[Enteroparasitosis in a child population of the Hurlingham District, Buenos Aires]. / Enteroparasitosis en una población infantil del Municipio de Hurlingham, Buenos Aires.

INTRODUCTION: Intestinal parasites have the greatest impact on child populations as they can, in the long term, lead to stunted growth with advances in cognitive development. The transmission of these parasites is favored by environments of social vulnerability. METHODS: In a cross-sectional study carried out in the District of Hurlingham, in the suburbs of Buenos Aires, the prevalence of intestinal parasitoses and its associated risk factors in a child population attending Primary Health Care Centers was estimated. Coproparasitological survey, Graham test and a socio-environmental and labor survey were performed. RESULTS: A total of 130 children, 50.8% women and 49.2% men (0-12 years) were analyzed; 89.1% of those over 4 years of age were in school. In 28.5% of households, the mother or father had a formal job and 63.8% received the Universal Child Allowance. Conditions of social vulnerability were observed in the analyzed population: poor access to network water and sewage and environmental sanitation. The parasitological diagnosis revealed that 75 children [57.7% (95% CI: 48.7-66.3)] were parasitized. Protists were more frequent than helminths and the most prevalent species were Blastocystis spp, Enterobius vermicularis, Giardia lamblia and Cryptosporidium sp. The parasites in children were associated with schooling (p <0.01) and age (p <0.05). DISCUSSION: This work constitutes the first survey on intestinal parasitoses in the District of Hurlingham and the socioeconomic and environmental context where it is developed.

Introducción: Los parásitos intestinales tienen mayor impacto en las poblaciones infantiles ya que pueden, a largo plazo, conducir a un retraso en el crecimiento con alteración del desarrollo cognitivo. Sumado a esto, los entornos de vulnerabilidad social favorecen la transmisión y permanencia de estos parásitos en el ambiente. Métodos: En un estudio transversal realizado en el Municipio de Hurlingham (conurbano bonaerense) se estimó la prevalencia de enteroparasitosis y sus factores de riesgo asociados en una población infantil concurrente a Centros de Atención Primaria para la Salud locales mediante un análisis coproparasitológico, un test de Graham y una encuesta socioambiental y laboral. Resultados: Un total de 66 niñas (50.8%) y 64 niños (49.2%) entre 0 a 12 años fueron analizados. El 89.1% de los mayores de 4 años estaban escolarizados. En el 28.5% de los hogares la madre o el padre tenía trabajo formal y el 63.8% percibía la asignación universal por hijo (AUH). Se observaron condiciones de vulnerabilidad social en la población analizada, tales como: falta de acceso al agua de red y cloacas y un saneamiento ambiental deficiente. El diagnóstico parasitológico reveló un total de 75 casos [57.7% (IC 95%: 48.7-66.3)] de parasitosis. Los protistas fueron los parásitos más frecuentes y las especies más prevalentes: Blastocystis spp, Enterobius vermicularis, Giardia lamblia y Cryptosporidium sp. La presencia de parásitos estuvo asociada a la escolarización (p <0.01) y a la edad del niño (p <0.05). Discusión: Este fue el primer relevamiento sobre las enteroparasitosis en el municipio de Hurlingham y el contexto socioeconómico y ambiental donde se desarrollan.

Enteroparasitosis en una población infantil del Municipio de Hurlingham, Buenos Aires / Enteroparasitosis in a child population of the Hurlingham District, Buenos Aires

Resumen Introducción: Los parásitos intestinales tienen mayor impacto en las poblaciones infantiles ya que pueden, a largo plazo, conducir a un retraso en el crecimiento con alteración del desarrollo cognitivo. Sumado a esto, los entornos de vulnerabilidad social favorecen la transmisión y permanencia de estos parásitos en el ambiente. Métodos: En un estudio transversal realizado en el Municipio de Hurlingham (conurbano bonae rense) se estimó la prevalencia de enteroparasitosis y sus factores de riesgo asociados en una población infantil concurrente a Centros de Atención Primaria para la Salud locales mediante un análisis coproparasitológico, un test de Graham y una encuesta socioambiental y laboral. Resultados: Un total de 66 niñas (50.8%) y 64 niños (49.2%) entre 0 a 12 años fueron analizados. El 89.1% de los mayores de 4 años estaban escolarizados. En el 28.5% de los hogares la madre o el padre tenía trabajo formal y el 63.8% percibía la asignación universal por hijo (AUH). Se observaron condiciones de vulnerabilidad social en la población analizada, tales como: falta de acceso al agua de red y cloacas y un saneamiento ambiental deficiente. El diagnóstico parasitológico reveló un total de 75 casos [57.7% (IC 95%: 48.7-66.3)] de parasitosis. Los protistas fueron los parásitos más frecuentes y las especies más prevalentes: Blastocystis spp, Enterobius vermicularis, Giardia lamblia y Cryptosporidium sp. La presencia de parásitos estuvo asociada a la escolarización (p<0.01) y a la edad del niño (p<0.05). Dis cusión: Este fue el primer relevamiento sobre las enteroparasitosis en el municipio de Hurlingham y el contexto socioeconómico y ambiental donde se desarrollan.

