Co-Designing a Strategy for Implementing the SPARC Holistic Needs Assessment Tool in the Colombian Clinical Context.

In Colombia, timely access to palliative care (PC) is hampered by difficulties in identifying and referring to necessary services. The SPARC (Sheffield Profile for Assessment and Referral for Care) instrument provides a holistic needs assessment to improve referrals for different forms of care. SPARC was recently validated in Colombian Spanish (SPARC-Sp) but has not yet been implemented in clinical practice. We undertook workshops that aimed to co-design an implementation strategy to inform a future trial testing SPARC-Sp in the Colombian healthcare system. Workshop attendees included patients, informal caregivers, healthcare professionals, volunteers, administrative staff and decision makers. Discussions within the workshops refined implementation and dissemination strategies for SPARC-Sp in practical scenarios. Results include the need for education, clarification and demystification of PC and the lack of time and skills of professionals to identify patients' needs. Attendees recognized SPARC-Sp as a valuable tool for highlighting patients' concerns, whose adaptations are needed in Colombia to address the low literacy of the population and specificities of the healthcare system. We proposed local adaptations to SPARC-Sp and produced five educational videos aimed at health professionals, patients and caregivers to strengthen understanding of holistic needs in PC while building a strategy for SPARC-Sp implementation in the Colombian context.

Barriers and facilitators to palliative care for patients with non-curable cancer in Colombia: perspectives of allied health and social care professionals.

BACKGROUND: Palliative care aims to improve the quality of life of people with life-limiting illness and their families by addressing physical, psychological, social and spiritual suffering. Allied Health and Social Care Professionals (AHSCP) are key to delivering comprehensive, high quality palliative care. In recent years, Colombia has developed changes in the legal, and regulatory framework for access to palliative care but barriers and facilitators to palliative care for patients with non-curable cancer have not been explored from the perspective of AHSCP. METHOD: This study aims to address this knowledge gap in two cities in Colombia: one in a medium-sized city in a rural area (Popayan) and one in a highly urbanized area (Bogota). Two focus groups with AHSCP were conducted using the World Cafe method, and a subsequent thematic analysis was performed to establish the main barriers and facilitators. RESULTS: A wide range of 18 AHSCPs attended the two World Cafe groups in Popayan and Bogota. As a result of this iterative process, we established five thematic areas: (i) Humanizing care, (ii) Normalizing palliative care: referral at the time of diagnosis, (iii) Misunderstandings related to palliative care, (iv) Barriers within the health system, and (v) Geographic barriers. CONCLUSION: This study provided the perspectives of AHSCPs in Colombia in relation to barriers and facilitators in the framework of comprehensive palliative care attention. Participants identified misconceptions about palliative care, which are explained by the lack of inclusion of this area in the educational programs of health professionals and AHSCPs, along with the limited supply and access to palliative care, especially in rural areas.

Delayed surgery and health related quality of life in patients with proximal femoral fracture.

This study aimed to establish factors associated with delayed surgery in patients with proximal femoral fracture and to assess patients' health-related quality of life (HRQoL) after surgery including all-cause 6-months mortality. This was a single-center, observational, prospective cohort study that included patients with a proximal femur fracture. We described patients' HRQoL measured by EuroQoL (EQ-5D-5L and EQ-VAS) questionnaire and perioperative complications (including mortality) 6 months after surgery. We included 163 patients with a mean age of 80.5 years, the majority were women and 76.1% reported falling from their own height. The mean time between hospital admission and surgery was 8.3 days (SD 4.9 days) and the mean hospital stay was 13.5 days (SD 10.4 days). After adjustment, the principal factor associated with delayed surgery was adjournment in surgery authorization (3.7 days). EQ-5D-5L index values and the VAS score at 1 month after surgery were 0.489 and 61.1, at 3 months were 0.613 and 65.8, and at 6 months 0.662 and 66.7 respectively. Mortality at 6 months of follow-up was 11% (18 patients). In conclusion, administrative authorization was the strongest associated factor with delayed time from hospital admission to surgery. HRQoL of patients with a proximal femoral fracture improved 6 months after surgery.Trial registration: NCT04217642.

