Effectiveness of a diabetes program based on digital health on capacity building and quality of care in type 2 diabetes: a pragmatic quasi-experimental study.

Health systems in Latin America face many challenges in controlling the increasing burden of diabetes. Digital health interventions are a promise for the provision of care, especially in developing countries where mobile technology has a high penetration. This study evaluated the effectiveness of the implementation of a Diabetes Program (DP) that included digital health interventions to improve the quality of care of persons with type 2 Diabetes (T2DM) in a vulnerable population attending the public primary care network. MATERIALS AND METHODS: A quasi-experimental pre-post uncontrolled study was conducted in 19 primary care centers and hospitals in the province of Corrientes, Argentina. We included persons with T2DM, age > = 18 years with access to a mobile phone. The multicomponent intervention included a mobile app with a diabetes registry, a clinical decision support tool for providers and a text messaging intervention for patients. RESULTS AND DISCUSSION: One thousand sixty-five participants were included, 72.8% had less than 12 years of formal education and 53.5% lacked health coverage. Comorbidities were hypertension (60.8%) and overweight/obesity (88.2%). During follow-up there was a significant increase in the proportion of participants who underwent laboratory check-ups (HbA1c 20.3%-64.4%; p < 0.01) and foot exams (62.1%-87.2%; p < 0.01). No changes were observed at 12 and 24 months in the proportion of participants with poor metabolic control. The proportion of participants with uncontrolled blood pressure (≥ 140/90 mmHg) decreased from 47.2% at baseline to 30.8% at 24 months in those with a follow-up visit. CONCLUSION: The DP was innovative by integrating digital health interventions in the public primary care level. The study showed improvements in quality indicators related with diabetes care processes and in blood pressure control.

[Communication products for COVID-19 prevention promoted by governments in Latin America and the CaribbeanProdutos de comunicação para a prevenção da COVID-19 promovidos pelos governos da América Latina e do Caribe]. / Productos comunicacionales para la prevención de la COVID-19 promovidos por los gobiernos de América Latina y el Caribe.

OBJECTIVE: Characterize the content of communication products for COVID-19 prevention promoted by governments in Latin America and the Caribbean (LAC) for the general public. METHODS: A descriptive, cross-cutting, and exploratory study of the communication products for COVID-19 prevention published up to 28 February 2021 on official websites of the ministries of health of the 47 countries and territories of LAC. Quantitative and qualitative methods based on the dimensions recommended by the World Health Organization (WHO) were employed, together with a social determinants of health (SDH) approach. The content analysis technique and investigator triangulation were used to improve internal validity. RESULTS: 3 253 information products were analyzed. In 47 countries and territories in LAC at least one product included a WHO recommendation; and in 46 at least one category or subcategory related to intermediate SDHs was addressed. Regarding structural SDHs, a gender approach was used in at least one product in only four countries, and an indigenous language in only seven countries. In 35 countries, at least one product was found to have erroneous information and in 13 countries the infodemic was not addressed. CONCLUSIONS: A substantial number of communication products for COVID-19 prevention were found, but they lacked an adequate diversity approach and comprehensive health approach, and they showed gaps and communication errors. The countries should review their health communication policies in the context of the pandemic.

OBJETIVO: Caracterizar o conteúdo dos produtos de comunicação dirigidos à população em geral, para a prevenção da COVID-19, promovidos pelos governos da América Latina e do Caribe (ALC). MÉTODOS: Estudo descritivo, transversal e exploratório dos produtos de comunicação publicados até 28 de fevereiro de 2021 nos sites oficiais dos ministérios da Saúde de 47 países e territórios da ALC para a prevenção da COVID-19. Foram utilizados métodos quantitativos e qualitativos com base nas dimensões recomendadas pela Organização Mundial da Saúde (OMS) e enfoque nos determinantes sociais da saúde (DSS). Foram utilizadas as técnicas de análise de conteúdo e triangulação de investigador. RESULTADOS: Foram analisados 3 253 produtos de informação. Nos 47 países e territórios da ALC, pelo menos um produto incluiu alguma recomendação da OMS, e em 46, foram abordadas algumas das categorias e subcategorias relacionadas aos DSS intermediários. Dos DSS estruturais, foram utilizados enfoque de gênero e alguma língua indígena em pelo menos um produto de apenas 4 e 7 países, respectivamente. Em 35 países foi encontrado pelo menos um produto com informações errôneas, e em 13 não foi abordada a infodemia. CONCLUSÕES: Foi encontrado um número considerável de produtos de comunicação para a prevenção da COVID-19; entretanto, eles não refletiam uma abordagem adequada à diversidade e à saúde integral, e apresentavam lacunas e erros de comunicação. Os países devem revisar suas políticas de comunicação em saúde no contexto da pandemia.

