Patient Experience of Herpes Zoster Disease in Argentina: Validation of a Health-Related Quality of Life Conceptual Model.

OBJECTIVES: Herpes zoster (HZ) substantially affects patients' health-related quality of life (HRQoL), both in the acute phase and also in those developing postherpetic neuralgia (PHN). Building upon a previous qualitative concept elicitation study in Canada, we adopted a similar approach to further understand the patient experience of HZ/PHN in Argentina and impact on quality of life and qualitatively validate the previously published conceptual model for Argentina. METHODS: (1) Comprehensive literature review of HZ impact on HRQoL in Latin America. (2) Qualitative concept elicitation interviews with participants aged ≥50 years with acute HZ or PHN. Verbatim interview transcripts underwent thematic and content analysis related to symptoms and impacts. RESULTS: Studies from the literature (n = 6) identified 5 dimensions of HZ impact on HRQoL: pain management, disease management, family life, work, and emotional impact. A total of 10 participants were interviewed (5 acute HZ and 5 with PHN) with a mean age of 68.5 years (range 50-77 years) and 60% female. All participants reported rash and pain (some reporting a migratory element), fatigue (7 of 10), and itchiness (4 of 10). HRQoL domains most commonly affected were activities of daily living (9 of 10), emotional functioning (8 of 10), physical functioning (8 of 10), and sleep (7 of 10). Emergent themes on disease management included the need for greater public disease awareness/education, participants with PHN seeking alternative/traditional medical therapies. CONCLUSIONS: This study qualitatively validates the previously reported HRQoL conceptual framework. HZ symptoms, especially acute and chronic pain, substantially impair various aspects of HRQoL, prompting some participants to seek out alternative medical treatments.

Development of a core outcome set for maternal and perinatal health research and surveillance in light of emerging and ongoing epidemic threats.

Background: Maternal and perinatal health is often directly and indirectly affected during infectious disease epidemics. Yet, a lack of evidence on epidemics' impact on women and their offspring delays informed decision-making for healthcare providers, pregnant women, women in the post-pregnancy period and policy-makers. To rapidly generate evidence in these circumstances, we aim to develop a Core Outcome Set (COS) for maternal and perinatal health research and surveillance in light of emerging and ongoing epidemic threats. Methods: We will conduct a Systematic Review and a four-stage modified Delphi expert consensus. The systematic literature will aim to inform experts on outcomes reported in maternal and perinatal research and surveillance during previous epidemics. The expert consensus will involve two individual, anonymous online surveys to rate outcomes' importance and suggest new ones, one virtual meeting to discuss disagreements, and one in-person meeting to agree on the final COS, outcomes definitions and measurement methods. Four panels will be established to participate in the modified Delphi with expertise in (a) maternal and perinatal health, (b) neonatal health, (c) public health and emergency response, and (d) representation of civil society. We will recruit at least 20 international experts for each stakeholder group, with diverse backgrounds and gender, professional, and geographic balance. Only highly-rated outcomes (with at least 80% of ratings being 7-9 on a 9-point Likert scale) and no more than 10% of low ratings (1-3) will be included in the final COS. Conclusions: Implementing this COS in future maternal and perinatal research and surveillance, especially in the context of emerging and ongoing epidemic threats, will facilitate the rapid and systematic generation of evidence. It will also enhance the ability of policy-makers, healthcare providers, pregnant women and women in the post-pregnancy period and their families to make well-informed choices in challenging circumstances.

Amyotrophic lateral sclerosis in Argentina: unveiling the burden of treatment through patient and caregiver perspectives.

PURPOSE: To examine the burden of treatment (BoT) experienced by people with Amyotrophic Lateral Sclerosis (ALS) in Argentina. METHODS: Qualitative methodological design based on semi-structured interviews. Nineteen semi-structured interviews were conducted (PwALS = 7, informal caregivers= 12). The interview guides were designed based on the literature and BoT theory. Data were analysed following a framework analysis approach. RESULTS: The research highlighted the arduous journey toward obtaining a diagnosis, marked by delays influenced by healthcare system inefficiencies, lack of disease awareness and pandemic-related anxiety. Receiving the diagnosis was a destabilising experience, triggering the need to reframe self-identity, a new reality. As the disease progressed, patients encountered significant challenges in their daily activities and basic tasks, affecting their ability to work, communicate, and manage personal care. The burden extended beyond the patients to their primary caregivers. Access to specialised care, bureaucratic complexities in securing treatment, and the financial impact of managing the disease posed substantial challenges. CONCLUSION: The findings offer valuable insights into the experiences of PwALS and their caregivers in Argentina. They underscore the need for increased disease awareness, improved access to specialised care, and enhanced support networks to alleviate the burdens PwALS and their families face.