Clinical course of neonatal acute kidney injury: multi-center prospective cohort study.

BACKGROUND: Neonatal acute kidney injury (AKI) has been associated with unfavorable outcomes, including increased mortality. We aimed to describe the clinical course and outcomes during the first 7 days after diagnosis in newborns with AKI in three neonatal intensive care units in Popayán-Colombia. METHODS: Multi-center prospective cohort study conducted between June 2019 and December 2020 in three NICUs after ethical approval. We included newborns between 2 and 28 days of life, first diagnosed with AKI using the KDIGO classification modified for newborns which consider increased serum creatinine values over baseline values as well as urine output over time in hours or both. Patients with chromosomal abnormalities, major kidney malformations, and complex congenital heart disease were excluded. Patients were followed for up to 7 days after diagnosis and the maximum KDIGO stage, recovery of kidney function, need for renal replacement therapy and cumulative incidence of death were evaluated. RESULTS: Over the 18 months of the study, 4132 newborns were admitted to the NICUs, and 93 patients (2.25, 95% CI 1.82-2.75%) developed neonatal AKI. 59.1% of the newborns were premature and there were no differences in severity according to gestational age. During follow-up, the maximum KDIGO was 64.5% for AKI-stage 1, 11.8% for AKI-stage 2, and 23.7% for AKI-stage 3. Kidney function recovery was higher in AKI-stage 1 patients vs. AKI-severe (AKI-stage 2 and 3) (95% vs. 48.5%). Five patients (5.4%) received renal replacement therapy and 15 died (16.1%), four in AKI-stage 1 vs. 11 in AKI-severe (6.7% vs 33.3%). CONCLUSIONS: Newborns admitted to the NICUs can develop AKI regardless of gestational age, and it is more frequent between the second and ninth days of life. More patients whit AKI-stage 1 recover and die less than those in a severe stage.

Quality of clinical practice guidelines for gestational and congenital toxoplasmosis: A systematic review of the literature.

OBJECTIVE: To evaluate the methodological quality and transparency of the clinical practice guidelines (CPGs) for the prevention, diagnosis, and treatment of gestational and congenital toxoplasmosis (CT). METHODS: Systematic review of the literature on gestational and CT CPGs conducted in the MEDLINE, Embase, TripDatabase, Biblioteca Virtual en Salud databases and extensive manual searches in 19 CPG repositories. The characteristics of each of the guidelines were extracted using My AGREE PLUS on-line. Three reviewers assessed overall quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. RESULTS: The combined systematic review found 8651 citations. Of them 46 full texts were reviewed, and eight documents were finally included: four toxoplasmosis CPGs, three prenatal care CPGs that included recommendations on toxoplasmosis, and one pregnancy infection guideline that also included recommendations on toxoplasmosis. The AGREE II domains found to have the highest scores were 'clarity of presentation' (85%; [37%-100%]), followed by 'scope and purpose' (73%; [33%-98%]), and 'editorial independence' (51%; [3%-94%]); the domains with the lowest scores were 'rigour of development' (36%; [11%-79%]), 'stakeholder involvement' (34%; [24%-85%]), and 'applicability' (17%; [6%-83%]). The Colombian and Spanish-Agencia de Evaluación de Tecnologías Sanitarias de Andalucía (AETSA) CPGs had the highest global AGREE II scores. Absolute interrater agreement was good to excellent. CONCLUSION: Substantial quality variation was found among CPGs, which provided recommendations in accordance with the context of the disease in the corresponding country or region. Only two of the CPGs appraised obtained a good score and are classified as 'recommended'.

Toward the "next normal": An opportunity to unlearn and reflect about life, death, and our mental health during the pandemic / Hacia la "próxima normalidad": una oportunidad para desaprender y reflexionar sobre la vida, la muerte y nuestra salud mental durante la pandemia

While pondering about a way to convey a message of hope, kindness and solidarity to my anesthesiology colleagues and to all the healthcare professionals and workers in Colombia and around the world, who are in the frontlines of the COVID-19 pandemic, I realized - once again- the severe impact it has had on our mental health and our lives. In the history of our generation and probably since 1918, mankind had not experienced the deleterious effect of a pandemic of such magnitude on our lives. A disrupting event of such magnitude invites us to reflect daily. So, I remembered that we, Colombian anesthesiologists, have a fantastic leader who sets an example for many of us, and who is renowned worldwide. A global leader in innovation and the creation of the future: Professor Alejandro Jadad. He used to speak often about pandemics, but pandemics of health and joy.

