Occupational Physical Activity and Cardiovascular Risk Factors Profile in the Adult Population of the Southern Cone of Latin America: Results From the CESCAS I Study

OBJECTIVE: We explore the association between occupational physical activity (OPA) and cardiovascular risk factors in four cities of the Southern Cone. METHODS: Robust multivariable linear regression models were used to examine the associations. RESULTS: The working population was constituted by 1868 men and 1672 women. Men performing high levels of OPA showed higher levels of high-density lipoprotein (HDL; mean adj. diff. = 2.24 mg/dL; P = 0.004), lower levels of triglycerides (-24.59 mg/dL; P = 0.006), and total cholesterol (TC)/HDL ratio values (-0.21; P = 0.015) than reference. Women in the highest category of OPA had higher levels of HDL (2.85 mg/dL; P = 0.006), lower TC/HDL (0.27; P = 0.001), and low-density lipoprotein/HDL ratios (-0.18; P = 0.003) than sedentary activities. CONCLUSION: Individuals who performed high levels of OPA did not exhibit a worse cardiovascular risk profile and an improvement on selected biomarkers was observed when compared with those performing sedentary activities.Fil: Poggio, Rosana. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Melendi, Santiago Ezequiel. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Gutierrez, Laura. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Elorriaga, Natalia. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentin

Towards a community of practice : a way to improve research, advocacy and policy in healthy food systems in Latin America and the Caribbean

This project aims to establish and sustain a community of practice for healthy food systems in Latin America and the Caribbean to encourage collaborative learning and quality information exchange among different individuals, groups and organizations involved with research and/or advocacy. The goal is to provide new forms of engagement and networking and to reinforce international cooperation to promote healthier food systems and prevent non‐communicable diseases in Latin America and the Caribbean (LAC). This report outlines the project’s rationale, objectives, methodology, and outputs

Use of m-Health Technology for Preventive Interventions to Tackle Cardiometabolic Conditions and Other Non-Communicable Diseases in Latin America- Challenges and Opportunities

In Latin America, cardiovascular disease (CVD) mortality rates will increase by an estimated 145% from 1990 to 2020. Several challenges related to social strains, inadequate public health infrastructure, and underfinanced healthcare systems make cardiometabolic conditions and non-communicable diseases (NCDs) difficult to prevent and control. On the other hand, the region has high mobile phone coverage, making mobile health (mHealth) particularly attractive to complement and improve strategies toward prevention and control of these conditions in low- and middle-income countries. In this article, we describe the experiences of three Centers of Excellence for prevention and control of NCDs sponsored by the National Heart, Lung, and Blood Institute with mHealth interventions to address cardiometabolic conditions and other NCDs in Argentina, Guatemala, and Peru. The nine studies described involved the design and implementation of complex interventions targeting providers, patients and the public. The rationale, design of the interventions, and evaluation of processes and outcomes of each of these studies are described, together with barriers and enabling factors associated with their implementation.Fil: Beratarrechea, Andrea Gabriela. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Diez Canseco, Francisco. Universidad Peruana Cayetano Heredia; PerúFil: Irazola, Vilma. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Miranda, Jaime. Universidad Peruana Cayetano Heredia; PerúFil: Ramirez Zea, Manuel. Institute of Nutrition of Central America and Panama; GuatemalaFil: Rubinstein, Adolfo Luis. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Socio-economic inequalities in smoking prevalence and involuntary exposure to tobacco smoke in Argentina: Analysis of three cross-sectional nationally representative surveys in 2005, 2009 and 2013

