Critical route for development of medical student leadership competencies in 35 Pan American Health Organization member states: A scoping review and thematic analysis.

The Pan American Health Organization has been committed to training physicians in leadership competencies since 2008. However, four reviews on teaching leadership using competency-based education in undergraduate medical education (UME) identified only two of 35 MS: Canada and the USA. Previous reviews did not use a systemic approach or qualitative methodology to explore factors influencing leadership education. Therefore, this review aims to identify facilitating and inhibiting factors in teaching leadership in UME using a scoping review and thematic analysis. Six databases containing grey and indexed literature in English, Spanish, and Portuguese were searched, including a hand search and authors' consultations. Forty-eight documents out of 7849 were selected based on eligibility criteria. Braun and Clarke's thematic analysis guide was used, identifying eight themes: curriculum, intended learning outcomes, teaching methods, assessment, addressing barriers, supporting organisational change, building networks, and developing expertise. Considering these themes, the authors propose a critical route for teaching leadership in UME in the Americas. First, institutional design should consider governance gaps, such as having national and international policies for leadership training in UME with inter-professional, trans-professional, and citizen-focused approaches. There is a pressing need to provide leadership training for physicians and other professionals from government, academia, non-governmental organisations, hospitals, and national and international organisations whose missions are related to health or education. Networking opportunities for stakeholders in leadership education and teacher training is also essential. Second, instructional design reveals knowledge-do gaps in member states (MS) when incorporating leadership into the medical curriculum. This includes using leadership frameworks, defining learning outcomes, and employing assessment and monitoring tools for leadership education. Mechanisms to reduce these gaps in MS include the Equator Network and Evidence-Informed Policy Networks fostering knowledge translation and governance.

Parameters of body composition do not predict survival in patients with multiple myeloma undergoing autologous stem cell transplantation.

Studies regarding the influence of body composition parameters as predictors on overall survival (OS) in patients with multiple myeloma (MM) are scarce. OS and progression-free survival (PFS) were retrospectively assessed in 129 patients with MM undergoing autologous stem cell transplantation (ASCT) after a follow-up of 2 years. A computed tomography (CT) based semi-automated assessment of body composition was performed. No statistically significant differences were noted in 2-year OS, PFS, or post-transplant adverse events in the body composition groups of subcutaneous adipose tissue (SAT) (low vs. high-SAT), visceral adipose tissue (VAT) (low vs. high-VAT), visceral-to-subcutaneous fat ratio (VSR) (low vs. high VSR), and sarcopenia in terms of skeletal muscle index (SMI) (non-sarcopenic vs. sarcopenic). In conclusion, adipose and muscle tissue do not limit OS or affect the PFS in patients with MM undergoing ASCT.

Association between sacroiliac joint forms and subchondral changes in patients with Crohn's disease.

AIM: To assess the relationship between anatomical variants of sacroiliac joint (SIJ) and subchondral changes detected in magnetic resonance enterography (MRE) in patients with Crohn's disease (CD). METHODS: This was a retrospective study of 60 CD patients, who were divided into two groups: with (n = 16) and without SIJ (n = 44) involvement, depending on the presence of inflammatory (bone marrow edema) and structural changes (sclerosis and erosions) in MRE. Anatomical variants of SIJ were assessed in CT of the abdomen and/or pelvis, distinguishing typical form with convex iliac surface and atypical forms. Univariate and multivariate analyses were performed to reveal an association between joint changes and forms. RESULTS: Our study included 60 patients (38 males; mean age 38.72 years ± 13.33). Patients with SIJ changes were older (p = .044). No significant differences in CD localization and behavior were found. The most common SIJ lesions were structural changes (in 75% of patients); the main atypical form was the iliosacral complex. The univariate and multivariate analyses showed a significant association of atypical forms with total subchondral changes (odds ratio [OR]: 3.429, 95% confidence interval [CI] 1.043-11.268; p = .042; OR: 5.066, 95% CI: 1.273-20.167; p = .021, respectively), and with structural changes (OR: 4.185, 95% CI: 1.155-15.160; p = .029; OR: 5.986, 95% CI: 1.293-27.700; p = .022, respectively). CONCLUSION: Atypical forms of SIJ are a risk factor for the occurrence of structural joint changes in CD patients. An association between bone marrow edema and atypical forms was not found.

Training needs assessment tools for the public health workforce at an institutional and individual level: a review.

BACKGROUND: The public health workforce (PHW) needs to have the necessary capacities to provide healthcare services and public health services. Training needs assessments (TNA) is necessary to assess and understand PHW and their capacities to provide services. This review attempts to identify and describe published studies on tools and methodologies for TNA of the workforce used in public health and health-related fields. METHODS: A systematized review of literature was carried out in February 2022. Cochrane Handbook for systematic review version 5.2.0 and PRISMA 2020 statement were used to guide reporting. This review includes original research, reports and grey literature from the websites of public health organizations in English. RESULTS: This review included 38 documents for evidence synthesis. Twenty-seven documents were indexed literature (71%) and 11 were grey documents (29%). TNA documents were published between 1999 and 2022. TNA was performed in many countries around the world. The organizations used either a validated questionnaire or created their own tools to perform organizational and individual self-assessments. The TNA tools were developed using different methods such as expert panels, literature reviews, stakeholder interviews and quantitative surveys. CONCLUSION: TNA is useful for defining and characterizing the public health workforce in every organization. Workforces consist of individuals who have their own training needs to fulfill their tasks. Therefore, individual and organizational TNA should be combined to study the public health workforce and their capacities.