Mientras reflexionaba sobre una manera de transmitir un mensaje de esperanza, amabilidad y solidaridad a mis colegas de anestesiología y a todos los profesionales y trabajadores de la salud en Colombia y en todo el mundo, que se encuentran en la primera línea de la pandemia de COVID-19, me di cuenta: una vez de nuevo, el impacto severo que ha tenido en nuestra salud mental y nuestras vidas. En la historia de nuestra generación y probablemente desde 1918, la humanidad no había experimentado el efecto deletéreo de una pandemia de tal magnitud en nuestras vidas. Un acontecimiento perturbador de tal magnitud nos invita a reflexionar a diario. Entonces, recordé que nosotros, los anestesiólogos colombianos, tenemos un líder fantástico que es un ejemplo para muchos de nosotros y que es reconocido mundialmente. Líder mundial en innovación y creación de futuro: el profesor Alejandro Jadad. Solía ​​hablar a menudo de pandemias, pero de pandemias de salud y alegría.

Palliative Care and Oncology in Colombia: The Potential of Integrated Care Delivery.

Palliative care is on the global health agenda, as only approximately 14% of people who require palliative care receive it [...].

Decision making in the end-of-life care of patients who are terminally ill with cancer - a qualitative descriptive study with a phenomenological approach from the experience of healthcare workers.

BACKGROUND: In Colombia, recent legislation regarding end-of-life decisions includes palliative sedation, advance directives and euthanasia. We analysed which aspects influence health professionals´ decisions regarding end-of-life medical decisions and care for cancer patients. METHODS: Qualitative descriptive-exploratory study based on phenomenology using semi-structured interviews. We interviewed 28 oncologists, palliative care specialists, general practitioners and nurses from three major Colombian institutions, all involved in end-of-life care of cancer patients: Hospital Universitario San Ignacio and Instituto Nacional de Cancerología in Bogotá and Hospital Universitario San José in Popayan. RESULTS: When making decisions regarding end-of-life care, professionals consider: 1. Patient's clinical condition, cultural and social context, in particular treating indigenous patients requires special skills. 2. Professional skills and expertise: training in palliative care and experience in discussing end-of-life options and fear of legal consequences. Physicians indicate that many patients deny their imminent death which hampers shared decision-making and conversations. They mention frequent ambiguity regarding who initiates conversations regarding end-of-life decisions with patients and who finally takes decisions. Patients rarely initiate such conversations and the professionals normally do not ask patients directly for their preferences. Fear of confrontation with family members and lawsuits leads healthcare workers to carry out interventions such as initiating artificial feeding techniques and cardiopulmonary resuscitation, even in the absence of expected benefits. The opinions regarding the acceptability of palliative sedation, euthanasia and use of medications to accelerate death without the patients´ explicit request vary greatly. 3. Conditions of the insurance system: limitations exist in the offer of oncology and palliative care services for important proportions of the Colombian population. Colombians have access to opioid medications, barriers to their application are largely in delivery by the health system, the requirement of trained personnel for intravenous administration and ambulatory and home care plans which in Colombia are rare. CONCLUSIONS: To improve end-of-life decision making, Colombian healthcare workers and patients need to openly discuss wishes, needs and care options and prepare caregivers. Promotion of palliative care education and development of palliative care centres and home care plans is necessary to facilitate access to end-of-life care. Patients and caregivers' perspectives are needed to complement physicians' perceptions and practices.

