Indicadores de qualidade da atenção a usuários com diabetes na Atenção Primária à Saúde do Brasil: 2012 e 2018 / Quality indicators of care for users with diabetes in Primary Health Care in Brazil: 2012 and 2018 / Indicadores de calidad de la atención a usuarios con diabetes en Atención Primaria de Salud en Brasil: 2012 y 2018

Introdução: Diabetes mellitus (DM) é uma doença crônica, não transmissível, cuja prevalência tem aumentado mundialmente. Seu manejo adequado na Atenção Primária à Saúde (APS) pode reduzir suas complicações e as internações por condições sensíveis à atenção primária. Objetivo: Comparar indicadores de qualidade da atenção a pessoas com diabetes atendidas na rede básica de saúde do Brasil e suas diferenças por região. Métodos: Com delineamento transversal, utilizaram-se dados dos Ciclos I e III do Programa de Melhoria do Acesso e da Qualidade (PMAQ). Os desfechos foram indicadores sintéticos, operacionalizados a partir de 24 variáveis: i) acesso; ii) disponibilidade de insumos e equipamentos em condições de uso; iii) disponibilidade de medicamentos em quantidade suficiente; iv) organização e gestão; v) cuidado clínico; e vi) relato de cuidado adequado. Foram calculadas as diferenças em pontos percentuais (p.p.) dos indicadores entre 2012 e 2018, e os dados foram estratificados por região. Resultados: No geral, houve uma melhora no cuidado à pessoa com DM na APS do Brasil e regiões entre as equipes participantes do PMAQ, entre 2012 e 2018. As prevalências de acesso, disponibilidade de insumos/equipamentos, medicamentos, oferta, organização e gestão apresentaram aumento de, no mínimo, 10 p.p. no período de 6 anos, mas podem melhorar. Conclusões: Considerando que a ocorrência de DM está aumentando no país, faz-se necessário maior investimento na estrutura dos serviços e em programas de educação permanente dos profissionais de saúde.

Introduction: Diabetes Mellitus (DM) is a non-communicable chronic disease whose prevalence has been increasing worldwide. Its adequate management in Primary Health Care (PHC) can reduce complications and hospitalizations for conditions sensitive to primary care. Objective: To compare quality indicators for the care of people with diabetes treated in the basic health network in Brazil and their differences by region. Methods: With a cross-sectional design, data from Cycles I and III of the PMAQ were used. The outcomes were synthetic indicators, operationalized from 24 variables: i) access; ii) availability of supplies and equipment in usable conditions; iii) availability of medications in sufficient quantities; iv) organization and management; v) clinical care; and vi ) report of adequate care. Differences in percentage points (p.p.) of the indicators between 2012 and 2018 were calculated, and the data were stratified by region. Results: Overall, there was an improvement in the care of people with DM in PHC in Brazil and regions among the teams participating in PMAQ, between 2012 and 2018. The prevalence of access, availability of supplies/equipment, medications, demand, organization, and management showed an increase of at least 10 p.p. within six years, but they can improve. Conclusions: Considering that the occurrence of DM is increasing in the country, greater investment is necessary in the structure of services and in continuing education programs for health professionals.

La Diabetes Mellitus es una enfermedad crónica no transmisible cuya prevalencia ha aumentado en todo el mundo. Su manejo adecuado en la Atención Primaria puede reducir sus complicaciones y las hospitalizaciones por afecciones sensibles a la Atención Primaria. Objetivo: comparar indicadores de calidad de la atención a personas con diabetes atendidas en la red básica de salud de Brasil y sus diferencias por región. Métodos: Con delineamiento transversal, se utilizaron datos de los Ciclos I y III del PMAQ. Los defectos fueron indicadores sintéticos, operacionalizados a partir de 24 variables: i) acceso, ii) disponibilidad de insumos y equipos en condiciones utilizables, iii) disponibilidad de medicamentos en cantidad suficiente, iv) organización y gestión, v) atención clínica y vi) reporte de atención adecuada. Se calcularon las diferencias en puntos porcentuales (p.p.) de los indicadores entre 2012 y 2018, y los datos se estratificaron por regiones. Resultados: En general, hubo una mejora en la atención a las personas con DM en APS en Brasil y regiones entre los equipos participantes en el PMAQ entre 2012 y 2018. La prevalencia del acceso, la disponibilidad de insumos/equipos, los medicamentos, el suministro, la organización y la gestión mostraron un aumento de al menos 10 p.p. en el periodo de seis años, pero pueden mejorar. Conclusiones: Considerando que la ocurrencia de DM está aumentando en el país, es necesario invertir más en la estructura de los servicios y en programas de educación continuada para los profesionales de salud.