Impact of a community program for child malnutrition. / Impacto de un programa comunitario para la malnutrición infantil.

OBJECTIVE: To evaluate the impact of a community program aimed at improving the children mal nutrition in a rural community of the State of Chiapas, Mexico, 2013. MATERIAL AND METHOD: Des criptive study of the evaluation program from a secondary database of nutritional data registry of 113 children under five years of age in a rural area of Mexico. The intervention and the survey were carried out during 2013. Baseline and 4-month measurements were recorded. The World Health Organization (WHO) Anthro software was used to calculate nutritional status indicators. According to WHO guidelines, the following data were estimated: weight for age (W/A), height for age (H/A), weight for height (W/H), and Body mass index for age (BMI/A). Position and dispersion measures were calculated; Student's T-test, Kruskal-Wallis, and MacNemar test were used for paired data and linear regression. RESULTS: Between the beginning and the end, the median of the Z W/H went from -0.7 (p25 -1.24, p75 -0.01) to -0.62 (p25 -1.09, p75 -0.15). The prevalence of low weight decreased from 5.31% (CI 2.38-11.44) to 4.42% (CI 1.83-10.32) (Z BMI/A). The appropriate weight according to Z score W/H increased from 78.76% (CI 70.12-85.43) to 84.96% (76.98-90.51). In the subgroup with low initial weight, the mean of Z BMI/A and Z W/H increased 0.4 (p = 0.003). The change in the mean of Z W/H was 0.02 points in the subgroup that received the direct transfer program and of -0.3 in which it did not (p = 0.020). CONCLUSIONS: It is concluded that the community program during the four months of implementation contributed to improve some anthropometric indicators, although no apparent effects were found in indicators related to chronic malnutrition.

Género, infodemia y desinformación en salud. Revisión de alcance global, vacíos de conocimiento y recomendaciones.

OBJETIVO: explorar el estado de la literatura científica sobre los aspectos de infodemia y desinformación en salud vinculados al género y a la interseccionalidad, detectar vacíos de conocimiento y brindar recomendaciones. MÉTODOS: revisión de alcance global, con la detección de vacíos de conocimiento y recomendaciones. Se buscó en ocho bases de datos: MEDLINE (Pubmed), Anthropological Index Online, Studies on Women & Gender Abstracts, LILACS, Scielo, Global Index Medicus, Web of Science, Google académico y se hizo una búsqueda manual en Google de documentos de los últimos 10 años, sin restricciones de idioma y geográficas. Se realizó un análisis de contenido de los estudios incluidos. RESULTADOS: 855 registros fueron identificados y 21 cumplieron con los criterios de inclusión. Predominan los estudios que tuvieron como primer autor/a una mujer (13/21), aunque en la autoría global se destacaron los hombres (10/21). El modelo binario fue el enfoque principal (16/21). La mayoría (18/21) se publicaron a partir del 2020. Se abordaron principalmente temas relacionados con la COVID-19 y la salud sexual y reproductiva (antes de la pandemia), y en menor medida la salud mental. Se identificaron interacciones entre diferencias de sexo/género en la desinformación/infodemia en salud especialmente en mujeres, colectivos de género diverso, personas mayores y población de bajo nivel socioeducativo. CONCLUSIONES: existen brechas de conocimiento en el tema explorado, con escaso número de estudios, y limitaciones de alcances y del enfoque de género y/o feminista (más allá del binario). No obstante, los resultados tentativos constatan la presencia de inequidades de género e interseccionalidad en la desinformación en salud. PALABRAS CLAVE: infodemia, desinformación, género, COVID-19, revisión sistemática.

Effectiveness of peer mentoring and self-monitoring to improve blood pressure control in a vulnerable population in Argentina: Pragmatic randomized open-label controlled trial.

OBJECTIVE: To evaluate the effectiveness of blood pressure (BP) self-monitoring and peer mentoring to improve the control of hypertension in clinical practice in primary care centers (PCCs) located in low-resource settings in Argentina. METHODS: An individual randomized controlled trial was carried out to test two different approaches based on behavioral interventions in PCCs in Argentina. Hypertensive adults were randomly assigned to one of three arms: BP self-monitoring, peer mentoring, and usual care. The primary outcome was the change in BP values from baseline to the end of follow-up at 3 months. A qualitative approach of participants' experiences of the peer mentoring arm was also conducted. RESULTS: A total of 442 participants with hypertension were included in the study. Self-monitoring and peer mentoring interventions did not show a significant difference in BP control compared to usual care. However, this trial showed an improvement regarding antihypertensive medication adherence among those assigned to the peer mentoring intervention compared to the control at the end of follow-up (p = 0.031). DISCUSSION: Self-monitoring and peer mentoring interventions did not demonstrate to be effective in BP control compared to usual care. Implementing a peer support strategy was demonstrated to be feasible and effective in improving medication adherence in this population.

