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RESUMEN Con el objetivo de priorizar políticas públicas para disminuir el consumo de bebidas azucaradas en Argentina, Brasil, El Salvador y Trinidad y Tobago e identificar las necesidades de información relacionadas con la carga de enfermedad atribuible a su consumo se realizó un diálogo de políticas en el que participaron miembros de gobierno, organizaciones de la sociedad civil, investigadores y comunicadores de países de Latinoamérica y el Caribe. Se llevaron a cabo exposiciones y talleres deliberativos utilizándose herramientas de recolección de datos semiestructuradas y discusiones grupales facilitadas. Las intervenciones priorizadas fueron el incremento de impuestos, el etiquetado frontal, la restricción de la publicidad, promoción y patrocinio y las modificaciones del entorno escolar. La principal barrera percibida fue la interferencia de la industria alimentaria. La realización de este diálogo de decisores permitió la identificación de las políticas públicas prioritarias para disminuir el consumo de bebidas azucaradas en la región. ABSTRACT In order to prioritize public policies to reduce the consumption of sugar-sweetened beverages in Argentina, Brazil, El Salvador and Trinidad and Tobago and to identify information gaps related to the burden of disease attributable to their consumption, a policy dialogue was held with government members, civil society organizations, researchers and communicators from Latin American and Caribbean countries. Presentations and deliberative workshops were conducted using semi-structured data collection tools and group discussions. The prioritized interventions were tax increases, front labeling, restriction of advertising, promotion and sponsorship, and modifications regarding the school environment. The main perceived barrier was the interference from the food industry. This dialogue among decision-makers led to the identification of priority public policies to reduce the consumption of sugar-sweetened beverages in the region.

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

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

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

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

Background Maternal immunization rates and vaccine uptake in Latin America vary from country to country. This variability stems from factors related to pregnant women, vaccine recommendations from healthcare providers and the health system. The aim of this paper is to describe women’s knowledge and attitudes to maternal immunziation, and barriers to access and vaccination related decision-making processes in Latin American countries. Methods We conducted focus group discussions (FGD) with pregnant women in five middle-income countries: Argentina, Brazil, Honduras, Mexico and Peru, between July 2016 and July 2018. The FGDs were conducted by trained qualitative researchers in diverse clinics located in the capital cities of these countries. Results A total of 162 pregnant women participated in the FGDs. In general, participants were aware of the recommendation to receive vaccines during pregnancy but lacked knowledge regarding the diseases prevented by these vaccines. Pregnant women expressed a desire for clearer and more detailed communication on maternal vaccines by their healthcare professionals instead of relying on other sources of information such as the internet. Overall, participants had positive attitudes towards maternal immunization and were open to receiving vaccines in pregnancy based on general trust they have in recommendations made by their healthcare providers. The main obstacles pregnant women said they encounter were mainly centered around their clinical experience: long waiting times, vaccine shortages, and impolite behavior of healthcare providers or clinical staff. Conclusion Important advances have been made in Latin America to promote maternal immunization. Results from this study show that an important aspect that remains to be addressed, and is crucial in improving vaccine uptake in pregnancy, is women’s clinical experience. We recommend pregnant women to be treated as a priority population for providing immunization and related healthcare education. It is imperative to train healthcare providers in health communication so they can effectively communicate with pregnant women regarding maternal vaccines and can fill knowledge gaps that otherwise might be covered by unreliable sources dispensing inaccurate information.

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

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

OBJECTIVE This study sought to estimate the frequency and types of mistreatment during childbirth and explore health professionals' opinions on barriers/facilitators to providing respectful childbirth care. METHODS This prospective mixed-methods investigation consisted of direct observations of childbirth (n = 250), at-home surveys with birthing individuals (n = 45), and qualitative in-depth health staff interviews (n = 6), conducted between January and July 2019, in two public facilities in Argentina. Frequencies of clinical practices and mistreatment and 5% confidence intervals were calculated. A logistic regression analysis was also conducted to examine associations between mistreatment and covariates of interest, with P

Background: Antenatal care providers have a key role in providing appropriate information and immunization recommendations to improve pregnant women's vaccine uptake. The objective of this study is to describe health care providers' perspectives and experience regarding the implementation of maternal immunization programs in Latin America. Methods: We conducted 33 in-depth interviews of health care providers from Argentina, Brazil, Honduras, Mexico, and Peru (6–7 per country). Qualitative data analysis was conducted using a combination of both manual techniques and the computer software program NVivo. We identified and coded main themes related to maternal immunization. Results: The main themes identified in this analysis were practices related to maternal immunization, knowledge and training, resource availability and interactions with pregnant women. Healthcare providers knew that recommendations exists but some did not know their content; they expressed concerns about insufficient training. Providers from all five countries expressed the need for additional human resources and supplies. They also expressed a desire for women to be more proactive and ask more questions during the health visits. Conclusion: This is the first multi-country study assessing the perspectives of health care providers about maternal immunization practices at the facility level in Latin America. Recommendations based on the results from this study include implementing additional trainings around maternal immunization, especially targeting obstetricians and midwives. These trainings should be conducted in coordination with improvements to supply chain and other structural issues. Fil: Malik, Fauzia A.. University of Yale; Estados Unidos Fil: Alonso, Juan Pedro. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Sanclemente, Lauren N.. University of Emory; Estados Unidos Fil: Vilajeliu, Alba. Organización Panamericana de la Salud; Estados Unidos Fil: Gutierrez, Mariana. University of Emory; Estados Unidos Fil: Gonzalez Casanova, Ines. University of Emory; Estados Unidos. Indiana University; Estados Unidos Fil: Jones, Daniel Eduardo. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Omer, Saad. University of Yale; Estados Unidos Fil: Ropero, Alba-Maria. Organización Panamericana de la Salud; Estados Unidos Fil: Belizán, María Melina Eleonora. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina

Despite efforts to improve detection and treatment of adults with hypertension and diabetes in Argentina, many public healthcare system users remain undiagnosed or face barriers in managing these diseases. The purpose of this study is to identify health system, provider, and user-related factors that may hinder detection and treatment of hypertension and diabetes using a traditional and behavioral economics approach. We did qualitative research using in-depth semistructured interviews and focus groups with healthcare providers and adult users of Public Primary Care Clinics. Health system barriers included inadequate care accessibility; poor integration between primary care clinics and local hospitals; lack of resources; and gender bias and neglect of adult chronic disease. Healthcare provider–related barriers were inadequate training; lack of availability or reluctance to adopt Clinical Practice Guidelines; and lack of counseling prioritization. From a behavioral economics perspective, bottlenecks were related to inertia and a status quo, overconfidence, and optimism biases. User-related barriers for treatment adherence included lack of accurate information; resistance to adopt lifelong treatment; affordability; and medical advice mistrust. From a behavioral economics perspective, the most significant bottlenecks were overconfidence and optimism, limited attention, and present biases. Based on these findings, new interventions that aim to improve prevention and control of chronic conditions can be proposed. The study provides empirical evidence regarding the barriers and bottlenecks in managing chronic conditions in primary healthcare settings. Results may contribute to the design of behavioral interventions targeted towards healthcare provision for the affected population.