Abstract Introduction: Intestinal parasites have the greatest impact on child populations as they can, in the long term, lead to stunted growth with advances in cognitive development. The transmission of these parasites is favored by environments of social vulnerability. Methods: In a cross-sectional study carried out in the District of Hurlingham, in the suburbs of Buenos Aires, the prevalence of intestinal parasitoses and its associated risk factors in a child population attending Primary Health Care Centers was estimated. Coproparasitological survey, Graham test and a socio-environmental and labor survey were performed. Results: A total of 130 children, 50.8% women and 49.2% men (0-12 years) were analyzed; 89.1% of those over 4 years of age were in school. In 28.5% of households, the mother or father had a formal job and 63.8% received the Universal Child Allowance. Conditions of social vulnerability were observed in the analyzed population: poor access to network water and sewage and environmental sanitation. The parasitological diagnosis revealed that 75 children [57.7% (95% CI: 48.7-66.3)] were parasitized. Protists were more frequent than helminths and the most prevalent species were Blastocystis spp, Enterobius vermicularis, Giardia lamblia and Cryptosporidium sp. The parasites in children were associated with schooling (p<0.01) and age (p<0.05). Discussion: This work constitutes the first survey on intestinal parasitoses in the District of Hurlingham and the socioeconomic and environmental context where it is developed.

Pulmonary tuberculosis infection among workers in the informal public transport sector in Lima, Peru.

BACKGROUND: Because a strong association was observed between pulmonary tuberculosis (TB) and the use of public transport, increasing with duration of journey, a study was carried out to assess infection by Mycobacterium tuberculosis and working conditions among workers in this sector. METHODS: A cross-sectional study was conducted between June and September 2008. A total of 104 workers from two public transport minibus ('combi') cooperatives covering marginal areas of the Ate-Vitarte district in Lima were interviewed. Demographic and occupational details were collected as well as prior family and personal history of TB and BCG vaccination. The tuberculin skin test (TST) was administered to each study subject and an induration of ≥ 10 mm was considered positive. Statistical analysis was based on logistic models, ORs and their 95% CIs. RESULTS: TST results were obtained for 70.2% (n=73), of whom 76.6% (n=56) were positive. Positivity was significantly associated with those who had worked for more than 2 years (crude OR 11.04; 95% CI 3.17 to 38.43) and more than 60 h/week (crude OR 9.8; 95% CI 2.85 to 33.72). These associations remained significant in a multivariate model as well. CONCLUSION: The association observed between years of working and weekly work burden among minibus workers suggests an occupational risk in service jobs in low-income countries with high TB prevalence. Consequently, other types of users are at increased risk for TB infection, with a causal relationship between effect and duration of exposure.

Formación de dirigentes gremiales médicos de la ciudad de Buenos Aires en condiciones y medio ambiente de trabajo / Training on work and environmental conditions for doctors

Objetivo: presentar la experiencia que la Asociación de Médicos Municipales (A.M.M) de la Ciudad de Buenos Aires desarrolló en materia de formación de delegados gremiales en prevención. Materiales y métodos: La AMM convocó a un grupo técnico especializado que diseñó, desarrolló y evaluó el primer curso de formación de delegados en prevención de riesgos laborales en CyMAT para médicos. Se presenta la programación general de dicho curso, sus contenidos y actividades, y los resultados de su evaluación. Resultados: Se presentan los resultados de las actividades de observación de los coordinadores del curso, los de una encuesta de evaluación a cargo de los alumnos y los emergentes cualitativos generales. Se han identificado: la toma de conciencia por parte de los delegados médicos sobre los riesgos a los que se encuentran expuestos en su ámbito laboral, haber establecido vínculos y adquirido conocimiento de otras realidades, y el reconocimiento de la responsabilidad del empleador. Asimismo, surgieron propuestas de acción colectiva que se comenzaron a desarrollar como parte de las acciones gremiales. Conclusión: Esta experiencia verifica la posibilidad de generar conocimiento traducido en acciones gremiales en el Sector Salud mediante el compromiso de los principales sujetos: los trabajadores médicos

