Implementation of cancer prevention practices in primary care: results of a cohort study in Chile 2018-2022.

OBJECTIVES: The burden of cancer is increasing rapidly in Latin America. Primary care has an essential role in cancer prevention, but implementation levels of prevention practices are not well known. This study evaluated implementation levels and associated factors of cancer preventive practices in primary care over time. STUDY DESIGN: The study incorporated a retrospective multicentre cohort study. METHODS: A population of 59,949 patients registered at three primary care clinics was followed from January 2018 to December 2022 in Santiago, Chile. We studied human papillomavirus (HPV) and hepatitis B virus (HBV) immunisation, brief counselling for smoking cessation and alcohol consumption, and cervical and breast cancer screening practices. Standardised electronic medical records were utilised as the source of information. Social, clinical, and organisational factors associated with prevention practices were studied. RESULTS: The cohort attrition level was 17.1%. Most of the population was of a low socioeconomic status, and 70% visited a primary health centre yearly. Implementation rates of immunisation practices were 90.84% for HPV and 80.94% for HBV in 2022. In contrast, brief counselling for smoking and alcohol consumption was below 20% during the study period. Cervical cancer screening decreased by 25.58% between 2018 and 2022, whereas breast cancer screening reached only 41.71% of the target population. Opportunistic medical visits were strongly associated with brief counselling and breast cancer screening. CONCLUSION: Implementation practices for cancer prevention in a Chilean primary care cohort are high for immunisation and very low for brief counselling and screening practices. A comprehensive non-medical-based model is needed to improve cancer prevention in primary care.

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.

Efectividad de la técnica manual de cirugía de catarata con incisión pequeña en un establecimiento privado de salud / Effectiveness of the manual technique of cataract surgery with small incision in a private health facility

Resumen Objetivo: Determinar la efectividad de la técnica manual de cirugía de catarata con incisión pequeña (MSICS) considerando agudeza visual, astigmatismo postoperatorio, complicaciones perioperatorias y mejora de la calidad de vida de los pacientes en función de la visión. Material y métodos: Estudio observacional, descriptivo, de corte transversal de pacientes operados de catarata con MSICS, entre el 2 de noviembre del 2009 y 30 de abril del 2010 en un centro oftalmológico privado de Lima. Se registraron las características demográficas y socioeconómicas, agudeza visual (AV), complicaciones perioperatorias, astigmatismo pre y postoperatorio y calidad de vida en función de la visión (CVFV). Resultados: Se realizaron 806 cirugías en 591 pacientes. La media de edad fue 75 años, 304 (51,49%) casos fueron del sexo femenino y 501 (84,74%) procedentes de Lima Metropolitana. Al alta, la AV sin corrección fue de 20/40 o mejor en 481 casos (59,64%), con astigmatismo quirúrgicamente inducido menor de 2,00 D en 732 (90,80%). En 64 (7,94%) casos ocurrieron complicaciones intraoperatorias y en 52 (6,45%), postoperatorias. La percepción de la CVFV del paciente en función de la visión a los 30 días fue: "Buena" en 311 (41,25%), "Muy Buena" en 405 (53,71%) con diferencia significativa (p<0.05) en relación a la evaluación preoperatoria. Conclusiones : El MSICS es una técnica quirúrgica altamente efectiva considerando una buena agudeza visual y bajo astigmatismo inducido postoperatorios, bajo porcentaje de complicaciones y significativa mejora de la CVFV del paciente.

