Abstract Objective: To identify the place of congenital syphilis on the health agenda and analyze the process of social determination and social determinants having an influence, at different levels, on the health policy agenda setting, from a right to health perspective. Methods: Qualitative exploratory, descriptive and transversal study, based on primary data (semi-structured interviews with those involved in the subject at the global, regional and local level) as well as secondary data. A model was developed to analyze the health agenda and the position that a topic occupies in it, in this case, congenital syphilis. Results: Social determinants, at different levels, linked to foreign policy, trade, science / technological innovation and production systems, hinder the advance of congenital syphilis from a formal agenda to a decision agenda. This process is also influenced by the absence of pressure groups and a low visibility of the disease as a public health problem. Conclusions: Congenital syphilis persists as a public health problem, and in many countries of the region, this issue does not move up to a decision agenda, which hinders its effective control. The elaborated model and the social determinants identified at its different levels constitute a contribution in this direction.

Resumen Objetivo: Identificar el lugar que ocupa la sífilis congénita en la agenda de salud y analizar el proceso de determinación social y los determinantes que, en distintos niveles, influyen para que este tema avance (o no) hacia una agenda de decisión, desde un enfoque del derecho a la salud. Métodos: Estudio cualitativo exploratorio, descriptivo y transversal, basado en datos primarios (entrevistas semi-estructuradas a actores involucrados en la temática del nivel global, regional y local) y secundarios. Se elaboró un modelo para analizar la agenda de salud internacional y la posición que ocupa un tema, en este caso sífilis congénita. Resultados: Determinantes sociales en distintos niveles, vinculados a la política exterior, comercio, ciencia/innovación tecnológica y los sistemas de producción, dificultan el avance de la sífilis congénita desde una agenda formal a una agenda de decisión, sumado a la ausencia de grupos de presión y un bajo grado de visibilidad de la enfermedad como problema. Conclusiones: La sífilis congénita persiste como problema de salud pública. En muchos países de la región no logra pasar a una agenda de decisión, dificultando su efectivo control. El modelo elaborado y los determinantes sociales identificados en sus distintos niveles constituyen un aporte en esta dirección.

Resumo Objetivo: Identificar o lugar que a sífilis congênita ocupa na agenda da saúde e analisar o processo de determinação social e os determinantes que, em diferentes níveis, influenciam esta questão para avançar (ou não) em uma agenda de decisão a partir de uma abordagem do direito à saúde. Métodos: Estudo qualitativo exploratório, descritivo e transversal, com base em dados primários (entrevistas semiestruturadas com atores envolvidos com o tema em nível global, regional e local) e dados secundários. Foi desenvolvido um modelo para analisar a agenda internacional de saúde e a posição de um problema, neste caso a sífilis congênita. Resultados: Determinantes sociais em diferentes níveis, vinculados a política externa, comércio, ciência / inovação tecnológica e sistemas de produção dificultam o avanço da sífilis congênita de uma agenda formal para uma agenda de decisão, somada a ausência de grupos de pressão e baixa visibilidade da doença como problema. Conclusões: A sífilis congênita persiste como problema de saúde pública. Em muitos países da região, não é possível avançar para uma agenda de decisões, o que dificulta seu controle eficaz. O modelo elaborado e os determinantes sociais identificados em seus diferentes níveis são uma contribuição nessa direção.

Resumo Objetivo: Identificar o lugar que a sífilis congênita ocupa na agenda da saúde e analisar o processo de determinação social e os determinantes que, em diferentes níveis, influenciam esta questão para avançar (ou não) em uma agenda de decisão a partir de uma abordagem do direito à saúde. Métodos: Estudo qualitativo exploratório, descritivo e transversal, com base em dados primários (entrevistas semiestruturadas com atores envolvidos com o tema em nível global, regional e local) e dados secundários. Foi desenvolvido um modelo para analisar a agenda internacional de saúde e a posição de um problema, neste caso a sífilis congênita. Resultados: Determinantes sociais em diferentes níveis, vinculados a política externa, comércio, ciência / inovação tecnológica e sistemas de produção dificultam o avanço da sífilis congênita de uma agenda formal para uma agenda de decisão, somada a ausência de grupos de pressão e baixa visibilidade da doença como problema. Conclusões: A sífilis congênita persiste como problema de saúde pública. Em muitos países da região, não é possível avançar para uma agenda de decisões, o que dificulta seu controle eficaz. O modelo elaborado e os determinantes sociais identificados em seus diferentes níveis são uma contribuição nessa direção.

