Diagnostic accuracy of the Edinburgh Postnatal Depression Scale: consequences of screening in Mexican women.

INTRODUCTION: Postpartum depression is a non-psychotic depressive episode with serious repercussions on the bond between the mother and her child, hence the importance of detecting it in a timely manner. OBJECTIVE: To determine the accuracy of the Edinburgh Postnatal Depression Scale as a diagnostic test and to analyze the consequences of screening and the probability of depression after applying the test. METHOD: Screening of 411 women with the Edinburgh Postnatal Depression Scale during the postpartum period; Beck's Depression Inventory was used as reference. RESULTS: At a cutoff point of 12, a sensitivity of 70.4 %, specificity of 72.2 %, positive predictive value of 36.9 % and negative predictive value of 91.4 % were obtained with Edinburgh Postnatal Depression Scale, as well as an area under the curve of 0.729 and a p-value of 0.0003. Out of 49 women without treatment for postpartum depression, five were identified to require it. CONCLUSIONS: The Edinburgh Postnatal Depression Scale has moderate accuracy; its application is simple, accessible and should be routine. It is necessary for strategies to detect and treat postpartum depression to be implemented in Mexico.

INTRODUCCIÓN: La depresión posparto es un episodio depresivo no psicótico con repercusiones graves en el vínculo de la madre con su hijo, de ahí la importancia de detectarla oportunamente. OBJETIVO: Determinar la exactitud de la Escala de Depresión Posnatal de Edimburgo como prueba diagnóstica y analizar las consecuencias del tamizaje y la probabilidad de depresión después de aplicar la prueba. MÉTODO: Tamizaje con la Escala de Depresión Posnatal de Edimburgo a 411 mujeres durante el posparto; se utilizó el Inventario de Depresión de Beck como referencia. RESULTADOS: En un punto de corte de 12, con la Escala de Depresión Posnatal de Edimburgo se obtuvo sensibilidad de 70.4 %, especificidad de 72.2 %, valor predictivo positivo de 36.9 % y valor predictivo negativo de 91.4 %, así como un valor del área bajo la curva de 0.729 y p = 0.0003. De 49 mujeres sin atención para depresión posparto, en cinco se identificó que la necesitaban. CONCLUSIONES: La Escala de Depresión Posnatal de Edimburgo tiene una exactitud moderada; su aplicación es sencilla, accesible y debería ser rutinaria. Es necesario que en México se implementen estrategias para detectar y tratar la depresión posparto.

Management of Barrett's esophagus: From screening to newer treatments. / Manejo del esófago de Barrett: del tamizaje a los nuevos tratamientos.

Barrett's esophagus is a premalignant condition of the esophagus in which the squamous epithelium of the lower end of the esophagus is replaced with columnar epithelium. Since the incidence of esophageal adenocarcinoma is on the rise, the major gastroenterology societies have come up with their recommendations for screening and surveillance. Specific factors like obesity, white race, age over 50 years, early age of onset of GERD, smoking and hiatal hernia have been identified as increasing the risk of Barrett's esophagus and adenocarcinoma. The diagnosis requires both endoscopic identification of columnar-lined mucosa and histological confirmation with biopsy. Most medical societies recommend screening people with GERD and other risk factors with endoscopy, but other alternatives employing less invasive methods are currently being studied. Surveillance strategies vary depending on the endoscopic findings and the Seattle biopsy protocol with random 4-quadrant sampling is recommended. Biomarkers have shown promising results, but more studies are needed in the future. White light endoscopy is the standard practice, but other advanced imaging modalities have shown variable results and hence more studies are awaited for further validation. Endoscopic eradication techniques, including both resection and ablation, have shown good but variable results for treating dysplastic lesions confined to the mucosa. Resection procedures to remove visible lesions followed by ablation of the dysplastic mucosa have shown the best results with higher eradication rates and lower recurrence rates. Surgical management is reserved for lesions with sub-mucosal invasion and lymph node spread with increased risk of metastasis.

Comparison between the KARVI scale and the Child Development Evaluation test (EDI) as a screening tool for suspected neurodevelopmental delay.

BACKGROUND: Early detection of suspected neurodevelopmental delay allows for timely diagnosis and appropriate intervention, for which numerous screening tests have been developed. However, most are complex and impractical for health-care workers at the community level. This study aimed to validate the KARVI scale in the neurodevelopment assessment of children under 1 year of age. METHODS: We conducted an observational, longitudinal, comparative, inferential, and prospective study. Healthy children without risk factors for developing neurodevelopmental delay from 0 to 12 months of age were evaluated remotely using the Zoom® application. The Child Development Evaluation Test and the KARVI scale were applied once a month for four consecutive months. RESULTS: Fifty individuals were analyzed, with a predominance of males in 52%. Adequate percentages for a screening test were obtained in the first evaluation with a sensitivity of 70% (confidence interval [CI] 95% 34.75-93.33) and a specificity of 75% (CI 95% 58.8-87.31), and in the fourth evaluation with a sensitivity of 100% (CI 95% 29.4-100) and a specificity of 78.72% (CI 95% 64.34-89.3), being significant in both evaluations (p = 0.007 and p = 0.001, respectively). CONCLUSIONS: The KARVI scale has the elements to be an effective screening test for suspected neurodevelopmental delay, but more extensive studies are needed to obtain more reliable results.

INTRODUCCIÓN: La identificación temprana de retraso en el neurodesarrollo permite un diagnóstico oportuno y una intervención apropiada. Para ello, se han creado diversas pruebas de tamizaje; sin embargo, la mayoría son complejas y poco prácticas para el personal de la salud a nivel comunitario. El objetivo del estudio fue realizar la validación de la escala KARVI en la valoración del neurodesarrollo en niños menores de un año. MÉTODOS: Se realizó un estudio observacional, longitudinal, comparativo inferencial y prospectivo, en el cual se evaluaron, vía remota mediante la aplicación Zoom®, niños sanos de 0 a 12 meses de edad sin factores de riesgo para desarrollar retraso en el neurodesarrollo. Se aplicaron la prueba EDI (Evaluación del Desarrollo Infantil) y la escala KARVI una vez al mes por cuatro meses consecutivos. RESULTADOS: Se analizaron 50 individuos, con predominio del sexo masculino en el 52%. Se obtuvieron porcentajes adecuados para una prueba de tamizaje tanto en la primera evaluación, con sensibilidad de 70% (IC 95% 34.75-93.33) y especificidad de 75% (IC 95% 58.8-87.31), como en la cuarta, con sensibilidad de 100% (IC 95% 29.4-100) y especificidad de 78.72% (IC 95% 64.34-89.3), con significación estadística en ambas evaluaciones (p = 0.007 y p = 0.001, respectivamente). CONCLUSIONES: Se considera que la escala KARVI cuenta con los elementos para considerarla como una prueba de tamizaje efectiva para detectar retraso del neurodesarrollo, sin embargo. Sin requieren estudios más extensos para obtener resultados más confiables.

