An evidence-based framework for identifying technologies of no or low-added value (NLVT).

OBJECTIVE: To synthetize the state of the art of methods for identifying candidate technologies for disinvestment and propose an evidence-based framework for executing this task. METHODS: An interpretative review was conducted. A systematic literature search was performed to identify secondary or tertiary research related to disinvestment initiatives and/or any type of research that specifically described one or more methods for identifying potential candidates technologies, services, or practices for disinvestment. An iterative and critical analysis of the methods described alongside the disinvestment initiatives was performed. RESULTS: Seventeen systematic reviews on disinvestment or related terms (health technology reassessment or medical reversal) were retrieved and methods of 45 disinvestment initiatives were compared. On the basis of this evidence, we proposed a new framework for identifying these technologies based on the wide definition of evidence provided by Lomas et al. The framework comprises seven basic approaches, eleven triggers and thirteen methods for applying these triggers, which were grouped in embedded and ad hoc methods. CONCLUSIONS: Although identification methods have been described in the literature and tested in different contexts, the proliferation of terms and concepts used to describe this process creates considerable confusion. The proposed framework is a rigorous and flexible tool that could guide the implementation of strategies for identifying potential candidates for disinvestment.

[Health working conditions and environment: conceptual model for remote and rural areas]. / Condiciones y medio ambiente de trabajo en salud: modelo conceptual para áreas remotas y rurales.

This report proposes a conceptual model on workplace environment and working conditions that integrates the available evidence to facilitate the design and evaluation of interventions aimed at improving the attraction, recruitment and retention of health personnel at the first level of care in rural and remote areas. Theoretical, empirical and testimonial evidence was consulted to support the model, and 15 frameworks disseminated in the last 20 years were synthesized. The article shows the diversity of perspectives and the complexity involved in establishing the dimensions to be considered in a proposal that is useful to apply to human resources for health policies.The proposed model includes four categories of components: factors of the external context, organizational factors, employment and work conditions, and individual factors. The boundaries between the components -as well as the weight and influence of each one- vary according to the interrelationship among them and the interaction with the environment, and thus its interpretation must be adapted to the context in which it is intended to be applied.Based on this conceptual model, the design and evaluation of interventions aimed at increasing the availability of health personnel -particularly at the primary care level in rural and remote areas of the Region of the Americas- should emerge from an interaction between health and employment policies, and the realities and expectations of workers and the communities.

[Factors and interventions that affect working conditions and environment to increase the attraction, recruitment and retention of human resources for health at the primary care level in rural, remote or underserved areas]. / Factores e intervenciones que inciden en las condiciones y medio ambiente de trabajo para incrementar la atracción, captación y retención de recursos humanos en salud en el primer nivel de atención de áreas rurales, remotas o desatendidas.

OBJECTIVE: To identify and systematize available empirical evidence on factors and interventions that affect working conditions and environment in order to increase the attraction, recruitment and retention of human resources for health at the primary care level in rural, remote or underserved areas. METHODS: Rapid review of reviews selected according to relevance, eligibility and inclusion criteria. The search was conducted on electronic and manual databases, including grey literature. AMSTAR I was used to assess the quality of systematic reviews and a thematic analysis for synthesis of the results. RESULTS: Sixteen reviews were included, one of which contained 14 reviews. Of the total, 20 reviews analyzed factors and 9 evaluated the effectiveness of interventions. The evidence on factors is abundant, but of limited quality. Individual, family and "previous exposure to a rural setting" factors were associated with higher recruitment; organizational and external context factors were important for human resource retention. Networking and professional support influenced recruitment and retention. Evidence on the effectiveness of interventions was limited, both in quantity and quality. The most frequently used intervention was incentives. CONCLUSIONS: Evidence on factors that are positively related to recruitment and retention of workers at the first level of care in rural, remote or underserved areas is sufficient and should be taken into account when designing interventions. Quality evidence on the effectiveness of interventions is scarce. More controlled studies with methodological rigor are needed, particularly in the Americas.

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

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 conducted. Searches were performed in electronic databases, 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 conducted based on the taxonomy of strategies proposed by Dougherty (patient/community-targeted, professionaltargeted, 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 multiplicity 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 prioritize and combine those that have proven effective and would have a greater impact.

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. Búsqueda 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 profesionales; otro tipo de estrategias). Resultados: Se identificaron 635 estudios; 36 fueron elegibles y 11 se descartaron por no contar con calidad 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 efectividad que las estrategias aisladas. Conclusiones: Es mayor la evidencia sobre estrategias dirigidas a la población que a profesionales. Las estrategias combinadas demostraron tener mayor efectividad, lo que destaca la necesidad de explorar, en cada contexto, las barreras en la población y en los profesionales para priorizar y combinar aquellas que demostraron ser efectivas y tendrían mayor impacto.

[Barriers and facilitators of colorectal cancer screening access]. / Barreras y facilitadores del acceso al tamizaje de cáncer colorrectal.

INTRODUCTION: Colorectal cancer (CRC) is a global health problem. In the public sector of Bahía Blanca, CRC screening is opportunistic, through the request of fecal occult blood test (FOBT). The objective of this study is to describe access to CRC screening for the population with exclusive public coverage residing in the programmatic area 2 of the city between 2019 and 2021, and to identify the barriers and facilitators that determine it. METHODS: The annual and cumulative usage rate was estimated based on the number of patients who requested FOBT. The barriers and facilitators were studied through 41 semi-structured individual interviews to healthcare staff from the area, the Municipal Hospital, Health Secretariat and users/non-users of the system. RESULTS: The cumulative usage rate of FOBT during the period was less than 5%. Among the perceived barriers to screening, we found: the difficulties in accessing more complex studies for patients with positive FOBT, the lack of population awareness and perception of CRC as a health problem, the low adherence of professionals to guidelines. The territoriality and link of health centers with the population, as well as the willingness of users and professionals to incorporate screening, emerge as facilitators. CONCLUSION: The identification of barriers and facilitators will allow the design of context-adapted strategies that will strengthen screening in the future.