Objectives: to present the experience of the Asociación de Médicos Municipales (AMM) from the city of Buenos Aires developed for teaching and training of union delegates in prevention. Materials and methods: The AMM convened a group of specialists for this goal, who have developed and evaluated this first training course for delegates at preventing occupational hazards in work-related environment and conditions of job for physicians. We present a general planning of the course and its schedule, its contents and activities, and the results of its assessment. Results: The results of the monitoring activities by the coordinators of course, the scores of the survey answered by the delegates and emerging qualitative issues. It have been identified some features: the awareness within delegates doctors about the risks to which they are exposed in their workplace, the links between themselves about their different realities and the acquired knowledge, and the recognition of the responsibility of the employer over the health of their workers. It also emerged that proposals for collective action began to develop as part of union action. Conclusion: This experience demonstrates the ability to optimize the in health knowledge and use it in union action within the workers of the Health Sector

Enfermedades emergentes no infecciosas / Emerging noninfectious diseases

In recent years, emerging diseases were defined as being infectious, acquiring high incidence, often suddenly, or being a threat or an unexpected phenomenon. This study discusses the hallmarks of emerging diseases, describing the existence of noninfectious emerging diseases, and elaborating on the advantages of defining noninfectious diseases as emerging ones. From the discussion of various mental health disorders, nutritional deficiencies, external injuries and violence outcomes, work injuries and occupational health, and diseases due to environmental factors, the conclusion is drawn that a wide variety of noninfectious diseases can be defined as emergent. Noninfectious emerging diseases need to be identified in order to improve their control and management. A new definition of "emergent disease" is proposed, one that emphasizes the pathways of emergence and conceptual traits, rather than descriptive features.

[Emerging noninfectious diseases]. / Enfermedades emergentes no infecciosas.

In recent years, emerging diseases were defined as being infectious, acquiring high incidence, often suddenly, or being a threat or an unexpected phenomenon. This study discusses the hallmarks of emerging diseases, describing the existence of noninfectious emerging diseases, and elaborating on the advantages of defining noninfectious diseases as emerging ones. From the discussion of various mental health disorders, nutritional deficiencies, external injuries and violence outcomes, work injuries and occupational health, and diseases due to environmental factors, the conclusion is drawn that a wide variety of noninfectious diseases can be defined as emergent. Noninfectious emerging diseases need to be identified in order to improve their control and management. A new definition of "emergent disease" is proposed, one that emphasizes the pathways of emergence and conceptual traits, rather than descriptive features.

[New clinical indicators. Health-related quality of life]. / Nuevos indicadores clínicos. La calidad de vida relacionada con la salud.

In the last decades the need of better measurements of health outcomes has increased the interest for new clinical indicators. Health-related quality of life (HRQoL) has emerged in this context as a multidimensional model approach where the patient is the exclusive source of information. The main objective of HRQoL measurement is to provide a global evaluation of the impact of diseases and the consequences of treatments over the daily life of the patients. The instruments developed for that purpose are questionnaires; either generic--for the comparison between different diseases-, or specific--aimed to evaluate particular conditions. These questionnaires must demonstrate several psychometric properties, such as reliability, validity, responsiveness, and for some authors also feasibility. In many areas, HRQoL studies have demonstrated to increase the knowledge of the natural history of diseases and its global consequences, beyond the classic health outcomes information based on morbidity and mortality rates. This knowledge may assist in the design of epidemiological studies and improve the comparison of strategies in therapeutic interventions. Nevertheless, some controversial issues remain such as the clinical implications of absolute scores obtained, and the need for updating the content of the instruments in accordance with the changes in natural history of diseases under evaluation.

Nuevos indicadores clinicos. La calidad de vida relacionada con la salud / New clinical indicators. Health-related quality of life

In the last decades the need of better measurements of health outcomes has increased the interest for new clinical indicators. Health-related quality of life (HRQoL) has emerged in this context as a multidimensional model approach where the patient is the exclusive source of information. The main objective of HRQoL measurement is to provide a global evaluation of the impact of diseases and the consequences of treatments over the daily life of the patients. The instruments developed for that purpose are questionnaires; either generic--for the comparison between different diseases-, or specific--aimed to evaluate particular conditions. These questionnaires must demonstrate several psychometric properties, such as reliability, validity, responsiveness, and for some authors also feasibility. In many areas, HRQoL studies have demonstrated to increase the knowledge of the natural history of diseases and its global consequences, beyond the classic health outcomes information based on morbidity and mortality rates. This knowledge may assist in the design of epidemiological studies and improve the comparison of strategies in therapeutic interventions. Nevertheless, some controversial issues remain such as the clinical implications of absolute scores obtained, and the need for updating the content of the instruments in accordance with the changes in natural history of diseases under evaluation