Gender and social protection and health policies promoted during the COVID-19 pandemic: Global scoping review and future challenges.

Background: Governmental interventions have been important tools for mitigating COVID-19 transmission, but they have also negatively impacted different gender-related components. We aimed to answer the following questions: What is the scope of the gender approach in the literature analysing health and social protection policies promoted during the COVID-19 pandemic? What are the challenges and recommendations for gender-sensitive policies for the post-pandemic and future crises? Methods: The study design is based on three stages: a global synthesis of the evidence through a scoping review, the generation of a framework of emerging inequalities based on sociocultural markers, and the creation of a matrix with the challenges and recommendations. In this scoping review, we searched 10 online databases for studies published until April 2022 and conducted a content analysis on the extracted studies. Results: Of the 771 identified records, 67 met our inclusion criteria. Most studies had a female person (52/67) as the first author. The binary model was the main approach addressed in the studies (61/67). The literature showed that the closure, distancing, and other social policies did not include a gender approach and generated negative gaps related to economic instability, reproductive roles, and gender violence. In the intersectionality dimension, multiple aspects emerged (macro, meso, micro-social level, and individual level). Greater gender gaps in connection with employment (related to increased housework) were observed during the closure and distancing stage of the pandemic. Asymmetries related to female participation in the management of the pandemic and an increase in discrimination and abuse of diversity groups were detected. Conclusions: We observed gaps both in the gender approach both in knowledge and in policy implementation during the pandemic in the different countries explored in this work. This is a call to attention and action for researchers, political decision-makers, and other interested parties to incorporate and accentuate the gender perspective in all policies related to the post-pandemic period and future social and health crises.

[Health promotion initiatives aimed at young adults. Qualitative study]. / Iniciativas de promoción de la salud destinadas a adultos jóvenes. Estudio cualitativo.

Introduction: Introduction. Health promotion initiatives, even more those promoted by the State, play a fundamental and strategic role in the construction of healthy lifestyles. The objective was to explore from the perspective of a group of young adults from the Autonomous City of Buenos Aires, dimensions and qualitative categories related to health promotion community initiatives with a focus on healthy diet, physical activity, and smoking cessation. Methods: A qualitative phenomenological study were conducted, including sixteen in-depth interviews with people under 40 years of age. Results: Were found and explored that interventions through websites, email, social networks, application- Mobile App (App), calls, text messages (SMS), printed material, or brief advice. The most acceptable interventions were: website, social networks, and the App. The potential use of these interventions would be related by the inclusion of audiovisual elements and personalized messages. Conclusion: The findings indicate that interventions that include social networks, App and web would have greater potential among young adults to promote healthy lifestyles.

Introducción: Las iniciativas de promoción de salud, más aún las impulsadas desde el Estado, juegan un papel fundamental y estratégico en torno a la construcción de estilos de vida saludables. El objetivo fue explorar desde la perspectiva de un grupo de adultos jóvenes de la Ciudad Autónoma de Buenos Aires dimensiones y categorías cualitativas relacionadas a iniciativas comunitarias de promoción de la salud con foco en alimentación saludable, actividad física y cesación tabáquica. Métodos: Se realizó un estudio cualitativo de carácter fenomenológico incluyendo 16 entrevistas en profundidad a personas menores de 40 años. Resultados: Se identificaron y exploraron intervenciones a través de sitios web, correo electrónico, redes sociales, aplicativo-App móvil (App), llamadas, mensajes de texto-SMS, material impreso o asesoría breve. Las intervenciones de mayor aceptabilidad fueron: sitio web, redes sociales y App. El uso potencial de las intervenciones estaría relacionado con la inclusión de elementos audiovisuales y los mensajes personalizados. Conclusión: Nuestros hallazgos indican que las intervenciones que incluyan redes sociales, App y web tendrían mayor potencial para promover estilos de vida saludables entre los adultos jóvenes.

The Use of 2 e-Learning Modalities for Diabetes Education Using Facebook in 2 Cities of Argentina During the COVID-19 Pandemic: Qualitative Study.