Abstract Objective: To identify the place of congenital syphilis on the health agenda and analyze the process of social determination and social determinants having an influence, at different levels, on the health policy agenda setting, from a right to health perspective. Methods: Qualitative exploratory, descriptive and transversal study, based on primary data (semi-structured interviews with those involved in the subject at the global, regional and local level) as well as secondary data. A model was developed to analyze the health agenda and the position that a topic occupies in it, in this case, congenital syphilis. Results: Social determinants, at different levels, linked to foreign policy, trade, science / technological innovation and production systems, hinder the advance of congenital syphilis from a formal agenda to a decision agenda. This process is also influenced by the absence of pressure groups and a low visibility of the disease as a public health problem. Conclusions: Congenital syphilis persists as a public health problem, and in many countries of the region, this issue does not move up to a decision agenda, which hinders its effective control. The elaborated model and the social determinants identified at its different levels constitute a contribution in this direction.

Resumen Objetivo: Identificar el lugar que ocupa la sífilis congénita en la agenda de salud y analizar el proceso de determinación social y los determinantes que, en distintos niveles, influyen para que este tema avance (o no) hacia una agenda de decisión, desde un enfoque del derecho a la salud. Métodos: Estudio cualitativo exploratorio, descriptivo y transversal, basado en datos primarios (entrevistas semi-estructuradas a actores involucrados en la temática del nivel global, regional y local) y secundarios. Se elaboró un modelo para analizar la agenda de salud internacional y la posición que ocupa un tema, en este caso sífilis congénita. Resultados: Determinantes sociales en distintos niveles, vinculados a la política exterior, comercio, ciencia/innovación tecnológica y los sistemas de producción, dificultan el avance de la sífilis congénita desde una agenda formal a una agenda de decisión, sumado a la ausencia de grupos de presión y un bajo grado de visibilidad de la enfermedad como problema. Conclusiones: La sífilis congénita persiste como problema de salud pública. En muchos países de la región no logra pasar a una agenda de decisión, dificultando su efectivo control. El modelo elaborado y los determinantes sociales identificados en sus distintos niveles constituyen un aporte en esta dirección.

ABSTRACT INTRODUCTION Legionella genus includes species that are found in a variety of aquatic environments, but must be incorporated into aerosols and inhaled to produce disease. Although most cases of pneumonia are caused by L. pneumophila, of the 58 species that constitute this genus, 24 were related to human disease. The aim of this study was to evaluate the presence of Legionella species in residential reservoirs of drinking water of Resistencia, Chaco. METHODS Forty six water samples taken from different points in the city were studied. Legionella detection In the samples was performed by culture as set out in the ISO standard 11731:1998. Real-time polymerase chain reaction (qPCR) assays were applied to isolates obtained by culture and identified as Legionellaspp. according to the ISO standard. The target sequences used corresponded to 23S rRNA gene, for the confirmation of the genus, and mip gene specific for the species L. pneumophila. RESULTS In 16 (34.8%) of the 46 samples studied Legionella spp. was recovered. Molecular technique confirmed the presence of Legionella pneumophila in 15 samples. In addition, 3 of these samples (6.5%) were also positive for anotherspecies of the genus Legionella. CONCLUSIONS This study demonstrated the presence of L. pneumophila and other species in residential drinking water reservoirs in Resistencia.