Introduction. Health promotion initiatives, even more those promoted by the State, play a fundamental and strategic role in the construction of healthy lifestyles. The objective was to explore from the perspective of a group of young adults from the Autonomous City of Buenos Aires, dimensions and qualitative categories related to health promotion community initiatives with a focus on healthy diet, physical activity, and smoking cessation.A qualitative phenomenological study were conducted, including sixteen in-depth interviews with people under 40 years of age.Were found and explored that interventions through websites, email, social networks, application- Mobile App (App), calls, text messages (SMS), printed material, or brief advice. The most acceptable interventions were: website, social networks, and the App. The potential use of these interventions would be related by the inclusion of audiovisual elements and personalized messages.The findings indicate that interventions that include social networks, App and web would have greater potential among young adults to promote healthy lifestyles.Las iniciativas de promoción de salud, más aún las impulsadas desde el Estado, juegan un papel fundamental y estratégico en torno a la construcción de estilos de vida saludables. El objetivo fue explorar desde la perspectiva de un grupo de adultos jóvenes de la Ciudad Autónoma de Buenos Aires dimensiones y categorías cualitativas relacionadas a iniciativas comunitarias de promoción de la salud con foco en alimentación saludable, actividad física y cesación tabáquica.Se realizó un estudio cualitativo de carácter fenomenológico incluyendo 16 entrevistas en profundidad a personas menores de 40 años.Se identificaron y exploraron intervenciones a través de sitios web, correo electrónico, redes sociales, aplicativo-App móvil (App), llamadas, mensajes de texto-SMS, material impreso o asesoría breve. Las intervenciones de mayor aceptabilidad fueron: sitio web, redes sociales y App. El uso potencial de las intervenciones estaría relacionado con la inclusión de elementos audiovisuales y los mensajes personalizados.Nuestros hallazgos indican que las intervenciones que incluyan redes sociales, App y web tendrían mayor potencial para promover estilos de vida saludables entre los adultos jóvenes.

The partograph is the most commonly used labour monitoring tool in the world. However, it has been used incorrectly or inconsistently in many settings. In 2018, a WHO expert group reviewed and revised the design of the partograph in light of emerging evidence, and they developed the first version of the Labour Care Guide (LCG). The objective of this study was to explore opinions of skilled health personnel on the first version of the WHO Labour Care Guide.Skilled health personnel (including obstetricians, midwives and general practitioners) of any gender from Africa, Asia, Europe and Latin America were identified through a large global research network. Country coordinators from the network invited 5 to 10 mid-level and senior skilled health personnel who had worked in labour wards anytime in the last 5 years. A self-administered, anonymous, structured, online questionnaire including closed and open-ended questions was designed to assess the clarity, relevance, appropriateness of the frequency of recording, and the completeness of the sections and variables on the LCG.A total of 110 participants from 23 countries completed the survey between December 2018 and January 2019. Variables included in the LCG were generally considered clear, relevant and to have been recorded at the appropriate frequency. Most sections of the LCG were considered complete. Participants agreed or strongly agreed with the overall design, structure of the LCG, and the usefulness of reference thresholds to trigger further assessment and actions. They also agreed that LCG could potentially have a positive impact on clinical decision-making and respectful maternity care. Participants disagreed with the value of some variables, including coping, urine, and neonatal status.Future end-users of WHO Labour Care Guide considered the variables to be clear, relevant and appropriate, and, with minor improvements, to have the potential to positively impact clinical decision-making and respectful maternity care.ANTECEDENTES: El partograma es la herramienta para el monitoreo del trabajo de parto más utilizada a nivel mundial. Sin embargo, en muchos entornos se utiliza de manera incorrecta o inconsistente. En 2018, un grupo de expertos de la OMS evaluó y modificó el diseño del partograma teniendo en cuenta la nueva evidencia científica, y elaboró la primera versión de la Guía para la Atención del Trabajo de Parto. El objetivo de este estudio fue explorar las perspectivas y opiniones de los profesionales de la salud sobre la primera versión de la Guía para la Atención del Trabajo de Parto. MéTODOS: Se identificó a profesionales de salud de servicios de maternidad (incluidos obstetras, parteras profesionales y médicos generalistas) de cualquier género de África, Asia, Europa y América Latina a través de una red de investigación internacional. Los coordinadores de países de la red invitaron entre 5 y 10 profesionales con nivel de experiencia media o avanzada que hubieran trabajado en servicios de maternidad en los últimos 5 años. Se diseñó un cuestionario en línea, autoadministrado, anónimo y estructurado que incluía preguntas cerradas y abiertas para evaluar la claridad, la pertinencia, la adecuación de la frecuencia de registro y la exhaustividad de las secciones y variables de la Guía para la Atención del Trabajo de Parto.Un total de 110 participantes de 23 países completaron la encuesta entre diciembre de 2018 y enero de 2019. Las variables incluidas en la Guía para la Atención del Trabajo de Parto se consideraron en general claras, pertinentes y con una frecuencia de registro apropiada. La mayoría de las secciones de la Guía para la Atención del Trabajo de Parto se consideraron completas. Los participantes estuvieron de acuerdo o muy de acuerdo con el diseño general, la estructura de la Guía para la Atención del Trabajo de Parto, y la utilidad de los umbrales de referencia para desencadenar evaluaciones y acciones adicionales. También estuvieron de acuerdo en que la Guía para la Atención del Trabajo de Parto tendrá un impacto positivo en la toma de decisiones clínicas y en el cuidado respetuoso. Los participantes no estuvieron de acuerdo con algunos parámetros propuestos en la Guía para la Atención del Trabajo de Parto, incluyendo el manejo de la situación por parte de las mujeres, parámetros urinarios y el estado neonatal.Los futuros usuarios de la Guía para la Atención del Trabajo de Parto consideraron que las variables eran claras, pertinentes y apropiadas, y que, con pequeñas mejoras, podría tener un impacto positivo en la toma de decisiones clínicas y la atención respetuosa del parto.RéSUMé: CONTEXTE: Le partogramme est l'outil de suivi du travail le plus couramment utillis dans le monde. Cependant, il est utilisé de façon incorrecte ou non uniforme dans de nombreux contextes. En 2018, un groupe d'experts de l'OMS a examiné et révisé la conception du partogramme à la lumière de nouvelles données et a développé la première version du Guide de Gestion du Travail. L'objectif de cette étude était d'explorer les points de vue et les opinions du personnel de santé qualifié sur la première version du Guide de Gestion du Travail de l'OMS. MéTHODES: Un vaste réseau mondial de recherche a permis d'identifier le personnel de santé qualifié (y compris des obstétriciens, des sages-femmes et des médecins généralistes) des deux sexes, en Afrique, Asie, Europe et en Amérique latine. Les coordinateurs nationaux du réseau ont invité entre 5 et 10 personnels de santé qualifiés de niveau intermédiaire à supérieur, et ayant travaillé dans des services de maternité à au cours des 5 dernières années. Un questionnaire en ligne, structuré, anonyme et à remplir soi-même, comprenant des questions fermées et ouvertes, a été conçu pour évaluer la clarté, la pertinence, la convenance de la fréquence d'enregistrement et l’intégrité des variables du Guide de Gestion du Travail. RéSULTATS: Au total, 110 participants de 23 pays ont répondu à l'enquête entre décembre 2018 et janvier 2019. Les variables incluses dans le Guide de Gestion du Travail ont t généralement considérées claires, pertinentes et avec une fréquence d'enregistrement appropriée. La plupart des sections du Guide de Gestion du Travail sont considérées complètes. Les participants ont approuvé ou fortement approuvé le concept générale, la structure du Guide de Gestion du Travail et l'utilité des seuils de référence pour déclencher une évaluation et des actions supplémentaires. Ils ont également convenu que le Guide de Gestion du Travail aura potentiellement un impact positif sur les prise de décisions cliniques et les soins maternels respectueux. Les personnes interrogées ont exprimé leur désaccord avec la valeur de certaines variables, notamment la capacité d'adaptation, l'urine et l'état néonatal. CONCLUSIONS: Les futurs utilisateurs du le Guide de Gestion du Travail ont estimé que les variables étaient claires, pertinentes et appropriées, et qu'elles pourraient avoir un impact positif sur la prise de décision clinique et les soins de maternit respectueux, moyennant quelques améliorations mineures.

