Resumo O aumento da frequência das ondas de calor (OsC) é uma das consequências proeminentes das alterações climáticas. O seu impacto na saúde humana tem sido relatado principalmente no hemisfério norte, mas tem sido mal estudado no hemisfério sul. O objetivo deste estudo foi analisar os efeitos das OsC ocorridas no verão de 2013-14 sobre a mortalidade na região centro-norte da Argentina, onde 22 milhões de pessoas vivem. Foi realizado um estudo observacional de tipo ecológico que contrasta a mortalidade ocorrida durante as OsC do verão 2013-14 com a mortalidade nos verões 2010-11 a 2012-13. A mortalidade foi analisada de acordo com local de residência, idade, sexo e causa de morte. Durante as OsC do verão de 2013-14, registaram-se 1.877 (RR=1.23, 95%IC 1.20-1.28) mortes em excesso. O risco de morte (RM) aumentou significativamente em 13 das 18 províncias analisadas. As taxas de mortalidade por sexo revelaram um comportamento heterogêneo tanto no tempo como na escala espacial. O RM foi aumentado com a idade; este aumento foi particularmente significativo em quatro províncias para o grupo de 60-79 anos e em seis províncias em pessoas com mais de 80 anos. As causas de morte que mostraram significativamente incrementos foram: doenças respiratórias, cardiovasculares, renais e diabetes.

Abstract Increased frequency of heat waves (HWs) is one of the prominent consequences of climate change. Its impact on human health has been mostly reported in the northern hemisphere but has been poorly studied in the southern hemisphere. The aim of this study was to analyze the effects of the HWs waves occurred in the warm season 2013-14 on mortality in the center-north region of Argentina, where 22 million people live. It was carried out an observational study of ecological-type contrasting the mortality occurred during the HWs of the summer 2013-14 with the mortality in the summers 2010-11 to 2012-13, free from HWs. The mortality was analyzed according to the following variables: place of residence, age, sex and cause of death. During the HWs of the summer 2013-14, 1877 (RR=1.23, 95%CI 1.20-1.28) deaths in excess were registered. Moreover, the death risk significantly increased in 13 of the 18 provinces analyzed. The mortality rates by sex revealed heterogeneous behaviour regarding both the time and spatial scale. The death risk increased with age; it was particularly significant in four provinces for the 60-79 years group and in six provinces in people of 80 years and over. The death causes that showed significantly increments were respiratory, cardiovascular, renal diseases and diabetes.

Resumo O aumento da frequência das ondas de calor (OsC) é uma das consequências proeminentes das alterações climáticas. O seu impacto na saúde humana tem sido relatado principalmente no hemisfério norte, mas tem sido mal estudado no hemisfério sul. O objetivo deste estudo foi analisar os efeitos das OsC ocorridas no verão de 2013-14 sobre a mortalidade na região centro-norte da Argentina, onde 22 milhões de pessoas vivem. Foi realizado um estudo observacional de tipo ecológico que contrasta a mortalidade ocorrida durante as OsC do verão 2013-14 com a mortalidade nos verões 2010-11 a 2012-13. A mortalidade foi analisada de acordo com local de residência, idade, sexo e causa de morte. Durante as OsC do verão de 2013-14, registaram-se 1.877 (RR=1.23, 95%IC 1.20-1.28) mortes em excesso. O risco de morte (RM) aumentou significativamente em 13 das 18 províncias analisadas. As taxas de mortalidade por sexo revelaram um comportamento heterogêneo tanto no tempo como na escala espacial. O RM foi aumentado com a idade; este aumento foi particularmente significativo em quatro províncias para o grupo de 60-79 anos e em seis províncias em pessoas com mais de 80 anos. As causas de morte que mostraram significativamente incrementos foram: doenças respiratórias, cardiovasculares, renais e diabetes.

Abstract Increased frequency of heat waves (HWs) is one of the prominent consequences of climate change. Its impact on human health has been mostly reported in the northern hemisphere but has been poorly studied in the southern hemisphere. The aim of this study was to analyze the effects of the HWs waves occurred in the warm season 2013-14 on mortality in the center-north region of Argentina, where 22 million people live. It was carried out an observational study of ecological-type contrasting the mortality occurred during the HWs of the summer 2013-14 with the mortality in the summers 2010-11 to 2012-13, free from HWs. The mortality was analyzed according to the following variables: place of residence, age, sex and cause of death. During the HWs of the summer 2013-14, 1877 (RR=1.23, 95%CI 1.20-1.28) deaths in excess were registered. Moreover, the death risk significantly increased in 13 of the 18 provinces analyzed. The mortality rates by sex revealed heterogeneous behaviour regarding both the time and spatial scale. The death risk increased with age; it was particularly significant in four provinces for the 60-79 years group and in six provinces in people of 80 years and over. The death causes that showed significantly increments were respiratory, cardiovascular, renal diseases and diabetes.