RESUMEN INTRODUCCIÓN El género Legionella comprende especies que se encuentran en ambientes acuáticos, pero se deben incorporar a aerosoles e inhalar para producir enfermedad. Si bien la mayoría de los casos de neumonía son causados por L. pneumophila, de las 58 especies que constituyen este género, 24 se relacionaron a enfermedad humana. El objetivo del trabajo fue evaluar la presencia de especies de Legionella en reservorios domiciliarios de agua potable de Resistencia, Chaco. MÉTODOS Se estudiaron 46 muestras de agua tomadas en diferentes puntos de la ciudad. La detección de Legionella se realizó por cultivo según lo establecido en la norma ISO 11731:1998. La técnica molecular de reacción en cadena de la polimerasa en tiempo real con colorante intercalante (Syber Green) se aplicó a los aislamientos obtenidos por cultivo e identificados como Legionella spp. Las secuencias diana utilizadas correspondieron a fragmentos conservados del gen 23SrRNA para la confirmación del género y el gen mip específico para la especie L. pneumophila. RESULTADOS En 16 (34,9%) de las 46 muestras estudiadas se recuperaron cepas de Legionella spp. Por la técnica molecular se confirmó la presencia de Legionella pneumophila en 15 de las muestras positivas por cultivo. Además, 3 de estas muestras (6,5%) también resultaron positivas para otras especies del género Legionella. CONCLUSIONES Este trabajo demostró la presencia de L. pneumophila y otras especies en los reservorios domiciliarios de agua potable en Resistencia.

Acute respiratory infection (ARI) is the most frequent pathology along human life, being the most common cause of morbidity and mortality in children under 5 years. The aim of this study was to determine the frequency of bocavirus (BoV) in infants under 5 years with symptoms of ARI from north Argentina (Chaco province). The study was performed on nasopharyngeal aspirates from 488 patients, in the period of January-December 2014. The samples were tested by real time PCR and 36 positive BoV cases (7.4%) were detected. The period with the highest detection rate was June-September with 28 cases (77.8%), of which 26 (72.2%) were infants between 6-18 moths of life. In half of BoV positive cases this virus was detected as single infection of the upper respiratory tract, and in the remaining 50%, as concomitant infection with other microorganisms. To our knowledge, this would be the first study on molecular epidemiology of BoV in northern Argentina. We emphasize the importance of investigating these new viruses capable of generating acute respiratory disease and also to disseminate awareness on their circulation within the community.

La infección respiratoria aguda (IRA) es la patología más frecuente a lo largo de la vida de una persona y es la causa más común de morbi-motalidad en menores de 5 años. El objetivo de este trabajo fue determinar la frecuencia de bocavirus (BoV) en pacientes menores de 5 años con diagnóstico presuntivo de IRA en una ciudad capital del norte argentino (Resistencia, Chaco). Se analizaron aspirados nasofaríngeos correspondientes a 488 niños durante el año 2014. Los mismos fueron testeados por PCR en tiempo real hallándose BoV en 36 casos (7.4%), de los cuales 26 (72.2%) fueron infantes de 6-18 meses de vida. La mayor concentración de positivos se registró en el período junio-septiembre con un total de 28 pacientes (77.8%). Los casos positivos para BoV se observaron como infección única en el 50% de los mismos y el resto como infecciones concomitantes con otros microorganismos. No conocemos que haya otro estudio de epidemiología molecular de BoV en el norte argentino y destacamos la importancia de investigar los nuevos virus capaces de generar infección respiratoria aguda, y difundir el conocimiento de su circulación en la comunidad.

Human papillomavirus (HPV) has the highest mortality rate due to cervical cancer in Northeastern Argentina. The aim of this work was to detect and characterize HPV in samples from the Province of Corrientes, Argentina. HPV detection and typing was performed using PCR-RFLP on samples with different cervical lesions (n = 255). Seventeen viruses typified as HPV-58 were sequenced (E6 and E7 genes) and mutations were analyzed. HPV DNA was detected in 56.1 % of the cervical lesions (143/255). Twenty-two different HPV types were detected. The type most frequently found among the total number of samples and HPV-positive samples was HPV-16 (14.5 % and 25.9 %, respectively), followed by HPV-58 (8.2 %/14.7 %, respectively), which is also considered a high-risk viral type. Increased severity of the cytological status was associated with greater rates of HPV detection and, especially, with the detection of greater rates of high-risk types. In addition, the evolutionary dynamics of the alpha-9 species group and HPV-58 was studied. All HPV-58 viruses reported in this work belonged to lineage A, sublineage A2. The phylodynamic analysis indicated that diversification of main groups within lineage A might have accompanied or preceded human migrations across the globe. Given that the most prevalent viruses found belonged to high-risk HPV types, some concerns might arise about the extent of cross protection of the vaccines against the types not included in their design.