Streamlined pathways for patients with amyotrophic lateral sclerosis in Argentina are necessary to ensure timely access to comprehensive support and interventions, laying the foundation for holistic rehabilitation.There is a need to encourage clear communication between healthcare providers and patients to establish ongoing dialogue incorporating emotional, social, and psychological aspects into rehabilitation, aligning with patient-centric approaches.There is a need to develop and implement adaptive rehabilitation strategies to sustain independence and enhance quality of life for amyotrophic lateral sclerosis patients, addressing the physical, emotional, and social implications of the disease's progression.Rehabilitation professionals should advocate for systemic improvements to ensure equitable access to therapies and support alleviate financial burdens, enabling a comprehensive, patient-focused approach to rehabilitation.

Barriers and facilitators to vaccination in Latin America: a thematic synthesis of qualitative studies.

Vaccines are often undervalued or underused for a variety of reasons, and vaccine hesitancy is a global challenge that threatens vaccine acceptance and the goals of immunization programs. This review aimed to describe the barriers and facilitators to vaccination in Latin America. The study design was a systematic review and thematic synthesis of qualitative studies reporting on the knowledge or attitudes of adults, parents of children at vaccination age, adolescents and health professionals towards vaccination in Latin America. The databases searched were PubMed, CENTRAL, Scopus, LILACS, SciELO, and CINAHL. A total of 56 studies were included. Facilitators included vaccination being recognized as an effective strategy for preventing infectious diseases and as a requirement for access to social assistance programs, schooling or employment. Recommendations from health professionals and positive experiences with health services were also identified as facilitators. The main barriers were lack of information or counseling, structural problems such as shortages of vaccines and limited hours of operation, the inability to afford over-the-counter vaccines or transportation to health facilities, certain religious beliefs, misconceptions and safety concerns. Qualitative research can contribute to understanding perceptions and decision-making about vaccination and to designing policies and interventions to increase coverage.

Barriers and facilitators to vaccination in Latin America: a thematic synthesis of qualitative studies / Barreras y facilitadores de la vacunación en América Latina: síntesis temática de estudios cualitativos / Barreiras e facilitadores para a vacinação na América Latina: síntese temática de estudos qualitativos

Vaccines are often undervalued or underused for a variety of reasons, and vaccine hesitancy is a global challenge that threatens vaccine acceptance and the goals of immunization programs. This review aimed to describe the barriers and facilitators to vaccination in Latin America. The study design was a systematic review and thematic synthesis of qualitative studies reporting on the knowledge or attitudes of adults, parents of children at vaccination age, adolescents and health professionals towards vaccination in Latin America. The databases searched were PubMed, CENTRAL, Scopus, LILACS, SciELO, and CINAHL. A total of 56 studies were included. Facilitators included vaccination being recognized as an effective strategy for preventing infectious diseases and as a requirement for access to social assistance programs, schooling or employment. Recommendations from health professionals and positive experiences with health services were also identified as facilitators. The main barriers were lack of information or counseling, structural problems such as shortages of vaccines and limited hours of operation, the inability to afford over-the-counter vaccines or transportation to health facilities, certain religious beliefs, misconceptions and safety concerns. Qualitative research can contribute to understanding perceptions and decision-making about vaccination and to designing policies and interventions to increase coverage.

Las vacunas suelen estar subvaloradas o desaprovechadas por diversas razones. La vacilación ante las vacunas es un desafío global y representa una amenaza para la aceptación de las vacunas y para los objetivos de los programas de inmunización. El objetivo de esta revisión es describir las barreras y los facilitadores de la vacunación en América Latina. El diseño del estudio fue una revisión sistemática y una síntesis temática de estudios cualitativos sobre conocimientos o actitudes de adultos, padres de niños en edad de vacunación, adolescentes y profesionales de la salud sobre la vacunación en América Latina. Las bases de datos analizadas fueron PubMed, CENTRAL, Scopus, LILACS, SciELO y CINAHL. Se incluyeron 56 estudios. Los facilitadores incluyeron la idea de que la vacunación era reconocida como una estrategia eficaz para prevenir enfermedades infecciosas y un requisito para el acceso a la asistencia social, la escolaridad o el empleo. También se identificaron como factores facilitadores las recomendaciones de los profesionales de la salud y las experiencias positivas con los servicios de salud. Los principales obstáculos fueron la falta de información o asesoramiento, problemas estructurales como la escasez de vacunas y los horarios de funcionamiento limitados, la imposibilidad de pagar vacunas no provistas de forma gratuita o de desplazarse a los centros de salud, ciertas creencias religiosas, conceptos erróneos sobre las vacunas y preocupaciones por la seguridad. La investigación cualitativa puede contribuir a la comprensión de las percepciones y a la toma de decisiones sobre la vacunación y al desarrollo de políticas e intervenciones para aumentar la cobertura de vacunación.

