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Revista argentina de cardiología

versión On-line ISSN 1850-3748

Rev. argent. cardiol. vol.83 no.3 Ciudad Autónoma de Buenos Aires jun. 2015




Estudio TAMARA II. Tabaquismo en médicos de la República Argentina II


Horacio m. Zylbersztejnmtsac, 1, 2, Walter m. Massonmtsac, 1, 2, Lorenzo m. Lobomtsac, 1, 2, Diego g. Manentemtsac, 1, 2, Mauro J. García aurelio1, adriana a. Angelmtsac, 1, 2, Andrés H. Mulassimtsac, 2, Mariano a. Giorgimtsac, 1, 2, María g. Rostan†, 2

Address for reprints: Horacio Mario Zylbersztejn - Hospital Ignacio Pirovano, División Cardiología - Av. Monroe 3555 - (1428) CABA, Argentina - e-mail:

Research Area, Council on Epidemiology and Cardiovascular Prevention, Inland Area. Argentine Society of Cardiology

MTSAC Full Member of the Argentine Society of Cardiology
To apply as full member of the Argentine Society of Cardiology
1 Research Area, Argentine Society of Cardiology
2 “Dr. Mario Ciruzzi” Council on Epidemiology and Cardiovascular Prevention, Argentine Society of Cardiology


background: Smoking is the leading cause of preventable morbidity and death. It is important to know the characteristics of smoking habits among physicians and their attitude toward patients who smoke.
Objective: The aim of this study is to investigate the prevalence of smoking among physicians in Argentina, the factors associated with tobacco consumption and their attitude toward their patients who smoke.
Methods: An observational cross- sectional study was performed between June and December 2013 in Argentine physicians of dif-ferent specialties. Using a structured survey, the following variables were analyzed: associated cardiovascular risk factors, charac-teristics of tobacco consumption, smoking cessation training and the attitude toward the patient who smokes.
results: 3,033 physicians were surveyed, ; 57% were men, and mean age was 41.3±12 years; 19.7% were current smokers and 21.7% were former smokers. The probability of being a smoker was higher among surgeons (OR 1.29) or physicians working at the emergency room (OR 1.41).
Undergraduate and postgraduate tobacco cessation training was achieved by 36.6% and 40.8% of physicians, respectively. Young physicians, clinical specialties or private practice were associated with higher level of training. Tobacco cessation counseling was more frequent in physicians with higher level of training than physicians who smoked or surgeons.
Former smokers presented higher prevalence of risk factors and cardiovascular events. Family history of smoking habit was more common in former smokers and current smokers.
Conclusions: The prevalence of smoking among Argentine physicians is high. Different factors are involved in the probability of smoking, tobacco cessation training or the possibility of medical counseling. Higher level of training in smoking cessation must be provided.

Key words: Smoking - Epidemiology - Physicians - Risk Factors, Vascular - Smoking cessation


introducción: El tabaquismo es la principal causa de morbimortalidad evitable, por lo que es importante conocer las características del tabaquismo en los médicos y su actitud con los pacientes fumadores.
Objetivo: Investigar la prevalencia de tabaquismo en médicos de la Argentina, los factores asociados con su consumo y la conducta frente a sus pacientes fumadores.
Material y métodos: Estudio observacional y transversal de médicos de distintas especialidades de la Argentina, realizado entre junio y diciembre de 2013. Mediante una encuesta estructurada, se analizaron factores de riesgo cardiovascular asociados, las características del consumo de tabaco, el entrenamiento en tabaquismo y la actitud frente al paciente fumador.
resultados: Se encuestaron 3.033 médicos, 57% varones, edad promedio 41,3 ± 12 años, con una proporción de fumadores del 19,7% y de exfumadores del 21,7%. Ejercer una especialidad quirúrgica (OR 1,29) o trabajar en urgencias (OR 1,41) aumentó la probabilidad de ser fumador.
El 36,6% y el 40,8% recibieron entrenamiento antitabaco en pregrado y posgrado, respectivamente. Ser joven, tener una especialidad clínica o trabajar en un medio privado se asoció con mayor adiestramiento. Aquellos con capacitación tenían mayor posibilidad de brindar siempre consejo de cesación y lo daban menos los fumadores o los que ejercían especialidades quirúrgicas. Los exfumadores presentaron una prevalencia mayor de factores de riesgo y de eventos vasculares. Estos y los fumadores tenían más antecedentes familiares de tabaquismo.
Conclusiones: La prevalencia de tabaquismo en médicos argentinos es elevada. Distintos factores repercuten en la probabilidad de ser fumador, en el entrenamiento en tabaquismo o en la posibilidad de dar consejo médico. Se debe brindar mayor entrenamiento antitabaco.