BackgroundColorectal cancer (CRC) is the third most common neoplasm and the fourth cause of cancer death worldwide. In Argentina, more than 16,000 cases are diagnosed and 8,700 people die each year. The Immunochemical Faecal Occult Blood Test (iFOBT) is recommended for the prevention and early detection of CRC in people of both sexes, between 50 and 75 years old with average-risk. The worksite setting has great potential to improve adherence to preventive interventions. We aimed to design and evaluate the feasibility, acceptability, and effectiveness of a strategy implemented in the workplace to improve the rate of adherence to the IFOBT screening in employees of the government’s Revenue Agency of the Province of Buenos Aires (ARBA). MethodsWe used a quasi-experimental research design, a controlled interrupted time-series (ITS). The study period was divided into two-time segments: (1) a 51- month pre-intervention period (July 2015 through September 2018); (2) a 5-month post-intervention period (October 2018 through February 2019). We performed an initial formative research using qualitative research methods (semi-structured interviews, focus groups) in order to inform the design of the intervention and adapt it, to ensure that it is both feasible and implementable by the target population. We fitted segmented linear regression models to evaluate changes in the monthly rates per 10,000 of tests done in ARBA employees, and controlling for the proportion of tests done in non-ARBA workers. ResultsA total of 1552 ARBA employees aged 50 or more participated. Overall, iFOBT mean uptake rates were 16 times higher in the intervened during the five-month intervention period, remaining statistically significant after adjusting by the proportion of tests done in the control group (p

