Healthcare program for sex workers: a public health priority.

OBJECTIVE: The objective of this study was to propose a model of health care for sexual workers (SWs) and transvestites (Ts) groups who were historically excluded from health services. MATERIALS AND METHODS: A prospective descriptive/analytical study with an intervention stage was performed, focusing on the health status of SWs and Ts. Access to health system, inclusion into social programs, beneficiaries' participation, and rate of risk behaviors were variables measured before and after intervention that consist in a program based on promotion/prevention activities and complete health care service suitable to SW-T needs. RESULTS: Nine hundred and fifty SW-Ts were included. At baseline, 99.7% lacked health insurance and 90.1% had no access to the health care. These data were compared with those obtained after attention quadruplicated among SW because of the implementation of the program. Risky sexual behaviors were reduced by 25 times. SWs have their own leader of health institutions and coordinate themselves with the program's activities. CONCLUSION: Responsibility of the state's authorities on vulnerable groups must focus on their inclusion. To this end, health services must adapt themselves in order to attend those community groups with special needs. Active participation of the target population contributes to viability of this type of proposals, and it is essential for the project's success.

"El rostro sin dientes del sistema de salud": salud bucal y el sistema de salud como determinante social, una experiencia en la provincia de Buenos Aires, Argentina / The toothless face of the health system: the health system as a negative social determinant in oral health, an experience in Buenos Aires Province, Argentine

INTRODUCCIÓN: las condiciones sociales condicionan el estado de salud de las personas. En Argentina, el bajo nivel de los servicios del sistema de salud bucal no impacta de la misma manera en toda la población y, en algunos casos, es el propio sistema quien acentúa estas diferencias reforzando las inequidades en salud. OBJETIVOS: evaluar el impacto de la falta de piezas dentales en las oportunidades laborales de personas jóvenes; evaluar un programa que otorga rehabilitación protésica. METODOLOGÍA: entrevistas a empleadores para la variable oportunidad laboral; evaluación de costos del programa de rehabilitación oral en tres municipios de Buenos Aires. RESULTADOS: Se observa una amplia diferencia en el acceso laboral en personas con dientes comparadas a personas sin piezas dentales. El acceso a prótesis dentales está limitado, debido al elevado costo del tratamiento en el mercado, éste disminuye hasta un 86% cuando es financiado por el estado. CONCLUSIONES: Existe un origen desigual e injusto en la pérdida de dientes. El sistema de salud promueve esta desigual distribución, dejando el acceso a la salud bucal en manos del mercado, se convierte en un determinante social negativo.

INTRODUCTION: social conditions are determinants of inequalities in health status.The poor performance of the oral health system in Argentina does not impactin the same way the whole population, reinforcing inequalities in health. OBJECTIVES: to assess the impact the impact of the lack of teeth of young peoplelow-income, over the employment opportunities. A state program of oral rehabilitation in edentulous young patients is evaluated. METODOLOGY: interviews to entrepreneurs were realized in order to measure the employment opportunities in edentulous young people. The costs of oral rehabilitation treatment are evaluated in the state program against marketoptions. RESULTS: People with teeth have better access to work; treatment improves thisto people without teeth. Access to dental prosthesis is limited, due to the highcost; it decreases in 86% when it is funded by the state. CONCLUSIONS: the most disadvantaged sectors of society are who more suffer the loss of teeth. The health system acts as a negative social determinant inoral health.

Detección de los tipos virales 16,18, 31 y 33 de papillomavirus humano en displasias severas y carcinoma in situ de cuello uterino / Detection of human papilloma (HPV) virus types 16,18, 31 y 33 in severe dysplasias and carcinoma-in-situ of the uterine cervix

Introducción: las displasias severas y los carcinomas in situ son los verdaderos precursores del cáncer de cuello uterino. La infección por el virus del papiloma humano (HPV) es unfactor etiológico importante en el origen de las lesiones intraepiteliales escamosas de alto grado (H-SIL) y el cáncer de cuello uterino de tipo epidermoide. Objetivo: determinar la prevalencia de los tipos de HPV descriptos como más frecuentes enotras regiones, en una muestra seleccionada de mujeres de Uruguay portadoras de displasias severas y carcinoma in situ de cuello uterino, con su diagnóstico confirmado por el estudiohistológico de piezas de conización quirúrgica. Material y método: Se seleccionó una muestra de piezas de conización quirúrgica realizadas amujeres portadoras de displasias severas y carcinomas intraepiteliales epidermoides de cuello uterino procedentes de Montevideo y Canelones. Las piezas fueron fijadas en formol y luego incluidas en parafina. Resultados: se detectó la presencia de ácido desoxirribonucleico (ADN) de HPV en 39 de las 49 (80%). El tipo viral hallado con mayor frecuencia fue el HPV 16 en 23 de los conos (47%), seguido por el tipo 33 con siete casos (14%) y el tipo 31 en dos casos (4%). Se destaca la ausencia del tipo HPV 18 en esta muestra. Conclusión: se demostró la frecuente asociación entre infección por HPV y las lesiones precursoras del cáncer de cuello uterino. Dentro de los cuatro tipos de HPV investigados ydescriptos como más frecuentes en otras regiones, se detectó con mayor frecuencia el tipo 16 al igual que lo ocurrido en otras regiones del mundo.