Colorectal cancer screening program implementation: biennial adherence and participation patterns.

INTRODUCTION AND AIM: Adherence to colorectal cancer (CRC) screening is essential for the effectiveness of screening programs. Even though organized screening programs can improve the quality of the process and adherence, there are still challenges to overcome. The aim of the present study, in which we implemented a biennial organized screening program for CRC, was to describe adherence and participation patterns. MATERIALS AND METHODS: A longitudinal, descriptive study was conducted, in which a team of trained patient navigators carried out interventions, with reminders via cellphone communication, to follow a cohort of 301 subjects eligible for CRC screening, utilizing a fecal immunochemical test (FIT). All the follow-up subjects received a FIT kit. RESULTS: A total of 747 cellphone calls were made and divided into three interventions. From the initial cohort, 126 subjects completed their biennial screening process through the FIT, indicating a consistent adherence rate of 41.8% to our program. The participation patterns were: 126 consistent participants (41.8%), 160 inconsistent participants (53.2%), and 15 participants that were never contacted (5%). CONCLUSIONS: In conclusion, our study underlines the importance of organized screening programs in the early detection of CRC. The implementation of follow-up interventions, through reminders and the training of patient navigators, can improve adherence, but there is a need for examining new strategies, to overcome barriers to communication via cellphone.

Neonatal screening of ABO/RhD blood group and direct antiglobulin Coombs test. Experience of a single institution.

BACKGROUND: Evaluating the ABO/RhD blood group and the direct antiglobulin Coombs test (DAT) at birth is recommended good practice, but there is variability in its universal implementation. This study aims to show the comparative results in various variables of clinical impact during the hospital stay of neonates with positive DAT compared with those with negative DAT, based on the systematic detection of the ABO/RhD group and DAT at birth. METHODS: Newborns between 2017 and 2020 in a high-risk pregnancy care hospital were included. The ABO/RhD and DAT group was determined in umbilical cord samples or the first 24 hours of life. Demographic, maternal, and neonatal variables were recorded. The association between the variables was estimated using the odds ratio (OR). RESULTS: 8721 pairs were included. The DAT was positive in 239 newborns (2.7%), with the variables associated with positive PDC being maternal age > 40 years (OR: 1.5; 95% CI: 1.0 to 2.3), birth by cesarean section (1.4; 1.1-2.0), mother group O (6.4; 3.8-11.8), prematurity (3.6; 2.6-5.0), birth weight < 2500 g (2.1; 1.6-2.8), newborn group A (15.7; 10.7-23.1) and group B (17.6; 11.4-27.2), hemoglobin at birth < 13.5 g/dl (4.5; 2.8-7.1) and reticulocytosis > 9% (1.9; 1.2 to 3.1). DISCUSSION: The frequency of neonatal positive PDC was 2.7%, with a significant association with maternal/neonatal incompatibility to the ABO and RhD group, with a substantial impact on various neonatal variables. These results support the policy of universal implementation at the birth of the ABO/RhD and DAT determination.

INTRODUCCIÓN: La determinación del grupo sanguíneo ABO/RhD y la prueba directa de Coombs (PDC) al nacimiento son una práctica recomendada, pero existe variabilidad en su implementación universal. Se presentan los resultados de la determinación al nacimiento del grupo ABO/RhD y la PDC en una cohorte institucional. MÉTODOS: Se incluyeron los recién nacidos entre 2017 y 2020 en un hospital de atención a embarazos de alto riesgo. Se determinó el grupo ABO/RhD y se realizó la PDC en muestras de cordón umbilical o en las primeras 24 horas de vida. Se registraron las variables demográficas, maternas y neonatales. Se estimó la asociación entre las variables mediante la razón de probabilidad (OR). RESULTADOS: Se incluyeron 8721 binomios. La PDC fue positiva en 239 recién nacidos (2.7%), siendo las variables asociadas a la PDC positiva la edad materna > 40 años (OR: 1.5;IC95%: 1.0-2.3), el nacimiento por vía cesárea (1.4; 1.1-2.0), la madre del grupo O (6.4; 3.8-11.8), la prematuridad (3.6; 2.6-5.0); el peso al nacer < 2500 g (2.1; 1.6-2.8); el neonato del grupo A (15.7; 10.7-23.1) o del grupo B (17.6; 11.4-27.2), la hemoglobina al nacer < 13.5 g/dl (4.5; 2.8-7.1) y la reticulocitosis > 9% (1.9; 1.2 a 3.1). DISCUSIÓN: La frecuencia de PDC positiva neonatal es del 2.7%, con asociación significativa la incompatibilidad materna/neonatal al grupo ABO y RhD, con impacto significativo en diversas variables neonatales. Estos resultados apoyan la política de implementación universal al nacimiento de la determinación de ABO/RhD y PDC.

[Adaptation in Spanish and validation in Mexico of the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP]. / Adaptación en español y validación en México de la herramienta de tamizaje nutricional STAMP (Screening Tool for the Assessment of Malnutrition in Paediatrics).

Introduction: Background: pediatric malnutrition is one of the main causes of complications in hospitalized children. Nutritional screening at admission is essential. The Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) is a simple, reproducible and easy-to-interpret tool, but it is not validated in Mexico. The objective of the study was to validate and adapt the STAMP nutritional screening tool to the Mexican population. Methods: the validation was carried out in two phases: firstly, the translation and cultural adaptation was carried out; and secondly, a cross-sectional study was performed comparing the STAMP tool with a complete nutritional assessment (CNA). A pediatrician specialized in nutrition performed the CNA with the evaluation of anthropometric, clinical and dietary parameters; later, two nutritionists carried out the same evaluation with the STAMP tool. Finally, the patients were graded as low risk and moderate or severe malnutrition risk. Results: of the 300 patients included in the study, 160 were boys (53.3 %) and 140 were girls (46.7 %), with a mean age of 9.44 ± 5.73 years. The assessments made by with the STAMP tool had a 100 % concordance. Compared with CNA, a kappa index of 0.480 (p < 0.01) was obtained. The STAMP test showed a sensitivity of 92 %, a specificity of 75 %, positive predictive value (PPV) of 45 %, negative predictive value (NPV) of 97 %, RVN of 3,68, and RVN of 0,10. Conclusions: the STAMP screening tool has the necessary elements to objectively assess the risk of malnutrition in Mexican children and is a highly sensitive and specific test. test.