Professionalization of the public health workforce: scoping review and call to action.

BACKGROUND: The 'WHO-ASPHER Roadmap to Professionalizing the Public Health Workforce in the European Region' provides recommendations for strategic and systematic workforce planning around professionalization levers including: (i) competencies, (ii) training and education, (iii) formal organization, (iv) professional credentialing and (v) code of ethics and professional conduct as well as taxonomy and enumeration. It was based on a literature review till 2016. This scoping review aims to explore how the professionalization was documented in the literature between 2016 and 2022. METHODS: Following the Joanna Briggs Institute guidelines, we searched Medline via PubMed, Web of Science, ERIC via EBSCO and Google Scholar and included studies on professionalization levers. Four critical appraisal tools were used to assess qualitative, quantitative, mixed methods studies and grey literature. The PRISMA Extension for Scoping Reviews (PRISMA-ScR) was used for reporting. RESULTS: Eleven articles included in this review spanned 61 countries, targeting undergraduate, master's, doctoral degrees and continuing professional development. Most of these documents were reviews. About half provided a definition of the public health workforce; more than half covered the taxonomy and included information about competences, but the use of frameworks was sporadic and inconsistent. Formal organization and the necessity of a code of conduct for the public health workforce were acknowledged in only two studies. CONCLUSIONS: In spite of some efforts to professionalize the public health workforce, this process is fragmented and not fully recognized and supported. There is an urgent need to engage policymakers and stakeholders to prioritize investments in strengthening the public health workforce worldwide.

Divergence and Convergence of the Public Health Leadership Competency Framework Against Others in Undergraduate Medical Education: A Scoping Review.

Objective: The following scoping review is aimed at identifying leadership competency frameworks in Undergraduate Medical Education (UME) by analyzing the thematic scopes, target audiences, and methods involved. A further objective is to compare the frameworks against a standard framework. Methods: The authors extracted the thematic scope and methods of each framework based on the original author's formulations in each selected paper. The target audience was divided into three sections: UME, medical education, and beyond medical education. The frameworks were converged and diverged against the public health leadership competency framework. Results: Thirty-three frameworks covering thematic scopes such as refugees and migrants were identified. The most common methods to develop leadership frameworks were reviews and interviews. The courses targeted multiple disciplines including medicine and nurses. The identified competency frameworks have not converged among important domains of leadership such as systems thinking, political leadership, leading change, and emotional intelligence. Conclusion: There is a variety of frameworks that support leadership in UME. Nevertheless, they are not consistent in vital domains to face worldwide health challenges. Interdisciplinary and transdisciplinary leadership competency frameworks which address health challenges should be used in UME.

Parameters of body composition and creeping fat are associated with activity of Crohn's disease.

AIM: This study aimed at assessing body composition parameters, creeping fat (CrF), and Crohn's disease's (CD) activity based on the Magnetic Resonance Index of Activity (MaRIA). METHODS: 114 CD patients who underwent magnetic resonance enterography (MRE) between June 2010 and April 2020 were retrospectively assessed. The semi-automated body composition segmentation, the qualitative evaluation of CrF, and MaRIA were performed. Based on their MaRIA score, patients were divided into two groups: mild-to-moderate disease (MaRIA <11, n = 50) and severe disease (MaRIA ≥11, n = 64). MRE parameters were analyzed between both groups. Patients were dichotomized according to body composition categories and the presence of CrF. Univariate regression analyses were performed to investigate the association between dichotomized variables and severe disease. Significant variables were incorporated into the multivariate logistic regression model. RESULTS: The severe disease group exhibited higher serum C-reactive protein (CRP) levels compared to the mild-to-moderate disease group (p ≤0.001). In the mild-to-moderate disease group, a higher proportion of patients had a body mass index (BMI) ≥ 25 (kg/m2) (32.0%) compared to the severe disease group (16.5%) (p = 0.04). The subcutaneous adipose tissue index (SATI) was significantly higher in the mild-to-moderate disease group (p = 0.04). The visceral to subcutaneous adipose tissue (VAT/SAT) ratio tended to be higher in the severe disease group (p = 0.09). There was no significant difference between both groups regarding total adipose tissue index (TATI) (p = 0.10), visceral adipose tissue index (VATI) (p = 0.51), intramuscular adipose tissue index (IMATI) (p = 0.38), skeletal muscle index (SMI) (p = 0.83), and sarcopenia (p = 0.75). In the multivariate analysis, CrF was significantly associated with severe disease (odds ratio [OR] 11.50, 95% confidence interval [CI] 3.13-42.17; p ≤0.001). Additionally, a BMI ≥ 25 (kg/m2) was protective against severe disease (OR: 0.34, 95% CI 0.12-0.95; p = 0.04). CONCLUSION: CrF is significantly associated with CD activity.

Body Composition Predictors of Complicated Crohn's Disease.