As vacinas são frequentemente subvalorizadas ou subutilizadas por uma série de razões. A hesitação vacinal é um desafio global, sendo uma ameaça à aceitação das vacinas e aos objetivos dos programas de imunização. O objetivo desta revisão é descrever barreiras e facilitadores para a vacinação na América Latina. O desenho do estudo foi uma revisão sistemática e síntese temática de estudos qualitativos sobre conhecimento ou atitudes de adultos, pais de crianças em idade de vacinação, adolescentes e profissionais de saúde sobre vacinação na América Latina. As bases de dados analisadas foram PubMed, CENTRAL, Scopus, LILACS, SciELO e CINAHL. Foram incluídos 56 estudos. Os facilitadores incluíram a ideia de que a vacinação era reconhecida como uma estratégia eficaz para prevenir doenças infecciosas e um requisito para o acesso à assistência social, escolaridade ou emprego. Além disso, recomendações de profissionais de saúde e experiências positivas com serviços de saúde também foram identificados como fatores facilitadores. Os principais obstáculos foram a falta de informação ou aconselhamento, problemas estruturais como escassez de vacinas e horário limitado de funcionamento, incapacidade de comprar vacinas pagas ou se transportar para unidades de saúde, certas crenças religiosas, concepções erradas sobre vacinas e preocupações de segurança. A pesquisa qualitativa pode contribuir para a compreensão das percepções e tomadas de decisão sobre a vacinação e para o desenvolvimento de políticas e intervenções para aumentar a cobertura vacinal.

What does our region need in order to strengthen public policies on sugar-sweetened beverages? decision-makers' dialogue. / ¿Qué necesita nuestra región para fortalecer políticas públicas sobre bebidas azucaradas? diálogo de decisores.

In order to prioritize public policies to reduce the consumption of sugar-sweetened beverages in Argentina, Brazil, El Salvador and Trinidad and Tobago and to identify information gaps related to the burden of disease attributable to their consumption, a policy dialogue was held with government members, civil society organizations, researchers and communicators from Latin American and Caribbean countries. Presentations and deliberative workshops were conducted using semi-structured data collection tools and group discussions. The prioritized interventions were tax increases, front labeling, restriction of advertising, promotion and sponsorship, and modifications regarding the school environment. The main perceived barrier was the interference from the food industry. This dialogue among decision-makers led to the identification of priority public policies to reduce the consumption of sugar-sweetened beverages in the region.

Con el objetivo de priorizar políticas públicas para disminuir el consumo de bebidas azucaradas en Argentina, Brasil, El Salvador y Trinidad y Tobago e identificar las necesidades de información relacionadas con la carga de enfermedad atribuible a su consumo se realizó un diálogo de políticas en el que participaron miembros de gobierno, organizaciones de la sociedad civil, investigadores y comunicadores de países de Latinoamérica y el Caribe. Se llevaron a cabo exposiciones y talleres deliberativos utilizándose herramientas de recolección de datos semiestructuradas y discusiones grupales facilitadas. Las intervenciones priorizadas fueron el incremento de impuestos, el etiquetado frontal, la restricción de la publicidad, promoción y patrocinio y las modificaciones del entorno escolar. La principal barrera percibida fue la interferencia de la industria alimentaria. La realización de este diálogo de decisores permitió la identificación de las políticas públicas prioritarias para disminuir el consumo de bebidas azucaradas en la región.

Data collection systems for active safety surveillance of vaccines during pregnancy in low- and middle-income countries: developing and piloting an assessment tool (VPASS).