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

Resumen: El ámbito laboral tiene un gran potencial para difundir información e implementar actividades de promoción de la salud, como la prevención y detección temprana del cáncer. Debido al desafío de implementar intervenciones sanitarias en este ámbito, se necesitan investigaciones formativas para adecuar el diseño y la implementación de las estrategias para que sean exitosas. Con el objetivo de informar el diseño e implementación de la intervención, para mejorar la tasa de adherencia al tamizaje con el test de sangre oculta en materia fecal, en un ámbito laboral en Argentina, se realizó una investigación formativa para identificar potenciales barreras y facilitadores. La investigación formativa siguió un diseño metodológico cualitativo. Se realizaron entrevistas con 10 responsables de áreas clave de la institución en que se desarrolló el estudio y 8 grupos focales con trabajadores mayores de 50 años. Se identificaron desafíos para la implementación de la intervención en el nivel institucional, como la dispersión geográfica de los trabajadores y la complejidad del organigrama de la institución, y en el nivel de la población objetivo, como el bajo conocimiento del cáncer colorrectal y de los test diagnósticos, así como la baja percepción de riesgo. Entre los facilitadores se destacaron la aceptabilidad de la intervención, además de la disponibilidad de recursos humanos y materiales para llevar adelante la intervención, como canales de comunicación institucional para la diseminación de información, así como la logística para la distribución de kits diagnósticos. La investigación formativa permitió relevar recursos e identificar potenciales barreras que informaron el diseño y la implementación de la intervención. Abstract: The workplace has great potential to disseminate information and implement health promotion activities such as cancer prevention and early detection. Due to the challenges of deploying health interventions in this setting, formative studies are needed to adjust the design and implementation of successful strategies. To inform the intervention’s design and implementation and improve the adherence rate to screening with fecal occult blood test in a workplace in Argentina, a formative study was conducted to identify potential barriers and facilitators. The formative study adopted a qualitative methodological design. Interviews were held with 10 individuals in charge of key areas in the institution where the main study was conducted, besides 8 focus groups with workers over 50 years of age. Challenges were identified at the institutional level for the intervention’s implementation, such as workers’ geographic dispersion and the complexity of the institution’s flowchart, as well as at the population level, such as low knowledge about colorectal cancer and diagnostic tests and low risk perception. The facilitators featured the intervention’s acceptability and the availability of human and material resources to proceed with the intervention, such as institutional communications channels for disseminating the information and logistics for distribution of diagnostic kits. The formative study allowed identifying resources and potential barriers that informed the intervention’s design and implementation. Resumo: O local de trabalho possui grande potencial para divulgar informação e implementar atividades de promoção da saúde, como a prevenção e detecção precoce do câncer. Frente ao desafio de implementar ações sanitárias naquele ambiente, são necessárias pesquisas formativas para adequar a estruturação e a implementação das estratégias para que sejam bem-sucedidas. Com o objetivo de subsidiar a concepção e a implementação da ação, visando melhorar a taxa de aderência ao screening com o teste de sangue oculto nas fezes no ambiente de trabalho na Argentina, foi desenvolvida uma pesquisa formativa para identificar potenciais barreiras e facilitadores. A pesquisa formativa seguiu um formato metodológico qualitativo. Foram realizadas entrevistas com 10 gerentes de áreas chaves da entidade onde foi desenvolvido o estudo e 8 grupos focais, com trabalhadores acima de 50 anos de idade. Foram identificados alguns desafios para a implementação de uma ação em nível institucional, como a dispersão geográfica dos trabalhadores e a complexidade do organograma da entidade, e em termos de população objetiva, como o baixo conhecimento a respeito do câncer colorretal e dos testes diagnósticos, além da baixa percepção de risco. Entre os facilitadores, destacaram-se a aceitabilidade da ação e a disponibilidade de recursos humanos e materiais para levar a cabo a ação, como canais de comunicação institucional, para a divulgação da informação e a logística, para a distribuição dos kits diagnósticos. A pesquisa formativa revelou recursos e identificou potenciais barreiras, ajudando na estruturação e implementação da ação.

El objetivo de este estudio fue evaluar la percepción de equipos de salud de atención en primer nivel y público objetivo acerca de facilitadores y barreras para el abordaje de Chagas a partir de una intervención multifacética, en una zona endémica. Se realizaron 12 entrevistas semiestructuradas y grupos focales en Centros de Atención Primaria en Resistencia, Chaco. El estudio fue guiado por el Marco Consolidado para la Investigación de la Implementación. Los profesionales tuvieron una impresión positiva de la intervención pero mostraron preocupación acerca de la factibilidad. Los profesionales perciben un número excesivo de programas, pocos insumos y recursos humanos, insuficiente capacitación, material informativo desactualizado, trabas burocrática para pedido de insumos y medicación; asimismo perciben falta de vinculación en niveles de atención y fragmentación de registros. Esta investigación contribuiría a la adaptación de intervenciones según barreras y facilitadores existentes. The objective of this study was to evaluate the perception of the healthcare teams and target population about the facilitators and barriers to address Chagas disease in primary level in an endemic area in Argentina. Twelve semi-structured interviews and focus groups were conducted in Primary Health Care Centres in Resistencia, Chaco. The study was guided by the Consolidated Framework for Implementation Research. While professionals had a positive perception of the proposed intervention to address Chagas, they showed concern about complexity and feasibility. Professionals perceive an excessive number of programs, limited material and resources, a lack of training in Chagas, outdated information material, bureaucratic obstacles to requesting supplies and medication, unrelated levels of care and fragmented records on Chagas. This research would contribute to the design of interventions that can be adapted to the existing barriers and facilitators. O objetivo deste estudo foi avaliar a percepção das equipes de saúde e da população alvo sobre os facilitadores e as barreiras para enfrentar a doença de Chagas ao nível primário em uma área endêmica na Argentina. Foram realizadas 12 entrevistas semiestruturadas e grupos focais em Centros de Saúde Primários em Resistencia, Chaco. O estudo foi orientado pelo Quadro Consolidado de Pesquisa para Implementação. Os profissionais tiveram uma percepção positiva da intervenção proposta para abordar o Chagas, mas mostraram preocupação com a sua complexidade e viabilidade. Os profissionais percebem um número excessivo de programas, material e recursos limitados, falta de treinamento em Chagas, material informativo desatualizado, obstáculos burocráticos para solicitar suprimentos e medicamentos, níveis de cuidados não relacionados e registros fragmentados sobre Chagas. Esta investigação contribuiria para a concepção de intervenções que possam ser adaptadas às barreiras e facilitadores existentes. Fil: Roberti, Javier Eugenio. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Alonso, Juan Pedro. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Rouvier, Mariel Vanesa. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Belizán, María Melina Eleonora. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Klein, Karen. Instituto de Efectividad Clínica y Sanitaria; Argentina