Introducción: El cáncer colorrectal (CCR) es un problema de salud a nivel global. En el sector público de Bahía Blanca, el tamizaje de CCR es oportunista, por solicitud de sangre oculta en materia fecal (SOMF). El objetivo de este trabajo es describir el acceso al tamizaje de CCR de la población con cobertura pública exclusiva que reside en el área programática 2 de la ciudad entre 2019 y 2021, y relevar las barreras y facilitadores que lo determinan. Métodos: Se estimó la tasa de uso anual y acumulada de SOMF. Las barreras y facilitadores se relevaron a través de 41 entrevistas individuales semi-estructuradas al personal de salud del área programática, el Hospital Municipal, Secretaría de Salud y usuarios/no usuarios del sistema. Resultados: La tasa acumulada de uso de SOMF en el período fue 4.8%. Entre las barreras al tamizaje percibidas se destacan: la dificultad en el acceso a estudios de mayor complejidad para pacientes con SOMF+, el desconocimiento y falta de percepción del CCR como un problema de salud por parte de la población y la baja adherencia de los profesionales a los lineamientos. La territorialidad y el vínculo de los centros de salud con la población, y la predisposición de usuarios y profesionales a incorporar el tamizaje surgen como facilitadores del mismo. Conclusiones: El relevamiento de las barreras orientará el diseño de estrategias adaptadas al contexto que permitan en el futuro reforzar el tamizaje.

Applying systems thinking to identify enablers and challenges to scale-up interventions for hypertension and diabetes in low-income and middle-income countries: protocol for a longitudinal mixed-methods study.

INTRODUCTION: There is an urgent need to reduce the burden of non-communicable diseases (NCDs), particularly in low-and middle-income countries, where the greatest burden lies. Yet, there is little research concerning the specific issues involved in scaling up NCD interventions targeting low-resource settings. We propose to examine this gap in up to 27 collaborative projects, which were funded by the Global Alliance for Chronic Diseases (GACD) 2019 Scale Up Call, reflecting a total funding investment of approximately US$50 million. These projects represent diverse countries, contexts and adopt varied approaches and study designs to scale-up complex, evidence-based interventions to improve hypertension and diabetes outcomes. A systematic inquiry of these projects will provide necessary scientific insights into the enablers and challenges in the scale up of complex NCD interventions. METHODS AND ANALYSIS: We will apply systems thinking (a holistic approach to analyse the inter-relationship between constituent parts of scaleup interventions and the context in which the interventions are implemented) and adopt a longitudinal mixed-methods study design to explore the planning and early implementation phases of scale up projects. Data will be gathered at three time periods, namely, at planning (TP), initiation of implementation (T0) and 1-year postinitiation (T1). We will extract project-related data from secondary documents at TP and conduct multistakeholder qualitative interviews to gather data at T0 and T1. We will undertake descriptive statistical analysis of TP data and analyse T0 and T1 data using inductive thematic coding. The data extraction tool and interview guides were developed based on a literature review of scale-up frameworks. ETHICS AND DISSEMINATION: The current protocol was approved by the Monash University Human Research Ethics Committee (HREC number 23482). Informed consent will be obtained from all participants. The study findings will be disseminated through peer-reviewed publications and more broadly through the GACD network.

Percepción de los niños y niñas del clima escolar según la dinámica de los roles que adoptan en situaciones de intimidación a lo largo del ciclo lectivo / Children's perception of the school climate according to the dynamics of the roles they adopt in bullying situation throughout the school cycle

Un clima escolar (CE) percibido negativamente facilita la ocurrencia y el sostenimiento de las situaciones de intimidación escolar (IE). No hay evidencia sobre cómo varía la percepción del mismo según la participación del alumno en dichas situaciones en el ámbito escolar a lo largo de un ciclo lectivo. El objetivo fue comparar la variación de la percepción del CE en los alumnos según el dinamismo de su participación en situaciones de intimidación. Fue un estudio descriptivo realizado en 2015 en niños/as de 8-12 años de edad de escuelas primarias de Bahía Blanca. Se utilizaron los cuestionarios PRECONCIMEI (versión niños) y ECLIS. Variables estudiadas: tipo de participación en IE, participación en IE, dinamismo de la participación en IE, percepción del CE. Se realizó test de ANOVA, prueba de Kruskal-Wallis y de la mediana. La media de las diferencias para la percepción del CE global entre los participantes fue de -3.91 (IC 95% -8,02; 0,21). La diferencia de clima global no difirió significativamente entre categorías de dinamismo (P=0,38). Se observó un empeoramiento del CE en las categorías de dinamismo de participación en IE respecto a la de los niños no participantes, quienes no experimentaron cambios en su percepción del CE a lo largo del ciclo lectivo. No se detectaron diferencias estadísticamente significativas en el análisis global y por dimensiones de la variación de CE entre ambas tomas.

A negatively perceived school climate (CE) facilitates the occurrence and maintenance of situations of school bullying (IE). There is no evidence on how the perception of it varies according to the participation of the student in said situations in the school environment throughout a school year. The objective was to compare the variation of the perception of the CE in the students according to the dynamism of their participation in bullying situations. It was a descriptive study carried out in 2015 in children aged 8-12 from primary schools in Bahía Blanca. The PRECONCIMEI (children's version) and ECLIS questionnaires were used. Variables studied: type of participation in EI, participation in EI, dynamism of participation in EI, perception of CE. ANOVA test and Kruskal-Wallis test were performed. The mean of the differences for the perception of the global CE between the participants was -3.91 (95% CI -8.02; 0.21). The global climate difference did not differ significantly between dynamism categories (P=0.38). A worsening of the CE was observed in the categories of dynamism of participation in IE with respect to that of the non-participating children, who did not experience changes in their perception of the CE throughout the school year. No statistically significant differences were detected in the overall analysis and by dimensions of the CE variation between the two intakes.