Objective: To determine the effectiveness of the manual technique of cataract surgery with small incision (MSICS) considering visual acuity, postoperative astigmatism, perioperative complications and improvement of the quality of life of patients based on vision. Methods: Observational, descriptive, cross-sectional study in patients operated on cataract with MSICS, between November 2, 2009 and April 30, 2010 in a private ophthalmological center in Lima. Demographic and socioeconomic characteristics, visual acuity (VA), perioperative complications, pre and postoperative astigmatism and quality of life based on vision (CVFV) are included. Results: 806 surgeries were performed in 591 patients. The mean age was 75 years, 304 cases (51.49%) were female and 501 (84.74%) from Metropolitan Lima. The VA without correction at discharge was 20/40 or better in 481 (59.64%) cases, with surgically induced astigmatism less than 2.00 D in 732 (90.80%). Intraoperative complications occurred in 64 cases (7.94%) and postoperative complications in 52 (6.45%). The patient's CVFV perception based on vision at 30 days was "Good" in 311 (41.25%), "Very Good" in 405 (53.71%) with significant difference (p <0.05) in relation to the preoperative evaluation. Conclusions: The MSICS is a highly effective surgical technique considering good visual acuity and low postoperative induced astigmatism, low percentage of complications and significant improvement of the patient's CVFV.

Together for Health: An Initiative to Access Health Services for the Hispanic/Mexican Population Living in the United States.

A disproportionately small percentage of the Hispanic/Mexican population in the United States has adequate access to health services, which decreases quality of life at both the individual and community levels. In addition, it increases risk for preventable diseases through insufficient screening and management. The Mexican Section of the U.S./Mexico Border Health Commission, in efforts to address barriers to accessing preventive health care services for vulnerable populations, launched the initiative Juntos por la Salud (JPLS) that offers health promotion and disease prevention services to Hispanics living in and around 11 U.S. metropolitan cities via mobile health units. This paper presents a descriptive analysis of the JPLS initiative and potential positive impact it has had in reducing barriers faced by the Hispanic population. JPLS screens and provides referrals to primary care services to establish a medical home and has the potential to reduce health care costs in a high-risk population through education and timely health screenings.

Evaluation of the Effectiveness of the Fun FRIENDS Program / Avaliação da Eficácia do Programa Amigos Divertidos (fun FRIENDS) / Evaluación de la Eficacia del Programa Amigos Divertidos (fun FRIENDS)

Abstract Anxiety and depression are the main complaints related to mental health in childhood and constitute a public health problem. In Brazil, there are few studies that describe evidence-based early intervention actions for these psychopathologies. Considering the problems related to anxiety and depression in childhood and their relative stability in development, health promotion and prevention actions are justified. One of the evidence-based programs directed toward health promotion and prevention of anxiety and depression in childhood is the FRIENDS Program (Fun FRIENDS). Therefore, this study sought to evaluate the effectiveness of the FRIENDS program regarding the reduction in symptoms of anxiety and depression and increase in socioemotional skills, in a city of Paraná state. A total of 25 children, aged from 5 to 7, and their caregivers participated. The CBCL (Child Behavior Checklist), SDQ (Strengths and Difficulties Questionnaire) and SCAS (Spence Children's Anesthesia Scale) were used as the evaluation instruments. The results demonstrated increases in socioemotional skills and reductions in anxiety and depression symptoms. Thus, it was concluded that there is evidence that supports the effectiveness of the program for the Brazilian population.

Resumo A ansiedade e a depressão são as maiores queixas encontradas em relação à saúde mental na infância, sendo um problema de saúde pública. No Brasil, poucos são os estudos que descrevem ações, baseadas em evidência, para intervenções precoces quanto a essas psicopatologias. Frente as problemáticas relacionadas à ansiedade e depressão na infância, e sua relativa estabilidade no desenvolvimento, justificam-se as ações de promoção e prevenção de saúde. Um dos programas, baseados em evidências, que visam a promoção de saúde e prevenção de ansiedade e depressão na infância é o Método FRIENDS (Amigos Divertidos/Fun FRIENDS). Nesse contexto, esta pesquisa buscou avaliar a eficácia do programa Amigos Divertidos quanto a diminuição de sintomas de ansiedade e depressão e aumento de habilidades socioemocionais, em uma cidade do interior do Paraná. Participaram 25 crianças, com idade entre cinco a sete anos, e seus cuidadores. Como instrumentos de avaliação, utilizou-se os instrumentos CBCL (Child Behavior Check List), SDQ (Strengths and Difficulties Questionnaire) e SCAS (Spence Children's Anxiety Scale). Os resultados demonstraram aumentos das habilidades socioemocionais e redução de sintomas de ansiedade e depressão. Com isso, conclui-se que há evidências que apoiam a eficácia do programa para a população brasileira.

