[Dynamics and epidemiological characterization of the dengue outbreak in Argentina 2016: the case of the Province of Buenos Aires]. / Dinámica y caracterización epidemiológica del brote de dengue en Argentina año 2016: el caso de la Provincia de Buenos Aires.

BACKGROUND: Dengue fever, widely distributed throughout the world, has reemerged in Argentina after more than 70 years of absence, with an endemic behaviour in the northern provinces of the country. During the year 2016 an epidemic spread to the Province of Buenos Aires was experienced. OBJECTIVE: To characterize the outbreak of dengue fever occurred in the Province of Buenos Aires, Argentina, during the period of beginning and expansion between January and May of the year 2016. METHODS: The National Health Surveillance system provided weekly data, also using ArcGis for spatial localization. Knox test was used to establish spatial-temporal coordinates and the epidemiological curve was designed calculating the diffusion coefficient. RESULTS: The relative risk and rates confirmed the epidemiological outbreak characterized by a rapid increase in propagation, with defined conglomerates. Towards week 17 the outbreak falls having the lowest diffusion values. DISCUSSION: The information evaluated through different systems of information and analysis allowed to identify weaknesses of the same ones as well as to visualize "hot spots" of circulation of the virus in order to determine actions aimed at concentrating the efforts of control of potential breeding grounds for immature mosquitoes in winter times.

Dinámica y caracterización epidemiológica del brote de dengue en Argentina año 2016: el caso de la Provincia de Buenos Aires / Dynamics and epidemiological characterization of the dengue outbreak in Argentina 2016: the case of the Province of Buenos Aires

Resumen Introducción: El dengue, de amplia distribución mundial, ha resurgido en Argentina tras más de 70 años de ausencia, con un comportamiento endémico en las provincias norteñas del país; durante el año 2016 se experimentó una diseminación epidémica a la Provincia de Buenos Aires. Objetivos: Caracterizar el brote de fiebre de dengue ocurrido en la Provincia de Buenos Aires, Argentina, durante el período de inicio y expansión del mismo entre enero y mayo del año 2016. Métodos: El Sistema Nacional de Vigilancia de la Salud proveyó los datos semanales, utilizándose, además, ArcGis para la localización espacial. Se empleó test de Knox para establecer relaciones de coordenadas temporo-espaciales y se diseñó la curva epidemiológica calculando el coeficiente de difusión. Resultados: El riesgo relativo y razones de tasas para casos confirmados y la razón infección fue caracterizada por un aumento rápido en su propagación, con conglomerados definidos acompañado de la modificación sostenida entre las razones de tasas de casos infectados provenientes de zonas endémicas y aquellos autóctonos. Hacia la semana 17, el brote cae teniendo los valores más bajos de difusión. Discusión: La información evaluada mediante diferentes sistemas de información y análisis permitió identificar debilidades de los mismos, así como visualizar "zonas calientes" de circulación del virus para determinar acciones tendientes a concentrar los esfuerzos de control de potenciales criaderos de estados inmaduros del mosquito en épocas invernales.

Background: Dengue fever, widely distributed throughout the world, has reemerged in Argentina after more than 70 years of absence, with an endemic behaviour in the northern provinces of the country. During the year 2016 an epidemic spread to the Province of Buenos Aires was experienced. Objective: To characterize the outbreak of dengue fever occurred in the Province of Buenos Aires, Argentina, during the period of beginning and expansion between January and May of the year 2016. Methods: The National Health Surveillance system provided weekly data, also using ArcGis for spatial localization. Knox test was used to establish spatial-temporal coordinates and the epidemiological curve was designed calculating the diffusion coefficient. Results: The relative risk and rates confirmed the epidemiological outbreak characterized by a rapid increase in propagation, with defined conglomerates. Towards week 17 the outbreak falls having the lowest diffusion values. Discussion: The information evaluated through different systems of information and analysis allowed to identify weaknesses of the same ones as well as to visualize "hot spots" of circulation of the virus in order to determine actions aimed at concentrating the efforts of control of potential breeding grounds for immature mosquitoes in winter times.

Chagas disease prevalence in pregnant women: migration and risk of congenital transmission.