Etnoenfermería y teoría del cuidado cultural, evidencias metodológicas en la investigación en enfermería: una revisión integrativa

Introducción: La atención en salud involucra aspectos culturales que deben conocerse para beneficiar a las personas desde el cuidado de enfermería. Objetivo: Describir el uso de la etnoenfermería como diseño de investigación y la teoría del cuidado cultural de Madeleine Leininger en la literatura de enfermería. Metodología: Se realizó una revisión integrativa bajo las fases de Withmoore y Knalf. La búsqueda bibliográfica se llevó a cabo en Medline, Cuiden Plus, Lilacs, Scopus y ScienceDirect, con los descriptores "investigación cualitativa", "enfermería", "asistencia sanitaria culturalmente competente" y "enfermería transcultural" en idioma inglés, español, portugués, incluyendo artículos originales publicados entre 2013 a 2023. Resultados: Se eligieron 12 artículos que fueron codificados para el surgimiento de cuatro categorías: necesidad de formación en etnoenfermería y teoría del cuidado de la cultura; reconocimiento del contexto cultural y barreras para el cuidado culturalmente congruente; diversidad y universalidad de los cuidados culturales; y acciones para el cuidado culturalmente congruente. Conclusiones: La revisión permitió reconocer que la teoría de cuidado cultural y la etnoenfermería han sido escasamente utilizadas en la práctica científica y profesional de enfermería. Es necesario incentivar en los profesionales la importancia de valorar el respeto por las diferentes culturas en los servicios de salud.

Introdução: O atendimento em saúde envolve aspectos culturais que devem ser conhecidos para beneficiar as pessoas a partir dos cuidados de enfermagem. Objetivo: Descrever a utilização da etnoenfermagem como desenho de investigação e a teoria cultural do cuidado de Madeleine Leininger na literatura de enfermagem. Métodos: Foi efetuada uma revisão integrativa segundo as fases de Withmoore e Knalf. A pesquisa bibliográfica foi realizada nas bases de dados Medline, Cuiden Plus, Lilacs, Scopus e ScienceDirect, com os descritores "pesquisa qualitativa", "enfermagem", "assistência à saúde culturalmente competente" e "enfermagem transcultural" em inglês, espanhol e português, incluindo artigos originais publicados entre 2013 a 2023. Resultados: Selecionou-se 12 artigos, codificados para o surgimento de quatro categorias: necessidade de formação em etnoenfermagem e teoria cultural do cuidado; reconhecimento do contexto cultural e barreiras para o cuidado culturalmente congruente; diversidade e universalidade do cuidado cultural; e ações para o cuidado culturalmente congruente. Conclusões: A revisão permitiu reconhecer que a teoria dos cuidados culturais e a etnoenfermagem têm sido escassamente utilizadas na prática científica e profissional da enfermagem. É necessário incentivar nos profissionais a importância de valorizar o respeito pelas diferentes culturas nos serviços de saúde..

Introduction: Health care involves cultural aspects that must be known to benefit people from the Nursing care provided. Objective: To describe the use of Ethnonursing as a research design and Madeleine Leininger's Theory of Culture Care in the Nursing literature. Methods: n integrative review was carried out following the phases proposed by Withmoore and Knalf. The bibliographic search was conducted in Medline, Cuiden Plus, Lilacs, Scopus and ScienceDirect. The "qualitative research", "nursing", "culturally competent health care" and "transcultural nursing" descriptors were used in English, Spanish and Portuguese, including original articles published between 2013 and 2023. Results: A total of 12 articles were chosen and coded to give rise to four categories, namely: need for training in Ethnonursing and in the Theory of Culture Care; recognition of the cultural context and of barriers to culturally congruent care; culture care diversity and universality; and actions for culturally congruent care. Conclusions: The review allowed recognizing that the Theory of Culture Care and Ethnonursing have been scarcely used in the scientific and professional Nursing practice. It is necessary to encourage professionals to value due respect for different cultures in health services.

Factores relacionados al estado Todo-Menos-Tesis en la formación de grado de odontólogos de una universidad peruana / Factors Related to All-But-Dissertation Status in Undergraduate Dental Education at a Peruvian University

Resumen Introducción: Elaborar una tesis es un proceso complejo y algunos estudiantes no la culminan, la abandonan o entran en un estado de postergación permanente. Objetivo: Identificar los factores que se relacionan con la presencia del estado Todo-Menos-Tesis (TMT) en los graduados de un programa de odontología. Método: Estudio exploratorio con enfoque cualitativo donde participaron 21 graduados. Se utilizó la técnica de la encuesta y una entrevista semiestructurada. El cuestionario recopiló información relacionada a la condición laboral, características personales, tiempo de graduación y características familiares. La guía de entrevista recopiló las categorías de motivos (personales, académicos, económicos y laborales), consecuencias (repercusiones de la postergación de la tesis) y recomendaciones para evitar el estado TMT. Resultados: El 57,1 % (n = 12) fueron varones. Los principales motivos para postergar la tesis estuvieron relacionados con la adquisición de recursos económicos, pérdida de interés, prioridades familiares, alejamiento académico y sensaciones de habilidades inadecuadas. Los participantes recomiendan ofrecer otras modalidades de titulación, realizar capacitaciones académicas, mejorar las experiencias investigativas y brindar orientación al graduado. Conclusiones: Los graduados de la carrera de estomatología de la Universidad Científica del Sur presentan múltiples factores personales, cognitivos e institucionales que influyen en la decisión de continuar o retomar la elaboración de su tesis de licenciatura. La dedicación laboral y las responsabilidades familiares son los principales factores que limitan el tiempo de dedicación a la tesis.