BACKGROUND: High visceral adipose tissue (VAT) and creeping fat (CrF) in Crohn's disease (CD) have been widely recognized. The VAT to subcutaneous adipose tissue (SAT) ratio and sarcopenia have been associated with CD complications. Studies regarding the influence of body composition predictors on CD complications assessed with magnetic resonance enterography (MRE) are scarce. AIM: The aim of this study was to assess body composition parameters and CrF in opportunistic MRE as predictors of complicated CD. METHODS: This was a retrospective study of 114 patients with inflammatory (n = 54) and complicated (n = 60) CD. The semiautomated assessment of body composition and the qualitative evaluation of CrF were performed. RESULTS: Body composition parameters did not differ between both groups regarding the body mass index (p = 0.50), total adipose tissue index (TATI) (p = 0.14), subcutaneous adipose tissue index (SATI) (p = 0.17), visceral adipose tissue index (VATI) (p = 0.33), VAT/SAT ratio (p = 0.77), intramuscular adipose tissue (p = 0.64), skeletal muscle index (p = 0.22), and sarcopenia (p = 0.50). 47 strictures, 18 fistulae, and seven abscesses were identified. Fistulae were more likely to occur in patients with CrF (odds ratio [OR] 5.07, 95% confidence interval [CI] 1.76-14.56; p=<0.001) and high VAT/SAT ratio (OR: 3.82, 95% CI 1.34-10.85; p = 0.01). CONCLUSION: Body composition measurements in CD patients displayed no statistically significant difference between the groups of inflammatory and complicated disease. Nonetheless, CD patients stratified in the group of high VAT/SAT ratio and the presence of CrF should be recognized as risk groups for the occurrence of fistulae.

SARS-CoV-2 Drive/Walk-Thru screening centers in Colombia: The CoVIDA Project / Centros de tamizaje masivo para SARS COV-2 en Colombia: Proyecto CoVIDA

Abstract Objective: The CoVIDA project is a public-private collaboration led by Universidad de los Andes that contributed to the SARS-CoV-2 epidemiological surveillance in Bogotá and nearby municipalities. We aimed to describe the development and performance of the Drive/Walk-through free RT- PCR for SARS-CoV-2 testing strategy implemented by CoVIDA. Material and method: We performed a descriptive analysis of the characteristics and performance of the CoVIDA Drive/Walk-through testing centers. The model and the process indicators to assess the model's performance were based on international experiences and scientific literature. Two screening centers were imple mented in shopping centers in the north and south of Bogotá. We reported the number of tests taken, the number of positive tests, and the number of participants that used the model by the type of occupations. Results: In total, 36,689 nasopharyngeal RT-PCR tests for SARS-CoV-2 were performed with a 5.75% cumulative positivity. Process indicators showed an excellent performance and an important contribution in reducing barriers to access to testing. Conclusions: the CoVIDA Drive/Walk-through testing centers supported the epidemiological surveillance in asymptomatic or mild-symptomatic population in Bo gotá. Low and middle-income countries can use this model as a cost-effective and innovative solution strategy to intensify testing and help mitigate the pandemic.

Resumen Objetivo: El proyecto CoVIDA es una colaboración público-privada liderada por la Universidad de los Andes que contribuyó a la vigilancia epidemiológica del SARS-CoV-2 en Bogotá y municipios cercanos. Nuestro objetivo fue describir el desarrollo y rendimiento de la estrategia de tamizaje gratuito con RT-PCR mediante un modelo Drive/Walk through para SARS-CoV-2 implementado por CoVIDA. Materiales y métodos: Realizamos un análisis descriptivo de las características y desempeño de los centros de tamizaje Drive/Walk through de CoVIDA. El modelo y los indicadores de proceso para evaluar el desempeño del modelo se basaron en experiencias internacionales y la literatura científica. Se implementaron dos cen tros de tamizaje en centros comerciales del norte y sur de Bogotá. Se reportó la cantidad de pruebas tomadas, pruebas positivas y de participantes que utilizaron el modelo de acuerdo con el tipo de ocupaciones. Resultados : En total, se realizaron 36,689 pruebas RT-PCR nasofaríngeas para SARS-CoV-2 con una positividad acumulada del 5,75%. Los indicadores de proceso mostraron un excelente desempeño y una contribución importante en la reducción de las barreras de acceso a las pruebas. Conclusiones: los centros de tamizaje con modelo Drive/Walk through de CoVIDA apoyaron la vigilancia epidemiológica en población asintomática o con síntomas leves en Bogotá. Los países de ingresos bajos y medianos pueden utilizar este modelo como una estrategia innovadora y rentable para aumentar la realización de las pruebas y ayudar a mitigar la pandemia.

Leadership Competencies for Knowledge Translation in Public Health: A consensus study.