ABSTRACT Objective Describe accessibility to public health services in the city of Concepción del Uruguay, Entre Ríos, and analyze the association between socioeconomic conditions of users and the health services chosen for routine care. Materials and Methods Observational cross-sectional study, with data obtained from primary sources from the application of a survey designed ad hoc from a two-stage probabilistic sampling. The data was analyzed through the preparation of contingency tables. The association between variables was measured using Chi2 tests and correspondence analysis. Results Evidence of a significant association between the type of health service the population attends and the highest level of education attained for α=0,05 (p<0,01). There is a correspondence between the categories "Incomplete Secondary" and "Complete Primary" and the choice of public Health Services, with greater force in the case of the Provincial Hospital and the Home health Referents with "Incomplete Secondary". Strong evidence was also found regarding the association between the occupation condition reported by the household health referents and the care service chosen by these households, for α=0,05 (p<0,01). Conclusion There is a gap in accessibility, where as the social position of users improves, the choice of primary care decreases and the choice of private services increases.

RESUMEN Objetivos Describir la accesibilidad a los servicios públicos de salud en la ciudad de Concepción del Uruguay, Provincia de Entre Ríos, y analizar la asociación existente entre las condiciones socioeconómicas de los usuarios y los servicios de salud elegidos para la atención habitual. Materiales y Métodos Estudio observacional de corte transversal, con datos obtenidos de fuentes primarias a partir de la aplicación de una encuesta diseñada ad hoc a partir de un muestreo probabilístico de dos etapas. Los datos fueron analizados a través de la confección de tablas de contingencia. La asociación entre las variables se midió a partir de pruebas de Chi2 y del análisis de correspondencias. Resultados Evidencia de asociación significativa entre el tipo de servicio de salud al que acude la población y el máximo nivel de instrucción alcanzado para α=0,05 (p<0,01). Existe una correspondencia entre las categorías "secundario incompleto" y "primaria completa" y la elección de los servicios de salud públicos, con una mayor fuerza para el caso del hospital provincial y los referentes de salud del hogar con secundario incompleto. También se halló una fuerte evidencia respecto a la asociación entre la condición de ocupación referida por los referentes de salud de los hogares y el servicio de atención elegido por estos, para α=0,05 (p<0,01). Conclusión Se observa una brecha en la accesibilidad en la que, a medida que mejora la posición social de los usuarios, disminuye la elección de la atención primaria y aumenta la elección de servicios privados.

ABSTRACT INTRODUCTION Mortality is associated with daily temperatures and extreme cold events. This study aimed to analyze the effects of low temperatures on mortality in the main urban areas of Argentina during 2005-2015. METHODS A time-series study with generalized additive models was conducted, modeling the relationship between low temperatures and mortality for 21 cities in Argentina between 2005 and 2015. Total mortality was analyzed as well as mortality by sex, age and cause of death, considering cold days, cold spells and delays of 7 and 14 days after those events. RESULTS Within a 7-day lag, the risk of death increases for a cold day in half of the cities analyzed between 1.04 [CI95%: 1.00-1.08] and 1.14 [CI95%: 1.06-1.23]. The most vulnerable group was people aged 65 or more years, with increases of up to 1.20 [CI95%: 1.05-1.39]. Cold spells are associated with an increased risk within the subsequent 7 days in 8 cities (1.05 [CI95%: 1.03-1.08] to 1.30 [CI95%: 1.03-1.65]), which increases to 10 cities for the 14-day lag, with slightly lower values. CONCLUSIONS With differences in magnitude and statistical robustness by cities, the population of most urban areas presents an increased risk of death within 7 and 14 days after an event of extreme cold.

RESUMEN INTRODUCCIÓN La mortalidad guarda relación con las temperaturas diarias y los eventos extremos. Este estudio buscó analizar los efectos de las bajas temperaturas sobre la mortalidad en las principales ciudades de Argentina en el período 2005-2015. MÉTODOS Se realizó un estudio de series temporales con modelos aditivos generalizados, modelando la relación entre bajas temperaturas y mortalidad para 21 ciudades de Argentina entre 2005 y 2015. Se analizó la mortalidad general y por grupos de sexo, edad y causa de muerte, en días fríos y días de olas de frío, así como los rezagos de 7 y 14 días posteriores a dichos eventos. RESULTADOS En los 7 días posteriores a un día frío, el riesgo de muerte aumenta en la mitad de las ciudades entre un 1,04 [IC95%: 1,00-1,08] y un 1,14 [IC95%: 1,06-1,23] según la ciudad. El grupo de 65 años y más es el que muestra mayor impacto, con un incremento de hasta el 1,20 [I C95%: 1,05-1,39]. Las olas de frío se asocian con un aumento más pronunciado en el riesgo de morir en los siguientes 7 días en 8 ciudades (1,05 [IC95%: 1,03-1,08] a 1,30 [IC95%: 1,03-1,65]), y en 10 ciudades en los siguientes 14 días, aunque con valores algo más bajos. CONCLUSIONES Con diferencias en magnitud y robustez estadística según las ciudades, la población de las áreas urbanas presenta un riesgo aumentado de muerte durante los 7 y 14 días posteriores a un evento de frío extremo.