The Revista Argentina de Salud Pública publish original articles on research, reviews, health interventions, epidemiological analyses and social studies with a clinical or Health Science perspective on different aspects of Public Health, with the purpose of disseminating scientific evidence in Public Health for health decision makers, health professionals, researchers and educators. The Revista Argentina de Salud Pública is an Open Access continuous publication that accepts the deposit of articles in preprint repositories and does not charge for editorial processing.
Accessibility to post-intensive care devices and resources for people with post COVID-19 syndrome
INTRODUCTION: Within the framework of the therapeutic itineraries of people with post-COVID-19 syndrome who were hospitalized in the Intensive Care Unit (ICU) and Post-ICU Intensive Rehabilitation Ward for COVID-19 (SARIP) of Juan A. Fernández Hospital in Buenos Aires city in 2021, the aim of this research was to explore the accessibility to post-ICU care devices and resources. METHODS: It was an exploratory, descriptive study with a cross-sectional/synchronic design, which used a qualitative methodological strategy and the semi-structured interview as a data collection technique. RESULTS: Fragmentation between emergency care and follow-up was observed. Difficulties were found in accessing health services after hospitalization, as a result of which the subjects developed multiple strategies (resorting to social security or prepaid health insurance, paying for consultations, contacting health professionals directly, circulating among various institutions, etc.), although often without results. DISCUSSION: These results allow to think about the organization of the health system after the pandemic, seeking to strengthen it in order to guarantee the right to access to health and care of the health-disease process from an integral health perspective.
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Children’s road safety: Observational study in kindergartens of the city of Mar del Plata, Buenos Aires Province, 2022
INTRODUCTION: Preventive behaviors, such as using helmets and child restraint systems, are a key factor for road safety. In Argentina, these measures are rarely taken for the child population. The objectives were: a) to know the percentage of preventive behaviors in children and accompanying adults traveling to kindergartens in three modes of transport (four-wheeled motor vehicles, motorcycles and bicycles); b) to identify factors associated with the use of such measures; and c) to analyze the relationship between preventive behaviors, road conditions in the immediate surroundings of the kindergartens and the level of socio-environmental vulnerability in the area where they are located. METHODS: A cross-sectional observational study was conducted. A total of 462 drivers and 508 children were observed in 13 municipal kindergartens in the city of Mar del Plata. RESULTS: On motorcycles, 18.3% of the children wore helmets. In four-wheeled vehicles, 12.5% used some type of restraint system. On bicycles, only one child wore a helmet. When drivers did not use safety devices and in areas of high vulnerability, it was more common for children to travel without protection. The most deficient road environments were located in highly vulnerable areas and were associated with a lower proportion of preventive behaviors. DISCUSSION: The results provide a relevant contribution for the development of child road safety policies.
SARS-CoV-2 outbreaks in long-term care facilities in Argentina: a national observational study
INTRODUCTION: The impact of the COVID-19 pandemic on the long-term care facility (LTCF) sector and its resident population was particularly severe, especially due to SARS-CoV-2 outbreaks. The aim of the study was to describe the evolution of SARS-CoV-2 outbreaks occurring in LTCFs nationwide in 2020 and 2021, characterize the affected population and analyze possible differences between pre- and post-COVID-19 vaccination. METHODS: A retrospective, observational study was designed, using data from the National Health Surveillance System (SNVS 2.0) and the Nominalized Federal Vaccination Registry (NOMIVAC) as well as the National Institute of Social Services for Retirees and Pensioners’ (INSSJP-PAMI) own database. RESULTS: Of the 493 outbreaks that occurred between April 2020 and December 2021, 363 (and 5643 cases in outbreak context) were reported in the pre-vaccination period and 130 (and 1378 cases) in the post-vaccination period. Incidence (34.1%), case fatality (20.7%) and mortality (7.1%) rates were higher in the pre- than in the postvaccination period (25.2%, 3.9% and 1%, respectively). DISCUSSION: These results suggest that the COVID-19 prevention and control policies implemented by the INSSJP-PAMI for the LTCF sector reduced the impact of the pandemic on a vulnerable and at-risk population.