Abstract Introduction: Preparing a thesis is a complex process and some students do not complete it, abandon it or enter a permanent state of procrastination. Objective: To identify the factors that are related to the presence of the All-But-Dissertation (ABD) state in the graduates of a Dentistry program. Method: Exploratory study with a qualitative approach in which 21 graduates participated. The survey technique and a semi-structured interview were used. The questionnaire collected information related to employment status, personal characteristics, time of graduation, and family characteristics. The interview guide collected the categories of reasons (personal, academic, economic, and labor), consequences (repercussions of postponing the thesis), and recommendations to avoid the syndrome. Results: 57.1% (n = 12) were male. The main reasons for postponing the thesis were related to the acquisition of economic resources, loss of interest, family priorities, academic distance and feelings of inadequate skills. The participants recommend offering other degree modalities, academic training, improving research experiences, and providing orientation to the graduate. Conclusions: Stomatology graduates of the Universidad Científica del Sur present multiple personal, cognitive, and institutional factors that influence the decision to continue or resume the elaboration of their degree thesis. Work dedication and family responsibilities are the main factors that limit the time devoted to the thesis.

Uso da adaptação transcultural nos cursos de pós-graduação em Enfermagem / Use of cross-cultural adaptation in Postgraduate Nursing courses / Uso de la adaptación transcultural en las carreras de grado en Enfermería

Objetivo: analisar a produção científica brasileira, na Pós-Graduação em Enfermagem, que utilizou o método de adaptação transcultural. Método: estudo documental, com busca realizada na Biblioteca Digital de Teses e Dissertações, que resultou em 140 dissertações e 72 teses para análise, oriundas de Programas de Pós-Graduação da região Sudeste, seguida das regiões Nordeste, Sul e Centro-Oeste, sem representação da região Norte. Resultados: os instrumentos adaptados foram, em sua maioria, procedentes do idioma inglês. Prevaleceram as pesquisas na área/campo Assistencial, destacando-se a linha de pesquisa Processo de Cuidar em Saúde e Enfermagem. Identificou-se descompasso entre o que é produzido na área e o que é recomendado internacionalmente. Conclusão: verificou-se aumento na utilização da adaptação transcultural como método de pesquisa, com persistência das assimetrias acadêmicas regionais e sem consenso sobre o referencial metodológico.

Objective: to analyze the Brazilian scientific production in Postgraduate Nursing education using the cross-cultural adaptation method. Method: documentary study with searches carried out in the Digital Library of Theses and Dissertations resulting in 140 Master's theses and 72 Doctoral dissertations for analysis originated from Postgraduate Programs carried out in the Southeast region of Brazil, followed by the Northeast, South and Midwest regions ­ there was no representation of the North region. Results: the adapted instruments were, mostly, originally written in English. Research in the Care area/field prevailed, highlighting the line of research called Health and Nursing Care Process. A gap between what is produced in the area and what is recommended internationally was identified. Conclusion: an increase in the use of cross-cultural adaptation as a research method was noticed, with the persistence of regional academic asymmetries and lack of consensus on the methodological framework.

Objetivo: analizar la producción científica brasileña, en el Postgrado en Enfermería, que utilizó el método de adaptación transcultural. Método: estudio documental, la búsqueda se realizó en la Biblioteca Digital de Tesis y Disertaciones, se obtuvieron 140 tesis de maestría y 72 tesis de doctorado para análisis, provenientes de Programas de Posgrado de la región Sudeste, seguida de las regiones Nordeste, Sur y Centro-Oeste, no se encontraron documentos de la región Norte. Resultados: los instrumentos adaptados fueron, en su mayoría, del idioma inglés. Predominaron las investigaciones en el área/campo Asistencial, se destacó la línea de investigación Proceso de Atención en Salud y Enfermería. Se identificó que lo que se produce en el área no coincide con lo que se recomienda a nivel internacional. Conclusión: se comprobó que aumentó el uso de la adaptación transcultural como método de investigación, que persisten las disparidades académicas regionales y que no hay consenso sobre el marco metodológico.

Physical exercise in Chilean breast cancer survivors: Qualitative study of barriers, facilitators and preferences. / Actividad física en chilenas sobrevivientes de cáncer de mama: estudio cualitativo de barreras, facilitadores y preferencias.