Background: Understanding patterns of socio-economic inequalities in tobacco consumption is key to design targeted public health policies for tobacco control. This study examines socio-economic inequalities in smoking and involuntary exposure to tobacco smoke between 2005 and 2013. Methods: Data were derived from the Argentine National Risk Factors Surveys, conducted in 2005, 2009, and 2013. Two inequality measures were calculated: the age-adjusted prevalence ratio (PR) and the disparity index (DI). Educational level, household income per consumer unit and employment status were used as proxies for socio-economic status (SES). Generalized linear models were used in the analysis. Results: Prevalence of smoking decreased from 29.7% to 25.1% between 2005 and 2013, mainly in women (p<0.001). Despite the overall prevalence reduction, socio-economic inequalities in smoking persisted. For both men and women, the DI was moderately high for smoking (14.47%-33.06%) across the three surveys. In men, the PR indicated a higher smoking prevalence for lower educational levels and lower household income throughout the analyzed period. In women, unlike previous years, the 2013 survey showed disparity related to unemployment. Involuntary exposure to tobacco smoke in 2013 was associated with educational level and household income, with lower involuntary exposure among those with higher SES. Conclusions: While overall smoking rates have decreased in Argentina, socio-economic disparities related to tobacco smoking persist. Comprehensive tobacco control programs targeted to address these inequalities are essential in developing strategies to reduce health disparities in tobacco-related diseases.Fil: Santero, Marilina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Melendi, Santiago Ezequiel. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Hernández Vásquez, Akram. Universidad San Ignacio de Loyola; PerúFil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentin

External Validation of Cardiovascular Risk Scores in the Southern Cone of Latin America: Which Predicts Better?

Introducción: La estimación inexacta del riesgo cardiovascular poblacional puede llevar a un manejo inadecuado de las intervenciones médicas preventivas, como, por ejemplo, el uso de estatinas. Objetivo: Evaluar la validez externa de ecuaciones de predicción de riesgo cardiovascular en población general del Cono Sur de Latinoamérica. Material y métodos: Se evaluaron ecuaciones que incluyen variables evaluadas en el estudio CESCAS y que predicen tanto morbilidad como mortalidad cardiovascular global (CUORE, Framingham, Globorisk y Pooled Cohort Studies Equations). Para cada ecuación se realizó un análisis independiente en el que se tuvieron en cuenta los eventos cardiovasculares relevados. Se evaluó la discriminación de cada ecuación a través del cálculo del estadístico-C y el índice Harrell C. Para evaluar la calibración se graficó la proporción de riesgos observados vs. estimados por quintilos de riesgo para cada ecuación y se calculó la pendiente β de regresión lineal para las estimaciones. Se calculó sensibilidad y especificidad para la detección de personas con elevado riesgo cardiovascular. Resultados: La mediana del tiempo de seguimiento de la cohorte al momento del análisis es de 2,2 años, con un rango intercuartilo de 1,9 a 2,8 años. Se incorporaron a los análisis 60 eventos cardiovasculares. Todos los valores de estadístico-C y del índice de Harrell fueron superiores a 0,7. El valor de la pendiente β más alejado de 1 fue el de Pooled Cohort Studies Euations. Conclusiones: Si bien los parámetros de validación externa evaluados fueron similares, CUORE, Globorisk y el índice de Framingham fueron las ecuaciones con mejores indicadores globales de predicción de riesgo cardiovascular.Background: Inaccurate estimates of demographic cardiovascular risk may lead to an inadequate management of preventive medical interventions such as the use of statins. Objectives: The aim of this study was to evaluate the external validity of cardiovascular risk equations in the general population of the Southern Cone of Latin America. Methods: Equations including variables evaluated in the CESCAS cohort study and that estimate overall cardiovascular mortality (CUORE, Framingham, Globorisk and Pooled Cohort Studies) were assessed. For each equation, an independent analysis was performed taking into account the cardiovascular events originally considered. Discrimination of each equation was evaluated through C-statistic and Harrell’s C-index. To assess calibration, a graph was built for each equation with the proportion of observed events vs. the proportion of estimated events by risk quintiles and the β slope of the resulting linear regression was calculated. Sensitivity and specificity were determined for the detection of people at high cardiovascular risk. Results: The median follow-up time of the cohort at the time of the analysis was 2.2 years, with an interquartile range of 1.9 to 2.8 years. Sixty cardiovascular events were incorporated into the analysis. All C-statistic and Harrell’s-C index values were greater than 0.7. The value of the β slope farthest from 1 was that of the Pooled Cohort Studies score. Conclusions: Although the external validation parameters evaluated were similar, CUORE, Globorisk and the Framingham equations showed the best global performance for cardiovascular risk estimation in our population.Fil: Gulayin, Pablo Elías. Universidad Nacional de La Plata; Argentina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Danaei, Goodarz. Harvard University. Harvard School of Public Health; Estados UnidosFil: Gutierrez, Laura. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Poggio, Rosana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Ponzo, Jaqueline. Universidad de la República; UruguayFil: Lanas, Fernando. Universidad de La Frontera; ChileFil: Rubinstein, Adolfo Luis. Ministerio de Salud de la Nación; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentin

Estereotipos de género en la publicidad gráfica a través de folletos promocionales de las grandes cadenas de supermercados de Argentina

Fundamentos: Hablar de equidad de género requiere de abordar estereotipos perjudiciales, donde amenudo se perpetúan a través de la publicidad. El objetivo del estudio fue explorar la construcción yreproducción de estereotipos de género presentes en la publicidad gráfica a través de folletos promocionales en las principales cadenas de supermercados de la Ciudad Autónoma de Buenos Aires (CABA), Argentina.Métodos: Se desarrolló una metodología cualitativa usando análisis documental y muestreo intencional. Se recolectaron folletos de 8 principales cadenas de supermercados de la CABA durante 3 meses (960 páginas de folletos).Resultados: Los hallazgos indican que existen marcados estereotipos de género en las publicidades impresas donde se representó a las mujeres en roles pasivos y tradicionales como madre-cuidadora y ama de casa; esta tendencia se vio asimismo en publicidades orientadas a la población infantil. La representación de hombres fue con actividades diferenciales y roles activos. Se observaron representaciones vinculadas a la mujer madre, cuidadora y ama de casa y al modelo de familia tradicional en torno a aspectos alimentarios.Conclusiones: Se concluye que en las publicidades gráficas a través de folletos promocionales existen estereotipos de género sexistas, sin observar una evolución positiva hacia otros patrones de género, inclusión y diversidad.Fil: Moyano, Daniela Luz. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Elorriaga, Natalia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentin

Association between religiosity and depression varies with age and sex among adults in South America: Evidence from the CESCAS I study

Prior studies have suggest that religiosity mitigates symptoms of depression. However, population-based data in South America are limited. This study determines the prevalence of religiosity and explores its association with depression in four cities of the Southern cone of Latin-America. In the CESCAS I study 7524 participants aged between 35 and 74 years old were recruited between 2011 and 2012 from randomly selected samples in 4 cities (Bariloche and Marcos Paz, Argentina; Temuco, Chile; and Pando-Barros Blancos, Uruguay). Religiosity was assessed with a questionnaire from the Hispanic Community Health Study/Study of Latinos. Two dimensions were used: 1) recognition as belonging to a religion; and 2) frequency of participation in religious activities. Depression was measured using the PHQ-9. Prevalence of religiosity was described by sociodemographic characteristics. Association between religiosity and depression was examined through logistic regression models controlling for sex, age and other potential confounders. Weekly religious activities were reported by 32.3% (95% CI: 30.1, 33.6) of participants. Prevalence of major depressive episode (MDE) was 14.6% (95% CI: 13.6, 15.6). After controlling for confounders, older women (≥65 years) who reported religious affiliation had 70% lower likelihood of having MDE (OR: 0.3; 95% CI, 0.1, 0.8). Moreover, in this group, women participating in religious activities more than once per week compared with "never" had 50% lower likelihood of having a MDE (OR: 0.5; 95% CI: 0.3, 0.9). No association between religious activities and depression was found in men. Religiosity is highly prevalent among adults in four cities of South America. Our study found an inverse association between religiosity and depression only in women, stronger in olders. Although longitudinal studies are necessary to determine the true nature of these relationships, religiosity may be a relevant factor that health care providers could take into account when exploring depression in their patients.Fil: Santero, Marilina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Daray, Federico Manuel. Universidad de Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Prado, Carolina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Hernández Vásquez, Akram. Universidad San Ignacio de Loyola; PerúFil: Irazola, Vilma. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

An innovative approach to improve the detection and treatment of risk factors in poor urban settings: a feasibility study in Argentina

