EVIPNet Americas: Overcoming barriers to integrate scientific evidence and health policies in the Americas

In response to the challenges created by the COVID-19 pandemic to the role of evidence in policymaking, the World Health Organization (WHO) in collaboration with the Pan American Health Organization (PAHO) convened the first Global Evidence-to-Policy (E2P) Summit.This summit brought together different stakeholders from all WHO Regions to identify common challenges, share lessons learned, and provide recommendations to support evidence-informed decisionmaking as a catalyst for policy and societal changes

Efectividad de las intervenciones digitales basadas en teléfonos móviles para la prevención de infecciones de transmisión sexual: protocolo de revisión sistemática / Effectiveness of digital interventions based on mobile phones for the prevention of sexually transmitted infections: A systematic review protocol

INTRODUCCIÓN Las infecciones de transmisión sexual, incluida el VIH, son un importante problema de salud pública. Cada día más de un millón de personas contraen una infección de transmisión sexual. Los sistemas de salud están buscando soluciones para mejorar la educación y lograr cambios en el comportamiento de las personas para prevenir infecciones de transmisión sexual. Las intervenciones digitales basadas en tecnologías móviles en salud (M-health), en especial las basadas en teléfonos móviles, podrían ser una importante herramienta en salud pública para la prevención de infecciones de transmisión sexual/VIH. Esta revisión sistemática resume la evidencia sobre la efectividad de las intervenciones basadas en teléfonos móviles para la prevención de infecciones de transmisión sexual/VIH. MÉTODOS Y ANÁLISIS El protocolo fue diseñado y será reportado en concordancia con la directriz "Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P)". Se incluirán ensayos controlados aleatorizados que evalúen el efecto de las intervenciones basadas en teléfonos móviles para la prevención de infecciones de transmisión sexual/VIH. Las intervenciones de interés serán aquellas dirigidas a usuarios de teléfonos móviles, basada en cualquier función o aplicación que pueda usarse o enviarse y que hayan sido diseñadas para educar, promocionar o modificar conductas para reducir comportamiento sexual de riesgo y prevención de infecciones de transmisión sexual incluyendo VIH. La búsqueda electrónica para identificar los estudios se realizará en el Registro Cochrane Central de ensayos controlados (CENTRAL), en EMBASE y MEDLINE/PubMed. Se evaluará el riesgo de sesgo utilizando la herramienta recomendada por la colaboración Cochrane. Se realizará metanálisis y se presentarán los datos mediante el método GRADE.

INTRODUCTION Sexually transmitted infections, including HIV, are an important public health problem. Every day, over one million persons become infected with a sexually transmitted infection (STI). Health systems are searching for solutions to improve sex education and change the sexual behavior of people in order to prevent them. In public health, digital interventions based on mobile health technologies (M-health), especially those based on mobile phones, might be a crucial tool for the prevention of STIs and HIV. This systematic will review and summarize the evidence on the effectiveness of mobile phone-based interventions for the prevention of STIs and HIV. METHODS AND ANALYSIS The protocol was designed and will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). The protocol will include randomized controlled trials that assess the effect of interventions based on mobile phones for the prevention of STIs/HIV. The interventions of interest will be those targeting mobile phone users and should consist of providing information by mobile phone through any function or application that can be used or sent to, and that has been designed to educate, promote or modify sexual behaviors and prevent STIs, including HIV. The data sources to identify these studies will be the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE and MEDLINE. The risk of bias will be assessed using the tool recommended by Cochrane. Finally, a meta-analysis will be done and data will be presented following the GRADE method.

When is a randomised controlled trial health equity relevant? Development and validation of a conceptual framework.

BACKGROUND: Randomised controlled trials can provide evidence relevant to assessing the equity impact of an intervention, but such information is often poorly reported. We describe a conceptual framework to identify health equity-relevant randomised trials with the aim of improving the design and reporting of such trials. METHODS: An interdisciplinary and international research team engaged in an iterative consensus building process to develop and refine the conceptual framework via face-to-face meetings, teleconferences and email correspondence, including findings from a validation exercise whereby two independent reviewers used the emerging framework to classify a sample of randomised trials. RESULTS: A randomised trial can usefully be classified as 'health equity relevant' if it assesses the effects of an intervention on the health or its determinants of either individuals or a population who experience ill health due to disadvantage defined across one or more social determinants of health. Health equity-relevant randomised trials can either exclusively focus on a single population or collect data potentially useful for assessing differential effects of the intervention across multiple populations experiencing different levels or types of social disadvantage. Trials that are not classified as 'health equity relevant' may nevertheless provide information that is indirectly relevant to assessing equity impact, including information about individual level variation unrelated to social disadvantage and potentially useful in secondary modelling studies. CONCLUSION: The conceptual framework may be used to design and report randomised trials. The framework could also be used for other study designs to contribute to the evidence base for improved health equity.

