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En Colombia, los estudios y encuestas poblacionales han incorporado preguntas sobre consumo de tabaco en adultos, aunque no existe un cuestionario estandarizado. Se buscó identificar los estudios o encuestas que han caracterizado el consumo de tabaco en adultos en Colombia y analizar las variables que se incluyen con ese fin, según su utilidad. Se revisaron las páginas web de organismos oficiales y se realizó una revisión narrativa de los estudios y encuestas publicados hasta febrero de 2022. Se identificaron 11 estudios o encuestas que incluyeron un número variable de preguntas sobre consumo de tabaco, todos permitieron estimar prevalencias de fumadores actuales, pero no las de exfumadores. La edad objetivo del estudio no es homogénea, el ámbito es nacional en la mayoría y muestran una enorme variabilidad en las preguntas. Estandarizar los instrumentos que permiten estimar la prevalencia de consumo de tabaco debería ser una prioridad en Colombia.

BACKGROUND AND PURPOSE: To investigate the association between clinician-scored toxicities and patient-reported health-related quality of life (HRQoL), in early-stage (ES-) and locally-advanced (LA-) non-small cell lung cancer (NSCLC) patients receiving loco-regional radiotherapy, included in the international real-world REQUITE study.MATERIALS AND METHODS: Clinicians scored eleven radiotherapy-related toxicities (and baseline symptoms) with the Common Terminology Criteria for Adverse Events version 4. HRQoL was assessed with the European Organization for Research and Treatment of Cancer core HRQoL questionnaire (EORTC-QLQ-C30). Statistical analyses used the mixed-model method; statistical significance was set at p=0.01. Analyses were performed for baseline and subsequent time points up to 2 years after radiotherapy and per treatment modality, radiotherapy technique and disease stage.RESULTS: Data of 435 patients were analysed. Pre-treatment, overall symptoms, dyspnea, chest wall pain, dysphagia and cough impacted overall HRQoL and specific domains. At subsequent time points, cough and dysphagia were overtaken by pericarditis in affecting HRQoL. Toxicities during concurrent chemo-radiotherapy and 3-dimensional radiotherapy had the most impact on HRQoL. Conversely, toxicities in sequential chemo-radiotherapy and SBRT had limited impact on patients' HRQoL. Stage impacts the correlations: LA-NSCLC patients are more adversely affected by toxicity than ES-NSCLC patients, mimicking the results of radiotherapy technique and treatment modality.CONCLUSION: Pre-treatment symptoms and acute/late toxicities variously impact HRQoL of ES- and LA-NSCLC patients undergoing different treatment approaches and radiotherapy techniques. Throughout the disease, dyspnea seems crucial in this association, highlighting the additional effect of co-existing comorbidities. Our data call for optimized radiotherapy limiting toxicities that may affect patients' HRQoL.

Children’s participation in the digital environment is gaining more attention as children seem to be active audiences, selecting and developing digital skills to access and interact across multiple platforms and devices. Nonetheless, little is known about media participation from the children’s perspective. This article presents the quantitative results of a survey of 244 children aged seven to fourteen years in Colombia about their perception of media use as a form of participation. The study’s results suggest that there is a varied range of media uses for different purposes that are not exclusive to just one device or one type of media. These results are significant as they show the way children look at their media landscape and engage with it. The authors also identify children’s perception of participation as well as their feelings regarding their media engagement. This research gives particular impetus to efforts aimed at recognizing the meanings of children’s participation in the media environment beyond the political and the civic duties to the social and the playful, incorporating children’s perceptions, experiences, and roles in society.

Background: There is evidence of strong links between exposure to different risk factors and life-threatening diseases. Assessing the burden of a risk factor on the population's mortality due to a given disease provides a clear picture of these links. The estimation of attributable mortality to a risk factor is the most widely used procedure for doing this. Although different methods are available to estimate attributable mortality, the prevalence-based methodology is the most frequent. The main objective of this study is to develop guidelines and checklists to STrengthen the design and REporting of Attributable Mortality Studies using a Prevalence-based method (STREAMS-P) and also to assess the quality of an already published study which uses this methodology. Methods: The design of the guideline and checklists has been done in two phases. A development phase, where we set recommendations based on the review of the literature, and a validation phase, where we validated our recommendations against other published studies that have estimated attributable mortality using a prevalence-based method. Results: We have developed and tested a guideline that includes the information required to perform a prevalence-based attributable mortality study to a given risk factor; a checklist of aspects that should be present when a report or a paper on attributable mortality is written or interpreted and a checklist of quality control criteria for reports or papers estimating attributable mortality. Conclusion: To our knowledge, the STREAMS-P is the first set of criteria specifically created to assess the quality of such studies and it could be valuable for authors and readers interested in performing attributable mortality studies or interpreting their reliability. This paper has been funded by the competitive research grant: Instituto de Salud Carlos III, Ministry of Science and Innovation of Spain, grant number PI19/00288 and co-funded by the European Union. Sí

Resumen Introduccion y objetivos Estimar la mortalidad atribuida (MA) al consumo de tabaco en las comunidades autonomas (CCAA) de Espana en poblacion de edad ≥ 35 anos en 2017. Metodos Se estimo la MA empleando un metodo dependiente de prevalencias basado en el calculo de fracciones atribuidas poblacionales. La mortalidad observada procede del Instituto Nacional de Estadistica; las prevalencias de consumo por sexo y edad, de la Encuesta Nacional de Salud de 2011 y 2017 y la Encuesta europea de 2014, y los riesgos relativos, del seguimiento de 5 cohortes norteamericanas. Se presentan estimaciones de MA y fracciones atribuidas poblacionales para cada comunidad autonoma por causa de muerte, sexo y edad y tasas de MA especificas y ajustadas. Resultados El tabaco causo 53.825 muertes en Espana en la poblacion de 35 o mas anos (el 12,9% de la mortalidad total). La carga de MA sobre la mortalidad observada varia del 10,8% en La Rioja al 15,3% en Canarias. Tras ajustar las tasas de MA por edad, las diferencias entre CCAA se mantienen, y las tasas mas altas en los varones se observan en Extremadura y en las mujeres, en Canarias. Las tasas ajustadas de los varones se correlacionan negativamente con las de las mujeres. El porcentaje que suponen las enfermedades cardiovasculares sobre la MA total de cada comunidad autonoma oscila entre el 21,8% de Castilla-La Mancha y el 30,3% de Andalucia. Conclusiones La carga de MA al consumo de tabaco varia entre las CCAA. Realizar un analisis detallado por regiones aporta informacion relevante para la implantacion de politicas sanitarias dirigidas a frenar el impacto del tabaquismo.

Introduction: Screening for coronavirus disease 2019 (COVID-19) exposure, coupled with engaged decision making to prioritize cancer treatment in parallel with reducing risk of exposure and infection, is crucial in the management of COVID-19 during cancer treatment. After two reported case studies of imaging findings during daily computed tomography (CT)-based image-guided radio-therapy (RT) scans, a call for submission of anonymized case reports was published with the objective of rapidly determining if there was a correlation between the onset of new pulmonary infiltrates found during RT and COVID-19. We hereby report the results of the aggregate analysis. Methods: Data of deidentified case reports for patients who developed biochemically confirmed COVID-19 during RT were submitted through an online portal. Information requested included a patient's sex, age, cancer diagnosis and treatment, and COVID-19 diagnosis and outcome. Coplanar CT-based imaging was requested to reveal the presence or absence of ground-glass opacities or infiltrates. Results: A total of seven reports were submitted from Turkey, Spain, Belgium, Egypt, and the United States. Results and imaging from the patients reported by Suppli et al. and McGinnis et al. were included for a total of nine patients for analysis. All patients were confirmed COVID-19 positive using polymerase chain reaction-based methods or nasopharyngeal swabs. Of the nine patients analyzed, abnormalities consistent with ground-glass opacities or in- filtrates were observed in eight patients. Conclusions: This is the largest case series revealing the potential use of CT-based image guidance during RT as a tool for identifying patients who need further workup for COVID-19. Considerations for reviewing image guidance for new pulmonary infiltrates and immediate COVID-19 testing in patients who develop new infiltrates even without COVID-19 symptoms are strongly encouraged. (c) 2021 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

Older adults walk with a shorter stride length, reduced hip range of motion (ROM) and higher cadence. These are signs of reductions in walking ability. This study investigated whether using a wireless smart insole system that monitored and provided biofeedback to encourage an extension of swing time could increase stride length and hip flexion, while reducing the cadence. Seven older adults were tested in this study, with and without the biofeedback device, in an outdoor environment. Gait analysis was performed by using GaitRite system and Xsens MVN. Repeated measures analysis demonstrated that with biofeedback, the swing time increased by 6.45%, stride length by 4.52% and hip flexion by 14.73%, with statistical significance. It also decreased the cadence significantly by 5.5%. This study has demonstrated that this smart insole system modified positively the studied gait parameters in older adults and has the potential to improve their walking ability.

Background This study sought to analyse the trend in smoking-attributable mortality (SAM) in Spain among the population aged ≥35 years across the period 1990–2018. Methods SAM was estimated by applying a prevalence-independent method, which uses lung cancer (LC) mortality as a proxy of tobacco consumption. We sourced observed mortality from the National Institute of Statistics (Spain), LC mortality rates in smokers and never smokers from the Cancer Prevention Study I–II, and relative risks from 5 US cohorts. Estimates of annual SAM by cause of death, sex and age are shown, along with crude and annual standardised SAM rates. The trend in standardised all-cause and LC rates was analysed using a joinpoint regression model. Results Tobacco caused 1 717 150 deaths in Spain in the period 1990–2018. Among men, cancers replaced cardiovascular diseases–diabetes mellitus (CVD–DM) as the leading group of tobacco-related cause of death in 1994. Among women, CVD–DM remained the leading cause of death throughout the period. Trend analysis of standardised SAM rates due to all causes and LC showed a decrease in men and an increase in women. Conclusions The tobacco epidemic in Spain across the period 1990–2018 has had an important impact on mortality and has evolved differently in both genders. SAM is expected to increase dramatically in women in the coming years. SAM data highlight the importance of including a gender perspective in SAM analyses, in designing more effective and comprehensive public health interventions and in developing gender-specific tobacco control policies to curb tobacco consumption.