Palabras clave: Tabaquismo - Epidemiología - Médicos - Factores de riesgo vascular - Cese del tabaquismo


DM Diabetes mellitus
CVrF Cardiovascular risk factors
Ht Hypertension
Mi Myocardial infarction
bMi Body mass index



Non-communicable diseases (cardiovascular diseases, chronic respiratory diseases, cancer and diabetes) ac-count for 60% of deaths, especially in low- and middle-income countries. Smoking is one of the most impor-tant risk factors for the development of cardiovascular disease and the main preventable cause of death worldwide, accounting for one sixth of deaths. (1, 2)

Since 1950, tobacco consumption in developed countries had been increasing by decade, particularly in men. However, since the end of the seventies, the number of men who smoke has diminished. The prev-alence of smoking remains high in low-and middle-income countries. To date, 1,300 million people smoke worldwide. Almost 70% of them live in Asia, Russia, the European Union and South America. (3, 4)

In 2010, smoking caused approximately 5 million deaths, and would reach 10 million annually by 2030 with the current smoking prevalence. (5, 6) Approxi-mately 50% of smokers could die due to chronic diseas-es caused by tobacco use, half of them at middle-age, with a significant reduction in life expectancy. (7) The risk of death is three times higher among smokers. (2)

Smoking prevalence in Argentina decreased from 29.7% in 2005 to 25.1% in 2013, (8-10), with an es-timated 40,000 tobacco-related deaths per year. (11) Smoking cessation and lower exposure to environ-mental tobacco smoke reduce mortality and acute cardiovascular events, and improves survival after acute myocardial infarction (AMI) and the outcomes after myocardial revascularization. (1) Brief interventions during the usual medical consultation by providing counseling to quit smoking are important for con-trolling and discouraging tobacco use. (11) However, physician's attitude toward smoking will depend on several factors, particularly on his/her personal rela-tionship with tobacco. (12)

The primary aim of the present study was to in-vestigate the prevalence and characteristics of smoking among physicians in Argentina and their attitude toward their patients who smoke. The secondary aim was to analyze the presence of associations between smoking and other cardiovascular risk factors (CVRF) in physicians.


We conducted an observational cross- sectional study be-tween June and December 2013. Physicians of both sexes and with different specialties were selected using a non-probability sample method in 22 provinces of Argentina, in-cluding Antarctic stations.

The survey consisted on a structured self-administered questionnaire which included the following variables: smoking habits, physical activity, body mass index (BMI) history

Mi Myocardial infarction bMi Body mass index

of hypertension (HT), dyslipidemia and diabetes mellitus (DM), family history of coronary artery disease, history of AMI and myocardial revascularization with percutaneous coronary intervention or surgery.

Current smoker was defined as smoking one cigarette/ day, for at least one year and during the past 12 months. A person who had been a smoker but had not smoked for a year was considered a former smoker. Non-smoker was de-fined as the one who had never smoked. The following in-formation was required: number of cigarettes smoked per day, age at starting smoking, places where he/she smoked, smoking in unauthorized areas, time to first cigarette after waking up, and smoking while sick and during pregnancy. The respondents were asked about the presence of smok-ers among their relatives, if they had received any kind of training in smoking-cessation counseling, either as formal courses or informative meetings, how often they advised their patients to quit smoking and whether they used drugs for tobacco cessation in both outpatients and hospitalized patients.