BACKGROUND: The COVID-19 pandemic and the confinement that was implemented in Argentina generated a need to implement innovative tools for the strengthening of diabetes care. Diabetes self-management education (DSME) is a core element of diabetes care; however, because of COVID-19 restrictions, in-person diabetes educational activities were suspended. Social networks have played an instrumental role in this context to provide DSME in 2 cities of Argentina and help persons with diabetes in their daily self-management. OBJECTIVE: The aim of this study is to evaluate 2 diabetes education modalities (synchronous and asynchronous) using the social media platform Facebook through the content of posts on diabetes educational sessions in 2 cities of Argentina during the COVID-19 pandemic. METHODS: In this qualitative study, we explored 2 modalities of e-learning (synchronous and asynchronous) for diabetes education that used the Facebook pages of public health institutions in Chaco and La Rioja, Argentina, in the context of confinement. Social media metrics and the content of the messages posted by users were analyzed. RESULTS: A total of 332 messages were analyzed. We found that in the asynchronous modality, there was a higher number of visualizations, while in the synchronous modality, there were more posts and interactions between educators and users. We also observed that the number of views increased when primary care clinics were incorporated as disseminators, sharing educational videos from the sessions via social media. Positive aspects were observed in the posts, consisting of messages of thanks and, to a lesser extent, reaffirmations, reflections or personal experiences, and consultations related to the subject treated. Another relevant finding was that the educator/moderator role had a greater presence in the synchronous modality, where posts were based on motivation for participation, help to resolve connectivity problems, and answers to specific user queries. CONCLUSIONS: Our findings show positive contributions of an educational intervention for diabetes care using the social media platform Facebook in the context of the COVID-19 pandemic. Although each modality (synchronous vs asynchronous) could have differential and particular advantages, we believe that these strategies have potential to be replicated and adapted to other contexts. However, more documented experiences are needed to explore their sustainability and long-term impact from the users' perspective.

Adaptación y confiabilidad inter-observador de un protocolo para evaluar la disponibilidad de alimentos en supermercados en Buenos Aires, Argentina.

Introducción: La Red Internacional para la Investigación, Monitoreo y Apoyo a la Acción para la Alimentación, Obesidad y Enfermedades No Transmisibles (INFORMAS por su sigla en inglés) ha desarrollado el Protocolo para evaluar la Disponibilidad de Alimentos en Supermercados. Objetivos: Describir el proceso de adaptación del protocolo para utilizarlo en la Ciudad de Buenos Aires (BA) y evaluar la variabilidad inter-observador al aplicarlo en supermercados de la ciudad. Metodología: El principal indicador del protocolo es la disponibilidad relativa de alimentos saludables (AS) vs. no saludables (ANS), calculado como el cociente entre la longitud (m) de estantes asignados a AS y ANS (longitudAS/ANS). Se adaptó la selección de alimentos a incluir en el indicador para utilizarlo en BA. Para explorar el funcionamiento del indicador se construyó una referencia, midiendo todos los alimentos y bebidas ofrecidos en 5 supermercados, que se clasificaron en AS y ANS según las guías alimentarias argentinas. El indicador se comparó con la disponibilidad relativa calculada a partir de la referencia. Para evaluar la confiabilidad inter-observador dos observadores realizaron mediciones en tres supermercados y se calculó el coeficiente de correlación intra-clase (CCI). Resultados: Según la referencia, el cociente longitudAS/ANS varió entre 0,16 y 0,61, con una media de 0,34 (DE 0,18). El indicador adaptado produjo resultados similares con una diferencia media de -0,05 (DE 0,04). El CCI entre la mediciones de ambos observadores resultó 0,92 (IC95% 0,86-0,98). Conclusión: Se adaptó el protocolo para aplicarlo en BA, con modificaciones en los alimentos a evaluar y una adecuada confiabilidad inter-observador.

Social and gender determinants related to health inequities in a community in Argentina / [Determinantes sociales y de género relacionados a las inequidades de salud en una comunidad de Argentina]

Introduction: The study analyzes social and gender health realities regarding access to public health systems in the Argentine interior. Objective: to analyze the relationship between social determinants, gender, with inequities of access in frequent users of the public health system in a region of Argentina. Methods: Descriptive, cross-sectional and analytical study, data collected between March and November 2018 by maximum variation sampling, with analysis of absolute, relative frequencies, standard error, confidence intervals; Multivariate logistic regression analysis with 95% CI and statistical significance of p <0.05. Results: With an n = 345, in an adjusted model, being a woman increased the risk of having problems in accessing the health system 2.2 times more (p = 0.032). People with a primary education level or less are 2.4 times more at risk of paying values ​​equal to or greater than $ 71.4 for health care in the public health system compared to those with a higher educational level (p = 0.000). No statistically significant associations were found between urban / rural location, with the variables of inconveniences in access to health care and out-of-pocket spending. Conclusion: Social inequities measured by level of education and gender have a negative impact on the scope of the right to universal access to health in the analyzed population. It is recommended to review state initiatives that seek to reduce health inequities from a perspective of social and gender determinants.