Background. The standard of care for patients (pts) with an ipsilateral breast tumour recurrence (IBTR) after breast conserving therapy (BCT) is a salvage mastectomy. However there is no solid data providing a clear advantage of radical surgery for IBTR in terms of the outcome for patients with isolated local recurrence after BCT. Nevertheless, there is a growing interest in the feasibility of repeating BCT for these patients (pts). We analyzed the oncological outcomes of repeated breast-conserving therapy (rBCT) related to the immunohistochemical subtype. Materials and methods. Between 2014 and 2020, 35 pts were selected for a 2nd BCT, a new lumpectomy with accelerated partial breast re-irradiation (APBrI), and prospectively followed in three university hospitals in Barcelona. Inclusion criteria were pts older than 50y with a late (> 48m from primary treatment) isolated IBTR less than 2cm, without having primary major radiotherapy toxicity. Oncological outcomes were analyzed. Results. At IBTR, median age was 65y and median time to ITBR was 154m. Patients characteristics are shown in table 1. Tumor’s recurrence was DCIS in 5 pts (14.3%) and invasive carcinoma in 30 pts (85.7%), where Luminal A in 10 pts (33.3%), Luminal B-HER2 negative in 12 pts (40%), Luminal B-HER2 positive in 2 (6.7%), non-Luminal HER2 positive in 3 (10%) and triple negative in 3 (10%). With a median follow-up of 37 months, there were 4 relapses (11.4%), one was a 2nd IBTR (2.85%) after in-situ IBTR, and 3 were metastatic recurrences (8.6%), two after invasive and one after in-situ IBTR. Both metastatic progressions after invasive IBTR, were hormone receptor positive and HER2 negative (Luminal B). There were 2 deaths not related with breast cancer. The 2nd IBTR rate was 2.85%. Five-year regional-free survival, metastasis-free survival, and overall survival was 82.4% (95% IC 52.6 - 94.4 %), %, 84.6% (95% IC 51 - 96 %) and 93.3% (95% IC 61.2 - 99%), respectively. Conclusion. Conservative treatment with breast conserving surgery and APBrI for isolated IBTR after BCT seems like a feasible technique as an alternative to mastectomy in selected patients. Second local recurrences and overall survival are similar to the rates described for salvage mastectomy for isolated ipsilateral breast tumour recurrence. In this cohort of patients, the immunohistochemical subtype tumors with poor prognosis (HER2 positive and triple negative) did not show increase in the local recurrence rate. Table 1.Patients Characteristicsn%Histology TypeIDC2777.1ILC0DCIS514.3Others38.6Differentiation gradeWell differentiated1028.6Moderately differentiated1851.4Poorly differentiated720Estrogen-receptor statusPositive2880Negative720Progesteron-receptor statusPositive1645.7Negative1748.6Unknown25.7HER2 statusOver-expressed617.1Non-over-expressed2674.3Unknown38.6Ki67< 20 %1748.6> 20 %1337.2Unknown514.3IHC subtypeLuminal A1033.3Luminal B1240Luminal B-HER2 positive26.7Non-luminal HER2 positive310Triple negative310IBTR locatedSame quadrant1748.6Different quadrant1645.7Unknwon25.7APBrI3D-CRT927.3IORT26.1IMRT2266.7 Citation Format: Martin Espinosa-Bravo, Victoria Reyes Lopez, Clara Morales Comas, Joaquín Rivero Déniz, Javier de La Torre Fernández de Vega, Irene Vives Roselló, Christian Sisó Raber, Manuel Altabas Gonzalez, Alexandra Giraldo Marin, Inma Alonso, Nuria Argudo, Pau Nicolau, Manel Algara, Xavier Sanz, Xavier Caparrós, Gabriela Oses, Jordi Saez, María Vernet-Tomas, Meritxell Mollà. Safety of conservative surgery with accelerated partial breast re-irradiation for isolated ipsilateral breast cancer recurrence regardless of immunohistochemical subtype. A multicentric prospective study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr PD7-09.

Este artículo es parte del estudio denominado: “Configuraciones que emergen de la relación desarrollo sostenible-ecofeminismo: un estudio regional”, aquí se trata sobre el hecho de que los ecofeminismos son corrientes del feminismo que han planteado diversas formas de interacción con la vida humana y no humana. En ese sentido, desarrolla la propuesta de relacionamiento con los animales que ha surgido a partir de estas corrientes, en el territorio colombiano denominado “el Eje Cafetero”. -En el trabajo de campo se identificó que surge una particular relación del desarrollo sostenible y el capitalismo, con la Naturaleza y los animales. Para analizar dicha relación se acudió a teorías latinoamericanas que han puesto en discusión el tema, al igual que a mujeres de la región con experiencias de vida de su diario quehacer; de igual manera, se consideraron Planes de Desarrollo municipales y departamentales, con el fin de identificar el abordaje en materia política a partir del feminismo y los animales. El artículo concluye con la identificación que, con base en diferentes postulados ecofeministas, el relacionamiento con los animales no humanos debe ser visto a partir de la ética y la empatía. Para las diferentes corrientes ecofeministas la lucha contra la opresión debe ser integral, inclusiva y abandonar la posición de opresión dominadora al utilizar los cuerpos de otros seres vivos, igualmente vulnerables, sintientes y explotados, de forma intensiva dentro de las prácticas del desarrollo sostenible, por lo que se acude a formas de vida como el veganismo y el consumo más consciente.

The history of physiotherapy in Latin America has received little attention thus far in the English-speaking literature. In this paper, we draw on narratives from activists, educators, and professional leaders who have been instrumental in shaping the development of physiotherapy in Argentina, Colombia, and Ecuador. Physiotherapists in the Latin American countries faced many similar challenges, including developing physiotherapy in the shadow of medicine, overcoming conservative attitudes toward women professionals, and frequent social upheaval.The paper explores the disputed story of physiotherapy's origins in the polio epidemics, the influence of Swedish remedial gymnastics, and the educational colonialism of North American and European educators. We examine some of the effects of social unrest and trauma, military rule, and economic instability on the professions attempts to establish itself in the face of competition from other professions allied to medicine. And we consider the efforts taken to establish the profession's autonomy and its shifting relationship with the state.We employed two different methods for data collection to explore aspects of physiotherapy's history in Latin America from a political and socio-cultural context: 1) A reconstruction of memories from activist physiotherapists in Colombia, Ecuador, and Argentina, who have seen, lived, and promoted the development of physiotherapy in their own countries, gleaned from in-depth interviews; and 2) Analysis of secondary sources. Data were analyzed following the method described by Maynes, Pierce, and Laslett (2008), exploring personal narratives. Textual data were analyzed using documentary research (Prior, 2003) using thematic analysis, to inductively discover, and describe relevant themes about the two main guiding study questions. A constant comparative method as outlined by Boeije (2002) was used to form categories, establish boundaries, and discerning conceptual similarities between participants' narrative.Five physiotherapists were interviewed. One from Colombia, two from Argentina and two from Ecuador. Three main themes were identified: 'A Female Profession?', 'training and education', and 'Present Day in Argentina, Ecuador, and Colombia'. Tensions between the interests of the State, professionals, patients, cultures, urban and rural services, and practices are prevalent throughout physiotherapy in Argentina, Colombia, and Ecuador. Operating within these tensions is very much the reality for physiotherapists in Latin America today.Multiple histories emerge from the research, opening up a space for a more nuanced, polyphonic reading of physiotherapy in Colombia, Ecuador, and Argentina than has been heard to date.

Background Serum cotinine has become the most widely used biomarker of secondhand smoke exposure (SHS) over time in all ages. The aim of this study was to review the serum cotinine cut-points used to classify children under 5 years as exposed to SHS. Methods A systematic review performed in the Pubmed (MEDLINE) and EMBASE databases up to April 2021 was conducted using as key words "serum cotinine", “tobacco smoke pollution” (MeSH), "secondhand smoke", "environmental tobacco smoke" and “tobacco smoke exposure”. Papers which assessed SHS exposure among children younger than 5 years old were included. The PRISMA 2020 guidelines were followed. Analysis was pre-registered in PROSPERO (registration number: CRD42021251263). Results 247 articles were identified and 51 fulfilled inclusion criteria. The selected studies were published between 1985–2020. Most of them included adolescents and adults. Only three assessed postnatal exposure exclusively among children under 5 years. None of the selected studies proposed age-specific cut-points for children < 5 years old. Cut-point values to assess SHS exposure ranged from 0.015 to 100 ng/ml. The most commonly used cut-point was 0.05 ng/ml, derived from the assay limit of detection used by the National Health and Nutrition Examination Survey (NHANES). Conclusions No studies have calculated serum cotinine age-specific cut-points to ascertained SHS exposure among children under 5 years old. Children’s age-specific cut-points are warranted for health research and public health purposes aimed at accurately estimating the prevalence of SHS exposure and attributable burden of disease to such exposure, and at reinforcing 100% smoke-free policies worldwide, both in homes, private vehicles and public places.

ObjectivesOpioid-induced constipation (OIC) can affect up to 63% of all patients with cancer. The objectives of this study were to assess quality of life as well as efficacy and safety of naloxegol, in patients with cancer with OIC.MethodsAn observational study was made of a cohort of patients with cancer and with OIC exhibiting an inadequate response to laxatives and treated with naloxegol. The sample consisted of adult outpatients with a Karnofsky performance status score ≥50. The Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QOL) and the Patient Assessment of Constipation Symptoms (PAC-SYM) were applied for 3 months.ResultsA total of 126 patients (58.2% males) with a mean age of 61.3 years (range 34–89) were included. Clinically relevant improvements (>0.5 points) were recorded in the PAC-QOL and PAC-SYM questionnaires (pConclusionsClinically relevant improvements in OIC-related quality of life, number of bowel movements and constipation-related symptoms were recorded as early as after 15 days of treatment with naloxegol in patients with cancer and OIC, with a good safety profile.

