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Abstract The Tolman–Ehrenfest criterion for the thermal equilibrium of a fluid at rest in a static general-relativistic geometry is generalized to scalar–tensor gravity. Surprisingly, the gravitational scalar field, which fixes the strength of the effective gravitational coupling, does not play a role in determining thermal equilibrium. As a result, heat does not sink more in a gravitational field where gravity is stronger.

AbstractA new public policy was instituted in Argentina for free distribution of subdermal contraceptive implants to women aged 15–24 years old in the public healthcare system. The objective of this study is to determine the extent to which this population adhered to the implant, as well as predictors of continuation. The retrospective cohort study was based on a telephone survey of a random sample of 1101 Ministry of Health-registered implant users concerning the continuation of use, satisfaction with the method and side-effects, and reasons for removal. Descriptive statistics and multivariate regression analysis were used to explore the association between adherence and having received contraceptive counselling, satisfaction, and side effects. We found high levels of adherence (87%) and satisfaction (94%). Common reported side effects were amenorrhoea or infrequent bleeding, perceived weight gain, increased menstrual bleeding and headaches. Multivariate regression analysis indicates that, among adolescents, having received contraceptive counselling increased comfort, while frequent bleeding at six months hindered trust. Participants who had a history of a prior delivery or who had themselves primarily chosen the method were less likely to request the removal of the implant. Our results support the public policy of free implant distribution in the public health sector. This is a sustainable public policy that contributes to equity and access to effective contraception. It is appropriate for adolescents and young women and will also reduce unintended pregnancies. Our results suggest that counselling patients is key prior to insertion of the implant, as it improves acceptability and continuation.

Objetivo. El Sistema Informático Perinatal (SIP) ha marcado un hito en el uso de información sistematizada en la Región de las Américas. Lo que se ha aprendido ha contribuido al desarrollo de un modelo basado en un conjunto mínimo de indicadores (CMI). El objetivo del estudio fue describir el proceso histórico y metodológico de desarrollo, implementación y escalamiento territorial de un CMI para monitorizar y evaluar políticas, programas y servicios de salud de la mujer y perinatal orientado a la gestión (SIP-GESTIÓN). Métodos. El estudio se llevó a cabo en dos etapas: 1) validación en cuatro fases de un CMI en una red de hospitales: a) construcción del modelo teórico de indicadores, b) implementación de la investigación operativa, c) selección final de indicadores, y d) definición de patrones de referencia, y 2) escalamiento territorial. Resultados. Se identificaron 17 modelos de indicadores. El modelo inicial incluyó 177 indicadores agrupados en siete dimensiones (contexto, hábitos, accesibilidad, uso de servicios, calidad de cuidados, impacto materno-fetal, e impacto materno-neonatal) que se redujeron a 21 tras tres rondas Delphi. El modelo final (SIP-GESTIÓN) incluyó 40 indicadores. Se analizaron 240 021 partos (79,1%) de un total de 303 559 atendidos en las 122 maternidades seleccionadas en 24 Jurisdicciones (100%) de Argentina. La información se presenta a nivel nacional y desagregada por región sanitaria, provincia y hospital. Conclusiones. Este modelo permitió alcanzar altos niveles de cobertura y calidad de la información y escalamiento territorial y es útil para la gestión, la investigación y la reorientación de programas y políticas.

La razón de mortalidad materna (RMM) se ha utilizado como indicador de salud sin considerar los eventos precedentes. La morbilidad materna severa (MMS) incluye a mujeres con morbilidad asociada a un embarazo, que amenaza sus vidas pero que finalmente permite la sobrevida. OBJETIVOS: Investigar la situación de la mortalidad materna (MM) y la MMS en Misiones, Jujuy y La Rioja. Establecer bases para un sistema de vigilancia y manejo de casos. MÉTODOS: Se realizó un estudio multicéntrico de prevalencia con un componente de implementación. Mujeres embarazadas, tratadas en el subsector público entre el 1 de octubre de 2013 y el 31 de marzo de 2014, fueron tamizadas para detectar condiciones potencialmente fatales (CPF) y notificar MMS y MM. RESULTADOS: Se analizaron 9.921 nacimientos. Ingresaron 294 mujeres, y hubo 219 (74,5%) casos de CPF, 67 (22,8%) de MMS y 8 (2,7%) de MM. Criterios de identificación por tamizaje: clínicos 78,1% de CPF, basados en enfermedad 94% de MMS, y 100% de MM presentó algún criterio clínico. Las principales causas de MMS fueron hipertensión (35,8%), hemorragias (29,9%) y complicaciones de abortos (13,4%). La incidencia global de CPF fue 2,21%, la de MMS 0,68% y la de MM 0,08%. El índice de morbimortalidad global fue de 8,4 (4,0-7,4), la tasa de letalidad global fue del 10,7%, y el uso global de intervenciones beneficiosas para el manejo de MMS fue del 54,8%. CONCLUSIONES: El estudio permitió conocer la MM y la MMS en las tres provincias y sentar las bases para implementar un sistema de vigilancia activa y respuesta rápida para el manejo de la MMS, consistente con el Plan Operativo Nacional.