Introducción: El estudio analiza realidades sanitarias sociales y de género en cuanto al acceso a los sistemas públicos de salud del interior argentino. Objetivo: analizar la relación entre determinantes sociales, género, con inequidades de acceso en usuarios frecuentes del sistema público de salud de una región de Argentina. Métodos: Estudio descriptivo, transversal y analítico, datos relevados entre  marzo y noviembre del 2018 por muestreo de variación máxima, con análisis de frecuencias absolutas, relativas, error estándar, intervalos de confianza; análisis multivariado de regresión logística con IC del 95% y significancia estadística de p<0,05. Resultados: Con un n=345, en modelo ajustado, el ser mujer aumento 2,2 veces más el riesgo de tener inconvenientes en el acceso al sistema de salud (p=0,032).  Las personas con nivel educativo primario o menor tienen 2,4 veces más de riesgo de pagar valores iguales o mayores a 71,4 dólares por atención en salud en sistema sanitario público con respecto  a los de mayor nivel educativo (p=0,000). No se encontraron asociaciones estadísticamente significativas entre localización urbana/rural, con las variables de inconvenientes en el acceso a la atención de salud y el gasto de bolsillo. Conclusión: Las inequidades sociales medido por nivel de educación y género tienen un impacto negativo en el alcance del derecho al acceso universal de salud en población analizada. Se recomienda revisar iniciativas estatales que busquen reducir inequidades en salud desde un enfoque de determinantes sociales y de género.

Urban Retail Food Environments: Relative Availability and Prominence of Exhibition of Healthy vs. Unhealthy Foods at Supermarkets in Buenos Aires, Argentina.

There is growing evidence that the food environment can influence diets. The present study aimed to assess the relative availability and prominence of healthy foods (HF) versus unhealthy products (UP) in supermarkets in Buenos Aires, Argentina and to explore differences by retail characteristics and neighborhood income level. We conducted store audits in 32 randomly selected food retails. Food availability (presence/absence, ratio of cumulative linear shelf length for HF vs. UP) and prominence inside the store (location visibility) were measured based on the International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) protocol. On average, for every 1 m of shelf length for UP, there was about 25 cm of shelf length for HF (HF/UP ratio: 0.255, SD 0.130). UP were more frequently available in high-prominence store areas (31/32 retails) than HF (9/32 retails). Shelf length ratio differed across commercial chains (p = 0.0268), but not by store size or type. Retails in the lower-income neighborhoods had a lower HF/UP ratio than those in the higher-income neighborhoods (p = 0.0329). Availability of the selected HF was overcome largely by the UP, particularly in high prominence areas, and in neighborhoods with lower income level, which may pose an opportunity for public health interventions.

[An analysis of policy interventions regarding school lunch programs and their role in the healthy nutrition of children in Córdoba, Argentina]. / Análisis de la intervención de la política de comedores escolares y el rol en la nutrición saludable de niños y niñas de Córdoba, Argentina.

The aim of this article is to analyze school lunch programs and their role in the healthy nutrition of children in Córdoba, Argentina from 2013 to 2018. A descriptive, cross-sectional study was conducted that included a sample of 10 schools in 2013 and 10 different schools in 2018. A survey of school lunch programs and 24-hour nutrition reminders was carried out with 341 children. The nutritional value of school lunch programs decreased over the study period, particularly among schools in contexts of greater social vulnerability. Significant reductions in average calcium and energy intake were also observed. Indicators of chronic malnutrition, overweight, and excess calcium and vitamin A and C intakes worsened among children attending school lunch programs. Regarding the association between school lunch program attendance and low height for age/risk of low height for age, the odds ratio was not statistically significant. We argue for the necessity of promoting policies that seek urgent improvements in child nutritional indicators from a rights-based perspective.

El objetivo fue analizar la intervención de la política de comedores escolares y el rol en la nutrición saludable de niños y niñas de Córdoba, Argentina en los años 2013 y 2018. Estudio descriptivo y trasversal. La muestra incluyó diez escuelas en 2013 y diez diferentes en 2018. Se realizó un relevamiento de comedores escolares y recordatorios alimentarios 24 hs a 341 niñas y niños. Los aportes nutricionales de los comedores escolares descendieron entre ambos periodos, en especial, en las escuelas insertas en contexto de mayor vulnerabilidad. También se observó una reducción significativa de la ingesta media de calcio y energía total. En las niñas y los niños asistentes a los comedores escolares se encontraron indicadores de desnutrición crónica, exceso de peso e ingestas de calcio, vitamina A y C deficitarios. En la asociación entre la asistencia al comedor escolar y el indicador baja talla/riesgo de baja talla, el odds ratio no fue estadísticamente significativa. Resulta necesario impulsar una política que busque de manera urgente mejoras de los indicadores de nutrición infantil, considerando un enfoque de derechos.

