Fallo en cifras del Sistema de Salud

Desde el inicio de la Pandemia de COVID-19 en 2020, el sistema de Salud le ha dedicado partidas, recurso humano y tiempo a la lucha contra esta enfermedad, pero dejó en el olvido el resto de los programas en las instalaciones de salud de primer nivel de atención donde funcionan los programas de prevención como el ampliado de inmunizaciones, ITS, Tuberculosis, VIH y enfermedades transmitidas por vectores. (provisto por Infomedic International)

Since the beginning of the COVID-19 Pandemic in 2020, the Health system has dedicated funds, human resources and time to the fight against this disease, but left in oblivion the rest of the programs in the first level of care health facilities where prevention programs such as the expanded immunization, STI, Tuberculosis, HIV and vector-borne diseases operate. (provided by Infomedic International)

Psychometric properties of a Brazilian adaptation of the Teacher Observation of Classroom Adaptation-Revised Scale for Children's Behavior / Propiedades psicométricas de la adaptación de la escala Teacher Observation of Classroom Adaptation-Revised (TOCA-R) para evaluar el comportamiento infantil en Brasil

Abstract The aim of this study was to describe the process of psychometric analysis of the Teacher Observation of Classroom Adaptation- Revised Scale (TOCA-R) for its use in Brazilian schools and to evaluate its validity and reliability. To evaluate the "Elos Program", which is the Brazilian culturally adapted version of the North American Program "Good Behavior Game", the TOCA-R was used. The researchers adapted the instrument in 2014, consisting of 33 items in a three-point ordinal response scale. A longitudinal quasi-experimental design with a single group was used. Participants were children aged 6 to 10 years evaluated by their teachers, before (n = 1448) and after (n = 673) the implementation of the Elos Program in 2014. The study involved initially four schools, 68 classes and their respective teachers. The analytical procedures were exploratory factorial analysis, confirmatory factorial analysis, longitudinal invariance analysis and reliability analysis by precision coefficients. The results of the exploratory factorial analysis showed an acceptable adjustment of five factors with 25 items, with a total explained variance of 60% and mean residual error of 0.02. The confirmatory factorial analysis expressed a satisfactory fit of the model (χ2 = 961, df = 265, RMSEA = .078, 95% IC [.07, .08], and CFI = 0.9). A configurational, metric and scalar invariance of latent structure was identified, which, together with the amplitude of variation of the precision coefficients between the instrument dimensions (α = .78, .92; ω = .76, .92), demonstrate evidence of validity and reliability for using the TOCA-R in evaluating the Elos Program in Brazilian schools.

Resumen El objetivo de este estudio fue realizar el análisis psicométrico de la escala Teacher Observation of Classroom Adaptation-Revised (TOCA-R) para su uso en escuelas brasileñas, y evaluar su validez y confiabilidad. Esta escala ha sido utilizada para evaluar el "Programa Elos", que es la versión brasileña culturalmente adaptada del programa norteamericano "Good Behavior Game". El instrumento fue adaptado por los investigadores en 2014 y está compuesto por 33 ítems con una escala de respuesta ordinal de tres puntos. En este estudio, se utilizó un diseño longitudinal cuasiexperimental de grupo único con los niños de 6 a 10 años, evaluados por sus maestros antes (n = 1448) y después (n = 673) de la implementación del Programa Elos en 2014. Se incluyeron cuatro ciudades brasileñas, 19 escuelas, 68 cursos y sus respectivos maestros, y los procedimientos analíticos fueron el análisis factorial exploratorio, el análisis factorial confirmatorio, el análisis de invariancia longitudinal y el análisis de confiabilidad por coeficientes de precisión. Los resultados del análisis factorial exploratorio mostraron un ajuste aceptable de cinco factores con 25 ítems, con una varianza total explicada del 60 % y un error residual medio de 0.02; el análisis factorial confirmatorio mostró un ajuste satisfactorio del modelo (χ2 = 961, df = 265, RMSEA = .078, IC 95 % = .07-.08, y CFI = 0.9); y se identificó la invariancia configuracional, métrica y escalar de la estructura latente, la cual, junto con la amplitud de variación de los coeficientes de precisión entre las dimensiones del instrumento (α = .78, .92; ω = .76, .92), da cuenta de evidencias de validez y confiabilidad que permiten utilizar la escala en la evaluación del Programa Elos en las escuelas brasileñas.