Global perioperative surgery research: A call to Latin America / Investigación global sobre el perioperatorio quirúrgico: un llamado a América Latina

Every year, around 300 million surgical procedures are performed worldwide 1,2, with an estimated 4% early postoperative mortality rate. 3,4 However, little is known about global quality of surgery, specifically in middle-income countries. Colombia, similar to other Latin American countries, has an interesting diversity of healthcare needs. In urban settings, the healthcare offered is among the best in Latin America, with top-quality hospitals and educational programs comparable to those in the USA or Europe. In contrast, in most rural areas of Latin America, including some of the most remote locations in the world (like the Pacific Coast or the Amazon forest), a frail and fragmented healthcare system prevails, similar to the conditions in very low-income countries. At least 7.1 million people (15.1% of the population) lack hospital access within a 2-hour drive, and despite these characteristics, the early reported postoperative mortality is low - 0.74%.

Cada año se realizan alrededor de 300 millones de intervenciones quirúrgicas en todo el mundo 1,2, con una tasa estimada de mortalidad postoperatoria temprana del 4%. 3,4 Sin embargo, poco se sabe sobre la calidad global de la cirugía, específicamente en los países de ingresos medios. Colombia, al igual que otros países latinoamericanos, presenta una interesante diversidad de necesidades de atención médica. En los entornos urbanos, la oferta sanitaria se encuentra entre las mejores de América Latina, con hospitales de primera calidad y programas educativos comparables a los de Estados Unidos o Europa. En cambio, en la mayoría de las zonas rurales de América Latina, incluidas algunas de las localidades más remotas del mundo (como la costa del Pacífico o la selva amazónica), prevalece un sistema sanitario frágil y fragmentado, similar a las condiciones de los países de muy bajos ingresos. Al menos 7,1 millones de personas (el 15,1% de la población) carecen de acceso a un hospital a menos de 2 horas de viaje, y a pesar de estas características, la mortalidad postoperatoria temprana reportada es baja: 0,74%.

Psychometric Properties of the Latin American Spanish Version of the Hospital Survey on Patient Safety Culture Questionnaire in the Surgical Setting.

OBJECTIVE: The Hospital Survey on Patient Safety Culture (HSPSC) was designed to assess staff views on patient safety and has been translated and validated into several languages and settings. This study developed a Latin American Spanish version of the HSPSC for use in perioperative settings and examines its psychometric properties. METHODS: After translation and adjustments, a web-based questionnaire was administered to all health care personnel at operating room in a public university-affiliated hospital in Popayán, Colombia. Descriptive statistics, internal reliability, confirmatory and exploratory factor analysis, and intercorrelations among survey composites were calculated. RESULTS: Confirmatory factor analysis showed inadequate model fit for the original 12-factor structure of the HSPSC. Rather, a 9-factor, 36-item instrument showed acceptable factor loadings, internal consistency, and psychometric properties. Five factors were formed with minor changes. Adjusted factors emerged, like "staffing and work pressure" and "supervisor/manager expectations and actions promoting patient safety," "organizational learning-continuous improvement," and "hospital management support for safety," as well as "repeated errors and perception of safety." Internal consistency for each remaining composite met or exceeded a Cronbach α value of 0.60. CONCLUSIONS: Psychometric analyses provided overall support for 9 of the 12 initial factors of patient safety culture. Our findings suggest that more validation studies need to be conducted before applying safety dimensions from the original HSPSC to perioperative settings only. By providing this initial tool, we hope to stimulate further studies and the patient safety research agenda in this part of the world.

Evidence and decision-making in times of pandemic / Evidencias y decisiones en tiempos de pandemia

In December 2019, an outbreak of a respiratory desease caused by a new coronavirus strain was detected in Wuhan, China. The disease spread rapidly around the world and was recognized as a pandemic by the World Health Organization in March 2020. From the very beginning of the pandemic, society was faced with a scenario fraught with uncertainty: a new disease with severe effects on some patients and no specific treatment. The medical community reacted promptly and undertook the quest for treatment options, some based on prior experiences with diseases caused by other coronavirus strains or related viruses, and other approaches based on potential pathophysiological mechanisms promising at the time but without any supporting scientific evidence.