Introducción: Antecedentes: la desnutrición pediátrica es una de las principales causas de complicaciones en niños hospitalizados, por ello, el tamizaje nutricional al ingreso es indispensable. La Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) es una herramienta sencilla, reproducible y fácil de interpretar, sin embargo, en México no se encuentra validada. El objetivo del estudio fue validar y adaptar a la población mexicana la herramienta de tamizaje nutricional STAMP. Metodología: la validación se realizó en dos fases: en primer lugar, se realizó la traducción y adaptación cultural; y en segundo lugar, se llevó a cabo un estudio transversal comparando la herramienta STAMP con una evaluación nutricional completa (ENC). Un médico pediatra especialista en nutrición realizó la ENC con la evaluación de parámetros antropométricos, clínicos y dietéticos y, posteriormente, dos nutriólogas realizaron la misma evaluación con la herramienta STAMP. Finalmente, se tamizaron todos los pacientes en leve y moderado o grave riesgo de desnutrición. Resultados: de los 300 pacientes incluidos en el estudio, 160 fueron niños (53,3 %) y 140, niñas (46,7 %), con una media de edad de 9,44 ± 5,73 años. Las valoraciones realizadas con la herramienta STAMP tuvieron una concordancia del 100 %. Comparado con la ENC, se obtuvo un índice kappa de 0,480 (p < 0,01). La prueba STAMP mostró una sensibilidad del 92 %, una especificidad del 75 %, valor predictivo positivo (VPP) del 45 %, valor predictivo negativo (VPN) del 97 %, LR- de 3,68 y LR- de 0,10. Conclusiones: la herramienta de tamizaje STAMP cuenta con los elementos necesarios para evaluar de forma objetiva el riesgo de desnutrición en niños mexicanos y es una prueba altamente sensible y específica.

[Validation of the nutritional screening tool for childhood cancer SCAN. Spanish version]. / Validación de la herramienta de tamizaje nutricional para el cáncer infantil SCAN. Versión en español.

Introduction: Introduction: the prevalence of undernutrition in the pediatric cancer population can vary considerably, an element that significantly influences the clinical outcome of patients. However, this is a potentially modifiable prognostic factor, which requires timely identification of nutritional risk to guide the nutritional care process. Objectives: to evaluate the operational performance of the Spanish version of the nutritional screening tool for childhood cancer (SCAN) in the context of the validation process of this instrument in a high-complexity hospital in the city of Bogotá, Colombia. Methods: the methodological design for the validation of a diagnostic scale was followed. The final sample consisted of 96 patients between 0 and 17 years with cancer and hospitalized at the Children's Cancer Center of the HOMI Foundation in Bogota. The SCAN-SP was applied to each patient and a complete nutritional assessment (CNA) was performed as a gold standard to determine nutritional status. Results: 82.3 % (n = 79) of patients were classified "at risk of malnutrition" by SCAN-SP and 69.8 % (n = 67) of the total sample had undernutrition. The evaluation of the operative performance of SCAN-SP against CNA showed excellent results: sensitivity of 100 %, specificity of 59 %, PPV of 85 %, NPV of 100 %, positive likelihood ratio of 2.4, and negative likelihood ratio of 0. Conclusion: the SCAN-SP scale performs well as a nutritional screening tool in pediatric cancer patients, so its use in clinical practice is recommended.

Introducción: Introducción: la prevalencia de la desnutrición en la población con cáncer infantil puede variar notablemente, elemento que influye de manera significativa en el desenlace clínico de los pacientes. No obstante, este es un factor pronóstico potencialmente modificable y para ello se requiere una identificación del riesgo nutricional oportuna que oriente el proceso de cuidado nutricional. Objetivo: evaluar el rendimiento operativo de la versión en español de la escala de tamización nutricional para el cáncer infantil (SCAN-SP) en el marco del proceso de validación del instrumento en un hospital de alta complejidad en la ciudad de Bogotá, Colombia. Métodos: se siguió el diseño metodológico para la validación de una escala diagnóstica. La muestra final fue de 96 pacientes entre los 0 y 17 años con cáncer y hospitalizados en el Centro de Cáncer Infantil de la Fundación HOMI en Bogotá. A cada paciente se le aplicó la SCAN-SP y también se le realizó una valoración nutricional completa (VNC) tomada como patrón de referencia para conocer su estado nutricional. Resultados: el 82,3 % (n = 79) de los pacientes fueron clasificados como "con riesgo de desnutrición" por la SCAN-SP y el 69,8 % (n = 67) del total de la muestra estaban realmente desnutridos. La evaluación del rendimiento operativo de la SCAN-SP contra la VNC mostro excelentes resultados: sensibilidad del 100 %, especificidad del 59 %, VPP del 85 %, VPN del 100 %, RVP de 2,4 y una RVN de 0. Conclusión: la escala SCAN-SP tiene un buen comportamiento como herramienta de tamización nutricional en el paciente pediátrico con cáncer, por lo que se recomienda su uso en la práctica clínica.

[Validation of the instrument "Infant Malnutrition and Feeding Checklist for Congenital Heart Disease", a tool to identify risk of malnutrition and feeding difficulties in infants with congenital heart disease]. / Validación del instrumento Infant Malnutrition and Feeding Checklist for Congenital Heart Disease, una herramienta para identificar riesgo de desnutrición y dificultades de alimentación en lactantes con cardiopatías congénitas.

Introduction: Introduction: currently, various tools have been designed to timely detect the risk of malnutrition in hospitalized children. In those with a diagnosis of congenital heart disease (CHD), there is only one tool developed in Canada: Infant Malnutrition and Feeding Checklist for Congenital Heart Disease (IMFC:CHD), which was designed in English. Objective: to evaluate the validity and reliability of the Spanish adaptation of the IMFC:CHD tool in infants with CHD. Methods: cross-sectional validation study carried out in two stages. The first, of translation and cross-cultural adaptation of the tool, and the second, of validation of the new translated tool, where evidence of reliability and validity were obtained. Results: in the first stage, the tool was translated and adapted to the Spanish language; for the second stage, 24 infants diagnosed with CHD were included. The concurrent criterion validity between the screening tool and the anthropometric evaluation was evaluated, obtaining a substantial agreement (κ = 0.660, 95 % CI: 0.36-0.95) and for the predictive criterion validity, which was compared with the days of hospital stay, moderate agreement was obtained (κ = 0.489, 95 % CI: 0.1-0.8). The reliability of the tool was evaluated through external consistency, measuring the inter-observer agreement, obtaining a substantial agreement (κ = 0.789, 95 % CI: 0.5-0.9), and the reproducibility of the tool showed an almost perfect agreement (κ = 1, CI 95 %: 0.9-1.0). Conclusions: the IMFC:CHD tool showed adequate validity and reliability, and could be considered as a useful resource for the identification of severe malnutrition.