Physical activity was defined as walking or playing any kind of sport for at least 30 minutes, 3 times a week or more. The respondents were considered as having HT, dyslipidemia or DM if they were aware of their condition or were receiving specific medication. Body mass index (BMI) was calculated using the Quetelet index (kg/m2) with the information about weight and height provided by the survey respondents. Body mass index was divided in three categories: < 25, 25-29.9 (overweight) and ≥30 (obesity). A history of AMI among relatives before the age of 55 in men and 65 in women was considered family history of coronary artery disease.

statistical analysis

The information was recorded in an Excel spreadsheet software program and was analyzed using the Epi-Info 7.0 software package. Continuous variables were compared with Student's t test (two samples) or with ANOVA (three samples or more) for normal distribution. For variables with non-normal distribution, the Mann-Whitney U test or the Kruskal-Wallis test was used. Categorical variables were analyzed with the chi square test.

Logistic regression analyses were used to evaluate the association between different variables with the probability of: 1) being an active smoker, 2) providing regular counseling to quit smoking, and, 3) being trained in smoking-cessation treatment. Multivariate analysis was performed with the variables presenting significant associations in univariate analysis. The different regressions included the variables sex and age. Age was incorporated in multivariate analysis as a dichotomous variable considering the median age of the population (39 years). The strength of the association was expressed as odds ratio (OR) with its corresponding 95% confidence interval (95% CI). A p value ≤0.05 was considered statistically significant.


The survey was responded by 3,062 physicians of dif-ferent specialties and both sexes from 22 provinces nationwide. Twenty-nine surveys with no data about age and sex were not considered; thus, the final analysis included 3,033 surveys. Thirty-seven percent of physi-cians corresponded to the Autonomous City of Buenos Aires and 31% to the province of Buenos Aires; 79% practiced clinical specialties, 31% worked only in pri-vate settings and 56% in emergency areas.

Table 1 shows the general characteristics of the physicians in this study. Mean age was 41.3 ± 12 years, 56.8% were men and they were older than women (p<0.001). The prevalence of current smokers was 19.7%, and 21.7% were former smokers. Mean use of cigarettes was 11.0±9 cigarettes/day; 24.1% smoked 20 cigarettes or more and age at starting smoking

was 18.03±4 years. Average exposure to environmen-tal tobacco smoke was of 5.4 hours/day in 51.5% of cases. The percentage of physicians who smoked after waking up was 31.6% and 22.3% smoked during a res-piratory or cardiovascular illness. The prevalence of smoking in workplaces and unauthorized areas was high, with no differences between both sexes; 8.8% of women had smoked during pregnancy.

Table 2 shows the population characteristics by age, sex, prevalence of CVRF and cardiovascular events in physicians related with smoking status. There were no differences related to sex in smoking status (p=0.35). Physicians who smoked were young-er. Former smokers were older, had higher prevalence cessation and in those >39 years; however, surgeons or active smokers were less likely to advice patients to stop smoking. Finally, the probability of being an active smoker was greater in physicians with surgi-cal specialties, or working in emergency settings, but lower in those doing physical activity.

table 1. General characteristics of the sample (n=3,033)

Hemodynamic parameter




male gender


median age, years


M: 42 W: 36


average age, years

41.3 ± 12

M: 43.3±12 W: 38.8±10


Cl¡n¡cal spedalty, %


M: 74.2

W: 84.8

1.94 (1.61-2.34)


Works only in private health care centers, %


M: 31.7

W: 29.6

1.10 (0.94-1.30)


Works only in emergency areas, %

M: 56.6

W: 54.6

1.08 (0.93-1.25)


Former smokers, %


M: 21.7

W: 21.7

1.00 (0.84-1.19)


Current smokers, %


M: 18.8

W: 20.8

0.87 (0.73-1.05)