INTRODUCTION: Argentina has been a preferential target for Bolivian immigrants for decades. The relatively recent migratory flux includes Germany, France, the United States, Australia, Japan, and some Latin American countries. The aim of this cross-sectional study was to describe the prevalence of Chagas disease in pregnant women, analyzing the Bolivian-specific Chagas prevalence as the main contributor of migratory populations from Chagas disease-endemic areas to Buenos Aires city, Argentina, and to evaluate the impact of these migrant influxes on the process of the "urbanization" of the disease in reference hospital José Maria Ramos Mejia (JMRM). METHODOLOGY: Overall, 21,332 pregnant women (100%) between 15 and 49 years of age derived from the public maternity service of JMRMH were studied. Serology data was obtained from registered serological diagnosis data, consisting of three different serological tests performed at the Public Parasitology Unit. RESULTS: Although general prevalence decreased during the analyzed period, the specific prevalence of pregnant women from Bolivian origin showed a sustained growth during 1983-2013. Solely 5% of the total pregnant women population from Bolivia contributed to one third of the total Chagas prevalence. CONCLUSIONS: This study showed that a cohort of pregnant women from Bolivia who attended JMRMH during the period 1983-2007 constituted a population at risk for congenital transmission. Increased migration from endemic areas of Bolivia might potentially increase the prevalence of Chagas disease among pregnant women. In addition, this study highlights the importance to analyze specific prevalence according to endemic areas to determine the profiles of potential hidden prevalence.

Assessment of child psychomotor development in population groups as a positive health indicator.

INTRODUCTION: It is necessary to use health indicators describing the conditions of all individuals in a population, not just of those who have a disease or die. OBJECTIVES: To introduce a method to collect population indicators of psychomotor development in children younger than 6 years old and show its results. POPULATION AND METHODS: Data were obtained from a cross-sectional assessment regarding compliance with 13 developmental milestones (selected from the national reference) conducted in 5465 children using five surveys administered by the Matanza-Riachuelo River Basin Authority in areas of this basin where a high proportion of families with unmet basic needs live. For each survey, a logistic regression analysis was used to estimate the median age at attainment of the 13 developmental milestones. A linear regression model between the estimated age at attainment of the 13 milestones was adjusted for each survey based on the corresponding age at attainment of the national reference. Based on this model, three indicators were defined: overall developmental quotient, developmental quotient at 4 years old, and developmental trend. RESULTS: Results from the five surveys ranged between 0.74 and 0.85, 0.88 and 0.81, and -0.15 and -0.26 for the overall developmental quotient, developmental quotient at 4 years old, and developmental trend, respectively. A distinct developmental delay and an increasing trend in delay with age were observed. CONCLUSIONS: Indicators are easily interpreted and related to social indicators (unmet basic needs, etc.). Collecting the information necessary to make estimations takes little time and can be applied to population groups, but not on an individual level.

INTRODUCCIÓN: Resulta necesario utilizar indicadores de salud que expresen las condiciones de todos los individuos de una población y no solo de aquellos enfermos o que mueren. OBJETIVOS: Presentar un método para obtener indicadores poblacionales de desarrollo psicomotor en niños menores de seis años y mostrar sus resultados. POBLACIÓN Y MÉTODOS: Los datos provienen de la evaluación transversal del cumplimiento de 13 ítems de desarrollo (seleccionados de la referencia nacional) de 5465 niños en cinco encuestas realizadas por la Autoridad de Cuenca Matanza Riachuelo en dicha cuenca en áreas con alta proporción de familias con necesidades básicas insatisfechas. Para cada encuesta, se estimó, por regresión logística, la edad mediana de cumplimiento de los 13 ítems de desarrollo. Se ajustó un modelo de regresión lineal entre la edad de cumplimiento estimada de los 13 ítems de cada encuesta en función de las correspondientes edades de la referencia nacional. A partir de este modelo, se definieron tres indicadores: el cociente global de desarrollo, el cociente a los 4 años y la tendencia del desarrollo. RESULTADOS: Los resultados para las cinco encuestas variaron entre 0,74 y 0,85; 0,88 y 0,81 y -0,15 y -0,26 para el cociente global de desarrollo, cociente global a los 4 años y la tendencia del desarrollo, respectivamente. Se expresó un marcado retraso en el desarrollo y una tendencia progresiva del retraso con la edad. CONCLUSIONES: Los indicadores sondeinterpretación sencilla y se relacionan con indicadores sociales (necesidades básicas insatisfechas, etc.). La obtención de la informaciónnecesaria para realizar los cálculos toma poco tiempo y es aplicable a grupos de población, pero no a individuos.

