron la presencia de secreción nasal y tos (24% y 21% de peso total). La correlación entre los predictores y lasrespuestas individuales fue alta (r2 =0.73). La probabilidad media y el índice de prescripción de antibióticos fueron cercanas al 50%. Los predictores del uso de antibióticos para infecciones respiratorias agudas entre médicosde atención ambulatoria en la muestra estudiada difieren de las guías internacionalmente aceptadas. Laprobabilidad de prescribir antibióticos para estas enfermedades es alta. La puesta en práctica de las recomendaciones internacionales para el uso de antibióticos en infecciones respiratorias agudas podría mejorarel uso de antibióticos y reducir el desarrollo de resistencia bacteriana.(AU)

The use of antibiotics in viral respiratory infections (common cold, acute rhinosinusitis and acute bronchitis) promotes the emergence and spread of resistant bacteria. Studies have found that antibiotics are prescribed for 50-70% of respiratory tract infections, despite the fact that most of them have a viral etiology. The objective of the study was to determine predictors of antibiotic use in acute respiratory infections. It was conducted as a cross-sectional study on physicians practices for antibiotic use. The subjects were internists and otolaryngologists of adult patients in an ambulatory setting in Buenos Aires. The instrument was a questionnaire with 20 clinical vignettes that included relevant variables for making decisions regarding antibiotic use in acute respiratory infections. The vignettes were constructed with a fractional factorial design with nine clinical variables. The absolute and relative weight of each clinical variable that predicted antibiotic use were calculated for each individual practitioner using multiple linear regression. The predictors with the greatest absolute weight in the decision to prescribe antibiotics were nasal discharge and cough (24% and 21% of total weight). The correlation between predictors and individual physician answers was high (r2 = 0.73). The mean probability and the rate of antibiotic prescription were both about 50%. Predictors of antibiotic use for acute respiratory infections among ambulatory physicians in this sample differ from internationally accepted guidelines. The likelihood of prescribing antibiotics for these illnesses is high. Wider implementation of management guidelines for acute respiratory infections could improve cost effective antibiotic use and decrease the development of antibiotic resistance.(AU)

Actitud de los medicos frente a las practicas de promocion de la industria farmaceutica / The attitude of physicians regarding the promotion strategies of the pharmaceutical industry

Hay evidencia de que las prácticas de promoción de la industria farmacéutica influyen en los patrones de prescripción de los médicos y en el consumo de medicamentos, pudiendo generar conflictos de intereses que alteren el juicio clínico. El objetivo del presente trabajo fue estimar la frecuencia con que los médicos reciben beneficios de la industria farmacÛutica y su opinión acerca de este tipo de actividades de promoción. Se realizó un estudio multicéntrico, descriptivo, de corte transversal en el cual se aplico una encuesta anónima, autoadministrada, a médicos/as clínicos, cardiólogos y dermatólogos que practican atención ambulatoria de adultos en la ciudad de Buenos Aires. De 96 cuestionarios entregados se recuperaron 78 (tasa de respuesta 81%). La edad promedio fue de 41 años, 44% fueron mujeres y 35% residentes. El 86% de los encuestados recibe muestras médicas con elevada frecuencia, 39% útiles de escritorio, 19% inscripciones a congresos y 12% invitaciones a comer. La mitad de los médicos opina que los beneficios de la industria farmacÛutica influyen en la prescripción, pero sólo el 27% reconoce que modifica su propia prescripción. Los residentes consideran con mayor frecuencia que estas actividades los afectan (42% vs. 18% p = 0.007, global: 30%); La mayoría de los encuestados considera apropiado recibir estos beneficios. Sin embargo, el 35% acuerda que éstos inciden en el costo final de los medicamentos. En conclusión, la población encuestada muestra uma alta interacción con la industria farmacéutica. Si bien reconocen que las actividades de promoción influyen em la prescripción y elevan el costo final de los productos, encuentran apropiado recibir esos beneficios. (AU)

Actitud de los medicos frente a las practicas de promocion de la industria farmaceutica / The attitude of physicians regarding the promotion strategies of the pharmaceutical industry