The Evidence-Informed Policy Network (EVIPNet) in Chile: lessons learned from a year of coordinated efforts

Informing the health policymaking process with the best available scientific evidence has become relevant to health systems globally. Knowledge Translation Platforms (KTP), such as the World Health Organization's Evidence Informed Policy Networks (EVIPNet), are a recognized strategy for linking research to action. This report describes the experience of implementing EVIPNet in Chile, from its objectives, organizational structure, strategy, activities, and main outputs, to its evolution over the course of its first year. Lessons learned are also covered. Of the activities initiated by EVIPNet-Chile, the Rapid Response Service proved to be a good starting point for engaging policymakers. Capacity building workshops and policy dialogues with relevant stakeholders were also successful. Additionally, EVIPNet-Chile developed a model for engaging academic institutions in policymaking through a network focused on preparing evidence briefs. A number of challenges, such as changing methods for producing rapid evidence syntheses, were also identified. This KTP implementation model located in a Ministry of Health could contribute to the development of similar initiatives in other health systems.

Protocol for the development of a CONSORT-equity guideline to improve reporting of health equity in randomized trials.

BACKGROUND: Health equity concerns the absence of avoidable and unfair differences in health. Randomized controlled trials (RCTs) can provide evidence about the impact of an intervention on health equity for specific disadvantaged populations or in general populations; this is important for equity-focused decision-making. Previous work has identified a lack of adequate reporting guidelines for assessing health equity in RCTs. The objective of this study is to develop guidelines to improve the reporting of health equity considerations in RCTs, as an extension of the Consolidated Standards of Reporting Trials (CONSORT). METHODS/DESIGN: A six-phase study using integrated knowledge translation governed by a study executive and advisory board will assemble empirical evidence to inform the CONSORT-equity extension. To create the guideline, the following steps are proposed: (1) develop a conceptual framework for identifying "equity-relevant trials," (2) assess empirical evidence regarding reporting of equity-relevant trials, (3) consult with global methods and content experts on how to improve reporting of health equity in RCTs, (4) collect broad feedback and prioritize items needed to improve reporting of health equity in RCTs, (5) establish consensus on the CONSORT-equity extension: the guideline for equity-relevant trials, and (6) broadly disseminate and implement the CONSORT-equity extension. DISCUSSION: This work will be relevant to a broad range of RCTs addressing questions of effectiveness for strategies to improve practice and policy in the areas of social determinants of health, clinical care, health systems, public health, and international development, where health and/or access to health care is a primary outcome. The outcomes include a reporting guideline (CONSORT-equity extension) for equity-relevant RCTs and a knowledge translation strategy to broadly encourage its uptake and use by journal editors, authors, and funding agencies.

Escoliosis en niños y adolescentes / Scoliosis in children and adolescents

La escoliosis es una deformidad de la columna que se presenta como una curva estructural que determina un grado variable de deformidad del tronco. La forma más común es la escoliosis idiopática del adolescente, que se desarrolla en la columna, en la fase de crecimiento y puede tener importantes efectos cosméticos y funcionales, pero es siempre un diagnóstico de exclusión. La escoliosis puede ser tratada con observación seriada, uso de ortesis o cirugía, según su magnitud y potencial evolución de severidad. Sin embargo, el comportamiento de la curva es frecuentemente difícil de predecir durante el desarrollo, por lo que el seguimiento clínico y radiológico seriado es clave en la decisión de tratamiento. Aparte de la cirugía, sólo el tratamiento con corset puede frenar la progresión de una curva, si bien no corregirla. Las curvas severas o que progresen dentro del corset tienen indicación de corrección y fusión quirúrgica. Las curvas noidiopáticas se comportan en forma diferente y su manejo es también distinto. El objetivo de este artículo es presentar los aspectos clave de la evaluación inicial de un paciente con escoliosis y entregar una visión actualizada del tratamiento de las distintas formas de presentación de esta afección.

Scoliosis is a structural deformity of the spine that can determine a varying degree of trunk deformity. It's most common presentation is that of Adolescent Idiopathic Scoliosis. This is a diagnosis of exclusion presenting itself in the growing spine and may result in significant cosmetic and functional effects. Depending on its severity, treatment may consist in serial observation, use of an orthosis or corrective surgery. Curve behaviour is however sometimes difficult to predict and clinical follow-up and serial radiographic review are fundamental during the developmental period. Aside from surgery, only brace treatment has demonstrated a capacity of containing curve progression for some cases. Severe curves or those that exhibit progression in spite of adequate brace treatment should be treated by surgical correction. Nonidiopathic forms of scoliosis present a different behaviour and require specific management. This article is to provides key aspects of the initial evaluation of a patient with scoliosis and offers an update on the management of it's most frequent forms of presentation.

Urinary parameters of Trichechus inunguis (Mammalia, Sirenia): reference values for the Amazonian Manatee.