Number of c¡garettes/day, %

11.0 ± 9

M: 11.5±9 W: 10.5±8


Smokes >20 c¡garettes/day, %


M: 25.3

W: 22.7

1.15 (0.77-1.70)


age at starting smoking

18.03 ± 4

M: 17.9±4 W: 18.2±4


Exposure to envíronmental tobáceo smoke, %


M: 51.2

W: 51.8

0.97 (0.84-1.12)


Smokes after waking up, %


M: 33.8

W: 28.9

1.25 (0.98-1.60)


smokes in the morning, %

M: 67.9

W: 63.6

1.21 (0.95-1.53)


Smokes whüe s¡ck, %


M: 23.2

W: 21.2

1.12 (0.85-1.46)


smokes at hospital, %


M: 86.1


1.10 (0.72-1.67)


Smokes at home, %


M: 74.6

W: 74.4

1.01 (0.78-1.30)


smokes in unauthorized areas, %

28 8

M: 28.0

W: 29.9

0.91 (0.71-1.16)


Smoked during pregnaney, %


M: Men. W: Women

Table 4. Physician characteristics by tobáceo cessation training (n = 3,016)


Not trained (n=1,323)


Trained (n=1,693)




Gender (n=3,016)

Female (43.2%)



0.75 (0.65-0.87)


male (56.8%)



Surgical specialty (n=620/2,929; 21.2%)



0.52 (0.44-0.63)


Works ¡n emergeney áreas (n=1597/2,863; 55.8%)



1.31 (1.13-1.52)


Works only ¡n prívate health care centers (n=864/2,809; 30.8%)


32 8

1.24 (1.05-1.46)


smoking status (n=3,016)

Current smokers 19.7%




Non-smokers 58.6%



Former smokers 21.7%



always provides tobacco cessation counseling (n=2,325/2,958; 78.6%)



1.26 (1.06-1.51)


never provides tobacco cessation counseling (n=66/2,958; 2.3%)



0.30 (0.17-0.52)


Uses drug therapy (n=1,206/2,332; 51,7%)



4.01 (3.36-4.79)


tobacco cessation counseling in hospitalized patients

(n=1,951/2,875; 67.9%)



2.68 (2.28-3.14)


Uses drug therapy in hospitalized patients

(n=412/2,808; 14.7%)



2.09 (1.66-2.63)


SD: Standard deviation. AMI: Acute myocardial infarction. CABGS: Coronary artery bypass graft surgery.




Smoking is the leading cause of preventable death worldwide, (1, 2) and responsible of a significant number of cardiovascular diseases, respiratory dis-eases and cancer. Evidently, the impact of smoking on health is such that physicians from almost all the spe-cialties deal with the direct or indirect consequences of smoking tobacco in all its forms; yet, many doctors smoke. The prevalence of smoking among physicians from different countries is difficult to know because the information derives from small-scale studies. The proportion of professionals who smoke differs accord-ing to the regions analyzed, with a trend toward high-er prevalence in men and in developing countries. (14) Recent studies have reported prevalence between 14% and 38%. (15-18) In 2004, the TAMARA trial reported a prevalence of 30% of physicians who smoked and 22.4% of former smokers in Argentina. (12) By that time, the prevalence of smoking in the general popula-tion in Argentina was about 30%. (8) The proportion of smokers in the general population has decreased over the past decade. (9, 10) Similarly, the prevalence of smoking habits found in the TAMARA II study experienced a 10-point reduction compared with the prevalence reported in the first TAMARA study.

Strikingly, an elevated number of doctors (85.6%) smoked in workplaces as hospitals. The implementa-tion of a smoke-free hospital policy demonstrated a

reduction in the prevalence of smoking and improved the attitude toward tobacco control among physicians. (19) In this setting, and observing the results of our in-vestigation, it would be highly relevant to implement such policies in as many medical centers as possible.