The workplace has great potential to disseminate information and implement health promotion activities such as cancer prevention and early detection. Due to the challenges of deploying health interventions in this setting, formative studies are needed to adjust the design and implementation of successful strategies. To inform the intervention's design and implementation and improve the adherence rate to screening with fecal occult blood test in a workplace in Argentina, a formative study was conducted to identify potential barriers and facilitators. The formative study adopted a qualitative methodological design. Interviews were held with 10 individuals in charge of key areas in the institution where the main study was conducted, besides 8 focus groups with workers over 50 years of age. Challenges were identified at the institutional level for the intervention's implementation, such as workers' geographic dispersion and the complexity of the institution's flowchart, as well as at the population level, such as low knowledge about colorectal cancer and diagnostic tests and low risk perception. The facilitators featured the intervention's acceptability and the availability of human and material resources to proceed with the intervention, such as institutional communications channels for disseminating the information and logistics for distribution of diagnostic kits. The formative study allowed identifying resources and potential barriers that informed the intervention's design and implementation.El ámbito laboral tiene un gran potencial para difundir información e implementar actividades de promoción de la salud, como la prevención y detección temprana del cáncer. Debido al desafío de implementar intervenciones sanitarias en este ámbito, se necesitan investigaciones formativas para adecuar el diseño y la implementación de las estrategias para que sean exitosas. Con el objetivo de informar el diseño e implementación de la intervención, para mejorar la tasa de adherencia al tamizaje con el test de sangre oculta en materia fecal, en un ámbito laboral en Argentina, se realizó una investigación formativa para identificar potenciales barreras y facilitadores. La investigación formativa siguió un diseño metodológico cualitativo. Se realizaron entrevistas con 10 responsables de áreas clave de la institución en que se desarrolló el estudio y 8 grupos focales con trabajadores mayores de 50 años. Se identificaron desafíos para la implementación de la intervención en el nivel institucional, como la dispersión geográfica de los trabajadores y la complejidad del organigrama de la institución, y en el nivel de la población objetivo, como el bajo conocimiento del cáncer colorrectal y de los test diagnósticos, así como la baja percepción de riesgo. Entre los facilitadores se destacaron la aceptabilidad de la intervención, además de la disponibilidad de recursos humanos y materiales para llevar adelante la intervención, como canales de comunicación institucional para la diseminación de información, así como la logística para la distribución de kits diagnósticos. La investigación formativa permitió relevar recursos e identificar potenciales barreras que informaron el diseño y la implementación de la intervención.O local de trabalho possui grande potencial para divulgar informação e implementar atividades de promoção da saúde, como a prevenção e detecção precoce do câncer. Frente ao desafio de implementar ações sanitárias naquele ambiente, são necessárias pesquisas formativas para adequar a estruturação e a implementação das estratégias para que sejam bem-sucedidas. Com o objetivo de subsidiar a concepção e a implementação da ação, visando melhorar a taxa de aderência ao screening com o teste de sangue oculto nas fezes no ambiente de trabalho na Argentina, foi desenvolvida uma pesquisa formativa para identificar potenciais barreiras e facilitadores. A pesquisa formativa seguiu um formato metodológico qualitativo. Foram realizadas entrevistas com 10 gerentes de áreas chaves da entidade onde foi desenvolvido o estudo e 8 grupos focais, com trabalhadores acima de 50 anos de idade. Foram identificados alguns desafios para a implementação de uma ação em nível institucional, como a dispersão geográfica dos trabalhadores e a complexidade do organograma da entidade, e em termos de população objetiva, como o baixo conhecimento a respeito do câncer colorretal e dos testes diagnósticos, além da baixa percepção de risco. Entre os facilitadores, destacaram-se a aceitabilidade da ação e a disponibilidade de recursos humanos e materiais para levar a cabo a ação, como canais de comunicação institucional, para a divulgação da informação e a logística, para a distribuição dos kits diagnósticos. A pesquisa formativa revelou recursos e identificou potenciais barreiras, ajudando na estruturação e implementação da ação.

Background: Zika virus (ZIKV) infection during pregnancy has severe consequences on the new-born. The World Health Organization declared the Zika outbreak to be a Public Health Emergency of International Concern (PHEIC) in 2016. Health facilities in the regions most affected by Zika lacked the capacity to respond to the increased demand for contraception. The objectives were to explore healthcare users' perceptions regarding contraception, Zika prevention during pregnancy and post-abortion care (PAC) services in the context of a Zika outbreak in Tegucigalpa, Honduras, and to follow these services over time. Methods: This study was part of a broader implementation research study. We used qualitative research consistent with grounded theory approach. Semi-structured interviews and focus groups were performed with women and their partners who used contraceptive services or received PAC services. Data were collected in two stages from December 2017 to July 2018. Themes explored included contraception, Zika and PAC services. Results: Participants had positive attitude towards the use of contraceptive methods and demanded more information on safety, efficacy and on side effects. Health care services were inconsistent in the provision of information on Zika and contraception services. ZIKV vector transmission was known but fewer participants were aware of risk of sexual transmission of Zika. Barriers to access healthcare services included contraceptive and PAC services included distance to healthcare facilities, disorganized admission process, long waiting times and out-of-pocket expenditure to purchase medicines. Furthermore, poor quality, mistreatment and abuse of women seeking PAC was prevalent. Some positive changes were noted over time, such as improvements in infrastructure including improved privacy and cleanliness, removal of fees, requisite to bring clean water to hospital. Conclusions: Our results highlight the challenges and areas for improvement in policy and practice related to contraceptive services and PAC in the context of ZIKV infection. Public policies to prevent epidemics should focus more on providing proper sanitation; removing barriers to access and use of effective contraception as human rights priority. Zika epidemic has highlighted weaknesses in health systems that obstruct access to and use of sexual and reproductive health services. The study results call for increased efforts to improve access, especially for women of low socio-economic status and intervene at different levels to eradicate discrimination and improve equity in the provision of health care. Qualitative methods can capture the community perspectives and can provide useful information to develop interventions to improve services. Fil: Belizan, Maria. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Maradiaga, Edna. Facultad de Ciencias Médicas; Honduras Fil: Roberti, Javier Eugenio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina Fil: Casco Aguilar, Maricela. Facultad de Ciencias Médicas; Honduras Fil: Ortez, Alison F.. Facultad de Ciencias Médicas; Honduras Fil: Avila Flores, Juan C.. Facultad de Ciencias Médicas; Honduras Fil: González, Gloria. Hospital Escuela; Honduras Fil: Bustillo, Carolina. Hospital Escuela; Honduras Fil: Calderón, Alejandra. Centro de Salud Alonso Suazo; Honduras Fil: Bock, Harry. No especifíca; Fil: Cafferata, María L.. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Tavares, Adriano B.. Organizacion Mundial de la Salud; Argentina Fil: Alger, Jackeline. Facultad de Ciencias Médicas; Honduras Fil: Ali, Moazzam. Organizacion Mundial de la Salud; Argentina