El impacto de la prueba de VPH en los programas de tamizaje en América Latina: el caso de Argentina / The impact of the HPV test in screening programs in Latin America: The case of Argentina

Resumen: Objetivo: Evaluar el impacto de la prueba de VPH (prueba de VPH) en los problemas que históricamente afectaron al tamizaje de cáncer cervical en América Latina, tomando como caso al Proyecto Demostración para la Introducción de la prueba de VPH en Jujuy (PDJ), Argentina. Material y métodos: Se sintetizó la evidencia sobre los problemas del tamizaje cervical en la región. Se analizó el impacto en los problemas a partir de la introducción de la prueba de VPH. El impacto se clasificó en directo/indirecto y positivo/negativo. Resultados: El impacto directo-positivo se dio en los problemas de adherencia a la edad/frecuencia de tamizaje, laboratorios de citología, baja/moderada sensibilidad de la citología y baja cobertura. El impacto directo-negativo se vinculó con el triaje de autotoma y el envío/etiquetado de muestras. El impacto indirecto-positivo se relacionó con la reorganización programática realizada para introducir la prueba de VPH. Conclusiones: La prueba de VPH representa una ventana de oportunidad para el mejoramiento del tamizaje pero no resuelve los problemas programáticos.

Abstract: Objective: To assess the impact of HPV testing on longstanding problems faced by screening programs in Latin America, using the case of the Jujuy Demonstration Project (JDP) in Argentina. Materials and methods: The study measured the level of impact produced by the introduction of HPV-testing on problems faced by cytology programs by analyzing modifications on specific problems produced during the JDP. Impact was classified as direct/indirect, and positive/ negative. Results: Direct/positive impact was found in issues concerning age and screening frequency, cytology laboratories and screening sensitivity, and low coverage. Direct/negative impact was mainly related to the adherence to triage cytology by HPV+ women with self-collected-tests, and the delivery and labelling of samples. Indirect impact of HPV-Test was mostly positive, and related to the programmatic reorganization which was facilitated by the introduction of HPV testing. Conclusions: HPV testing provides an opportunity window for improving primary screening, but does not solve programmatic problems.

Adopción e implementación del ofrecimiento de la autotoma VPH por agentes sanitarios en Jujuy, Argentina / Adoption and implementation of HPV self-collection sampling by CHWs in Jujuy, Argentina

Resumen: Objetivo: Evaluar la adopción e implementación en escala de la estrategia orientada a ofrecer puerta a puerta la autotoma de la prueba del virus del papiloma humano (AT-VPH), por parte de agentes sanitarios (AS), en Jujuy, Argentina. Material y métodos: Se aplicó una encuesta autoadministrada a 478 AS. Las dimensiones de adopción e implementación fueron evaluadas con el modelo RE-AIM. Resultados: Adopción: 81.8% de los AS ofreció la AT-VPH y 86.4% expresó gratificación con la estrategia. Implementación: los problemas encontrados fueron la demora en la entrega de tubos (61.3%) y resultados (70.0%); falta de recursos humanos (28.3%), y dificultades al obtener turnos para realizar el triage (26.1%). El principal obstáculo fue la sobrecarga de trabajo (50.2%), mientras que la capacitación (38.0%) y el listado de mujeres a contactar (28.7%) fueron los elementos facilitadores. Conclusiones: La adopción de la AT-VPH fue alta entre los AS. Deben reforzarse las estrategias programáticas para motivar a los AS y reducir su carga de trabajo al implementar la AT-VPH.

Abstract: Objective: To evaluate adoption and implementation of scaling up of HPV self-collection (SC) strategy offered door-to-door by Community Health Workers (CHWs) in Jujuy, Argentina. Materials and methods: A self-administered questionnaire was applied to 478 CHWs. RE-AIM model was used to evaluate adoption and implementation dimensions. Results: Adoption: 81.8% offered SC and 86.4% were satisfied with the strategy. Implementation: main problems were delays in the delivery of tubes (61.3%) and results (70.0%), lack of human resources (28.3%) and difficulties in obtaining an appointment for triage (26.1%). The main obstacle was the excessive workload of CHWs (50.2%). Training (38.0%) and the list of women to be offered the test (28.7%) were identified as facilitators. Conclusions: The adoption of SC strategy was high among CHWs. Program strategies should be strengthened to motivate and reduce the excessive workload of CHWs when implementing SC strategy.

Programa de detección del cáncer cervicouterino: políticas públicas y experiencias de los actores que implementan el programa en el estado de Veracruz, México / Screening program for cervical cancer: public policies and experiences of actors who implement the program in the state of Veracruz, Mexico

RESUMEN El propósito fue analizar cómo se desarrolla el Programa de Detección del Cáncer Cervicouterino en una clínica de displasias y algunos centros de salud en el estado de Veracruz, a través de las representaciones y prácticas de los actores sociales que implementan el programa. Para ello, se realizaron entrevistas en profundidad y observación de la práctica de estos prestadores de servicios durante varios periodos a lo largo de 3 años entre 2009 y 2011. A partir de la información obtenida pretendemos dar cuenta de las dificultades, aciertos y resultados que dicho programa tiene como parte de una política pública, sobre la base de que las políticas en salud tienen como prioridad que toda la población se vea beneficiada por los servicios de atención preventiva y curativa, y si bien la evidencia nos muestra que las poblaciones marginadas no se ven beneficiadas por dichos programas, pareciera que esta información no permea los saberes populares y médicos.