Introduction: Breast cancer survivors often experience pre and post-treatment physical and psychological symptoms, negatively affecting their quality of life. Regular physical exercise is associated with better quality of life and lower recurrence of cancer, and therefore all oncological patients are recommended to practice it in a regular basis. Despite this, breast cancer survivors have low adherence to physical exercise. The purpose of this study is to identify barriers, facilitators and preferences of Chilean breast cancer survivors to practice physical exercise. Methods: Phenomenological qualitative study of 12 in-depth interviews with adjuvant radiation therapy concluded at least three months ago. Results: Breast cancer survivors ignored the benefits of physical exercise during and after treatment. The barriers were physical symptoms, psychological barriers, sociocultural barriers, health system barriers, disinformation and sedentary lifestyle. Facilitators were coping with physical symoptoms, psychological issues, having information and active lifestyle. The preferences were painless and familiar exercises. Preferred exercise was walking. Conclusions: Breast cancer survivors may adhere to physical exercise despite barriers when certain facilitators are present, which may be promoted by the health team when reporting the benefits of the physical exercise, prescribing personalized, safe and painless physical exercise and educating both patient and her family about the role of the physical exercise in cancer recovering process.

Introducción: Las sobrevivientes de cáncer de mama suelen ver afectada negativamente su calidad de vida por síntomas físicos y psicológicos pre y post tratamiento. La práctica regular de ejercicio físico se asocia a mejor calidad de vida y menor recurrencia del cáncer, por esto es recomendado a todos los pacientes oncológicos. Sin embargo, existe baja adherencia a este. El propósito de este artículo es identificar barreras, facilitadores y preferencias de sobrevivientes de cáncer de mama chilenas para realizar ejercicio físico. Métodos: Estudio cualitativo fenomenológico, basado en entrevistas en profundidad a 12 sobrevivientes de cáncer de mama que terminaron la radioterapia adyuvante hace tres o más meses. Resultados: Las sobrevivientes de cáncer de mama desconocían la importancia del ejercicio físico durante y después del tratamiento. Las barreras identificadas fueron síntomas físicos, barreras psicológicas, socioculturales, del sistema de salud; desinformación y sedentarismo. Los facilitadores fueron físicos, psicológicos, contar con información y práctica de ejercicio físico antes del diagnóstico. Las preferencias fueron ejercicios indoloros y familiares. El ejercicio preferido fue caminar. Conclusiones: Es posible que las sobrevivientes de cáncer de mama adhieran al ejercicio físico, a pesar de las barreras cuando hay ciertos facilitadores presentes. Estos pueden ser generados por el equipo médico al informar los beneficios del ejercicio físico, prescribir ejercicio físico personalizado, seguro e indoloro y educar a la paciente y a su familia sobre el rol del ejercicio físico en la recuperación de sobrevivientes de cáncer de mama.

Impact of hydrophobic and hydrophilic surface properties on Pseudomonas aeruginosa adhesion in materials used in mineral water wells.

Microbiologically contaminated water is a significant source of infections in humans and animals, with Pseudomonas aeruginosa (PSA) being particularly concerning due to its ability to thrive in water environments and its resistance to many disinfectants. Therefore, this study investigates the adhesion potential of PSA strains on various materials used in mineral water extraction wells, focusing on hydrophobic and hydrophilic properties. Mineral water samples were collected from three wells (P-01, P-07, and P-08) within the Guarani Aquifer System and Fractured Aquifer System (SAF) in Brazil. The physicochemical properties of the water, including concentrations of Sr (strontium), Fe (iron), Si (silicon), SO42- (sulfate ions), Cl- (chloride ions), and ORP (oxidation-reduction potential), were analyzed. Results indicated higher PSA adhesion on hydrophobic materials, particularly high-density polyethylene (HDPE) and geomechanically plasticized polyvinyl chloride (PVC). Multiple correlation analyses revealed positive correlations between PSA adhesion on hydrophilic materials and Sr, Fe, Si, SO42-, and Cl- concentrations. Conversely, ORP negatively correlated with bacterial adhesion on PVC surfaces, suggesting higher ORP values reduced PSA attachment. These findings highlight the importance of water composition and material properties in influencing bacterial adhesion and potential biofilm formation in mineral water extraction systems.

What matters beyond particle matter?: Examining air pollution's synergistic effects on bodies and health through Bio3Science in Medellin.

Scientific literature on the health effects of air pollution is diverse, and broadly acknowledges the importance of human experience and social and economic precarity as modifying factors. Still, the inclusion of the embodied experience of air pollution has been limited. Also, the health effects of pollution are often studied at the group or population level, without adequately considering individual difference. This paper uses a Bio3Science framework, which integrates biology, biography, and biosphere, to explore how air pollution affects residents in Medellín, Colombia. By using qualitative research on individual experiences of air pollution (biography) to probe the intersection of individual health (biology) and environment (biosphere), we illustrate how pollution shapes lived rhythms at multiple scales. Our findings emphasize that air pollution's health impacts extend beyond measurable pollutants to include the complex synergies of smoke, noise, stress, and disruptions to daily life. This comprehensive approach provides a nuanced understanding of how air pollution materially shapes the lives of individuals and communities, advocating for research models that capture the subtle, everyday experiences often overlooked by traditional group or population-level analyses.