BACKGROUND: There is an urgent need for active safety surveillance to monitor vaccine exposure during pregnancy in low- and middle-income countries (LMICs). Existing maternal, newborn, and child health (MNCH) data collection systems could serve as platforms for post-marketing active surveillance of maternal immunization safety. To identify sites using existing systems, a thorough assessment should be conducted. Therefore, this study had the objectives to first develop an assessment tool and then to pilot this tool in sites using MNCH data collection systems through virtual informant interviews. METHODS: We conducted a rapid review of the literature to identify frameworks on population health or post-marketing drug surveillance. Four frameworks that met the eligibility criteria were identified and served to develop an assessment tool capable of evaluating sites that could support active monitoring of vaccine safety during pregnancy. We conducted semi-structured interviews in six geographical sites using MNCH data collection systems (DHIS2, INDEPTH, and GNMNHR) to pilot domains included in the assessment tool. RESULTS: We developed and piloted the "VPASS (Vaccines during Pregnancy - sites supporting Active Safety Surveillance) assessment tool" through interviews with nine stakeholders, including central-level systems key informants and site-level managers from DHIS2 and GNMNHR; DHIS2 in Kampala (Uganda) and Kigali (Rwanda); GNMNHR from Belagavi (India) and Lusaka (Zambia); and INDEPTH from Nanoro (Burkina Faso) and Manhica (Mozambique). The tool includes different domains such as the system's purpose, the scale of implementation, data capture and confidentiality, type of data collected, the capability of integration with other platforms, data management policies and data quality monitoring. Similarities among sites were found regarding some domains, such as data confidentiality, data management policies, and data quality monitoring. Four of the six sites met some domains to be eligible as potential sites for active surveillance of vaccinations during pregnancy, such as a routine collection of MNCH individual data and the capability of electronically integrating individual MNCH outcomes with information related to vaccine exposure during pregnancy. Those sites were: Rwanda (DHIS2), Manhica (IN-DEPTH), Lusaka (GNMNHR), and Belagavi (GNMNHR). CONCLUSION: This study's findings should inform the successful implementation of active safety surveillance of vaccines during pregnancy by identifying and using active individual MNCH data collection systems in LMICs.

¿Qué necesita nuestra región para fortalecer políticas públicas sobre bebidas azucaradas? diálogo de decisores / What does our region need in order to strengthen public policies on sugar-sweetened beverages? decision-makers' dialogue

Con el objetivo de priorizar políticas públicas para disminuir el consumo de bebidas azucaradas en Argentina, Brasil, El Salvador y Trinidad y Tobago e identificar las necesidades de información relacionadas con la carga de enfermedad atribuible a su consumo se realizó un diálogo de políticas en el que participaron miembros de gobierno, organizaciones de la sociedad civil, investigadores y comunicadores de países de Latinoamérica y el Caribe. Se llevaron a cabo exposiciones y talleres deliberativos utilizándose herramientas de recolección de datos semiestructuradas y discusiones grupales facilitadas. Las intervenciones priorizadas fueron el incremento de impuestos, el etiquetado frontal, la restricción de la publicidad, promoción y patrocinio y las modificaciones del entorno escolar. La principal barrera percibida fue la interferencia de la industria alimentaria. La realización de este diálogo de decisores permitió la identificación de las políticas públicas prioritarias para disminuir el consumo de bebidas azucaradas en la región.

In order to prioritize public policies to reduce the consumption of sugar-sweetened beverages in Argentina, Brazil, El Salvador and Trinidad and Tobago and to identify information gaps related to the burden of disease attributable to their consumption, a policy dialogue was held with government members, civil society organizations, researchers and communicators from Latin American and Caribbean countries. Presentations and deliberative workshops were conducted using semi-structured data collection tools and group discussions. The prioritized interventions were tax increases, front labeling, restriction of advertising, promotion and sponsorship, and modifications regarding the school environment. The main perceived barrier was the interference from the food industry. This dialogue among decision-makers led to the identification of priority public policies to reduce the consumption of sugar-sweetened beverages in the region.

Design and feasibility of an implementation strategy to address Chagas guidelines engagement focused on attending women of childbearing age and children at the primary healthcare level in Argentina: a pilot study.

BACKGROUND: Chagas is a public health problem, especially in Latin America, exacerbated by migratory movements and increasing urbanization. Argentina is among the countries with the highest estimated prevalence in the region, with 1,500,000 people infected, with mother to child as the main mode of transmission. Vertical transmission has been significantly reduced by treating women of childbearing age; several guidelines in the region recommend treatment as a primary prevention strategy for the child and a secondary prevention strategy for women and their families. Despite recommendations, women of childbearing age are not always treated, and children do not receive timely diagnosis and treatment. The objective of this research was to design an implementation strategy to improve using Chagas guidelines focused on attending women of childbearing age and children at the primary healthcare level and pilot it in three primary health care centers in Argentina. METHODS: We conducted a pilot feasibility study using the Consolidated Framework for Implementation Research. A qualitative process evaluation was conducted using semi-structured interviews with health care providers and observations in primary health care centers. RESULTS: We developed a multifaceted implementation strategy including training, flowcharts and reminders, a register of suspected and confirmed cases, and the selection of a management facilitator. The pilot study took place between September 2019 and May 2020. The implementation level was heterogeneous and varied depending on the components, being the facilitating factors, the simplicity of the intervention, professionals' willingness to expand the indication of serologic tests, and staff commitment to the adoption of intervention components. The main barriers found were the change of authorities at the local level, some professionals´ reluctance to administer etiological treatment, staff shortages, lack of diagnostic supplies, and the health emergency caused by the COVID-19 pandemic. CONCLUSIONS: Behavioral change strategies should be applied to improve implementation to address some of the main barriers, including support actions offered by opinion leaders, medical experts, and local health authorities. Rapid diagnostic tests should be readily available to maintain behavior changes. We suggest further refinement of the strategy and its implementation in more centers to assess outcomes prospectively with a hybrid implementation research design.

