Efectividad de las intervenciones para la transferencia y apropiación social del conocimiento de las Guías de práctica clínica y salud pública basadas en la evidencia (Revisión Sistemática)

OBJETIVO: Evaluar la efectividad de las intervenciones para realizar apropiación social y transferencia del conocimiento (KT) de las guías de práctica clínica (GPC) y salud pública basadas en la evidencia (GSP) para mejorar la adherencia de los pacientes y/o comunidad. METODOLOGÍA: Revisión sistemática de las intervenciones de KT comparadas con el desarrollo clásico de las guías y estrategias para los pacientes y/o comunidad. Se realizó una búsqueda hasta abril de 2017 en MEDLINE (Ovid), EMBASE, SCOPUS, CENTRAL (Ovid), Web of Science, LILACS, Academic Search y Scielo. Dos evaluadores independientes calificaron el riesgo de sesgo y la calidad de la evidencia de los estudios incluidos. RESULTADOS: Ocho estudios fueron incluidos relacionados con GPC y 3 con GSP. El desenlace de adherencia de las recomendaciones se observó en tres estudios. Se presentó alta heterogeneidad en los estudios debido a la variabilidad en la población, tipo de guía y de las herramientas de medición. El riesgo de sesgo fue alto debido principalmente al sesgo de desempeño, degaste, selección y reporte. Los estudios de GSP presentaron un mayor riesgo de sesgo que los GPC. La mayoría de los desenlaces presentaron una calidad de la evidencia muy baja y baja, solamente del desenlace de adherencia y de mortalidad en algunos estudios fueron evaluados con calidad moderada. A pesar que no se pudo realizar un efecto global de la intervención, se detalla que la intervención mejora los desenlaces de adherencia, conocimiento de las recomendaciones y algunos desenlaces clínicos cuando se realiza una combinación de estrategias de KT como educación combinadas con la modificación del entorno o con el grupo de profesionales de la salud. CONCLUSIÓN: Las intervenciones a corto plazo presentan un leve efecto a favor en el desenlace de adherencia, y las mixtas (pacientes y profesionales) en algunos desenlaces clínicos. Sin embargo, se requieren nuevos estudios con menos heterogeneidad que permitan confirmar estos resultados.Abstract. OBJECTIVE: To assess the effectiveness of knowledge translation (KT) and knowledge appropriation social interventions to improve patients and/or community adherence to clinical practice guidelines (CPG) and Evidence-Based Public health guidelines (PHG). METHODS: We performed a systematic review of KT interventions compared with classical interventions for patients and/or communities. We searched the following electronic databases up to April 2017: MEDLINE (Ovid), EMBASE, SCOPUS, CENTRAL (Ovid), Web of Science, LILACS, Academic Search, and Scielo. Two independent raters qualified the relevance, risk of bias, and quality of included studies. RESULTS: Eight studies were finally included relation CPG and three for PHG. Patients adherence was observed in 3 studies. There was high heterogeneity due to the variability of the population, types of guidelines, and types of measurement tools. The risk of bias was high by performance bias, attrition bias, selection and report bias. The studies of PHG had a greater risk of bias than CPG. The quality of evidence of the outcomes majority was classified as very low and low evidence, only the outcomes of adherence and mortality had a moderate evidence. Although an overall effect of the intervention could not be realized, it is detailed that the intervention improves the outcomes of adherence, knowledge of the recommendations and some clinical outcomes when a combination of strategies of KT is realized as education combined with the modification of the environment or with the group of health professionals. CONCLUSION: KT interventions might have a slight positive effect on patient adherence and some short-term clinical outcomes, particularly within mixed interventions (patients and health professionals). However, future studies with less heterogeneity are necessary to confirm these results.Maestrí

Effectiveness of knowledge translation and knowledge appropriation of clinical practice guidelines for patients and communities, a systematic review

Introduction: Knowledge translation and knowledge appropriation social interventions apply knowledge to improve health services and outcomes. These interventions can be implemented routinely to improve patient adherence to clinical practice guidelines. Objective: To assess the effectiveness of knowledge translation interventions to improve patient and community adherence to clinical practice guidelines. Materials and methods: We performed a systematic review of these interventions compared with classical interventions for patients and/or communities. We searched the following electronic databases up to April 2017: Medline (Ovid), Embase, Scopus, Central (Ovid), Web of Science, LILACS, Academic Search, and Scielo. Two independent raters qualified the relevance, risk of bias, and quality of included studies. Results: Eight studies were included. Patient adherence to recommendations was observed in two studies. There was high heterogeneity due to the variability of the population, types of guidelines, and types of measurement tools. The risk of bias was high: a 60% risk of performance bias, 50% risk of attrition bias, 25% risk of selection and reporting bias, and 15% risk of detection bias. The quality of evidence was moderate for the outcomes of adherence and mortality. The interventions that used a combination of strategies, such as with the group of health professionals, could improve some clinical outcomes in the patients (Average deviation: -3.00; 95% IC: -6.08-0.08). Conclusions: Knowledge translation interventions might have a slight positive effect on patient adherence and some short-term clinical outcomes, particularly within mixed interventions (patients and health professionals). However, future studies with less heterogeneity are necessary to confirm these results