OBJECTIVE: To perform a comprehensive assessment of maternal mortality in Argentina, the ultimate purpose being to strengthen the surveillance system and reorient reproductive health policies to prevent maternal deaths. METHODS: Our multicentre population-based study combining qualitative and quantitative methodologies included a descriptive analysis of under-registration and distribution of causes of death, a case-control study to identify risk factors in health-care delivery and verbal autopsies to analyse social determinants associated with maternal deaths. FINDINGS: A total of 121 maternal deaths occurred during 2002. The most common causes were abortion complications (27.4%), haemorrhage (22.1%), infection/sepsis (9.5%), hypertensive disorders (8.4%) and other causes (32.6%). Under-registration was 9.5% for maternal deaths (n = 95) and 15.4% for late maternal deaths (n = 26). The probability of dying was 10 times greater in the absence of essential obstetric care, active emergency care and qualified staff, and doubled with every 10-year increase in age. Other contributing factors included delays in recognizing "alarm signals"; reluctance in seeking care owing to desire to hide an induced abortion; delays in receiving timely treatment due to misdiagnosis or lack of supplies; and delays in referral/transportation in rural areas. CONCLUSION: A combination of methodologies is required to improve research on and understanding of maternal mortality via the systematic collection of health surveillance data. There is an urgent need for a comprehensive intervention to address public health and human rights issues in maternal mortality, and our results contribute to the consensus-building necessary to improve the existing surveillance system and prevention strategies.

A study was conducted to investigate the effects of the 2009 pandemic influenza A (H1N1) on children in six pediatric hospitals in Argentina. Results indicated that the H1N1 virus resulted in pediatric death rates that were ten times higher than normal seasonal influenza.