Resumen (analítico) La presencia de medios análogos y digitales en la vida de los niños, niñas y adolescentes redimensiona la discusión sobre participación infantil, centrándola en lo que ocurre en las pantallas. Realizamos un estudio cualitativo de corte descriptivo con 75 niños, niñas y adolescentes, de 7 a 14 años, de tres ciudades (Barranquilla, Cali y Bogotá). Los resultados indican que los niños, niñas y adolescentes tienen formas complejas y diversas de pensar la participación, que superan las divisiones, escalas y prescripciones adultas e institucionales, para incluir acciones de ocio, socialización y consumo cultural. Se trata de una participación heterogénea, convergente y multiplataforma que incluye actividades como generar contenidos, dar likes, hacer suscripciones, navegar, buscar tareas o simplemente ver vídeos, fotos, jugar, divertirse y socializar, mostrando intereses, subjetividades y formas de socialización infantiles en medios y TIC. Abstract (analytical) The presence of analogue and digital media in the lives of children and adolescents reshapes discussions on child participation, with an emphasis on participation that is facilitated through screens. A qualitative descriptive study was carried out with 75 children and adolescents aged 7 to 14 years old in three cities (Barranquilla, Cali and Bogotá). The results suggest that children and adolescents have complex and diverse ways of thinking about participation that go beyond adultcentric and institutional concepts such as divisions and different scales. Children conceive their own participation in terms of leisure, socialization and cultural consumption activities. Theirs is a heterogeneous, convergent and multi-platform participation that includes activities such as creating content, liking, subscribing, browsing the web, doing homework, as well as watching videos, looking at pictures, playing games, having fun and socializing. These results show children’s interests, subjectivities and forms of socialization using media and ICTs. Resumo (analítico) A presença da mídia analógica e digital na vida das crianças e adolescentes, redimensiona a discussão sobre a participação infantil enfocando o que acontece nas telas. Foi realizado um estudo qualitativo descritivo com 75 crianças de 7 a 14 anos em três cidades (Barranquilla, Cali e Bogotá). Os resultados indicam que as crianças e adolescentes têm formas complexas e diversas de pensar a participação, assim como seus papéis na mídia e no cenário digital, que vão além das divisões, escalas e prescrições de adultos e instituições. Esta participação é heterogênea, convergente e multiplataforma, que inclui atividades como a criação de conteúdo, dar likes, fazer trabalhos escolares ou simplesmente olhar vídeos, fotos, jogar, brincar e socializar; mostrando os interesses, subjetividades e formas de socialização das crianças na mídia e nas TIC.

After smoking, residential radon is the second risk factor of lung cancer in general population and the first in never-smokers. Previous studies have analyzed radon attributable lung cancer mortality for some countries. We aim to identify, summarize, and critically analyze the available data regarding the mortality burden of lung cancer due to radon, performing a quality assessment of the papers included, and comparing the results from different countries. We performed a systematic scoping review using the main biomedical databases. We included original studies with attributable mortality data related to radon exposure. We selected studies according to specific inclusion and exclusion criteria. PRISMA 2020 methodology and PRISMA Extension for Scoping Reviews requirements were followed. Data were abstracted using a standardized data sheet and a tailored scale was used to assess quality. We selected 24 studies describing radon attributable mortality derived from 14 different countries. Overall, 13 studies used risk models based on cohorts of miners, 8 used risks from residential radon case-control studies and 3 used both risk model options. Radon geometric mean concentration ranged from 11 to 83 Becquerels per cubic meter (Bq/m

Este libro que hace parte de un kit que te llevará a explorar tu entorno desde una nueva mirada. El programa de formación ciudadana Unbaniños® busca incentivar a los niños como tú a participar en la intervención de las ciudades de manera sostenible, y ¿cómo es esto?, comprendiendo el lugar donde vivimos, motivándonos a buscar soluciones colectivamente y apoyándonos en nuestras comunidades para desarrollar proyectos que aporten y mejoren nuestra ciudad.

Breast Radiation Therapy; Machine-Learning Prediction; Acute Desquamation Raditeràpia de mama; Predicció d'aprenentatge automàtic; Descamació aguda Radioterapia de mama; Predicción de aprendizaje automático; Descamación aguda Purpose Some patients with breast cancer treated by surgery and radiation therapy experience clinically significant toxicity, which may adversely affect cosmesis and quality of life. There is a paucity of validated clinical prediction models for radiation toxicity. We used machine learning (ML) algorithms to develop and optimise a clinical prediction model for acute breast desquamation after whole breast external beam radiation therapy in the prospective multicenter REQUITE cohort study. Methods and Materials Using demographic and treatment-related features (m = 122) from patients (n = 2058) at 26 centers, we trained 8 ML algorithms with 10-fold cross-validation in a 50:50 random-split data set with class stratification to predict acute breast desquamation. Based on performance in the validation data set, the logistic model tree, random forest, and naïve Bayes models were taken forward to cost-sensitive learning optimisation. Results One hundred and ninety-two patients experienced acute desquamation. Resampling and cost-sensitive learning optimisation facilitated an improvement in classification performance. Based on maximising sensitivity (true positives), the “hero” model was the cost-sensitive random forest algorithm with a false-negative: false-positive misclassification penalty of 90:1 containing m = 114 predictive features. Model sensitivity and specificity were 0.77 and 0.66, respectively, with an area under the curve of 0.77 in the validation cohort. Conclusions ML algorithms with resampling and cost-sensitive learning generated clinically valid prediction models for acute desquamation using patient demographic and treatment features. Further external validation and inclusion of genomic markers in ML prediction models are worthwhile, to identify patients at increased risk of toxicity who may benefit from supportive intervention or even a change in treatment plan.

The field of participatory research with children developed largely thanks to shared learning between different cultures, places, and disciplines. However, grand narratives and power relationships in academia inherited from colonialism and imperialism can threaten to obstruct the transformative value of this approach. In this article, we present the case of Think Big, a multinational collaboration for participatory research with children that involved adult and child coresearchers from Australia, Chile, Colombia, and the United Kingdom. Our aim was to explore how this project helped build solidarities between adult researchers from different countries and disciplines. We applied a methodology of diffraction to explore the processes and outcomes of this collaboration and presented our insights using the metaphor of a tree to explain the roots (knowledges and frameworks), trunk (ongoing collaboration and communication between the teams from different countries), branches (local projects), and fruits (research outcomes) of our work. Based on our experience, we proposed that multinational collaborations for participatory research offer important opportunities for adult researchers to collaborate with children to generate more democratic knowledge about their lives and to generate more egalitarian relationships between adult researchers from different places and backgrounds. However, it is important to anticipate that multinational collaborations are more likely to be affected by social and political upheavals, and language barriers must be overcome to decentralize academia. Also, the organizations involved in these collaborations need to develop strategies that facilitate funding, ethics clearance, and international research agreements.

To determine lung cancer mortality trends in Colombia during the period 1985-2018 in the population aged 35 years and over and identify changes in the trend.Analysis of mortality time series. The specific standardized rates by sex and age group were calculated. Using joinpoint regression, the annual percentage change in the rates was estimated and points of change were identified.During the period 1985-2018, 105 553 deaths from lung cancer were reported in the population aged 35 and over. The standardized rates exhibit a downward trend during the period 1985-2005, except in people over the age of 64.Lung cancer death rates in Colombia are trending downward. Primary and secondary prevention measures with respect to tobacco use need to be enhanced and other risk factors, such as residential radon or occupation, monitored.Determinar a evolução da mortalidade por câncer de pulmão na Colômbia no período de 1985 a 2018, na população com 35 anos de idade ou mais, e identificar mudanças na tendência.Análise de séries temporais de mortalidade. Foram calculadas taxas específicas e padronizadas por sexo e faixa etária. Por meio da regressãoNo período de 1985 a 2018, foram registradas 105.553 mortes por câncer de pulmão na população com 35 anos de idade ou mais. As taxas padronizadas demonstram tendência decrescente no período de 1985 a 2005, exceto para maiores de 64 anos.A tendência das taxas de mortalidade por câncer de pulmão na Colômbia é descendente. É necessário promover medidas de prevenção primária e secundária acerca do consumo de tabaco e monitorar outros fatores de risco, como a exposição ao radônio residencial ou a ocupação.

Resumen Objetivo: Presentar un plan de decisiones y acciones de enfermería basado en un enfoque transcultural a través del Modelo del Sol Naciente propuesto por Madeleine Leininger. Síntesis de contenido: Investigación cualitativa tipo reporte de caso, en la que participó una familia residente del área rural del municipio de Villamaría (Caldas, Colombia) entre noviembre de 2017 y septiembre de 2018. Se realizaron entrevistas semiestructuradas sobre condiciones de cuidado individual-familiar, determinantes sociales y riesgo familiar, y se aplicaron instrumentos de valoración de la familia. La información se analizó mediante la técnica de Bardin, previa sistematización en el software ATLAS.ti. Se presenta un plan de decisiones y acciones de enfermería a la luz de una valoración coherente con la cultura, resultado de la conjunción de los sistemas populares y profesionales. Se valoraron siete factores a partir del Modelo del Sol Naciente (tecnológicos, religiosos, sociales, culturales, políticos, económicos y educativos) y se seleccionó el fenómeno "sobrecarga del cuidador familiar del adulto mayor". Conclusiones: La propuesta de abordaje otorga herramientas de análisis al profesional de enfermería para brindar cuidado según necesidades, valores, creencias y modos de vida de las personas. Resumo Objetivo: Apresentar o plano de decisões e ações de enfermagem baseado em um enfoque transcultural por meio do Modelo do Sol Nascente de Madeleine Leininger. Síntese do conteúdo: Pesquisa qualitativa do tipo relato de caso, da qual participou uma família domiciliada na área rural do município de Villamaria, Caldas, Colômbia, entre novembro de 2017 e setembro de 2018. Realizaram-se entrevistas semiestruturadas sobre condições de cuidado individual-familiar, determinantes sociais e risco familiar, utilizaram-se também instrumentos de valoração da familia. A informação se analisou pela técnica de Bardin, com prévia sistematização no software ATLAS. ti. Apresenta-se um plano de decisões e ações de enfermagem à luz de uma valoração consistente com a cultura, resultado da conjunção dos sistemas populares e profissionais. Avaliaram-se sete fatores a partir do Modelo do Sol Nascente (tecnológicos, religiosos, sociais, culturais, políticos, econômicos, educativos) e se selecionou o fenômeno "sobrecarga do cuidador familiar do idoso". Conclusões: A proposta de abordagem outorga ao profissional de enfermagem ferramentas de análise para oferecer cuidado segundo necessidades, valores, crenças e modos de vida das pessoas. Abstract Objective: To introduce a nursing decision-and-action plan based on a cross-cultural approach through the Rising Sun Model created by Madeleine Leininger. Content synthesis: Qualitative research under the case report method that involved the participation of a rural family from the municipality of Villamaría (Caldas, Colombia), from November 2017 to September 2018. Semi-structured interviews were conducted on individual-family care conditions, social determinants, and family risk. Family assessment instruments were also applied. The information was analyzed using the Bardin technique, after its systematization in ATLAS.ti software. A plan for nursing decisions and actions, resulting from the conjunction of popular and professional systems, is presented in the light of an assessment consistent with culture. Seven factors were evaluated based on the Rising Sun Model (technological, religious, social, cultural, political, economic, educational), selecting the phenomenon known as "overload of elderly family caregivers." Conclusions: The suggested approach gives nursing professionals analytical tools in order to provide care according to people's needs, values, beliefs, and lifestyles.