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

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

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

The Development of a New International Generic Measure (EQ-HWB): Face Validity and Psychometric Stages in Argentina.

OBJECTIVES: This study aimed to present the face validity and psychometric stages performed in Spanish in Argentina, the only Spanish-speaking country of an international collaboration that undertook the construction of a new measure that can be used in economic evaluation across health, social care, and public health, the EQ EQ-HWB (EQ Health and Wellbeing). We also explored the relationship among 3-level version EQ-5D (EQ-5D-3L), 5-level version EQ-5D (EQ-5D-5L), and EQ-HWB. METHODS: Face validity was based on semistructured face to face interviews of a purposive sample to explore translatability of language and concepts of 97 candidate items, translated into Argentina Spanish. The psychometric evaluation using an online panel assessed the psychometric properties of 64 items that were carried forward (floor and ceiling effects, item correlations, known-group differences in relevant prespecified subgroups by the international and local teams, exploratory and confirmatory factor analysis, and item response theory). EQ-5D-3L, EQ-5D-5L, and EQ-HWB correlations were explored. RESULTS: In the face validity stage, 24 interviews with carers, general public, patients, and users of social services were included. Most items showed adequate face validity. In the psychometric assessment, 497 participants were recruited (64% reporting a long-term health condition). Most of the items showed adequate psychometrics in an Argentinian context. EQ-5D-3L and EQ-5D-5L had strong correlations, and EQ-HWB was moderately correlated to EQ visual analog scale. The Argentina team recommended 23 of the final 25 items. CONCLUSIONS: The assessment of Spanish items contributed to the overall development of EQ-HWB and helped inform the design of an internationally relevant 25-item and a short 9-item measure intended to be used in economic evaluations.

Implementing Strategies at the Workplace Level to Increase Colorectal Cancer Screening Uptake in Argentina: A Controlled Interrupted Time-series Study.

Colorectal cancer is the third most common neoplasm. The immunochemical fecal occult blood test (iFOBT) is recommended for screening. The worksite setting has great potential to deliver preventive interventions. We aimed to design and evaluate the feasibility and potential impact of a multicomponent strategy in a workplace [Internal Revenue Agency of the Province of Buenos Aires (ARBA from its acronym in Spanish "Agencia de Recaudación de Buenos Aires") in Argentina].We used a quasi-experimental research design, a controlled interrupted time-series (ITS). The study involved: (i) a preintervention period (July 2015-September 2018); and (ii) an intervention period (October 2018-February 2019). We used semi-structured interviews and focus groups to design the intervention and to ensure feasibility and implementability. We fitted segmented linear regression models to evaluate changes in the monthly rates per 10,000 tests done in ARBA employees and controlling for the proportion of tests done in non-ARBA workers. A total of 1,552 ARBA employees aged 50 or more participated. Overall, iFOBT mean uptake rates were 16 times higher in the intervened during the five-month intervention period, remaining statistically significant after adjusting by the proportion of tests done in the control group (P < 0.001). The effect was higher in women aged 50 to 59 years. Activities were suspended due to the COVID-19 pandemic. A multifaceted workplace-based intervention proved to be feasible and acceptable to increase the uptake of colorectal cancer screening in employees of Argentina. Achieving high implementation rates requires building a healthy relationship with the partner organization, adding their values and views, and establishing agreed-upon mechanisms. PREVENTION RELEVANCE: Employee-facing multifaceted worksite cancer screening interventions are a valuable means to increase knowledge and utilization of workers. The controlled ITS showed that colorectal cancer screening mean uptake rates were 16 times higher in the intervened versus the control population during the intervention period, particularly among women aged 50 to 75.

Multisite, mixed methods study to validate 10 maternal health system and policy indicators in Argentina, Ghana and India: a research protocol.