Vigilancia epidemiológica de COVID-19 mediante testeos agrupados focalizada en trabajadores de salud asintomáticos en Bahía Blanca / Epidemiological surveillance of COVID-19 through group testing focused on asymptomatic health workers in Bahía Blanca

INTRODUCCIÓN: Uno de los desafíos más relevantes al comienzo de la pandemia consistió en implementar estrategias dirigidas a prevenir la transmisión del virus SARS-CoV-2 y mitigar el impacto de la COVID-19. El propósito de este estudio fue contribuir a reducir la transmisión comunitaria a través de una iniciativa interinstitucional, cuyos objetivos fueron validar un método de detección de ARN del SARS-CoV-2 e implementar y evaluar la vigilancia en trabajadores de salud asintomáticos de instituciones de salud pública de Bahía Blanca. MÉTODOS: Se validó una prueba de detección del gen E del coronavirus mediante RT-PCR a partir de ARN aislado de hisopados nasofaríngeos. Para aumentar la capacidad de testeo se validó la detección del ARN viral en muestras agrupadas (pooles). Se realizó un estudio de cohorte prospectiva entre el 15/09/20 y el 15/09/21. RESULTADOS: La sensibilidad y especificidad de la prueba en muestras individuales fue del 95% (IC 95%: 85%-100%). La sensibilidad de la detección en pooles fue del 73% (IC 95%: 46%-99%) y la especificidad, del 100%. A lo largo de la vigilancia se incluyeron 855 trabajadores y 1764 hisopados, con una incidencia acumulada anual de 2,3% (IC 95%: 1,2%-3,4%). Se detectaron 20 casos asintomáticos positivos. DISCUSIÓN: El tamizaje de trabajadores de salud asintomáticos en la pandemia contribuyó a reducir el riesgo de brotes hospitalarios. Asimismo, se generó un marco de trabajo interdisciplinario aplicable a otros problemas de salud.

COVID-19 epidemiological surveillance through pool testing focused on asymptomatic healthcare workers in the city of Bahía Blanca / Vigilancia epidemiológica de covid-19 mediante testeos agrupados focalizada en trabajadores de salud asintomáticos en bahía blanca

RESUMEN INTRODUCCIÓN: Uno de los desafíos más relevantes al comienzo de la pandemia consistió en implementar estrategias dirigidas a prevenir la transmisión del virus SARS-CoV-2 y mitigar el impacto de la COVID-19. El propósito de este estudio fue contribuir a reducir la transmisión comunitaria a través de una iniciativa interinstitucional, cuyos objetivos fueron validar un método de detección de ARN del SARS-CoV-2 e implementar y evaluar la vigilancia en trabajadores de salud asintomáticos de instituciones de salud pública de Bahía Blanca. MÉTODOS: Se validó una prueba de detección del gen E del coronavirus mediante RT-PCR a partir de ARN aislado de hisopados nasofaríngeos. Para aumentar la capacidad de testeo se validó la detección del ARN viral en muestras agrupadas (pooles). Se realizó un estudio de cohorte prospectiva entre el 15/09/20 y el 15/09/21. RESULTADOS: La sensibilidad y especificidad de la prueba en muestras individuales fue del 95% (IC 95%: 85%-100%). La sensibilidad de la detección en pooles fue del 73% (IC 95%: 46%-99%) y la especificidad, del 100%. A lo largo de la vigilancia se incluyeron 855 trabajadores y 1764 hisopados, con una incidencia acumulada anual de 2,3% (IC 95%: 1,2%-3,4%). Se detectaron 20 casos asintomáticos positivos. DISCUSIÓN: El tamizaje de trabajadores de salud asintomáticos en la pandemia contribuyó a reducir el riesgo de brotes hospitalarios. Asimismo, se generó un marco de trabajo interdisciplinario aplicable a otros problemas de salud.

ABSTRACT INTRODUCTION: One of the most important challenges at the beginning of the pandemic was to implement strategies to prevent SARS-CoV-2 virus transmission and reduce the impact of COVID-19. The purpose of this study was to contribute to the reduction of community transmission through an interinstitutional initiative, aimed at validating a SARS-CoV-2 RNA detection method, and at implementing and assessing the surveillance of asymptomatic infected healthcare workers (HCWs) at public health institutions in the city of Bahía Blanca. METHODS: To validate a coronavirus RNA detection method, RNA was extracted from nasopharyngeal swabs and identification of the viral E gene was done by RT-PCR. Validation of sample pooling was performed to increase the testing capacity. A prospective cohort study was conducted from 15 September 2020 to 15 September 2021. RESULTS: The sensitivity and specificity of the test in individual samples was 95% (CI 95%: 85%-100%). The sensitivity of the pooling strategy was 73% (CI 95%: 46%-99%) and the specificity was 100%. A total of the 855 HCWs were included in the surveillance and 1764 swabs were performed, with an annual cumulative incidence of 2.3% (CI 95%: 1,2%-3,4%), and 20 positive asymptomatic cases were detected. DISCUSSION: The screening of asymptomatic HCWs during the pandemic contributed to reduce the risk of outbreaks in hospital settings. Moreover, an interdisciplinary team framework applicable to other health problems was generated.

Health-related quality of life in children with and without chronic conditions: A multicenter study.