Effects of the COVID-19 pandemic on the patients with diabetes mellitus healthcare, General Pueyrredon District, Argentina
INTRODUCTION: The COVID-19 pandemic led to the adoption of confinement measures with impact on the control of diabetes mellitus (DM). The aim was to assess the effect of the pandemic on the care of people with DM in the public and private health subsectors of General Pueyrredon District (PGP). The primary endpoints were glycosylated hemoglobin (HbA1c) and metabolic control, and the secondary were fasting plasma glucose, body mass index (BMI), triglycerides, cholesterol, medical visits, hospitalization, ophthalmoscopy and albumin-to-creatinine ratio. Differences with a p-value. RESULTS: A total of 327 participants were included (51.7% from the public subsector). Median HbA1c increased from 8.1% (interquartile range [IQR] 2.7) to 8.8% (IQR 2.8). The pandemic along with the public subsector healthcare and incomplete DM treatment were independent predictors of the HbA1c increase; while insulin treatment was a predictor of glycemic control decrease. DISCUSSION: The pandemic had a negative impact on DM medical care, which highlights inequalities in the subsectors of the healthcare system.
Reformulation of ultra-processed products in Argentina after the implementation of front-of-pack labeling
INTRODUCTION: The implementation of front-of-package labeling in Argentina encourages product reformulation, promoting healthier food environments. The objective was to analyze the changes in the content of energy, added sugar, total fat, saturated fat, and sodium in ultra-processed products during the first stage and upon completion of the implementation period of the law regulating frontof-package labeling in the country. METHODS: A longitudinal study with non-probabilistic sampling was conducted. Data were collected in two stages: T1 (June-August 2022) and T2 (December 2023-March 2024). Changes were evaluated using the Wilcoxon signed-rank test. RESULTS: The sample comprised 682 products in T1 and 527 in T2. Energy content decreased in dairy and sweet biscuits (p<0.05) There was a notable reduction in total fat (40 %) and saturated fat (38.73 %) content in dairy products (p<0.05), followed by decreases in saturated fat (11.76 %) and sodium (9.69 %) in savory snacks (p<0.05), while it decreased in ice cream, chocolates, sweet biscuits, and “alfajores” ” (p<0.05). DISCUSSION: There was no evidence of a general pattern of product reformulation; this phenomenon was observed in certain groups and specific nutrients such as total fat, saturated fat, and sodium.
Food environment: drinking water availability and kiosks access at public schools in Buenos Aires province
INTRODUCTION: The school environment plays an important role in the prevention of malnutrition in childhood. The objective was to evaluate the availability of drinking water in the kitchen, the supply at lunchtime and during the school day, and the presence of the kiosks at public schools in Buenos Aires province, based on food provision and unsatisfied basic needs (UBN). METHODS: A post-hoc analysis of the 2016-2019 School Food Service Survey was conducted. It included 3342 early childhood, primary and secondary schools. Kitchen water supply, drinking water sources for students, beverage at lunch and kiosk availability were assessed. Variables were analyzed by educational level and stratified according to food provision. A descriptive statistical analysis was carried out. RESULTS: About 1% (n=30) of the schools did not have drinking water in the kitchen, and no percentage differences were observed by benefit or UBN tertile. Ten percent of schools did not offer any beverage at lunch, and 7 out of 10 did not have an accessible source of drinking water; 4 out of 10 primary and secondary schools had a kiosk. When assessed by UBN, the proportion of schools with kiosks decreased as the tertile increased. DISCUSSION: It is essential to generate policies to regulate the school environment with a comprehensive and systemic approach in order to prevent malnutrition in the most vulnerable child population.
Reformulation of cookies and beverages in La Plata Partido, Buenos Aires Province, following National Law 2764
INTRODUCTION: The front-of-package nutrition warning labeling addressed in National Law No. 27642 is intended to generate an impact at the population level, modifying consumption patterns and reducing the purchase of ultra-processed foods with high content of critical nutrients. In addition, the industry is expected to reformulate its products by reducing the content of critical nutrients and, consequently, the warning labels. The aim was to evaluate the reformulation of packaged cookies and beverages in La Plata Partido, Buenos Aires Province, as a response from the industry to the Healthy Eating Promotion Law. METHODS: An observational, descriptive and longitudinal study was carried out, with two photographic records of all the cookies and beverages present in four hypermarkets between April and September 2023. Differences in the composition of sugars, total and saturated fats, sodium, energy, sweeteners and caffeine were analyzed, as well as changes in the presence of warning labels and cautionary legends. RESULTS: A total of 497 products (305 cookies and 192 beverages) were analyzed. Both increases and decreases in the content of critical nutrients were found for both categories. No frequent changes were found in the presence of warning labels and cautionary legends. DISCUSSION: No concrete evidence was found of the impact of the front-ofpackage warning labeling policy on the favorable reformulation of critical nutrients in cookies and beverages in La Plata and Gran La Plata.
