[Mapping of research protocols, publications, and collaborations on COVID-19 in Latin America and the CaribbeanMapeamento de protocolos de pesquisa, publicações e colaborações sobre COVID-19 na América Latina e no Caribe]. / Mapeo de protocolos de investigación, publicaciones y colaboraciones sobre la COVID-19 en América Latina y el Caribe.

Objective: To map research protocols, publications, and collaborations on coronavirus disease 2019 (COVID-19) developed in Latin America and the Caribbean (LAC). Methods: Included were research protocols registered in international platforms and research publications containing populations, data, or authors from LAC. The source of information for protocols was primarily the International Clinical Trial Registry Platform (ICTRP) of the World Health Organization; for publications, specific electronic databases and repositories pertaining to COVID-19 were used. The search for publications was conducted up to 11 November; the search for protocols, up to 30 November 2020 (both dates inclusive). Data was extracted from protocols using standardized variables from the ICTRP, and from publications following pre-established criteria. Results: Among the protocols, 63.0% were therapeutic studies, 10% focused on prevention, and 45% were collaborative; 64% of the protocols received no funding from industry; 23% of the publications were not peer-reviewed and 23% were collaborative in nature. The most frequent study designs were systematic reviews and cross-sectional studies; 47.1% of studies were conducted in health facilities and 22% in community settings; 38.0% focused on diagnosis and 27.9% on prognosis. A qualitative synthesis was performed by line of care and approach strategies. Conclusions: There was an increase in the number of collaborative research studies relative to earlier studies and in protocols not funded by industry. The proposed research agenda was covered in large part as the pandemic unfolded.

Objetivo: Mapear protocolos de pesquisa, publicações e colaborações sobre a doença causada pelo coronavírus 2019 (COVID-19, na sigla em inglês) desenvolvidos na América Latina e no Caribe (ALC). Métodos: Foram incluídos protocolos registrados em plataformas internacionais e publicações de pesquisas que consideraram população, dados e autores da ALC. A fonte de informação para os protocolos foi principalmente a Plataforma Internacional de Registros de Ensaios Clínicos (ICTRP, na sigla em inglês) da Organização Mundial da Saúde. Para as publicações, foram utilizadas bases de dados eletrônicas e repositórios específicos sobre COVID-19. As publicações foram pesquisadas até 11 de novembro, e os protocolos, até 30 de novembro de 2020 (inclusive). As informações dos protocolos foram extraídas de acordo com variáveis padronizadas da plataforma ICTRP e das publicações, segundo critérios pré-estabelecidos. Resultados: Dos protocolos, 63% eram estudos sobre terapias, 10% sobre prevenção e 45% eram colaborativos. Em relação ao financiamento, 64% dos protocolos não vieram da indústria. Em relação às publicações, 23% eram sem revisão por pares e 23% eram colaborativas. Os delineamentos mais frequentes foram revisões sistemáticas e estudos transversais; 47,1% foram realizados em serviços de saúde e 22% no âmbito comunitário; 38,0% focaram no diagnóstico e 27,9% no prognóstico. Realizou-se uma síntese qualitativa segundo a linha de cuidado e as estratégias de abordagem. Conclusões: Observou-se um aumento no número de pesquisas colaborativas (em comparação com estudos anteriores) e de protocolos não financiados pela indústria. A agenda de pesquisa proposta foi coberta, em grande parte, à medida que a pandemia progredia.

Mapeo de protocolos de investigación, publicaciones y colaboraciones sobre la COVID-19 en América Latina y el Caribe

[RESUMEN]. Objetivo. Mapear protocolos de investigación, publicaciones y colaboraciones sobre la enfermedad por el coronavirus 2019 (COVID-19, por su sigla en inglés) desarrollados en América Latina y el Caribe (ALC). Métodos. Se incluyeron protocolos registrados en plataformas internacionales y publicaciones de investigaciones que consideraron población, datos y autores de ALC. La fuente de información para los protocolos fue principalmente la Plataforma Internacional de Registro de Ensayos Clínicos (ICTRP, por su sigla en inglés) de la Organización Mundial de la Salud; para las publicaciones se utilizaron bases electrónicas y repositorios específicos sobre la COVID-19. Se realizaron búsquedas de las publicaciones hasta el 11 de noviembre y de los protocolos hasta el día 30 de noviembre de 2020, inclusive. La información de los protocolos se extrajo según variables estandarizadas de la plataforma ICTRP y la de las publicaciones, según criterios preestablecidos. Resultados. De los protocolos, 63,0% fueron estudios sobre terapias, 10% de prevención y 45% fueron colaborativos. Con respecto al financiamiento, 64% de los protocolos no provino de la industria. En cuanto a las publicaciones, 23% fueron sin revisión de pares y 23% fueron colaborativas. Los diseños más frecuentes fueron las revisiones sistemáticas y estudios de corte transversal; 47,1% fueron realizados en servicios de salud y 22% en el ámbito comunitario; 38,0% se enfocaron en el diagnóstico y 27,9% en el pronóstico. Se realizó una síntesis cualitativa según la línea de cuidado y las estrategias de abordaje. Conclusiones. Se observó un aumento del número de investigaciones colaborativas en comparación con estudios anteriores y de protocolos no financiados por la industria. La agenda de investigación propuesta se cubrió en gran parte conforme al avance de la pandemia.