En diciembre de 2019, se detectó en Wuhan (China) un brote de una enfermedad respiratoria causada por una nueva cepa de coronavirus. La enfermedad se extendió rápidamente por todo el mundo y fue reconocida como pandemia por la Organización Mundial de la Salud en marzo de 2020. Desde el principio de la pandemia, la sociedad se enfrentó a un escenario cargado de incertidumbre: una nueva enfermedad con graves efectos en algunos pacientes y sin tratamiento específico. La comunidad médica reaccionó rápidamente y emprendió la búsqueda de opciones de tratamiento, algunas basadas en experiencias previas con enfermedades causadas por otras cepas de coronavirus o virus relacionados, y otras aproximaciones basadas en posibles mecanismos fisiopatológicos prometedores en ese momento pero sin ninguna evidencia científica que los respaldara.

Construcción y validación de un instrumento para medir conocimientos de madres y cuidadores sobre alimentación complementaria de infantes / Construction and validation of an instrument to measure knowledge of mothers and caregivers on complementary feeding of infants

INTRODUCCIÓN: La nutrición adecuada durante los primeros dos años de vida es fundamental para el desarrollo pleno del potencial del ser humano. La introducción inadecuada, precoz o tardía de la alimentación complementaria trae consecuencias a corto y largo plazo. La alimentación complementaria depende en gran medida de los conocimientos del cuidador que en los países de Latinoamérica generalmente es la madre. OBJETIVO: construir y validar un instrumento para medir los conocimientos maternos y de cuidadores sobre alimentación complementaria. SUJETOS Y MÉTODO: Estudio de observación. Participaron 80 madres comunitarias y 12 pediatras expertos. Se desarrolló en dos etapas: la creación del instrumento a partir de las 7 fases propuestas por Sampieri, y la validación mediante la evaluación de validez aparente, de constructo, de contenido, consistencia interna y fiabilidad intra-observador. RESULTADOS: Se creó un instrumento autoadministrado que incluyó inicialmente 14 preguntas sobre conocimientos maternos y de cuidadores. Durante la validación de constructo se identificaron 3 dominios y se eliminaron cuatro preguntas. En la validación de contenido, 10 preguntas del instrumento definitivo obtuvieron calificaciones superiores a 9 (en una escala de 0-10) en las características: calidad, vocabulario, relevancia y actualidad. La consistencia interna global del instrumento fue moderada (Alfa de Cronbach: 0,64) y la fiabilidad intra-observador fue aceptable (k: 0,21-0,40) para el 80% de ítems del instrumento. CONCLUSIONES: Se presenta el primer instrumento autoadministrado validado en la región, que permite medir conocimientos de las madres y los cuidadores sobre alimentación complementaria. A futuro, permitirá diseñar y desarrollar estrategias de evaluación e intervención en relación con los conocimientos maternos y de los cuidadores sobre alimentación complementaria.

INTRODUCTION: Adequate nutrition during the first two years of life is crucial for the full development of human potential. Inadequate, early, or late introduction of complementary feeding has consequences in the short- and long-term. Complementary feeding depends largely on the knowledge of the caregiver who, in Latin American countries, is usually the mother. OBJECTIVE: To create and validate an ins trument to measure knowledge about complementary feeding. SUBJECTS AND METHOD: Observational study in which 80 community mothers and 12 expert pediatricians participated. It was carried out in two stages, the creation of the instrument (following the 7 phases proposed by Sampieri) and the va lidation through the evaluation of the apparent validity, construct and content validity, internal con sistency, and intra-observer reliability. RESULTS: A self-administered instrument was created that ini tially included 14 questions about maternal and caregiver's knowledge. During the validation of the construct, 3 domains were identified and four questions were eliminated. In the content validation, 10 questions of the final instrument scored higher than 9 (on a scale of 0-10) in the characteristics of quality, vocabulary, relevance, and topicality. The global internal consistency of the instrument was moderate (Cronbach's alpha: 0.64) and the intra-observer reliability was acceptable (k: 0.21-0.40) for 80% of its items. CONCLUSIONS: the first self-administered instrument validated in the region to measure the knowledge of mothers and caregivers about complementary feeding is presented. It will allow to design and develop strategies in relation to maternal and caregiver's knowledge of comple mentary feeding.