Canine fecal contamination, zoonotic helminths and protozoa in Buenos Aires: Association with environmental variables
INTRODUCTION: Zoonoses caused by protozoa and helminths affect around 3.5 billion people in the world. Dogs are a source of infection and environmental contaminants of these pathologies. Although there is information on this problem in the Autonomous City of Buenos Aires (CABA), the socio-environmental heterogeneity makes it necessary to analyze all its communes. The objective was to evaluate canine fecal contamination, presence and parasitic load of zoonotic helminths and protozoa in fecal matter (FM) of CABA squares, analyzing their possible association with urban-environmental variables (UEV). METHODS: A descriptive, analytical, quantitative and cross-sectional study was carried out in 40 green spaces in CABA during 2022-2023. FM quantity was counted, UEV were surveyed and 800 FM samples were collected for coproparasitological analysis and determination of parasitic load. Frequency and percentage of each taxonomic group were calculated, analyzing the possible association between fecal contamination, infestation, parasite load and UEV. RESULTS: A total of 7198 feces were counted (21% infested). The species observed were Ancylostoma caninum, Trichuris vulpis, Toxocara canis, Cystoisospora canis and Giardia sp. DISCUSSION: The green spaces represent an important source of environmental contamination and contagion of parasitic zoonoses. Strategies must be improved through public policies of responsible ownership and health education.
Cost and affordability of a nutritious diet as a barrier to a healthy food in Argentinian regions
INTRODUCTION: Low nutritional quality diets are a major risk factor for NCDs, the leading cause of death worldwide. Food cost and affordability have been emphasized as factors influencing consumption decisions. OBJECTIVE: To analyze the cost and affordability of the common diet (CD) and healthy diet (HD) for the Argentine population, and the differences according to regions of the country. METHODS: Descriptive, cross-sectional analysis, based on the design of diets for the Argentine population and the calculation of their cost and affordability in 2020. Food prices were obtained from the National Government’s Precios Claros website. RESULTS: HDs are more expensive than CH in all regions, and the gap reached its maximum value in the North Eastern Region (NER) (HD between 33.9%-23.9% more expensive than CD) and the minimum in Patagonia Region (HD between 28.8%-19.1% more expensive). In terms of affordability, the differences between regions were more relevant, given the great variability in income. In NER, a higher percentage of income is required to buy the diets, while in Patagonia the lowest percentages are required. DISCUSSION: The study showed that healthier diets are more expensive and less affordable for all Argentine population, a situation that is even more worrying in the northern region of the country, where the affordability of diets is lower.
Evaluation of the attributes of the national electronic tuberculosis registration system in Argentina according to the CDC methodology in 2019-2023
INTRODUCTION: The registration of information is a fundamental component in the care of patients with tuberculosis (TB) and the control of the disease. The objective was to evaluate attributes of the national TB notification system in Argentina following the methodology proposed by the Centers for Disease Control and Prevention (CDC) of the USA. METHODS: Indicators were constructed to evaluate quality, timeliness and positive predictive value (PPV), working with the information recorded for all TB cases reported during 2019-2022 in the National Health Surveillance System (SNVS). Surveys were carried out to assess the perception of users of the system regarding its simplicity, flexibility, acceptability, usefulness and stability in health facilities in the cities of Salta and Santa Fe and locations of the Metropolitan Area of Buenos Aires (AMBA), and information available in the facilities during 2023 was collected to assess sensitivity. RESULTS: The quality of the recorded information did not meet the requirements to achieve the proposed standards. The PPV for TB cases was 89.7%. The quality of the system was evaluated as good; simplicity, flexibility, stability and acceptability, as average. The sensitivity was 97.7%. DISCUSSION: The national electronic TB registration system is a valuable tool for surveillance, but there is room for improvement in its design and use by users.