Resumen Introducción: la formación del talento humano en enfermería requiere de la articulación, de manera imprescindible, con las Instituciones Prestadoras de Servicios de Salud (IPS). Objetivo: analizar la relación docencia-servicio para la formación de talento humano en enfermería en Colombia. Materiales y métodos: estudio de tipo descriptivo. Se envió una encuesta electrónica con preguntas estructuradas y semiestructuradas a 53 Instituciones de Educación Superior (IES). Se incluyeron instituciones con programas de enfermería y con convenios docencia-servicio para prácticas formativas. Resultados: participaron 48 programas de enfermería de IES privadas (60,4 %) y públicas (39,6 %). El 62,5 % no contaban con una IPS propia para el desarrollo de prácticas formativas en salud, situación que deriva en estructuración de convenios docencia-servicio y pagos en dinero o servicios por las IES. Las principales modalidades de contraprestación fueron capacitación del recurso humano, educación continuada y dotación tecnológica. Conclusiones: la integración docencia-servicio de universidades públicas y privadas con diferentes instituciones es necesaria en la formación integral de profesionales de enfermería. Las IES se ven abocadas a ofrecer actividades de compensación y contraprestación según su capacidad y valoración de las necesidades conjuntas. Un bajo porcentaje cuenta con IPS propias, cuya mayoría es de carácter privado. La relación docencia-servicio mejora la atención, educación, orientación a los pacientes y familiares y la credibilidad por la presencia de la academia en las unidades asistenciales. Resumo Introdução: para a formação do talento humano em enfermagem, é essencial articular-se com as instituições prestadoras de serviços de saúde (IPS). Objetivo: analisara relação ensino-serviço para a formação do talento humano em enfermagem na Colômbia. Materiais e métodos: estudo descritivo, o qual utilizou enquete eletrônica com perguntas estruturadas e semiestruturadas enviadas a 53 Instituições de Ensino Superior (IES). Foram incluídas instituições com programas de enfermagem e convênios docentes para as práticas de formação. Resultados: participaram 48 programas de enfermagem de IES privadas (60,4 %) e públicas (39,6 %). 62,5 % não contavam com IPS própria para o desenvolvimento de estágios em saúde; essa situação leva à estruturação de convênios de prestação de serviços docentes e pagamentos em dinheiro ou serviços pelas IES. As principais formas de contraprestação foram treinamento do recurso humano, educação continuada e dotação tecnológica. Conclusões: a integração ensino-serviço de universidades públicas e privadas com diferentes instituições é necessária na formação integral dos profissionais de enfermagem. As IES são forçadas a oferecer atividades de compensação e remuneração de acordo com sua capacidade e avaliação de necessidades conjuntas. Uma porcentagem baixa tem suas IPS, e a maioria é privada. A relação ensino-serviço melhora o atendimento, a educação, a orientação e a credibilidade do paciente e da família, devido à presença da academia nas unidades de atendimento. Abstract Introduction: The training of human talent in nursing requires the articulation with the health services institutions (IPS, in Spanish) as an essential feature. Objective: To analyze the teaching-service relationship for the training of human talent in nursing in Colombia. Materials and methods: Descriptive study using an electronic survey with structured and semi-structured questions sent to 53 higher education institutions (IES, in spanish). Institutions with nursing programs and teaching service agreements for training practices were included. Results: 48 nursing programs from private (60.4 %) and public (39.6 %) IES participated in this study. 62.5 % of these did not have an IPS in charge of providing their own health services for the development of training practices. This situation leads to the structuring of teaching service agreements and payments in money or services by IES. The main forms of compensation were human resource training, continuing education, and technological endowment. Conclusions: The teaching-service integration of public and private universities with different institutions is necessary for the comprehensive training of nursing professionals. IES are forced to offer compensation activities according to their capacity and assessment of joint needs. A low percentage have their own IPS, whose majority are private institutions. The teaching-service relationship improves care, education, patient and family orientation and credibility due to the presence of the academy in health care units.

Objetivo.Determinar la evolución de la mortalidad por cáncer de pulmón en Colombia en el período 1985-2018 en la población de 35 años y más e identificar cambios en la tendencia.Métodos.Análisis de series temporales de mortalidad. Se calcularon las tasas específicas y estandarizadas por sexo y grupos de edad. Mediante la regresiónjoinpointse estimó el porcentaje de cambio anual de las tasas y se identificaron puntos de cambio.Resultados.En el período 1985-2018 se registraron 105 553 muertes por cáncer de pulmón en la población de 35 años y más. Las tasas estandarizadas muestran una tendencia decreciente en el período 1985-2005, excepto en mayores de 64 años.Conclusiones.La tendencia de las tasas de mortalidad por cáncer de pulmón es decreciente en Colombia. Es necesario potenciar medidas de prevención primaria y secundaria sobre el consumo de tabaco y vigilar otros factores de riesgo como el radón residencial o la ocupación.

Smoking-attributable mortality (SAM) is an indicator that reflects the evolution of the tobacco epidemic at the population level. The objective of this study is to identify and to describe published studies that have estimated SAM in Spain. A search in PubMed and EMBASE databases was performed, limited to studies published until April 15th, 2021. Studies that estimated SAM in Spain or its constituent regions were included. Of the 146 studies identified, 22 met eligibility criteria. The first estimate of SAM in Spain dates from 1978 and the last from 2017. Twelve of the studies found estimated SAM at national level, 8 in regions, 1 in a province and 1 in a city. Most estimates were made for adults aged over 34, categorized as smokers, ex-smokers and never smokers. Observed mortality derived, in all studies, from official records, and relative risks mostly from Cancer Prevention Study II. In the period analyzed, a decrease in the burden of SAM was observed. In Spain, different SAM estimates are available globally, but they do not have regular periodicity, and such estimates are infrequently made by region. Due to variations in methodology and data sources, it is difficult to assess changes in SAM. Having global and regional periodic estimates would be necessary to correctly monitor the tobacco epidemic in Spain.La mortalidad atribuida (MA) al consumo de tabaco es un indicador que refleja la evolución de la epidemia tabáquica a nivel poblacional. El objetivo de este trabajo es identificar y describir los estudios publicados que hayan estimado MA al consumo de tabaco en España. Se realizó una búsqueda en las bases de datos de PubMed y EMBASE de los trabajos publicados hasta el 15/04/2021. Se incluyeron estudios que estimaron MA en España en su conjunto o en unidades territoriales. Se identificaron 146 estudios y 22 cumplieron los criterios de elegibilidad. La primera estimación de MA en España data de 1978 y la última de 2017. En 12 estudios se estimó la MA a nivel nacional, 8 en comunidades autónomas, 1 a nivel provincial y 1 en una ciudad. La mayoría de estimaciones se realizaron en adultos mayores de 34 años categorizados como fumadores, exfumadores y nunca fumadores. La mortalidad observada derivó en todos los estudios de registros oficiales y los riesgos relativos mayoritariamente del Cancer Prevention Study II. En el periodo analizado se observó una disminución en la carga de MA en relación con la mortalidad total. En España se dispone de estimaciones de MA a nivel global, pero no tienen periodicidad regular y es infrecuente que se realicen en unidades territoriales. Debido a variaciones en la metodología y en las fuentes de datos es difícil evaluar de forma precisa cambios en la MA. Sería necesario disponer de estimaciones periódicas globales y regionales para monitorizar correctamente la epidemia tabáquica en España.

Smoking-attributable mortality (SAM) is an indicator that reflects the evolution of the tobacco epidemic at the population level. The objective of this study is to identify and to describe published studies that have estimated SAM in Spain. A search in PubMed and EMBASE databases was performed, limited to studies published until April 15th, 2021. Studies that estimated SAM in Spain or its constituent regions were included. Of the 146 studies identified, 22 met eligibility criteria. The first estimate of SAM in Spain dates from 1978 and the last from 2017. Twelve of the studies found estimated SAM at national level, 8 in regions, 1 in a province and 1 in a city. Most estimates were made for adults aged over 34, categorized as smokers, ex-smokers and never smokers. Observed mortality derived, in all studies, from official records, and relative risks mostly from Cancer Prevention Study II. In the period analyzed, a decrease in the burden of SAM was observed. In Spain, different SAM estimates are available globally, but they do not have regular periodicity, and such estimates are infrequently made by region. Due to variations in methodology and data sources, it is difficult to assess changes in SAM. Having global and regional periodic estimates would be necessary to correctly monitor the tobacco epidemic in Spain.