BACKGROUND: In 2010, 240 billion US dollars was invested worldwide to conduct research for health; unfortunately, 200 billion was misused in the production and reporting of the evidence researched. Universities could facilitate students to acquire leadership competencies to move well-conducted research findings into practical use; this could be an essential move to reduce the misuse of investment. METHODS: A literature review was done based on the Equator Network and Cochrane guidelines, followed by three Delphi rounds to select competencies. RESULTS: Eleven papers were analysed out of 1121 items and 39/78 identified competencies were prioritized to be presented in the Delphi. Four out of 12 participants accepted to be involved in this project, and 22 competencies reached consensus and stability after three rounds. This framework conceptualizes competencies as the knowledge, skills, attitudes and values. The competencies were framed in four domains: knowledge management, engage diverse others in public health initiatives, training and capacity building/change management and communication. CONCLUSION: This framework offers guidance to universities when instructing students with leadership competencies for KT. This project emphasizes that effective leadership should include personal conscience and self-determination values.

Progress in trial registration in Latin America and the Caribbean, 2007–2013 / Registro de ensaios clínicos na América Latina e no Caribe

This descriptive study identifies trends in clinical trial registration in the World Health Organization International Clinical Trial Registry Platform (ICTRP) for Latin America and the Caribbean (LAC), from 2007–2013, and provides adjusted estimates for registration rates by population and publications (2007–2011). Trends and data are presented by subregion and language in interactive graphs, including annual registration rates by population (2007–2011) and publications (LILACS and MEDLINE) listed in SCIENTI Network (Science and Technology Indicators). Of the 11 945 clinical trials involving LAC countries, 8 282 were in South America, with Brazil leading at 4 070 (49%); 2 421 in North and Central America, with Mexico leading at 1 886 (78%); and 1 242 in the Caribbean, with Puerto Rico leading at 857 (69%). After adjusting by population and publication rates Chile, Panama, Argentina, and Peru led registration rates per 1 million inhabitants. Variations in the number of trials per year are quite substantial. Clinical trial registration increased in a steady yet inconsistent way. The implementation of the Policy on Research for Health has been followed by an increase in countries that require registration and have established clinical trial registries. However, there is room for improvement in adherence throughout LAC. Trial registration is offered gratis by Brazilian, Cuban, Peruvian, and United States registries, among others.

Estudo descritivo que identifica as tendências no registro de ensaios clínicos na Plataforma Internacional de Registro de Ensaios Clínicos (ICTRP) da Organização Mundial da Saúde (OMS) para América Latina e Caribe de 2007 a 2013, e apresenta estimativas ajustadas dos índices de registro por população e publicação (2007–2011). As tendências e os dados são apresentados por sub-região e idioma em gráficos interativos, incluindo os índices anuais de registro por população (2007–2011) e publicação (LILACS e MEDLINE) listada na SCIENTI Network (Science and Technology Indicators). Dos 11.945 ensaios clínicos realizados nos países da América Latina e Caribe, 8.282 foram conduzidos na América do Sul, na sua maioria (4.070) no Brasil (49%), 2.421 nas Américas Central e do Norte, na maior parte (1.886) no México (78%), e 1.242 no Caribe, em maior número (857) em Porto Rico (69%). Após o ajuste por população e publicação, Chile, Panamá, Argentina e Peru apresentaram os maiores índices de registro por 1 milhão de habitantes. A variação no número anual de estudos é bastante considerável. Verificou-se um crescimento estável, porém inconsistente, no registro de ensaios clínicos. Com a implementação da Política para pesquisa em saúde, aumentou o número de países em que o registro de ensaios clínicos é exigido e que implantaram registros próprios. No entanto, é possível melhorar ainda mais a adesão na América Latina e Caribe visto que este registro é gratuito no Brasil, Cuba, Peru e nos Estados Unidos, entre outros.

Progress in trial registration in Latin America and the Caribbean, 2007-2013.

This descriptive study identifies trends in clinical trial registration in the World Health Organization International Clinical Trial Registry Platform (ICTRP) for Latin America and the Caribbean (LAC), from 2007-2013, and provides adjusted estimates for registration rates by population and publications (2007-2011). Trends and data are presented by subregion and language in interactive graphs, including annual registration rates by population (2007-2011) and publications (LILACS and MEDLINE) listed in SCIENTI Network (Science and Technology Indicators). Of the 11 945 clinical trials involving LAC countries, 8 282 were in South America, with Brazil leading at 4 070 (49%); 2 421 in North and Central America, with Mexico leading at 1 886 (78%); and 1 242 in the Caribbean, with Puerto Rico leading at 857 (69%). After adjusting by population and publication rates Chile, Panama, Argentina, and Peru led registration rates per 1 million inhabitants. Variations in the number of trials per year are quite substantial. Clinical trial registration increased in a steady yet inconsistent way. The implementation of the Policy on Research for Health has been followed by an increase in countries that require registration and have established clinical trial registries. However, there is room for improvement in adherence throughout LAC. Trial registration is offered gratis by Brazilian, Cuban, Peruvian, and United States registries, among others.