INTRODUCTION: Chronic conditions (CCs) in the early stages of life may have an impact on various dimensions of health-related quality of life (HRQoL) in children. OBJECTIVE: To compare HRQoL in children with confirmed CCs, reported CCs, and without CC. POPULATION AND METHOD: Cross-sectional study conducted in 2012 in the context of a larger research study carried out at schools in Córdoba and Bahía Blanca, and at Hospital Italiano of Buenos Aires and Hospital Prof. Dr. Juan P. Garrahan at Buenos Aires. The presence of a chronic condition was established by medical diagnosis at the hospital or as reported by schoolchildren's caregivers. Eight-to-twelve year-old children completed the KIDSCREEN-52 questionnaire on HRQoL, a pubertal development scale, and a family financial resource scale. The association between CCs and HRQoL adjusted by sex, age, pubertal development, maternal education level, and socioeconomic level was estimated. RESULTS: Six hundred and seventy children/ caregiver dyads participated; 13.3% (n= 89) had confirmed CCs, 14.5% (n= 97) were schoolchildren with reported CCs, and the rest corresponded to healthy schoolchildren. Their average age was 10.2 years old (standard deviation= 1.01); 54.8% were girls. Having a confirmed CC was associated with a higher frequency of low physical wellbeing (odds ratio |-OR-|: 2.61; 95% confidence interval |-95% CI-|:1.43-4.76), while the presence of a reported CC was associated with a low score in psychological well-being (OR: 1.96; 95% CI: 1.06-3.63), self-perception (OR: 2.22; 95% CI: 1.28-3.87), and parent relations (OR: 2.04; 95% CI: 1.21-3.44). CONCLUSIONS: Children with confirmed CCs showed a higher frequency of physical discomfort, and those with reported CCs showed discomfort in psychosocial areas compared to children without CCs.

El cáncer como prioridad en la agenda sanitaria / Cancer as a priority on the health agenda

El cáncer concentra el 20% del total de defunciones en el país y representa la segunda causa de muerte. El objetivo de esta investigación operativa fue elaborar un análisis de situación con propuestas de mejora para incorporar al cáncer en la agenda política de los candidatos presidenciales. El estudio incluyó técnicas cualicuantitativas, el uso del Monitoreo de Resultados para un Sistema de Equidad (MoRES, "Monitoring Results for Equity System") para identificar brechas en relación a derechos vulnerados, mapeo de actores, uso de herramientas analíticas epidemiológicas y comunicacionales. Los resultados mostraron dos ejes programáticos para acercar propuestas a los distintos espacios políticos: incremento y optimización del financiamiento y la gestión de la enfermedad, por un lado, y, por el otro, incremento y optimización del financiamiento de los registros oncológicos a nivel provincial que permita mejorar la calidad de los datos. Todos tenemos responsabilidades sobre el monitoreo de las acciones y la implementación de la agenda de salud. Con la información disponible, Argentina está en condiciones de avanzar sobre la reducción en brechas de inequidades, pero hace falta que los portadores de derechos y de obligaciones se movilicen con visión y agenda compartida, un gran desafío que no es imposible de alcanzar. (AU)

Cancer represents the second cause of death, concentrating approximately 20% of the total deaths. The objective of this operational investigation was to elaborate a situation analysis with proposals for improvement to place cancer on the political agenda of presidential candidates. The study included qualitative and quantitative techniques, the use of MoRES ("Monitoring Results for Equity System") to identify inequality gaps in relation to violated rights, stakeholder mapping, the use of epidemiological and communicational analytical tools. The results of two programmatic axes to bring proposals to the different political spaces: improvements in financing and disease management, on the one hand, and, on the other, better financing and management of cancer registries at the provincial level that allowsimproving the quality of the data. We all have responsibilities on health agenda. With the available information, Argentina is in a position to move forward on the reduction of inequity and inequality gaps. An informed society, committed to health and aware of where priorities are, can contribute more and better to the formulation of a based rights health agenda. (AU)

Reliability and validity of the KIDSCREEN-52 questionnaire to measure health related quality of life in the 8 to 18 year-old Argentinean population.

INTRODUCTION: The KIDSCREEN questionnaire is an instrument to measure health-related quality of life (HRQoL). It allows to differentiate health levels or to assess the efficacy of interventions. The objective was to evaluate the reliability and validity of the Argentine version of the questionnaire in the population aged 8-18 years-old in the city of Bahía Blanca. POPULATION AND METHODS: Cross sectional study conducted in public and private schools in 2008 using a district-stratified sampling. The questionnaire was self-administered and included the KIDSCREEN questionnaire (52 items) and questions about age, gender and family socioeconomic level (SEL). Reliability was analyzed using standard psychometric analysis techniques and the item response theory. The analysis of the factorial structure was performed using a confirmatory factor analysis (CFA), and that of the construct validity was conducted comparing dimension mean scores by age, gender and SEL. RESULTS: Most dimensions had a Cronbach's alpha of >0.7 and 80% of items, and sufficient infit or outfit values (<0.8). The CFA showed an adequate data adjustment to the ten-dimension structure. The mean values of the dimensions confirmed lower scores in adolescents than in children, and lower scores in females than in males, as expected in several of the HRQoL dimensions. CONCLUSIONS: The reliability and validity of the Argentinean version of the KIDSCREEN-52 questionnaire were acceptable; therefore its use can be recommended for the 8-18 year-old Argentinean population.