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

Objectives: (1) To produce Peruvian general population EQ-5D-5L value sets on a quality-adjusted life-year scale, (2) to investigate the feasibility of a “Lite” protocol less reliant on the composite time trade-off (cTTO), and (3) to compare cTTO and discrete choice experiment (DCE) value sets. Methods: A random sample of adults (N = 1000) in Lima, Arequipa, and Iquitos did a home interview; 300 were randomly selected to complete 11 cTTOs first. All respondents completed a DCE, including 10 latent-scale pairs (A/B) with 5 EQ-5D-5L attributes, and 12 matched pairs (A/B and B/C) with 5 EQ-5D-5L and one lifespan attributes. We estimated a cTTO heteroscedastic tobit (N = 300) model and 3 DCE Zermelo-Bradley-Terry models (N = 300, 700, and 1000). Results: Each model produced a consistent value set (20 positive incremental parameters). Nevertheless, their lowest quality-adjusted life-year values differed greatly (cTTO: –1.076 [N = 300]; DCE: –0.984 [300], 0.048 [700], –0.213 [1000]). Compared with the cTTO, the DCE (N = 300) produced different parameters (Pearson's correlation = 0.541), fewer insignificant parameters (0 vs 8), and fewer values less than 0 (26% vs 44%). Compared with the DCE (N = 300), the DCE (N = 700) produced higher values but similar parameters (Pearson's correlation = 0.800). Conclusions: Besides producing EQ-5D-5L value sets for Peru, the results casts doubt about the feasibility of a Lite protocol like the one in this study. Additionally, fundamental differences between cTTO and DCE—without the existence of a gold standard—need further clarification. The choice between the two rational value sets produced in the current study is a matter of judgment and may have substantial policy implications. Fil: Augustovski, Federico Ariel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina Fil: Belizán, María. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Gibbons, Luz. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Reyes, Nora. Instituto Nacional de la Salud; Perú Fil: Stolk, Elly. Euroqol Research Foundation; Países Bajos Fil: Craig, Benjamin M.. University of South Florida; Estados Unidos Fil: Tejada, Romina A.. Instituto Nacional de la Salud; Perú

The Healthy Municipalities and Communities Strategy (HMCS) was developed by the Pan American Health Organization in 1990. Evaluation and monitoring are fundamental components of health promotion policies. The aim of this study is to explore the indicators used in Latin America and the Caribbean (LAC) countries to assess the performance of HMCS. We searched MEDLINE, EMBASE, LILACS, BVSDE and Google Advanced Search for documents published between January 2000 and April 2016. We included only documents with assessment indicators of the strategy. All articles were independently assessed for eligibility by pairs of reviewers. We classified the indicators with a supporting framework proposed by O’Neill and Simard (Choosing indicators to evaluate Healthy Cities projects: a political task? Health Promot Int 2006, 21, 145–152.). Local level indicators figured far more prominently among countries and were distributed both in projects and specific activities. Regarding the evolution of the HMCS, indicators were reported in the five levels of analysis (local projects and activities, provincial, national and international networks). Empowerment was represented through the presence of active community organizations and different methods of community participation (forums, open hearing and participation maps). Public policies (such as for tobacco cessation) and bylaws adherence and changes in school’s curricula regarding healthy eating were frequently mentioned. However, this review demonstrated that impact indicators related to lifestyle changes or built environment are not clearly defined and there is a lack of indicators to measure progress in achieving change in long-term outcomes in LAC. We highlight the importance of designing validated indicators for measuring the impact of health promotion policies in partnership with each country involved.

El objetivo fue describir experiencias, barreras y facilitadores en la im- plementación de intervenciones de control del Aedes aegypti en América Latina y Caribe. Fue realizado un abordaje cualitativo con entrevistas en profundidad semiestructuradas a expertos en implementación de programas (19 participantes de nueve países). Se utilizó un software para la codificar los datos y se confeccionaron matrices para su comparación. En base a los hallazgos desarrollamos una representación gráfica de dimensiones teóricas que agrupan las barreras y facilitadores para la implementación de intervenciones. A nivel global, el ambiente natural y construido contribuye a la reproducción del mosquito. En el sistema de salud, la falta de priorización del problema y la escasez de recursos materiales y humanos representan los obstáculos más importantes. Se necesita que otros sectores diferentes al de salud se responsabilicen de las acciones para mejorar los determinantes sociales de la salud. Existen barreras transversales relacionadas con la gobernanza, como la descoordinación entre los niveles centrales y locales, falta de continuidad de las intervenciones y de los grupos técnicos. La comunidad enfrenta problemas como la falta de información, pobreza o resistencias a recomendaciones. La opinión pública puede tener un impacto positivo o negativo, influyendo indirectamente en las decisiones políticas. Este estudio propone un marco de dimensiones de análisis construido desde los hallazgos; describe factores influyentes en la implementación de políticas que pueden orientar las acciones futuras desde un enfoque integrado. This study sought to describe experiences, barriers and facilitators to the implementation of interventions for controlling Aedes aegypti in Latin America and the Caribbean. A qualitative approach with semi-structured in-depth interviews with program implementation experts (19 participants in nine countries) was carried out. We used a software to codify the data and created matrices to compare them. Based on our findings, we developed a graphic representation of the theoretical dimensions that encompass the barriers and facilitators to the implementation of interventions. At the global level, the natural and built environment contributed to the mosquito’s reproduction. In the health system, the lack of priority given to the problem and the scarcity of material and human resources are the most important obstacles. Sectors other than health must take responsibility for actions directed at improving social determinants of health. There are transversal barriers related to governance, lack of coordination between central and local levels, lack of continuity in terms of interventions and technical groups. The community faces problems such as lack of information, poverty or resistance to recommendations. Public opinion can have a positive or negative impact, indirectly influencing political decisions. This study proposes a framework of analytical dimensions based on our findings; describes factors that influence policy implementation, which can guide future actions from an integrated perspective. O objetivo foi descrever experiências, barreiras e facilitadores na implementação de intervenções de controle do Aedes aegypti na América Latina e no Caribe. Uma abordagem qualitativa foi realizada com entrevistas semiestruturadas em profundidade com especialistas na implementação do programa (19 participantes de nove países). Foi usado um software para codificar os dados e foram feitas matrizes para comparação. Com base nos resultados, desenvolvemos uma representação gráfica das dimensões teóricas que agruparam as barreiras e facilitadores para a implementação das intervenções. Em nível global, o ambiente natural e construído contribui para a reprodução do mosquito. No sistema de saúde, a falta de priorização do problema e a escassez de recursos materiais e humanos representam os obstáculos mais importantes. É necessário que outros setores, além do setor saúde, assumam ações de melhoria dos determinantes sociais da saúde. Existem barreiras transversais relacionadas à governança, como a falta de coordenação entre os níveis central e local e a falta de continuidade das intervenções e dos grupos técnicos. A comunidade enfrenta problemas como falta de informação, pobreza ou resistência a recomendações. A opinião pública pode ter um impacto positivo ou negativo, influenciando indiretamente as decisões políticas. Este estudo propõe um quadro de dimensões de análise construído a partir dos resultados; descreve fatores influentes na implementação de políticas que podem orientar ações futuras a partir de uma abordagem integrada. Fil: Tapia López, Elena. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Bardach, Ariel Esteban. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina Fil: Ciapponi, Agustín. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina Fil: Alcaraz, Andrea. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: García-Perdomo, Herney Andrés. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Ruvinsky, Silvina. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; Argentina Fil: Belizán, María. Instituto de Efectividad Clínica y Sanitaria; Argentina