Background: The effective management of cardiovascular (CVD) prevention among the population with exclusive public health coverage in Argentina is low since less than 30% of the individuals with predicted 10-year CVD risk ≥10% attend a clinical visit for CVD risk factors control in the primary care clinics (PCCs). Methods: We conducted a non-controlled feasibility study using a mixed methods approach to evaluate acceptability, adoption and fidelity of a multi-component intervention implemented in the public healthcare system. The eligibility criteria were having exclusive public health coverage, age ≥ 40 years, residence in the PCC’s catchment area and 10-year CVD risk ≥10%. The multi-component intervention addressed (1) system barriers through task shifting among the PCC’s staff, protected medical appointments slots and a new CVD form and (2) Provider barriers through training for primary care physicians and CHW and individual barriers through a home-based intervention delivered by community health workers (CHWs). Results: A total of 185 participants were included in the study. Of the total number of eligible participants, 82.2% attended at least one clinical visit for risk factor control. Physicians intensified drug treatment in 77% of participants with BP ≥140/90 mmHg and 79.5% of participants with diabetes, increased the proportion of participants treated according to GCP from 21 to 32.6% in hypertensive participants, 7.4 to 33.3% in high CVD risk and 1.4 to 8.7% in very high CVD risk groups. Mean systolic and diastolic blood pressure were lower at the end of follow up (156.9 to 145.4 mmHg and 92.9 to 88.9 mmHg, respectively) and control of hypertension (BP < 140/90 mmHg) increased from 20.3 to 35.5%. Conclusion: The proposed CHWs-led intervention was feasible and well accepted to improve the detection and treatment of risk factors in the poor population with exclusive public health coverage and with moderate or high CVD risk at the primary care setting in Argentina. Task sharing activities with CHWs did not only stimulate teamwork among PCC staff, but it also improved quality of care. This study showed that community health workers could have a more active role in the detection and clinical management of CVD risk factors in low-income communities.Fil: Poggio, Rosana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Danaei, Goodarz. Harvard University. Harvard School of Public Health; Estados UnidosFil: Gutierrez, Laura. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Cavallo, Ana. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Lopez, María Victoria. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentin

Dietary patterns in adult population from Argentina

1p.Background and objectives: Dietary patterns (DP) have been used to identify different combinations of foods that may be associated with mortality and risk of chronic disease. The objective of this study was to identify DP in the adult population of Argentina, and explore associations with socio-demographic features. Methods: We defined DP among 3,000 adults between 35 to 74 years old, participating in CESCAS I, a population-based cohort study carried out in two cities in Argentina, Marcos Paz and Bariloche. Data on food intake was obtained from a validated self-administered food frequency questionnaire. Principal component Analysis (PCA) was used to identify DP. A summary score for each pattern was then derived and used in multiple regression analysis to examine the relationship between DP and socio-demographic variables. Results: Using PCA, we identified 3 major eating patterns. The first factor (Traditional dietary pattern), was characterized by a high intake of refined grains, red meat, whole fat dairy products, vegetable oils, and ?mate?, a traditional South American infused drink frequently consumed in Argentina; the second factor (Healthy dietary pattern), was characterized by a high intake of vegetables, fruit, low fat dairy products, whole grains, and legumes; the third factor (Processed-food dietary pattern) consisted mainly of processed meat, snacks, pizza, and ?empanadas?, a stuffed bread baked or fried. After adjusting for energy intake, we found that DP were associated with age, gender, and educational level. Healthy DP score was higher among women and high educational level (p=0.001) while men and young people scored significantly higher in the Processed-food DP (p=0.01). Conclusions: Local DP has been identified in our population. This study will provide useful information to set priority targets for nutrition interventions.https://www.karger.com/Article/PDF/354245Fil: Elorriaga, Natalia. Universidad Nacional de Córdoba. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Ciencias de la Salud. Universidad de Buenos Aires. Escuela de Nutrición. Cátedra de Evaluación Nutricional; Argentina.Fil: Defagó, María Daniela. Universidad Nacional de Córdoba. Escuela de Nutrición. Universidad de Tulane. Escuela de Salud Pública. Cátedra de Salud Cardiovascular. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Ciuencias de la Salud; Argentina.Fil: Gutiérrez, Laura: Universidad Nacional de Rosario. Cátedra de Bioestadística y Metodología de la Investigación. Universidad de Buenos Aires. Facultad de Medicina. Cátedra Estadística de la Maestría en Efectividad Clínica; Argentina.Fil: Poggio, Rosana. Universidad Nacional de Córdoba. Consejo Nacional de Investigaciones Científicas. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Buenos Aires. Escuela de Medicina; Argentina.Fil: Irazola, Vilma. Universidad de Buenos Aires. Escuela de Medicina. Maestría en Efectividad Clínica. Cátedra de Medición de Resultados, Estadística Avanzada y Bioestadística; Argentina.Nutrición, Dietétic