Introducción: Introducción: actualmente, se han diseñado diversas herramientas para detectar oportunamente el riesgo de desnutrición en niños hospitalizados. En aquellos con diagnóstico de cardiopatías congénitas (CC), solo existe una herramienta desarrollada en Canadá, llamada Infant Malnutrition and Feeding Checklist for Congenital Heart Disease (IMFC:CHD), la cual fue diseñada en idioma inglés. Objetivo: evaluar la validez y confiabilidad de la adaptación en español de la herramienta IMFC:CHD en lactantes con CC. Métodos: estudio transversal de validación realizado en dos etapas: la primera, de traducción y adaptación transcultural de la herramienta; y la segunda, de validación de la nueva herramienta traducida, donde se obtuvieron las evidencias de confiabilidad y validez. Resultados: en la primera etapa se obtuvo la herramienta traducida y adaptada al idioma español; para la segunda etapa se incluyeron 24 lactantes con diagnóstico de CC. Se evaluó la validez de criterio concurrente entre la herramienta de tamizaje y la evaluación antropométrica, obteniéndose un acuerdo sustancial (κ = 0,660, IC 95 %: 0,36-0,95). Para la validez de criterio predictiva, la cual fue comparada con los días de estancia hospitalaria, se obtuvo un acuerdo moderado (κ = 0,489, IC 95 %: 0,1-0,8). La confiabilidad de la herramienta se evaluó mediante consistencia externa, midiendo la concordancia interobservador, y se obtuvo un acuerdo sustancial (κ = 0,789, IC 95 %: 0,5-0,9); la reproducibilidad de la herramienta mostró un acuerdo casi perfecto (κ = 1, IC 95 %: 0,9-1,0). Conclusiones: la herramienta IMFC:CHD mostró una adecuada validez y confiabilidad, por lo que podría considerarse un recurso útil para la identificación de desnutrición grave.

Efforts for detection of aortic aneurysms and human resources training for the optimization of their treatment.

OBJECTIVE: To review admissions, interventions and in-hospital mortality associated to Abdominal Aortic Aneurysms (AAA), and to analyze the impact of the introduction of a training program and imaging screening at our institution. METHODS: Retrospective study where hospitalizations, procedures and mortality secondary to AAA were recorded. The national databases (ND) from the Secretariat of Health were utilized from 2010 to 2020. In-hospital lethality was calculated and compared with the experience at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ). The statistical analysis was completed with the STATA version 17. RESULTS: According to the ND, 899 (91%) hospital admissions secondary to AAA occurred, while in the INCMNSZ 85 (9%). Most of them belonged to the male gender (68%); 811 (82%) patients underwent open surgical repair, and 173 (18%) to an endovascular exclusion (EVAR), the latter approach was significantly more frequently performed at our institution (p = 0.007). The 30-day hospital mortality was 22.5%; in the ND was 23.9 vs. a 16.4% in the INCMNSZ without significant difference (p = 0.1). CONCLUSIONS: AAA remain unrecognized in our country. The introduction of University programs and imaging screening might impact in the early detection, and to reduce the morbidity and mortality associated to emergency procedures.

OBJETIVO: Revisar los ingresos, procedimientos y defunciones intrahospitalarias asociadas a aneurismas aórticos abdominales (AAA) y analizar el impacto de la introducción de programas de formación de recursos humanos y tamizaje ultrasonográfico. MÉTODOS: Estudio retrospectivo, se analizaron las bases de datos nacionales obtenidas del portal datos abiertos de la Dirección General de Información en Salud (DGIS) del año 2010 al 2020. Se calculó la letalidad intrahospitalaria anual y comparamos la experiencia del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ). El análisis estadístico se realizó en el programa STATA versión 17. RESULTADOS: De acuerdo con la base nacional (BN), se registraron 899 (91%) ingresos, mientras que en el INCMNSZ 85 (9%). La mayoría pertenecía al sexo masculino (68%), un total de 811 (82%) pacientes fueron sometidos a cirugía abierta, mientras que 173 (18%) a terapia endovascular (EVAR), siendo este abordaje más frecuente en nuestra institución (p = 0.007). La mortalidad intrahospitalaria fue del 22.5%, en la BN fue del 23.9%, mientras que en el INCMNSZ fue del 16.4%, sin que encontráramos diferencia significativa (p = 0.1). CONCLUSIONES: Los AAA continúan siendo poco reconocidos en nuestro país. La introducción de programas universitarios de especialidad y el tamizaje podría impactar en la reducción de la morbimortalidad.

[Prostate cancer screening with Prostate-Specific Antigen (PSA) to men over 70 years old in an urban health zone, 2018-2020: A cross-sectional study]. / Uso del antígeno prostático específico (PSA) para el cribado de cáncer de próstata en la población de 70 años o más de una zona de salud urbana, 2018-2020. Un estudio transversal.

OBJECTIVES: To describe the epidemiology and estimate the cost of Prostate-Specific Antigen (PSA) screening tests to men ≥ 70 years old in an urban health zone. METHODS: A cross-sectional study was performed. We obtained every PSA test made in the health zone from 2018 to 2020, and classified them retrospectively as screening (PSAc) or not according to pre-established criteria, reviewing electronic health records. Testing rates were calculated by centres and clinical specialities. The standard population was provided by the city register of inhabitants (VM70). Cost estimation was made using our health system's price list. RESULTS: Two thousand and thirty six PSA, of 888 men ≥ 70 years old were obtained, and 350 met screening classification criteria. Six adenocarcinomas were diagnosed from those tests. We estimated 76.07 PSAc/1000 VM70-year from any centre, 1.45 tests for each screened individual, and 15.71% prevalence. The standard population was 1534 men (mean 2018-2020, SD 45.37). Patients who were screened (median age 75, SD 4.04) were younger than those not screened. We estimated a total screening test cost of 9,751 €. CONCLUSIONS: The epidemiology and cost of PSA screening tests to men ≥ 70 years old are reported, both in primary health care and in the hospital. PSA screening tests are common practice amongst professionals attending elderly men in our health zone, mostly in primary care. The screening testing rate of men without prostate cancer is similar to that reported in the literature.

Spanish-language cognitive screening tests: a critical review.