[ABSTRACT]. Objective. To map research protocols, publications, and collaborations on coronavirus disease 2019 (COVID- 19) developed in Latin America and the Caribbean (LAC). Methods. Included were research protocols registered in international platforms and research publications containing populations, data, or authors from LAC. The source of information for protocols was primarily the International Clinical Trial Registry Platform (ICTRP) of the World Health Organization; for publications, specific electronic databases and repositories pertaining to COVID-19 were used. The search for publications was conducted up to 11 November; the search for protocols, up to 30 November 2020 (both dates inclusive). Data was extracted from protocols using standardized variables from the ICTRP, and from publications following pre-established criteria. Results. Among the protocols, 63.0% were therapeutic studies, 10% focused on prevention, and 45% were collaborative; 64% of the protocols received no funding from industry; 23% of the publications were not peerreviewed and 23% were collaborative in nature. The most frequent study designs were systematic reviews and cross-sectional studies; 47.1% of studies were conducted in health facilities and 22% in community settings; 38.0% focused on diagnosis and 27.9% on prognosis. A qualitative synthesis was performed by line of care and approach strategies. Conclusions. There was an increase in the number of collaborative research studies relative to earlier studies and in protocols not funded by industry. The proposed research agenda was covered in large part as the pandemic unfolded.

[RESUMO]. Objetivo. Mapear protocolos de pesquisa, publicações e colaborações sobre a doença causada pelo coronavírus 2019 (COVID-19, na sigla em inglês) desenvolvidos na América Latina e no Caribe (ALC). Métodos. Foram incluídos protocolos registrados em plataformas internacionais e publicações de pesquisas que consideraram população, dados e autores da ALC. A fonte de informação para os protocolos foi principalmente a Plataforma Internacional de Registros de Ensaios Clínicos (ICTRP, na sigla em inglês) da Organização Mundial da Saúde. Para as publicações, foram utilizadas bases de dados eletrônicas e repositórios específicos sobre COVID-19. As publicações foram pesquisadas até 11 de novembro, e os protocolos, até 30 de novembro de 2020 (inclusive). As informações dos protocolos foram extraídas de acordo com variáveis padronizadas da plataforma ICTRP e das publicações, segundo critérios pré-estabelecidos. Resultados. Dos protocolos, 63% eram estudos sobre terapias, 10% sobre prevenção e 45% eram colaborativos. Em relação ao financiamento, 64% dos protocolos não vieram da indústria. Em relação às publicações, 23% eram sem revisão por pares e 23% eram colaborativas. Os delineamentos mais frequentes foram revisões sistemáticas e estudos transversais; 47,1% foram realizados em serviços de saúde e 22% no âmbito comunitário; 38,0% focaram no diagnóstico e 27,9% no prognóstico. Realizou-se uma síntese qualitativa segundo a linha de cuidado e as estratégias de abordagem. Conclusões. Observou-se um aumento no número de pesquisas colaborativas (em comparação com estudos anteriores) e de protocolos não financiados pela indústria. A agenda de pesquisa proposta foi coberta, em grande parte, à medida que a pandemia progredia.

Mapeo de protocolos de investigación, publicaciones y colaboraciones sobre la COVID-19 en América Latina y el Caribe / Mapping of research protocols, publications, and collaborations on COVID-19 in Latin America and the Caribbean / Mapeamento de protocolos de pesquisa, publicações e colaborações sobre COVID-19 na América Latina e no Caribe

RESUMEN Objetivo. Mapear protocolos de investigación, publicaciones y colaboraciones sobre la enfermedad por el coronavirus 2019 (COVID-19, por su sigla en inglés) desarrollados en América Latina y el Caribe (ALC). Métodos. Se incluyeron protocolos registrados en plataformas internacionales y publicaciones de investigaciones que consideraron población, datos y autores de ALC. La fuente de información para los protocolos fue principalmente la Plataforma Internacional de Registro de Ensayos Clínicos (ICTRP, por su sigla en inglés) de la Organización Mundial de la Salud; para las publicaciones se utilizaron bases electrónicas y repositorios específicos sobre la COVID-19. Se realizaron búsquedas de las publicaciones hasta el 11 de noviembre y de los protocolos hasta el día 30 de noviembre de 2020, inclusive. La información de los protocolos se extrajo según variables estandarizadas de la plataforma ICTRP y la de las publicaciones, según criterios preestablecidos. Resultados. De los protocolos, 63,0% fueron estudios sobre terapias, 10% de prevención y 45% fueron colaborativos. Con respecto al financiamiento, 64% de los protocolos no provino de la industria. En cuanto a las publicaciones, 23% fueron sin revisión de pares y 23% fueron colaborativas. Los diseños más frecuentes fueron las revisiones sistemáticas y estudios de corte transversal; 47,1% fueron realizados en servicios de salud y 22% en el ámbito comunitario; 38,0% se enfocaron en el diagnóstico y 27,9% en el pronóstico. Se realizó una síntesis cualitativa según la línea de cuidado y las estrategias de abordaje. Conclusiones. Se observó un aumento del número de investigaciones colaborativas en comparación con estudios anteriores y de protocolos no financiados por la industria. La agenda de investigación propuesta se cubrió en gran parte conforme al avance de la pandemia.

