ABSTRACT
INTRODUCTION: Gastric cancer (GC) is the first cause of cancer-related death in Chile and 6th in Latin America and the Caribbean (LAC). Helicobacter pylori (H. pylori) is the main gastric carcinogen, and its treatment reduces GC incidence and mortality. Esophageal-gastro-duodenoscopy (EGD) allows for the detection of premalignant conditions and early-stage GC. Mass screening programs for H. pylori infection and screening for premalignant conditions and early-stage GC are not currently implemented in LAC. The aim of this study is to establish recommendations for primary and secondary prevention of GC in asymptomatic standard-risk populations in Chile. METHODS: Two on-line synchronous workshops and a seminar were conducted with Chilean experts. A Delphi panel consensus was conducted over 2 rounds to achieve>80% agreement on proposed primary and secondary prevention strategies for the population stratified by age groups. RESULTS: 10, 12, and 12 experts participated in two workshops and a seminar, respectively. In the Delphi panel, 25 out of 37 experts (77.14%) and 28 out of 52 experts (53.85%) responded. For the population aged 16-34, there was no consensus on non-invasive testing and treatment for H. pylori, and the use of EGD was excluded. For the 35-44 age group, non-invasive testing and treatment for H. pylori is recommended, followed by subsequent test-of-cure using non-invasive tests (stool antigen test or urea breath test). In the ≥45 age group, a combined strategy is recommended, involving H. pylori testing and treatment plus non-invasive biomarkers (H. pylori IgG serology and serum pepsinogens I and II); subsequently, a selected group of subjects will undergo EGD with gastric biopsies (Sydney Protocol), which will be used to stratify surveillance according to the classification Operative Link for Gastritis Assessment (OLGA); every 3 years for OLGA III-IV and every 5 years for OLGA I-II. CONCLUSION: A "test-and-treat" strategy for H. pylori infection based on non-invasive studies (primary prevention) is proposed in the 35-44 age group, and a combined strategy (serology and EGD) is recommended for the ≥45 age group (primary and secondary prevention). These strategies are potentially applicable to other countries in LAC.
Subject(s)
Consensus , Delphi Technique , Helicobacter Infections , Helicobacter pylori , Primary Prevention , Secondary Prevention , Stomach Neoplasms , Stomach Neoplasms/prevention & control , Humans , Chile , Helicobacter Infections/complications , Secondary Prevention/methods , Adult , Young Adult , Adolescent , Middle Aged , Male , FemaleABSTRACT
La sensibilidad del adulto ha sido ampliamente estudiada en la primera infancia, por asociarse a un vínculo de apego seguro con el niño(a). Existen diferentes instrumentos de medición de este constructo, principalmente a través de métodos observacionales. La mayoría de ellos requiere un contexto experimental o extensa capacitación. El objetivo del presente estudio es crear un nuevo instrumento para medir la sensibilidad en adultos significativos para el niño(a) de 6 a 36 meses de edad, de manera simple, denominado Escala de Sensibilidad del Adulto, E.S.A. Se evalúa una breve interacción de juego libre, la cual es filmada y codificada. A continuación se presenta el proceso de construcción del instrumento, sus propiedades psicométricas, el análisis de concordancia interjuez y la confiabilidad. Se analiza una muestra de 99 díadas adulto significativo-niño(a) y se concluye que la E.S.A. presenta muy adecuadas propiedades psicométricas y puede ser utilizada en diferentes contextos familiar, educacional o instituciones.
The adult sensitivity has been extensively studied in early childhood, for it is associated with a secure attachment bond with the child. Different sensitivity measuring instruments have been developed, primarily through observational methods. Most of them require extensive training or a complex experimental s setting. The aim of this study is to develop a new instrument to assess sensitivity in adult caretaker of children aged 6 to 36 months, with few requirements for its use. The context of measurement involved a brief free-play interaction, which is filmed and encoded. The instrument was applied to a sample of 99 significant adult-child dyads and the videos analyzed with a rubric for each sensitivity indicator. Results show that the instrument has adequate psychometric properties and can be used in different familiar, educational or institutional contexts.