Search

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.

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.

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.

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.

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.

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.

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.

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 Obtener versiones de los cuestionarios Primary Care Assessment ToolsChild Edition y Adult Edition (PCAT-CE y PCAT-AE) para evaluar las funciones dela atención primaria con equivalencia a las versiones originales y adecuación alcontexto colombiano.Métodos Proceso de adaptación transcultural modificado a partir de las versionesadaptadas y validadas en español en Argentina, Uruguay y España, en consenso conla Colaboración Iberoamericana IA-PCAT.Resultados Dieciocho de 99 ítems del PCAT-CE y 31 de 112 del PCAT-AE fueron ade-cuados para Colombia según las versiones iberoamericanas; 76 y 73, respectivamente,requirieron cambios lingüísticos mínimos; 2 y 4 ítems, cambios mayores; 1 y 4 ítems fueron eliminados. Las entrevistas confirmaron la comprensión y permitieron mejoras.Conclusiones Se obtuvieron versiones adaptadas al sistema de salud colombiano. La metodología empleada capitalizó los resultados de otros países y puede contribuir al logro de mayor equivalencia entre instrumentos de diferentes países. Objective To obtain versions adapted to the Colombian context of the Primary Care Assessment Tools Child Edition and Adult Edition questionnaires (PCAT-CE and PCAT-AE, respectively) to assess the functions of primary care with equivalence to their original versions. Methods Transcultural adaptation process based on the adapted versions in Spanish validated in Argentina, Uruguay and Spain, in agreement with the Ibero-American Collaboration IA-PCAT. Results Eighteen out of 99 PCAT-CE items and 31 out of 112 PCAT-AE items were suitable for Colombia according to the Latin American versions. Of them, 76 and 73, respectively, required minimal idiomatic changes, 2 and 4 required major changes, and 1 and 4 items were removed. Interviews confirmed understanding and allowed improvements. Conclusions Versions tailored to the Colombian health system were obtained. The methodology used capitalized on the results of other countries and can contribute to achieving greater equivalence between instruments from different countries. Fil: Giraldo-Osorio, Alexandra. Universidad de Caldas; Colombia Fil: Vélez Álvarez, Consuelo. Universidad de Caldas; Colombia Fil: Ponzo, Jacqueline. Universidad de la República; Uruguay Fil: Pasarín, Isabel. Agencia de Salut Pública de Barcelona; España Fil: Berra, Silvina del Valle. Universidad Nacional de Córdoba; Facultad de Medicina.; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba; Argentina