Factors associated with hindering the acceptance of HPV vaccination among caregivers - A cross-sectional study in Argentina.

BACKGROUND: The northeastern region of Argentina has the highest age-adjusted cervical cancer mortality rates. Given the strong link between HPV infections and cervical cancer, one of the main interventions is the population-based use of HPV vaccines. However, the acceptability is not very clear in low- and middle-income countries. The purpose of this study was to estimate the level of HPV vaccine acceptance and associated determinants among caregivers of girls in a northeastern city of Argentina. METHODS: A school-based survey was conducted in 2015 using a multistage sampling method. The primary sample unit were schools stratified by socioeconomic status selected at random, and caregivers of school girls were interviewed. The acceptability was determined using the adapted Theory of Planned Behavior. We performed logistic regression models to assess associated determinants. RESULTS: The study included 347 caregivers. The intention to vaccinate was 59.88%. A positive attitude of caregivers (aOR 4.67; 3.11-7.03) and positive influence of social norms (aOR 1.95; 1.03-3.70) were the main predictors independently associated to the intention to vaccinate against HPV. In contrast, practicing a Christian non-Catholic religion decreased the intention to vaccinate against HPV (OR 0.59; 0.36-0.95). All other factors evaluated were not significantly associated with intention to vaccinate against HPV. CONCLUSIONS: This study shows that evaluating attitudes, normative social beliefs, and perceived self-efficacy regarding HPV vaccination can be of utmost importance for mapping and planning of health-related strategies in developing countries.

Perceptions and Acceptability of Text Messaging for Diabetes Care in Primary Care in Argentina: Exploratory Study.

BACKGROUND: Engagement in self-care behaviors that are essential to optimize diabetes care is challenging for many patients with diabetes. mHealth interventions have been shown to be effective in improving health care outcomes in diabetes. However, more research is needed on patient perceptions to support these interventions, especially in resource settings in low- and middle-income countries. OBJECTIVE: The goal of the research was to explore perceptions and acceptability of a short message service (SMS) text messaging intervention for diabetes care in underserved people with diabetes in Argentina. METHODS: A qualitative exploratory methodology was adopted as part of the evaluation of a program to strengthen diabetes services in primary care clinics located in low-resource settings. The diabetes program included a text messaging intervention for people with diabetes. A total of 24 semistructured telephone interviews were conducted with people with diabetes. RESULTS: Twenty-four middle-aged persons with diabetes were interviewed. Acceptability was considered adequate in terms of its actual use, frequency, and the role of texts as a reminder. We found that text messages could be a mediating device in the patient's learning processes. Also, being exposed to the texts seemed to help bring about changes in risk perception and care practices and to function as psychosocial support. Another relevant finding was the role of text messaging as a potential facilitator in diabetes care. In this sense, we observed a strong association between receiving text messages and having a better patient-physician relationship. Additionally, social barriers that affect diabetes care such as socioeconomic and psychosocial vulnerability were identified. CONCLUSIONS: Our findings show positive contributions of a text messaging intervention for the care of people with diabetes. We consider that an SMS strategy has potential to be replicated in other contexts. However, further studies are needed to explore its sustainability and long-term impact from the perspective of patients.

Using mH ealth Tools to Improve Access and Coverage of People With Public Health Insurance and High Cardiovascular Disease Risk in Argentina: A Pragmatic Cluster Randomized Trial.

Background Control of cardiovascular disease ( CVD ) risk factors is suboptimal in Argentina, despite the government's provision of free blood pressure and cholesterol-lowering medications for people without private insurance. We assessed whether community health workers' use of an integrated mH ealth tool encourages patients to attend visits at primary care clinics to improve CVD risk management in 2 provinces of Argentina. Methods and Results We conducted a pragmatic cluster randomized trial, with primary care clinics randomly assigned to intervention or control. Eligible people were aged 40 to 79 years, lived in the catchment area of primary care clinics, possessed a mobile phone for personal use, had public health coverage, and a 10-year CVD risk ≥10%. In the control arm, community health workers screened for CVD risk using a paper-based tool and encouraged high-risk people to present to the primary care clinics for care. In the intervention arm, community health workers used the mH ealth tool to calculate CVD risk and confirm a scheduled physician appointment. Primary outcomes were the proportion of participants who attended a baseline visit and completed at least 1 follow-up, respectively. We enrolled 755 people (376 interventions; 379 controls). Intervention participants were significantly more likely to complete baseline visits (49.4% versus 13.5%, P value 0.0008) and follow-up visits (31.9% versus 7.7%; P value 0.0041). The use of chronic medication and current smoking were significant predictors of primary outcomes. Conclusions Use of mH ealth tools identifies patients at high CVD risk in their home, increases the likelihood of participating in chronic CVD risk factor management, and strengthens referrals. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 02913339.