Factibilidad de implementar una intervención compleja para prevenir la intimidación entre pares en el ámbito escolar / Feasibility of Implementing a Complex Intervention to Prevent Bullying at School

INTRODUCCIÓN: La intimidación entre estudiantes es un fenómeno que preocupa por su frecuencia y gravedad. OBJETIVOS: Diseñar y evaluar la factibilidad de una intervención compleja dirigida a reducir las situaciones de intimidación entre pares. MÉTODOS: Se realizó un estudio de factibilidad de diseño antes-después con control histórico en 2012 en 5 escuelas de gestión estatal de Bahía Blanca. Se evaluó aceptabilidad, fidelidad de implementación y eficacia limitada (variación de la frecuencia de intimidación y de la calidad de vida relacionada a la salud [CVRS] en niños/as de 8 a 12 años, al inicio y final del ciclo lectivo 2014). RESULTADOS: Se diseñó una intervención compleja, que combinó evidencia teórica, empírica y experiencial. De 35 docentes, 70% consideró que la intervención era aplicable en su escuela; 75% que mejoraba la convivencia y 90% que la implementaría en un futuro. En 2014, el 50% de los 534 niños/as refirió no participar (NP) en situaciones de intimidación a lo largo del año, el 40% participó esporádicamente (16% al inicio [PI] y 25% al final [PF]) y un 9% participó en forma sostenida al inicio y al final del año (PS). En 2012, estos porcentajes habían sido de 55% (NP), 22% (PI), 10% (PF) y 13% (PS). La CVRS no presentó variaciones en 2014, a diferencia de 2012, que mostró mejores puntuaciones a fin de año. CONCLUSIONES: La intervención compleja fue factible de implementar. Se observaron efectos positivos en resultados intermedios.

INTRODUCTION: Bullying among students is a worrying phenomenon due to its frequency and severity. OBJECTIVES: To design and assess the feasibility of implementing a complex intervention aimed at reducing bullying situations. METHODS: A feasibility quasiexperimental before-and-after study with a historical control (year 2012) was conducted at five public schools in Bahía Blanca city. The acceptability, fidelity and limited efficacy were assessed (variation of the frequency of bullying and health related quality of life [HRQL] applied in 8-12 years-old children, at the beginning and end of 2014 school year). RESULTS: A complex intervention was designed, which combined theoretical, empirical and experiential evidence. Among the 35 teachers who responded the acceptability questionnaire, 70% referred that the intervention was applicable in their schools, 75% that it improved coexistence among children and 90% that they would implement it in the future. In 2014, 50% of the 534 included children referred that they did not participate in bullying situations through the school year (NP), 40% referred sporadic participation (16% at the beginning [PB] and 25% at the end [PE]) and 9% participated at the beginning and end of the year (PS). In 2012, the corresponding percentages were 55% (NP), 22% (PB), 10% (PE) and 13% (PS). HRQL showed no variation in 2014, while in 2012 it showed an improvement through the year. CONCLUSIONS: The complex intervention was feasible to apply and showed positive effects on intermediate results.

Intimidación entre niños y niñas de una escuela pública de la ciudad de Bahía Blanca y su relación con el rendimiento académico / Bullying among boys and girls in a public school in the city of Bahía Blanca and its correlation with academic performance

Introducción: La intimidación entre pares en el ámbito escolar tiene consecuencias inmediatas y a largo plazo, afectando la calidad de vida relacionada a la salud de los niños. El objetivo del presente trabajo fue analizar la asociación entre la participación del niño/a en situaciones de intimidación y su rendimiento académico a fin del ciclo lectivo. Materiales y Métodos: estudio de cohorte retrospectivo que incluyó a niños/as de entre 8-12 años de una escuela estatal de Bahía Blanca. Se describieron los perfiles de intimidación a través del cuestionario PRECONCIMEI y se obtuvieron los promedios de fin de año de las materias lengua, matemática y educación física. Resultados: Se obtuvo una muestra final de 95 niños/as. Cualitativamente, el rendimiento académico fue similar en ambos grupos: educación física fue la asignatura con mayor promedio en ambos grupos (expuesto y no expuesto); matemática se ubica en segundo lugar y lengua es la de menor promedio. Empero, los niños/as que refieren participar en situaciones de intimidación presentan un rendimiento más bajo que aquellos que no participan. Los niños/as con un perfil agresor presentaron los promedios más bajos, en comparación al resto de los perfiles (victima, victima-agresor, no participa). Estas diferencias fueron más importantes en las materias Lenguaje y Matemática. En el caso de Educación Física, si bien los promedios fueron menores, la diferencia no alcanzó significación estadística. Conclusiones: Este estudio permitió corroborar la asociación entre intimidación y rendimiento escolar. Estos hallazgos ponderan la importancia de las intervenciones escolares oportunas.

Introduction: Bullying at schools has immediate and long-term consequences, affecting health-related quality of life among children. This study aims at analyzing the association between participation in bullying situations and academic performance at the end of the school year. Materials and Methods: A retrospective cohort study of children aged 8-12 from a public school in Bahía Blanca was carried out. Bullying profiles were described using the PRECONCIMEI Questionnaire and the final qualifications obtained in Mathematics, Spanish and Physical Education. Results: A final sample of 95 children (boys and girls) was obtained. Qualitatively, academic performance was similar in both groups: Physical Education was the subject with the highest average in both groups (exposed and unexposed); Mathematics was located in the second place and Spanish obtained the lowest average. Nevertheless, children who referred to have been involved in bullying situations had a lower academic performance than those who referred not to have been involved. Those who were identified as aggressors had the lowest averages, compared to the rest of the profiles (victim, victim-aggressor, and non-participant). These differences were more important in "Spanish" and "Mathematics". In the case of Physical Education, although averages were lower, the difference was not statistically significant. Conclusions: This study confirmed the association between bullying and academic performance. These findings confirm the importance of timely school interventions.