A survey conducted by Shkedy et al. among practic-ing physicians at a university-affiliated medical center in Israel, showed a greater prevalence of smoking habits among surgical specialties. (20) In a similar way, the prevalence of tobacco use in our study was significantly greater in these specialties compared with clin-ical specialties. The probability of being a smoker was 29% higher among surgical specialties, independently of the other variables evaluated. Cardiologists had the lowest proportion of smokers compared to other specialists, and this finding is similar to the one re-ported in the previous TAMARA study (16% vs. 18%). (12) Among surgical specialists, otorhinolaryngolo-gists had the lowest prevalence of smokers (9%); this proportion was similar to the one observed in a study among otorhinolaryngologists from Brazil (7%). (21)

We observed that working in emergency settings was independently associated with a higher probabil-ity of being an active smoker. This finding is not a minor subject. Many patients visiting the emergency department are interested in smoking cessation coun-seling. (22, 23) However, emergency department-based smoking cessation counseling is suboptimal. (24-26) The emergency department setting could represent an excellent opportunity to implement strategies to quit smoking, and emergency doctors should be en-couraged to provide counseling for smoking cessation.

In previous publications conducted in general populations (27, 28), and coincidental with our find-ings, current smokers were significantly more likely

table 5. Variables indepen-dently associated with training in tobacco cessation, pos-sibility of providing regular counseling to quit smoking or of being a current smoker to be physically inactive.

Multivariate models OR

95% Cl


1. Variables associated with training ¡n tobáceo cessation*

Age>39 years 0.73



Surgícal spedalty 0.54



Works only in private health care centers 1.29



Works in emergency areas 1.32



II. Variables associated with regular tobacco cessation Counseling**

training in tobacco cessation 1.23



Surgícal spedalty 0.70



Current smoker 0.43



Age>39 years 1.21



III. Variables associated with current smoking***

Surgícal spedalty 1.29



Works in emergency areas 1.41



Physlcal act¡v¡ty 0.73



* Adjusted for age, sex, emergency areas, clinical/surgical specialty and smoking status.

** Adjusted for age, sex, clinical/surgical specialty, smoking status and tobacco cessation training.

*** Adjusted for age, sex, emergency areas, clinical/surgical specialty, risk factors and history of coronary

artery disease.


As in other epidemiological studies, we have ob-served a significant association between the pres-ence of a family history of smokers and starting and keeping smoking in physicians. (29-31) Of note, the descendants of physicians who smoke have 4 times greater probability of acquiring smoking habits due to parent influence.

In our study, physicians trained in tobacco cessa-tion were more likely to provide regular counseling to quit smoking. This finding coincides with a study per-formed in Chinese doctors, which demonstrated that those physicians who had ever read any recommenda-tion about tobacco cessation counseling interventions were more likely to report smoking status in the clini-cal record and to provide tobacco cessation counseling to their patients. (16) In addition, an investigation performed in Argentine obstetrician/gynecologists demonstrated that insufficient knowledge in tobacco cessation interventions was negatively associated with smoking cessation counseling. (32) In agreement with our observations, a Ukrainian study found a negative association between the high prevalence of smoking among certain medical specialties and the likelihood of providing counseling to quit smoking. (33) The results of our investigation are similar to those found by a Brazilian study which reported that clinical spe-cialties were associated with a greater probability of providing tobacco cessation counseling. (34)

Addiction to tobacco is one the most relevant CVRF with significant incidence of acute events as AMI or sudden death; thus, its prevention and treatment should be a priority. The identification of patients' smoking status is fundamental, and tobacco cessation therapies should be offered to patients who smoke in all the areas related with cardiovascular health. (11-35) Cardiologists should be trained in therapies to quit smoking and should act in the same manner they do to investigate and treat other well-known CVRF as HT, DM and dyslipidemia. (35-37)

Ethical considerations

The protocol was evaluated and approved by the Argentine Society of Cardiology Bioethics Committee. Filling out the questionnaire was assumed as consent. No personal data that could identify the survey re-spondents were requested.

study limitations

Our investigation has the typical limitations of any epidemiological cross-sectional study. As we were un-able to obtain the records of professionals from the different medical colleges, the participants were se-lected using a simple, non-probability random sam-pling method. This could be associated with biased results. However, the considerable number of persons evaluated and distributed in 22 provinces nationwide could reflect a part of the smoking facts among physi-cians in Argentina


The prevalence of smoking among physicians was high; smokers were younger and worked in emergency settings or practiced surgical specialties. The propor-tion of CVRF and history of coronary artery disease were higher among current smokers and former smok-ers. About 56% of professionals had been trained in smoking cessation which was associated with a higher probability of providing counseling to quit smoking. The implementation of tobacco cessation programs to train health care professionals is mandatory.