Food Insecurity Experience Scale (FIES) in Colombia, Guatemala, and México

Objetive. To compare the psychometric characteristics of the Food Insecurity Experience Scale (FIES) and the grade of similitude or difference among Colombia, Guatemala, and Mexico during three years. Materials and methods. Psychometric comparison using the Rasch model to calculate the relative severity of each item in FIES, INFIT and contrast in the Differential Functioning of Items (c-DIF). Results. The majority of items showed a relative severity corresponding to the theoretical construct and acceptably fit the model (INFIT=0.7-1.3). No c-DIF above 1.0 logit was observed in the comparison men vs women. In the comparison among countries by year 87% of the items showed c-DIF below 0.5 logit. Conclusion. The FIES presents psychometric characteristics corresponding to the theoretical construct of the tool. Future studies with the inclusion of more countries and more time points are essential to evaluate the relative severity, behavior and distribution of items

Quality of life in refractory generalized myasthenia gravis : a rapid review of the literature

Generalized myasthenia gravis (GMG) is a neuromuscular transmission disorder that creates a fluctuating weakness of the voluntary muscles. This study is aimed at understanding the effect that refractory GMG has on the quality of life of patients who suffer from it, and the effect of eculizumab on it. A systematic literature search was conducted in MEDLINE (Ovid), EMBASE and the Cochrane Database of Systematic Reviews (Ovid). Eligibility criteria were verified via the title and summary and afterward through the full text. The risk of bias of the included randomized clinical trials was evaluated and the data were synthesized in a descriptive manner. Nine studies were identified that evaluated the quality of life of patients with GMG. Regarding the effect of eculizumab, two studies were identified. The quality of life in patients with GMG is lower compared to ocular myasthenia gravis (MG) and MG in remission, especially in the domains of physical function, physical role, bodily pain, vitality, and social function. Patients treated with eculizumab had a better perception of their quality of life compared to those who received placebo. GMG affects the quality of life more than other types of MG. This outcome is of great importance for the choice of therapeutic options in patients with refractory GMG. Eculizumab generates improvements in the perception of patients' quality of life compared to placebo, making it a relevant therapeutic option in the management of refractory GMG.N/

Consecuencias de los conflictos armados en la salud mental de niños y adolescentes: revisión de revisiones de la literatura

Introduction: Armed conflicts affect the mental health of children and adolescents. Their outcomes in these populations have been documented identifying vulnerability and significant biopsychosocial damage as the most common factors.Objective: To identify and synthesize the mental health consequences of armed conflicts in children and adolescents.Materials and methods: We carried out a comprehensive and systematic search of reviews published until July 2019 in the MEDLINE (Ovid), EMBASE, Cochrane Central Register of Controlled Trials, and LILACS databases, as well as in additional sources. The information was retrieved and analyzed narratively by describing the characteristics and objectives of the studies and the mental health consequences of armed conflicts in three periods of time: pre-armed conflict, during the armed conflict, and post-conflict.Results. Out of 587 potentially relevant studies, we finally selected 72. In the pre-armed conflict period, we described in detail the psychological experiences and the anticipatory somatic symptoms. During the conflict, we identified regressive, behavioral, and cognitive symptoms such as enuresis, fear, sadness, aggression, hyperactivity, and inattention, among others. Direct mental health consequences such as adjustment disorders, depression, anxiety, and post-traumatic stress were also identified. Finally, in the postconflict period, we referred to the transmission of mental health consequences and resilience processes. On the other hand, we reviewed in depth the potential consequences of armed conflicts on biopsychosocial development, morality, identity, culture, education, and society.Conclusion. The development of mental health consequences due to the exposure to armed conflicts in these populations is a complex process that depends on the stage of the exposure, the length of the conflict, and contextual factors.Introducción. Los conflictos armados dejan consecuencias evidentes en la salud mental de la población infantil y adolescente. En ese marco, se ha documentado una serie de situaciones que tienen como factor común la vulnerabilidad de esta población y las afectaciones biopsicosociales significativas.Objetivo. Determinar y sintetizar las diferentes consecuencias de los conflictos armados en la salud mental de la población infantil y adolescente.Materiales y métodos. Se realizó una búsqueda sistemática exhaustiva de revisiones bibliográficas hasta julio de 2019 en las bases de datos MEDLINE (Ovid), EMBASE, Cochrane Central Register of Controlled Trials, LILACS y otras. Se seleccionaron los artículos y se analizaron de forma narrativa sus características, objetivos y consecuencias en salud mental en tres momentos: antes del conflicto, durante el conflicto y en el posconflicto.Resultados. De un total de 587 artículos potencialmente relevantes, se seleccionaron 72. En los estudios sobre el periodo anterior al conflicto, se detallaron experiencias psicológicas y síntomas somáticos anticipatorios. Durante el conflicto, se evidenciaron síntomas regresivos, conductuales y cognitivos, como enuresis, miedo, tristeza, agresión, hiperactividad e inatención, entre otros. Además, se establecieron consecuencias directas, como trastornos de adaptación, depresión, ansiedad y, en mayor medida, estrés postraumático. Por último, en el posconflicto, se recopiló la información sobre los procesos de transmisión de las consecuencias y la resiliencia. Por otro lado, se profundizó en las consecuencias potenciales en el desarrollo biopsicosocial, la moralidad, la identidad, el contexto, la cultura, la educación y la sociedad.Conclusiones. Las consecuencias de los conflictos armados en la salud mental se inscriben en un proceso complejo que se expresa en función de la etapa evolutiva de la exposición, del tiempo del conflicto armado y de los factores contextuales