INTRODUCTION: Dementia is a chronic, degenerative disease with a strong impact on families and health systems. The instruments currently in use for measuring cognitive impairment have different psychometric characteristics in terms of application time, cut-off point, reliability, and validity. The objective of this review is to describe the characteristics of the validated, Spanish-language versions of the Mini-Cog, Clock-Drawing Test, and Mini-Mental State Examination scales for cognitive impairment screening. DEVELOPMENT: We performed a three-stage literature search of articles published on Medline since 1953. We selected articles on validated, Spanish-language versions of the scales that included data on reliability, validity, sensitivity, and specificity. CONCLUSIONS: The 3 screening tools assessed in this article provide support for primary care professionals. Timely identification of mild cognitive impairment and dementia is crucial for the prognosis of these patients.

Mapping the availability of translated versions of posttraumatic stress disorder screening questionnaires for adults: A scoping review.

Background: The most used questionnaires for PTSD screening in adults were developed in English. Although many of these questionnaires were translated into other languages, the procedures used to translate them and to evaluate their reliability and validity have not been consistently documented. This comprehensive scoping review aimed to compile the currently available translated and evaluated questionnaires used for PTSD screening, and highlight important gaps in the literature.Objective: This review aimed to map the availability of translated and evaluated screening questionnaires for posttraumatic stress disorder (PTSD) for adults.Methods: All peer-reviewed studies in which a PTSD screening questionnaire for adults was translated, and which reported at least one result of a qualitative and /or quantitative evaluation procedure were included. The literature was searched using Embase, MEDLINE, and APA PsycInfo, citation searches and contributions from study team members. There were no restrictions regarding the target languages of the translations. Data on the translation procedure, the qualitative evaluation, the quantitative evaluation (dimensionality of the questionnaire, reliability, and performance), and open access were extracted.Results: A total of 866 studies were screened, of which 126 were included. Collectively, 128 translations of 12 different questionnaires were found. Out of these, 105 (83.3%) studies used a forward and backward translation procedure, 120 (95.2%) assessed the reliability of the translated questionnaire, 60 (47.6%) the dimensionality, 49 (38.9%) the performance, and 42 (33.3%) used qualitative evaluation procedures. Thirty-four questionnaires (27.0%) were either freely available or accessible on request.Conclusions: The analyses conducted and the description of the methods and results varied substantially, making a quality assessment impractical. Translations into languages spoken in middle- or low-income countries were underrepresented. In addition, only a small proportion of all translated questionnaires were available. Given the need for freely accessible translations, an online repository was developed.HIGHLIGHTS We mapped the availability of translated PTSD screening questionnaires.The quality of the translation and validation processes is very heterogenous.We created a repository for translated, validated PTSD screening questionnaires.

Ophthalmology examination during well-child visits in primary care health centres: Knowledge and difficulties experienced by health workers. / Examen oftalmológico durante el control del niño sano en atención primaria: conocimiento y dificultades de los miembros del equipo de salud.

INTRODUCTION: The red reflex examination (RRE) and visual acuity testing (VA) is a mandatory part of the examination during the well-child visits (WCV) in primary health care centres of the public system of health in Chile. The eye examination is aimed at the early detection of severe eye diseases in children, such as retinoblastoma, congenital cataracts, and amblyopia. The knowledge and difficulties experienced by health workers in primary care health centres for evaluating the red reflex during WCV in Chile is unknown. MATERIAL AND METHODS: A survey was performed in primary community health centres of XXX Santiago de Chile. RESULTS: The WCV were mainly performed by physicians (45.2%) and nurses (35.8%). Only 34% of health workers performed the red reflex test, and 42.3% checked VA during the WCV. The main reasons for not doing it include the lack of direct ophthalmoscopes and VA charts (55.2% and 43.9%, respectively) at their centres, and not having the knowledge or skills (29.3% and 22%, respectively) to properly perform these clinical tests. CONCLUSION: In this series, the eye examination of children attending WCV was unfrequently performed. A better implementation of the health centres and training of the health workers are needed in order to improve the access and quality of the paediatric eye examination in primary health care institutions in Chile.

Comparison between the KARVI scale and the Child Development Evaluation test (EDI) as a screening tool for suspected neurodevelopmental delay / Comparación entre la escala KARVI y la prueba de Evaluación del Desarrollo Infantil (EDI) como tamizaje para la sospecha de retraso en el neurodesarrollo

Abstract Background: Early detection of suspected neurodevelopmental delay allows for timely diagnosis and appropriate intervention, for which numerous screening tests have been developed. However, most are complex and impractical for health-care workers at the community level. This study aimed to validate the KARVI scale in the neurodevelopment assessment of children under 1 year of age. Methods: We conducted an observational, longitudinal, comparative, inferential, and prospective study. Healthy children without risk factors for developing neurodevelopmental delay from 0 to 12 months of age were evaluated remotely using the Zoom® application. The Child Development Evaluation Test and the KARVI scale were applied once a month for four consecutive months. Results: Fifty individuals were analyzed, with a predominance of males in 52%. Adequate percentages for a screening test were obtained in the first evaluation with a sensitivity of 70% (confidence interval [CI] 95% 34.75-93.33) and a specificity of 75% (CI 95% 58.8-87.31), and in the fourth evaluation with a sensitivity of 100% (CI 95% 29.4-100) and a specificity of 78.72% (CI 95% 64.34-89.3), being significant in both evaluations (p = 0.007 and p = 0.001, respectively). Conclusions: The KARVI scale has the elements to be an effective screening test for suspected neurodevelopmental delay, but more extensive studies are needed to obtain more reliable results.

Resumen Introducción: La identificación temprana de retraso en el neurodesarrollo permite un diagnóstico oportuno y una intervención apropiada. Para ello, se han creado diversas pruebas de tamizaje; sin embargo, la mayoría son complejas y poco prácticas para el personal de la salud a nivel comunitario. El objetivo del estudio fue realizar la validación de la escala KARVI en la valoración del neurodesarrollo en niños menores de un año. Métodos: Se realizó un estudio observacional, longitudinal, comparativo inferencial y prospectivo, en el cual se evaluaron, vía remota mediante la aplicación Zoom®, niños sanos de 0 a 12 meses de edad sin factores de riesgo para desarrollar retraso en el neurodesarrollo. Se aplicaron la prueba EDI (Evaluación del Desarrollo Infantil) y la escala KARVI una vez al mes por cuatro meses consecutivos. Resultados: Se analizaron 50 individuos, con predominio del sexo masculino en el 52%. Se obtuvieron porcentajes adecuados para una prueba de tamizaje tanto en la primera evaluación, con sensibilidad de 70% (IC 95% 34.75-93.33) y especificidad de 75% (IC 95% 58.8-87.31), como en la cuarta, con sensibilidad de 100% (IC 95% 29.4-100) y especificidad de 78.72% (IC 95% 64.34-89.3), con significación estadística en ambas evaluaciones (p = 0.007 y p = 0.001, respectivamente). Conclusiones: Se considera que la escala KARVI cuenta con los elementos para considerarla como una prueba de tamizaje efectiva para detectar retraso del neurodesarrollo, sin embargo. Sin requieren estudios más extensos para obtener resultados más confiables.

