Proceso de actualización de la Agenda Nacional de Investigación Salud Pública 2021-2022 / Update process of the National Agenda for Public Health Research 2021-2022

INTRODUCCIÓN: Una Agenda Nacional de Investigación en Salud Pública (ANISP) participativa y con priorización temática constituye un elemento estratégico para generar recomendaciones y políticas públicas basadas en evidencia, que impacten positivamente en la salud de las poblaciones y permitan lograr los objetivos sanitarios. En la actualización de la ANISP participaron la Dirección de Investigación en Salud (DIS) del Ministerio de Salud de la Nación (MSAL), a través de la Red Ministerial de Investigación en Salud (REMINSA), y actores de los niveles gubernamentales provinciales y nacionales pertenecientes a los sectores público, privado, de la salud, académico y de investigación. Se adaptó la herramienta original propuesta por la Organización Panamericana de la Salud, utilizada en el proceso en 2019. La actualización abarcó diferentes etapas. La selección de los temas contó con la legitimidad, reconocimiento y participación de los actores vinculados a la salud, a la gestión gubernamental y privada y a la investigación científica; se trabajó de manera federal y transversal, por consenso con las redes provinciales y un Comité Central Asesor en el MSAL. A partir de los lineamientos preliminares obtenidos, se elaboró una encuesta en línea semiestructurada, que fue distribuida a todos los actores federales y recibió 431 respuestas. El proceso resultó en 55 lineamientos priorizados, divididos en 6 áreas temáticas y 33 subtemas, seleccionados por votación según importancia, impacto y factibilidad

Evaluación del desempeño del programa de tutorías “IDEAS PROYECTO” del ministerio de salud de Argentina / Performance evaluation of mentoring program “ideas proyecto”, national ministry of health, Argentina

INTRODUCCIÓN: argentina ha evidenciado desde hace varios años una desigualdad entre los profesionales de lasdistintas jurisdicciones en el acceso a las becas de investigación quefinancia el Ministerio de Salud de la Nación. Debido a ello se haimplementado el programa de tutorías “Ideas Proyecto”, a travésdel cual se asiste metodológicamente a investigadores noveles enla formulación de proyectos a fin de mejorar la calidad y reducirla inequidad en el acceso a las becas Salud Investiga. OBJETIVOS: Evaluar la efectividad del programa para la obtención de una beca,así como la opinión y satisfacción de los participantes. MÉTODOS: La efectividad del programa se evaluó mediante un modelo bayesianojerárquico y la satisfacción mediante una encuesta auto administrada. RESULTADOS: Se registraron 2172 postulaciones a becas, de lascuales 40 fueron tutoradas. La tutoría aumentó la chance de obteneruna beca. La comprensibilidad de la información proporcionada por el tutor y la valoración general de la experiencia con la tutoría fueron los ítems con mayor valoración positiva (97%), mientras quela percepción de mejora del posicionamiento laboral fue el de mayor valoración negativa (24%). Los obstaculizadores y facilitadores másmencionados fueron la dosificación y el rol del tutor, respectivamente. CONCLUSIONES: Los resultados demuestran la eficacia de la tutoría para el logro de los objetivos del programa. La satisfacción positiva,los factores obstaculizadores y los factores facilitadores hallados permitirán mejorar el diseño e implementación del programa.

INTRODUCTION: argentina has shown for several years an inequality among professionals in the various jurisdictions in access to research grants that the National Ministry of Health finances. Because of that a mentoring program, “Ideas Proyecto”, was implemented, which assists methodologically junior researchers in the formulation of projects to improve quality and reduce inequality in access to Salud Investiga health research grants. OBJECTIVES: To evaluate the effectiveness of the program to obtain a scholarship as well as the opinion and satisfaction of participants. METHODS: The effectiveness of the program was assessed using a Bayesian hierarchical model and the satisfaction through a self-administered survey. RESULTS: A total of 2 172 scholarship applications were recorded, of which 40 were tutored. Mentoring increased the chance of getting ascholarship. The comprehensibility of the information providedby the tutor and the overall assessment of the experience withtutoring were the items with the most positive assessment (97%), while the perception of improvement in labor positioning had the most negative assessment (24%). The most mentioned hindering and facilitating factors were dosage and role of tutor,respectively. CONCLUSIONS: The results show the effectiveness of mentoring for achieving the program objectives. Positive satisfaction, hindering factors and facilitating factors found will help improve the design and implementation of the program.

Smoke-free environments: age, sex, and educational disparity in 25 Argentinean cities.