Evaluación del desarrollo psicomotor del niño en grupos de población como indicador positivo de salud / Assessment of child psychomotor development in population groups as a positive health indicator

Introducción. Resulta necesario utilizar indicadores de salud que expresen las condiciones de todos los individuos de una población y no solo de aquellos enfermos o que mueren. Objetivos. Presentar un método para obtener indicadores poblacionales de desarrollo psicomotor en niños menores de seis años y mostrar sus resultados. Población y métodos. Los datos provienen de la evaluación transversal del cumplimiento de 13 ítems de desarrollo (seleccionados de la referencia nacional) de 5465 niños en cinco encuestas realizadas por la Autoridad de Cuenca Matanza Riachuelo en dicha cuenca en áreas con alta proporción de familias con necesidades básicas insatisfechas. Para cada encuesta, se estimó, por regresión logística, la edad mediana de cumplimiento de los 13 ítems de desarrollo. Se ajustó un modelo de regresión lineal entre la edad de cumplimiento estimada de los 13 ítems de cada encuesta en función de las correspondientes edades de la referencia nacional. A partir de este modelo, se definieron tres indicadores: el cociente global de desarrollo, el cociente a los 4 años y la tendencia del desarrollo. Resultados. Los resultados para las cinco encuestas variaron entre 0,74 y 0,85; 0,88 y 0,81 y -0,15 y -0,26 para el cociente global de desarrollo, cociente global a los 4 años y la tendencia del desarrollo, respectivamente. Se expresó un marcado retraso en el desarrollo y una tendencia progresiva del retraso con la edad. Conclusiones. Los indicadores sondeinterpretación sencilla y se relacionan con indicadores sociales (necesidades básicas insatisfechas, etc.). La obtención de la informaciónnecesaria para realizar los cálculos toma poco tiempo y es aplicable a grupos de población, pero no a individuos.

Introduction. It is necessary to use health indicators describing the conditions of all individuals in a population, not just of those who have a disease or die. Objectives. To introduce a method to collect population indicators of psychomotor development in children younger than 6 years old and show its results. Population and methods. Data were obtained from a cross-sectional assessment regarding compliance with 13 developmental milestones (selected from the national reference) conducted in5465 children using five surveys administered by the Matanza-Riachuelo River Basin Authority in areas of this basin where a high proportion of families with unmet basic needs live. For each survey, a logistic regression analysis was used to estimate the median age at attainment of the 13 developmental milestones. A linear regression model between the estimated age at attainment of the 13 milestones was adjusted for each survey based on the corresponding age at attainment of the national reference. Based on this model, three indicators were defined: overall developmental quotient, developmental quotient at 4 years old, and developmental trend. Results. Results from the five surveys ranged between 0.74 and 0.85, 0.88 and 0.81, and -0.15 and -0.26 for the overall developmental quotient, developmental quotient at 4 years old, and developmental trend, respectively. A distinct developmental delay and an increasing trend in delay with age were observed. Conclusions. Indicators are easily interpreted and related to social indicators (unmet basic needs, etc.). Collecting the information necessary to make estimations takes little time and can be applied to population groups, but not on an individual level.

Participación social en la prevención del dengue, zika y chikungunya: adaptación de la guía para el promotor

A fines del año 2015 y principios de 2016, la Argentina presenta una nueva epidemia de dengue, pero en esta oportunidad, con ciertas particularidades que la distinguen de situaciones epidémicas previas. La principal diferencia, que torna a la epidemia un fenómeno aún más grave y genera profunda preocupación en autoridades sanitarias, se debe a la coexistencia del dengue, con dos enfermedades virales, antes inexistentes en América Latina y el Caribe: el Zika y el Chikungunya. Ambas constituyen enfermedades virales transmitidas por el mismo vector que el dengue, el mosquito Aedes Aegypti; sin embargo, su potencial epidémico es muy alto, precisamente por tratarse de enfermedades emergentes en la Región, con una gran cantidad de población susceptible, nunca antes expuesta a este tipo de virus. Además, en el caso del Zika, la preocupación es aún mayor, dada la potencial asociación que tendría la infección por este virus en embarazadas, con la presencia de cierto tipo de malformaciones congénitas, particularmente la microcefalia. La figura del promotor comunitario cobra una singular importancia como agente catalizador de los cambios y la transformación social necesaria para la modificación de prácticas y hábitos de la comunidad: los promotores trabajan “con y para” la comunidad, buscando identificar sus principales problemas, necesidades y demandas pero también estimulando un mayor compromiso, involucramiento y participación de la propia comunidad en la solución a estos problemas. La presente guía busca fortalecer la participación de estos agentes en la actual epidemia de dengue, Zika y Chikungunya. Constituye una revisión y adaptación de una guía previa, elaborada y difundida por UNICEF, en conjunto con otras organizaciones gubernamentales y no gubernamentales, y que fue resultado de un intenso trabajo en equipo, interdisciplinario, intersectorial e interagencial...