Resumen La ansiedad y la depresión son las mayores quejas en relación en relación a la salud mental en la infancia, sendo uno problema de la salud pública. En Brasil, pocos son los estudios que describen acciones basados en evidencia, para intervenciones temprano cuanto a esas psicopatologias. Frente a las problemáticas relacionadas a la ansiedad y depresión en la infancia, y su relativa estabilidad en el desenvolvimiento, justificanse las acciones de promoción y prevención de la salud. Uno de los programas basados en evidencias que visan la promoción y la prevención de ansiedad y depresión en la infancia es lo Método FRIENDS (Amigos Divertidos/Fun FRIENDS). Nese contexto, esta pesquisa buscou valuar la eficacia del programa Amigos Divertidos en una ciudad del interior del Paraná. Participaran 25 niños, con edad entre los cinco y siete años, y sus cuidadores. Como instrumiento de avalación, utilizouse los instrumientos (Child Behavior Check List), SDQ (Strengths and Difficulties Qustionnaire) y SCAS (Spence Children's Anxiety Scale). Los resultados demonstraran aumento de las habilidades socioemocionales y reducción de los sintomas de la ansiedad y depresión. Con eso, concluise que hay evidencias que apoyan la eficacia del programa a la población brasileña.

Análisis conductual de niños brasileños que participan del "Programa boquita del bebé" ­ Gurupi/Tocantins / Behavioral analysis of Brazilian children participating in the "Baby's Little Mouth Program" at Gurupi-Tocantins / Análise comportamental de crianças brasileiras participantes do "Programa Bo-quinha do Bebê" ­ Gurupi/Tocantins

La respuesta del comportamiento del niño ha sido estudiada en algunas investigaciones y es útil para predecir cómo el niño reacciona al tratamiento odontológico, especialmente los bebés y los niños más pequeños, que es donde se encuentra uno de los mayores desafíos de la odontopediatría. Objetivo: Evaluar el patrón de comportamiento de niños de 3 a 5 años de edad, en un programa preventivo de la municipalidad de Gurupi/Tocantins, Brasil. Materiales y métodos: Este estudio fue evaluado y aprobado por el comité de ética e investigación. Un total de 60 niños, con diferentes perfiles de participación del programa "boquita del bebé" fueron analizadas. Entre ellos, 20 frecuentaban el programa, 20 habían desistido y 20 nunca participaron anteriormente. El perfil de comportamiento fue analizado por un examinador externo en el momento de la higiene bucal (profilaxis) por medio de la escala de comportamiento de Venham. Los datos fueron analizados mediante la regresión de Poisson (α=5%). Resultados: Los niños que presentaron peor comportamiento fueron aquellas que nunca participaron del programa "boquita del bebé" (OR: 3.80 / p=0.008), así como, los niños que no permitían el cepillado en casa (OR: 4.17 / p=0.001) y aquellos que sólo permitían el cepillado en ocasiones (OR: 3.07 / p=0.010). Conclusión: Existe una influencia positiva del programa en el condicionamiento psicológico, en la ansiedad de los niños y en la adopción de hábitos correctos en sus rutinas diarias.

The behavioral response of the child has been studied in some researches and is useful to predict how the child reacts to dental treatment, especially infants and young children, which is one of the greatest challenges of pediatric dentistry. Ob-jective: To evaluate the behavioral pattern of children from 3 to 5 years of age in a preventive program in the municipality of Gurupi /Tocantins, Brazil. Materials and methods: This study was evaluated and approved by the Ethics and Research Committee. A total of 60 children, with different participation profiles of the program "Baby's Little Mouth" were analyzed. Of these, 20 were frequent program participants, 20 were dropouts and 20 had never participated in the program before. The behavioral profile was analyzed by an external examiner, at the time of oral hygiene (prophylaxis), through the behavioral scale of Venham. Data were analyzed using Poisson regression analysis (α = 5%). Results: The children who presented the worst behavior were those who had never participated in the "Baby's Little Mouth" program (OR=3.80; p=0.008), as well as children who did not allow brushing at home (OR=4.17; p=0.001) and those that only allowed brushing someti-mes (OR=3.07; p=0.010). Conclusion: There is a positive influence of the program on psychological conditioning, on the anxiety of children and on the adoption of correct daily habits in their routines.