En este estudio descriptivo se establecen las tendencias en cuanto al registro de ensayos clínicos en la Plataforma de Registros Internacionales de Ensayos Clínicos (ICTRP) de la Organización Mundial de la Salud (OMS) en América Latina y el Caribe en el período 2007-2013, y se incluyen cálculos ajustados de las tasas de registro por población y por publicaciones (2007-2011). Las tendencias y los datos se presentan por subregiones e idiomas en gráficos interactivos, y además se incluyen las tasas anuales de registro por población (2007-2011) y publicaciones (LILACS y MEDLINE) que figuran en la Red ScienTi (indicadores de ciencia y tecnología). De los 11 945 ensayos clínicos realizados en países de América Latina y el Caribe, 8 282 tuvieron lugar en América del Sur, en donde Brasil lleva la delantera con 4 070 (49 %); 2 421 se realizaron en América del Norte y Centroamérica, donde México se ubica en primer lugar con 1 886 (78 %), y 1 242 se realizaron en el Caribe, donde la mayoría de los ensayos fueron en Puerto Rico, con un número de 857 (69 %). Después de ajustar las tasas por población y publicaciones, Chile, Panamá, Argentina y Perú tuvieron las tasas más altas de registro por 1 millón de habitantes. Hubo amplias variaciones en el número de ensayos clínicos por año.El registro de ensayos clínicos aumentó de manera constante, aunque no uniforme. La ejecución de la Política de investigación para la salud de la Organización Panamericana de la Salud (OPS) llevó a un aumento del número de países que han establecido registros de ensayos clínicos y que requieren que se realice este registro. Sin embargo, podría mejorarse la observancia de esa política en América Latina y el Caribe en su totalidad. El registro de ensayos es gratuito en Brasil, Cuba, Estados Unidos y Perú.

Estudo descritivo que identifica as tendências no registro de ensaios clínicos na Plataforma Internacional de Registro de Ensaios Clínicos (ICTRP) da Organização Mundial da Saúde (OMS) para América Latina e Caribe de 2007 a 2013, e apresenta estimativas ajustadas dos índices de registro por população e publicação (2007­2011). As tendências e os dados são apresentados por sub-região e idioma em gráficos interativos, incluindo os índices anuais de registro por população (2007­2011) e publicação (LILACS e MEDLINE) listada na SCIENTI Network (Science and Technology Indicators). Dos 11.945 ensaios clínicos realizados nos países da América Latina e Caribe, 8.282 foram conduzidos na América do Sul, na sua maioria (4.070) no Brasil (49%), 2.421 nas Américas Central e do Norte, na maior parte (1.886) no México (78%), e 1.242 no Caribe, em maior número (857) em Porto Rico (69%). Após o ajuste por população e publicação, Chile, Panamá, Argentina e Peru apresentaram os maiores índices de registro por 1 milhão de habitantes. A variação no número anual de estudos é bastante considerável.Verificou-se um crescimento estável, porém inconsistente, no registro de ensaios clínicos. Com a implementação da Política para pesquisa em saúde, aumentou o número de países em que o registro de ensaios clínicos é exigido e que implantaram registros próprios. No entanto, é possível melhorar ainda mais a adesão na América Latina e Caribe visto que este registro é gratuito no Brasil, Cuba, Peru e nos Estados Unidos, entre outros.

Progress in trial registration in Latin America and the Caribbean, 2007-2013 / Registro de ensayos clínicos en América Latina y el Caribe / Registro de ensaios clínicos na América Latina e no Caribe

ABSTRACT This descriptive study identifies trends in clinical trial registration in the World Health Organization International Clinical Trial Registry Platform (ICTRP) for Latin America and the Caribbean (LAC), from 2007-2013, and provides adjusted estimates for registration rates by population and publications (2007-2011). Trends and data are presented by subregion and language in interactive graphs, including annual registration rates by population (2007-2011) and publications (LILACS and MEDLINE) listed in SCIENTI Network (Science and Technology Indicators). Of the 11 945 clinical trials involving LAC countries, 8 282 were in South America, with Brazil leading at 4 070 (49%); 2 421 in North and Central America, with Mexico leading at 1 886 (78%); and 1 242 in the Caribbean, with Puerto Rico leading at 857 (69%). After adjusting by population and publication rates Chile, Panama, Argentina, and Peru led registration rates per 1 million inhabitants. Variations in the number of trials per year are quite substantial. Clinical trial registration increased in a steady yet inconsistent way. The implementation of the Policy on Research for Health has been followed by an increase in countries that require registration and have established clinical trial registries. However, there is room for improvement in adherence throughout LAC. Trial registration is offered gratis by Brazilian, Cuban, Peruvian, and United States registries, among others.

RESUMEN En este estudio descriptivo se establecen las tendencias en cuanto al registro de ensayos clínicos en la Plataforma de Registros Internacionales de Ensayos Clínicos (ICTRP) de la Organización Mundial de la Salud (OMS) en América Latina y el Caribe en el período 2007-2013, y se incluyen cálculos ajustados de las tasas de registro por población y por publicaciones (2007-2011). Las tendencias y los datos se presentan por subregiones e idiomas en gráficos interactivos, y además se incluyen las tasas anuales de registro por población (2007-2011) y publicaciones (LILACS y MEDLINE) que figuran en la Red ScienTi (indicadores de ciencia y tecnología). De los 11 945 ensayos clínicos realizados en países de América Latina y el Caribe, 8 282 tuvieron lugar en América del Sur, en donde Brasil lleva la delantera con 4 070 (49 %); 2 421 se realizaron en América del Norte y Centroamérica, donde México se ubica en primer lugar con 1 886 (78 %), y 1 242 se realizaron en el Caribe, donde la mayoría de los ensayos fueron en Puerto Rico, con un número de 857 (69 %). Después de ajustar las tasas por población y publicaciones, Chile, Panamá, Argentina y Perú tuvieron las tasas más altas de registro por 1 millón de habitantes. Hubo amplias variaciones en el número de ensayos clínicos por año. El registro de ensayos clínicos aumentó de manera constante, aunque no uniforme. La ejecución de la Política de investigación para la salud de la Organización Panamericana de la Salud (OPS) llevó a un aumento del número de países que han establecido registros de ensayos clínicos y que requieren que se realice este registro. Sin embargo, podría mejorarse la observancia de esa política en América Latina y el Caribe en su totalidad. El registro de ensayos es gratuito en Brasil, Cuba, Estados Unidos y Perú.