Stakeholder Engagement in the Translation of a Hypertension Control Program to Guatemala's Public Primary Health Care System: Lessons Learned, Challenges, and Opportunities.

BACKGROUND: There is an urgent need to define appropriate intervention strategies to control blood pressure in low- and middle-income countries. In 2018, a program proven effective in Argentina was translated to Guatemala's public primary health care system in rural and primarily indigenous communities. OBJECTIVES: This paper describes the stakeholder engagement process used to adapt the program to the Guatemalan rural context prior to implementing a type II hybrid effectiveness-implementation trial and shares lessons learned. METHODS: We identified key differences in the 2 contexts that are relevant to translating the intervention to the Guatemalan context. Alongside interviews and focus group discussions, we conducted consultation workshops in July and August 2018, applying a participatory translation process involving patients, family members, community members, health care providers, and Ministry of Health officials. The process consisted of multiple meetings in Guatemala City, as well as meetings in each of the 5 departments where the study will be implemented, and 1 district per department. During the workshops, we presented the evidence-based experience from Argentina and then focused on the challenges and recommended solutions that the participants identified for each of the intervention's 6 components. The process concluded with a meeting in which the research team and Ministry of Health officials defined specific details of the intervention. RESULTS: The outcome of the process is an adapted approach appropriate to integrate into Guatemala's public primary health care system in the trial phase. The approach considers the challenges and recommended strategies for each of the 6 intervention components. CONCLUSIONS: We identified lessons learned, challenges, and opportunities during the adaptation process. Findings will inform ongoing stakeholder engagement during the study implementation and future scale-up and efforts to translate evidence-based hypertension control strategies to low- and middle-income countries globally.

[Nutritional contribution the school canteens program to the children of ten municipal schools in the city of Córdoba, Argentina.] / Contribución nutricional del programa Comedores Escolares a la población infantil de diez escuelas municipales de la ciudad de Córdoba, Argentina.

Introduction: School canteens are one of the most widespread programs in recent decades which may have significant impacts on nutrition, health, growth and development in children. Objetive: To assess the nutritional contribution of School Canteens (PCE) program to children from municipal schools of Cordoba. Material and methods: Was a descriptive and analytical study. I applied an observation guide and ration weighing measurements of the school canteens food supply and food recall method was used 24 hours a sample of 170 school children. Results: The breakfasts/snacks they had a deficit in Calcium, vitamin A and C and iron and excess of simple sugars. The lunches they had a excess of saturated fats and deficit of energy, calcium, iron, fiber and vitamin A. The food consumption of school children was high in discretionary calories, sugars and saturated fats and deficit in fiber, calcium and vitamin A, associated with some sociodemographic characteristics. There had associations between the inadequacy of the target intake of calcium and vitamin found and suboptimal quality and dining in these nutrients (p< 0,05). Conclusions: We conclude what in this context there are nutritional aspects that are necessary improve.

El objetivo fue evaluar la contribución nutricional del programa Comedores Escolares (PCE) a la población infantil de escuelas municipales de Córdoba. Fue un estudio descriptivo y analítico. Se empleó una guía de observación y mediciones en comedores y recordatorios alimentarios 24 hs. a 150 escolares. Los desayunos/meriendas tuvieron déficit en energía, calcio, vitamina A y C y hierro y exceso de azúcares. Los almuerzos tuvieron exceso en grasas saturadas y déficit en energía, calcio, hierro, fibra y vitamina A. El consumo en escolares fue alto en calorías dispensables, azúcares y grasas saturadas y deficitario en fibra, calcio y vitamina A, asociados a algunas características sociodemográficas. Hubo asociaciones entre la falta de adecuación de la ingesta a la meta en calcio y vitamina A y la calidad poco óptima del comedor en estos nutrientes (p<0,05). Se concluye que en este contexto hay aspectos nutricionales que son necesarios mejorar.

[School Agroecology and health-related quality of life to adolescents] / Agroecología en la escuela y calidad de vida relacionada a la salud de los adolescentes.

The study aimed to evaluate the contribution of school agroecology to the quality of life related to health of adolescents of a school of Cordoba, Argentina. Feasibility study. It was a study quasi- experimental whit control group carried out in a middle-level public school. The sample consisted of 58 adolescents in the intervention group and 77 in the control group. After the intervention increased consumption of agro-ecological food (from 26% to 74% p<0,05). Changes were detected in acquired knowledge about agroecology in the classroom level going from 37% to 63% (p< 0,05). Positive changes detected in awareness with the environment and relationship (p<0,05). It was evidenced that the implementation of school agroecology can provide resolutive contributions to some of the problems the health related quality of life of adolescents.