Despite the risks associated with the use of new forms of tobacco consumption, such as electronic cigarettes or heated tobacco products such as IQOS (I Quit Ordinary Smoking), few studies have estimated the prevalence of use at the population level. The aims of this study were to describe, in Galicia, the evolution of the prevalence of the use of electronic cigarettes and the reasons for its use in the period 2014-2018, and, the use and knowledge of IQOS in 2018.The information analyzed comes from 4 cross-sectional surveys conducted in 2014 (n=7,874), 2015 (n=7,908), 2017 (n=7,841) and 2018 (n=7,853) within the framework of the Information System on Risk Behaviors (SICRI), being the target population Galicians aged 16 and over. Estimates of prevalence of consumption, the devices knowledge and reasons for use are shown accompanied with 95% confidence intervals (95% CI), globally, by gender, age group and tobacco consumption.In the period under study, the prevalence of electronic cigarette use remained stable. In 2018 it was estimated at 0.7% (0.5-0.9). In 2017, the only year in which changes were observed, it fell to 0.3% (0.2-0.4). Prevalence of electronic cigarette use among the population aged 16 to 24 increased from 0.8% in 2014 to 2.1% in 2018. The main reason for using electronic cigarettes was to quit smoking. The prevalence of the IQOS use at the time study (2018) was 0.1% (0.01-0.15) and 4.2% (3.7-4.7) of the Galicians knew what the IQOS was.In Galicia, the prevalence of electronic cigarette and IQOS use is low, although an increase was observed among the population aged 16-24 between 2014 and 2018. Surveillance of use at the population level should not be neglected.A pesar de los riesgos asociados al uso de nuevas formas de consumo de tabaco, como los cigarrillos electrónicos o los productos de tabaco calentado como los IQOS (I Quit Ordinary Smoking), son pocos los estudios que han estimado su prevalencia de uso a nivel poblacional. Los objetivos de este trabajo fueron describir, en Galicia, la evolución de la prevalencia y las razones de uso de cigarrillos electrónicos en el periodo 2014-2018; y el uso y conocimiento del IQOS en 2018.La información analizada procede de 4 estudios transversales que se realizaron en 2014 (n=7.874), 2015 (n=7.908), 2017 (n=7.841) y 2018 (n=7.853) en el marco del Sistema de Información sobre Conductas de Riesgo (SICRI), siendo la población objetivo la población gallega de 16 años y más. Se presentan estimaciones puntuales de prevalencia de consumo y de conocimiento de los dispositivos y razones de uso acompañadas de intervalos de confianza al 95% (IC95%), en global, en función del sexo, el grupo de edad y el consumo de tabaco.En el periodo a estudio la prevalencia de uso de cigarrillos electrónicos se mantuvo estable. En 2018 se estimó en el 0,7% (0,5-0,9). En 2017, único año en el que se observaron cambios, se redujo al 0,3% (0,2-0,4). La prevalencia de uso de cigarrillos electrónicos entre la población de 16 a 24 años pasó del 0,8% en 2014 al 2,1% en 2018. El principal motivo de su uso de cigarrillos electrónicos fue dejar de fumar. La prevalencia de uso de IQOS en el momento del estudio (2018) fue del 0,1% (0,01-0,15) y el 4,2% (3,7-4,7) de los gallegos sabían lo que era el IQOS.En Galicia, la prevalencia de uso de cigarrillos electrónicos e IQOS es baja, aunque se observó un aumento entre la población de 16 a 24 años entre 2014 y 2018. No se debe descuidar la vigilancia del uso a nivel poblacional.

Background Dating from the 1920s and linked to the increase in mortality among smokers, tobacco has become one of the most studied health risk factors. Tobacco-use series, whether for the general population or for specific groups, are unavailable for most South American countries, something that hinders the characterisation of this risk factor. Objectives To identify and analyse studies that estimate smoking-attributable mortality (SAM) in South America and provide an overview of the impact of smoking habit on mortality in the region. Methods Systematic review using PubMed, Embase, LILACS, Biblioteca Virtual en Salud, Google Scholar and Google, and including all papers published until June 2020 reporting studies in which SAM was estimated. Results The search yielded 140 papers, 17 of which fulfilled the inclusion criteria. There were SAM estimates for all South American countries, with Argentina having the most. The first estimate covered 1981 and the latest, 2013. The method most used was prevalence-based. Regardless of the country and point in time covered by the estimate, the highest figures were recorded for men in all cases. The burden of attributable vs observed mortality varied among countries, reaching a figure of 20.3% in Argentina in 1986. The highest SAM burden was registered for the group of cardiovascular diseases. Conclusions SAM estimates are available for all South American countries but the respective study periods differ and the frequency of the estimates is unclear. For 4 countries, the only estimates available are drawn from reports, something that does not allow for a detailed assessment of the estimates obtained. To help with decision-making targeted at evaluating and enhancing the impact of smoking control policies, further studies are needed in order to update the impact of smoking on all countries across South America.

Stage III non-small cell lung cancer (NSCLC) includes a highly heterogeneous group of patients with differences in the extent and localization of disease. Many aspects of stage III disease are controversial. The data supporting treatment approaches are often subject to a number of limitations, due to the heterogeneous patient populations involved in the trials. Furthermore, the definition of stage III disease has changed over time, and early studies were frequently inadequately powered to detect small differences in therapeutic outcome, were not randomized, or had a limited follow-up times. Major improvements in therapy, including the use of more active chemotherapy agents and refinements in radiation and surgical techniques, also limit the interpretation of earlier clinical trials. Lastly, improvements in pretreatment staging have led to reclassification of patients with relatively minimal metastatic disease as stage IV rather than stage III, leading to an apparent increase in the overall survival of both stage III and IV patients. Median overall stage III NSCLC survival ranges from 9 to 34 months. Higher survival rates are observed in younger Caucasian women with good performance status, adenocarcinoma, mutations, stage IIIA, and in patients with multidisciplinary-team-based diagnoses.

Este artículo busca contribuir a la comprensión de los retos que enfrentan los docentes en relación con las transformaciones actuales que los usos de las tecnologías y los medios digitales en el aula traen consigo para la enseñanza y el aprendizaje escolar. Se presentan los principales hallazgos de una investigación en la que se diseñó y se implementó un dispositivo pedagógico de cinco etapas, en el que participaron tres docentes de distintas instituciones educativas públicas de Cali. Con este dispositivo se exploró cómo los docentes orientaron e hicieron acompañamiento a sus estudiantes en la realización de proyectos de clase, al incorporar diversos recursos digitales y lenguajes mediáticos. Los resultado sugieren que los docentes partieron de una problematización que no solamente configuró una serie de pasos a seguir, sino que también se fue actualizando en las etapas subsiguientes. Esto les exigió una movilización permanente de estrategias, recursos y competencias. Así, los docentes pusieron en marcha su agencia para resolver distintas necesidades e imprevistos a lo largo del desarrollo de cada proyecto.

Radon is a colorless, odorless, and tasteless noble gas, causally related with the onset of lung cancer. We aimed to describe the distribution of radon exposure in the municipality of Manizales, Colombia, in order to estimate the population’s exposure and establish the percentage of dwellings that surpass reference levels. A cross-sectional study representing all geographical areas was carried out by measuring indoor radon concentrations. Participants answered a short questionnaire. Alpha-track type radon detectors were installed in all residences for six months. The detectors were subsequently processed at the Galician Radon Laboratory, an accredited laboratory at the University of Santiago de Compostela. A total of 202 homes were measured. Seventy-seven percent of the sampled houses were three stories high, their median age was 30 years, and half were inhabited by three people or fewer. For most dwellings, the building materials of walls and flooring were brick and covered cement, respectively. Results showed a geometric mean of radon concentration of 8.5 Bq/m3 and a maximum value of 50 Bq/m3. No statistically significant differences were found either between the geometric mean of the dwelling’s site, the height at which detectors were placed inside the home, or the wall and flooring materials, or between mean 222Rn concentrations in rural and urban areas. No dwelling surpassed the 222Rn reference level established by the WHO. This study shows that residential radon levels in Manizales, Colombia, seem to be low, though a more in-depth approach should be carried out. Despite these results, it is essential to create a national radon program and establish a radon concentration reference level for Colombia in line with international recommendations This study was funded by the Galician Radon Laboratory from the University of Santiago de Compostela (School of Medicine) and by the Institute of Health Research and Vicerrectorate of Research and post-graduate studies REF 0340220) of the University of Caldas (Manizales, Colombia) SI

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-PLAT (Primary Care Assessment Tools for lberomerica) 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. (C) 2020 SESPAS. Published by Elsevier Espana, S.L.U. Resumen 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.

RESUMEN: Objetivo: Actualizar la estimación de la mortalidad atribuida al consumo de tabaco en Brasil en población de 35 y más años. Métodos: Se aplicó un método dependiente de prevalencia, basado en la fracción atribuida poblacional. Este método estima la mortalidad atribuida a partir de la mortalidad observada en Brasil (fuente: Sistema de Información de Mortalidad del Sistema Único de Salud de Brasil-2016); de las prevalencias de fumadores, exfumadores y nunca fumadores (Encuesta Nacional de Salud de Brasil-2013) y del exceso de riesgo de morir (riesgo relativo) que tienen los fumadores y exfumadores en comparación con los nunca fumadores (5 estudios de cohortes norteamericanos). Se presentan estimaciones de mortalidad atribuida globales, por sexo, grupo de edad (35-54; 55-64; 65-74 y 75 años en adelante) y 3 grupos de enfermedades: tumores malignos, enfermedades cardiometabólicas y respiratorias. Resultados: En 2016, el consumo de tabaco causó con 163.831 muertes en Brasil, el 67% (109.369) fue en hombres y cuatro de cada diez (62.791) sucedieron antes de los 65 años. El 42% de la mortalidad atribuida se asocia a enfermedades cardiometabólicas, seguidas de respiratorias (34%) y tumorales (24%), sin diferencias por sexo. Conclusión: El 14% de las muertes que sucedieron en Brasil durante 2016 en población de 35 y más años se atribuye al consumo de tabaco. Realizar de forma periódica estimaciones de MA es necesario para valorar y fortalecer las leyes de control de tabaquismo implantadas. ABSTRACT: Objective: To update the estimation of tobacco attributable mortality (AM) in the Brazilian population aged 35 years old and older. Methods: A prevalence-dependent analysis was applied based on the population attributed fraction. This method estimates the tobacco AM taking into account the mortality observed in Brazil (source: Brazilian Mortality Information System - 2016); the prevalence of smokers, former smokers, and never smokers (National Health Survey Brazil - 2013) and the excess of risk of death (relative risk) of smokers and former smokers in comparison to never smokers (derived from 5 North American cohorts). Estimates of overall AM are shown by gender, age group (35-54; 55-64; 65-74; and 75 years old and older) and 3 groups: malignant tumors, cardiometabolic diseases, and respiratory diseases. Results: In 2016, tobacco consumption caused 163,831 deaths in Brazil, 67% (109,369) were in men and four out of ten (62,791) occurred before the age of 65. Without differences by gender, 42% of the AM is associated with cardiometabolic diseases, followed by respiratory diseases (34%) and malignant tumors (24%). Conclusion: During 2016, 14% of the deaths occurred in the Brazilian population aged 35 years old and older were attributed to tobacco consumption. Periodic tobacco AM estimations are mandatory to assess and strengthen smoking control strategies and policies.