RESUMO Estudo descritivo que identifica as tendências no registro de ensaios clínicos na Plataforma Internacional de Registro de Ensaios Clínicos (ICTRP) da Organização Mundial da Saúde (OMS) para América Latina e Caribe de 2007 a 2013, e apresenta estimativas ajustadas dos índices de registro por população e publicação (2007-2011). As tendências e os dados são apresentados por sub-região e idioma em gráficos interativos, incluindo os índices anuais de registro por população (2007-2011) e publicação (LILACS e MEDLINE) listada na SCIENTI Network (Science and Technology Indicators). Dos 11.945 ensaios clínicos realizados nos países da América Latina e Caribe, 8.282 foram conduzidos na América do Sul, na sua maioria (4.070) no Brasil (49%), 2.421 nas Américas Central e do Norte, na maior parte (1.886) no México (78%), e 1.242 no Caribe, em maior número (857) em Porto Rico (69%). Após o ajuste por população e publicação, Chile, Panamá, Argentina e Peru apresentaram os maiores índices de registro por 1 milhão de habitantes. A variação no número anual de estudos é bastante considerável. Verificou-se um crescimento estável, porém inconsistente, no registro de ensaios clínicos. Com a implementação da Política para pesquisa em saúde, aumentou o número de países em que o registro de ensaios clínicos é exigido e que implantaram registros próprios. No entanto, é possível melhorar ainda mais a adesão na América Latina e Caribe visto que este registro é gratuito no Brasil, Cuba, Peru e nos Estados Unidos, entre outros.

Analysis of registered cancer clinical trials in Latin America and the Caribbean, 2007-2013.

Objective To characterize cancer clinical trials in Latin America and the Caribbean (LAC), with a focus on registration and enrollment trends. Methods Data were collected from 1 285 active cancer clinical trials registered up until 31 May 2014 in the World Health Organization's International Clinical Trial Registry Platform (ICTRP). The trials were categorized by six characteristics of the continuum of cancer control and care: 1) control and planning, 2) prevention, 3) detection and screening, 4) diagnosis, 5) treatment, and 6) survivorship and palliative care. The search strategy protocol included the use of optimized keywords combined with the names of the 43 countries selected for a descriptive analysis. Results A total of 973 registered and 972 enrolled cancer clinical trials between January 2007 and December 2013 were identified. Trends of growth were observed for both registration and enrollment of cancer treatment clinical trials; for other types of cancer clinical trials, trends for registration and enrollment varied in direction. Conclusions Growth trends in the registration of cancer treatment clinical trials indicate incremental adherence to cancer research reporting and improvements in cancer research transparency. The higher proportion of cancer treatment trials versus other types of cancer clinical trials indicates an imbalance in cancer research in the LAC region and suggests the need for more funding and incentives for other areas of research in order to achieve a more comprehensive approach to gaining knowledge on cancer issues.

Knowledge, attitudes and practices of prevention for cervical cancer and breast cancer among medical students / Encuesta CAP a estudiantes de medicina para prevención del cáncer de mama y cuello uterino

Objective To assess the knowledge, attitudes and practices of medical students for health promotion, primary prevention and early detection of breast neoplasm and uterine cervical neoplasm, as well as to make recommendations for improving the Public Health curriculum at the Universidad de los Andes. Methodology This study utilized a survey of medical knowledge, attitudes and practices applied to fifth year Colombian medical students attending the Universidad de los Andes in the first semester of 2013. Results 64/76 students answered the surveys (response rate 84.2 %): 62.5% (40/64) and 37.5 % (24/64) response rates from students in their ninth and tenth semesters, respectively; and 64.1 % (41/64) and 35.9 % (23/64) response rates from female and male students, respectively. Knowledge: clinical breast exam (CBE), breast self-examination (BSE) and mammography were recommended by 95.3 % (61/64) of students, 96.9 % (62/64) of medical students and 90.7 % (58/64) of students, respectively. Attitude: the most effective tests to reduce mortality in women aged ≥ 50 years were the Papanicolaou test according to 90.6% (58/64) of students and mammography according to 82.8% (53/64) of students. Practice: 55.0% (35/64) of students had received training in the guidelines and protocols for breast neoplasm and uterine cervical neoplasm screening. Discussion To promote early detection of cervical and breast cancer, knowledge, attitudes and practices must be improved to enhance clinical practices (e.g. Papanicolaou test) and medical student training guidelines or protocols for these two cancers. Overall, with induced demand and support from research communities and institutions seeking to make these improvements, we collaborate to decrease missed opportunities in medical research and Public Health.(AU)