Characterization of physicians and nurses in the Buenos Aires province based on the cross-referencing of administrative records of the labor forcé
INTRODUCTION: In fragmented health systems, such as Argentina’s, planning human resource allocation is complex. The statistical use of administrative records from various public agencies belonging to different jurisdictions allows for new perspectives on the labor market for physicians and nurses. OBJECTIVE: To characterize physicians and nurses in the province of Buenos Aires (PBA) by cross-referencing administrative record databases. METHODS: A relational database was constructed by integrating tables from the Red Federal de Registros de Profesionales de la Salud (REFEPS) and the Registro Federal de Establecimientos de Salud (REFES). The data was validated and enriched using the National Tax and Social Identification System. RESULTS: Of the 77,865 physicians and 90,759 nurses licensed in PBA in 2020, only 34,907 physicians and 42,109 nurses were on PBA staff, revealing a gap between licensing and labor market integration. Among licensed physicians, 47.5% were women, rising to 52.8% among those under 65 years old. In nursing, 82.8% were women, though this dropped slightly to 81.8% among those under 65. Multi-employment (ME) in nursing reached 13.7% and increased with the level of training, while in medicine, ME reached 36.6%. DISCUSSION: Cross-referencing databases provided greater precision regarding the healthcare labor market and active professionals, which can enhance the design of public policies.
Characterization of a low-cost recycled UV-C light source and assessment of its germicidal activity against bacteria and viruses
INTRODUCTION: Since the COVID-19 pandemic, there has been an increased demand for UV-C radiation as a disinfectant agent for surfaces and enclosed spaces. While this disinfection mechanism is well-known, the devices used are very large and expensive. This study addressed a reliable, versatile, accessible and very low-cost UV-C source. The main objective was to characterize and evaluate the germicidal efficacy of a UV-C source, consisting of a quartz bulb found inside commercial public lighting fixtures. METHODS: For spectral characterization, an Acton Research Corporation VM-504 monochromator was used and irradiance was measured with a specifically designed and manufactured sensor. To analyze the germicidal action, radiation studies were carried out on different strains of bacteria and viruses. The spectral characteristics of the chosen source were studied and compared to the commercial one. The bactericidal and virucidal power was evaluated in laboratory samples, confirmed with four types of bacteria and one virus. RESULTS: It was demonstrated that the radiation generated by this source eliminated all bacteria within 30 seconds of exposure and within 1 minute in the case of the virus, both tests at a distance of 300 mm. DISCUSSION: This equaled or even surpassed the germicidal power of a commercial source in some cases.
Comparative profile of winners of “Salud Investiga” grants 2022- 2023 and 2023-2024 awarded by the Argentine Ministry of Health
Since 2002, the Directorate of Health Research (DIS) has carried out the call for “Salud Investiga” grants with the aim of promoting research in Public Health to reduce the gap between production and use of scientific evidence in health decision-making. The aim of this article was to describe and compare the profiles of the winners of the last two calls (2022-2023), highlighting the strategies implemented by the DIS to improve the equity and quality of the proposals. It should be noted that both calls had the distinctive feature of reestablishing a set of Multiple Investigator Study (MIS) grants by Invitation, with topics previously selected as priorities by the Ministry of Health. In 2022, 58 grants were awarded for Individual Studies (IS), 242 for MIS and MIS by Invitation, and similarly in 2023, 52 grants were awarded for IS and 248 for MIS and MIS by Invitation. The guideline with the highest number of awarded projects both in 2022 and 2023 was Non-Communicable Chronic Diseases.
Non-communicable disease mortality trends in Argentina between 1997 and 2021
INTRODUCTION: Non-communicable diseases (NCDs) are mainly represented by diabetes, cardiovascular diseases, cancer and chronic respiratory diseases, and are the main cause of death globally and in Argentina. NCDs affect people of all ages and are responsible for more than 70% of total deaths worldwide. The objective of this work was to characterize the epidemiological profile of NCD mortality in Argentina. METHODS: A descriptive time series study was carried out using official data on deaths between 1997 and 2021. RESULTS: During the period analyzed, mortality due to NCDs decreased constantly, with average annual reductions of 1.2% in the rate. This downward trend was observed mainly in cardiovascular disease and cancer. For the other groups of causes, the trends were uneven. DISCUSSION: Despite this decline, NCDs are historically responsible for more than 70% of total deaths in Argentina (except for the years 2020 and 2021, as mortality due to COVID-19 decreased their relative weight). Therefore, considering the major burden of these diseases, policy design and implementation should continue in order to reduce morbimortality due to this cause.