Point-of-care biochemistry for primary healthcare in low-middle income countries: a qualitative inquiry.

BACKGROUND: Access to essential diagnostics is crucial for primary healthcare (PHC) in low-and-middle income countries (LMICs). Many LMICs have invested in equipping PHC with point-of-care (PoC) diagnostics for infectious diseases, however there has been no similar investment to improve PHC capacities for clinical chemistry. The biochemistry gap is among the deterrents to universal health coverage. METHODS: A social sciences project was conducted with the aim to understand the key PHC stakeholders' insights on the pertinence of PoC biochemistry for PHC in LMICs. Data generation was conducted between July-November 2023 in Mongolia, Nigeria and Peru. Decision-makers in healthcare delivery, healthcare professionals, and patient and community advocates were engaged using a combination of sampling techniques. Unstructured individual and group conversations, and non-participant observation were conducted. Analysis involved an inductive line-by-line coding on printed transcripts, followed by a deductive coding and theme-by-theme analysis on digitized transcripts. RESULTS: Fifteen, 51 and 20 informants from Mongolia, Nigeria and Peru, respectively, participated. Fifty-five of the 94 informants were female. Most informants considered that PoC biochemistry in PHC would be pertinent, from a clinical and a resources-saving perspective. Those households that currently bear the burden of referrals (i.e., the poor, the bedridden, the older adults) would benefit the most from the deployment of PoC biochemistry for essential biochemistry parameters. Improved access to PoC glycated hemoglobin (HbA1c), lipid, liver and kidney profile was perceived as helpful to inform clinicians' decision-taking. The value of PoC biochemistry for the management of noncommunicable diseases (diabetes, hypertension) and infectious conditions (dengue, malaria, tuberculosis), to improve child health outcomes (severe dehydration in children with diarrhea and/or malnutrition) and to reduce preventable causes of death (dengue-related renal failure) was highlighted. CONCLUSIONS: PoC biochemistry holds potential to revert the impact that the biochemistry gap has for patient care in some LMICs' PHC settings. PoC equipment for parameters such as HbA1c, urea, creatinine or electrolytes could enhance community-level management of preventable causes of mortality, improve service delivery for patients affected by locally-prevalent infectious conditions, and improve the psychosocial and economic wellbeing of patients facing the burden of referrals to remote biochemistry-equipped centers. TRIAL REGISTRATION: Not applicable.

SPINE20 Recommendations 2024 -Spinal Disability: Social Inclusion as a Key to Prevention and Management.

Spine disorders are the leading cause of disability worldwide. To promote social inclusion, it is essential to ensure that people can participate in their societies by improving their ability, opportunities, and dignity, through access to high-quality, evidence-based, and affordable spine services for all.To achieve this goal, SPINE20 recommends six actions.- SPINE20 recommends that G20 countries deliver evidence-based education to the community health workers and primary care clinicians to promote best practice for spine health, especially in underserved communities.- SPINE20 recommends that G20 countries deliver evidence-based, high-quality, cost-effective spine care interventions that are accessible, affordable and beneficial to patients.- SPINE20 recommends that G20 countries invest in Health Policy and System Research (HPSR) to generate evidence to develop and implement policies aimed at integrating rehabilitation in primary care to improve spine health.- SPINE20 recommends that G20 countries support ongoing research initiatives on digital technologies including artificial intelligence, regulate digital technologies, and promote evidence-based, ethical digital solutions in all aspects of spine care, to enrich patient care with high value and quality.- SPINE20 recommends that G20 countries prioritize social inclusion by promoting equitable access to comprehensive spine care through collaborations with healthcare providers, policymakers, and community organizations.- SPINE20 recommends that G20 countries prioritize spine health to improve the well-being and productivity of their populations. Government health systems are expected to create a healthier, more productive, and equitable society for all through collaborative efforts and sustained investment in evidence-based care and promotion of spine health.

Drivers of interspecific synchrony and diversity-stability relationships in floodplain fish communities.

Diversity and interspecific synchrony are among the main drivers behind the temporal stability of community abundance. Diversity can increase stability through the portfolio effect, while higher synchrony generally decreases stability. In turn, species interactions and similar responses to environmental variation are considered the main factors underlying the strength of interspecific synchrony, despite the challenges in determining their relative roles. The analysis of the relationship between interspecific synchrony and the trait (or phylogenetic) distance between species can increase the robustness of inferences about these factors. Here, we used pairwise interspecific and community-wide analyses to investigate, respectively, the drivers of interspecific synchrony and the influence of trait and phylogenetic diversity on the stability of fish communities. For that, we used 18 years of fish abundance data from the Upper Paraná River floodplain. At the interspecific level, we used quantile regressions to test within-guild relationships between interspecific synchrony and trait and phylogenetic distance between species. At the community level, we tested the relationships between community-wide synchrony, stability, and (trait and phylogenetic) diversity. We found that interspecific synchrony decreased with trait and phylogenetic distances. In the community-level analysis, we found that more synchronous fish communities were less stable, but the relationship between diversity and stability was in general weak. At the interspecific level, our study highlights the role of similar responses to environmental variation in driving species' temporal dynamics. At the community level, the strength of the relationships between trait or phylogenetic diversity and community stability depended on the feeding guild. On the other hand, we found strong relationships between synchrony and stability. These results suggest that increased synchrony levels in response to regional environmental changes could decrease the stability of fish communities in this floodplain.