INTRODUCTION: Most efforts to assess maternal health indicator validity focus on measures of service coverage. Fewer measures focus on the upstream enabling environment, and such measures are typically not research validated. Thus, methods for validating system and policy-level indicators are not well described. This protocol describes original multicountry research to be conducted in Argentina, Ghana and India, to validate 10 indicators from the monitoring framework for the 'Strategies toward Ending Preventable Maternal Mortality' (EPMM). The overall aim is to improve capacity to drive and track progress towards achieving the priority recommendations in the EPMM strategies. This work is expected to contribute new knowledge on validation methodology and reveal important information about the indicators under study and the phenomena they target for monitoring. Validating the indicators in three diverse settings will explore the external validity of results. METHODS AND ANALYSIS: This observational study explores the validity of 10 indicators from the EPMM monitoring framework via seven discrete validation exercises that will use mixed methods: (1) cross-sectional review of policy data, (2) retrospective review of facility-level patient and administrative data and (3) collection of primary quantitative and qualitative cross-sectional data from health service providers and clients. There is a specific methodological approach and analytic plan for each indicator, directed by unique, relevant validation research questions. ETHICS AND DISSEMINATION: The protocol was approved by the Office of Human Research Administration at Harvard University in November 2019. Individual study sites received approval via local institutional review boards by January 2020 except La Pampa, Argentina, approved June 2020. Our dissemination plan enables unrestricted access and reuse of all published research, including data sets. We expect to publish at least one peer-reviewed publication per validation exercise. We will disseminate results at conferences and engage local stakeholders in dissemination activities in each study country.

Adaptation and implementation of the Batz guide for bedside advocacy in two hospitals.

BACKGROUND: The patients' guide by the Batz Patient Safety Foundation promotes patients' active participation in healthcare and a safe hospital experience. OBJECTIVE: The aim was to adapt the Spanish version of the guide to the local context and evaluate its acceptability from healthcare professionals' and patients' perspectives in two hospitals in Buenos Aires, Argentina. METHODS: This implementation study had a formative research phase to adapt the guide with input from individual interviews and focus group discussions. The intervention comprised training sessions for professionals on patient-centered care and use of the guide, the appointment of coordinators, and distribution of the guide. The adapted guide (section During Admission) was distributed in two hospitals. Before and after intervention, we administered surveys to explore acceptability, utility, and patient satisfaction. RESULTS: Findings from formative research showed that the Batz guide needed to be shortened and adapted to the local healthcare context Although professionals had agreed on the importance of clinical guidelines; after using the Batz guide, they found it complex and difficult to implement. Patients' satisfaction with healthcare before and after implementing the guide did not differ significantly. Best scores were found in items related to availability of nurses, staff competence and staff kindness. A 78% of patients found the Batz guide useful. CONCLUSION: It is of critical importance to adapt the guide to the local culture, pilot it, and provide training to promote its implementation, improving acceptability and utility.

Observations and reports of incidents of how birthing persons are treated during childbirth in two public facilities in Argentina.

OBJECTIVE: This study sought to estimate the frequency and types of mistreatment during childbirth and explore health professionals' opinions on barriers/facilitators to providing respectful childbirth care. METHODS: This prospective mixed-methods investigation consisted of direct observations of childbirth (n = 250), at-home surveys with birthing individuals (n = 45), and qualitative in-depth health staff interviews (n = 6), conducted between January and July 2019, in two public facilities in Argentina. Frequencies of clinical practices and mistreatment and 5% confidence intervals were calculated. A logistic regression analysis was also conducted to examine associations between mistreatment and covariates of interest, with P < 0.05 considered statistically significant. RESULTS: Overall, 61/250 (24.4%, confidence interval 19.6%-30.6%) observations recorded instances of mistreatment; 20/45 surveyed participants (44.4%) reported at least one episode of mistreatment. The most frequent perpetrators were physicians (35.6%), birth companions (24.4%), midwives (22.2%), and nurses (13.3%). Participants with lower educational attainment and those racialized as non-white had higher odds of being mistreated. Health providers reported that respectful childbirth is currently widely implemented due to authorities' and communities' awareness on respectful birth´s rights. CONCLUSION: Almost a quarter of birthing people were observed to suffer mistreatment - primarily verbal abuse - and 44.4% of surveyed individuals reported mistreatment. Future research is needed to determine how to ensure the provision of respectful childbirth care for all. A quarter of participants experienced mistreatment; mostly those with lower educational attainment and/or racialized as non-white. Further research on implementation of respectful childbirth is warranted.

[Formative research for the design and implementation of a strategy to increase colorectal cancer screening in the workplace in Argentina]. / Investigación formativa para el diseño e implementación de una estrategia para aumentar el rastreo de cáncer colorrectal en el ámbito laboral en Argentina.