[Alcohol versus bath and natural drying for term newborns' umbilical cord care: a prospective randomized clinical trial]. / Higiene del cordón umbilical con alcohol comparado con secado natural y baño antes de su caída, en recién nacidos de término: ensayo clínico controlado aleatorizado.

BACKGROUND: Umbilical cord (UC) care is a cause of concern for parents right from birth until its separation. Standard practice in Argentina includes frequent cleansing of the UC with alcohol and body bath only two days after its separation. The effect of different methods of UC care on its separation time and on colonization with microorganisms has been insufficiently explored. OBJECTIVES: Main: To compare the effect on time of UC separation when using body bath with neutral soap followed by natural drying of the UC vs. standard care. Secondary: a) colonization rates during hospitalization; b) incidence of skin infection and conjunctivitis and c) parental comfort with both types of care. POPULATION: Normal term newborns (≥37 weeks), born at the HPS, and whose parents provided informed consent. METHODS: Open prospective controlled clinical trial, with random allocation to two groups: study group -natural drying of the UC and body bath with neutral soap- and control group -UC hygiene with alcohol 70% at each diaper change until its separation and bath two days later-. UC separation time; UC colonization during hospital stay and skin and conjunctive infections in the first 30 days of life were monitored. Analysis was by intention-to-treat. RESULTS: 362 newborns were included, 181 in each group. The groups were well balanced in baseline characteristics. Being in the study group was associated with a shorter time to UC separation (median [interquartile range]= 6.00 [3] vs. 7.00 [4] days; p <0.001) and an increased frequency in nosocomial UC colonization (adjusted OR= 1.92 [1.22- 3.12], p= 0.007). No difference in the rate of infections was observed between both groups. Parental comfort was high and similar in both groups. CONCLUSIONS: Compared to standard practice in Argentina, body bath with neutral soap and natural drying of the UC reduced the time to cord separation. This practice increased the colonization rate, but the risk of skin and conjunctive infections was apparently not modified by it. However, the study has insufficient power for secondary outcomes. Health care providers should continue to develop evidence to support or eliminate historical practices.

La fuerza de tareas de Estados Unidos recomienda el rastreo de cáncer de pulmón por medio de la tomografía axial computada: ¿es suficiente la evidencia para apoyar su adopción en el contexto sanitario de nuestro país? / The Task Force recommends the US Lung cancer screening using computed tomography: is it sufficient evidence to support its adoption in healthcare context of our country?

A fines del 2013, la Fuerza de Tareas de Servicios Preventivos de Estados Unidos (USPSTF) recomendó el rastreo anual para el cáncer de pulmón con tomografía computarizada de baja dosis (TCBD). Dada la ausencia de guías nacionales sobre esta práctica, existe incertidumbre sobre si debe adoptarse o no esta r recomendación. El presente estudio tuvo como objetivo evaluar la calidad y exhaustividad del cuerpo de evidencia que sustenta esta recomendación a través de métodos rigurosos. La calidad de la guía y la revisión sistemática sobre la que se sustenta la recomendación de uso del rastreo difundida por la USPSTF es de calidad intermedia. Se identificaron otras revisiones sistemáticas no incluidas en esta guía, cuyos resultados no son tan contundentes respecto al balance de riesgos y beneficios de esta práctica. La adopción de una práctica como política o programa en nuestro país, mas aun cuando es de relativo alto costo, y no está exenta de efectos adversos, requiere una evaluación rigurosa, exhaustiva y, por sobre todo, participativa. Los resultados que se presentan buscan aportar elementos para el debate, al que deben sumarse entidades gubernamentales, sociedades científicas, aseguradores y otros grupos de interés, incluyendo las voces de los propios pacientes. PALABRAS CLAVE: Neoplasias Pulmonares, Tamizaje Masivo, Tomografía Computarizada Multidetector, Guías de Práctica Clínica.

In 2013 the United States Preventive Services Task Force (USPSTF) recommended annual screening for lung cancer with low-dose (TCBD) CT for certain population. Given the absence of national guidelines on this practice, there is uncertainty about whether this recommendation should be adopted or not. The present study aimed to evaluate the quality and completeness of the body of evidence that underpins this recommendation through rigorous methods. The quality of the guideline, and the systematic review on which is based the recommendation by the USPSTF is of intermediate quality, identified. Other systematic reviews not included, whose results are not so conclusive about the balance of risks and benefits of this practice were identified. The adoption of these recommendations policy or regular program in our country requires a rigorous, exhaustive and participatory evaluation, because it is costly, and it is not free of side effects The results aim to provide elements for this debate that should include the government, the scientific societies, insurers and other stakeholders, and the voices of patients as well. KEYWORDS: Lung Neoplasms, Mass Screening, Multidetector Computed Tomography Practice Guidelines.

Calidad de vida relacionada con la salud en niños con y sin trastornos crónicos: Estudio multicéntrico / Health-related quality of life in children with and without chronic conditions: A multicenter study