Características de pacientes adultos con cáncer y su atención en el Hospital Universitario San José de Popayán, Colombia / Characteristics of adult cancer patients and their care at the San José University Hospital, Popayán, Colombia

Resumen Objetivo: Describir las características sociodemográficas y clínicas de los pacientes adultos con diagnóstico de cáncer atendidos en el Hospital Universitario San José (HUSJ) de Popayán, Colombia. Métodos: Estudio observacional con datos rutinarios de cáncer que incluyó pacientes mayores de 18 años atendidos entre 2012 y 2017 en los servicios de urgencias y hospitalización con diagnóstico de cáncer, según el Manual CIE 10 (Clasificación Internacional de Enfermedades, décima versión) en el HUSJ. Se aplicó una estrategia de muestreo aleatorio simple con afijación proporcional por años y se analizaron de forma descriptiva y gráfica. Resultados: Se incluyeron 245 pacientes. El 51% de los cuales correspondió al género femenino y la mediana de edad fue de 64 años. El cáncer más frecuente en ambos sexos fue el de estómago, seguido por el cáncer de ovario y cérvix en mujeres y por el cáncer de próstata, de tejido sanguíneo y de médula ósea en hombres. Los tipos histológicos de cáncer registrados en la mayoría de los pacientes fueron los carcinomas y adenocarcinomas. En el 36,7% de los pacientes se documentó la presencia de metástasis. La mortalidad durante la última hospitalización fue del 20% y el 12% de los pacientes requirieron remisión a otro nivel de atención superior. Conclusión: Los resultados de este estudio muestran similitudes con el comportamiento de la enfermedad en el país, con excepción del cáncer ginecológico. Adicionalmente, aporta información valiosa tanto a nivel regional como a la institución y crea conciencia de la necesidad de la implementación y mantenimiento de registros hospitalarios de cáncer.

Abstract Objective: To describe the socio-demographic and clinical characteristics of adult cancer patients who received treatment at the San José University Hospital (HUSJ) in Popayán, Colombia. Methods: Observational study with routine cancer data, which included patients aged over 18 years, who received treatment between 2012 and 2017 in the emergency and hospitalization departments, with cancer diagnosis according to the ICD Manual 10 (International Statistical Classification of Diseases, tenth revision) in the HUSJ. It was applied a simple random sampling strategy, with proportional allocation by years, and they were analyzed descriptively and graphically. Results: 245 patients were included, 51% of which corresponded to female gender; median age, 64 years. The most frequent cancer in both sexes was stomach cancer, followed by ovary cancer and cervix cancer in women; and cancer of the prostate, blood tissue, and bone marrow in men. The histological types of cancer registered in most of the patients were carcinomas and adenocarcinomas. The presence of metastases was documented in 36.7% of the patients. The mortality during the last hospitalization was 20%; and 12% of patients required referral to another higher level of care. Conclusion: The results of this study show similarities with the behavior of the disease in the country, with the exception of gynecological cancer. Additionally, it provides valuable information both regionally and at institution level, as well as it raises awareness of the need for the implementation and maintenance of hospital cancer records.

Economic analysis in anesthesiology in Colombia / Análisis económicos en la anestesiología colombiana

In this era of a technological revolution in the health arena, we are constantly being confronted with new interventions for disease diagnosis, treatment, or rehabilitation. No health system is immune to challenges when it comes to cover high demand for resources required for these innovations which are increasingly more costly in relation to limited resources.1 The ethical implications and the balance between medical autonomy and the resources needed to ensure sustainability of the health system have been subjects of discussion in Colombia.

En esta era de revolución tecnológica en salud, diariamente enfrentamos la aparición de nuevas intervenciones para el diagnostico, tratamiento o rehabilitación de la enfermedad. Inevitablemente, todo sistema de salud tiene dificultades al momento de cubrir la alta demanda de recursos necesarios para estas innovaciones, las cuales, en general, son cada vez más costosas frente a unos recursos limitados.1 Las implicaciones éticas y el balance entre la autonomía médica y los recursos necesarios para la sostenibilidad de los sistemas de salud han sido tema de discusión en Colombia.

The era of digital diffusion and changes in biomedical publishing / La era de difusión digital y los cambios en la publicación biomédica

The technological revolution of recent years has produced an absolute and irremediable alteration in the creation, production, diffusion, distribution, reproduction, use and consumption of contents of biomedical scientific journals.1 These changes include the way of transmitting knowledge and represent new and renewed evolutionary strategies of communication. Thirty years ago, we could predict that the electronic and technological revolution would dramatically change and gradually reduce the use of printed publications.2 We have reached that point, and regional and global scientific journals are no unaware of these changes. There has been a gradual shift toward the online content publication as a priority form of dissemination.