ABSTRACT The aim of this article is to analyze the way in which the Screening Program for Cervical Cancer is carried out in a dysplasia clinic and related health centers in the state of Veracruz, through the representations and practices of the social actors who implement the program. In order to do so, in-depth interviews and observations of the practices of health service providers were carried out during different periods over the course of three years, from 2009 to 2011. Through the information obtained, the article explores the difficulties, achievements and results of this program as part of a public policy. Although a priority of public health policy is to see the whole population benefit from preventive and curative health care services, evidence shows that marginalized populations are not benefitted by such programs; such information does not however seem to permeate popular and medical knowledge.

Evaluación de un programa de detección temprana de cáncer cervicouterino en Colombia / Evaluation of A Cervical Cancer Early Detection Program In Colombia

Resumen Objetivo: Evaluar el proceso de atención del programa de detección temprana de cáncer cervicouterino enfocado en cobertura de tamización, oportunidad de atención y adherencia en el direccionamiento del diagnóstico y tratamiento en seis municipios de Colombia. Métodos: Estudio observacional descriptivo de corte transversal a partir del análisis de fuentes secundarias de información del programa de detección temprana de cáncer cervicouterino de una aseguradora en salud de personas afiliadas con vinculación laboral y capacidad de pago. El procesamiento y análisis de los datos fueron realizados mediante el programa estadístico SPSS® versión 22 con la identificación de frecuencias absolutas, relativas, medidas de tendencia central y variabilidad. Resultados: Para el 2014, se tomaron 28.442 citologías cervicales, el 2,3% fueron resultados con algún tipo de anormalidad. Se evidenció cobertura anual de tamización del 28,2% (0,0% -280,6%), oportunidad de atención; entre toma y entrega de resultado: 15 días (4 -118), entre el resultado y el diagnóstico: 18 días (2 - 294) y entre el diagnóstico y tratamiento: 49,5 días (2 -240). Para adherencia, el 81,6% evidencia cumplimiento del direccionamiento al diagnóstico a partir del resultado citológico y el 62,6% evidencia cumplimiento en el direccionamiento del diagnóstico al tratamiento. Conclusiones: El programa de detección temprana de cáncer cervicouterino presenta coberturas bajas de tamización, falencias en el cumplimiento de la oportunidad en la atención y de la adherencia en el direccionamiento del diagnóstico y del tratamiento.

Abstract Objective: To evaluate the care process of the Cervical Cancer Early Detection program focused on screening coverage, access to care, and adherence when addressing the diagnosis and treatment, in six towns of Colombia. Methods: A cross-sectional, descriptive, observational study conducted using the analysis of secondary information sources from the Cervical Cancer Early Detection program of an occupational health insurer of persons employed, and with the ability to pay. Data processing and analysis were performed using the statistical program SPSS® version 22 with the identification of absolute and relative frequencies, central tendency, and variability measurements. Results: In the year 2014, of the 28,442 PAP smear tests taken, 2.3% were found to have some kind of anomaly. An annual screening coverage of 28.2% (0.0% - 280.6%) was observed. The access to care between the date of the sample and the delivery of the result was 15 days (4 - 118), between the result of the test and the diagnosis: 18 days (2 - 294), and 49.5 days (2 - 240) between the diagnosis and treatment. For adherence, 81.6% showed adherence to the diagnosis based on the cytological result, and 62.6% showed compliance in the diagnosis-treatment approach. Conclusions: The cervical cancer early detection program has a low screening coverage, with failures in complying with timely care and adherence in addressing diagnosis and treatment.

Elementos para programas de prevención en consumo de alcohol en universitarios / Elements for prevention programs in alcohol consumption by university students

El presente estudio no experimental, tuvo como objetivo proponer elementos para los programas de prevención del consumo de alcohol con universitarios, partiendo del análisis de los niveles, situaciones y características del consumo. En 10 universidades de Bogotá, 2.910 universitarios respondieron la ficha características del consumo, el CEAL y el ISCA, y 80 participaron en 15 grupos focales. El consumo es alto, se inicia tempranamente con aprobación de los padres y en él influyen las presiones académicas, la soledad y la cultura. Existen indicadores de abuso y dependencia. Las situaciones asociadas al consumo son las emociones y los momentos agradables, la urgencia por consumir y la presión social. Los programas preventivos deben ser implementados por jóvenes, orientados al consumo responsable, utilizando una variedad de actividades con responsabilidad de los actores.