Introducción: La telemedicina es un medio para superar las inequidades en el acceso a servicios sanitarios y su implementación ha aumentado durante la pandemia por Covid-19, durante la cual los prestadores tienen autorización transitoria para esta modalidad. Posterior a la emergencia sanitaria se deberá cumplir una serie de requisitos para la continuidad. Una de las variables que aportan al éxito de dicha continuidad y sostenibilidad es la intención de uso de pacientes y profesionales de la salud, la cual determina el éxito o rechazo de estos servicios. Métodos: Estudio cuantitativo, transversal y analítico realizado en 174 médicos y 820 pacientes. Se utilizó un instrumento auto diligenciado, basado en el Modelo de Aceptación de la Tecnología (TAM). Resultados: Las variables utilidad percibida, facilidad de uso percibida y actitud, en médicos y pacientes, presentaron coeficientes de correlación superiores a 0.70, (r= 0.78, r=0.82, r=0.87 en médicos y r=0.79, r=0.82, r= 0.88 en pacientes). Las variables facilitadores y compatibilidad presentaron mayor correlación con la intención de uso (r=0.89 para ambas en médicos, y r= 0.89, r=0.90 en pacientes). Conclusiones: Estos resultados revelan la importancia de los elementos facilitadores como factor clave para la aceptación de la telemedicina. Como han demostrado otros estudios, para mejorar la adopción de esta tecnología es necesario crear condiciones que faciliten su apropiación, previo a su implementación, tales como dotación de infraestructura, formación y ajustes en el aspecto organizativo.

This present review includes a systematic search for peer-reviewed articles published between March 2009 and March 2020 that evaluated the effects of wearable devices with biofeedback on the biomechanics of running. The included articles did not focus on physiological and metabolic metrics. Articles with patients, animals, orthoses, exoskeletons and virtual reality were not included. Following the PRISMA guidelines, 417 articles were first identified, and nineteen were selected following the removal of duplicates and articles which did not meet the inclusion criteria. Most reviewed articles reported a significant reduction in positive peak acceleration, which was found to be related to tibial stress fractures in running. Some previous studies provided biofeedback aiming to increase stride frequencies. They produced some positive effects on running, as they reduced vertical load in knee and ankle joints and vertical displacement of the body and increased knee flexion. Some other parameters, including contact ground time and speed, were fed back by wearable devices for running. Such devices reduced running time and increased swing phase time. This article reviews challenges in this area and suggests future studies can evaluate the long-term effects in running biomechanics produced by wearable devices with biofeedback.

Càncer de mama; Model de predicció; Radioteràpia Cáncer de mama; Modelo de predicción; Radioterapia Breast cancer: Prediction model; Radiotherapy Background: Acute skin toxicity is a common and usually transient side-effect of breast radiotherapy although, if sufficiently severe, it can affect breast cosmesis, aftercare costs and the patient's quality-of-life. The aim of this study was to develop predictive models for acute skin toxicity using published risk factors and externally validate the models in patients recruited into the prospective multi-center REQUITE (validating pREdictive models and biomarkers of radiotherapy toxicity to reduce side-effects and improve QUalITy of lifE in cancer survivors) study. Methods: Patient and treatment-related risk factors significantly associated with acute breast radiation toxicity on multivariate analysis were identified in the literature. These predictors were used to develop risk models for acute erythema and acute desquamation (skin loss) in three Radiogenomics Consortium cohorts of patients treated by breast-conserving surgery and whole breast external beam radiotherapy (n = 2,031). The models were externally validated in the REQUITE breast cancer cohort (n = 2,057). Results: The final risk model for acute erythema included BMI, breast size, hypo-fractionation, boost, tamoxifen use and smoking status. This model was validated in REQUITE with moderate discrimination (AUC 0.65), calibration and agreement between predicted and observed toxicity (Brier score 0.17). The risk model for acute desquamation, excluding the predictor tamoxifen use, failed to validate in the REQUITE cohort. Conclusions: While most published prediction research in the field has focused on model development, this study reports successful external validation of a predictive model using clinical risk factors for acute erythema following radiotherapy after breast-conserving surgery. This model retained discriminatory power but will benefit from further re-calibration. A similar model to predict acute desquamation failed to validate in the REQUITE cohort. Future improvements and more accurate predictions are expected through the addition of genetic markers and application of other modeling and machine learning techniques. TRat is currently an NIHR Clinical Lecturer. He was previously funded by a National Institute of Health Research (NIHR) Doctoral Research Fellowship (DRF 2014-07-079). This publication presents independent research funded by the NIHR. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. The REQUITE study received funding from European Union's 7th Framework Programme for research, technological development and demonstration under grant agreement no. 601826. The ISE study was supported by the German Office for Radiation Protection, project number St. Sch. 4116 and 4233. The LeND study received funding from Breast Cancer Now (formerly Breast Cancer Campaign) under grant ref. 2007NovPR45.

To update the estimation of tobacco attributable mortality (AM) in the Brazilian population aged 35 years old and older.A prevalence-dependent analysis was applied based on the population attributed fraction. This method estimates the tobacco AM taking into account the mortality observed in Brazil (source: Brazilian Mortality Information System - 2016); the prevalence of smokers, former smokers, and never smokers (National Health Survey Brazil - 2013) and the excess of risk of death (relative risk) of smokers and former smokers in comparison to never smokers (derived from 5 North American cohorts). Estimates of overall AM are shown by gender, age group (35-54; 55-64; 65-74; and 75 years old and older) and 3 groups: malignant tumors, cardiometabolic diseases, and respiratory diseases.In 2016, tobacco consumption caused 163,831 deaths in Brazil, 67% (109,369) were in men and four out of ten (62,791) occurred before the age of 65. Without differences by gender, 42% of the AM is associated with cardiometabolic diseases, followed by respiratory diseases (34%) and malignant tumors (24%).During 2016, 14% of the deaths occurred in the Brazilian population aged 35 years old and older were attributed to tobacco consumption. Periodic tobacco AM estimations are mandatory to assess and strengthen smoking control strategies and policies.Actualizar la estimación de la mortalidad atribuida al consumo de tabaco en Brasil en población de 35 y más años.Se aplicó un método dependiente de prevalencia, basado en la fracción atribuida poblacional. Este método estima la mortalidad atribuida a partir de la mortalidad observada en Brasil (fuente: Sistema de Información de Mortalidad del Sistema Único de Salud de Brasil-2016); de las prevalencias de fumadores, exfumadores y nunca fumadores (Encuesta Nacional de Salud de Brasil-2013) y del exceso de riesgo de morir (riesgo relativo) que tienen los fumadores y exfumadores en comparación con los nunca fumadores (5 estudios de cohortes norteamericanos). Se presentan estimaciones de mortalidad atribuida globales, por sexo, grupo de edad (35-54; 55-64; 65-74 y 75 años en adelante) y 3 grupos de enfermedades: tumores malignos, enfermedades cardiometabólicas y respiratorias.En 2016, el consumo de tabaco causó con 163.831 muertes en Brasil, el 67% (109.369) fue en hombres y cuatro de cada diez (62.791) sucedieron antes de los 65 años. El 42% de la mortalidad atribuida se asocia a enfermedades cardiometabólicas, seguidas de respiratorias (34%) y tumorales (24%), sin diferencias por sexo.El 14% de las muertes que sucedieron en Brasil durante 2016 en población de 35 y más años se atribuye al consumo de tabaco. Realizar de forma periódica estimaciones de MA es necesario para valorar y fortalecer las leyes de control de tabaquismo implantadas.

espanolResumen El presente articulo aborda la propuesta pedagogica que el proyecto "Urbaninos, resiliencia y educacion" ha venido desarrollando en su primer ano de trabajo (agosto del 2017-julio del 2018). La apuesta busca comprender la relacion entre la educacion de los ninos y su capacidad de intervencion sobre el entorno. Por un lado, el texto expone los principios, la estructura y los elementos del dispositivo pedagogico implementado a traves de talleres con los ninos; por otro, aborda los aprendizajes hasta ahora obtenidos en relacion con la participacion infantil y la construccion de ciudadania. EnglishAbstract This article addresses the pedagogical proposal regarding the development of the project "Urban-children, resilience and education" during its first year (August 2017-July 2018). The proposal seeks to understand the relationship between children's education and their capacity to intervene in their environment. The text exposes the principles, structures and elements of the pedagogical device implemented through workshops with children; additionally, it deals with the lessons learned to the present regarding children's participation and the construction of citizenship. portuguesResumo Este artigo aborda a proposta pedagogica que o projeto "Urbacriancas, resilienciay educacao" vem desenvolvendo em seu primeiro ano de trabalho (agosto de 2017 a julho de 2018). A aposta busca entender a relacao entre a educacao das criancas e sua capacidade de intervir no meio ambiente. Por um lado, o texto expoe os principios, estrutura e elementos do dispositivo pedagogico implementado mediante oficinas com criancas. Por outro lado, trata das licoes aprendidas ate o momento em relacao a participacao infantil e a construcao da cidadania.

Resumen: El objetivo fue analizar la evidencia científica sobre la relación docencia-servicio como responsabilidad social en la formación de talento humano en salud en Colombia. Se realizó una revisión documental de publicaciones en revistas científicas, documentos de instituciones gubernamentales y portales web entre 2005 y 2015. Se utilizaron los descriptores relación docencia servicio, práctica formativa, salud, Colombia, escenarios de práctica, convenios docencia servicio, instituciones de educación, instituciones de salud y estudiantes de salud. Los artículos fueron analizados a partir del título, resumen, año de publicación, idioma, país y fuente de publicación. A partir del texto completo se analizaron las variables tipo de contraprestación, actividades, costos y otras. Se obtuvieron 218 artículos, fueron excluidos 172 y evaluados para su inclusión 46; de estos, 28 no cumplieron los criterios de inclusión, quedando 18 para el análisis. En la formación del talento humano en salud se requiere conciliar intereses de los diferentes actores del Sistema General de Seguridad Social en Salud y las universidades. Se cuenta con el respaldo normativo para establecer la relación docencia-servicio. No hay contundencia en la evidencia científica que vincule a las actividades docentes y las prácticas estudiantiles. Abstract: The objective was to analyze the scientific evidence about the teaching-service relationship as a social responsibility in the training of human talent in health in Colombia. A documentary review of publications in scientific journals, documents of governmental institutions and web portals between 2005 and 2015 was carried out. Teaching service relationship, training practice, health, Colombia, practice scenarios, teaching service agreements, health institutions and health students descriptors were used. The articles were analyzed based on the title, abstract, year of publication, language, country and publication source. From the complete text the variables type of consideration, activities, costs and others were analyzed. Two hundred eighteen articles were obtained, 172 were excluded and 46 were evaluated for their inclusion. Twenty-eight of these 28 did not meet the inclusion criteria, leaving 18 for the analysis. In the human talent training in health, it is necessary to reconcile interests of the different actors in the General Health Social Security System and the Universities. The normative support to establish the teaching-service relationship is counted on. There is no conclusiveness in the scientific evidence linking teaching activities and student practices. Palabras clave: Desarrollo de personal, Recursos Humanos en salud, Prácticas clínicas, Servicios de integración docente asistencial, Convenios médico-hospital, Colombia, Keywords: Staff development, Health manpower, Clinical clerkship, Teaching care integration services, Hospital-physician joint ventures, Colombia