ABSTRACT Objective. To map research protocols, publications, and collaborations on coronavirus disease 2019 (COVID-19) developed in Latin America and the Caribbean (LAC). Methods. Included were research protocols registered in international platforms and research publications containing populations, data, or authors from LAC. The source of information for protocols was primarily the International Clinical Trial Registry Platform (ICTRP) of the World Health Organization; for publications, specific electronic databases and repositories pertaining to COVID-19 were used. The search for publications was conducted up to 11 November; the search for protocols, up to 30 November 2020 (both dates inclusive). Data was extracted from protocols using standardized variables from the ICTRP, and from publications following pre-established criteria. Results. Among the protocols, 63.0% were therapeutic studies, 10% focused on prevention, and 45% were collaborative; 64% of the protocols received no funding from industry; 23% of the publications were not peer-reviewed and 23% were collaborative in nature. The most frequent study designs were systematic reviews and cross-sectional studies; 47.1% of studies were conducted in health facilities and 22% in community settings; 38.0% focused on diagnosis and 27.9% on prognosis. A qualitative synthesis was performed by line of care and approach strategies. Conclusions. There was an increase in the number of collaborative research studies relative to earlier studies and in protocols not funded by industry. The proposed research agenda was covered in large part as the pandemic unfolded.

RESUMO Objetivo. Mapear protocolos de pesquisa, publicações e colaborações sobre a doença causada pelo coronavírus 2019 (COVID-19, na sigla em inglês) desenvolvidos na América Latina e no Caribe (ALC). Métodos. Foram incluídos protocolos registrados em plataformas internacionais e publicações de pesquisas que consideraram população, dados e autores da ALC. A fonte de informação para os protocolos foi principalmente a Plataforma Internacional de Registros de Ensaios Clínicos (ICTRP, na sigla em inglês) da Organização Mundial da Saúde. Para as publicações, foram utilizadas bases de dados eletrônicas e repositórios específicos sobre COVID-19. As publicações foram pesquisadas até 11 de novembro, e os protocolos, até 30 de novembro de 2020 (inclusive). As informações dos protocolos foram extraídas de acordo com variáveis padronizadas da plataforma ICTRP e das publicações, segundo critérios pré-estabelecidos. Resultados. Dos protocolos, 63% eram estudos sobre terapias, 10% sobre prevenção e 45% eram colaborativos. Em relação ao financiamento, 64% dos protocolos não vieram da indústria. Em relação às publicações, 23% eram sem revisão por pares e 23% eram colaborativas. Os delineamentos mais frequentes foram revisões sistemáticas e estudos transversais; 47,1% foram realizados em serviços de saúde e 22% no âmbito comunitário; 38,0% focaram no diagnóstico e 27,9% no prognóstico. Realizou-se uma síntese qualitativa segundo a linha de cuidado e as estratégias de abordagem. Conclusões. Observou-se um aumento no número de pesquisas colaborativas (em comparação com estudos anteriores) e de protocolos não financiados pela indústria. A agenda de pesquisa proposta foi coberta, em grande parte, à medida que a pandemia progredia.

Knowledge translation strategies for dissemination with a focus on healthcare recipients: an overview of systematic reviews.

BACKGROUND: While there is an ample literature on the evaluation of knowledge translation interventions aimed at healthcare providers, managers, and policy-makers, there has been less focus on patients and their informal caregivers. Further, no overview of the literature on dissemination strategies aimed at healthcare users and their caregivers has been conducted. The overview has two specific research questions: (1) to determine the most effective strategies that have been used to disseminate knowledge to healthcare recipients, and (2) to determine the barriers (and facilitators) to dissemination of knowledge to this group. METHODS: This overview used systematic review methods and was conducted according to a pre-defined protocol. A comprehensive search of ten databases and five websites was conducted. Both published and unpublished reviews in English, Spanish, or Portuguese were included. A methodological quality assessment was conducted; low-quality reviews were excluded. A narrative synthesis was undertaken, informed by a matrix of strategy by outcome measure. The Health System Evidence taxonomy for "consumer targeted strategies" was used to separate strategies into one of six categories. RESULTS: We identified 44 systematic reviews that describe the effective strategies to disseminate health knowledge to the public, patients, and caregivers. Some of these reviews also describe the most important barriers to the uptake of these effective strategies. When analyzing those strategies with the greatest potential to achieve behavioral changes, the majority of strategies with sufficient evidence of effectiveness were combined, frequent, and/or intense over time. Further, strategies focused on the patient, with tailored interventions, and those that seek to acquire skills and competencies were more effective in achieving these changes. In relation to barriers and facilitators, while the lack of health literacy or e-literacy could increase inequities, the benefits of social media were also emphasized, for example by widening access to health information for ethnic minorities and lower socioeconomic groups. CONCLUSIONS: Those interventions that have been shown to be effective in improving knowledge uptake or health behaviors should be implemented in practice, programs, and policies-if not already implemented. When implementing strategies, decision-makers should consider the barriers and facilitators identified by this overview to ensure maximum effectiveness. PROTOCOL REGISTRATION: PROSPERO: CRD42018093245.