Violence due to Armed Conflict and Prevalence of Mood Disorders, Anxiety and Mental Problems in the Colombian Adult Population

Antecedentes La violencia en Colombia tiene una historia de más de 50 años. se calcula que entre 1985 y 2012 han fallecido 220.000 colombianos y cerca de 6.000.000 han sido desplazados por la violencia. Objetivo Describir y comparar las prevalencias de algunos problemas y trastornos mentales en la población adulta colombiana teniendo en cuenta las características del municipio respecto a su historia de violencia o conflicto armado. Métodos Se utilizaron los resultados de los adultos (mayores de 18 años) sobre algunos problemas y trastornos mentales de la ENSM de 2015, y se clasificaron los municipios según la presencia y la intensidad del conflicto utilizando la clasificación propuesta por la CERAC. Se realizó la medición de trastorno (con el CIDI-CAPI), problemas (con AUDIT, PCL modificado) y consumo de sustancias psicoactivas. Resultados Se entrevistó a 10.870 personas, de las que 5.429 no habían cambiado de residencia. El 21,8% de los municipios sufrían conflicto permanente; el 65,5%, interrumpido, y solamente el 12,7% había sido pacificado o no tenía conflicto. La intensidad del conflicto se reportó alta en el 31,8%. Los municipios violentos presentaban prevalencias más altas de trastornos de ansiedad, depresivos, posible trastorno de estrés postraumático y consumo de cigarrillo. El consumo de alcohol era más frecuente en municipios con menor intensidad del conflicto. Conclusiones Los municipios clasificados como con altos niveles de violencia presentaban mayor prevalencia de trastornos mentales y de la mayoría de los problemas mentales.Q4Artículo original147-153Background Violence in Colombia has a history of over 50 years. Between 1985 and 2012 an estimated of 220,000 Colombians have died and about 6,000,000 have been displaced by violence. Objective To describe and compare the prevalence of some problems and mental disorders in the adult population in Colombia, taking into account the characteristics of the municipality, as regards its history of violence or armed conflict. Methods The results for adults (over 18 years) of some problems and mental disorders were taken from the ENSM-2015. The municipalities were classified according to the presence and intensity of the conflict using the classification proposed by the CERAC. Disorders were measured using CIDI-CAPI, and problems with AUDIT, modified PCL (Post-Traumatic Stress Disorder Checklist). An estimate was also made of psychoactive substances consumption. Results A total of 10,870 people were interviewed, of whom 5,429 had not changed residence. There was had permanent conflict in 21.8% of the municipalities, 65.5% had a discontinued conflict, and only 12.7% had been pacified or had no conflict. The intensity of the conflict was reported as high by 31.8% of the people. Violent municipalities have a higher prevalence of anxiety disorders, depression, possible Post-Traumatic Stress Disorder, and smoking. Alcohol consumption was more common in municipalities with less intense conflict. Conclusions The municipalities classified as having high levels of violence have a higher prevalence of mental disorders and the majority of the mental problems