Depressive symptoms in pregnant women treated at the Hospital Infantil del Estado de Sonora / Sintomatología depresiva en embarazadas atendidas en el Hospital Infantil del Estado de Sonora

Abstract Introduction Pregnancy, being a situation of vulnerability and with its inherent changes, places women at a great risk of depression. In Mexico, the prevalence of probable depression in pregnant women treated at the Instituto Nacional de Perinatología, was 17.8%, assessed using the Edinburgh Perinatal Depression Scale (EPDS). To date, there are no data regarding this issue in Sonora. Objective To determine the prevalence of depressive symptoms in pregnant women treated at the Hospital Infantil del Estado de Sonora (México). Method An observational, descriptive, transversal, and prospective study was conducted in 2021, applying the EPDS in 168 2nd/3rd trimester pregnant women, selected by non-probabilistic sampling by consecutive cases. Sociodemographic variables, pathological/non-pathological, gynecological, and obstetrical personal history were explored. The analysis was performed using measures of central tendency and dispersion for quantitative variables; for qualitative variables, frequency and percentage; χ2 test to assess differences in distribution of depressive symptomatology by age and the rest of variables. Results A global prevalence of "probable depression" of 14.3% was determined. The majority, within 20-29 age group, with a partner and a planned/desired pregnancy. High school educational level, 50%. History of intimate partner violence, 54.2%. Almost 40%, primigravida. Substance use, denied. Overweight/obesity, in 70%. Discussion and conclusion There is a high prevalence of depressive symptoms during pregnancy, going unnoticed for reasons such as insufficient knowledge (patient/health care providers), since there is no routine screening. It is imperative to work on prevention, detection and treatment, since it entails multiple consequences at a binomial, family, and social level.

Resumen Introducción El embarazo, al ser una situación de vulnerabilidad y los cambios que conlleva, ubica a las mujeres en mayor riesgo de padecer depresión. En México, la prevalencia de probable depresión en embarazadas en el Instituto Nacional de Perinatología, fue del 17.8%, mediante la Escala de Depresión Perinatal de Edimburgo (EPDS). Hasta hoy, no se cuenta con datos en Sonora sobre este problema. Objetivo Determinar la prevalencia de sintomatología depresiva en embarazadas atendidas en el Hospital Infantil del Estado de Sonora (México). Método Se realizó un estudio observacional, descriptivo, transversal y prospectivo en 2021, utilizando la EPDS en 168 embarazadas cursando 2o/3er trimestre, seleccionadas por muestreo no probabilístico por casos consecutivos. Se exploraron variables sociodemográficas, antecedentes patológicos/no patológicos y ginecoobstétricos. El análisis se realizó mediante medidas de tendencia central y dispersión para variables cuantitativas; para cualitativas, frecuencia y porcentaje; prueba de χ2 para evaluar diferencias en distribución de sintomatología depresiva por edad y resto de variables. Resultados Se determinó prevalencia global de "probable depresión" de 14.3%. La mayoría, grupo etario 20-29 años, con pareja y embarazo planeado/deseado. Escolaridad preparatoria, 50%. Antecedente de violencia de pareja, 54.2%. Casi 40%, primigestas. Consumo de sustancias, negado. Sobrepeso/obesidad, en 70%. Discusión y conclusión Existe una alta prevalencia de sintomatología depresiva durante el embarazo, pasando desapercibida por motivos como conocimiento insuficiente (paciente y proveedores de salud), pues no se cuenta con un tamizaje rutinario. Es apremiante trabajar en prevención, detección y tratamiento, ya que conlleva múltiples consecuencias a nivel binomio, familiar y social.

Versión argentina de la herramienta de evaluación de la alimentación pediátrica PediEAT / Argentine version of the PediEAT, a pediatric eating assessment tool

Introducción. Durante la infancia, los niños pueden experimentar algún grado de dificultad al comer. Existe una herramienta, desarrollada en Estados Unidos, de evaluación de la alimentación pediátrica (PediEAT), que permite identificar síntomas problemáticos. Objetivo. Realizar una adaptación transcultural para una versión argentina, con adecuación cultural y equivalencia semántica respecto a su versión original. Población y métodos. Se utilizó una versión autoadministrada del PediEAT que fue respondida por familias y/o cuidadores de niños de 6 meses a 7 años. Se realizó una primera fase de evaluación de validez del contenido con un grupo de expertos. Luego, una fase de pretest con familias mediante entrevistas cognitivas para comprobar la comprensión de las palabras y frases. Se realizaron las modificaciones necesarias para que quedara adaptada al contexto. Resultados. En la fase de evaluación de validez del contenido con el grupo de 8 expertos, de los 80 ítems se modificaron 36. En el pretest, se realizaron entrevistas cognitivas a 18 cuidadores; se realizaron cambios en 11 ítems para mejorar la comprensión por parte de la población argentina. La versión argentina fue aprobada por los autores originales. Conclusiones. El instrumento PediEAT versión argentina resulta lingüísticamente equivalente a su versión original, lo que permite su uso para la detección de problemáticas alimentarias en niños.

Introduction. During childhood, children may experience some degree of difficulty eating. A tool (PediEAT) has been developed in the United States and is available to assess pediatric eating and to identify problematic symptoms. Objective. To obtain an Argentine version that is transculturally adapted, culturally adequate, and semantically equivalent to the original version. Population and methods. A self-administered version of the PediEAT was used and completed by families and/or caregivers of children aged 6 months to 7 years. In the first phase, content validity was assessed by a group of experts. This was followed by a pre-test phase with families using cognitive interviews to test word and phrase comprehension. The necessary changes were made to obtain a version adapted to the context. Results. The tool's content validity was assessed by a group of 8 experts; as a result, 36 of the 80 items were changed. During the pre-test phase, cognitive interviews were conducted with 18 caregivers; 11 items were changed to improve comprehension by the Argentine population. The Argentine version was approved by the original authors. Conclusions. The Argentine version of the PediEAT tool is linguistically equivalent to the original version, and this allows its use to screen for feeding problems in children.