Objective To perform a comprehensive assessment of maternal mortality in Argentina, the ultimate purpose being to strengthen the surveillance system and reorient reproductive health policies to prevent maternal deaths. Methods Our multicentre population-based study combining qualitative and quantitative methodologies included a descriptive analysis of under-registration and distribution of causes of death, a case-control study to identify risk factors in health-care delivery and verbal autopsies to analyse social determinants associated with maternal deaths. Findings A total of 121 maternal deaths occurred during 2002. The most common causes were abortion complications (27.4%), haemorrhage (22.1%), infection/sepsis (9.5%), hypertensive disorders (8.4%) and other causes (32.6%). Under-registration was 9.5% for maternal deaths (n = 95) and 15.4% for late maternal deaths (n = 26). The probability of dying was 10 times greater in the absence of essential obstetric care, active emergency care and qualified staff, and doubled with every 10-year increase in age. Other contributing factors included delays in recognizing "alarm signals"; reluctance in seeking care owing to desire to hide an induced abortion; delays in receiving timely treatment due to misdiagnosis or lack of supplies; and delays in referral/transportation in rural areas. Conclusion A combination of methodologies is required to improve research on and understanding of maternal mortality via the systematic collection of health surveillance data. There is an urgent need for a comprehensive intervention to address public health and human rights issues in maternal mortality, and our results contribute to the consensus-building necessary to improve the existing surveillance system and prevention strategies. Objectif Evaluer de maniere exhaustive la mortalite maternelle en Argentine, avec comme objectif final de renforcer le systeme de surveillance et de reorienter les politiques de sante genesique visant a prevenir les deces maternels. Methodes Notre etude multicentrique en population, associant methodes qualitatives et quantitatives, comprend une analyse descriptive du sous-enregistrement des deces maternels et de la distribution de leurs causes, une etude cas-temoins destinee a identifier les facteurs de risque dans la prestation des soins de sante, ainsi que des autopsies verbales, permettant d&apos;analyser les determinants sociaux lies aux deces maternels. Resultats Au total, 121 deces maternels sont intervenus au cours de l&apos;annee 2002. Ces deces etaient le plus souvent imputables a des complications d&apos;avortement (27,4 %), a des hemorragies (22,1 %), a des infections ou a des accidents septiques (9,5 %), a des troubles hypertensifs (8,4 %) et a d&apos;autres causes (32,6 %). Le taux de sous-enregistrement s&apos;elevait a 9,5 % pour les deces maternels (n = 95) et a 15,4 % pour les deces maternels tardifs (n = 26). La probabilite pour la mere de mourir etait 10 fois plus elevee en l&apos;absence de soins obstetricaux essentiels, de soins d&apos;urgence actifs et de personnel qualifie, et multipliee par 2 pour chaque augmentation de 10 ans de l&apos;age maternel. Parmi les autres facteurs contribuant a la mortalite maternelle, figurent la reconnaissance tardive des << signes d&apos;alerte >> ; la reticence des femmes a solliciter des soins dans le cas d&apos;un avortement induit qu&apos;elles veulent cacher ; les retards dans l&apos;administration d&apos;un traitement (erreur diagnostique ou manque de fournitures) et, en zone rurale, les delais dans l&apos;orientation vers un etablissement specialise ou le transport. Conclusion L&apos;association de plusieurs types de methodes s&apos;impose pour ameliorer la recherche et les connaissances sur la mortalite maternelle a partir de donnees de surveillance sanitaire collectees de maniere systematique. Il est urgent d&apos;organiser une intervention de grande ampleur pour repondre aux problemes lies a la mortalite maternelle qui relevent de la sante publique et des droits de l&apos;homme et nos resultats contribueront a l&apos;etablissement du consensus necessaire pour ameliorer les strategies de prevention et le systeme de surveillance deja en place. Objetivo Realizar una evaluacion integral de la mortalidad materna en la Argentina, con el objetivo ultimo de fortalecer el sistema de vigilancia y reorientar las politicas de salud reproductiva para evitar las defunciones maternas. Metodos Nuestro estudio multicentrico basado en la poblacion, en el que se combinaron metodos cualitativos y cuantitativos, incluyo un analisis descriptivo del subregistro y la distribucion de las causas de defuncion, un estudio caso-control para identificar los factores de riesgo en la prestacion de atencion de salud y autopsias verbales para analizar los determinantes sociales asociados a la mortalidad materna. Resultados Durante 2002 se registraron en total 121 defunciones maternas. Las causas mas comunes fueron complicaciones de abortos (27,4%), hemorragias (22,1%), infecciones/septicemia (9,5%), trastornos hipertensivos (8,4%) y otras causas (32,6%). El subregistro fue del 9,5% para las defunciones maternas (n = 95) y del 15,4% para las defunciones maternas tardias (n = 26). La probabilidad de morir fue diez veces mayor en ausencia de atencion obstetrica esencial, guardia activa y personal calificado, y se duplicaba con cada aumento de 10 anos de la edad. Otros factores contribuyentes fueron las demoras en el reconocimiento de las << senales de alarma >>; la resistencia a buscar atencion para ocultar un aborto provocado; los retrasos del inicio del tratamiento como consecuencia de un diagnostico erroneo o de la falta de suministros; y los retrasos de la derivacion y el transporte en las zonas rurales. Conclusion Se requiere una combinacion de metodos para mejorar las investigaciones sobre la mortalidad materna y los conocimientos sobre la misma mediante la recopilacion sistematica de datos de vigilancia sanitaria. Urge implementar una intervencion integral que aborde los aspectos de la mortalidad materna relacionados con la salud publica y los derechos humanos. Nuestros resultados pueden ayudar a lograr el consenso necesario para mejorar el sistema de vigilancia y las estrategias de prevencion actuales., Introduction Maternal mortality is a human rights issue and an unequivocal expression of the economic, social and cultural disadvantages that women experience. (1,2) Maternal mortality has been identified as a [...]