Healthiness, processing, and price discounts of foods advertised in supermarket flyers in Buenos Aires, Argentina

Introduction: The food environment, encompassing factors such as food availability, advertising, and promotions, can significantly impact dietary choices. The main objective of this study was to characterize the profile of the advertised products in relation to the food groups defined by the Dietary Guidelines for the Argentine Population (GAPA), the degree of processing and their price discounts. Methods: This cross-sectional study analyzed 4355 promotions of foods and beverages in supermarket circulars from seven supermarket chains over an 8-week period in Buenos Aires. Foods were classified into four categories based on the GAPA: 1) core food groups and water, 2) "optional" products (those to be limited), 3) alcoholic beverages, and 4) other foods. Additionally, NOVA classification was used to assess the degree and purpose of processing. The minimum purchase amount required for the discount and the unit price discount were analyzed by food group and degree of processing. Results: Only 37.0% of advertised food products were from the core recommended food groups, while 45.3% and 11.7% were "optional/discretionary" products and alcoholic beverages. In addition, 56% of the food and non-alcoholic beverage promotions included ultra-processed (UP) products. The minimum purchase amount to obtain a discount and relative discounts were higher for "optional" products (p<0.001) and UP (p<0.001) compared to staple food groups and unprocessed or minimally processed foods, respectively. Conclusions: Most advertisements and price promotions found in supermarket circulars were for UP and items that the GAPA recommend limiting, suggesting an environment that is conducive to promoting unhealthy eating behaviors.Introducción. El ambiente alimentario, que abarca factores como la disponibilidad, publicidad y ofertas de alimentos puede influir significativamente sobre las elecciones alimentarias. El objetivo principal de este estudio fue caracterizar el perfil de los productos publicitados en relación con los grupos de alimentos definidos en las Guías Alimentarias para la Población Argentina (GAPA), el grado de procesamiento y sus descuentos en el precio. Metodología. Este estudio transversal analizó 4355 promociones de alimentos y bebidas en circulares de supermercados de siete cadenas de supermercados durante un período de 8 semanas en Buenos Aires. Los alimentos se clasificaron en cuatro categorías basadas en el GAPA: 1) grupos de alimentos básicos y agua, 2) productos "opcionales/discrecionales" (aquellos a limitar), 3) bebidas alcohólicas y 4) otros alimentos. Además, la clasificación NOVA se utilizó para evaluar el grado y la finalidad del procesamiento. La cantidad mínima de compra requerida para el descuento y el descuento en el precio unitario se analizaron por grupo de alimentos y grado de grado de procesamiento. Resultados. Solo el 37% de los productos alimenticios anunciados pertenecía a los grupos de alimentos básicos recomendados, mientras que el 45,3% y 11,7% eran productos "opcionales/discrecionales" y bebidas alcohólicas. Además, el 56% de las promociones de alimentos y bebidas no alcohólicas incluían productos ultraprocesados (UP). La cantidad mínima de compra para obtener un descuento y los descuentos relativos fueron mayores para los productos "opcionales/discrecionales" (p <0,001) y los UP (p <0,001) en comparación con los grupos de alimentos básicos y los alimentos no procesados o mínimamente procesados, respectivamente. Conclusión. La mayoría de los anuncios y promociones de precios en los volantes eran para productos que las GAPA recomiendan limitar y UP, sugiriendo un entorno tendiente a promover conductas de alimentación poco saludable.Fil: Elorriaga, Natalia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Escuela de Nutrición; Argentina. Universidad Nacional de la Matanza. Departamento de Cs. de la Salud; ArgentinaFil: Cavallo, Ana Soledad. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Moyano, Daniela Luz. Instituto de Efectividad Clínica y Sanitaria; Argentina. Universidad Nacional de la Matanza. Departamento de Cs. de la Salud; ArgentinaFil: Torres, Verónica. University of New York; Estados UnidosFil: Faye, Maimouna. University of New York; Estados UnidosFil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentin