[Therapies, bonds and quality of life of children and adolescents with cerebral palsy: experiences and perceptions of their caregivers during the pandemic]. / Terapias, vínculos y calidad de vida de niños, niñas y adolescentes con parálisis cerebral: vivencias y percepciones de sus cuidadores durante la pandemia.

The COVID-19 pandemic affected the health of children and adolescents (CA). Isolation-related conditions could have impacted not only the functionality of children and adolescents with cerebral palsy (CP) but also their social and emotional well-being, affecting their health-related quality of life (HRQoL). OBJECTIVE: To analyze perceptions of impairment during the pandemic and differences in HRQoL dimensions compared with a previous registry in Argentinean children and adolescents diagnosed with CP from the perspective of their caregivers. SUBJECTS AND METHOD: Cross-sectional observational study at two time points (2019 and 2021) where 98 caregivers participated. We used the KIDSCREEN-27 and CP-QOL questionnaires for the assessment of HRQoL and an open-ended question regarding the impact of the pandemic on the health of children and adolescents, including in 2021. We compared mean scores of the dimensions of the questionnaires in both stages (significant differences: Cohen's d≥0.3). Responses to the open-ended question were analyzed via "open" and "axial" coding. RESULTS: The scores of the dimensions Participation, Emotional well-being, Social well-being, and School environment (CP-QOL) and Psychological well-being, Friends, School environment, and General HRQoL index (KIDSCREEN-27) were lower during the pandemic (2021) compared with 2019 (d>0.3). Regarding perceived affectation during the pandemic, we identified three main recurrences: "impairment due to interruption of therapies and treatments", "deterioration of peer bonding", and "increased and positive appraisal of self-care". CONCLUSIONS: The pandemic affected the psychosocial dimensions of health. Qualitative data highlight the positive assessment of self-care.

Gender differences in trajectories of health-related quality of life from childhood to adolescence in a 7-year follow-up study in a urban socially disadvantaged sample from Argentina.

PURPOSE: The transition from childhood to adolescence is a period of developmental changes, with social influences. Few previous studies have analyzed changes in health-related quality of life (HRQoL) during childhood and adolescence based on longitudinal studies in high-income countries. This study aimed to describe the evolution of HRQoL scores by gender in a school sample over a 7-year period in Argentina. METHODS: Prospective cohort of children attending fourth grade in public schools. HRQoL was measured using the KIDSCREEN-52 questionnaire. Trajectories of HRQoL were estimated for girls and boys through multilevel models, adjusted by socioeconomic status (SES). RESULTS: The study began in 2014 with a sample of 494 school children, reaching an 85.6% response rate in 2016, 31.4% in 2018, and 41.9% in 2021. Most of the predicted scores are negatively associated with linear age or/and quadratic age, suggesting a decrease in scores over the 7-year follow-up. Interactions between gender and age denote an increase in the differences in scores between girls and boys over time in favor of the latter. For the Index, Physical Well-being, Psychological Well-being, Autonomy, Parent relations, Social support and peers and Financial resources, individuals with medium or high SES have significantly higher scores than those with low SES. CONCLUSIONS: HRQoL scores decrease during the transition period from childhood to adolescence, with girls showing the greatest decrease. There were also socioeconomic inequalities in the evolution of HRQoL in a context characterized by social segregation and economic crisis, possibly aggravated by the COVID-19 pandemic.

Adaptación transcultural del Trans Women Voice Questionnaire (TWVQ) para mujeres trans hablantes del español de uso en Argentina / Transcultural adaptation of the Trans Women Voice Questionnaire (TWVQ) for trans women speakers of Spanish of use in Argentina

Antecedentes: En las mujeres trans los aspectos fisiológicos vocales pueden significar limitaciones, generando sentimientos de inadecuación, restringiendo la participación en actividades sociales y afectando su calidad de vida. El Trans Women Voice Questionnaire (TWVQ) fue desarrollado en Australia y Canadá para medir la autopercepción vocal y su impacto en la vida diaria de las mujeres trans. Objetivo: Realizar la adaptación transcultural del TWVQ y determinar su validez de apariencia, contenido y equivalencia conceptual, práctica y lingüística para valorar la autopercepción de la voz y su impacto en la vida diaria de las mujeres trans de Argentina. Método: Se siguió el método recomendado por la Organización Mundial de la Salud (OMS) en cinco etapas: I. Dos traducciones semánticas directas e independientes inglés-español, II. Síntesis de traducciones por panel de expertos, III. Entrevista con panel de tres mujeres trans, IV. Traducción inversa literal español-inglés, V. Pre-test y pruebas cognitivas a seis mujeres trans. Resultados: A través del proceso se controló que la equivalencia conceptual, práctica y lingüística, así como la comprensión y viabilidad del Versión del TWVQ adaptada para su uso en Argentina (TWVQ-AR) fueran adecuados. Cinco ítems requirieron adaptaciones mayores para lograr la equivalencia semántica en aquellos que midieron el tema «tono», que las participantes interpretaron como variaciones de intensidad del sonido y no de frecuencia. Conclusión: El TWVQ-AR resultó en adecuada validez por apariencia y contenido; equivalente al original australiano-canadiense y correcto en el aspecto conceptual, la práctica y la lingüística para mujeres trans de Argentina. Se deben examinar sus propiedades métricas como indicador de calidad de vida relacionada con la voz en esta población.(AU)

Context: In trans women, the physiological aspects of their voices that may be different from expected, either by them or other people they interact with, may result in limitations in their daily lives generating feelings of inadequacy, restricting social interaction, and impacting their overall psychosocial well-being. Objective: The objective was to undertake the transcultural adaptation of the TWVQ and test its face and content validity, as well as its conceptual, practical, and lingüistic equivalence to measure the self-perception of trans women's voices from Argentina and its impact on their daily lives in relation to their health. Method: This study followed the World Health Organization guidelines for transcultural adaptations recommended by the author of the original TWVQ Georgia Dacakis. The adaptation underwent five different stages. I – Two forward translations (from English to Spanish from Argentina), II – expert panel revision, III – interview with a group of trans women to test comprehension, IV – two back translations (from Argentinian Spanish back to English), and V – pre-testing and cognitive interviewing with a group of trans women. Conclusion: The TWVQ-AR is valid in face and content validity as well as in conceptual, practical, and lingüistic equivalence to the original TWVQ to successfully measure the self-perception of trans women's voices from Argentina and its impact on their daily lives in relation to their health.(AU)

[Properties of the CP-QOL-PCQ to measure health-related quality of life in children and adolescents with cerebral palsy in Argentina] / Propiedades del CP-QOL-PCQ para medir calidad de vida relacionada con la salud en niños, niñas y adolescentes con parálisis cerebral en Argentina.

Introduction: The impact of cerebral palsy (CP) on quality of life requires the incorporation of subjective assessments of health, functional status, and well-being. A specific health-related quality of life (HRQoL) measure for CP is the Australian CP-QOL questionnaire, whose version for caregivers (PCQ) was adapted in Argentina. This study aimed to achieve the final structure and evaluate the reliability and validity of the CP-QOL-PCQ for the Argentine child and adolescent population. Methods: 100 caregivers of people from 3 to 24 years old with a diagnosis of CP from Argentina participated. In addition to the CP-QOL-PCQ, the KIDSCREEN-27 questionnaire was applied. Analysis of response distributions of all items, inter-item correlations, and internal consistency of the scales were performed using Cronbach's alpha. The convergent validity of the instrument was tested through the correlation with scales of similar content from the KIDSCREEN and through a priori hypotheses in groups of different ages and functional impairment. Results: A final structure of the CP-QOL-PCQ was achieved with 8 multidimensional scales, with satisfactory inter-item correlations (>0.30) and internal consistency (>0.70). Moderate and high correlations (r>0.30) were obtained between similar dimensions of the CP-QOL-PCQ and the KIDSCREEN with similar concepts. Higher HRQoL scores were confirmed at a younger age and at a lower level of functional impairment (Cohen's d >0.20). Conclusion: This provides evidence of reliability and validity to be expected for a HRQoL measurement instrument that can be implemented in the Argentine child and adolescent population with CP.

Introducción: El impacto de la parálisis cerebral (PC) en la calidad de vida exige la incorporación de valoraciones subjetivas de la salud, el estado funcional y el bienestar. Una medida de calidad de vida relacionada con la salud (CVRS) específica para PC es el cuestionario australiano CP-QOL, cuya versión para cuidadores (PCQ) fue adaptada en Argentina. Este estudio se propuso lograr la estructura final y evaluar la fiabilidad y validez del CP-QOL-PCQ para población infantil y adolescente argentina. Métodos: Participaron 100 cuidadores de personas de 3 a 24 años con diagnóstico de PC de Argentina. Además del CP-QOL-PCQ se aplicó el cuestionario KIDSCREEN-27. Se realizaron análisis de distribuciones de respuesta de todos los ítems, correlaciones inter-ítems y consistencia interna de las escalas mediante el alfa de Cronbach. Se probó la validez convergente del instrumento mediante la correlación con escalas de similar contenido del KIDSCREEN y mediante hipótesis a priori en grupos de diferente edad y afectación de la funcionalidad. Resultados: Se logró una estructura final del CP-QOL-PCQ con 8 escalas multidimensionales, con satisfactorias correlaciones inter-ítems satisfactorias (>0.30) y consistencia interna (>0.70). Se obtuvieron correlaciones moderadas y altas (r>0.30) entre dimensiones similares del CP-QOL-PCQ y del KIDSCREEN con conceptos similares. Se confirmaron mayores puntuaciones de CVRS a menor edad y a menor nivel de afectación funcional (d de Cohen >0,20). Conclusión: Este trabajo aporta evidencias de fiabilidad y validez esperables para un instrumento de medición de la CVRS que puede ser implementado en población infantil y adolescente argentina con PC.

Adaptación transcultural de un cuestionario de alimentación para niños de edad escolar en Córdoba, Argentina / Cross-cultural adaptation of a food questionnaire for schoolchildren in Córdoba, Argentina

Fundamentos: La evaluación de la ingesta en la niñez requiere instrumentos adecuados para la edad. Elobjetivo fue adaptar transculturalmente un cuestionario de alimentación para escolares desarrollado en Brasil(QUADA) y analizar su confiabilidad y validez para su aplicación en Córdoba, Argentina Métodos: El QUADA fue traducido al español y se reemplazaron las ilustraciones por alimentosrepresentativos localmente. Se realizaron pruebas de comprensión para evaluar interpretación de consignas eilustraciones y realizar modificaciones hasta llegar al cuestionario final: CuAE-24. Se evaluó la fiabilidad testretest aplicando el CuAE-24 dos veces el mismo día en una muestra de 113 escolares y se analizó la concordancia entre ambas aplicaciones usando test de Kappa. La validez se evaluó mediante la observación de la comida escolar (“gold standard”) el día anterior a la aplicación del CuAE-24, que fue contrastada con lasrespuestas de los escolares. Se calculó sensibilidad, especificidad, valores predictivos positivos (VPP) y negativos (VPN). Resultados: El CuAE-24 presenta 5 secciones (desayuno, media-mañana, comida, merienda, cena), con 76 alimentos ilustrados agrupados en 24 ítems. El test-retest presentó adecuada concordancia y se hallaron valores de sensibilidad, especificidad, VPP y VPN aceptables. Conclusiones: El CuAE-24 presenta validez y confiabilidad satisfactorias para utilizarse en investigaciones epidemiológicas en escolares de Córdoba, Argentina. (AU)

Background: Food intake assessment in childhood requires age-appropriate instruments. The objective was to analyze the cross-culturally adapt a food questionnaire for schoolchildren developed in Brazil (QUADA) andanalyze its reliability and validity for its application in Córdoba, Argentina.Methods: The QUADA was translated into Spanish and the illustrations were replaced by locally representative foods. Comprehension tests was carried out to evaluate interpretation of instructions and illustrations and to make modifications until reaching the final questionnaire: CuAE-24. To evaluate the testretest reliability, the CuAE-24 was applied twice the same day, in a sample of 113 schoolchildren. The Kappa test was used to analyze the concordance between both applications. The validity was analyzed by observing the school lunch (“gold standard”) the day before the application of the CuAE-24, which was contrasted with the responses of the schoolchildren. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were calculated.Results: The CuAE-24 presents 5 sections (breakfast, mid-morning, lunch, snack, dinner), with 76 illustrated foods grouped into 24 items. The test-retest presented adequate concordance and acceptable sensitivity, specificity, PPV and NPV values were found in most of the items. Conclusions: The CuAE-24 presents satisfactory validity and reliability to be used in epidemiologicalresearches in schoolchildren in Córdoba, Argentina. (AU)

Aceptabilidad lingüística en la comprensión de cuestionarios de valoración de servicios de salud en Iberoamérica / Linguistic acceptability in the comprehension of health services assessment questionnaires in Ibero-America

La utilización de cuestionarios como instrumentos de medición implica el uso de procesos lingüísticos. La variedad intralingüística del español conlleva diferentes modos de percibir, analizar y actuar en el mundo que deben considerarse al diseñar o adaptar cuestionarios. La armonización de los cuestionarios IA-PCAT (Primary Care Assessment Tools para Iberoamérica) difiere de los escenarios de adaptación transcultural descritos en la literatura porque intenta obtener un único producto en español adecuado para numerosas poblaciones meta a partir la armonización de cuestionarios provenientes de diversas poblaciones fuente hispanohablantes, por lo que requiere innovaciones en las categorías de análisis que se utilizan. El objetivo de este trabajo es proponer definiciones discriminantes de equivalencia conceptual, equivalencia práctica y aceptabilidad lingüística como categorías de análisis para la comprensión de cuestionarios, y ofrecer ejemplos de pruebas de comprensión realizadas mediante entrevistas cognitivas con profesionales y personas usuarias de servicios de salud. (AU)

The use of questionnaires as measuring tools involves the use of language. Spanish intralinguistic variation entails differences in the ways of perceiving the world, analyzing events and behaving, which must be taken into account when designing and adapting questionnaires. The IA-PCAT (Primary Care Assessment Tools for Iberomerica) harmonization process differs from the cross-cultural adaptation scenarios described in the scientific literature, since it intends to obtain a single Spanish product suitable for multiple target populations, that emanates from questionnaires previously adapted in several populations. Hence, this work requires the use of new analysis categories. The aim of this methodological note is to propose discriminant definitions of conceptual equivalence, practical equivalence and linguistic acceptability as analysis categories of the data collected during cognitive interviews to assess the questionnaires' comprehension, carried out with health professionals and users of healthcare services. (AU)

Percepción de riesgo ante el coronavirus en la primera fase de la pandemia en Argentina / Perception of risk facing coronavirus in the first phase of the pandemic in Argentina / Percepção de risco perante o coronavírus na primeira fase da pandemia na Argentina

Resumen Objetivo. Analizar los factores asociados a la percepción de riesgo de coronavirus en la primera fase de la pandemia en Argentina. Métodos. Se desarrolló un estudio transversal en población adulta (n=992) argentina. En marzo 2020 se aplicó un cuestionario online de la Organización Mundial de la Salud adaptado a Argentina. Se estimó la asociación entre la percepción de probabilidad de contagio y de severidad en caso de contagio, y sentimientos en relación al coronavirus, autoeficacia y búsqueda de información, mediante modelos de regresión lineal múltiple. Resultados. La percepción de riesgo frente al coronavirus en la primera fase de la pandemia fue moderada. Sin embargo, la proporción de personas que indicó puntuaciones altas fue mucho mayor en la percepción de severidad, comparado con la percepción de probabilidad de contagio. La percepción de probabilidad de contagio fue menor a mayor percepción de lejanía del virus y a mayor frecuencia de búsqueda de información. La percepción de severidad en caso de contagio se asoció positivamente con la frecuencia de búsqueda de información. En cambio, se asoció inversamente con la percepción de lejanía del virus y la autoeficacia. Conclusiones. Existen diferentes factores tanto emocionales como sociales asociados a la percepción de contagio y de severidad en Argentina. Esta complejidad debería considerarse en el diseño de políticas públicas para la prevención de COVID-19.

Abstract Objective: to analyze the factors associated with the perception of risk of coronavirus in the first phase of the pandemic in Argentina. Methods: a cross-sectional study was carried out in the Argentine adult population (n = 992). An online survey of the World Health Organization adapted to Argentina was applied in March-2020. The association between the perception of probability of contagion and severity in case of contagion and feelings related to the coronavirus, self-efficacy and health, were estimated using multiple linear regression models. Results: The perception of risk facing the first phase of the pandemic was moderate. However, the proportion of people who indicated high scores in the perception of severity was much higher compared to the perception of probability of contagion. The perception of probability of contagion was lower at greater perception of remoteness of the virus and it was greater at a higher frequency of information search. The perception of severity in case of contagion was positively associated with frequency of information search. Instead, it was inversely associated with the perception of remoteness of the virus and self-efficacy. Conclusions: There are different social and emotional factors associated with the perception of contagion and severity of coronavirus in Argentina. This complexity should be considered in the design of public policies for the prevention of COVID-19.

Resumo Objetivo. Analisar os fatores associados à percepção de risco de coronavírus na primeira fase da pandemia na Argentina. Métodos. Desenvolveu-se um estudo transversal em população adulta (n=992) na Argentina. Em março de 2020 foi aplicado um questionario online da Organização Mundial da Saúde adaptado para a Argentina. Estimouse a associação entre a percepção de probabilidade de contágio e da severidade no caso de contágio, e sentimentos em relação ao coronavírus, auto-eficácia e busca de informação, mediante modelos de regressão linear múltipla. Resultados. A percepção de risco frente ao coronavírus na primeira fase da pandemia foi moderada. Entretanto, a proporção de pessoas que indicou pontuações altas foi muito maior na percepção de severidade, comparado com a percepção de probabilidade de contágio. A percepção de probabilidade de contágio foi menor quanto maior a percepção de distância do vírus e a maior frequência de busca de informação. A percepção de severidade no caso de contágio é associada positivamente à frequência de busca de informação; por outro lado é associada inversamente à percepção de distância do vírus e a auto-eficácia. Conclusões. Existem diferentes fatores tanto emocionais como sociais associados à percepção de contágio e de severidade na Argentina. Esta complexidade deveria ser considerada no planejamento de políticas públicas para a prevenção da COVID-19.

Evaluación de la atención primaria, versión modificada del instrumento PCAT-A10 / Modified version of the PCAT-A10 tool for the evaluation of primary care

OBJETIVO: Evaluar las características métricas del índice Primary Care Assessment Tool de 10 ítems, para adultos (PCAT-A10), versión en castellano y catalán, reducida del original Primary Care Assessment Tool-Adult Edition (PCAT-AE), habiendo modificado el ítem de salud mental. DISEÑO: Estudio observacional transversal. Emplazamiento: Población residente en la ciudad de Barcelona. PARTICIPANTES: De los 3.496 participantes mayores de 14 años de la muestra aleatoria representativa de la población de Barcelona, de la Encuesta de Salud de Barcelona 2016-17, se seleccionaron los que declararon tener un médico/a de cabecera, que alguna vez en la vida habían realizado una visita a algún especialista y que habían contestado más del 50% de ítems del PCAT-A10 (n = 3.107). Mediciones principales: Descriptiva de los ítems, análisis de consistencia interna y de correlación ítem-total corregida del índice PCAT-A10 modificado y los 10 ítems que lo conforman. Se analizan tres escenarios de tratamiento de las no respuestas: sustitución por 0, por el valor intermedio (2,5) y excluyendo las personas que no contestaron algún ítem. RESULTADOS: El índice PCAT-A10 obtuvo alfa de Cronbach de 0,73, 0,79 y 0,85 en los tres escenarios nombrados, correlaciones ítem-total corregida entre 0,41 y 0,66, y 20,8% de no respuesta al ítem de salud mental. CONCLUSIONES: La nueva versión del PCAT-A10 presenta una alta fiabilidad con una mayor respuesta en el ítem de salud mental respecto a la versión anterior

OBJECTIVE: To evaluate the measurement characteristics of the Spanish and Catalan versions of the 10-Item Primary Care Assessment Tool for adults (PCAT-A10), shortened from the original Primary Care Assessment Tool (PCAT), with a new mental health item. DESIGN: Cross-sectional observational study. LOCATION: The city of Barcelona. PARTICIPANTS: Of the 3,496 people over 14 years of age from the representative random sample of the Barcelona population, from the 2016-17 Barcelona Health Survey, those who declared they had a family doctor, and had visited a specialist at some time in their lives, and had answered more than 50% of PCAT-A10 items were selected (n = 3,107). MAIN MEASUREMENTS: Item descriptive analysis, analysis of internal consistency, corrected item - total correlation, of the PCAT-A10 index and the 10 items that make it up. Three scenarios for non-response to treatment were analysed: substitution by 0, by the intermediate value, and excluding people who did not answer any item. RESULTS: The PCAT-A10 index obtained Cronbach alphas of 0.73, 0.79, and 0.85 in the three mentioned scenarios, correlation item total corrected between 0.41 and 0.66, and 20.8% non-responses to the mental health item. CONCLUSIONS: The new version of PCAT-A10 has a high reliability with a higher response in the mental health item compared to the previous version

[Modified version of the PCAT-A10 tool for the evaluation of primary care]. / Evaluación de la atención primaria, versión modificada del instrumento PCAT-A10.

OBJECTIVE: To evaluate the measurement characteristics of the Spanish and Catalan versions of the 10-Item Primary Care Assessment Tool for adults (PCAT-A10), shortened from the original Primary Care Assessment Tool (PCAT), with a new mental health item. DESIGN: Cross-sectional observational study. LOCATION: The city of Barcelona. PARTICIPANTS: Of the 3,496 people over 14 years of age from the representative random sample of the Barcelona population, from the 2016-17 Barcelona Health Survey, those who declared they had a family doctor, and had visited a specialist at some time in their lives, and had answered more than 50% of PCAT-A10 items were selected (n=3,107). MAIN MEASUREMENTS: Item descriptive analysis, analysis of internal consistency, corrected item - total correlation, of the PCAT-A10 index and the 10 items that make it up. Three scenarios for non-response to treatment were analysed: substitution by 0, by the intermediate value, and excluding people who did not answer any item. RESULTS: The PCAT-A10 index obtained Cronbach alphas of 0.73, 0.79, and 0.85 in the three mentioned scenarios, correlation item total corrected between 0.41 and 0.66, and 20.8% non-responses to the mental health item. CONCLUSIONS: The new version of PCAT-A10 has a high reliability with a higher response in the mental health item compared to the previous version.

[Linguistic acceptability in the comprehension of health services assessment questionnaires in Ibero-America]. / Aceptabilidad lingüística en la comprensión de cuestionarios de valoración de servicios de salud en Iberoamérica.

The use of questionnaires as measuring tools involves the use of language. Spanish intralinguistic variation entails differences in the ways of perceiving the world, analyzing events and behaving, which must be taken into account when designing and adapting questionnaires. The IA-PCAT (Primary Care Assessment Tools for Iberomerica) harmonization process differs from the cross-cultural adaptation scenarios described in the scientific literature, since it intends to obtain a single Spanish product suitable for multiple target populations, that emanates from questionnaires previously adapted in several populations. Hence, this work requires the use of new analysis categories. The aim of this methodological note is to propose discriminant definitions of conceptual equivalence, practical equivalence and linguistic acceptability as analysis categories of the data collected during cognitive interviews to assess the questionnaires' comprehension, carried out with health professionals and users of healthcare services.

Food Intake and the Significance of Feeding in Qom Children of Northern Argentina.

BACKGROUND: As part of the ubiquitous nutritional transition indigenous are experiencing, the typical diet of most indigenous communities is being substituted by one with high-fat and high-energy-density foods. Domestic feeding transmits cultural factors through meaning and symbolism influential in food, preparation, and meal experiences, which in turn influence children's eating habits differently among social groups. OBJECTIVES: The aims of this study were to explore the food consumption patterns of Qom preschoolers and to describe cultural domains about the significance of feeding in this indigenous population in northern Argentina. METHODS: This cross-sectional and mixed-methods study was conducted in 2016-2017 and focused on 160 preschoolers and their mothers in the village of Namqom. It used a closed questionnaire, three 24-h recalls, and free listing techniques. RESULTS: Qom preschoolers had a high prevalence of excess weight (25%) and stunting (16%). Mothers reported only 38 food items consumed by preschoolers. Almost all of the children (96%) consumed white bread, whereas 89% consumed milk, 87.5% sweet cookies, 84.7% some sort of stew, 72% fried dough, and 63.1% soup. In addition, it was found that preschoolers consumed neither fresh and varied vegetables, nor available fruits. They did not consume fresh fish and other meats, either. Caregivers related the term "feeding" with "having to eat," which might be associated with the context of poverty in which they live. Caregivers also mentioned "eating right" to get healthy or grow up strong. CONCLUSIONS: The present study revealed a relatively elevated consumption of high-energy but nutritionally poor food, and malnutrition, which reflects the impacts of poverty. We found that the cultural domain of food is linked to survival and depletion ideas.

Inequities in neighborhood public park use for schoolchildren's physical activity: multilevel evidence from Cordoba, Argentina.

INTRODUCTION: The complexity of urbanization processes across Latin American societies encourages investigating its implications in health conditions, especially during childhood. One of the possible links between them is recreation, a component of the daily life of children and, therefore, essential to produce health and life itself. The objective of this study was to examine the associations between neighborhood context and active public park use among school-aged children in Cordoba, Argentina. METHODS: A cross-sectional study was conducted with 1466 children, aged 9 to 11, attending 19 schools and living in 110 neighborhoods. Multilevel models with Poisson distribution were used for the analyses, stratified by gender. Socio-demographic, behavioral, and physical covariates were included at the individual level, and socioeconomic neighborhood conditions at second level. RESULTS: Girls residing in neighborhoods with a worse socioeconomic context were less likely to report frequent public park use for physical activity, while those from neighborhoods with better socioeconomic conditions were more likely to, regardless of individual characteristics. CONCLUSION: This study suggests that socioeconomic conditions of neighborhoods are associated with public park use for physical activity in school-aged girls, demonstrating gender inequality in the use and appropriation of public spaces.

Adaptación transcultural de un cuestionario de calidad de vida relacionada con la salud en parálisis cerebra / Cross-cultural adaptation of a questionnaire on health-related quality of life in cerebral palsy

RESUMEN INTRODUCCIÓN los indicadores de calidad de vida relacionada con la salud (CVRS) son importantes en la valoración de personas con discapacidad porque incorporan su propia perspectiva. El CP QOL (Cerebral Palsy Quality of Life) es un cuestionario australiano que mide CVRS en niños, niñas y adolescentes con parálisis cerebral por autoadministración o por informador indirecto. El objetivo del presente estudio fue obtener una versión del CP QOL-PCQ (Primary Caregiver Questionnaire) adecuada culturalmente a la población argentina, que fuera práctica y semánticamente equivalente a la versión original. MÉTODOS se realizó una adaptación transcultural incluyendo traducción y retrotraducción por lingüistas profesionales, control de equivalencia por expertos y autores, y pruebas de comprensión mediante entrevistas cognitivas a una muestra de cuidadores. La adecuación, equivalencia y comprensión fueron comprobadas en los discursos de expertos y las respuestas de entrevistas. RESULTADOS se tradujeron 95 ítems, y 19 se modificaron durante las etapas de revisión y consenso con expertos y autores. En las entrevistas cognitivas se detectó dificultad de comprensión y equivalencia cultural y se modificaron 6 ítems. DISCUSIÓN se dispone de versiones del CP QOL-PCQ adecuadas culturalmente a la población infantil y adolescente argentina, con pruebas de su comprensión en población diana. Sus propiedades métricas y conformación definitiva serán evaluadas próximamente.

ABSTRACT INTRODUCTION Health-related quality of life (HRQL) indicators are important in the assessment of people with disabilities because they incorporate their own perspective. The CP QOL (Cerebral Palsy Quality of Life) is an Australian questionnaire that measures HRQL in children and adolescents with cerebral palsy by self-administration or through proxies. The objective of this study was to obtain a culturally adequate version of the CP QOL-PCQ (Primary Caregiver Questionnaire) for the Argentine population, practical and semantically equivalent to the original version. METHODS A cross-cultural adaptation was conducted, including translation and back translation by professional linguists, control of equivalence by experts and authors, and comprehension tests through cognitive interviews with a sample of caregivers. Adequacy, equivalence, and comprehension were verified in the expert's speeches and interviews responses. RESULTS Ninety-five items were translated and 19 were modified during the review and consensus with experts and authors. In cognitive interviews, comprehension difficulty and cultural equivalence were detected and 6 items were modified. DISCUSSION Culturally appropriate versions of the CP QOL-PCQ are available for the Argentine child and adolescent population, with evidence of their understanding in the target population. Metric properties and final conformation will be evaluated in the near future.

Incipient Neighborhood and Socioeconomic Stratification Associated to Nutritional Status in Indigenous Qom Preschoolers from Formosa, Argentina.

Indigenous populations in Latin America are among the most socially vulnerable groups and their children often suffer severe deprivation in terms of access to proper nutrition, water, and shelter. This study describes the nutritional status of Qom preschoolers in general, and by neighborhood area and family's socioeconomic characteristics in a peri-urban village of Formosa, Argentina. Across-sectional study was carried out between January and December 2016, with 160 Qom children between 2 and 5 years of age. Interviews and anthropometric measures were conducted at the children's homes. Nutritional status was determined by body mass index. The prevalence of excess weight (overweight + obesity) and of stunting were associated with neighborhood area and socioeconomic level. The overall prevalence of stunting was 15.6% and it was found to be higher (25.8%) in areas of relatively lower access to material resources. The overall prevalence of excess weight reached 25%; however, neighborhood areas with greater access to material resources had a significantly higher prevalence of children with excess weight (41.2%). Despite the entire community living under the line of poverty, we found differences in nutritional status by neighborhood areas, suggesting an incipient social stratification and a deepening of inequalities in access to resources.

Calidad de los instrumentos que valoran las funciones de la atención primaria: revisión sistemática / Quality of the instruments that value the functions of primary health: a systematic review / Qualidade dos instrumentos que valoram as funções da atenção primaria: revisão sistemática

Objetivo: evaluar las propiedades métricas de los instrumentos que valoran las funciones de la atención primaria en salud desde la perspectiva de usuarios. Métodos: revisión sistemática. Se utilizaron los descriptores "primary health care", "questionnaires", "psychometrics", "outcome measurement" y "process measurement". Los criterios de inclusión fueron publicaciones de revistas científicas en español, inglés y portugués, estudios de validación de cuestionarios que evaluaran funciones de la atención primaria en salud. Las propiedades métricas de los instrumentos se valoraron mediante el cuestionario EMPRO (por su sigla en inglés: Evaluating Measures of Patient Reported Outcomes). Resultados: se identificaron 28 artículos que cumplieron con los criterios de inclusión. Los cuestionarios que resultaron adecuados para su aplicación fueron 11, y de estos, ocho partían del PCAT (por su sigla en inglés: Primary Care Assessment Tool), ya que reunieron más evidencias sobre la calidad de sus propiedades métricas. Conclusiones: existen cuestionarios para evaluar las funciones esenciales de la atención primaria en salud. Las propiedades métricas del PCAT fueron adecuadas en la mayoría de las versiones adaptadas y validadas, por lo que permite obtener resultados confiables.

Objective: To evaluate the metric properties of the instruments that value the functions of primary health care from the perspective of the users. Materials and methods: Systematic review. The "primary health care" descriptors, "questionnaires", "psychometrics", "outcome measurement", and "process measurement" were used. The inclusion criteria were publications of scientific journals in Spanish, English and Portuguese, validation studies of questionnaires that evaluated functions of primary health care. The metric properties of the instruments were assessed using the EMPRO (by its acronym in English: Evaluating Measures of Patient Reported Outcomes) questionnaire. Results: A total of 28 descriptors that met the inclusion criteria were identified. Eleven questionnaires were suitable for application, and of these, eight came from the PCAT (by its acronym in English: Primary Care Assessment Tool), since they gathered more evidence on the quality of their metric properties. Conclusions: There are questionnaires to evaluate the essential functions of primary health care. The metric properties of the PCAT were adequate in most of the adapted and validated versions thus allowing reliable results.

Objetivo: avaliar as propriedades métricas dos instrumentos que valoram as funções da atenção primaria em saúde desde a perspectiva de usuários. Métodos: revisão sistemática. Utilizaram-se os descriptores "primary health care", "questionnaires", "psychometrics", "outcome measurement" e "process measurement". Os critérios de inclusão foram publições de revistas científicas em espanhol, inglês e português, estudos de validação de questionários que avaliaram funções da atenção primaria em saúde. As propriedades métricas dos instrumentos se valoraram mediante o questionário EMPRO (por sua sigla em inglês: Evaluating Measures of Patient Reported Outcomes). Resultados: Identificaram se 28 artigos que cumpriram com os criterios de inclusão. Os questionários que resultaram adequados para sua aplicação foram 11, e destes, oito partiam do PCAT (por sua sigla em inglês: Primary Care Assessment Tool), já que reuniram mais evidencias sobre a qualidade de suas propriedades métricas. Conclusões: existem questionários para avaliar as funções essenciais da atenção primaria em saúde. As propriedades métricas do PCAT foram adequadas na maioria das versões adaptadas e validadas, pelo que permite obter resultados confiáveis.

Inequities in neighborhood public park use for schoolchildren's physical activity: multilevel evidence from Cordoba, Argentina / Desigualdades no uso do parque público de bairro para a atividade física de crianças: evidências multiníveis de Córdoba, Argentina

ABSTRACT: Introduction: The complexity of urbanization processes across Latin American societies encourages investigating its implications in health conditions, especially during childhood. One of the possible links between them is recreation, a component of the daily life of children and, therefore, essential to produce health and life itself. The objective of this study was to examine the associations between neighborhood context and active public park use among school-aged children in Cordoba, Argentina. Methods: A cross-sectional study was conducted with 1466 children, aged 9 to 11, attending 19 schools and living in 110 neighborhoods. Multilevel models with Poisson distribution were used for the analyses, stratified by gender. Socio-demographic, behavioral, and physical covariates were included at the individual level, and socioeconomic neighborhood conditions at second level. Results: Girls residing in neighborhoods with a worse socioeconomic context were less likely to report frequent public park use for physical activity, while those from neighborhoods with better socioeconomic conditions were more likely to, regardless of individual characteristics. Conclusion: This study suggests that socioeconomic conditions of neighborhoods are associated with public park use for physical activity in school-aged girls, demonstrating gender inequality in the use and appropriation of public spaces.

RESUMO: Introdução: O processo de urbanização das sociedades latino-americanas estimula investigar suas consequências nas condições de saúde. Um dos elos possíveis é a recreação, componente do cotidiano das crianças essencial para a produção da saúde e da própria vida. O objetivo foi examinar as relações entre o contexto do bairro e o uso ativo do parque público entre as crianças em idade escolar em Córdoba, Argentina. Métodos: Foi realizado um estudo transversal com 1466 crianças que frequentam 19 escolas e moram em 110 bairros. Modelos multinível com distribuição de Poisson foram utilizados para as análises, estratificados por sexo. Covariáveis sociodemográficas, comportamentais e físicas foram incluídas no nível individual e as condições socioeconômicas do bairro, no segundo nível. Resultados: As meninas que residem em bairros com pior contexto socioeconômico foram menos prováveis a relatar o uso frequente de parques públicos para atividades físicas, enquanto aquelas provenientes de bairros com melhores condições eram mais prováveis, independentemente das características individuais. Conclusões: Este estudo sugere que as condições socioeconômicas dos bairros estão associadas ao uso de parques públicos para atividade física em meninas unicamente, demonstrando uma desigualdade de gênero.

Adaptación transcultural de un cuestionario de calidad de vida relacionada con la salud en paralisis cerebral / Cross-cultural adaptation of a questionnaire on health-related quality of life in cerebral palsy

INTRODUCCIÓN: los indicadores de calidad de vida relacionada con la salud (CVRS) son importantes en la valoración de personas con discapacidad porque incorporan su propia perspectiva. El CP QOL (Cerebral Palsy Quality of Life) es un cuestionario australiano que mide CVRS en niños, niñas y adolescentes con parálisis cerebral por autoadministración o por informador indirecto. El objetivo del presente estudio fue obtener una versión del CP QOL-PCQ (Primary Caregiver Questionnaire) adecuada culturalmente a la población argentina, que fuera práctica y semánticamente equivalente a la versión original. MÉTODOS: se realizó una adaptación transcultural incluyendo traducción y retrotraducción por lingüistas profesionales, control de equivalencia por expertos y autores, y pruebas de comprensión mediante entrevistas cognitivas a una muestra de cuidadores. La adecuación, equivalencia y comprensión fueron comprobadas en los discursos de expertos y las respuestas de entrevistas. RESULTADOS: se tradujeron 95 ítems, y 19 se modificaron durante las etapas de revisión y consenso con expertos y autores. En las entrevistas cognitivas se detectó dificultad de comprensión y equivalencia cultural y se modificaron 6 ítems. DISCUSIÓN: se dispone de versiones del CP QOLPCQ adecuadas culturalmente a la población infantil y adolescente argentina, con pruebas de su comprensión en población diana. Sus propiedades métricas y conformación definitiva serán evaluadas próximamente

Prevalencia de hipertensión arterial en escolares de Córdoba, Argentina, y su relación con el nivel socioeconómico / Prevalence of high blood pressure among schoolchildren from Córdoba, Argentina, and its relation to socioeconomic status

Introducción. Estudios previos en Argentina encontraron prevalencias variables de hipertensión arterial (HTA) en niños, utilizando diferentes métodos de medición. El objetivo de este estudio fue conocer la prevalencia de HTA en escolares de la ciudad de Córdoba y su relación con el sexo, el estado nutricional, el nivel socioeconómico (NSE) y la escolaridad materna. Población y métodos. Se obtuvieron mediciones de presión arterial e información sobre el NSE, la educación materna y el índice de masa corporal de niños escolarizados de la ciudad de Córdoba, Argentina. La HTA se definió como niveles de presión arterial sistólica o diastólica iguales al percentil 95 o mayores para una edad, sexo y percentil de altura determinados, en tres mediciones consecutivas realizadas en días diferentes. Resultados. Participaron 1531 niños y niñas de 10,6 años de edad promedio. Cincuenta y cinco niños tenían HTA. Los niveles de presión arterial sistólica y diastólica se asociaron significativamente con la obesidad (p= 0,001), pero no con la edad (p= 0,87), el sexo (sistólica: p= 0,48; diastólica: p= 0,71) o el NSE (sistólica: p= 0,07; diastólica: p= 0,09). Conclusiones. La prevalencia de HTA en una muestra de escolares de Argentina fue de 3,7%. Se asoció significativamente con la obesidad, pero no con el NSE.

Introduction. Prior studies conducted in Argentina found variable prevalence rates of high blood pressure (HBP) among children using different measurement methods. The objective of this study was to know the prevalence of HBP among schoolchildren from the city of Córdoba and its relation to sex, nutritional status, socioeconomic status (SES), and level of maternal education. Population and methods. Blood pressure measurements and information on SES, level of maternal education, and body mass index of schoolchildren from the city of Córdoba, Argentina, were obtained. HBP was defined as systolic or diastolic blood pressure levels that are greater than or equal to the 95th percentile for a given age, sex, and height percentile at three consecutive measurements on separate days. Results. A total of 1531 boys and girls participated; their average age was 10.6 years. Fifty-five children had HBP. Systolic and diastolic blood pressure levels showed a significant association with obesity (p= 0.001), but not with age (p= 0.87), sex (systolic: p= 0.48; diastolic: p= 0.71) or SES (systolic: p= 0.07; diastolic: p= 0.09). Conclusions. The prevalence of HBP in a sample of schoolchildren from Argentina was 3.7%. It showed a significant association with obesity, but not with SES.

Prevalence of high blood pressure among schoolchildren from Córdoba, Argentina, and its relation to socioeconomic status. / Prevalencia de hipertensión arterial en escolares de Córdoba, Argentina, y su relación con el nivel socioeconómico.

INTRODUCTION: Prior studies conducted in Argentina found variable prevalence rates of high blood pressure (HBP) among children using different measurement methods. The objective of this study was to know the prevalence of HBP among schoolchildren from the city of Córdoba and its relation to sex, nutritional status, socioeconomic status (SES), and level of maternal education. POPULATION AND METHODS: Blood pressure measurements and information on SES, level of maternal education, and body mass index of schoolchildren from the city of Córdoba, Argentina, were obtained. HBP was defined as systolic or diastolic blood pressure levels that are greater than or equal to the 95th percentile for a given age, sex, and height percentile at three consecutive measurements on separate days. RESULTS: A total of 1531 boys and girls participated; their average age was 10.6 years. Fifty-five children had HBP. Systolic and diastolic blood pressure levels showed a significant association with obesity (p= 0.001), but not with age (p= 0.87), sex (systolic: p= 0.48; diastolic: p= 0.71) or SES (systolic: p= 0.07; diastolic: p= 0.09). CONCLUSIONS: The prevalence of HBP in a sample of schoolchildren from Argentina was 3.7%. It showed a significant association with obesity, but not with SES.

Introducción. Estudios previos en Argentina encontraron prevalencias variables de hipertensión arterial (HTA) en niños, utilizando diferentes métodos de medición. El objetivo de este estudio fue conocer la prevalencia de HTA en escolares de la ciudad de Córdoba y su relación con el sexo, el estado nutricional, el nivel socioeconómico (NSE) y la escolaridad materna. Población y métodos. Se obtuvieron mediciones de presión arterial e información sobre el NSE, la educación materna y el índice de masa corporal de niños escolarizados de la ciudad de Córdoba, Argentina. La HTA se definió como niveles de presión arterial sistólica o diastólica iguales al percentil 95 o mayores para una edad, sexo y percentil de altura determinados, en tres mediciones consecutivas realizadas en días diferentes. Resultados. Participaron 1531 niños y niñas de 10,6 años de edad promedio. Cincuenta y cinco niños tenían HTA. Los niveles de presión arterial sistólica y diastólica se asociaron significativamente con la obesidad (p= 0,001), pero no con la edad (p= 0,87), el sexo (sistólica: p= 0,48; diastólica: p= 0,71) o el NSE (sistólica: p= 0,07; diastólica: p= 0,09). Conclusiones. La prevalencia de HTA en una muestra de escolares de Argentina fue de 3,7%. Se asoció significativamente con la obesidad, pero no con el NSE.

Armonización iberoamericana de los instrumentos PCAT para la evaluación del primer nivel de atención

Cuarenta años después de Alma Ata, el mundo está reforzando la consciencia sobre la importancia de los atributos y funciones del primer nivel de atención, pero aún queda mucho por hacer para implementarlos, medirlos y aprender de las experiencias exitosas de algunos países. El conjunto de instrumentos Primary Care Assessment Tools (PCAT), desarrollados en los años 90 en Estados Unidos de América por Starfield y Shi (1), se ha mostrado como la herramienta más completa para el análisis de la atención primaria de la salud (APS) y su utilidad fue reconocida en numerosos países y regiones del mundo. El objetivo de esta carta es comunicar preliminarmente el proceso de armonización de las versiones PCAT ya adaptadas en diversos países de Iberoamérica y subrayar la importancia de estas herramientas para evaluar y comparar el primer nivel de atención, particularmente en sistemas de salud fundados en la estrategia de APS.