A population-based study of cognitive impairment in socially vulnerable adults in Argentina. The Matanza Riachuelo Study: preliminary results / Estudo de comprometimento cognitivo de base populacional em adultos socialmente vulneráveis. estudo Matanza Riachuelo

Population aging has taken place intensively worldwide, even in developing countries. These countries have population groups with low resources and basic unmet needs that are frequently omitted from epidemiological studies. Objective: The purpose of this study was to determine the prevalence of cognitive impairment (CI) and dementia in aneconomic and socially vulnerable population from Argentina. Methods: A door-to-door observational population-based survey among adults over 60 years of cognitive impairment and dementia in the social vulnerable area of the Matanza Riachuelo Basin, in the suburban area of Buenos Aires, Argentina was conducted. Trained psychologists interviewed subjects and a proxy informant. A standardized protocol including a socio-demographic questionnaire, the Mini-Mental State Examination, the Geriatric Depression Scale and a functional inventory for IADL and ADL was administered. Diagnoses were divided into three general categories: normal cognitive function, cognitive impairment-no dementia (CIND) and dementia. Results and Conclusions: A total of 2437 elderly persons were assessed, of which 73.6% fulfilled inclusion criteria. The prevalence of CI among those over 60 was 26.4% (18.1% CIND and 8.3% dementia) with higher prevalence of dementia in younger individuals than rates reported in developed counties, probably due to low control of vascular risk factors. This information can help inform health public decisions in the generation of programs and plans for the prevention, diagnosis and treatment of cognitive impairment in this type of socially vulnerable population.

O envelhecimento da população idosa tem aumentado mundialmente, mesmo em países em desenvolvimento. Estes países têm grupos populacionais de poucos recursos, com necessidades básicas não satisfatórias, frequentemente omitidas nos estudos epidemiológicos. Objetivo: O propósito deste estudo foi determinar a prevalência de comprometimento cognitivo (CC) e demência em uma população socioeconomicamente vulnerável na Argentina. Métodos: Foi realizada pesquisa observacional de base populacional porta-a-porta entre adultos acima de 60 anos numa área de vulnerabilidade social em Matanza Riachuelo, no subúrbio de Buenos Aires, Argentina. Psicólogos treinados entrevistaram o sujeito e um acompanhante. Um protocolo estandardizado que incluiu um questionário sociodemográfico, o MEEM, a escala de depressão geriátrica e um inventário funcional para ABVD e AIVD foram administrados. Os diagnósticos foram divididos em três categorias: função cognitiva normal, comprometimento cognitivo sem demência (CCSD) e demência. Resultados: Foram avaliados um total de 2437 de idosos, dos quais 73,6% preencheram os critérios de inclusão. A prevalência de CC entre aqueles acima de 60 anos foi de 26,4% (18,1% CCSD e 8,3% de demência) com maiores prevalência de demência em indivíduos mais jovens do que os reportados em países desenvolvidos, provavelmente devido a controle inadequado dos fatores de risco vasculares. Conclusão: Esta informação pode contribuir para tomada de decisões em saúde pública para geração de programas e planos que apontem para a prevenção, diagnóstico e tratamento de CC neste tipo de população em vulnerabilidade social.

Desarrollo psicomotor infantil en la Cuenca Matanza-Riachuelo: pesquisa de problemas inaparentes del desarrollo / ChildÆs Psychomotor Development at Matanza-Riachuelo Basin: screening for Non-Apparent