Sobreuso de ecografía transvaginal en un hospital universitario privado de Argentina: estudio de corte transversal / Transvaginal ultrasound overuse in a private university hospital in Argentina: a cross-sectional study

Introducción. Si bien contamos con recomendaciones basadas en la evidencia en contra de realizar tamizaje de cáncer ovárico con ecografía transvaginal debido a que aumenta el riesgo de resultados falsamente positivos y de cascadas diagnósticas, sin disminuir la mortalidad por esta enfermedad, su solicitud en mujeres sanas es frecuente. Sin embargo, no conocemos la magnitud de la implementación de esta práctica, que constituye un cuidado de bajo valor. Objetivo. Documentar el sobreuso de ecografías transvaginales realizadas en forma ambulatoria en un hospital universitario privado de Argentina. Métodos. Estudio de corte transversal de una muestra aleatoria de ecografías realizadas en forma ambulatoria durante 2017 y 2018. Mediante revisión manual de las historias clínicas, la solicitud de cada ecografía fue clasificada como apropiada cuando algún problema clínico justificaba su realización, o inapropiada cuando había sido realizada con fines de control de salud o por una condición clínica sin indicación de seguimiento ecográfico. Resultados. De un total de 1.997 ecografías analizadas, realizadas a 1.954 mujeres adultas (edad promedio 50 años),1.345 (67,4 %; intervalo de confianza [IC] 95 % 65,2 a 69,4) habían sido solicitadas en el contexto de un control de saludo sin un problema asociado en la historia clínica y otras 54 (8,3 %; IC 95 % 6,3 a 10,7), por condiciones de salud para las que no hay recomendaciones de realizar seguimiento ecográfico. Conclusiones. Esta investigación documentó una alta proporción de sobre utilización de la ecografías transvaginales en nuestra institución. Futuras investigaciones permitirán comprender los motivos que impulsan esta práctica y ayudarán a diseñar intervenciones para disminuir estos cuidados de bajo valor. (AU)

Background. Although we have evidence-based recommendations against screening for ovarian cancer with transvaginalultrasound because it increases the risk of false positive results and diagnostic cascades without reducing mortality from this disease, its request in healthy women is frequent. However, we do not know the magnitude of the implementation of this practice, which constitutes low-value care. Objective. To document the overuse of transvaginal ultrasounds performed on an outpatient basis in a private university hospital in Argentina. Methods. Cross-sectional study of a random sample of outpatient ultrasounds performed during 2017 and 2018. Through a manual review of the medical records, the request for each ultrasound was classified as appropriate when a clinical problem justified its performance or inappropriate when it was carried out for health control purposes or for a clinical condition that had no indication for ultrasound follow-up. Results. Of a total of 1997 ultrasounds analyzed, performed on 1954 adult women (average age 50 years), 1,345 (67.4 %;95 % confidence interval [CI] 65.2 to 69.4) had been requested in the context of a health check-up or without a documented problem in the medical history that would support its performance, and another 54 (8.3 %; 95 % CI 6.3 to 10.7), for health conditions for which there are no treatment recommendations to perform ultrasound follow-up. Conclusions. This research documented a high proportion of overuse of transvaginal ultrasound in our institution. Future research will allow us to understand the reasons that drive this practice and will help design interventions to reduce thislow-value care. (AU)

Waist-to-height ratio may be an alternative tool to the body mass index for identifying Colombian adolescents with cardiometabolic risk factors.

INTRODUCTION: Background: there is limited information about the usefulness of the waist-to-height ratio (WHtR) to identify Colombian adolescents with cardiometabolic risk factors (CRF). Objective: to compare the utility of WHtR, body mass index (BMI), and waist circumference (WC) to identify adolescents with CRF. Methods: a study with 346 youths (aged 14.0 ± 2.3 years) was performed. Anthropometric measurements were collected and BMI, WC and WHtR were calculated. Fasting blood lipids, glucose and insulin were measured; the homeostasis model assessment of insulin resistance (HOMA-IR) was computed. The presence of multiple non-WC metabolic syndrome (MetS) factors (high HOMA-IR, high triglycerides and low high-density lipoprotein cholesterol [HDL-C]) was analyzed. The area under the curve (AUC) and the odds ratios (OR) were calculated. Results: the BMI, WC and WHtR were comparable at identifying adolescents with high HOMA-IR (AUC = 0.686, 0.694 and 0.641, respectively), low HDL-C (AUC = 0.623, 0.652 and 0.572, respectively) and multiple non-WC MetS factors (AUC = 0.694, 0.715 and 0.688, respectively). The OR of having multiple non-WC MetS factors was similar in overweight adolescents (1.65, 95% CI: 0.86-3.14) and those with WHtR ≥ 0.50 (3.76, 95% CI: 1.95-7.3). There were no OR differences of having multiple non-WC MetS factors among adolescent with obesity (9.88, 95% CI: 3.1-31.7), WC ≥ P90 (18.3, 95% CI: 4.0-83.5) and WHtR ≥ 0.55 (11.0, 95% CI: 3.0-4.4). Conclusions: WHtR, BMI and WC have similar capacities to identify Colombian adolescents with CRF. WHtR showed to be an alternative tool to BMI and WC measurements when screening adolescents for cardiometabolic risk.

INTRODUCCIÓN: Introducción: hay información limitada sobre la utilidad de la relación cintura-estatura (rCE) para identificar adolescentes colombianos con factores de riesgo cadiometabólicos (FRC). Objetivo: comparar la utilidad de la rCE, el índice de masa corporal (IMC) y la circunferencia de cintura (CC) para identificar adolescentes con FRC. Metodología: se evaluaron 346 jóvenes (14,0 ± 2,3 años). Se obtuvieron medidas antropométricas, IMC, CC, rCE, glucosa, insulina y lípidos sanguíneos en ayunas e índice HOMA-IR. Se analizó la presencia de múltiples factores del síndrome metabólico (MetS) diferentes a la CC (HOMA-IR alto, triglicéridos aumentados, concentración del colesterol de alta densidad [HDL-C] baja). Se calculó el área bajo la curva (AUC) y razón de ventajas (OR). Resultados: el IMC, CC y rCE fueron similares para identificar adolescentes con alto HOMA-IR (AUC = 0,686, 0,694 y 0,641, respectivamente), bajo HDL-C (AUC = 0,623, 0,652 y 0,572, respectivamente) y múltiples factores del MetS diferentes a la CC (AUC = 0,694, 0,715 y 0,688, respectivamente). La OR de tener esta última condición fue similar en adolescentes con sobrepeso (1,65, IC 95%: 0,60-3,14) y aquellos con rCE ≥ 0,50 (3,76, IC 95%: 1,95-7,3). La presencia de múltiples factores del MetS diferentes a la CC en adolescentes con obesidad (9,88, IC 95%: 3,1-31,7), CC ≥ P90 (18,3, IC 95%: 4,0-83,5) y rCE ≥ 0,55 (11,0, IC 95%: 3,0 a 4,4) fue similar. Conclusión: rCE, IMC y CC tienen capacidades similares para identificar adolescentes colombianos con FRC. El rCE demostró ser una herramienta alternativa al IMC y la CC cuando se tamizan adolescentes para identificar la presencia de FRC.