The workplace has great potential to disseminate information and implement health promotion activities such as cancer prevention and early detection. Due to the challenges of deploying health interventions in this setting, formative studies are needed to adjust the design and implementation of successful strategies. To inform the intervention's design and implementation and improve the adherence rate to screening with fecal occult blood test in a workplace in Argentina, a formative study was conducted to identify potential barriers and facilitators. The formative study adopted a qualitative methodological design. Interviews were held with 10 individuals in charge of key areas in the institution where the main study was conducted, besides 8 focus groups with workers over 50 years of age. Challenges were identified at the institutional level for the intervention's implementation, such as workers' geographic dispersion and the complexity of the institution's flowchart, as well as at the population level, such as low knowledge about colorectal cancer and diagnostic tests and low risk perception. The facilitators featured the intervention's acceptability and the availability of human and material resources to proceed with the intervention, such as institutional communications channels for disseminating the information and logistics for distribution of diagnostic kits. The formative study allowed identifying resources and potential barriers that informed the intervention's design and implementation.

El ámbito laboral tiene un gran potencial para difundir información e implementar actividades de promoción de la salud, como la prevención y detección temprana del cáncer. Debido al desafío de implementar intervenciones sanitarias en este ámbito, se necesitan investigaciones formativas para adecuar el diseño y la implementación de las estrategias para que sean exitosas. Con el objetivo de informar el diseño e implementación de la intervención, para mejorar la tasa de adherencia al tamizaje con el test de sangre oculta en materia fecal, en un ámbito laboral en Argentina, se realizó una investigación formativa para identificar potenciales barreras y facilitadores. La investigación formativa siguió un diseño metodológico cualitativo. Se realizaron entrevistas con 10 responsables de áreas clave de la institución en que se desarrolló el estudio y 8 grupos focales con trabajadores mayores de 50 años. Se identificaron desafíos para la implementación de la intervención en el nivel institucional, como la dispersión geográfica de los trabajadores y la complejidad del organigrama de la institución, y en el nivel de la población objetivo, como el bajo conocimiento del cáncer colorrectal y de los test diagnósticos, así como la baja percepción de riesgo. Entre los facilitadores se destacaron la aceptabilidad de la intervención, además de la disponibilidad de recursos humanos y materiales para llevar adelante la intervención, como canales de comunicación institucional para la diseminación de información, así como la logística para la distribución de kits diagnósticos. La investigación formativa permitió relevar recursos e identificar potenciales barreras que informaron el diseño y la implementación de la intervención.

O local de trabalho possui grande potencial para divulgar informação e implementar atividades de promoção da saúde, como a prevenção e detecção precoce do câncer. Frente ao desafio de implementar ações sanitárias naquele ambiente, são necessárias pesquisas formativas para adequar a estruturação e a implementação das estratégias para que sejam bem-sucedidas. Com o objetivo de subsidiar a concepção e a implementação da ação, visando melhorar a taxa de aderência ao screening com o teste de sangue oculto nas fezes no ambiente de trabalho na Argentina, foi desenvolvida uma pesquisa formativa para identificar potenciais barreiras e facilitadores. A pesquisa formativa seguiu um formato metodológico qualitativo. Foram realizadas entrevistas com 10 gerentes de áreas chaves da entidade onde foi desenvolvido o estudo e 8 grupos focais, com trabalhadores acima de 50 anos de idade. Foram identificados alguns desafios para a implementação de uma ação em nível institucional, como a dispersão geográfica dos trabalhadores e a complexidade do organograma da entidade, e em termos de população objetiva, como o baixo conhecimento a respeito do câncer colorretal e dos testes diagnósticos, além da baixa percepção de risco. Entre os facilitadores, destacaram-se a aceitabilidade da ação e a disponibilidade de recursos humanos e materiais para levar a cabo a ação, como canais de comunicação institucional, para a divulgação da informação e a logística, para a distribuição dos kits diagnósticos. A pesquisa formativa revelou recursos e identificou potenciais barreiras, ajudando na estruturação e implementação da ação.

Theory-driven, rapid formative research on quality improvement intervention for critical care of patients with COVID-19 in Argentina.

The challenges of implementing interventions in healthcare settings have been more apparent during the COVID-19 pandemic. This pre-implementation evaluation used a rapid qualitative approach to explore barriers and facilitators to an intervention in intensive care units in Argentina, aimed to promote the use of personal protection equipment, provide emotional support for professionals, and achieve patient flow goals. Data were collected using semi-structured interviews with health professionals of 15 public hospitals in Argentina. Normalization Process Theory was used to guide content analysis of the data. Participants identified potential barriers such as the incorporation of non-specialist staff, shortage of resources, lack of communication between groups and shifts. Potential facilitators were also identified: regular feedback and communication related to implementation, adequate training for new and non-specialist staff, and incentives (e.g., scholarships). The immediacy of the pandemic demanded rapid qualitative research, sharing actionable findings in real time.

Comparison of EQ-5D Values Sets Among South American Countries.