Knowledge translation strategies for dissemination with a focus on healthcare recipients: an overview of systematic reviews

Contexto: Embora haja uma ampla literatura sobre a avaliação de intervenções de tradução de conhecimento voltadas para profissionais de saúde, gestores e formuladores de políticas, tem havido menos foco nos pacientes e seus cuidadores informais. Além disso, nenhuma visão geral da literatura sobre estratégias de divulgação direcionadas aos usuários de saúde e seus cuidadores foi realizada. A visão geral tem duas questões específicas de pesquisa: (1) para determinar as estratégias mais eficazes que foram usadas para disseminar o conhecimento aos destinatários da saúde, e (2) para determinar as barreiras (e facilitadores) para a disseminação do conhecimento para este grupo. Métodos: Esta visão geral utilizou métodos de revisão sistemática e foi conduzida de acordo com um protocolo pré-definido. Uma pesquisa abrangente de dez bancos de dados e cinco sites foi realizada. Foram incluídas revisões publicadas e não publicadas em inglês, espanhol ou português. Foi realizada uma avaliação da qualidade metodológica; comentários de baixa qualidade foram excluídos. Foi realizada uma síntese narrativa, informada por uma matriz de estratégia por medida de resultado. A taxonomia de evidências do sistema de saúde para "estratégias direcionadas ao consumidor" foi usada para separar as estratégias em uma das seis categorias. Resultados: Identificamos 44 revisões sistemáticas que descrevem as estratégias eficazes para disseminar o conhecimento em saúde para o público, pacientes e cuidadores. Algumas dessas análises também descrevem as barreiras mais importantes para a adoção dessas estratégias eficazes. Ao analisar as estratégias com maior potencial para alcançar mudanças comportamentais, a maioria das estratégias com evidências suficientes de eficácia foram combinadas, frequentes e / ou intensas ao longo do tempo. Além disso, as estratégias voltadas para o paciente, com intervenções sob medida, e aquelas que buscam adquirir habilidades e competências foram mais eficazes para alcançar essas mudanças. Em relação às barreiras e facilitadores, embora a falta de alfabetização em saúde ou e-alfabetização possa aumentar as iniquidades, os benefícios das mídias sociais também foram enfatizados, Conclusões: Aquelas intervenções que se mostraram eficazes na melhoria da absorção de conhecimento ou comportamentos de saúde devem ser implementadas na prática, programas e políticas, se ainda não implementadas. Ao implementar estratégias, os tomadores de decisão devem considerar as barreiras e facilitadores identificados por esta visão geral para garantir a eficácia máxima.

Background: While there is an ample literature on the evaluation of knowledge translation interventions aimed at healthcare providers, managers, and policy-makers, there has been less focus on patients and their informal caregivers. Further, no overview of the literature on dissemination strategies aimed at healthcare users and their caregivers has been conducted. The overview has two specific research questions: (1) to determine the most effective strategies that have been used to disseminate knowledge to healthcare recipients, and (2) to determine the barriers (and facilitators) to dissemination of knowledge to this group. Methods: This overview used systematic review methods and was conducted according to a pre-defined protocol. A comprehensive search of ten databases and five websites was conducted. Both published and unpublished reviews in English, Spanish, or Portuguese were included. A methodological quality assessment was conducted; low-quality reviews were excluded. A narrative synthesis was undertaken, informed by a matrix of strategy by outcome measure. The Health System Evidence taxonomy for "consumer targeted strategies" was used to separate strategies into one of six categories. Results: We identified 44 systematic reviews that describe the effective strategies to disseminate health knowledge to the public, patients, and caregivers. Some of these reviews also describe the most important barriers to the uptake of these effective strategies. When analyzing those strategies with the greatest potential to achieve behavioral changes, the majority of strategies with sufficient evidence of effectiveness were combined, frequent, and/or intense over time. Further, strategies focused on the patient, with tailored interventions, and those that seek to acquire skills and competencies were more effective in achieving these changes. In relation to barriers and facilitators, while the lack of health literacy or e-literacy could increase inequities, the benefits of social media were also emphasized, for example by widening access to health information for ethnic minorities and lower socioeconomic groups. Conclusions: Those interventions that have been shown to be effective in improving knowledge uptake or health behaviors should be implemented in practice, programs, and policies­if not already implemented. When implementing strategies, decision-makers should consider the barriers and facilitators identified by this overview to ensure maximum effectiveness. Protocol registration: PROSPERO: CRD42018093245

Risk factors for chronic kidney disease of non-traditional causes: a systematic review.

OBJECTIVES: To evaluate the potential associations between chronic kidney disease of uncertain or non-traditional etiology (CKDnT) and agrochemicals, heat stress, heavy metals, and other factors identified in the literature in any region of the world and at any time. METHODS: This was a systematic review of the most frequent exposures suspected to be possible causes of CKDnT. A search was conducted of PubMed, LILACS, World Wide Science electronic databases, among other sources. Only medium- and high-quality studies were included. The synthesis of evidence included a narrative synthesis, meta-analysis, and meta-regression. RESULTS: Four systematic reviews and 61 primary studies were included. Results of the meta-analysis suggest that exposure to agrochemicals and working in agriculture increase the risk of CKDnT, but this only reached significance for working in agriculture. When cross-sectional studies were excluded, agrochemical exposure became significant. However, there is substantial heterogeneity in the effect sizes. CONCLUSIONS: Based on the existing evidence and the precautionary principle, it is important to implement preventive measures to mitigate the damage caused by CKDnT to both agricultural workers and their communities (i.e., improvement of working conditions, cautious management of agrochemicals, etc.). More high-quality research is needed to measure impact and to build the evidence base.

Risk factors for chronic kidney disease of non-traditional causes: a systematic review

[ABSTRACT]. Objectives. To evaluate the potential associations between chronic kidney disease of uncertain or nontraditional etiology (CKDnT) and agrochemicals, heat stress, heavy metals, and other factors identified in the literature in any region of the world and at any time. Methods. This was a systematic review of the most frequent exposures suspected to be possible causes of CKDnT. A search was conducted of PubMed, LILACS, World Wide Science electronic databases, among other sources. Only medium- and high-quality studies were included. The synthesis of evidence included a narrative synthesis, meta-analysis, and meta-regression. Results. Four systematic reviews and 61 primary studies were included. Results of the meta-analysis suggest that exposure to agrochemicals and working in agriculture increase the risk of CKDnT, but this only reached significance for working in agriculture. When cross-sectional studies were excluded, agrochemical exposure became significant. However, there is substantial heterogeneity in the effect sizes. Conclusions. Based on the existing evidence and the precautionary principle, it is important to implement preventive measures to mitigate the damage caused by CKDnT to both agricultural workers and their communities (i.e., improvement of working conditions, cautious management of agrochemicals, etc.). More high-quality research is needed to measure impact and to build the evidence base.

[RESUMEN]. Objetivos. Evaluar las posibles asociaciones de la enfermedad renal crónica de etiología incierta o no tradicional (ERCnT) con los agroquímicos, el estrés por calor, los metales pesados y otros factores señalados en la bibliografía de cualquier región del mundo y en cualquier período. Métodos. La presente es una revisión sistemática de las exposiciones más frecuentes que se sospecha podrían ser posibles causas de la ERCnT. Se realizó una búsqueda en las bases de datos electrónicas de PubMed, LILACS y World Wide Science, entre otras fuentes. Se incluyeron solamente estudios de calidad media y alta. La síntesis de la evidencias incluyó síntesis narrativa, metanálisis y metarregresión. Resultados. Se incluyeron cuatro revisiones sistemáticas y 61 estudios primarios. Los resultados del metaanálisis sugieren que la exposición a agroquímicos y el trabajo agrícola aumentan el riesgo de ERCnT, pero esto solo alcanzó un nivel significativo con respecto al trabajo agrícola. Al excluir los estudios transversales, la exposición a agroquímicos se tornó significativa. Sin embargo, existe una heterogeneidad sustancial en las magnitudes del efecto. Conclusiones. Con base en las pruebas científicas existentes y en el principio de precaución, es importante aplicar medidas preventivas para mitigar el daño ocasionado por la ERCnT tanto para los agricultores como para sus comunidades (es decir, mejoras en las condiciones de trabajo, uso prudente de agroquímicos, etc.). Es necesario aumentar la investigación de alta calidad para medir el impacto y ampliar la base de pruebas científicas.

[RESUMO]. Objetivos. Avaliar as associações em potencial entre doença renal crônica de etiologia incerta ou não tradicional e produtos agroquímicos, estresse térmico, metais pesados e outros fatores identificados na literatura em qualquer região do globo ou espaço de tempo. Métodos. Trata-se de uma revisão sistemática dos tipos mais comuns de exposição suspeitas de serem possíveis causas de doença renal crônica de etiologia incerta ou não tradicional. Foram pesquisadas as bases de dados eletrônicas PubMed, LILACS, World Wide Science, entre outras fontes. Somente foram incluídos estudos de qualidade intermediária e alta. Síntese narrativa, meta-análise e metarregressão foram usadas para sumarizar as evidências. Resultados. Este estudo compreendeu quatro estudos de revisão sistemática e 61 estudos primários. Os resultados da meta-análise indicaram que a exposição a produtos agroquímicos e o trabalho na agricultura aumentam o risco de doença renal crônica de etiologia incerta ou não tradicional, com risco significativo apenas para o trabalho na agricultura. Após a exclusão dos estudos transversais, a exposição a produtos agroquímicos também representou um risco significativo. Porém, observou-se considerável heterogeneidade nos tamanhos do efeito. Conclusões. Diante das evidências existentes e com base no princípio da precaução, é importante implementar medidas preventivas para atenuar os danos causados pela doença renal crônica de etiologia incerta ou não tradicional aos trabalhadores e às comunidades agrícolas, como melhoria das condições de trabalho e manipulação cautelosa dos produtos agroquímicos, entre outros. Faz-se necessário realizar outras pesquisas de alta qualidade para avaliar o impacto e aumentar a base de evidências.

Effectiveness of interventions to prevent motorcycle injuries: systematic review of the literature.

Globally, 49% of deaths from traffic crashes occur among vulnerable road users, including pedestrians, bicyclists, and motorcyclists. Approximately, a quarter of those killed are motorcyclists. The authors carried out a systematic review of the literature to evaluate the effectiveness of interventions to prevent motorcycle crashes and the associated morbidity and mortality. The studies included in this review provide evidence for the effectiveness of helmet use, protective clothing, training, and penalties for alcohol consumption and speeding in preventing injury and death to motorcyclists. The use of helmets is effective, especially if it is universally required by law for drivers and passengers. Training to obtain a license also has positive effects but not when it is totally voluntary. There is limited but consistent evidence that strengthening laws for penalties related to alcohol consumption or speeding has an impact on risk. Traffic calming interventions could help reduce crashes in urban areas. In jurisdictions where there is limited regulation or adherence to effective measures, such as the use of helmets, efforts should be directed primarily at expanding such practices. In other areas, efforts can focus on approaches based on alternative effective measures or on more innovative interventions adapted to local conditions.

Intervenciones para mejorar el acceso a los servicios de salud de los pueblos indígenas en las Américas / Interventions to improve access to health services by indigenous peoples in the Americas

Objetivo. Sintetizar la evidencia sobre la efectividad de intervenciones diseñadas para mejorar el acceso de los pueblos indígenas a los servicios de salud. Métodos. Revisión de revisiones sistemáticas publicadas hasta julio de 2015, de las cuales se seleccionaron y analizaron solamente los estudios realizados en la Región de las Américas. La búsqueda bibliográfica abarcó Medline, Lilacs, Scielo, EMBASE, DARE, HTA, The Cochrane Library y sitios web de organizaciones. Dos revisores independientes seleccionaron los estudios y analizaron su calidad metodológica. Se realizó una síntesis narrativa de los resultados. Resultados. Veintidós revisiones cumplieron los criterios de inclusión. Todos los estudios seleccionados se realizaron en Canadá y Estados Unidos de América (EE.UU.). La mayoría de las intervenciones fueron preventivas, para sortear barreras geográficas, aumentar el uso de medidas efectivas, desarrollar recursos humanos y mejorar las destrezas o disposición de las personas para atenderse. Los temas incluyeron embarazo, factores de riesgo cardiovascular, diabetes, abuso de sustancias, desarrollo infantil, cáncer, salud mental, oral y lesiones. Algunas intervenciones mostraron efectividad con estudios de calidad moderada o alta: estrategias educativas para prevención de depresión, intervenciones para prevención de caries infantiles y programas multicomponente para promover el uso de asientos de seguridad en niños. En enfermedades crónicas no transmisibles los resultados fueron en general negativos o inconsistentes. Conclusiones. Existen algunas intervenciones que tienen potencial de producir efectos positivos en el acceso a los servicios de salud de las poblaciones indígenas en las Américas, pero los estudios disponibles se limitan a Canadá y EE.UU. Existe una significativa brecha de investigación sobre el tema en América Latina y el Caribe.

Objective. Synthesize evidence on effectiveness of interventions designed to improve access to health services by indigenous populations. Methods. Review of systematic reviews published as of July 2015, selecting and analyzing only studies in the Region of the Americas. The bibliographic search encompassed MEDLINE, Lilacs, SciELO, EMBASE, DARE, HTA, The Cochrane Library, and organization websites. Two independent reviewers selected studies and analyzed their methodological quality. A narrative summary of the results was produced. Results. Twenty-two reviews met the inclusion criteria. All selected studies were conducted in Canada and the United States of America. The majority of the interventions were preventive, to surmount geographical barriers, increase use of effective measures, develop human resources, and improve people’s skills or willingness to seek care. Topics included pregnancy, cardiovascular risk factors, diabetes, substance abuse, child development, cancer, mental health, oral health, and injuries. Some interventions showed effectiveness with moderate or high quality studies: educational strategies to prevent depression, interventions to prevent childhood caries, and multicomponent programs to promote use of child safety seats. In general, results for chronic non-communicable diseases were negative or inconsistent. Conclusions. Interventions do exist that have potential for producing positive effects on access to health services by indigenous populations in the Americas, but available studies are limited to Canada and the U.S. There is a significant research gap on the topic in Latin America and the Caribbean.

Intervenciones para mejorar el acceso a los servicios de salud de los pueblos indígenas en las Américas / Interventions to improve access to health services by indigenous peoples in the Americas

RESUMEN Objetivo Sintetizar la evidencia sobre la efectividad de intervenciones diseñadas para mejorar el acceso de los pueblos indígenas a los servicios de salud. Métodos Revisión de revisiones sistemáticas publicadas hasta julio de 2015, de las cuales se seleccionaron y analizaron solamente los estudios realizados en la Región de las Américas. La búsqueda bibliográfica abarcó Medline, Lilacs, Scielo, EMBASE, DARE, HTA, The Cochrane Library y sitios web de organizaciones. Dos revisores independientes seleccionaron los estudios y analizaron su calidad metodológica. Se realizó una síntesis narrativa de los resultados. Resultados Veintidós revisiones cumplieron los criterios de inclusión. Todos los estudios seleccionados se realizaron en Canadá y Estados Unidos de América (EE.UU.). La mayoría de las intervenciones fueron preventivas, para sortear barreras geográficas, aumentar el uso de medidas efectivas, desarrollar recursos humanos y mejorar las destrezas o disposición de las personas para atenderse. Los temas incluyeron embarazo, factores de riesgo cardiovascular, diabetes, abuso de sustancias, desarrollo infantil, cáncer, salud mental, oral y lesiones. Algunas intervenciones mostraron efectividad con estudios de calidad moderada o alta: estrategias educativas para prevención de depresión, intervenciones para prevención de caries infantiles y programas multicomponente para promover el uso de asientos de seguridad en niños. En enfermedades crónicas no transmisibles los resultados fueron en general negativos o inconsistentes. Conclusiones Existen algunas intervenciones que tienen potencial de producir efectos positivos en el acceso a los servicios de salud de las poblaciones indígenas en las Américas, pero los estudios disponibles se limitan a Canadá y EE.UU. Existe una significativa brecha de investigación sobre el tema en América Latina y el Caribe.

