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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.

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.

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.

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.

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.

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.

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.

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.

Objetivo: Realizar una revisión narrativa sobre artículos que presentan instrumentos utilizados para la evaluación de la atención primaria de salud a nivel mundial. Materiales y métodos: La búsqueda se realizó en Pubmed, Embase, Cochrane y Lilacs de artículos publicados entre 2008 y 2013. Los descriptores utilizados fueron: primary health care, health care evaluation mechanisms, questionnaires and validation study. Como criterios de elegibilidad de los artículos se incluyeron tres idiomas y estudios de validación. Se construyó una matriz de análisis por base de datos con las características de cada artículo, luego se consolidó una matriz final con los artículos que cumplieron con los criterios de inclusión y se analizaron los instrumentos encontrados. El análisis de la información se llevó a cabo por las dos autoras de forma independiente, para una mayor objetividad. Resultados: Se obtuvieron 128 artículos que cumplieron con los criterios de inclusión establecidos en el estudio. El porcentaje de instrumentos identificados por categorías de análisis fueron: Estilos de vida y enfermedades crónicas 20,3%, Estrategia de APS – Administración 5,4%, Estrategia de APS - Relación Equipo de salud Usuario 23,4%, Salud Mental 28,9% y otras áreas temáticas 21,9%. Conclusiones: Existe una amplia y variada disponibilidad de instrumentos genéricos y específicos que han sido validados en el contexto mundial para evaluar la estrategia de atención primaria de salud, sobre los cuales es posible reconstruir la mejor evidencia como herramienta de trabajo. ABSTRACT Objective: To conduct a narrative review about articles that present instruments used for primary health care evaluation worldwide. Materials and methods: The search was performed in PubMed, Embase, Cochrane, and Lilacs of articles published between 2008 and 2013. The descriptors used were: primary health care, health care evaluation mechanisms, questionnaires and validation study. The eligibility criteria for articles were three languages and validation studies. An analysis matrix was constructed by database with the characteristics of each item, then a final matrix was consolidated with the articles that met the inclusion criteria and the found instruments were analyzed. The data analysis was carried out by the two authors independently for greater objectivity. Results: 128 articles that met the inclusion criteria for the study were obtained. The percentage of instruments identified by analysis categories were: Lifestyle and chronic diseases 20.3%, PHC - Management 5.4% PHC - Relationship between Health equipment and User 23.4 %, Mental health 28, 9% and other subject areas 21.9%. Conclusions: There is a wide and varied availability of generic and specific instruments that have been validated in the global context for evaluating the primary health care strategy, from which it is possible to reconstruct the best evidence as a working tool.

Objetivos: Identificar las características del desarrollo de la estrategia de Atención Primaria de Salud desde la perspectiva de los usuarios y los factores que se relacionan con la utilización de los servicios. Materiales y métodos: Estudio descriptivo, mixto. Muestra 393 usuarios beneficiarios de la estrategia. La selección de la muestra se realizó según criterios establecidos. Se utilizaron el grupo focal y la encuesta. La información fue categorizada y procesada en el SPSS 15.0. Resultados: La edad promedio fue 37.62 años. Las principales razones para solicitar una atención fueron recuperarse y prevenir la enfermedad. La edad se asoció significativamente con recuperarse como una razón para solicitar una atención p