La revolución tecnológica de los últimos años ha producido una alteración absoluta e irremediable en la creación, producción, difusión, distribución, reproducción, uso y consumo de contenidos de las revistas científicas biomédicas.1 Estos cambios incluyen la forma de transmitir el conocimiento y representan nuevas y renovadas estrategias evolutivas de comunicación. Hace treinta años, podíamos predecir que la revolución electrónica y tecnológica cambiaría drásticamente y reduciría gradualmente el uso de las publicaciones impresas.2 Hemos llegado a ese punto, y las revistas científicas regionales y mundiales no son ajenas a estos cambios. Se ha producido un cambio gradual hacia la publicación de contenidos en línea como forma prioritaria de difusión.

Construction and validation of an instrument to measure knowledge of mothers and caregivers on complementary feeding of infants. / Construcción y validación de un instrumento para medir conocimientos de madres y cuidadores sobre alimentación complementaria de infantes.

INTRODUCTION: Adequate nutrition during the first two years of life is crucial for the full development of human potential. Inadequate, early, or late introduction of complementary feeding has consequences in the short- and long-term. Complementary feeding depends largely on the knowledge of the caregiver who, in Latin American countries, is usually the mother. OBJECTIVE: To create and validate an ins trument to measure knowledge about complementary feeding. SUBJECTS AND METHOD: Observational study in which 80 community mothers and 12 expert pediatricians participated. It was carried out in two stages, the creation of the instrument (following the 7 phases proposed by Sampieri) and the va lidation through the evaluation of the apparent validity, construct and content validity, internal con sistency, and intra-observer reliability. RESULTS: A self-administered instrument was created that ini tially included 14 questions about maternal and caregiver's knowledge. During the validation of the construct, 3 domains were identified and four questions were eliminated. In the content validation, 10 questions of the final instrument scored higher than 9 (on a scale of 0-10) in the characteristics of quality, vocabulary, relevance, and topicality. The global internal consistency of the instrument was moderate (Cronbach's alpha: 0.64) and the intra-observer reliability was acceptable (k: 0.21-0.40) for 80% of its items. CONCLUSIONS: the first self-administered instrument validated in the region to measure the knowledge of mothers and caregivers about complementary feeding is presented. It will allow to design and develop strategies in relation to maternal and caregiver's knowledge of comple mentary feeding.

Enhancing the value of research reports: time for complete reporting / Aumentando valor a los reportes de investigación. El tiempo del reporte completo

Editorial dissemination of research is the reflection of a scientific production and reward system which is not at its best at the present time in the world. Health sciences literature has been under the spotlight over the past few years and, as a result, its ability to provide valid, unbiased answers is widely challenged.1 There is growing evidence that suggests that a vast amount of biomedical scientific literature may contain significant bias2 and distortion,3 may not be reproducible,4 and that its methods may have been hijacked to serve vested interests, including financial gain.5 Regrettably, these occurrences have given rise to a growing amount of research waste.6 In this bed of thorns, each of us as academics, researchers, and users are partly to be blamed.

La difusión editorial de la investigación es el reflejo de un sistema de producción y recompensa científica que no pasa por su mejor momento en el mundo. La literatura en ciencias de la salud ha estado en el punto de mira durante los últimos años y, como resultado, su capacidad para proporcionar respuestas válidas e imparciales está ampliamente cuestionada.1 Cada vez hay más pruebas que sugieren que una gran cantidad de literatura científica biomédica puede contener importantes sesgos2 y distorsiones,3 puede no ser reproducible,4 y que sus métodos pueden haber sido secuestrados para servir a intereses creados, incluyendo el beneficio financiero.5 Lamentablemente, estos hechos han dado lugar a una cantidad cada vez mayor de residuos de investigación.6 En este lecho de espinas, cada uno de nosotros, como académicos, investigadores y usuarios, tenemos parte de culpa.