Introducción. Los trastornos crónicos (TC) en etapas tempranas de la vida pueden influir en diferentes dimensiones de la calidad de vida relacionada con la salud (CVRS) de los niños/as. Objetivo. Comparar la CVRS de niños/as con TC confirmados, con TC declarados y sin TC. Población y método. Estudio transversal en el marco de una investigación mayor realizada en escuelas de Córdoba y Bahía Blanca, y en los hospitales Italiano y Garrahan de Buenos Aires, Argentina, en 2012. La presencia de TC fue establecida por diagnóstico médico en hospitales o por declaración de sus cuidadores en escolares. Los niños/as de 8 a 12 años respondieron el cuestionario KIDSCREEN-52 sobre CVRS, una escala de desarrollo puberal y una escala de recursos económicos familiares. Los cuidadores indicaron el nivel educativo materno. Se estimó la asociación entre TC y CVRS ajustada por sexo, edad, desarrollo puberal, nivel educativo materno y nivel socioeconómico. Resultados. Participaron 670 duplas niños/as-cuidadores, 13,3% (n= 89) con TC confirmados (muestras de hospitales), 14,5% (n= 97) escolares con trastornos declarados y el resto eran escolares sanos. La edad promedio fue 10,2 años (desvío estándar= 1,01); 54,8% fueron niñas. Tener TC confirmados se asoció a una mayor frecuencia de bajo bienestar físico (OR 2,61; IC 95%: 1,43-4,76), mientras que la presencia de TC declarados se asoció con bajas puntuaciones en bienestar psicológico (OR 1,96; IC 95%: 1,063,63), autopercepción (OR 2,22; IC 95%: 1,283,87) y relación con los padres (OR 2,04; IC 95%: 1,21-3,44). Conclusiones. Los niños/as con TC confirmados mostraron con mayor frecuencia malestar físico y los que tenían TC declarados manifestaron malestar en áreas psicosociales, en comparación con los niños/as sin trastorno.

Introduction. Chronic conditions (CCs) in the early stages of life may have an impact on various dimensions of health-related quality of life (HRQoL) in children. Objective. To compare HRQoL in children with confirmed CCs, reported CCs, and without CC. Population and Method. Cross-sectional study conducted in 2012 in the context of a larger research study carried out at schools in Córdoba and Bahía Blanca, and at Hospital Italiano of Buenos Aires and Hospital Prof. Dr. Juan P. Garrahan at Buenos Aires. The presence of a chronic condition was established by medical diagnosis at the hospital or as reported by schoolchildren's caregivers. Eight-to-twelve year-old children completed the KIDSCREEN-52 questionnaire on HRQoL, a pubertal development scale, and a family financial resource scale. The association between CCs and HRQoL adjusted by sex, age, pubertal development, maternal education level, and socioeconomic level was estimated. Results. Six hundred and seventy children/ caregiver dyads participated; 13.3% (n= 89) had confirmed CCs, 14.5% (n= 97) were schoolchildren with reported CCs, and the rest corresponded to healthy schoolchildren. Their average age was 10.2 years old (standard deviation= 1.01); 54.8% were girls. Having a confirmed CC was associated with a higher frequency of low physical wellbeing (odds ratio --OR--: 2.61; 95% confidence interval --95% CI--:1.43-4.76), while the presence of a reported CC was associated with a low score in psychological well-being (OR: 1.96; 95% CI: 1.06-3.63), self-perception (OR: 2.22; 95% CI: 1.28-3.87), and parent relations (OR: 2.04; 95% CI: 1.21-3.44). Conclusions. Children with confirmed CCs showed a higher frequency of physical discomfort, and those with reported CCs showed discomfort in psychosocial areas compared to children without CCs.

Estudio descriptivo de la morbilidad referida por la poblacion de Bahía Blanca / Descriptive study of morbility referred by the population of Bahía Blanca city

Introducción: Los estudios epidemiológicos permiten conocer la prevalencia de enfermedades referidas por la poblacion y su asociación con factores de riesgo. Objetivos: Describir la morbilidad referida por las personas que residen en la ciudad de Bahía Blanca en el año 2005, los factores de riesgo y su asociación con las enfermedades en estudio. Población y métodos: Estudio de corte transversal por modalidad de encuesta poblacional domiciliaria. Muestreo por conglomerados con sub-muestreo, con probabilidades proporcionales a su tamaño (en base al Censo Nacional de Población y Vivienda 2001 y a la Encuesta Permanente de Hogares). Se utilizaron los test Chi2, t-test, Mann Whitney o Kruskall Wallis y una regresión logística múltiple. Resultados: Se contactaron y aceptaron participar 1447 personas (individuos proxy) quienes suministraton datos de 4766 personas (poblacion de estudio) que residían en las viviendas seleccionadas. Las enfermedades respiratorias, seguidas por las cardiovasculares y las endocrinopatías, fueron el grupo de enfermedades más frecuentemente reportadas. Discusión: La frecuencia de enfermedades referidas en esta encuesta presenta, en algunos casos, valores similares a los reportados en otros estudios. Respecto a los factores de riesgo, la prevalencia fue menor a la reportada a nivel nacional. Este fue el primer estudio de relevamiento de la morbilidad referida en una población representativa de la ciudad.

Introduction: epidemiological studies provide and insight into the prevalence of those diseases reported by the population and their association with risk factors. Objetives: Describe the morbidity reported by individuals living in the city of Bahía Blanca 200f, the risk factors, and their association with deseases and their study. Population and methods: cross-sectional population survey carried out at the individual's home. Cluster sumpling and sub-sumpling with probabilities proportional to size (based on the 2001 National population And Housing Census and the Permanent Household Survey). The Chi2 test, t-test, Mann Whitney or Kruskell Wallis and multiple logistic regression test were used. Results: 1447 individuals were contacted and agreed to participate (proxy individuals). Such individuals supplied information from 4766 individuals (study population) living in the selected household. Respiratory disease, following by cardiovascular deseases and endocrinopathies, were the most frequently reported conditions. Discussion: the frequency of deseases refered to in this survey shows, in some cases, values similar to those reported in other studies. Regarding risk factors, the prevalence was lower than that reported at National level. This was the first study to survey the reported morbidity in a representative population of the city.