BACKGROUND: There is scarce evidence of secondhand smoke (SHS) and disparity in developing countries. We evaluated the relationship between socio-demographic variables and secondhand smoke-related factors in Argentina. METHODS: We conducted a randomized telephone survey (2008/2009) in 25 Argentinean cities. We included a sample of 160 respondents per city stratified by sex and age. We used different generalized multivariate regression models with a confidence interval of 95 % for the five outcome variables. RESULTS: We sampled 4,000 respondents, 52.2 % women, 36 % adolescents and young adults (15-29 years), 58 % ≥12 years of education, and 72.6 % nonsmokers. Support to 100 % smoke-free environment legislation was higher in older than in younger respondents, OR = 1.5 (IC: 1.2-2.0), and in people with higher education levels, OR = 1.2 (IC: 1.1-1.4). Exposure to SHS was significantly lower in men than in women at home and in public places, IRR = 0.7 (IC: 0.5-0.9) and IRR  = 0.8 (IC: 0.6-0.9), respectively. Older respondents reported lower exposure at home and in public places than adolescents and young adults, IRR = 0.6 (IC: 0.4-0.8) and IRR = 0.4 (IC: 0.3-0.5), respectively. People with higher education levels had a higher level of exposure in indoor public places than less educated people, IRR = 1.1 (IC: 1.1-1.2). Knowledge of respiratory disease in children caused by SHS exposure was lower in men than in women, RRR = 0.3 (IC: 0.1-0.6). Perceived compliance was higher in men than in women, OR = 1.4 (IC: 1.1-1.8) and in people with higher education levels, OR = 1.2 (IC: 1.1-1.4). Older and more educated respondents were more empowered than. younger and less educated people, OR = 1.5 (IC: 1.2-1.9) and OR = 1.2 (IC: 1.1-1.3), respectively. Reference groups for each variable were age: 15-29; education: ≤7 years; and sex: men. CONCLUSIONS: This is the first study to explore socio-demographic variables regarding secondhand smoke in our country. Women and younger people are more vulnerable to SHS-related factors in Argentina.

Reversal of primary and pseudo-primary T wave abnormalities by ventricular pacing. A novel manifestation of cardiac memory.

AIMS: "Cardiac memory" refers to abnormal T waves (TW) appearing after transient periods of altered ventricular depolarization. The aim of the study was to test the hypothesis that in the presence of abnormal TW, short periods of tailored ventricular pacing (VP) can be followed by normalization of ventricular repolarization. METHODS: Ten patients with normal TW (control group) and 18 patients with abnormal TW (study group) underwent 15 min of VP at a cycle length of 500 ms. In the control group, VP was performed from the right ventricular apex, and in the study group from right or left ventricular sites that resulted in paced QRS complexes of opposite polarity to that of the abnormal TW. Before and after VP, atrial pacing was maintained at a stable cycle length. Simultaneous 12-lead electrocardiography (ECG) was recorded before, during, and following VP to assess changes in TW polarity, amplitude, electrical axis, QTc interval, and QTc interval dispersion. RESULTS: As expected, VP was followed by memory-induced changes in TW in eight of ten patients in the control group. Mean T wave axis shifted from +60 degrees + or - 21.2 degrees to +23.5 degrees + or - 50.7 degrees (p = 0.01) in the frontal plane. In the study group, complete or partial normalization of TW occurred in 17 of 18 patients. Mean T wave axis shifted from -23.7 degrees + or - 22.9 degrees to +19.7 degrees + or - 34.7 degrees (p < 0.0002) in the frontal plane when paced from right ventricular outflow tract. The QTc interval shortened after VP both in the control group (424 + or - 25 vs. 399 + or - 27 ms; p = 0.007) and in the study group (446 + or - 26 vs. 421 + or - 22 ms; p < 0.0002). No significant changes were found in QTc interval dispersion. CONCLUSIONS: Transient changes in the sequence of ventricular activation may either induce or normalize abnormal TW. The background of preceding ventricular depolarization needs to be taken into account before determining the clinical significance of a given pattern of ventricular repolarization.

Low urinary 6-sulfatoxymelatonin levels in patients with severe congestive heart failure.

OBJECTIVE: To assess urinary 6-sulfatoxymelatonin excretion in patients admitted to the hospital because of congestive heart failure (CHF). METHODS: Urinary 6-sulfatoxymelatonin was measured by a specific radioimmunoassay in 33 hospitalized patients with CHF and in 146 healthy ambulatory volunteers. Individuals with hepatic or renal failure were excluded from the sample. Data were analyzed by the Mann-Whitney test and regression analysis. RESULTS: 6-Sulfatoxymelatonin levels were significantly lower in CHF patients than controls (median 2.6 vs 6.02 microg, p < 0.0001). This decrease was observed regardless of beta-adrenergic blocker or benzodiazepine medication. A significant decrease in 6-sulfatoxymelatonin excretion occurred with age. There were no significant differences in urinary 6-sulfatoxymelatonin levels between chronic and acute CHF patients. CONCLUSIONS: The results suggest that circulating melatonin levels are low in patients with CHF. Such a decrease may precede aggravation of heart failure.