Objetivo Evaluar el conocimiento, actitudes y prácticas (CAP) de los estudiantes de medicina para prevención de neoplasia de la mama y neoplasia del cuello uterino, así mismo el estudio proveerá recomendaciones para mejorar el currículo de las clases de salud pública. Metodología El estudio empleo una encuesta CAP aplicada a estudiantes de quinto año de medicina de la Universidad de los Andes en el primer semestre del año 2013. Resultados Del total de 76 estudiantes 64 contestaron la encuesta. Estudiantes de noveno semestre 62.5 % (40/64) y de decimo semestre 37.5 % (24/64). Género: Femenino 64,1 % (41/64) y masculino 35,9 % (23/64). Conocimiento: El examen clínico de seno fue recomendado por los estudiantes un 95,3 % (61/64), el auto examen de seno 96.9 % (62/64) y la mamografía 90.7 % (58/64). Actitudes: Los exámenes más efectivos para reducir la mortalidad en mujeres ≥ 50 años fueron la prueba de Papanicolaou 90,6 % (58/64) y la mamografía 82,8 % (53/64). Practica: 55,0 % (35/64) de los estudiantes han recibido entrenamiento en guías de manejo o protocolos para el tamizaje de neoplasia de seno y neoplasia de cuello uterino. Discusión Con el fin de realizar detección temprana en cáncer se deben mejorar las destrezas, el conocimiento y el entrenamiento ¿en cuanto a demanda inducida, búsqueda activa tanto comunitaria como institucional y disminución de oportunidades perdidas relacionadas con Salud Publica. Adicionalmente, es importante mejorar la práctica clínica relacionada con el examen de Papanicolaou y entrenamiento sobre guías clínicas y protocolos para estos tipos de cáncer.(AU)

Analysis of registered cancer clinical trials in Latin America and the Caribbean, 2007-2013 / Análisis de los ensayos clínicos sobre el cáncer registrados en América Latina y el Caribe del 2007 al 2013

ABSTRACT Objective To characterize cancer clinical trials in Latin America and the Caribbean (LAC), with a focus on registration and enrollment trends. Methods Data were collected from 1 285 active cancer clinical trials registered up until 31 May 2014 in the World Health Organization’s International Clinical Trial Registry Platform (ICTRP). The trials were categorized by six characteristics of the continuum of cancer control and care: 1) control and planning, 2) prevention, 3) detection and screening, 4) diagnosis, 5) treatment, and 6) survivorship and palliative care. The search strategy protocol included the use of optimized keywords combined with the names of the 43 countries selected for a descriptive analysis. Results A total of 973 registered and 972 enrolled cancer clinical trials between January 2007 and December 2013 were identified. Trends of growth were observed for both registration and enrollment of cancer treatment clinical trials; for other types of cancer clinical trials, trends for registration and enrollment varied in direction. Conclusions Growth trends in the registration of cancer treatment clinical trials indicate incremental adherence to cancer research reporting and improvements in cancer research transparency. The higher proportion of cancer treatment trials versus other types of cancer clinical trials indicates an imbalance in cancer research in the LAC region and suggests the need for more funding and incentives for other areas of research in order to achieve a more comprehensive approach to gaining knowledge on cancer issues.

RESUMEN Objetivo Caracterizar los ensayos clínicos sobre el cáncer realizados en América Latina y el Caribe, con especial atención en las tendencias del registro y la incorporación de pacientes. Métodos Se recogieron datos de 1285 ensayos clínicos activos sobre cáncer, registrados del 1° de enero del 2007 al 31 de mayo del 2014 en la Plataforma de Registros Internacionales de Ensayos Clínicos (ICTRP) de la Organización Mundial de la Salud. Los ensayos se clasificaron según seis características del espectro continuo del control y la atención del cáncer, a saber: 1) control y planificación, 2) prevención, 3) detección y tamizaje, 4) diagnóstico, 5) tratamiento y 6) supervivencia y cuidados paliativos. El protocolo de la estrategia de búsqueda incluyó la utilización de palabras clave optimizadas, asociadas con los nombres de los 43 países seleccionados para un análisis descriptivo. Resultados Se encontraron 973 ensayos clínicos registrados y 972 ensayos con pacientes incorporados de enero del 2007 a diciembre del 2013. Se observó una tendencia creciente en el crecimiento del registro y la incorporación de pacientes en los ensayos clínicos de tratamiento; las tendencias del registro y la incorporación en los demás tipos de ensayos clínicos sobre cáncer revelaron direcciones diversas. Conclusiones La tendencia creciente del registro de los ensayos clínicos de tratamiento del cáncer indica un cumplimiento progresivo de la notificación de las investigaciones sobre este tema y un adelanto en materia de transparencia. La mayor proporción de ensayos sobre tratamiento, en comparación con los otros tipos de ensayos clínicos sobre cáncer, pone de manifiesto un desequilibrio de la investigación sobre el cáncer en América Latina y el Caribe y destaca la necesidad de aumentar el financiamiento y mejorar los incentivos en otras esferas de la investigación, a fin de lograr una estrategia más integral que permita ampliar los conocimientos sobre los diferentes aspectos del cáncer.