Gravitational microlensing can detect isolated stellar-mass black holes (BHs), which are believed to be the dominant form of Galactic BHs according to population synthesis models. Previous searches for BH events in microlensing data focused on long time-scale events with significant microlensing parallax detections. Here we show that, although BH events preferentially have long time-scales, the microlensing parallax amplitudes are so small that in most cases the parallax signals cannot be detected statistically significantly. We then identify OGLE-2006-BLG-044 to be a candidate BH event because of its long time-scale and small microlensing parallax. Our findings have implications to future BH searches in microlensing data. [ABSTRACT FROM AUTHOR]

Objective. The Perinatal Information System (SIP) represents a milestone in the use of systematized information in the Region of the Americas. What has been learned from the system has contributed to the development of a model based on a set of core indicators (SCI). The objective of the study was to describe the historical and methodological process involved in the development, implementation, and territorial scaling- up of an SCI to monitor and evaluate women's and perinatal health policies, programs, and services geared to management (SIP-GESTIÓN). Methods. The study was conducted in two stages: 1) a four-phase validation of an SCI in a hospital network: a) construction of the theoretical indicator model, b) operations research, c) final selection of the indicators, and d) the definition of reference standards; and 2) territorial scaling-up. Results. A total of 17 indicator models were identified. The initial model included 177 indicators divided into seven dimensions (context, habits, accessibility, use of services, quality of care, maternal and fetal impact, and maternal and neonatal impact), with 21 indicators remaining after three Delphi rounds. The final model (SIPGESTIÓN), which included 40 indicators, was then used to study 240,021 (79.1%) of the 303,559 deliveries attended in 122 selected maternity facilities in 24 jurisdictions (100%) in Argentina. The information is presented in national terms and by health region, province, and hospital. Conclusions. This model has made it possible to achieve high levels of information coverage and quality and territorial scaling-up and is useful for management, research, and the reorientation of programs and policies. [ABSTRACT FROM AUTHOR]

Objective: Threatened preterm labor (tPTL) is a complication of pregnancy. Identification of women and clinical definition differs between countries. This study investigated differences in tPTL and effectiveness of vaginal progesterone to prevent preterm birth (PTB) between two countries.Methods: Secondary analysis of a randomized controlled trial (RCT) from Argentina and Switzerland comparing vaginal progesterone to placebo in women with tPTL (n = 379). Cox proportional hazards analysis was performed to compare placebo groups of both countries and to compare progesterone to placebo within each country. We adjusted for baseline differences. Iatrogenic onset of labor or pregnancy beyond gestational age of interest was censored.Results: Swiss and Argentinian women were different on baseline. Risks for delivery <14 days and PTB < 34 and < 37 weeks were increased in Argentina compared to Switzerland, HR 3.3 (95% CI 0.62-18), 54 (95% CI 5.1-569) and 3.1 (95% CI 1.1-8.4). In Switzerland, progesterone increased the risk for delivery <14 days [HR 4.4 (95% CI 1.3-15.7)] and PTB <37 weeks [HR 2.5 (95% CI 1.4-4.8)], in Argentina there was no such effect.Conclusion: In women with tPTL, the effect of progesterone may vary due to population differences. Differences in populations should be considered in multicenter RCTs. [ABSTRACT FROM AUTHOR]

Objective To evaluate the effectiveness of 200 mg of daily vaginal natural progesterone to prevent preterm birth in women with preterm labour. Design Multicentre, randomised, double-blind, placebo-controlled trial. Setting Twenty-nine centres in Switzerland and Argentina. Population A total of 385 women with preterm labour (240/7 to 336/7 weeks of gestation) treated with acute tocolysis. Methods Participants were randomly allocated to either 200 mg daily of self-administered vaginal progesterone or placebo within 48 hours of starting acute tocolysis. Main outcome measures Primary outcome was delivery before 37 weeks of gestation. Secondary outcomes were delivery before 32 and 34 weeks, adverse effects, duration of tocolysis, re-admissions for preterm labour, length of hospital stay, and neonatal morbidity and mortality. The study was ended prematurely based on results of the intermediate analysis. Results Preterm birth occurred in 42.5% of women in the progesterone group versus 35.5% in the placebo group (relative risk [ RR] 1.2; 95% confidence interval [95% CI] 0.93-1.5). Delivery at <32 and <34 weeks did not differ between the two groups (12.9 versus 9.7%; [ RR 1.3; 95% CI 0.7-2.5] and 19.7 versus 12.9% [ RR 1.5; 95% CI 0.9-2.4], respectively). The duration of tocolysis, hospitalisation, and recurrence of preterm labour were comparable between groups. Neonatal morbidity occurred in 44 (22.8%) cases on progesterone versus 35 (18.8%) cases on placebo ( RR: 1.2; 95% CI 0.82-1.8), whereas there were 4 (2%) neonatal deaths in each study group. Conclusion There is no evidence that the daily administration of 200 mg vaginal progesterone decreases preterm birth or improves neonatal outcome in women with preterm labour. [ABSTRACT FROM AUTHOR]