Quality indicators for chronic disease management in Europe: a scoping review protocol

Background: Chronic disease management systems aim to collect, analyse, interpret and disseminate information on the prevalence of and risk factors for chronic conditions in a population. Quality indicators (QIs) could provide a set of metrics to consistently measure the burden and allow planning at national and international level. This scoping review explores existing literature to identify quality indicators for chronic disease management in the EU and UK. Methods: The scoping review will describe quality indicators used in selected European countries to monitor chronic diseases. This scoping review will be conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. A systematic search strategy will be carried out in MEDLINE (OVID), EMBASE and SCOPUS along with manual searches of relevant websites, national action plans and other grey literature. The results will be collated into a narrative. Conclusion: This scoping review will identify current literature on quality indicators for chronic disease management

Plan de seguro de salud: factor que más contribuye a las desigualdades en la mortalidad por COVID-19 en Colombia

Objetivo. Cuantificar las desigualdades socioeconómicas en la mortalidad por COVID-19 en Colombia y evaluar en qué medida el tipo de seguro de salud, la carga de enfermedades concomitantes, la zona de residencia y el origen étnico explican estas desigualdades. Métodos. Se analizaron los datos de una cohorte retrospectiva de casos de COVID-19. Se estimó el índice relativo de desigualdad (IRD) y el índice de desigualdad basado en la pendiente (IDP) utilizando modelos de supervivencia con todos los participantes, y estratificándolos por edad y sexo. El porcentaje de reducción del IRD y el IDP se calculó después de ajustar con respecto a factores que podrían ser relevantes. Resultados. Se pusieron en evidencia desigualdades notables en toda la cohorte y en los subgrupos (edad y sexo). Las desigualdades fueron mayores en los adultos más jóvenes y disminuyeron de manera gradual con la edad, pasando de un IRD de 5,65 (intervalo de confianza de 95% [IC 95%] = 3,25-9,82) en los participantes menores de 25 años a un IRD de 1,49 (IC 95% = 1,41-1,58) en los mayores de 65 años. El tipo de seguro de salud fue el factor más importante, al cual se atribuyó 20% de las desigualdades relativas y 59% de las absolutas. Conclusiones. La mortalidad por COVID-19 en Colombia presenta importantes desigualdades socioeconómicas. El seguro de salud aparece como el factor que mQ1Q1Objectives. To quantify socioeconomic inequalities in COVID-19 mortality in Colombia and to assess the extent to which type of health insurance, comorbidity burden, area of residence, and ethnicity account for such inequalities. Methods. We analyzed data from a retrospective cohort of COVID-19 cases. We estimated the relative and slope indices of inequality (RII and SII) using survival models for all participants and stratified them by age and gender. We calculated the percentage reduction in RII and SII after adjustment for potentially relevant factors. Results. We identified significant inequalities for the whole cohort and by subgroups (age and gender). Inequalities were higher among younger adults and gradually decreased with age, going from RII of 5.65 (95% confidence interval [CI] = 3.25, 9.82) in participants younger than 25 years to RII of 1.49 (95% CI = 1.41, 1.58) in those aged 65 years and older. Type of health insurance was the most important factor, accounting for 20% and 59% of the relative and absolute inequalities, respectively. Conclusions. Significant socioeconomic inequalities exist in COVID-19 mortality in Colombia. Health insurance appears to be the main contributor to those inequalities, posing challenges for the design of public health strategies.Revista Internacional - IndexadaS

The Effectiveness of Interactive Dashboards to Optimise Antibiotic Prescribing in Primary Care: A Systematic Review

Governments and healthcare organisations collect data on antibiotic prescribing (AP) for surveillance. This data can support tools for visualisations and feedback to GPs using dashboards that may prompt a change in prescribing behaviour. The objective of this systematic review was to assess the effectiveness of interactive dashboards to optimise AP in primary care. Six electronic databases were searched for relevant studies up to August 2022. A narrative synthesis of findings was conducted to evaluate the intervention processes and results. Two independent reviewers assessed the relevance, risk of bias and quality of the evidence. A total of ten studies were included (eight RCTs and two non-RCTs). Overall, seven studies showed a slight reduction in AP. However, this reduction in AP when offering a dashboard may not in itself result in reductions but only when combined with educational components, public commitment or behavioural strategies. Only one study recorded dashboard engagement and showed a difference of 10% (95% CI 5% to 15%) between intervention and control. None of the studies reported on the development, pilot or implementation of dashboards or the involvement of stakeholders in design and testing. Interactive dashboards may reduce AP in primary care but most likely only when combined with other educational or behavioural intervention strategies