Analysis of registered cancer clinical trials in Latin America and the Caribbean, 2007–2013 / Análisis de los ensayos clínicos sobre el cáncer registrados en América Latina y el Caribe del 2007 al 2013

Objective. To characterize cancer clinical trials in Latin America and the Caribbean (LAC), with a focus on registration and enrollment trends. Methods. Data were collected from 1 285 active cancer clinical trials registered up until 31 May 2014 in the World Health Organization’s International Clinical Trial Registry Platform (ICTRP). The trials were categorized by six characteristics of the continuum of cancer control and care: 1) control and planning, 2) prevention, 3) detection and screening, 4) diagnosis, 5) treatment, and 6) survivorship and palliative care. The search strategy protocol included the use of optimized keywords combined with the names of the 43 countries selected for a descriptive analysis. Results. A total of 973 registered and 972 enrolled cancer clinical trials between January 2007 and December 2013 were identified. Trends of growth were observed for both registration and enrollment of cancer treatment clinical trials; for other types of cancer clinical trials, trends for registration and enrollment varied in direction. Conclusions. Growth trends in the registration of cancer treatment clinical trials indicate incremental adherence to cancer research reporting and improvements in cancer research transparency. The higher proportion of cancer treatment trials versus other types of cancer clinical trials indicates an imbalance in cancer research in the LAC region and suggests the need for more funding and incentives for other areas of research in order to achieve a more comprehensive approach to gaining knowledge on cancer issues.

Objetivo. Caracterizar los ensayos clínicos sobre el cáncer realizados en América Latina y el Caribe, con especial atención en las tendencias del registro y la incorporación de pacientes. Métodos. Se recogieron datos de 1285 ensayos clínicos activos sobre cáncer, registrados del 1° de enero del 2007 al 31 de mayo del 2014 en la Plataforma de Registros Internacionales de Ensayos Clínicos (ICTRP) de la Organización Mundial de la Salud. Los ensayos se clasificaron según seis características del espectro continuo del control y la atención del cáncer, a saber: 1) control y planificación, 2) prevención, 3) detección y tamizaje, 4) diagnóstico, 5) tratamiento y 6) supervivencia y cuidados paliativos. El protocolo de la estrategia de búsqueda incluyó la utilización de palabras clave optimizadas, asociadas con los nombres de los 43 países seleccionados para un análisis descriptivo. Resultados. Se encontraron 973 ensayos clínicos registrados y 972 ensayos con pacientes incorporados de enero del 2007 a diciembre del 2013. Se observó una tendencia creciente en el crecimiento del registro y la incorporación de pacientes en los ensayos clínicos de tratamiento; las tendencias del registro y la incorporación en los demás tipos de ensayos clínicos sobre cáncer revelaron direcciones diversas. Conclusiones. La tendencia creciente del registro de los ensayos clínicos de tratamiento del cáncer indica un cumplimiento progresivo de la notificación de las investigaciones sobre este tema y un adelanto en materia de transparencia. La mayor proporción de ensayos sobre tratamiento, en comparación con los otros tipos de ensayos clínicos sobre cáncer, pone de manifiesto un desequilibrio de la investigación sobre el cáncer en América Latina y el Caribe y destaca la necesidad de aumentar el financiamiento y mejorar los incentivos en otras esferas de la investigación, a fin de lograr una estrategia más integral que permita ampliar los conocimientos sobre los diferentes aspectos del cáncer.

Knowledge, attitudes and practices of prevention for cervical cancer and breast cancer among medical students.

Objective To assess the knowledge, attitudes and practices of medical students for health promotion, primary prevention and early detection of breast neoplasm and uterine cervical neoplasm, as well as to make recommendations for improving the Public Health curriculum at the Universidad de los Andes. Methodology This study utilized a survey of medical knowledge, attitudes and practices applied to fifth year Colombian medical students attending the Universidad de los Andes in the first semester of 2013. Results 64/76 students answered the surveys (response rate 84.2 % ): 62.5 % (40/64) and 37.5 % (24/64) response rates from students in their ninth and tenth semesters, respectively; and 64.1 % (41/64) and 35.9 % (23/64) response rates from female and male students, respectively. Knowledge: clinical breast exam (CBE), breast self-examination (BSE) and mammography were recommended by 95.3 % (61/64) of students, 96.9 % (62/64) of medical students and 90.7 % (58/64) of students, respectively. Attitude: the most effective tests to reduce mortality in women aged ≥ 50 years were the Papanicolaou test according to 90.6 % (58/64) of students and mammography according to 82.8 % (53/64) of students. Practice: 55.0 % (35/64) of students had received training in the guidelines and protocols for breast neoplasm and uterine cervical neoplasm screening. Discussion To promote early detection of cervical and breast cancer, knowledge, attitudes and practices must be improved to enhance clinical practices (e.g. Papanicolaou test) and medical student training guidelines or protocols for these two cancers. Overall, with induced demand and support from research communities and institutions seeking to make these improvements, we collaborate to decrease missed opportunities in medical research and Public Health.