ABSTRACT Objective Synthesize evidence on effectiveness of interventions designed to improve access to health services by indigenous populations. Methods Review of systematic reviews published as of July 2015, selecting and analyzing only studies in the Region of the Americas. The bibliographic search encompassed MEDLINE, Lilacs, SciELO, EMBASE, DARE, HTA, The Cochrane Library, and organization websites. Two independent reviewers selected studies and analyzed their methodological quality. A narrative summary of the results was produced. Results Twenty-two reviews met the inclusion criteria. All selected studies were conducted in Canada and the United States of America. The majority of the interventions were preventive, to surmount geographical barriers, increase use of effective measures, develop human resources, and improve people’s skills or willingness to seek care. Topics included pregnancy, cardiovascular risk factors, diabetes, substance abuse, child development, cancer, mental health, oral health, and injuries. Some interventions showed effectiveness with moderate or high quality studies: educational strategies to prevent depression, interventions to prevent childhood caries, and multicomponent programs to promote use of child safety seats. In general, results for chronic non-communicable diseases were negative or inconsistent. Conclusions Interventions do exist that have potential for producing positive effects on access to health services by indigenous populations in the Americas, but available studies are limited to Canada and the U.S. There is a significant research gap on the topic in Latin America and the Caribbean.

[Interventions to improve access to health services by indigenous peoples in the Americas]. / Intervenciones para mejorar el acceso a los servicios de salud de los pueblos indígenas en las Américas.

OBJECTIVE: Synthesize evidence on effectiveness of interventions designed to improve access to health services by indigenous populations. METHODS: Review of systematic reviews published as of July 2015, selecting and analyzing only studies in the Region of the Americas. The bibliographic search encompassed MEDLINE, Lilacs, SciELO, EMBASE, DARE, HTA, The Cochrane Library, and organization websites. Two independent reviewers selected studies and analyzed their methodological quality. A narrative summary of the results was produced. RESULTS: Twenty-two reviews met the inclusion criteria. All selected studies were conducted in Canada and the United States of America. The majority of the interventions were preventive, to surmount geographical barriers, increase use of effective measures, develop human resources, and improve people's skills or willingness to seek care. Topics included pregnancy, cardiovascular risk factors, diabetes, substance abuse, child development, cancer, mental health, oral health, and injuries. Some interventions showed effectiveness with moderate or high quality studies: educational strategies to prevent depression, interventions to prevent childhood caries, and multicomponent programs to promote use of child safety seats. In general, results for chronic non-communicable diseases were negative or inconsistent. CONCLUSIONS: Interventions do exist that have potential for producing positive effects on access to health services by indigenous populations in the Americas, but available studies are limited to Canada and the U.S. There is a significant research gap on the topic in Latin America and the Caribbean.

Antibiotic regimens for management of intra-amniotic infection.

BACKGROUND: Chorioamnionitis is a common infection that affects both mother and infant. Infant complications associated with chorioamnionitis include early neonatal sepsis, pneumonia, and meningitis. Chorioamnionitis can also result in maternal morbidity such as pelvic infection and septic shock.Clinical chorioamnionitis is estimated to occur in 1% to 2% of term births and in 5% to 10% of preterm births; histologic chorioamnionitis is found in nearly 20% of term births and in 50% of preterm births. Women with chorioamnionitis have a two to three times higher risk for cesarean delivery and a three to four times greater risk for endomyometritis, wound infection, pelvic abscess, bacteremia, and postpartum hemorrhage. OBJECTIVES: To assess the effects of administering antibiotic regimens for intra-amniotic infection on maternal and perinatal morbidity and mortality and on infection-related complications. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 October 2014), CENTRAL, MEDLINE, Embase, LILACS, and the WHO ICTRP (September 2014). We also searched reference lists of retrieved studies and contacted experts in the field. SELECTION CRITERIA: Randomized controlled trials (RCTs) that included women who experienced intra-amniotic infection. Trials were included if they compared antibiotic treatment with placebo or no treatment (if applicable), treatment with different antibiotic regimens, or timing of antibiotic therapy (intrapartum and/or postpartum). Therefore, this review assesses trials evaluating intrapartum antibiotics, intrapartum and postpartum antibiotic regimens, and postpartum antibiotics. Diagnosis of intra-amniotic infection was based on standard criteria (clinical/test), and no limit was placed on gestational age. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and trial quality. Two review authors independently extracted data and checked them for accuracy. We assessed the quality of the evidence using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach and included a 'Summary of findings' table. MAIN RESULTS: Our prespecified primary outcomes were maternal and neonatal mortality, maternal and neonatal severe infection, and duration of maternal and neonatal hospital stay.We included 11 studies (involving 1296 women) and assessed them as having low to moderate risk of bias - mainly because allocation concealment methods were not adequately reported, most studies were open, and outcome reporting was incomplete. The quality of the evidence was low to very low for most outcomes, as per the GRADE approach. The following antibiotics were assessed in the included trials: ampicillin, ampicillin/sulbactam, gentamicin, clindamycin, and cefotetan. During labor: meta-analysis of two studies found no clear differences in rates of neonatal sepsis (163 neonates; risk ratio (RR) 1.07, 95% confidence interval (CI) 0.40 to 2.86; I² = 9%; low quality of evidence), treatment failure (endometritis) (163 participants; RR 0.86, 95% CI 0.27 to 2.70; I² = 0%; low quality of evidence), and postpartum hemorrhage (RR 1.39, 95% CI 0.76 to 2.56; I² = 0%; low quality of evidence) when two different dosages/regimens of gentamicin were assessed. No clear differences between groups were found for any reported maternal or neonatal outcomes. The review did not identify data for a comparison of antibiotics versus no treatment/placebo. Postpartum: meta-analysis of two studies that evaluated use of antibiotics versus placebo after vaginal delivery showed no significant differences between groups in rates of treatment failure or postpartum endometritis. No significant differences were found in rates of neonatal death and postpartum endometritis when use of antibiotics was compared with no treatment. Four trials assessing two different dosages/regimens of gentamicin or dual-agent therapy versus triple-agent therapy, or comparing antibiotics, found no significant differences in most reported neonatal or maternal outcomes; the duration of hospital stay showed a difference in favor of the group of women who received short-duration antibiotics (one study, 292 women; mean difference (MD) -0.90 days, 95% CI -1.64 to -0.16; moderate quality of evidence). Intrapartum versus postpartum: one small study (45 women) evaluating use of ampicillin/gentamicin during intrapartum versus immediate postpartum treatment found significant differences favoring the intrapartum group in the mean number of days of maternal postpartum hospital stay (one trial, 45 women; MD -1.00 days, 95% CI -1.94 to - 0.06; very low quality of evidence) and the mean number of neonatal hospital stay days (one trial, 45 neonates; MD -1.90 days, 95% CI -3.91 to -0.49; very low quality of evidence). Although no significant differences were found in the rate of maternal bacteremia or early neonatal sepsis, for the outcome of neonatal pneumonia or sepsis we observed a significant difference favoring intrapartum treatment (one trial, 45 neonates; RR 0.06, 95% CI 0.00 to 0.95; very low quality of evidence). AUTHORS' CONCLUSIONS: This review included 11 studies (having low to moderate risk of bias). The quality of the evidence was low to very low for most outcomes, as per the GRADE approach. Only one outcome (duration of hospital stay) was considered to provide moderate quality of evidence when antibiotics (short duration) were compared with antibiotics (long duration) during postpartum management of intra-amniotic infection. Our main reasons for downgrading the quality of evidence were limitations in study design or execution (risk of bias), imprecision, and inconsistency of results.Currently, limited evidence is available to reveal the most appropriate antimicrobial regimen for the treatment of patients with intra-amniotic infection; whether antibiotics should be continued during the postpartum period; and which antibiotic regimen or what treatment duration should be used. Also, no evidence was found on adverse effects of the intervention (not reported in any of the included studies). One small RCT showed that use of antibiotics during the intrapartum period is superior to their use during the postpartum period in reducing the number of days of maternal and neonatal hospital stay.