Objetivo: obtener versiones de los cuestionarios Primary Care Assessment Tool (PCAT) para Colombia (CO-PCAT), dirigidos a profesionales (PCAT-PE), gestores y directivos de atencion primaria (PCAT-FE) a traves de un proceso colaborativo internacional. Metodos: proceso de adaptacion transcultural modificado a partir de las versiones adaptadas y validadas en espanol, en consenso con la Colaboracion Iberoamericana IA-PCAT. El metodo busca conseguir la equivalencia de la version CO-PCAT de los cuestionarios con la version original de Estados Unidos de America. Se desarrollaron tres fases de trabajo: I) valoracion de la adecuacion de versiones iberoamericanas en lengua espanola y adaptacion al contexto colombiano, II) revision internacional realizada por investigadores de la Colaboracion Iberoamericana PCAT y III) pruebas preliminares de los cuestionarios. Consideraciones eticas: es una investigacion sin riesgos para los seres humanos conforme a la Resolucion 08430 de 1993 de Colombia y la Declaracion de Helsinki. Resultados: del PCAT-PE se incluyeron en la version colombiana 182 items. En cuanto al PCAT-FE se trabajo con 197 items en total. Conclusion: se obtuvieron versiones adaptadas al sistema de salud colombiano. La metodologia empleada puede contribuir al logro de mayor equivalencia entre instrumentos de diferentes paises. Palabras clave: atencion primaria de salud, servicios de salud, encuestas y cuestionarios, Colombia. Collaborative transcultural adaptation of the PCAT questionnaires for Colombia AbstractObjective: Obtain versions of the Primary Care Assessment Tool (PCAT) questionnaires for Colombia (CO-PCAT), directed to professionals (PCAT-PE), managers and directives of primary care (PCAT-FE) through an international, collaborative process. Methods: a transcultural adaptation process modified from the adapted and validated Spanish versions, in consensus with the Ibero-American Collaboration IA-PCAT. The method intends to get an equivalence of the CO-PCAT questionnaires version with the original version of the United States. Three phases of the work were developed: I) assessment of the adaptation of ibero-american versions in Spanish and adaptation to the Colombian context. II) international review performed by researchers of the Ibero-American Collaboration PCAT, and III) preliminary trials of the questionnaires. Ethical considerations: it is a non-risk research for human beings according to the Resolution 08430 of 1993 of Colombia and the Declaration of Helsinki. Results: From the PCAT-PE, 182 items were included in the Colombian version. Regarding PCAT-PE, the research worked with a total of 197 items. Conclusion: Adapted versions to the Colombian health system were obtained. The methodology used can contribute to the accomplishment of a greater equivalence between instruments of different countries.Keywords: primary health care, health services, surveys and questionnaires, Colombia.Adaptacao transcultural colaborativa de questionarios PCAT para ColombiaResumoObjetivo: obter versoes dos questionarios Primary Care Assessment Tool (PCAT) para Colombia (CO-PCAT), dirigidos a professionais (PCAT-PE), encargados e diretivos de atencao primaria (PCAT-FE) atraves de um processo colaborativo internacional. Metodos: processo de adaptacao transcultural modificado a partir das versoes adaptadas e validadas em espanhol, em consenso com a Colaboracao Ibero-americana IA-PCAT. O metodo procura alcancar a equivalencia da versao CO-PCAT dos questionarios com a versao original de Estados Unidos da America. Desenvolveram-se tres fases de trabalho: I) valoracao da adequacao de versoes Ibero-americanas em lingua espanhola e adaptacao ao contexto colombiano, II) revisao internacional realizada por pesquisadores da Colaboracao Ibero-americana PCAT e III) testes preliminares dos questionarios. Consideracoes eticas: e uma pesquisa sem riscos para os seres humanos conforme a Resolucao 08430 de 1993 da Colombia e a Declaracao de Helsinki. Resultados: do PCAT-PE se incluiram na versao colombiana 182 itens. Em quanto ao PCAT-FE se trabalho com 197 itens em total. Conclusao: obtiveram-se versoes adaptadas ao sistema de saude colombiano. A metodologia utilizada pode contribuir para a obtencao de maior equivalencia entre instrumentos de diferentes paises. Palavras-chave: atencao primaria de saude, servicos de saude, pesquisas e questionarios, Colombia.

Objetivo. Comprender los saberes populares de las familias campesinas de Villamaría (Caldas, Colombia), a partir del rol de enfermería en la Atención Primaria de Salud. Método. Etnografía interpretativa con observación participante y entrevistas a profundidad. Participaron 7 familias de la zona rural dispersa. Se realizaron 29 visitas familiares (septiembre de 2017 a noviembre de 2018). El análisis se realizó con Atlas.ti mediante cuatro fases: recolección y registro de datos; agrupación, clasificación y codificación; identificación de patrones recurrentes, y hallazgos de investigación. Resultados. Se identificó el tema cultural “Con nuestros saberes populares salimos adelante y nos cuidamos”, justificado en tres patrones: “sobreviviendo con la familia, la espiritualidad y quienes nos apoyan”, “riesgos y experiencias ante la salud y enfermedad” y “con las comidas y métodos para cuidar sobrevivimos a los riesgos”. Conclusiones. Los saberes populares de las familias campesinas están formados por varios elementos en búsqueda de bienestar. Para la enfermedad, se encuentra sincretismo entre la medicina occidental y los métodos naturales, en especial con el manejo de las plantas. Los resultados aportan al currículo y atención de los profesionales de la salud, especialmente a enfermería al contribuir como respuesta a la normativa actual en salud. Objective. To understand the popular knowledge of the rural families of Villamaría (Caldas, Colombia), based on the role of nursing in Primary Health Care. Methods. Interpretive ethnography with participant observation and in-depth interviews. Seven families from the dispersed rural area participated. 29 family visits were made (September 2017 to November 2018). The analysis was performed with Atlas.ti, through four phases: data collection and recording; grouping, classification and coding; identification of recurring patterns, and research findings. Results. The cultural theme was identified “With our popular knowledge we go ahead and take care of ourselves”, justified in three patterns: “Surviving with the family, spirituality and those who support us”, “Risks and experiences in the face of health and illness” and “With the meals and caring methods we survive the risks”. Conclusions. The popular knowledge of peasant families consists of several elements in search of well-being. For the disease, syncretism is found between Western medicine and natural methods, especially the use of plants. The results contribute to the curriculum and attention of health sciences professionals, particularly those of nursing by contributing in response to current health regulations. Objetivo. Compreender o conhecimento popular das famílias camponesas de Villamaría (Caldas-Colômbia), desde o papel da enfermagem na Atenção Primaria em Saúde. Métodos. Etnografia interpretativa com observação participante e entrevistas a profundidade. Participaram 7 famílias da área rural dispersa. Foram realizadas 29 visitas familiares (setembro de 2017 até novembro de 2018). A análise foi feita com Atlas.ti, diante quatro momentos: recolecção e registro de dados; agrupação, classificação e codificação; identificação de padrões recorrentes, e achados de pesquisa. Resultados: foi identificado o tema cultural “Com o nosso conhecimento popular vamos em frente e a gente se cuidou”, justificado em três padrões: “sobrevivendo com a família, a espiritualidade e das pessoas que apoiam a gente”, “Riscos e experiências diante a saúde e a doença” e “Com as comidas e métodos pra cuidar sobrevivemos a os riscos”. Conclusões. O conhecimento popular das famílias camponesas está formado por vários elementos na procura de bem-estar. Pra doença, se encontra sincretismo entre a medicina ocidental e os métodos naturais, em especial no atendimento das plantas. Os resultados contribuem no currículo e atenção dos professionais das ciências da saúde, do jeito particular, os de enfermagem contribuindo como resposta a legislação atual de saúde.

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.

ObjectivesNaloxegol is a peripherally acting µ-opioid receptor antagonist (PAMORA) for treatment of opioid-induced constipation (OIC). The main objective was to analyse the long-term efficacy, quality of life (QOL) and safety of naloxegol in patients with cancer in a real-world study.MethodsThis one-year prospective study included patients older than 18 years, with active oncological disease who were under treatment with opioids for pain control and Karnofsky≥50 and OIC with inadequate response to treatment with laxative (s). All the patients received treatment with naloxegol according to clinical criteria. The main efficacy objectives were measured by the patient assessment of constipation QOL questionnaire (PAC-QOL), the PAC symptoms (PAC-SYM), the response rate at day 15, and months 1-3-6-12, and global QOL (EuroQoL-5D-5L).ResultsA total of 126 patients (58.7% males) with a mean age of 61.5 years (95% CI 59.4 to 63.7) were included. PAC-SYM and PAC-QOL total score and all their dimensions improved from baseline (pConclusionThe results of this first long-term and real-world-data study in patients with cancer, showed the sustained efficacy and safety of naloxegol for the treatment of OIC in this group of patients.