INTRODUCCION: El desarrollo psicomotor del niño tiene que ver con la expresión de sus potencialidades, su integración social y su desempeño en la vida. La oportuna detección de problemas mediante tamizaje permite realizar intervenciones eficaces y costo-efectivas. La Dirección General de SaludAmbiental (DGSA) de la Autoridad Cuenca Matanza-Riachuelo (ACUMAR) realiza encuestas en población vulnerable. OBJETIVO: Detectar problemas de nutrición y desarrollo psicomotor en niños menores de seis años, realizar un análisis toxicológico yuna investigación cualitativa sobre crianza y percepción de problemasambientales, y efectuar una georreferenciación. METODOS:Se recurrió a la Prueba Nacional de Pesquisa (PRUNAPE) y al Cuestionario PRUNAPE Pre-Pesquisa (CPPP) a cargo de la DGSA. Se realizaron nueve encuestas en las jurisdicciones dela Cuenca û14 municipios del conurbano y parte de la Ciudad Autónoma de Buenos Aires (aproximadamente 5 millones de habitantes)û en más de 7.000 niños. RESULTADOS: El estudioreveló: alta proporción de riesgo de problemas de desarrollo, mayor prevalencia en varones, aumento desde el nacimiento hasta los cuatro años y disminución a los cinco. Los principalesdeterminantes fueron: nivel de pobreza/indigencia, nivel educativoparental y bajo peso al nacer. CONCLUSIONES: La instalaciónde esta problemática en la agenda de la DGSA implica un progreso en el enfoque de la salud pública y permite actuarsobre los determinantes para promover el desarrollo infantil.

INTRODUCTION: Childpsychomotor development is related to the expression of potentialities, to social integration andto performance in life. Early detection of problems with screening techniques ensures appropriate and cost-effective interventions. The General Direction of Environmental Health (DGSA) fromMatanza-Riachuelo Basin Authority (ACUMAR) performs surveys on vulnerable population in that highly polluted area. OBJECTIVE: To detect problems of nutrition and psychomotor development in children under six years of age, to perform a toxicological analysis and a qualitative research on rearing practices and environmentalrisk perception, and to make a georeferenced image. METHODS:The DGSA used the National Screening Test (PRUNAPE) and the PRUNAPE Pre-Screening Questionnaire (CPPP). Nine surveys were carried out in more than 7000 children living in the jurisdictionsof the Basin: 14 municipalities of the Buenos Aires metropolitan area and part of the Autonomous City of Buenos Aires (with over 5 million inhabitants). RESULTS: The study showed a high rateof risk of developmental problems, a higher prevalence in boys than in girls, a growing prevalence from birth up to four years and a decrease at five. The main determinants were poverty and indigence levels, parental educational level and low birth weight. CONCLUSIONS: The inclusion of this issue in the DGSA agenda means a significant progress in the public health approach and allows the tackling of major determinants to improve thedevelopment of children.

A population-based study of cognitive impairment in socially vulnerable adults in Argentina. The Matanza Riachuelo study preliminary results.

Population aging has taken place intensively worldwide, even in developing countries. These countries have population groups with low resources and basic unmet needs that are frequently omitted from epidemiological studies. OBJECTIVE: The purpose of this study was to determine the prevalence of cognitive impairment (CI) and dementia in an economic and socially vulnerable population from Argentina. METHODS: A door-to-door observational population-based survey among adults over 60 years of cognitive impairment and dementia in the social vulnerable area of the Matanza Riachuelo Basin, in the suburban area of Buenos Aires, Argentina was conducted. Trained psychologists interviewed subjects and a proxy informant. A standardized protocol including a socio-demographic questionnaire, the Mini-Mental State Examination, the Geriatric Depression Scale and a functional inventory for IADL and ADL was administered. Diagnoses were divided into three general categories: normal cognitive function, cognitive impairment-no dementia (CIND) and dementia. RESULTS AND CONCLUSIONS: A total of 2437 elderly persons were assessed, of which 73.6% fulfilled inclusion criteria. The prevalence of CI among those over 60 was 26.4% (18.1% CIND and 8.3% dementia) with higher prevalence of dementia in younger individuals than rates reported in developed counties, probably due to low control of vascular risk factors. This information can help inform health public decisions in the generation of programs and plans for the prevention, diagnosis and treatment of cognitive impairment in this type of socially vulnerable population.