[What is being investigated and who conducts clinical research related to medicines in Argentina?] / ¿Qué se investiga y quién realiza en Argentina la investigación clínica relacionada a medicamentos?

INTRODUCTION: Clinical trials that involve medicines are performed in order to determine their effectiveness and safety. In Argentina, these studies are presented either to National Administration of Drugs, Food and Medical Technology (ANMAT) to obtain drug registration, or to the National Ministry of Health (MSAL) (to obtain the official recognition). This work was carried out to increase the knowledge about the clinical trials performed in Argentina. MATERIALS AND METHODS: The MSAL/ANMAT databases were explored. The variables were: dates of request, institution, phase of the study, enrollment modality, product investigated, therapeutic group, comparator, pathology involved, and location of laboratory performance. RESULTS: A total of 201 protocols were detected in the period of study, all of them performed with registration purposes. Twenty pharmaceutical companies carried out 60% of the studies (17 with foreign capital). Seventy percent were phase III (90% multicenter protocols). Three out of 4 trials corresponded to the oncology / immunosuppressant therapeutical group. In 65% the comparator used was placebo. A 71% of the studies were carried out in health institutions of Buenos Aires City. Ninety-eight per cent of laboratory controls were carried out abroad. DISCUSSION: Foreign pharmaceutical companies are the only ones that carry out clinical trials on medicines in Argentina, all of them for registration purposes. The use of placebo as a comparator is inappropriate, since each drug is expected to be validated against another of recognized efficacy already available in the market. Oncological/immunological pathologies are the ones that arouse greater interest among local researchers due to their prevalence and their greater profitability in the pharmaceutical market.

Introducción: Los ensayos clínicos que involucran medicamentos, tienen como objetivo determinar su eficacia y seguridad. En Argentina, estos estudios se presentan ante la agencia reguladora Administración Nacional Medicamentos, Alimentos y Tecnología Médica (ANMAT), para registrarlos; o bien ante el Ministerio de Salud de la Nación (MSAL). El objetivo de este trabajo fue conocer cuáles son los medicamentos de interés y quiénes son los que llevan adelante este tipo investigación clínica en Argentina. Materiales y métodos: Se exploraron las bases de datos MSAL/ANMAT. Las variables fueron fechas de solicitud del trámite, institución solicitante, fase del estudio, modalidad de enrolamiento, producto investigado, grupo terapéutico, comparador, enfermedad involucraday lugar de realización de laboratorio. Resultados: Se detectaron en el periodo 201 protocolos, todos ellos con fines registrales. Veinte compañías farmacéuticas realizaron el 60% de los estudios (17 de capitales extranjeros). El 70% fueron fase III (90% multicéntricos). Tres de cada 4 ensayos correspondieron al grupo de oncológicos/ inmunosupresores. En el 65% el comparador fue placebo. El 71% de los estudios se realizaron en instituciones de la Ciudad Autónoma de Buenos Aires. El 98 % de controles de laboratorio se realizaron en el exterior. Discusión: Las compañías farmacéuticas extranjeras son quienes realizan con fines registrales el mayor número de ensayos clínicos sobre medicamentos en Argentina. El predominio del uso de placebo como comparador resulta inapropiado, ya que el verdadero valor del estudio es cuando un fármaco innovador demuestra superioridad contra otro ya existente de reconocida eficacia. Las enfermedades oncológicas/inmunológicas fueron aquellas que despertaron mayor interés entre los investigadores y patrocinantes por prevalencia y rentabilidad.

Healthcare can't stop evolving: innovation as the catalyst for unleashing the managerial potential of value-based healthcare by stimulating intangible assets and enhancing organizational resilience.