Introduction: severe dysplasia and carcinoma-in-situ (CIN) is actually the first grade of uterine cervical cancer.HPV infection constitutes an important etiological factor for the origin of High-grade Squamous Intraepithelial Lesion(H-SIL) and uterine cervical epidermoid cancer. Objective: to determine the prevalence of HPV types that are described as more frequent in other regions, from a sample of Uruguayan women carriers of severe dysplasiaand uterine cervix carcinoma in situ, with diagnosis confirmed by the histological study of surgical conizationpieces. Method: we selected a sample of surgical conization pieces from women who were carriers of severe dysplasiaand intraepithelial epidermoid cancer of the uterine cervix in Montevideo and Canelones. Pieces were fixed in formoland then embedded in paraffin.Results: we identified the presence of HPV deoxiribonucelic acid (DNA) in 39 out of 49 patients (80%). The most common type of virus found was HPV 16 in 23 of cones (47%), followed by HPV 33, found in seven cases (14%). We stand out the absence of HPV 18 in this sample. Conclusion: we proved the usual association between HPV infections and precursor lesions to uterine cervicalcancer. Among the four types of HPV studied and described as more common in other regions, we identified HPV 16 as the most common, the same as it happens in other parts of the world.

Introdução: as displasias severas e os carcinomas in situ são os verdadeiros precursores do câncer de colo uterino.A infecção pelo vírus do papiloma humano (HPV) é um fator etiológico importante na origem das lesões intraepiteliais escamosas de alto grado (H-SIL) e o câncer de colo uterino de tipo epidermoide. Objetivo: determinar a prevalência dos tipos de HPVdescritos como mais freqüentes em outras regiões, em uma amostra selecionada de mulheres no Uruguai portadoras de displasias severas e carcinoma in situ de colo uterino, com diagnóstico confirmado pelo exame histológico de material obtido por conização cirúrgica. Material e método: uma amostra de peças de conizaçãocirúrgica realizadas a mulheres de Montevidéu e Canelones portadoras de displasias severas e carcinomas intraepiteliais epidermoides de colo uterino foi selecionada. As peças foram fixadas em formol e posteriormente incluídas em parafina. Resultados: em 39 das 49 (80%) amostras foi detectadaa presença de ácido desoxirribonucléico (ADN) de HPV. O tipo16 de HPV foi encontrado em 23 dos cones (47%),seguido pelo tipo 33 com sete casos (14%) e o tipo 31 em dois casos (4%). Nesta amostra o tipo HPV 18 não foidetectado. Conclusão: a associação entre infecção por HPV e lesões precursoras de câncer de colo uterino foi demonstrada. Dos quatro tipos de HPV pesquisados e descritos como freqüentes em outras regiões, o tipo 16 foi o que apresentou maior freqüência como em outras partes do mundo.

The quality of primary care health centres in Buenos Aires, Argentina.

BACKGROUND: Primary healthcare strategies have been included in the health policies of many countries since the 1970s. The aim of this study was to evaluate the quality of care provided by primary care health centres (PCHCs) in Buenos Aires, Argentina. METHODS: We surveyed 20% of PCHCs in Buenos Aires State to investigate the structure, process and results of care. Variables related to 'structure' included human resources, qualifications and skills, geographical coverage and buildings. 'Process' variables were: shift handling, service organisation and demand planning. 'Outcome' or 'results' indicators included vaccination coverage, percentage of pregnant women attending before the 12th week, percentage of children consulting, and patient satisfaction. RESULTS: Our evaluation showed deficiencies in the structure and processes of care, and serious shortfalls in outcomes. Health teams in PCHCs lacked knowledge about the demography, health needs, and population statistics relating to their area of responsibility. Valid information was only available for the 13% of the population who sought help from the PCHC. As a result, there was low vaccination coverage (63.6%), low levels of child health surveillance (38.8%), and poor early detection of pregnancy (6.9%). CONCLUSION: Attention to these areas of deficiency could improve the quality of health care and outcomes for the communities of Buenos Aires.

Síndromes en medicina interna

Se enfocan en esta obra las principales patologías de la medicina interna a partir de los síndromes. Además de una definición y breve reseña fisiopatológica cada síndrome es descripto con su clasificación, los distintos factores etiológicos capaces de producirlo y los estudios complementarios actuales necesarios para su diagnóstico y para precisar su etiología. No sólo se mencionan los distintos estudios necesarios, sino también los resultados esperados a tal fin...

Prenatal and postnatal characterization of a de novo Xq22.1 terminal deletion.

We present a case of a de novo Xq22.1 chromosomal terminal deletion discovered prenatally by conventional cytogenetics. The pregnancy resulted in the birth of a normal girl. Preferential inactivation of the abnormal X was demonstrated postnatally. Fluorescence in situ hybridization (FISH) demonstrated a terminal Xq deletion spanning Xq22.1 -->qter. An X painting probe ruled out a translocation. The deleted X chromosome was determined to be of paternal origin. The girl is now 4 years old with normal physical and psychomotor development. X chromosomal deletions are infrequent findings in prenatal diagnosis and present a difficult counseling challenge when they occur. Prenatal X-inactivation studies provide an opportunity for more informative genetic counseling when a de novo X chromosome deletion is detected.