The authors thank the invaluable cooperation of all the investigators participating in this study, without whose collaboration this research would have been impossible, and of Mrs. Lilian Capdevila, secretary of the Research Area of the Argentine Society of Cardiol-ogy, for her help in preparing the manuscript.

Conficts of interest

Walter Masson is Boehringer Ingelheim´s speaker. (See author´s conflicts of interest forms in the web / Supple-mentary Material)


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General coordination: Horacio M Zylbersztejn and Walter Masson

Principal investigators: Lorenzo Lobo, Diego Manente, Mauro García Aurelio, Adriana Angel, Andrés Mulassi, Mariano

Giorgi, María Rostan, Analía Rubilote, Aníbal Picarel.


Carlos Gómez, Gabriel Dionisio, Adrián Linenberg, Alejandra Francesia, Bernardo Ribas, Mariana Radrizzani, Silvia Kusznier, Yanina Castillo, Patricia Avellana, Federico Cintora, Alfonso Díaz Trigo, Natalia Zunino, Diego Cabrera, Soledad Vizzari, José Luis Castellanos, Soledad Palacios, Víctor Mauro, Emiliano Spampinato, Juan Buscema, María Teresa Carnuc-cio, Daniel Avayu, Horacio Zylbersztejn, Walter Masson, Lorenzo Lobo, Diego Manente, Mauro García Aurelio, Adriana Angel, Mariano Giorgi, María Rostan, Marina Montes.

2. Atlantic Regional District (Mar del Plata, Province of Buenos Aires)

Luis Lembo, Sebastián Cámara, Martín Ciordia.

3. Southern Regional District (Province of Tierra del Fuego)

Ignacio Grane, Raúl Maltez, César Berenstein, Mariela Di Nunzio.

4. Bahía Blanca Regional District (Province of Buenos Aires)

Walter Zuckerman, Marcelo Guimaraez, María José Estebánez, Adriana Montovani, Fernando González Pardo.

5. Bariloche Regional District (Province of Río Negro)

Dres. Mariano Trevisán, Daniel Llanos, Matías Calandrelli.

6. Catamarca Regional District

Dres. Guillermo Mazo, César Cado, Franco Brey, Carlos Pereyra, Patricia Ojeda.

7. Center Regional District (Province of Buenos Aires)

Carlos Vignau, Ricardo Violante, Luis Giorgio, Mario Agarzúa.

8. Chaco Regional District

Juan Rousseau, Marina González.

9. Comodoro Rivadavia Regional District (Comodoro Rivadavia, Province of Chubut y Caleta Olivia, Province of Santa Cruz)

Susana Fernández, Edgardo Gurevich.

10. North Suburban Regional District (Province of Buenos Aires)

Gustavo Vieyra, Héctor Paves Palacios, Ana Río, Adriana Salazar, Ana Di Leva, Yenifers Torres, Jorge Franchella, Enrique Pautasso, Marcelo Boscaró, César Cáceres Monié, Alfredo Sackmann, Diego Cabrera, Laura Álvarez Argüello, Ángel Gutiérrez, Juan Stel, Claudio Peruyera, Fabio Monserrat, TPC María Eugenia Briones.

11. West Suburban Regional District (Province of Buenos Aires)

Beatriz Zucchiatti, Noemí Zucchiatti, Oscar Montaña, Carlos D'Amico, Liliana González, Mauricio Meccico, Cristian Ponce, Daniel Abad, Adrián Fernández, Cristina Quiroz, Graciela Molinero, Licia Lobo, Alejandro Caisson, Fabian Colombo, Néstor Vetrano, Gabriela Bontá, María del Carmen Vázquez, Eduardo Quiroga.