Background: With increasing healthcare service utilization and the introduction of costly therapies, healthcare organizations are pressured to deliver cost-effective services within constrained budgets. Rising costs and the need for efficient healthcare delivery are major concerns for governments, insurers, and health plans. Objectives: It aims to understand the impact of these intangible assets on creating value and organizational resilience in healthcare, informing better practices and strategies for VBHC implementation. Methods: An applied research approach using the Work Breakdown Structure (WBS) methodology was adopted. The research was divided into seven interconnected Work Packages (WPs), each designed to investigate different aspects of the integration between VBHC and intangible assets, with a focus on enhancing organizational resilience through innovative health processes. Key methodologies included literature reviews and qualitative analyses, employing Open Innovation and Design Thinking. Results: The study revealed a dynamic interplay between VBHC, organizational resilience, and intangible assets. It showed that managerial effectiveness is influenced by direct patient outcomes and elements like intellectual capital and organizational reputation. Data integration from various Work Packages provided new insights into how intangible assets underpin VBHC strategies, proposing novel management approaches. Findings highlight the essential role of intangible assets in enhancing service delivery and fostering sustainable healthcare practices. Discussion: The study highlights a significant oversight in the integration of intangible assets within healthcare organizations, despite their crucial role in optimizing VBHC. It supports literature emphasizing the importance of intellectual capital and organizational culture in enhancing healthcare management efficiency and resilience. A paradigm shift in VBHC to include these assets is needed for building a more adaptable and sustainable healthcare system. This integration can lead to better clinical outcomes, patient satisfaction, and overall healthcare efficiency, aligning more closely with VBHC goals. Conclusion: Recognizing and effectively managing intangible assets are paramount for the successful implementation of VBHC and enhanced organizational resilience. Strategic integration of these assets into healthcare management practices can significantly improve patient outcomes and create a more sustainable, patient-centered, and resilient healthcare system. Future studies should develop methodologies for robust measurement and integration of these assets to fully realize the potential of VBHC.

Tailoring Sexual Health Research Practices to Meet the Needs of Adolescent Girls in Low- and Middle-Income Countries: Findings from Mexico.

Sexual and reproductive health (SRH) research is essential for the development of population-tailored evidence-based policies and programs that support sexual health among adolescent girls. However, ethical challenges create barriers to girls' participation in low- and middle-income countries (LMICs). From February to September 2019, girls aged 16-20 (n = 30) who participated in the Jovenes Sanos study in Tijuana, Baja California (ClinicalTrials: NCT03660514) responded to in-depth interviews (IDs) on the perceived risks and benefits of participating in studies which address gender-based violence, unintended pregnancy, and STIs. Emergent themes indicated the need to ensure that consent and incentive procedures are tailored to the developmental level of participants, while highlighting the importance of researcher-participant relationships, and demonstrating how research can serve as an opportunity to empower girls to express their sexual health medical needs. Understanding adolescent girls' voices is a critical step in ensuring that consent to participate SRH research is tailored to the developmental needs of participants, is culturally competent, and has a participant-centered approach.

Factors associated with scientific production conditions among dental students from the Peruvian capital: an analysis under a multivariable regression model.

BACKGROUND: The purpose of scientific production is to synthesize and capture research for eventual publication. In Peru, scientific production at the undergraduate level is relatively limited. The purpose of this study was to identify the factors associated with scientific production conditions among dental students from the Peruvian capital. METHODS: This cross-sectional and analytical study evaluated 338 dental students from the Peruvian capital using a questionnaire composed of 15 questions on conditions for scientific production. Pearson's chi-square test and Fisher's exact test were used for bivariate analysis. To evaluate the influential variables, the adjusted Poisson regression model with robust variance using the adjusted prevalence ratio (APR) was employed. The significance level was p < 0.05. RESULTS: A total of 17.8% of the students carried out research studies, while 1.5% published scientific articles. Conditions for scientific production were considered unfavorable in 28.4% of the cases, while 50.6% were classified as somewhat favorable and 21% as favorable. Students who dedicated < 2 h and ≥ 2 h per week to research were 3.04 and 3.84 times more likely to have favourable conditions for scientific production, respectively, compared to those who had no time for it (APR = 3.04, 95% CI: 1.02-9.03 and APR = 3.84, 95% CI: 1.13-13.02; respectively). CONCLUSION: A minority of dental students reported favorable conditions for scientific production. On the other hand, students with more weekly time for research are more likely to have favourable conditions for scientific production compared to those with no time.

Pathways to strengthen the climate resilience of health systems in the Peruvian Amazon by working with Indigenous leaders, communities and health officers.

BACKGROUND: Indigenous knowledge and responses were implemented during the COVID-19 pandemic to protect health, showcasing how Indigenous communities participation in health systems could be a pathway to increase resilience to emergent hazards like climate change. This study aimed to inform efforts to enhance climate change resilience in a health context by: (1) examining if and how adaptation to climate change is taking place within health systems in the Peruvian Amazon, (2) understanding how Indigenous communities and leaders' responses to climatic hazards are being articulated within the official health system and (3) to provide recommendations to increase the climate change resilience of Amazon health systems. METHODS: This study was conducted among two Peruvian Amazon healthcare networks in Junin and Loreto regions. A mixed methodology design was performed using a cross-sectional survey (13 healthcare facilities), semistructured interviews (27 official health system participants and 17 Indigenous participants) and two in-person workshops to validate and select key priorities (32 participants). We used a climate-resilient health system framework linked to the WHO health systems building blocks. RESULTS: Indigenous and official health systems in the Peruvian Amazon are adapting to climate change. Indigenous responses included the use of Indigenous knowledge on weather variability, vegetal medicine to manage health risks and networks to share food and resources. Official health responses included strategies for climate change and response platforms that acted mainly after the occurrence of climate hazards. Key pathways to articulate Indigenous and official health systems encompass incorporating Indigenous representations in climate and health governance, training the health work force, improving service delivery and access, strengthening the evidence to support Indigenous responses and increasing the budget for climate emergency responses. CONCLUSIONS: Key resilience pathways call for a broader paradigm shift in health systems that recognises Indigenous resilience as valuable for health adaptation, moves towards a more participatory health system and broadens the vision of health as a dimension inherently tied to the environment.