Background: Engagement in self-care behaviors that are essential to optimize diabetes care is challenging for many patients with diabetes. mHealth interventions have been shown to be effective in improving health care outcomes in diabetes. However, more research is needed on patient perceptions to support these interventions, especially in resource settings in low- and middle-income countries. Objective: The goal of the research was to explore perceptions and acceptability of a short message service (SMS) text messaging intervention for diabetes care in underserved people with diabetes in Argentina. Methods: A qualitative exploratory methodology was adopted as part of the evaluation of a program to strengthen diabetes services in primary care clinics located in low-resource settings. The diabetes program included a text messaging intervention for people with diabetes. A total of 24 semistructured telephone interviews were conducted with people with diabetes. Results: Twenty-four middle-aged persons with diabetes were interviewed. Acceptability was considered adequate in terms of its actual use, frequency, and the role of texts as a reminder. We found that text messages could be a mediating device in the patient's learning processes. Also, being exposed to the texts seemed to help bring about changes in risk perception and care practices and to function as psychosocial support. Another relevant finding was the role of text messaging as a potential facilitator in diabetes care. In this sense, we observed a strong association between receiving text messages and having a better patient-physician relationship. Additionally, social barriers that affect diabetes care such as socioeconomic and psychosocial vulnerability were identified. Conclusions: Our findings show positive contributions of a text messaging intervention for the care of people with diabetes. We consider that an SMS strategy has potential to be replicated in other contexts. However, further studies are needed to explore its sustainability and long-term impact from the perspective of patients. Fil: Moyano, Daniela Luz. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Morelli, Daniela. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Santero, Marilina. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Belizan, Maria. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina Fil: Beratarrechea, Andrea Gabriela. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina

To explore the motivations and expectations of the users of the Program for Healthy Centers in the Autonomous City of Buenos Aires and to evaluate its potential health impact.In-depth interviews were conducted (n = 34) and a self-administered survey was sent to users of the program (n = 605). An epidemiological model was developed to estimate the impact of the program on cardiovascular events (CVE) and disability-adjusted life years (DALYs).The main motivating factors for using the healthy centers were geographic and economic accessibility (free services) and satisfaction with the care received. 14.4% (95% CI, 10.3-18.5%) of hypertensive users and 24.8% (95% CI, 17.6-32.0%) of diabetic users reported having learned of their altered values in the healthy center. More than half of the respondents reported some improvement in their knowledge about the benefits of physical activity and healthy eating; this was more frequent among those who were younger, of lower educational level, users of the public health system, users of a healthy center in the South zone and those who had a cardiometabolic risk factor (p0.05). It was estimated that the healthy centers would prevent 12.5 cardiovascular and cerebrovascular events per year in the assisted population (4.75 events/100 000) and 47.75 DALYs due to these causes.The healthy centers are a favorable space for the implementation of health promotion and prevention actions, contributing to the detection of and facilitating the monitoring of risk factors, with a potential to prevent cardiovascular events and its consequences.Explorar as motivações e expectativas dos usuários do Programa Estações Saudáveis na Cidade Autônoma de Buenos Aires e avaliar seu impacto potencial na saúde.Foram realizadas entrevistas em profundidade (n = 34) e uma pesquisa auto-administrada (n = 605) a usuários do programa. Um modelo epidemiológico foi desenvolvido para estimar o impacto do programa em eventos cardiovasculares e anos de vida ajustados por incapacidade (DALY).Os principais fatores motivadores para o uso do estações saudáveis foram a acessibilidade geográfica, econômica (serviços gratuitos) e a satisfação com o atendimento recebido. 14,4% (intervalo de confiança de 95% [IC95%] 10,3-18,5%) de usuários hipertensos e 24,8% (IC95% 17,6-32,0%) dos diabéticos relataram ter aprendido sobre seus valores alterados na estação saudável. Mais da metade dos entrevistados relataram alguma melhora no conhecimento sobre os benefícios da atividade física e da alimentação saudável, com maior freqüência entre os mais jovens, de menor escolaridade, usuários do sistema público de saúde, usuários de estações saudáveis na zona sul e aqueles que apresentaram algum fator de risco cardiometabólico (p0,05). Estimou-se que, devido à existência de estações saudáveis, 12,5 eventos cardiovasculares e cerebrovasculares por ano seriam evitados na população atendida (4,75 eventos/100 000) e 47,75 DALY por essas causas.As estações saudáveis são um espaço propício para a implementação de ações de promoção e prevenção da saúde, contribuindo para a detecção e facilitação do monitoramento dos fatores de risco, com potencial para prevenir os eventos cardiovasculares e suas consequências.

Fusarium meridionale and F. boothii cause Gibberella Ear Rot (GER) in maize. This study determined the effects of temperature (5–35 °C) and water activity (0.90–0.995 aw) on the growth, and deoxynivalenol (DON) and nivalenol (NIV) production of F. meridionale and F. boothii strains in maize grains. Fusarium graminearum sensu stricto strains from wheat were also tested. The three Fusarium species grew best at 0.995 aw and 25 °C. Growth was absent or marginal at 0.90 aw regardless of temperature. F. meridionale and F. boothii were sensitive to 30 °C and more affected by water stress than F. graminearum sensu stricto. The highest DON levels were at 0.995–0.97 aw and 30 °C and at 0.97 aw and 20 °C for F. graminearum sensu stricto, and at 0.995–0.97 aw and 20 °C for F. boothii. Fusarium meridionale reached maximum NIV accumulation at 0.995 aw and 20 °C. This produced DON at negligible levels compared to the other two Fusarium species. Growth of F. meridionale and F. boothii was well adapted to the usual autumn high humidity and mild temperatures associated with GER in northwest Argentina. Control strategies during grain development should be taken into account to reduce the risk of the presence of DON and NIV in the harvested grains.