Hay evidencia de que las prácticas de promoción de la industria farmacéutica influyen en los patrones de prescripción de los médicos y en el consumo de medicamentos, pudiendo generar conflictos de intereses que alteren el juicio clínico. El objetivo del presente trabajo fue estimar la frecuencia con que los médicos reciben beneficios de la industria farmacêutica y su opinión acerca de este tipo de actividades de promoción. Se realizó un estudio multicéntrico, descriptivo, de corte transversal en el cual se aplico una encuesta anónima, autoadministrada, a médicos/as clínicos, cardiólogos y dermatólogos que practican atención ambulatoria de adultos en la ciudad de Buenos Aires. De 96 cuestionarios entregados se recuperaron 78 (tasa de respuesta 81%). La edad promedio fue de 41 años, 44% fueron mujeres y 35% residentes. El 86% de los encuestados recibe muestras médicas con elevada frecuencia, 39% útiles de escritorio, 19% inscripciones a congresos y 12% invitaciones a comer. La mitad de los médicos opina que los beneficios de la industria farmacêutica influyen en la prescripción, pero sólo el 27% reconoce que modifica su propia prescripción. Los residentes consideran con mayor frecuencia que estas actividades los afectan (42% vs. 18% p = 0.007, global: 30%); La mayoría de los encuestados considera apropiado recibir estos beneficios. Sin embargo, el 35% acuerda que éstos inciden en el costo final de los medicamentos. En conclusión, la población encuestada muestra uma alta interacción con la industria farmacéutica. Si bien reconocen que las actividades de promoción influyen em la prescripción y elevan el costo final de los productos, encuentran apropiado recibir esos beneficios.

Predictors of antibiotic prescription in respiratory tract infections by ambulatory care practitioners

El uso excesivo de antibióticos promueve la aparición ydiseminación de bacterias resistentes. Se ha encontrado una tasa de prescripción de antibióticos en infecciones respiratorias (resfrío común, rinosinusitis aguda y bronquitis aguda) del 50 al 70%, aunque la etiología sea viral en la mayoría de los casos. Esta investigación se condujo con el objetivo de identificar cuáles son los predictoresdel uso de antibióticos en las infecciones respiratorias agudas. Se realizó un estudio de corte transversal. Losparticipantes fueron médicos internistas generales y otorrinolaringólogos que atienden pacientes adultos en formaambulatoria en Buenos Aires. Se utilizó un cuestionario con 20 viñetas sobre casos clínicos, que incluían variablesimportantes en la toma de decisiones sobre el tratamiento antibiótico en infecciones respiratorias agudas.Las viñetas fueron construidas según un diseño factorial fraccionado con nueve variables clínicas. Se calculóel peso absoluto y relativo de cada variable clínica que predijo el uso de antibióticos, para cada médico, medianteregresión lineal múltiple. Los predictores con mayor peso para la decisión de prescribir antibióticos, fueron la presencia de secreción nasal y tos (24% y 21% de peso total). La correlación entre los predictores y lasrespuestas individuales fue alta (r2 =0.73). La probabilidad media y el índice de prescripción de antibióticos fueron cercanas al 50%. Los predictores del uso de antibióticos para infecciones respiratorias agudas entre médicosde atención ambulatoria en la muestra estudiada difieren de las guías internacionalmente aceptadas. Laprobabilidad de prescribir antibióticos para estas enfermedades es alta. La puesta en práctica de las recomendaciones internacionales para el uso de antibióticos en infecciones respiratorias agudas podría mejorarel uso de antibióticos y reducir el desarrollo de resistencia bacteriana.

The use of antibiotics in viral respiratory infections (common cold, acute rhinosinusitis and acute bronchitis) promotes the emergence and spread of resistant bacteria. Studies have found that antibiotics are prescribed for 50-70% of respiratory tract infections, despite the fact that most of them have a viral etiology. The objective of the study was to determine predictors of antibiotic use in acute respiratory infections. It was conducted as a cross-sectional study on physicians' practices for antibiotic use. The subjects were internists and otolaryngologists of adult patients in an ambulatory setting in Buenos Aires. The instrument was a questionnaire with 20 clinical vignettes that included relevant variables for making decisions regarding antibiotic use in acute respiratory infections. The vignettes were constructed with a fractional factorial design with nine clinical variables. The absolute and relative weight of each clinical variable that predicted antibiotic use were calculated for each individual practitioner using multiple linear regression. The predictors with the greatest absolute weight in the decision to prescribe antibiotics were nasal discharge and cough (24% and 21% of total weight). The correlation between predictors and individual physician answers was high (r2 = 0.73). The mean probability and the rate of antibiotic prescription were both about 50%. Predictors of antibiotic use for acute respiratory infections among ambulatory physicians in this sample differ from internationally accepted guidelines. The likelihood of prescribing antibiotics for these illnesses is high. Wider implementation of management guidelines for acute respiratory infections could improve cost effective antibiotic use and decrease the development of antibiotic resistance.