Environmental degradation, climate change and health from the perspective of Brazilian Indigenous stakeholders: a qualitative study.

BACKGROUND: The WHO identifies climate change as the most significant threat to global health systems. Indigenous peoples, whose lives are deeply intertwined with nature, are particularly vulnerable to the impacts of these changes. OBJECTIVE: This study aimed to understand the perspectives of Indigenous stakeholders and public services managers on the interconnectedness of climate change and Indigenous health. DESIGN: A qualitative study with 22 Indigenous stakeholders and public service managers on climate change and perceived impact on Indigenous health. SETTING AND PARTICIPANTS: Indigenous stakeholders and public service managers on climate change and perceived impact on Indigenous health from Brazil. Data was collected through interviews incorporating two vignette videos depicting environmental and health scenarios. Thematic content analysis was used to analyse the data. RESULTS: The analytical process yielded six subcategories that were further grouped into three overarching thematic macro-categories: environmental degradation and climate change in the context of Indigenous peoples; environment, vulnerability and impact on Indigenous mental health; and actions and public health policies for Indigenous peoples. CONCLUSION: The perspectives of Indigenous stakeholders and public service managers on the interconnectedness of climate change and Indigenous health were deeply entrenched in their lived experiences of loss of their lands from deforestation and environmental degradation. They argued strongly for the strengthening of public health policies aimed at the Indigenous peoples, to face many challenges, especially suicide, and to have a voice in decision-making. A sensitive approach that values Indigenous peoples' connections with nature is fundamental to promote their health and well-being.

Rupture of the Fibro-Osseous Septum of the Second Extensor Compartment as the Cause of True Dorsal Trigger Wrist: Case Report.

This article presents a case of a dorsal trigger wrist, which was brought on by a rupture of the fibro-osseous septum of the second extensor compartment. This situation is highly uncommon and has not been previously documented. The septum, which divides the extensor carpi radialis brevis and the extensor carpi radialis longus on the second extensor compartment, is present in almost 45% of the population. The patient underwent surgical reconstruction of the septum, and a complete resolution of symptoms was achieved.

"I feel more confident": a mixed methods evaluation of the influence of Good Life with osteoarthritis Denmark (GLA:D®) on physical activity participation, capability, barriers, and facilitators in people with knee osteoarthritis.

BACKGROUND: A mixed methods study which aimed to evaluate the influence of Good Life with osteoArthritis Denmark (GLA:D®) on physical activity participation, including perceived capability, barriers, and facilitators in people with knee osteoarthritis. OBJECTIVE: Quantify changes in physical activity participation at 3- and 12-months for people with knee osteoarthritis who participated in an education and exercise-therapy program (GLA:D®). METHODS: A mixed-methods study involving 44 participants with knee osteoarthritis who completed GLA:D®. Guided by the Theoretical Domains Framework, 19 were interviewed, with transcripts analysed using reflexive thematic analysis. University of California Los Angeles physical activity scores were dichotomised as 'more' (≥7) or 'less' active (≤6), and compared between baseline and 3- and 12-months using McNemar's test. Motivation and confidence to exercise (0-10 scale); fear of knee joint damage with exercise (yes/no); and Knee Osteoarthritis Outcome Scores (KOOS) were evaluated. RESULTS: Four overarching themes were identified: prior to GLA:D® 1) fear of knee joint damage, and scarcity of exercise and physical activity information prior to GLA:D®; and following GLA:D® 2) varied exercise-therapy and physical activity participation; 3) facilitators including reduced fear of knee damage, increased confidence, routine, strategies, and support; and 4) ongoing barriers including persistent knee pain, comorbidities, cost, and lack of opportunity and motivation. There was no difference in the proportion of 'more' active participants between baseline (41%) and at 3-months (37%, p = 0.774) or 12-months (35%, p = 0.375). The proportion with fear of damage reduced from baseline (50%) to 3-months (5%) and 12-months (21%). Self-reported motivation (9.1/10) and confidence (9.1/10) to exercise at 3-months were high, and all KOOS subscales improved from baseline to 3-months (effect sizes = 0.41-0.58) and 12-months (effect sizes = 0.29-0.66). CONCLUSION: Varied and often inadequate physical activity participation following GLA:D® indicates more targeted interventions to address ongoing barriers may be required.