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Drawing on a mixed-methods cross-cultural study undertaken in five locations in Argentina, Denmark, Hong Kong, England and the United States in 2018, this paper explores how children (aged five and seven) conceive of playfulness. Following a card-sorting task, 387 children selected familiar activities that they felt were most representative of play and not-play and explained their reasons. The children's justifications were fully transcribed, and five corpora were created (one per site). Lexicometry was applied, generating sets of the characteristic responses per age in each site. In-depth qualitative interpretation of these modal responses revealed nine dimensions across play and not-play: pleasure, social context, materials, movement, agency, risk, goal, time and focus. Commonalities revealed that children's ideas around play are not aligned with specific activities but with the sense of agency in a secure physical and social context when carrying out an activity experienced as an end in itself. Implications for playful pedagogies highlight the need to open up play with opportunities for children's choice and initiative, confident exploration and immersion in the activities in which they participate. [Spanish translation by Mercè Rius.]

Introduction: Critical congenital heart disease (CCHD) is a term that refers to ductus-dependent structural anomalies of the heart that may be fatal or require invasive management in the first month of life., Objective: To know the prevalence and distribution of CCHD among newborns in Argentina, compared to other countries, and the proportion of prenatal detection and perinatal mortality., Material and Methods: Data provided by the National Network of Congenital Anomalies (Red Nacional de Anomalías Congénitas de Argentina, RENAC) for the 2009-2018 period and by other surveillance systems in the United States, Europe, and Colombia were used. For Argentina, the proportion of prenatal detection, perinatal mortality, and CCHD prevalence in newborns by jurisdiction and health system subsector were analyzed., Results: The prevalence of CCHD was 11.46 (95% confidence interval: 11.02-11.92) every 10 000 births. Prenatal detection was possible in 43.93% of cases, and perinatal mortality was 25%. Tetralogy of Fallot was the most frequent specific defect. The prevalence of CCHD and percentage of prenatal detection was significantly lower in the public subsector, whereas perinatal mortality was higher in this subsector. The prevalence of CCHD was lower than in the United States (NBDPN) and European (EUROCAT) registries. The Bogotá Registry showed different specific prevalence values., Conclusion: The prevalence of CCHD is lower than what has been observed in other countries, and even lower in the public sector of Argentina. The need to improve prenatal detection and implement pulse oximetry among newborns as a mandatory and universal screening is emphasized.

Acute lower respiratory infections (ARI) continue being an important cause of morbidity and mortality in our region. Standardized case management is a valuable tool to deal with them. In addition to aspects related to the diagnosis and treatment of these diseases, the analysis of risk factors (both biological and socio-environmental) from a local and current perspective, allows the implementation of effective control and/or prevention measures, as well as identifying those patients susceptible to presenting serious forms or complications. Since 1996, the Sociedad Argentina de Pediatría asumed the challenge of generating a document that guides the comprehensive management of patients with ARI. This fourth update includes the latest advances on the subject., Competing Interests: None, (Sociedad Argentina de Pediatría.)

Literature concerning patients with Treatment-Resistant Depression (TRD) treatment response and patient report outcomes (PROs) -such as QoL or disability- in Argentina is scarce. In the scope of the Treatment-Resistant Depression in America Latina (TRAL) study which previous results highlighted the burden of TRD compared to non-TRD patients as well as essential epidemiological data in the region, this paper reports on the outcomes of Standard-of-Care (SOC) over a 1-year follow-up of TRD patients in the subsample for Argentina. From a sample of 220 MDD patients identified in 5 sites in Argentina, 72 patients were diagnosed with TRD. Exclusion criteria included patients with psychosis, schizophrenia, bipolar disorder, schizoaffective disorder, dementia, with severe chemical dependence or currently participating in another clinical trial. MADRS, PHQ-9 and PROs (EQ-5D and SDS) were used as outcomes. Patients’ mean age was 54.7 years and 70.3% of the patients were female. Around 61% of the patients achieved a response (reduction of MADRS score ≥ 50%), but over 33% did not achieve a remission (MADRS total score ≤12). Almost 67% of the patients still felt anxious/depressed at the end of the study (EQ-5D), while disruption affected patients in diverse areas -71% in work/school, 69.7% in social life/leisure and 66.6% in their family life/personal responsibilities. The burden of TRD is significant in Argentina, and more effort should be put in the implementation of treatment protocols with better outcomes., (CC BY NC ND)