OBJECTIVE: Social health preference sets are necessary for conducting health economic evaluations. Values from other countries are often used when local sets are not available, which may alter the results. We aimed to evaluate the degree of variability of currently available country-specific value sets of the EuroQol EQ-5D instrument from South American countries (SAC). METHODS: We selected EQ-5D value sets from SAC and 2 reference countries. We obtained crosswalk value sets for the countries that use the EQ-5D-3L instrument. We compared the value sets with the Kruskal-Wallis test and then carried out pairwise comparisons with the Sign test. We also assessed correlations among the countries' value sets using the Spearman test. We calculated the absolute difference across countries for each health state, considering a difference of greater than 0.05 relevant. RESULTS: The range of value sets varied greatly. The Peruvian value set had the widest range (1 to -1.076) and the lowest values (median: 0.055; interquartile range: -0.171 to 0.275). The Ecuadorian set had the highest values (median: 0.587; interquartile range: 0.443-0.704). The Peruvian value set also had the greatest proportion of health states (43.6%) with a negative value, and the Uruguayan set had the smallest proportion (0.9%). Differences among countries were significant in all cases, with the greatest difference between Ecuador and Peru (median difference: 0.495; 95% confidence interval: 0.515-0.528). CONCLUSION: Social health preference sets varied greatly among SAC. Using non-local values could distort resource allocation decisions; hence, we recommend that countries obtain and use local value sets.

The development of the WHO Labour Care Guide: an international survey of maternity care providers.

BACKGROUND: The partograph is the most commonly used labour monitoring tool in the world. However, it has been used incorrectly or inconsistently in many settings. In 2018, a WHO expert group reviewed and revised the design of the partograph in light of emerging evidence, and they developed the first version of the Labour Care Guide (LCG). The objective of this study was to explore opinions of skilled health personnel on the first version of the WHO Labour Care Guide. METHODS: Skilled health personnel (including obstetricians, midwives and general practitioners) of any gender from Africa, Asia, Europe and Latin America were identified through a large global research network. Country coordinators from the network invited 5 to 10 mid-level and senior skilled health personnel who had worked in labour wards anytime in the last 5 years. A self-administered, anonymous, structured, online questionnaire including closed and open-ended questions was designed to assess the clarity, relevance, appropriateness of the frequency of recording, and the completeness of the sections and variables on the LCG. RESULTS: A total of 110 participants from 23 countries completed the survey between December 2018 and January 2019. Variables included in the LCG were generally considered clear, relevant and to have been recorded at the appropriate frequency. Most sections of the LCG were considered complete. Participants agreed or strongly agreed with the overall design, structure of the LCG, and the usefulness of reference thresholds to trigger further assessment and actions. They also agreed that LCG could potentially have a positive impact on clinical decision-making and respectful maternity care. Participants disagreed with the value of some variables, including coping, urine, and neonatal status. CONCLUSIONS: Future end-users of WHO Labour Care Guide considered the variables to be clear, relevant and appropriate, and, with minor improvements, to have the potential to positively impact clinical decision-making and respectful maternity care.

Feasibility of Conducting a Trial Assessing Benefits and Risks of Planned Caesarean Section Versus Planned Vaginal Birth: A Cross-Sectional Study.

INTRODUCTION: Though interest is growing for trials comparing planned delivery mode (vaginal delivery [VD]; cesarean section [CS]) in low-risk nulliparous women, appropriate study design is unclear. Our objective was to assess feasibility of three designs (preference trial [PCT], randomized controlled trial [RCT], partially randomized patient preference trial [PRPPT]) for a trial comparing planned delivery mode in low-risk women. METHODS: A cross-sectional survey of low-risk, nulliparous pregnant women (N = 416) and healthcare providers (N = 168) providing prenatal care and/or labor/delivery services was conducted in Argentina (2 public, 2 private hospitals). Proportion of pregnant women and providers willing to participate in each design and reasons for not participating were determined. RESULTS: Few women (< 15%) or professionals (33.3%) would participate in an RCT, though more would participate in PCTs (88% women; 65.9% professionals) or PRPPTs (44.4% public, 63.4% private sector women; 44.0% professionals). However, most women would choose vaginal delivery in the PCT and PRPPT (> 85%). Believing randomization unacceptable (RCT, PRPPT) and desiring choice of delivery mode (RCT) were women's reasons for not participating. For providers, commonly cited reasons for not participating included unacceptability of performing CS without medical indication, difficulty obtaining informed consent, discomfort enrolling patients (all designs), and violating women's right to choose (RCT). CONCLUSIONS FOR PRACTICE: Important limitations were found for each trial design evaluated. The necessity of stronger evidence regarding delivery mode in low-risk women suggests consideration of additional designs, such as a rigorously designed cohort study or an RCT within an obstetric population with equivocal CS indications.