Background: Obesogenic environments promote sedentary behavior and high dietary energy intake. The objective of the study was to identify barriers and facilitators to the implementation and impact evaluation of projects oriented to promote physical activity and healthy diet at community level. We analyzed experiences of the projects implemented within the Healthy Municipalities and Communities Program (HMCP) in Argentina. Methods: A mixed methods approach included (1) in-depth semi-structured interviews, with 44 stakeholders, and (2) electronic survey completed by 206 individuals from 96 municipalities across the country. Results: The most important barriers included the lack of: adequate funding (43%), skilled personnel (42%), equipment and material resources (31%), technical support for data management and analysis (20%), training on project designs (12%), political support from local authorities (17%) and acceptance of the proposed intervention by the local community (9%). Facilitators included motivated local leaders, inter-sectorial participation and seizing local resources. Project evaluation was mostly based on process rather than outcome indicators. Conclusions: This study contributes to a better understanding of the difficulties in the implementation of community-based intervention projects. Findings may guide stakeholders on how to facilitate local initiatives. There is a need to improve project evaluation strategies by incorporating process, outcome and context specific indicators.

A 96-well plate micromethod was developed to measure 5-n-alkylresorcinols (5nARs) in cereal grains and food derived products. The 5nARs reacted in alkaline alcoholic medium with Fast Blue RR ½ZnCl2 salt to yield coloured azo-derivatives. The highest sensitivity for 5nARs was obtained at 490 nm with 0.025% ethanolic Fast Blue RR and 5% K2CO3. This reaction showed good linearity for olivetol (0.05–0.20 μg). Contents of 5nARs determined in cereal grains and derived products by the new Fast Blue RR micromethod were highly correlated (R2 = 0.9944) with those obtained by a Fast Blue B method currently used. A Bland–Altman analysis indicated a small positive bias near to zero (R2 = 0.0401), suggesting that the methods can be interchangeably used. The new reaction is completed in 15 min and the coloured products are read within the 15 min after completion. The micromethod offers a fast analysis of 5nARs in cereal grains and derived products with low consumption of reagents and solvents. Fil: Sampietro, Diego Alejandro. Universidad Nacional de Tucumán. Facultad de Bioquímica, Química y Farmacia; Argentina Fil: Jiménez, Cristina Marisol. Universidad Nacional de Tucumán. Facultad de Bioquímica, Química y Farmacia; Argentina Fil: Belizán, María Melina Eleonora. Universidad Nacional de Tucumán. Facultad de Bioquímica, Química y Farmacia; Argentina Fil: Vattuone, Marta Amelia. Universidad Nacional de Tucumán. Facultad de Bioquímica, Química y Farmacia; Argentina Fil: Catalan, Cesar Atilio Nazareno. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Tucumán. Instituto de Quimica del Noroeste; Argentina

Twenty six isolates of Fusarium graminearum from grains of maize hybrids harvested in ±west Argentina were grown on autoclaved rice grain to assess their ability to produce type B trichothecenes. Chemical analysis indicated that 38% of isolates were nivalenol (NIV) producers only, 31% were major NIV producers with high DON(deoxynivalenol)/NIV ratios, 8% were major DON producers with minor NIV production, and 23% were DON producers only. Isolates showed a high variability in their toxigenic potential which was not related to fungal biomass. The distribution of the different chemotypes as well as the high and the low trichothecene-producing Fusarium isolates could not be associated to a geographical origin. Our results confirmed for the first time that isolates of Fusarium graminearum from maize of northwest Argentina are able to produce DON and NIV. A substancial contamination with both NIV and DON is likely in maize from northwest Argentina. Their contents should be quantified in regional surveillances for mycotoxin contamination. Fil: Sampietro, Diego Alejandro. Universidad Nacional de Tucumán. Facultad de Bioquímica, Química y Farmacia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Apud, Gisselle Raquel. Universidad Nacional de Tucumán. Facultad de Bioquímica, Química y Farmacia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Belizán, María Melina Eleonora. Universidad Nacional de Tucumán. Facultad de Bioquímica, Química y Farmacia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Vattuone, Marta Amelia. Universidad Nacional de Tucumán. Facultad de Bioquímica, Química y Farmacia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Catalan, Cesar Atilio Nazareno. Universidad Nacional de Tucumán. Facultad de Bioquímica, Química y Farmacia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Tucumán. Instituto de Quimica del Noroeste; Argentina; Argentina

Ziziphus mistol Griseb. (Rhamnaceae), popularly known as ?mistol,? is widely distributed throughout Perú, Bolivia, Paraguay and Argentina. Its fruit is consumed in different forms in several argentinean communities. The present study was carried out to investigate the medicinal properties and safety of Ziziphus mistol (mistol) fruits ethanol and aqueous extracts and arrope. Antinociceptive activity was assessed using the formalin, acetic acid-induced writhing and tail-flick tests in rats. Anti-inflammatory effects were determinated through carrageenan induced edema test and cotton pellet-induced granuloma formation, in rats. The safety was evaluated with test of acute toxicity (48 hs) and sub-chronic toxicity (91 days).All extracts (1,000 mg / kg body weight) showed significant inhibition (P

Objectives: After 4 years of deepening recession, Argentina's economy plummeted after default in 2002. This crisis critically affected health expenditures and triggered acute rationing. Our objective was to explore health decision-makers' knowledge and attitudes about economic evaluations (EE) and whether health technology assessment (HTA) were increasingly used for decision making.Methods: A qualitative design based on semistructured interviews and focus groups was used to explore how decision makers belonging to different health sectors implement resource allocation decisions.Results: Informants were mostly unaware of EE. The most important criteria mentioned to adopt a treatment were evidence of effectiveness, social/stakeholder demand, or resource availability. Despite general positive attitudes about EE, knowledge was rather limited. Although cost considerations were widely accepted by purchasers and managers, clinicians argued about these issues as interfering with the doctor–patient relationship. Other important perceived barriers to HTA use were lack of confidence in the transferability of studies conducted in developed countries and institutional fragmentation of the Argentine healthcare system. The new macroeconomic context was cited as a justification of implicit rationing measures. Although explicit priority setting was implemented by many purchasers and managers, HTA was not used to improve technical and/or allocative efficiency.Conclusions: The crisis seems to be a strong incentive to extend the use of HTA in Argentina, provided decision makers are aware as well as involved in the generation of local studies.