The non - experimental study, aimed to propose from university's students items for prevention programs of alcohol consumption obtain by examining levels, situations and characteristics of alcohol consumption of 2910 students in ten universities of Bogotá - Colombia who answered the features tab in consumption, the CEAL and the ISCA, participating in 15 focus groups, 80 students. Consumption is high, begins at early ages, approved by parents, associated by academic pressures loneliness and culture. There are indices of abuse and dependence. The situations associated with consumption are emotions and good times, the urge to consume and social pressure. Preventive programs should be implemented by youth-oriented, responsible consumption using a variety of activities with responsibility from the actors.

Estrategias de prevención e intervención del "burnout" en el ámbito educativo

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Summary In the European Union 50 per cent leave their jobs due to stress. Burnout is an English term literally meaning "to be burnt out by work", that is, to be emotionally exhausted. Later on, this term was extended and consolidated by Maschlach and Jackson who considered burnout as a threedimensional syndrome derived from emotional chronic stress characterized by physical and/or psychological tiredness, a feeling of being unable to work more (emotional exhaustion), a cold and impersonal attitude towards other people, and a feeling that the current job position and the fulfilled tasks are inadequate. From a psychosocial point of view, burnout must not be identified as psychological stress, yet it has to be understood as a response to chronic stress sources developed from relationships between assistance services users and the workers who take care of them. From the psychiatric scope, Olza pointed out that psychological problems that are job related have not been given enough attention. Burnout is one of the major problems that has strong financial, social and personal effects. Our review is centered in the burnout syndrome prevalence among education professionals. In the past years many authors analysed and defended the need of a deep research regarding this subject. These authors also established burnout as a non questionable feature in the case of teaching, taking into account that somatic and psychological problems are common and affect teachers' performance as well as their relationship with students and their teaching quality. Prevention and intervention strategies Burnout research has been centered in describing the syndrome, facilitating variables, and describing syndrome consequences. It has been taken also as a statistical analysis of measure instruments. Alvarez and Fernandez classify the researches reviewed in their work in two categories considering burnout prevention and treatment. The first one is related to primary prevention and the second covers secondary prevention; it includes researches that examine and compare diverse intervention techniques. Individual strategies This part refers to a preventive and treatment focused approach meant to promote self-adaptation improvement strategies, and stress confronting regarding many personal factors. Physiological techniques Techniques oriented towards physiological arousal and emotional or physical unrest caused by labour stress sources, such as physical relaxation, breath control and biofeedback are considered among others. Behavioural techniques Those techniques are aimed to self-acquired skills and competences to facilitate labour conflict solving. Assertive training, social skills training, problem solving techniques and self-control are considered among others. Cognitive techniques Cognitive approach focuses on the perception, interpretation, and evaluation of labour conflicts and self resources that are at work in the subject. Taking into account that burnout is mediated by irrational thinking derived from stressing events, it is important to confront it according to cognitive techniques in order to change automate thinking. The following are among cognitive techniques: Systematic desensibilization, mind detention, stress inoculation, cognitive restructuration, irrational thinking control, dysfunctional attitude suppression and rational-emotive therapy. Social intervention strategies Social intervention strategies are considered to break isolation and improve socialization processes, strengthening social support trough cooperative work policies. It seems clear that social support crushes the nocive effects produced by stress sources and increases self-capacity to confront them. Sandin points out that social support affects health directly; therefore, to have a support net facilitates individual experiences regarding self-esteem, positive affection and control, protecting the worker from multiple diseases and improving the immunologic system. Final remarks Different researches reviewed, clearly show that, for burnout to be explained in all its complexity, it is necessary a wider approach. This takes us to lay out a more efficient way to handle prevention and treatment as a holistic intervention that includes single, social and organizational contexts. Other researches propose a psychopedagogical intervention program from a behavioural-cognitive approach, aimed to provide confronting strategies that will allow to improve health, labor quality and personal confort. Information society has changed its pattern and needs professionals being capable of adapting to continuous technological, social and cultural changes. Static job positions have disappeared and initial formation does not have the level needed to confront the educational challenging that our educational reality has become. It is now needed a fresh and continued formation where other values rather than technical ones are taken into account. We are undoubtedly referring to personal, emotional and professional competence development programs, that will allow ourselves to communicate efficiently, work in groups, and control our emotions as well as our creative and innovative capabilities. Currently there are no measures to soften burnout in teachers; burnout teachers performance gets worse and their presence has negative effects on their teaching quality. These reasons moved us to propose the design and implementation of a prevention and intervention program dealing with teacher's stress, trough a research project. We believe that in the future, setting, development, and -most important- evaluation of this kind of programs will be strictly held; meanwhile, we hope to contribute with this article to promote dysfunction prevention and health improvement, as well as the involvement and monitoring of challenging programs designed to improve single, social and labour competences.