Introducción: Las comunidades indígenas presentan un mayor riesgo de inseguridad alimentaria y malnutrición, menor disponibilidad de recursos, y una creciente dependencia de alimentos más baratos aunque con un alto grado de procesamiento. Objetivo: Identificar el estado nutricional y aspectos alimentarios en mujeres indígenas de tres comunidades del Departamento de Presidente Hayes, Chaco Paraguayo. Metodología: Estudio observacional de diseño transversal con componente analítico, que incluyó a 81 mujeres de 15 a 44 años de edad, de las etnias Maká y Toba Qom. Previo consentimiento informado, se realizó la valoración nutricional y la entrevista para obtener los datos sociodemográficos y alimentarios. Resultados: Las mujeres indígenas presentaron una frecuencia de sobrepeso de 30,8% y obesidad del 21,0%, mientras que el 1,2 % presentó desnutrición. No encontramos diferencia significativa entre las etnias, en relación al sobrepeso y obesidad, (p>0,05). Observamos que las indígenas tenían una alta ingesta de frutas, azúcares y mieles. El 87 y 88% de las mujeres indígenas de ambas etnias estudiadas refirieron no consumir lácteos y derivados y entre 65 y 69% refirieron no consumir verduras. Conclusiones: Observamos un elevado porcentaje de obesidad y sobrepeso, un bajo consumo de lácteos y verduras y un alto consumo de azúcares, relacionados posiblemente a cambios en los aspectos alimentarios y sus costumbres, influenciados por la cercanía a las zonas urbanas y el acceso a alimentos de menor precio y mayor contenido energético.

Introduction: Indigenous communities present higher risk of food insecurity and malnutrition, lower availability of resources and growing dependence on cheaper food but with high degree of processing. Objective: To identify the nutritional state and food aspects in indigenous women from three communities of Presidente Hayes Department, Paraguayan Chaco. Methodology: Cross-sectional observational study with analytical component including 81 women who were 15 to 44 years old from the Maká and Toba Qom ethnic groups. After giving their informed consent, the nutritional assessment and the interview to collect socio-demographic and food data were carried out. Results: The indigenous women presented an overweight frequency of 30.8 % and obesity of 21.0%, while malnutrition was observed in 1.2%. No significant differences were found between ethnic groups in relation to overweight and obesity (p>0.05). High ingestion of fruits, sugar and honey was observed and 87% and 88% of the indigenous women from both ethnic groups referred that they did not consume dairy products and derivatives and 65% and 69% referred that they did not consume vegetables. Conclusions: High percentages of obesity and overweight were observed. Low consumption of dairy products, its by products and vegetables and a high consumption of sugar were observed, related probably to changes in food aspects and the habits of these groups, influenced by the proximity to urban areas and the access to low prices food with high energetic content.

Objectives: High-risk types of human papillomavirus (HPV) are strongly associated with cervical cancer (CC), and Chlamydia trachomatis (CT), the most frequent sexually transmitted bacterial infection (STBI) worldwide, seems to be a risk factor for HPV infection and for CC. It is also known that both agents are more prevalent in vulnerable communities where lack of adequate primary health care is a cause for concern. The aim of this work was to determine the impact of CT and HPV infections in women belonging to an isolated aboriginal population (Pilaga community) from a poor region in Northern Argentina (province of Formosa). For this purpose, a cross-sectional study was performed in all sexually active Pilaga women, who attended a local community-based gynecological health screening project. The polymerase chain reaction (PCR) method on a cervical brush specimen was used to detect both agents. Results: A total of 227 women (20% of the total female population of the Pilaga community) were studied and the overall prevalence was 26.4% for CT, 46.7% for HPV and 16.3% for concurrent infection. CT infection was higher in HPV DNA positive (34.2%) than in HPV DNA negative women (19%; OR: 2.22/95% CI = 1.16-4.28 / p = 0.009) and the most prevalent HPV types were HPV-16 (19.4%), 6 and 18 (5.3%), 58 (3.5%) and 33 (3.1%). Conclusions: The prevalence of CT and HPV observed in Pilaga women are among the worst registered in Latin America. Also, data collected suggest that chlamydial infection may play an important role in the natural history of HPV infection. On this respect, we propose that the association between these two agents seems to be more related to a mutual potentiation than to the fact that they share a common route of transmission.