Intimidación entre pares (bullying) en el ámbito escolar. Comparación de la percepción de los docentes con la de sus alumnos. / Bullying at school. A comparison of the perception of teachers and students

Introducción: La intimidación entre pares es un problema frecuente en el ámbito escolar, con consecuencias a corto y largo plazo. Objetivos: Analizar las percepciones sobre este problema que poseen docentes de escuelas públicas de la ciudad de Bahía Blanca (2012) y la medida en la que estas percepciones coinciden con las de los alumnos. Métodos: Estudio cuali-cuantitativo en docentes y alumnos de cuarto a sexto grado que combino una encuesta (muestreo por conveniencia) por medio de cuestionario validado PRECONCIMEI (versiones alumnos y docentes) y grupos de discusión con docentes. Resultados: Encuestas: 407 niños/as y 37 docentes. Seis grupos de discusión en los que participaron 19 docentes en total. Percepción de niños/as: 36% manifiesta haber estado involucrado en situaciones de intimidación; 14% y 36% opino que las familias y docentes, respectivamente, "deberían hacer algo" para que se solucione el problema. Percepción de docentes: 38% opina que la intimidación es un problema grave, aunque predomina una conceptualización mas acotada (casos puntuales de agresión física por alumnos varones). Reconocen que tanto la familia como los docentes tienen un rol esencial en la prevención de este problema, aunque señalan que el rol docente estaría muy condicionado por factores externos. Conclusiones: Docentes y alumnos perciben a la intimidación como un hecho frecuente, aunque en los primeros predomina una conceptualización mas acotada. Si bien ambos reconocen que la familia posee un rol clave, los alumnos le otorgan menor relevancia. En contraste, el rol docente es jerarquizado tanto por los niños/ as como por sus docentes.

Introduction: Intimidation among peers is a frequent issue in school environments with short and long term consequences. Objetive: To analyze the perceptions of Bahía Blanca city public school teachers (2012) on this problem and the extent to which these perceptions are in agreement with those of the students. Methods: Quali-quantitative study of teachers and students from fourth to sixth grade combining a survey (convenience survey) using the PRECONCIMEI validated questionnaire (student and teacher versions) and discussion groups with teachers. Results: Surveys: 407 children and 37 teachers. Six discussion groups in which 19 teachers participated in total. Perception of Children: 36% expressed to have been involved in bullying situations; 14% and 36% said that families and teachers, respectively, "should do something" to solve the problem. Perception of Teachers: 38% considered that bullying is a serious problem although the concept is more circumscribed -special cases of physical aggression by male students. They recognized that both the family and the teachers have a key role in preventing this problem, although they pointed out that the role of teachers would be largely conditioned by external factors. Conclusions: Teachers and students perceive bullying as a frequent event, although in the former a more circumscribed conceptualization prevails. Although both recognize that the family has a key role, students consider this less relevant. In contrast, the role of teachers is prioritized both by the children and their teachers.

Reliability and validity of the KIDSCREEN-52 questionnaire to measure health related quality of life in the 8 to 18 year-old Argentinean population / Fiabilidad y validez del cuestionario KIDSCREEN-52 para medir calidad de vida relacionada con la salud para población argentina de 8 a 18 años

Introduction. The KIDSCREEN questionnaire is an instrument to measure health-related quality of life (HRQoL). It allows to differentiate health levels or to assess the efficacy of interventions. The objective was to evaluate the reliability and validity of the Argentine version of the questionnaire in the population aged 8-18 years-old in the city of Bahía Blanca. Population and Methods. Cross sectional study conducted in public and private schools in 2008 using a district-stratified sampling. The questionnaire was self-administered and included the KIDSCREEN questionnaire (52 items) and questions about age, gender and family socioeconomic level (SEL). Reliability was analyzed using standard psychometric analysis techniques and the item response theory. The analysis of the factorial structure was performed using a confirmatory factor analysis (CFA), and that of the construct validity was conducted comparing dimension mean scores by age, gender and SEL. Results. Most dimensions had a Cronbach's alpha of >0.7 and 80% of items, and sufficient infit or outfit values (<0.8). The CFA showed an adequate data adjustment to the ten-dimension structure. The mean values of the dimensions confirmed lower scores in adolescents than in children, and lower scores in females than in males, as expected in several of the HRQoL dimensions. Conclusions. The reliability and validity of the Argentinean version of the KIDSCREEN-52 questionnaire were acceptable; therefore its use can be recommended for the 8-18 year-old Argentinean population.

Introducción. El cuestionario KIDSCREEN es una medida de la calidad de vida relacionada con la salud (CVRS). Permite discriminar niveles de salud o evaluar la eficacia de las intervenciones. El objetivo fue evaluar la fiabilidad y la validez de la versión argentina del cuestionario en población de 8-18 años de edad de la ciudad de Bahía Blanca. Población y métodos. Estudio transversal en escuelas públicas y privadas durante el año 2008 mediante un muestreo estratificado por delegación. El cuestionario fue autoadministrado e incluyó el KIDSCREEN (52 ítems) y preguntas sobre edad, sexo y el nivel socioeconómico (NSE) de la familia. Se analizó la fiabilidad mediante técnicas de análisis psicométrico clásicas, así como la teoría de respuesta al ítem. La estructura factorial fue analizada mediante un análisis factorial confirmatorio (AFC) y, la validez del constructo, comparando las puntuaciones medias de las dimensiones según edad, sexo y NSE. Resultados. La mayoría de las dimensiones presentaron un alfa de Cronbach >0,7 y el 80% de los ítems, valores de infit o de outfit suficientes (< 0,8). El AFC mostró un adecuado ajuste de los datos a la estructura de diez dimensiones. Las medias de las dimensiones confirmaron puntuaciones menores en adolescentes que en niños/as y menores en mujeres que en varones, como se esperaba en varias dimensiones de la CVRS. Conclusiones. La versión argentina del KIDSCREEN- 52 presentó una aceptable fiabilidad y validez, por lo que puede recomendarse su utilización en población argentina de 8-18 años.