[Social and familial determinants of anxiety and depressive symptoms in middle to low income women]. / Violencia y factores sociales asociados a salud mental en mujeres de la ciudad de Temuco.

BACKGROUND: Among women, risk factors for mental disorders are violence, economical inequities and disadvantages and discrimination. AIM: To determine the prevalence of anxiety and depressive symptoms in women and to determine factors associated with them. MATERIAL AND METHODS: A cross sectional study of a probabilistic sample of 422 women aged 34 years as a mean, living in a medium to low income neighborhood in Temuco, Chile. Mental health was assessed with the self reporting questionnaire (SRQ20), partner violence was evaluated using a 12 item scale and family conflict and violence was evaluated using the Conflicts Tactics scale. A logistic repression analysis was used to identify factors associated with mental health alterations. RESULTS: Forty one percent of women had anxiety or depressive symptoms. The main associated factors with these symptoms were severe physical violence against children (odds ratio (OR)=14.3), sexual violence against women (OR=9.7), self perception of health (OR=4.5), alcohol abuse (OR=4.4), psychological violence during childhood (OR=3.2) and lack of family support network (OR=2.7). Unemployment and lack of a support network of relatives had an OR 3.3 for mental health alterations. The OR for psychological violence plus sexual violence was 18.5. The figure for psychological violence plus sexual violence plus a history of parental violence during childhood was 26.5. CONCLUSIONS: Forty one percent of this group of women had mental health alterations. There is a strong association between these alterations, family violence and socioeconomic factors.

[Associated factors to depressive symptoms and somatic symptoms in climacteric women in the city of Temuco]. / Factores asociados a síntomas depresivos y síntomas somáticos en mujeres climatéricas de la ciudad de Temuco.

BACKGROUND: Depression is an important mental health problem. The Chilean Ministry of Health has considered depression in women as one of the health priorities for the country. AIM: To assess the prevalence of depressive and somatic symptoms and their risk factors in climacteric women. MATERIAL AND METHODS: A special questionnaire was applied to 171 women (45 to 55 years of age), coming from a community organization (PRODEMU) and a private health institution (ISAPRE Banmedica). Risk factors for depression were determined using multiple logistic regression. RESULTS: The prevalence of depressive symptoms was 43%. Women with primary education had an odds ratio for depression of 2.49, compared with women with high school or university education. Other risk factor for depression was the lack of a renumerated job (Odds ratio 1.9). The risk factors for somatic symptoms were the presence of depressive symptoms (OR 3.2), lack of secondary or university education (OR 2.4), low income (OR 1.9) and having a current partner (OR 3.6). CONCLUSIONS: There is a high prevalence of depressive symptoms in the studied population of climacteric women. Lack of education and of a renumerated job are important risk factors for the presence of such symptoms. Women with a low level of education and with depressive symptoms have also a high risk of presenting somatic symptoms.