Infección congénita por citomegalovirus, hipoacusia y tamizaje neonatal. Una actualización / Congenital cytomegalovirus infection, hearing loss and newborn screening. An update

El citomegalovirus congénito (CMVc) es la infección congénita más común y la principal causa no genética de hipoacusia congénita. Gran parte de los recién nacidos (RN) con CMVc sintomático desarrolla secuelas graves permanentes, donde la hipoacusia es la más frecuente. Sin embargo, el 90% de los casos se presenta en forma asintomática, pudiendo desarrollar secuelas auditivas tardías. El diagnóstico precoz de CMVc requiere un alto índice de sospecha. Actualmente, técnicas eficientes para su detección están disponibles, lo que facilita el diagnóstico en las primeras 3 semanas de vida. La terapia antiviral es la primera línea de tratamiento para el CMVc sintomático, logrando buenos resultados auditivos. A pesar de los avances en los métodos de detección y beneficios del tratamiento, los RN no son tamizados para CMVc. El tamizaje selectivo de CMVc en pacientes que no pasan el screening auditivo facilita la intervención precoz en los casos identificados, pero no permite detectar el número significativo de niños que presenta hipoacusia de aparición tardía. El tamizaje universal permite hacer seguimiento auditivo a los pacientes en riesgo de desarrollar hipoacusia sensorioneural (HSN) por CMVc, identificando así los casos de hipoacusia de aparición tardía, pero la costo-efectividad es aún controversial. Es necesario avanzar en una estrategia local para el tamizaje de CMVc, buscando reducir su impacto a nivel nacional.

Congenital cytomegalovirus (cCMV) is the most common congenital infection and the main non-genetic cause of congenital hearing loss. A significant number of newborns (NB) with symptomatic cCMV will develop permanent serious sequelae, being hearing loss the most frequent. However, 90% of the cases are asymptomatic and may develop late auditory sequelae. Early diagnosis of cCMV requires a high index of suspicion. Currently, efficient detection techniques for its detection are available, which facilitates diagnosis within the first 3 weeks of life. Antiviral therapy is the first line of treatment for symptomatic cCMV, achieving good hearing results. Despite advances in detection methods and the benefits of antiviral therapy, NB are not routinely screened for cCMV. Selective screening for cCMV in patients who fail newborn hearing screening facilitates early intervention in identified cases but fails to detect a significant number of children with late onset hearing loss. Universal screening allows hearing follow up in patients at risk of developing sensorineural hearing loss (SNHL) due to cCMV, thus identifying late-onset hearing loss cases, but cost-effectiveness is still controversial. It is necessary to advance in a local strategy for cCMV screening, aiming to reduce its national impact.

Efectividad de estrategias para incrementar la adherencia al tamizaje de cáncer colorrectal: una revisión sistemática / Effectiveness of strategies to increase adherence to colorectal cancer screening: a systematic review

Resumen Introducción : En Argentina la cobertura al tamizaje de cáncer colorrectal (CCR) es muy baja. El objetivo de esta revisión fue relevar y sintetizar la evidencia sobre la efectividad de estrategias dirigidas a incrementar la adherencia al tamizaje de CCR del personal de salud y población con riesgo promedio. Métodos : Revisión de revisiones sistemáticas (RS) que evaluaron la efectividad de dichas estrategias. Bús queda en bases de datos electrónicas, meta-buscadores, biblioteca Cochrane y búsqueda manual. Aplicación de criterios de elegibilidad e inclusión; con evaluación de la calidad de las RS a través del AMSTAR-II y la certeza de la evidencia por el método GRADE. Síntesis temática sobre la base de la taxonomía de estrategias propuesta por Dougherty (dirigidas al paciente/comunidad; a pro fesionales; otro tipo de estrategias). Resultados : Se identificaron 635 estudios; 36 fueron elegibles y 11 se descartaron por no contar con cali dad suficiente, incluyéndose 10 RS. Se identificó una multiplicidad de estrategias de efectividad variada, la mayoría dirigida a la población. Entre estas, destacan la educación, el auto-test con recolección en lugares específicos y recordatorios. En el caso de profesionales, solo educación y recordatorios mostraron ser efectivas. La combinación de estrategias mostró tener mayor efec tividad que las estrategias aisladas. Conclusiones : Es mayor la evidencia sobre estrategias dirigidas a la población que a profesionales. Las estrate gias combinadas demostraron tener mayor efectividad, lo que destaca la necesidad de explorar, en cada con texto, las barreras en la población y en los profesionales para priorizar y combinar aquellas que demostraron ser efectivas y tendrían mayor impacto.

Abstract Introduction : Coverage for colorectal cancer screening in Argentina is very low. The objective of this review is to assess and synthesize the evidence on the effectiveness of strategies aimed at increasing adherence to colorectal cancer screening among healthcare personnel and the general population at average risk. Methods : A review of systematic reviews (SRs) that evaluated the effectiveness of these strategies was con ducted. Searches were performed in electronic data bases, meta-search engines, the Cochrane Library, and through manual searching. Eligibility and inclusion criteria were applied, with assessment of the quality of the SRs using AMSTAR II and the certainty of evidence using the GRADE approach. Thematic synthesis was con ducted based on the taxonomy of strategies proposed by Dougherty (patient/community-targeted, professional-targeted, and other types of strategies). Results : A total of 635 studies were identified, with 36 deemed eligible and 11 excluded due to insufficient quality, resulting in the inclusion of 10 SRs. A multi plicity of strategies with varying effectiveness were identified, with the majority targeting the population. Among these, education, self-testing with specimen collection at specific locations, and reminders stood out. For professionals, only education and reminders showed effectiveness. Combined strategies demonstrated greater effectiveness than isolated strategies. Conclusions : There is more evidence on strategies targeting the population than professionals. Combined strategies showed greater effectiveness, highlighting the need to explore barriers in both the population and professionals in each specific context in order to priori tize and combine those that have proven effective and would have a greater impact.