The presence of Chlamydia trachomatis and human papillomavirus (HPV) was evaluated by PCR technique in 189 sexually active women, between 15 and 58 years old, with cytological abnormalities in their uterine cervical epithelium and belonging to a region of Argentina with high incidence of cervical cancer. Risk factors in relation to chlamydial infection were also analyzed. Total prevalence for C. trachomatis infection was 24.9%, but there was a significant difference between prevalence in low socio-economical level (32.9%) and high or medium socio-economical level (17.7%). Total prevalence for DNA of HPV was 52.9%, but women infected with C. trachomatis showed a higher risk for viral infection than non-infected ones (OR=2.27 / CI 95%=1.10-4.73), with statistical significant difference (p=0.016).

Se estudió mediante técnica de PCR la presencia de Chlamydia trachomatis y de papilomavirus humano (HPV) en 189 mujeres sexualmente activas de entre 15 y 58 años de edad, con alteraciones citológicas del epitelio cérvico-uterino, provenientes de una región con alta incidencia de cáncer de cuello uterino de Argentina, y se analizaron los factores de riesgo. La prevalencia global por C. trachomatis fue de 24.9%; observándose una diferencia significativa de la prevalencia entre las mujeres de bajo nivel socio-económico (32.9%) y las de nivel medio o alto (17.7%). En cuanto a la infección por HPV, la prevalencia fue de 52.9% y se pudo observar que las mujeres infectadas con C. trachomatis presentan un mayor riesgo de infección por este virus que las no infectadas (OR=2.27 / IC 95%=1.10-4.73) con una diferencia estadísticamente significativa (p=0.016).

It has been well demonstrated the relationship between the infection with high-risk human papillomavirus (HPVs) genotypes and cervical cancer. In Northeastern Argentina a high incidence of this pathology has been described and therefore a high prevalence of HPV infection is expected. In order to identify HPV genotypes associated with malignant and pre-malignant cervical lesions present in the area, 53 ecto-endo cervical cell specimens obtained from women with cytohistological alterations were studied by a PCR-RFLP technique. Out of 53 patients, 34 (64.2%) were positive for HPV infection, being HPV-16 (32.3%) the most frequently found genotype, followed by HPV-58 (14.7%), -6, -18 and -45 (5.9%), -33, -52, -53, -54, -56, -66, -MM4 and -LVX100 (2.9%). Also 5 cases of infection caused by multiple genotypes were found, which corresponded to 14.7% of the positive cases. Results indicate that besides HPV-16 and -18, the most prevalent high-risk HPV genotypes worldwide, others like -45 and -58 as well as co-infection cases are frequent between women of Northeastern Argentina, and a particular attention should be paid to this circumstance because it could be an epidemiological feature of regional importance and a useful information for a future vaccination program.

La relación entre la infección por los virus papiloma humanos (HPVs) de alto riesgo y el cáncer de cuello de útero ha sido bien demostrada. En el Nordeste de Argentina se observa una alta incidencia de esta patología y en consecuencia se estima una alta prevalencia de infección por HPV. A fin de identificar los genotipos de HPV presentes en el área, asociados a casos de lesiones malignas y premalignas de cuello de útero, se estudiaron 53 muestras ecto-endo cervicales de mujeres con alteraciones citohistológicas residentes permanentes de las ciudades de Resistencia y Corrientes. De las 53 pacientes estudiadas, 34 resultaron positivas para HPV (64.2%), correspondiendo la mayor frecuencia a HPV-16 (32.3%), seguido por HPV-58 (14.7%), HPV-6, -18 y -45 (5.9%), -33, -52, -53, -54, -56, -66, -MM4 y -LVX100 (2.9%). Además, se encontraron 5 casos de infecciones mixtas causadas por mas de un genotipo, lo que resulta de importancia ya que representan el 14.7% del total de los casos positivos. Los resultados demuestran que, además de HPV-16 y -18 que son los genotipos de alto riesgo de mayor prevalencia a nivel mundial, otros como el HPV-45 y -58 y los casos de infecciones múltiples son frecuentes en mujeres del nordeste argentino, lo que podría constituir un rasgo epidemiológico de importancia regional y ser de utilidad en el futuro en los programas de vacunación.