We are currently witnessing a renaissance of psychedelic science in clinical research. In Argentina, the challenges related to its study and the development of new treatments in the field of Psychiatry are subject to the adoption of certain regulatory policies. The evolution of the knowledge about the effects, mechanisms of action and therapeutic potential of serotonergic psychedelics warrants a change in the regulatory framework for their use in clinical research. In a world that demands rapid flexibility and adaptation, we should avoid waiting for advances from developed countries. It is evident that psychopharmacological progress in the last thirty years have not been up to the expectations of the so-called "decade of the brain". Aware of these limitations, in this paper we carry out a historical and ethnopharmacological review of the classic psychedelics, from the 50's to the present -without ignoring their ancestral uses-, in order to highlight the political and cultural controversies that these molecules have raised in the field of Psychiatry. We hope to promote in the local environment an approach devoid of stigmas and that considers the therapeutic potential of these substances, with the ultimate goal of providing relief to severe mental illnesses that to this day continue to remain unanswered., Competing Interests: The author declare no conflict of interest

In the paediatric population, paticulary in the field of child and adolescent psychiatry, off-label indications are the rule rather than the exception. This may occur when a drug is indicated for a pathology, age, route of administration or treatment length other than those described in the product label. Argentina, unlike other countries, has no explicit regulation on off-label prescribing. Therefore, the prescription of a medicine in a manner different from that approved by the National Administration of Medicines, Food and Medical Technology (ANMAT) does not have a regulatory framework regarding the conditions that must be met at the time of treatment. Although off-label use is not prohibited, it carries an additional risk. In order to encourage research in paediatrics, regulatory agencies such as the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) have introduced legislative reform. The following paper will review the current framework of the regulatory agencies that are relevant to the paediatric population and will analyse criteria to guide physicians in the rational use of off-label pharmacotherapy., Competing Interests: The authors have no conflicts of interest to declare., (Creative Commons BY-NC-ND 4.0)

Introduction: Housing is one of the main supports needed to guarantee community life of people who had long-term psychiatric hospitalizations. In Argentina, housing support experiences have been developed for decades, although their systematization is scarce. The objective of this paper is to describe three housing support experiences developed in the province of Buenos Aires, Argentina, which have continuity over time for more than 20 years., Materials and Methods: Document analysis and interviews with workers from the three experiences were carried out, as part of a broader project on community life and neighborhood relations of people discharged after long-term psychiatric hospitalizations. The material was analyzed qualitatively, using a time dimension and a structure and functioning one which included financing, technical resources, housing devices and support provided., Results: Although the types of support provided are somehow similar between the three experiences, heterogeneity in structure and functioning is observed., Discussion and Conclusions: Despite the fact that the human rights framework proposes the provision of flexible and adequate support according to the needs of people, it is worth reflection on whether the reduced systematization of experiences such as those presented is due to the difficulties of the heterogeneity mentioned, or is due to a scarce evaluation culture that obstacles the learning from those experiences.