O envelhecimento da população idosa tem aumentado mundialmente, mesmo em países em desenvolvimento. Estes países têm grupos populacionais de poucos recursos, com necessidades básicas não satisfatórias, frequentemente omitidas nos estudos epidemiológicos. OBJETIVO: O propósito deste estudo foi determinar a prevalência de comprometimento cognitivo (CC) e demência em uma população socioeconomicamente vulnerável na Argentina. MÉTODOS: Foi realizada pesquisa observacional de base populacional porta-a-porta entre adultos acima de 60 anos numa área de vulnerabilidade social em Matanza Riachuelo, no subúrbio de Buenos Aires, Argentina. Psicólogos treinados entrevistaram o sujeito e um acompanhante. Um protocolo estandardizado que incluiu um questionário sociodemográfico, o MEEM, a escala de depressão geriátrica e um inventário funcional para ABVD e AIVD foram administrados. Os diagnósticos foram divididos em três categorias: função cognitiva normal, comprometimento cognitivo sem demência (CCSD) e demência. RESULTADOS: Foram avaliados um total de 2437 de idosos, dos quais 73,6% preencheram os critérios de inclusão. A prevalência de CC entre aqueles acima de 60 anos foi de 26,4% (18,1% CCSD e 8,3% de demência) com maiores prevalência de demência em indivíduos mais jovens do que os reportados em países desenvolvidos, provavelmente devido a controle inadequado dos fatores de risco vasculares. CONCLUSÃO: Esta informação pode contribuir para tomada de decisões em saúde pública para geração de programas e planos que apontem para a prevenção, diagnóstico e tratamento de CC neste tipo de população em vulnerabilidade social.

Validación de un formulario para la detección de niños con alto riesgo de padecer trastornos del desarrollo: Cuestionario PRUNAPE pre-pesquisa / Validation of a questionnaire for the detection of children at risk of developmental disorders: The PRUNAPE Pre-screening Test

Introducción. La administración de la Prueba Nacional de Pesquisa (PRUNAPE), herramienta efcaz para la detección de trastornos inaparentes del desarrollo en menores de 6 años, requiere capacitación, tiempo, espacio y mobiliario adecuados. Para facilitar esta pesquisa en grandes grupos de población, podría ser útil un cuestionario sencillo a fn de identifcar a los niños en riesgo. Objetivo. Evaluar la validez del cuestionario PRUNAPE pre-pesquisa (CPPP) para identifcar a los niños en riesgo de no pasar la prueba. Métodos. Se transformaron en preguntas 57 pautas PRUNAPE, organizadas en cinco formularios (uno para cada grupo etario entre 6 y 71 meses) con dibujos ilustrativos. El trabajo se realizó en Florencio Varela y en Promoción de la Salud del Hospital de Niños Ricardo Gutiérrez de la Ciudad Autónoma de Buenos Aires. En una muestra de 533 niños sanos con sus madres, de bajo nivel socioeconómico, el CPPP fue sucesivamente: a) autoadministrado por cada madre (CPPP-A), b) por personal de salud (CPPP-PS), y fnalmente, c) se administró la PRUNAPE a cada niño por profesionales capacitados. Cada paso fue realizado por un profesional diferente en forma de triple ciego. En la elección del punto de corte se priorizó el valor predictivo positivo (VPP) para lograr el menor número posible de falsos positivos. Resultados. Para el CPPP-A y el CPPP-PS, los resultados globales fueron respectivamente: coeficiente kappa de Cohen: 0,23 y 0,28; sensibilidad: 0,41 y 0,42; especifcidad: 0,81 y 0,85; valor predictivo negativo 0,57 y 0,59, y VPP 0,71 y 0,76. Conclusiones. El CPPP resulta una herramienta válida para identifcar a los niños que más necesitan que se les administre la PRUNAPE.(AU)

Introduction.The administration of the National Screening Test (PruebaNacional de Pesquisa, PRUNAPE), a tool which is effective to screen inapparent developmental disorders in children under 6 years old, requires adequate training, time, space and furniture. A simple questionnaire to help screen large population groups could be useful to identify children at risk. Objective.To evaluate the validity of the PRUNAPE pre-screening questionnaire (cuestionario PRUNAPE pre-pesquisa, CPPP) to identify children at risk of not passing the test. Methods.Fifty seven PRUNAPE milestones were transformed into questions; they were organized in fve questionnaires (one for each age group between 6 and 71 months old) with illustrative pictures. The study was performed in Florencio Varela and in the Health Promotion Unit of Hospital de Niños "Ricardo Gutiérrez" in the Autonomous City of Buenos Aires. In a sample of 533 healthy children and their mothers, of a low socio-economic level, the CPPP was consecutively: a) self-administered by each mother (CPPP-SA), b) by healthcare personnel (CPPP-HP), and fnally, c) the PRUNAPE test was administered to each child by qualifed professionals. Each step was performed by a different professional in a triple-blind fashion. When choosing the cutoff point, the positive predictive value (PPV) was prioritized to reach the least possible number of false positives. Results.For the CPPP-SA and the CPPP-HP, the overall results were, respectively: Cohens kappa coeffcient: 0.23 and 0.28; sensitivity: 0.41 and 0.42; specifcity: 0.81 and 0.85; negative predictive value 0.57 and 0.59; and PPV 0.71 and 0.76. Conclusions.The CPPP is a valid tool to identify children who most require the PRUNAPE to be administered.(AU)