A new public policy was instituted in Argentina for free distribution of subdermal contraceptive implants to women aged 15-24 years old in the public healthcare system. The objective of this study is to determine the extent to which this population adhered to the implant, as well as predictors of continuation. The retrospective cohort study was based on a telephone survey of a random sample of 1101 Ministry of Health-registered implant users concerning the continuation of use, satisfaction with the method and side-effects, and reasons for removal. Descriptive statistics and multivariate regression analysis were used to explore the association between adherence and having received contraceptive counselling, satisfaction, and side effects. We found high levels of adherence (87%) and satisfaction (94%). Common reported side effects were amenorrhoea or infrequent bleeding, perceived weight gain, increased menstrual bleeding and headaches. Multivariate regression analysis indicates that, among adolescents, having received contraceptive counselling increased comfort, while frequent bleeding at six months hindered trust. Participants who had a history of a prior delivery or who had themselves primarily chosen the method were less likely to request the removal of the implant. Our results support the public policy of free implant distribution in the public health sector. This is a sustainable public policy that contributes to equity and access to effective contraception. It is appropriate for adolescents and young women and will also reduce unintended pregnancies. Our results suggest that counselling patients is key prior to insertion of the implant, as it improves acceptability and continuation.

Maternal mortality is an important public health and human rights problem and reflects the effects of social determinants on women's health. Understanding the extent and causes of maternal death has been insufficient to achieve the Millennium Development Goals. This article proposes a model for a comprehensive approach to maternal mortality, covering seven areas: prioritization and definition of the problem, contextual description, methodological scope, knowledge management, innovation, implementation, and a monitoring and evaluation system. This model helps address problems associated with maternal mortality and severe maternal morbidity through early monitoring of potentially fatal complications in the reproductive process. Knowledge management is important for the reorientation of policies, programs, and health care. Interaction and synergies among people, communities, and actors in the health system should be strengthened in order to improve the results of health programs. More validated scientific information is needed on how actions should be implemented in different environments. It is essential to strengthen communication among research centers, cooperation agencies, and government organizations and to include them in programs and in the definition of a new women's health agenda in the Region of the Americas.

Objective: To analyse life-threatening obstetric complications that occurred in public hospitals in Argentina., Design: Multicentre collaborative cross-sectional study., Setting: Twenty-five hospitals included in the Perinatal Network of Buenos Aires Metropolitan Area., Population: Women giving birth in participating hospitals during a 1-year period., Methods: All cases of severe maternal morbidity (SMM) and maternal mortality (MM) during pregnancy (including miscarriage and induced abortion), labour and puerperium were included. Data were collected prospectively., Main Outcome Measures: Identification criteria, main causes and incidence of SMM; case-fatality rates, morbidity-mortality index and effective intervention's use rate., Results: A total of 552 women with life-threatening conditions were identified: 518 with SMM, 34 with MM. Identification criteria for SMM were case-management (48.9%), organ dysfunction (15.2%) and mixed criteria (35.9%). Incidence of SMM was 0.8% (95% confidence interval [95% CI] 0.73-0.87%) and hospital maternal death ratio was 52.3 per 100 000 live births (95% CI 35.5-69.1). Main causes of MM were abortion complications and puerperal sepsis; main causes of SMM were postpartum haemorrhage and hypertension. Overall case-fatality rate was 6.2% (95% CI 4.4-8.6): the highest due to sepsis (14.8%) and abortion complications (13.3%). Morbidity-mortality index was 15:1 (95% CI 7.5-30.8). Use rate of known effective interventions to prevent or treat main causes of MM and SMM was 52.3% (95% CI 46.9-57.7)., Conclusions: This study describes the importance of life-threatening obstetric complications that took place in public hospitals with comprehensive obstetric care and the low utilisation of known effective interventions that may decrease rates of SMM and MM. It also provides arguments that justify the need to develop a surveillance system for SMM., (© 2013 RCOG.)