Nuevos indicadores clinicos. La calidad de vida relacionada con la salud / New clinical indicators. Health-related quality of life

In the last decades the need of better measurements of health outcomes has increased the interest for new clinical indicators. Health-related quality of life (HRQoL) has emerged in this context as a multidimensional model approach where the patient is the exclusive source of information. The main objective of HRQoL measurement is to provide a global evaluation of the impact of diseases and the consequences of treatments over the daily life of the patients. The instruments developed for that purpose are questionnaires; either generic--for the comparison between different diseases-, or specific--aimed to evaluate particular conditions. These questionnaires must demonstrate several psychometric properties, such as reliability, validity, responsiveness, and for some authors also feasibility. In many areas, HRQoL studies have demonstrated to increase the knowledge of the natural history of diseases and its global consequences, beyond the classic health outcomes information based on morbidity and mortality rates. This knowledge may assist in the design of epidemiological studies and improve the comparison of strategies in therapeutic interventions. Nevertheless, some controversial issues remain such as the clinical implications of absolute scores obtained, and the need for updating the content of the instruments in accordance with the changes in natural history of diseases under evaluation (AU)

Nuevos indicadores clínicos. La calidad de vida relacionada con la salud. / [New clinical indicators. Health-related quality of life]

In the last decades the need of better measurements of health outcomes has increased the interest for new clinical indicators. Health-related quality of life (HRQoL) has emerged in this context as a multidimensional model approach where the patient is the exclusive source of information. The main objective of HRQoL measurement is to provide a global evaluation of the impact of diseases and the consequences of treatments over the daily life of the patients. The instruments developed for that purpose are questionnaires; either generic--for the comparison between different diseases-, or specific--aimed to evaluate particular conditions. These questionnaires must demonstrate several psychometric properties, such as reliability, validity, responsiveness, and for some authors also feasibility. In many areas, HRQoL studies have demonstrated to increase the knowledge of the natural history of diseases and its global consequences, beyond the classic health outcomes information based on morbidity and mortality rates. This knowledge may assist in the design of epidemiological studies and improve the comparison of strategies in therapeutic interventions. Nevertheless, some controversial issues remain such as the clinical implications of absolute scores obtained, and the need for updating the content of the instruments in accordance with the changes in natural history of diseases under evaluation.

A randomized clinical trial comparing nelfinavir or nevirapine associated to zidovudine/lamivudine in HIV-infected naive patients (the Combine Study).

BACKGROUND: Non-nucleoside reverse transcriptase inhibitor-containing regimens may be a valid alternative to protease inhibitor-containing regimens for initial antiretroviral therapy, but to date few studies comparing these two strategies have been performed. OBJECTIVE: To evaluate the efficacy and safety of nelfinavir or nevirapine associated to zidovudine/lamivudine in HIV-infected naive patients. DESIGN: Randomized, open-label, multicentre trial. SETTING: Twelve centres in Spain (9) and Argentina (3). PATIENTS: One hundred and forty-two HIV-infected naive patients without AIDS. INTERVENTIONS: Patients received combivir (zidovudine 300 mg/lamivudine 150 mg, twice-daily) plus either nelfinavir (1250 mg) twice-daily (zidovudine/lamivudine/nelfinavir, n=70) or nevirapine (200 mg) twice-daily (zidovudine/lamivudine/nevirapine, n=72), and were followed for 12 months. The primary endpoint was the proportion of patients with a plasma HIV-1 RNA (pVL) of less than 200 copies/ml by PCR at 12 months. pVL of less than 20 copies/ml (PCR), changes in CD4 counts, clinical progression and adverse events were also evaluated. Efficacy was assessed using intent-to-treat (ITT) (missing=failure) and on-treatment analysis. RESULTS: At 12 months in the ITT analysis the proportion of patients with pVL below 200 copies/ml was 60% (95% CI 48.5-71.5) in the zidovudine/lamivudine/nelfinavir arm and 75% (95% CI 65-85) in the zidovudine/lamivudine/nevirapine arm (P=0.06), and the proportion below 20 copies/ml was 50% (95% CI 38.3-61.7) and 65% (95% CI 54.2-76.2), respectively (P=0.06). No differences were found when comparing the subgroup of patients with baseline pVL of more than 100,000 copies/ml. A gain of +173 and +162 CD4 cells/mm3, respectively, was observed. Zidovudine/lamivudine/nelfinavir was discontinued in 21% of patients, and zidovudine/lamivudine/nevirapine in 25%, due to toxicity (P>0.2). CONCLUSIONS: Our results suggest that zidovudine/lamivudine/nevirapine is at least as effective as zidovudine/lamivudine/nelfinavir as first-line therapy for HIV disease.