Validación de un formulario para la detección de niños con alto riesgo de padecer trastornos del desarrollo: Cuestionario PRUNAPE pre-pesquisa / Validation of a questionnaire for the detection of children at risk of developmental disorders: The PRUNAPE Pre-screening Test

Introducción. La administración de la Prueba Nacional de Pesquisa (PRUNAPE), herramienta efcaz para la detección de trastornos inaparentes del desarrollo en menores de 6 años, requiere capacitación, tiempo, espacio y mobiliario adecuados. Para facilitar esta pesquisa en grandes grupos de población, podría ser útil un cuestionario sencillo a fn de identifcar a los niños en riesgo. Objetivo. Evaluar la validez del cuestionario PRUNAPE pre-pesquisa (CPPP) para identifcar a los niños en riesgo de no pasar la prueba. Métodos. Se transformaron en preguntas 57 pautas PRUNAPE, organizadas en cinco formularios (uno para cada grupo etario entre 6 y 71 meses) con dibujos ilustrativos. El trabajo se realizó en Florencio Varela y en Promoción de la Salud del Hospital de Niños Ricardo Gutiérrez de la Ciudad Autónoma de Buenos Aires. En una muestra de 533 niños sanos con sus madres, de bajo nivel socioeconómico, el CPPP fue sucesivamente: a) autoadministrado por cada madre (CPPP-A), b) por personal de salud (CPPP-PS), y fnalmente, c) se administró la PRUNAPE a cada niño por profesionales capacitados. Cada paso fue realizado por un profesional diferente en forma de triple ciego. En la elección del punto de corte se priorizó el valor predictivo positivo (VPP) para lograr el menor número posible de falsos positivos. Resultados. Para el CPPP-A y el CPPP-PS, los resultados globales fueron respectivamente: coeficiente kappa de Cohen: 0,23 y 0,28; sensibilidad: 0,41 y 0,42; especifcidad: 0,81 y 0,85; valor predictivo negativo 0,57 y 0,59, y VPP 0,71 y 0,76. Conclusiones. El CPPP resulta una herramienta válida para identifcar a los niños que más necesitan que se les administre la PRUNAPE.

Introduction.The administration of the National Screening Test (PruebaNacional de Pesquisa, PRUNAPE), a tool which is effective to screen inapparent developmental disorders in children under 6 years old, requires adequate training, time, space and furniture. A simple questionnaire to help screen large population groups could be useful to identify children at risk. Objective.To evaluate the validity of the PRUNAPE pre-screening questionnaire (cuestionario PRUNAPE pre-pesquisa, CPPP) to identify children at risk of not passing the test. Methods.Fifty seven PRUNAPE milestones were transformed into questions; they were organized in fve questionnaires (one for each age group between 6 and 71 months old) with illustrative pictures. The study was performed in Florencio Varela and in the Health Promotion Unit of Hospital de Niños "Ricardo Gutiérrez" in the Autonomous City of Buenos Aires. In a sample of 533 healthy children and their mothers, of a low socio-economic level, the CPPP was consecutively: a) self-administered by each mother (CPPP-SA), b) by healthcare personnel (CPPP-HP), and fnally, c) the PRUNAPE test was administered to each child by qualifed professionals. Each step was performed by a different professional in a triple-blind fashion. When choosing the cutoff point, the positive predictive value (PPV) was prioritized to reach the least possible number of false positives. Results.For the CPPP-SA and the CPPP-HP, the overall results were, respectively: Cohen's kappa coeffcient: 0.23 and 0.28; sensitivity: 0.41 and 0.42; specifcity: 0.81 and 0.85; negative predictive value 0.57 and 0.59; and PPV 0.71 and 0.76. Conclusions.The CPPP is a valid tool to identify children who most require the PRUNAPE to be administered.

Validation of a questionnaire for the detection of children at risk of developmental disorders: the PRUNAPE Pre-screening Test.