12. South Suburban Regional District (Province of Buenos Aires)

Héctor Locarmine, Analía Robilote, Aníbal Picarel, Fernando Casas, Verónica Marchesi, Marcelo Domínguez, Nicolás Mo-glioni, Pablo Cicarelli, Roberto Dilernia, Jorge Giordano, Eleno Martínez Aquino, María Uhri, Silvia Caramés, Fernando Balerio, Lucio Marino.

13. Southeast Suburban Regional District (Province of Buenos Aires)

Roberto Ruiz Deza, Adrián Hrabar.

14. Córdoba Regional District

Daniel Morisse, Alejandro Contreras, Fernando Gaghero, Matías Mayoraz, Lilian Hamity, Jorge Paolasso, Bruno Michelli, María Cattoni, Ana Grassani.

15. Corrientes Regional District

Jorge Verón, Claudia Ruiz Díaz, Raúl Duarte, Guillermo Sanz.

16. Cuenca del Salado Regional District (Province of Buenos Aires)

Jorge Chiabaut Svane, Andrés Mulassi, Maximiliano Mulassi.

17. Comahue Regional District (Neuquén y Río Negro)

Carlos Labaroni, Carlos Baruf.

18. Eastern Regional District (San Pedro, Zárate, Campana, Province of Buenos Aires)

José Cañavera Ayala.

19. La Pampa-Center-West Regional District

Carlos Andreani, Aldo Arévalo, Ramiro Oporto.

20. La Rioja Regional District

Pablo Santander, Walter Santander, Osvaldo Paredes, Ana Uriarte, Iván Metersky.

21. Mendoza Regional District

Jorge Piasentin, Alejandra Malfa, Valeria González. Sra. Claudia Sosa.

22. Misiones Regional District

Francisco G. Fazio.

23. Western Regional District (Lincoln, Chacabuco, Junín, Pehuajó, Province of Buenos Aires)

Gloria Cóppola, Rodrigo Delaico, Mildred Colaberardino, TPC Alba Mucci.

24. Puerto Madryn - Rawson - Trelew Regional District (Province of Chubut)

Edgardo Caporalini, Lucas Bauk, Alejandro Almeyra, Alejandro Sarries, Héctor Costa, Germán Echeverría, Ignacio Hernández, Alberto Sánchez.

25. Río Cuarto Regional District (Province of Córdoba)

Gonzalo Steigerwald, Marcelo García, Daniel Ferrero, Marcos Acuña, Juan Romea.

26. Río Gallegos Regional District (Province of Santa Cruz)

Mario Fernández.

27. Río Paraguay Regional District (Formosa, Clorinda - Province of Formosa)

Guillermo Castro.

28. Río Uruguay Regional District (Gualeguaychú, Chajarí, Concepción del Uruguay, Concordia, Province of Entre Ríos)

Pablo Alperini, Federico López Gullo, Carlos Pedroza, Ezequiel Forte.

29. Salta Regional District

Luis Gagliero, Sebastián Saravia Toledo, Javier Sánchez, Carolina Licubis.

30. San Juan Regional District

Félix Pintor, Sofía Nievas, Carlos Soria, Armando Rosales, Gonzalo Peñafort.

31. San Luis Regional District

Jorge Álvarez, Sergio Vissani.

32. Santiago del Estero Regional District

Mariano Vital, Carlos Manfredi, Eduardo Fornes, Santiago Coroleu.

33. Tucumán Regional District

Rubén Toledo, Bibiana de la Vega.

34. Province of Santa Fe

Gustavo Lavenia, Diego Nannini, Graciela Molinero.

35. La Plata (Province of Buenos Aires)

Andrés Mulassi, Maximiliano Mulassi, Carolina Grecco, Ariel Manti.

36. Antarctic Sector

Fabio Monserrat, Paulo Locastro.

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