Treatment-Resistant Depression (TRD) prevalence varies considerable between regions and epidemiology of TRD in Argentina is lacking. Based on the Treatment-Resistant Depression in America Latina (TRAL) study, epidemiology and burden of TRD in MDD patients from Argentina is reported in this paper. A sample of adult MDD patients (n=396) from 5 sites in Argentina, with clinical diagnosis were included. Patients with psychosis, schizophrenia, bipolar disorder, schizoaffective disorder, dementia, with severe chemical dependence or currently participating in another clinical trial were excluded. Patient reported outcomes and clinical assessment scales were used as outcomes. The prevalence of TRD in MDD patients in Argentina is 33.2%, based on TRAL data. Patients in TRD are older compared to those without TRD, and was more evident in married/consensual union MDD patients. Higher suicidality, greater comorbidity based on MINI, and worse scores in MADRS and PHQ-9 were identified in TRD patients. The prevalence identified in TRAL study for Argentina is substantial comparing with other Latin American countries and worldwide prevalence. TRD represents a disproportional burden to society, and efforts should be placed on reducing the burden of MDD and TRD in Argentina by improving early diagnosis, therapeutic management and ensuring that all patients have better access to mental healthcare.

Direct oral anticoagulants have emerged as the drugs that have changed the management of the antithrombotic treatment in the last 15 years. Their advantages, like a more friendly way of anticoagulation and their lower risk of bleeding, especially in the brain, have positioned these new anticoagulants as the first drug of choice in the two most frequent indications of anticoagulation, atrial fibrillation, and the venous thromboembolic disease. However, not all the patients can receive these agents, not all the direct oral anticoagulants have the same characteristics, and most importantly, not all the diseases with an indication of an anticoagulant drug can be treated with them. Therefore, it is mandatory that all the faculties involved in the management of these drugs must know them in depth, to decide the best treatment for the patient. This position paper, from a group of experts in anticoagulation in Argentina, can help the general practitioner in the daily use of direct oral anticoagulants based on the new evidence and the experience of a wide group of professionals. The way we relate to the anticoagulant treatment has changed in the last years. The doctors who work with them must also do so.

Introduction: Neuropsychiatric symptoms are common in patients with mild cognitive impairment and dementia. This symptomatology can appear or be exacerbated with changes in routine and in the patient's usual environment. The lockdown situation during the COVID-19 pandemic has meant a drastic and unexpected change in the daily life of the general population, with a particular impact on the most physically and mentally vulnerable groups, including patients with cognitive impairment., Aim: To know the impact of lockdown measures imposed due to the COVID-19 pandemic on neuropsychiatric symptomatology in people with mild cognitive impairment and dementia., Materials and Methods: Exploratory systematic review, in accordance with the PRISMA guidelines, of Pubmed and Psycinfo databases papers published from January 2020 to April 2021 which related confinement due to COVID-19 with the presentation or worsening of neuropsychiatric symptoms in patients with mild cognitive impairment mild or dementia., Results: Worsening of neuropsychiatric symptoms was observed in patients with dementia and mild cognitive impairment, especially agitation/aggression, anxiety, depression and apathy. Neuropsychiatric symptoms were more common in patients with dementia than in those with mild cognitive impairment, although their typology varied depending on the severity of dementia., Conclusions: During lockdown a worsening in the psychobehavioral area has been observed in people with mild cognitive impairment or dementia. Therefore, considerations arise on the need of promoting social contact in people with mild cognitive impairment and dementia, avoiding situations of isolation and low stimulation.

The implementation of electronic medical record tools in pediatric care implies the creation of use recommendations and a clear definition of functional features. The objective of this paper is to describe minimum specific functionalities for an electronic medical record in pediatrics, with the aim to contribute to a definition of design criteria and best practices for its use. In this report, we will go over the generic functionality of the electronic medical record; we will frame the legal context in Argentina; we will approach some implementation aspects; and finally, we will describe minimum pediatric specific functionalities. Despite the adoption barriers in the field of pediatrics when it comes to incorporating electronic medical records into their professional activity, there are multiple resources to enable this digital transformation process. It is also fundamental to understand that, like any other technology, there are responsibilities related to their appropriate use., Competing Interests: None, (Sociedad Argentina de Pediatría.)