Radon gas is a pulmonary carcinogen and the second leading cause of lung cancer after smoking. There are many countries that have not implemented measures to reduce the risk it poses to the general population. The aim of this study was to locate available evidence on exposure to residential radon and the regulations to monitor and control this across Central and South America, by conducting a review of the scientific literature and government documents in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This review included 31 studies which had taken measurements of radon in these countries. While Brazil, Argentina, and Peru have undertaken most research, no country in Central and South America has a national map of exposure to residential radon. The prevalence of exposure to radon was uneven, both among the different countries and within individual countries. No country has regulations to prevent the entry of radon into homes, and nine countries have not set maximum permissible concentrations for residential radon. There is a limited number of studies in South and Central America, with a limited spatial coverage, and there is a need to improve knowledge on exposure to residential radon and its effects, and for governments to take the necessary actions to introduce preventive measures in their statutory regulations.

e24155 Background: Naloxegol is a peripherally acting, µ-opioid receptor antagonist for treatment of opioid-induced constipation (OIC). The main objective of this study was to analyze the efficacy and safety of naloxegol in patients with cancer in a real-world 12-month follow-up study. Methods: An observational prospective study was conducted in 16 Spanish centers. Patients older than 18 years, with active oncological disease who were under treatment with opioids for pain control and Karnofsky ≥ 50 were selected. OIC with inadequate response to treatment with laxative (s) was the main diagnostic. All the patients received treatment with naloxegol according to clinical criteria. Efficacy was measured by the response rate and symptoms evolution measured by means of PAC-SYM questionnaire. Intensity of pain was measured by a 0-10-point visual analogue scale (VAS). Intent to treat last observation carried forward was applied. Results: A total of 126 patients were included in the study. About 58.7% were men, with a mean age of 61.5 years (34-89). Lung cancer was observed in 35.7%, breast cancer in 16.7%, 10.3% digestive cancer and 8.7% had prostate cancer. About 67.5% had metastases. Naloxegol at doses of 25 mg/day was administered to 88.1% and with concomitant laxatives in 48.4%. At 12 months, 77.8% of the patients were responders to naloxegol treatment: 78.6% at doses of 12.5 mg/day, and 78.4% with 25 mg/day. Furthermore, response was observed in 78.5% of patients without concomitant laxative treatment and 77% of patients with any concomitant laxative. PAC-SYM total score and all the dimensions improved from baseline (p < 0.0001). VAS pain intensity was reduced and controlled from baseline onwards (Baseline-12 months: 4.6 to 3.6, p < 0.001). A total of 28 adverse reactions mainly gastrointestinal were observed in 15.1% of the patients (19/126), 75% (21) mild, 17.9% (5) moderate and 7.1% (2) severe. Most adverse reactions (67.9%) were observed the first 15 days of treatment with naloxegol. Conclusions: The results of this first real-world-data study in patients with cancer confirm the long-term efficacy of naloxegol for the treatment of OIC in this group of patients. Naloxegol is safe and well tolerated in patients with cancer while maintaining pain control.

El objetivo fue armonizar las ediciones de PCAT (PE-proveedores o equipos de Salud, FE-gestores, AE-usuarios adultos y CE-usuarios niños y adolescentes). Entre sí y, adicionalmente, adecuar aún más el contenido de los instrumentos al contexto cultural, sanitario y epidemiológico latinoamericano, en función de la evidencia científica publicada y el desarrollo tecnológico en los procesos de atención, manteniendo los principios teóricos y operativos del modelo original. Participan en este proyecto 19 personas de 10 grupos de investigación que tenían la experiencia previa de haber adaptado PCAT en 9 países: Argentina, Bolivia, Brasil, Colombia, Chile, Ecuador, España, México y Uruguay. La armonización se llevó a cabo en cuatro etapas: 1) Conformación del fondo de versiones PCAT disponibles en Iberoamérica de las cuatro ediciones: PCAT-PE, PCAT-FE, PCAT-AE y PCAT-CE. Se confeccionaron planillas de trabajo por cada edición que permitieran la comparación ítem-por-ítem de todas las versiones disponibles, incluyendo la original de los EUA. 2) Identificación de enunciados predominantes de cada ítem, es decir, aquellas frases coincidentes en la mayoría de países y primera ronda de revisión internacional para valorar la equivalencia entre los ítems de cada versión en la región y la adecuación cultural de los enunciados predominantes en cada país. 3) Valoración, mediante una segunda ronda de trabajo, de la equivalencia de ítems similares entre las diferentes ediciones de PCAT (PE, FE, AE y CE), teniendo a la vista los enunciados de todos los países para cada ítem. 4) Focalización del trabajo en ítems con problemas de equivalencia o de actualidad, señalados en las fases anteriores, teniendo en cuenta los cambios epidemiológicos, sanitarios y tecnológicos desde la creación de estos instrumentos, acontecidos desde la creación de PCAT a la fecha. Las deliberaciones se realizaron por conferencia sincrónica de todo el panel de expertos. Para las secciones de orientación comunitaria e idoneidad cultural fue necesario conformar adicionalmente grupos de trabajo que pusieron a consideración del panel las propuestas de cambios. En todas las etapas, se dispuso de materiales elaborados previamente por coordinadoras o grupos de trabajo para la revisión de cada equipo, y luego se realizaron teleconferencias vía WebEx o Skype, tras lo cual se elaboraron minutas que fueron revisadas y corregidas por todos los participantes. Este proceso concluyó a fines de 2017 con la formulación de las versiones preliminares de IA PCAT (AE, CE, PE, FE). Se trabajó con 26 cuestionarios PCAT de Iberoamérica (8 PE, 5 FE, 8 AE, 5 CE), además de las 4 versiones originales. Se revisaron, compararon y valoraron 1311 ítems de la edición PE, 865 ítems de la edición FE, 946 ítems de la edición AE y 472 ítems de la edición CE. Muchos términos y enunciados fueron cambiados y se encontraron soluciones adecuadas para todos los países (por ejemplo, ?servicio? en lugar de ?establecimiento?, ?institución?, ?centro?, ?CAP?, etc.) manteniendo, no obstante, la posibilidad de adecuar palabras a una expresión local más adecuada si era necesario. También se realizó un proceso de selección de ítems para incluir nuevos o eliminar algunos originales, particularmente en la sección de integralidad. Las versiones preliminares obtenidas hasta el momento serán sometidas a pruebas de comprensión, fiabilidad y validez en el futuro inmediato. Este proceso capitalizó la experiencia de numerosos equipos de investigación de Iberoamérica para lograr versiones preliminares de instrumentos (ahora IA-PCAT) más adecuados a la región y a la situación epidemiológica y sanitaria actual, sobre la base de los principios, conceptos y constructos originales del modelo PCAT. La actualización realizada puede ser de interés para otras regiones del mundo. Fil: Ponzo J.

Objetivo Realizar una revisión temática sobre los instrumentos que se han desarrollado para evaluar las funciones de la atención primaria de salud (APS) desde la perspectiva de usuarios, en el contexto mundial, validados entre 1994 y 2014. Métodos Revisión temática de artículos publicados en PubMed, EMBASE y Biblioteca Virtual en Salud. Como criterios de inclusión se establecieron publicaciones de revistas científicas, idiomas español, inglés y portugués y estudios de validación de cuestionarios que evaluaran funciones de la APS. Resultados En total se encontraron 28 cuestionarios, desarrollados y validados. Conclusiones Existen instrumentos validados, disponibles para evaluar las funciones esenciales de la APS. Objective To conduct a narrative review about the instruments that have been developed to evaluate the functions of primary health care from the user's perspective, in the global context, between 1994 and 2014. Methods a thematic review of articles published in PubMed, EMBASE and Biblioteca Virtual en Salud was performed. As an eligibility criteria for articles were publications in scientific journals, Spanish, English and Portuguese languages and validation studies of questionnaires to assess functions of primary health care. Results A total of 28 questionnaires developed and validated was found. Conclusions there are validated instruments available to assess the essential functions of the APS. Revisión temática de artículos publicados en PubMed, EMBASE y Biblioteca Virtual en Salud. Como criterios de inclusión se establecieron publicaciones de revistas científicas, idiomas español, inglés y portugués y estudios de validación de cuestionarios que evaluaran funciones de la APS. Realizar una revisión temática sobre los instrumentos que se han desarrollado para evaluar las funciones de la atención primaria de salud (APS) desde la perspectiva de usuarios, en el contexto mundial, validados entre 1994 y 2014 En total se encontraron 28 cuestionarios, desarrollados y validados. Conclusiones Existen instrumentos validados, disponibles para evaluar las funciones esenciales de la APS.

Objetivo: establecer las características de la estrategia de Atención Primaria de Salud (APS) en una institución de primer nivel de atención a partir del equipo que la ejecuta. Materiales y Métodos: Investigación cualicuantitativa. Población: 32 integrantes del Equipo de Atención Primaria (EAP) al momento del estudio. Técnicas: grupo focal y encuesta. La información se analizó retomando las características de la APS, y se procesó en el Statistical Package for the Social Sciences (SPSS) 15.0. Resultados: el EAP está conformado por personal médico y asistencial. El 96.9% informó que la APS es el primer contacto de los usuarios con el servicio de salud. Las estrategias básicas son promoción de la salud, prevención de la enfermedad, detección temprana y protección específica. El 75.8% realiza educación en todos los grupos poblacionales. La estrategia posee enfoque comunitario. La atención ha sido a través de visita familiar (81.3%), unidad móvil y jornadas de salud (68.8%). La frecuencia de visitas familiares es según el riesgo. El 81.3% afirmó que existe una coordinación de los servicios con otros niveles y que se articulan con otros actores. Existe asociación y dependencia entre la motivación para hacer parte del EAP como formación profesional y el convencimiento de la relevancia de la estrategia con la satisfacción en la atención brindada p

ResumenEn Latinoamérica ha surgido un proceso de desarrollo marcado por la reaparición de la Atención Primaria de Salud como eje central de los sistemas de salud. Los gobiernos han asumido el compromiso de renovar esta estrategia como base de sus sistemas de salud. Sin embargo, principalmente enfrentan retomar el valor de equidad y son comunes los desafíos como dotar a los sistemas de salud con talento humano en número suficiente y capacitado, superar la fragmentación/segmentación de los sistemas, garantizar la sostenibilidad financiera, mejorar la gobernanza, la calidad de la atención y los sistemas de información, ampliar coberturas, prepararse para afrontar las consecuencias del envejecimiento poblacional y el cambio del perfil epidemiológico y aumentar la capacidad resolutiva del sistema público de salud. Con este artículo se pretende brindar una visión integral de los avances y los desafíos actuales de la inclusión de la Atención Primaria de Salud en los sistemas de salud de los países latinoamericanos.AbstractA development process, marked by the re-appearance of the primary health care as the core of health systems, has emerged in Latin America. Governments have made a commitment to renew this strategy as the basis of their health systems. However, these health systems are mainly faced with re-introducing equity values, and there are common challenges such as providing the health systems with trained human resources in sufficient numbers, overcoming the fragmentation/segmentation of the systems, ensuring financial sustainability, improving governance, quality of care and information systems, expanding coverage, preparing to face the consequences of an aging population, the changing epidemiological profile, and increase in the response capacity of the public health system. This article is intended to provide a comprehensive view of the progress and challenges of the inclusion of primary care health systems in Latin American countries.