The Amazonian manatee, Trichechus inunguis (Natterer 1883) is endemic to the Amazon Basin and is currently considered a vulnerable species. In order to establish normality ranges of urinary parameters to help monitor the health of this species in captivity, chemical urinalyses were performed on twelve males and nine females of various age groups. Urine was collected once a month for twelve months in the tanks just after being drained, by placing stainless steel containers under the genital slit of females and applying abdominal massages to males in order to stimulate urination. Quantitative data of glucose, urea, creatinine, uric acid and amylase levels were obtained using colorimetric spectrophotometry. Dip strips were also useful for routine analyses, despite only providing qualitative results. Normal range to glucose levels, regardless of sex or age class, was 3.0 to 3.6 mgxdL-1, coinciding with qualitative values of glucose measured by dip strips. Statistical differences observed in some parameter levels suggest that some urine parameters analysed must take into consideration the sex and the age class of the animal studied, being these differences less remarkable in creatinine and amylase levels. To this last one, statistical difference was detected only in the calve's urine (7.0 to 11.5 mgxdL-1) compared to other age classes samples (4.1 to 5.3 mgxdL-1). The results presented here may be used as comparative data in future research on urinalysis in related species.

Urinary parameters of Trichechus inunguis (Mammalia, Sirenia): reference values for the Amazonian Manatee / Parâmetros urinários de Trichechus Inunguis (Mammalia, Sirenia): valores-referência para o peixe-boi da Amazônia

The Amazonian manatee, Trichechus inunguis (Natterer 1883) is endemic to the Amazon Basin and is currently considered a vulnerable species. In order to establish normality ranges of urinary parameters to help monitor the health of this species in captivity, chemical urinalyses were performed on twelve males and nine females of various age groups. Urine was collected once a month for twelve months in the tanks just after being drained, by placing stainless steel containers under the genital slit of females and applying abdominal massages to males in order to stimulate urination. Quantitative data of glucose, urea, creatinine, uric acid and amylase levels were obtained using colorimetric spectrophotometry. Dip strips were also useful for routine analyses, despite only providing qualitative results. Normal range to glucose levels, regardless of sex or age class, was 3.0 to 3.6 mg.dL-1, coinciding with qualitative values of glucose measured by dip strips. Statistical differences observed in some parameter levels suggest that some urine parameters analysed must take into consideration the sex and the age class of the animal studied, being these differences less remarkable in creatinine and amylase levels. To this last one, statistical difference was detected only in the calve's urine (7.0 to 11.5 mg.dL-1) compared to other age classes samples (4.1 to 5.3 mg.dL-1). The results presented here may be used as comparative data in future research on urinalysis in related species.

O peixe-boi da Amazônia, Trichechus inunguis (Natterer 1883) é endêmico da Bacia Amazônica e é considerado atualmente como espécie vulnerável. Com o objetivo de estabelecer valores de normalidade para os parâmetros urinários com vistas a ajudar no monitoramento da saúde desta espécie em cativeiro, foi realizada urinálise química em doze machos e nove fêmeas de várias classes etárias. A urina era coletada uma vez por mês, durante doze meses, nos tanques, logo após esvaziamento, colocando-se coletores de aço inoxidável sob o orifício genital das fêmeas e aplicando massagem abdominal nos machos para estimular a micção. Dados quantitativos dos níveis de glicose, ureia, creatinina, ácido úrico e amilase foram obtidos por meio de espectrofotometria colorimétrica. O uso de tiras reativas também foi útil para análises de rotina, apesar de somente fornecerem resultados qualitativos. A faixa de normalidade para os níveis de glicose, independente de classe etária e sexo foi de 3,0 a 3,6 mg.dL-1, coincidindo com os valores qualitativos identificados pelas tiras reativas. Diferenças estatísticas observadas nos níveis de alguns parâmetros analisados sugerem que estes devem levar em consideração o sexo e a classe etária do animal estudado. Estas diferenças foram menos marcantes nos níveis de creatinina e de amilase, sendo que para esta última foi detectada diferença estatística apenas nas urinas de filhotes lactentes (7,0 a 11,5 mg.dL-1), em comparação às amostras das demais classes etárias (4,1 a 5,3 mg.dL-1). Os resultados aqui apresentados podem ser usados como dados comparativos em futuras pesquisas sobre urinálise em espécies relacionadas.

[Alcohol consumption in the adult population from the metropolitan region: prevalence and consumption modalities]. / Consumo de alcohol en población adulta de la región metropolitana: prevalencia y modalidad de consumo.

A representative sample from the adult population of metropolitan Santiago was surveyed for prevalence and modality of alcohol consumption. The "problem drinker" was identified according to the CAGE questionnaire. Socioeconomic situation was classified according to the method of Graffar. 70% of male and 50% of female drinkers consumed less than 400 ml of ethanol per month. Prevalence of drinking in males and females was: all categories 56.2 and 19.8%, regular drinkers 40.8 and 14.4%; heavy drinkers 4 and 0.82% and problem drinkers 12.4 and 1.5%, respectively. 85% were weekend drinkers, 11% consumed alcohol throughout the week. Males consumed mostly wine and mixed alcoholic beverages, females mostly the latter. In males, drinking was related to age and not to socioeconomic condition, except for problem drinkers who were mostly found in the low category. Females problem drinkers were found mostly in the high socioeconomic group. These data may be used in planing intervention strategies to prevent damage caused by alcohol consumption.