INTRODUCTION: The administration of the National Screening Test (PruebaNacional de Pesquisa, PRUNAPE), a tool which is effective to screen inapparent developmental disorders in children under 6 years old, requires adequate training, time, space and furniture. A simple questionnaire to help screen large population groups could be useful to identify children at risk. OBJECTIVE: To evaluate the validity of the PRUNAPE pre-screening questionnaire (cuestionario PRUNAPE pre-pesquisa, CPPP) to identify children at risk of not passing the test. METHODS: Fifty seven PRUNAPE milestones were transformed into questions; they were organized in fve questionnaires (one for each age group between 6 and 71 months old) with illustrative pictures. The study was performed in Florencio Varela and in the Health Promotion Unit of Hospital de Niños "Ricardo Gutiérrez" in the Autonomous City of Buenos Aires. In a sample of 533 healthy children and their mothers, of a low socio-economic level, the CPPP was consecutively: a) self-administered by each mother (CPPP-SA), b) by healthcare personnel (CPPP-HP), and fnally, c) the PRUNAPE test was administered to each child by qualifed professionals. Each step was performed by a different professional in a triple-blind fashion. When choosing the cutoff point, the positive predictive value (PPV) was prioritized to reach the least possible number of false positives. RESULTS: For the CPPP-SA and the CPPP-HP, the overall results were, respectively: Cohen's kappa coeffcient: 0.23 and 0.28; sensitivity: 0.41 and 0.42; specifcity: 0.81 and 0.85; negative predictive value 0.57 and 0.59; and PPV 0.71 and 0.76. CONCLUSIONS: The CPPP is a valid tool to identify children who most require the PRUNAPE to be administered.

Validation of a questionnaire for the detection of children at risk of developmental disorders: the PRUNAPE Pre-screening Test. / Validation of a questionnaire for the detection of children at risk of developmental disorders: the PRUNAPE Pre-screening Test.

INTRODUCTION: The administration of the National Screening Test (PruebaNacional de Pesquisa, PRUNAPE), a tool which is effective to screen inapparent developmental disorders in children under 6 years old, requires adequate training, time, space and furniture. A simple questionnaire to help screen large population groups could be useful to identify children at risk. OBJECTIVE: To evaluate the validity of the PRUNAPE pre-screening questionnaire (cuestionario PRUNAPE pre-pesquisa, CPPP) to identify children at risk of not passing the test. METHODS: Fifty seven PRUNAPE milestones were transformed into questions; they were organized in fve questionnaires (one for each age group between 6 and 71 months old) with illustrative pictures. The study was performed in Florencio Varela and in the Health Promotion Unit of Hospital de Niños "Ricardo Gutiérrez" in the Autonomous City of Buenos Aires. In a sample of 533 healthy children and their mothers, of a low socio-economic level, the CPPP was consecutively: a) self-administered by each mother (CPPP-SA), b) by healthcare personnel (CPPP-HP), and fnally, c) the PRUNAPE test was administered to each child by qualifed professionals. Each step was performed by a different professional in a triple-blind fashion. When choosing the cutoff point, the positive predictive value (PPV) was prioritized to reach the least possible number of false positives. RESULTS: For the CPPP-SA and the CPPP-HP, the overall results were, respectively: Cohens kappa coeffcient: 0.23 and 0.28; sensitivity: 0.41 and 0.42; specifcity: 0.81 and 0.85; negative predictive value 0.57 and 0.59; and PPV 0.71 and 0.76. CONCLUSIONS: The CPPP is a valid tool to identify children who most require the PRUNAPE to be administered.

El sistema nacional de investigación para la salud: ¿Debe ser responsabilidad del Estado? / The national system of health research: Should be the responsibility of the state?

Durante la celebración en Cuba del Foro Mundial para la Investigación en Salud 2009, el tema de la gobernanza y la rectoría se destacó como uno de los ejes del Sistema Nacional de Investigación para la Salud. Hubo coincidencia en que ambos aspectos son responsabilidades inherentes a la función del Estado, ubicando a la investigación para la salud como una actividad estratégica.

Hacia un Sistema Nacional de Investigación para la Salud / Towards a national system for health research

El Ministerio de Salud de Argentina se encamina a la conformación de un Sistema Nacional de Investigación para la Salud que promueva, oriente, desarrolle y coordine una investigación al servicio de la salud de la población. Parte de esa estrategia son las Becas Carrillo û Oñativia y la publicaciónde esta revista de salud pública para la difusión del conocimiento científico.