El estudio tuvo como objetivo evaluar la contribución de la agroecología escolar a la calidad de vida relacionada a la salud de los adolescentes de una escuela de la ciudad de Córdoba, 2015-2016. Fue un estudio cuasi experimental con grupo control llevado a cabo en una escuela urbana pública de nivel medio. La muestra fue de 58 adolescentes en el grupo intervención y 77 en el grupo control.Después de la intervención se observó un incremento significativo en el consumo de alimentos agroecológicos (de un 26% a un 74% p<0,05). Los conocimientos teóricos-prácticos adquiridos sobre agroecología a nivel áulico aumentaron de un 37% a un 63% (p<0,05). Se detectaron cambios significativos en la sensibilización con el ambiente y en la dimensión de relacionamiento (p<0,05).Se concluye que implementar agroecología escolar puede brindar aportes resolutivos a algunas de las problemáticas de la calidad de vida relacionada a la salud de adolescentes.

mHealth Interventions to Counter Noncommunicable Diseases in Developing Countries: Still an Uncertain Promise.

mHealth constitutes a promise for health care delivery in low- and middle-income countries (LMICs) where health care systems are unprepared to combat the threat of noncommunicable diseases (NCDs). This article assesses the impact of mHealth on NCD outcomes in LMICs. A systematic review identified controlled studies evaluating mHealth interventions that addressed NCDs in LMICs. From the 1274 abstracts retrieved, 108 articles were selected for full text review and 20 randomized controlled trials were included from 14 LMICs. One-way SMS was the most commonly used mobile function to deliver reminders, health education, and information. mHealth interventions in LMICs have positive but modest effects on chronic disease outcomes.

Transparencia y acceso a la información pública de la política alimentaria de comedores escolares, Argentina / Transparency and access to public information on the food policy of school canteens, Argentina

Introducción: La transparencia y el acceso a la información pública son mecanismos importantes que facilitan y posibilitan políticas públicas participativas. Sin embargo, existen escasos antecedentes que apliquen sus principios a las políticas alimentarias y nutricionales. Objetivo: Explorar el estado actual de la transparencia de la política alimentaria de comedores escolares en Argentina a través de las posibilidades de acceso a la información pública. Métodos: Estudio descriptivo, transversal y exploratorio con métodos cuantitativos y cualitativos a partir del análisis de documentos gubernamentales publicados hasta el año 2019 en los sitios web de ministerios a nivel nacional y de las 24 jurisdicciones del país. Se utilizó la técnica de análisis de contenido y triangulación por observador. Se incluyeron 308 documentos. Resultados: Veinte jurisdicciones contaron con normativa para el acceso a la información pública y seis no tuvieron regulaciones para los comedores escolares. En cualquier escenario normativo (con/sin ley sobre el acceso a la información pública) fue escaso el acceso a la información de las políticas de comedores escolares. Los aspectos más críticos fueron: indicadores, periodo de implementación de los servicios alimentarios, presupuestos, presencia de enfoque de accesibilidad universal y articulación con otras políticas sociales. Conclusiones: Se necesita de manera urgente aplicar criterios de transparencia a las políticas de comedores escolares. Los gobiernos a nivel nacional y subnacional deben demostrar un mayor compromiso para garantizar el derecho al acceso a la información pública en las políticas alimentarias y nutricionales y consolidar los entornos virtuales como principal herramienta para aproximar el Estado a la ciudadanía(AU)

Introduction: Transparency and access to public information are important mechanisms that facilitate and enable participatory public policies. However, there is little precedent for applying its principles to food and nutrition policies. Objective: Explore the current state of transparency of the food policy of school canteens in Argentina through the chances of access to public information. Methods: Descriptive, cross-sectional and exploratory study with quantitative and qualitative methods based on analysis of government documents published until 2019 on the websites of ministries at the national level and of the 24 jurisdictions of the country. The technique of content analysis and triangulation by observer was used. 308 documents were included. Results: Twenty jurisdictions had regulations for access to public information and six had no regulations for school canteens. In any regulatory scenario (with/without a law on access to public information) access to information on school canteen policies was scarce. The most critical aspects were: indicators, period of implementation of food services, budgets, presence of a universal accessibility approach and articulation with other social policies. Conclusions: There is an urgent need to apply transparency criteria to school canteen policies. Governments at the national and sub-national levels must show a greater commitment to guarantee the right to access public information in food and nutrition policies and consolidate virtual environments as the main tool to bring the State closer to citizens(AU)