A resposta comportamental da criança tem sido estudada em algumas pesquisas e sendo útil para prever como a criança reage ao tratamento odontológico, especialmente os bebês e as crianças mais novas, que é onde se encontra um dos maiores desafios da odontopediatria. Objetivo: Avaliar o padrão comportamental de crianças de 3 a 5 anos de idade, em um programa preventi-vo do município de Gurupi/Tocantins, Brasil. Materiais e métodos: Este estudo foi avaliado e aprovado pelo Comitê de ética e pesquisa. Um total de 60 crianças, com diferentes perfis de participação do programa "Boquinha do bebê" foram analisadas. Dentre elas, 20 eram frequentadoras assíduas do programa, 20 eram desistentes e 20 nunca participaram anteriormente. O perfil comportamental foi analisado por um examinador externo no momento da higienização bucal (profilaxia) por meio da escala comportamental de Venham. Os dados foram analisados mediante a Regressão de Poisson (α=5%). Resultados: As crianças que apresentaram pior comportamento foram aquelas que nunca participaram do programa "Boquinha do bebê" (OR: 3,80 / p=0,008), assim como, as crianças que não permitiram escovação em casa (OR: 4,17 / p=0,001) e aquelas que só permi-tiam a escovação às vezes (OR: 3,07 / p=0,010). Conclusão: Existe uma influência positiva do programa no condicionamento psicológico, na ansiedade das crianças e na adoção de corretos hábitos em suas rotinas.

Avaliação de programas preventivos: relato de experiência / Preventive programs evaluation: experience story / Evaluación de programas preventivos: relato de experiencia

A análise criteriosa de um projeto permite refiná-lo identificando seus aspectos dificultadores e facilitando a inclusão de estratégias efetivas para correção dos problemas. Alguns autores sugerem que a avaliação de programas preventivos seja feita considerando-se as etapas: análise do problema, delineamento do programa, realização de teste-piloto, realização de teste avançado, disseminação ou ampliação para outros contextos. O presente artigo, observando as referidas etapas, procurou avaliar um projeto preventivo que visa a estimular o desenvolvimento de habilidades sociais em crianças de 6 a 8 anos. Constatou-se que o projeto analisado tem vários aspectos positivos: promove mudanças sutis no comportamento das crianças e sensibiliza os pais para que estimulem condutas pró-sociais. Por outro lado, permitiu detectar que a não-utilização de uma estratégia efetiva de recrutamento e retenção dos participantes pode comprometer a transformação deste projeto em um programa.(AU)

A critical analysis of a project allows refining it by identifying the aspects that make it difficult in order to facilitate the inclusion of effective strategies for the correction of the problems. Some authors suggest that the evaluation of preventive programs is made, considering the stages: analysis of the problem, delineation of the program, accomplishment of test-pilot, accomplishment of advanced test, dissemination or enlargement for other contexts. The objective of this paper is to evaluate a preventive project that aim to stimulate the development of social abilities in children from 6 to 8 years old. It was observed that the analyzed project has some positive aspects: it promotes subtle changes in the behavior of the children and sensitizes the parents in order to stimulate pro-social behaviors. On the other hand, it allowed to detect that a non use of an effective strategy of recruitment and retention of the participants can compromise the transformation of this project in a program.(AU)

El análisis riguroso de un proyecto permite refinarlo, identificando aspectos dificultadores del mismo y facilitando la inclusión de estrategias efectivas para corrección de los problemas. El presente artículo procuró evaluar un proyecto preventivo que busca estimular el desarrollo de habilidades sociales en niños de 6 a 8 años. El análisis fue hecho tomando por base las etapas: análisis del problema, delineamiento del programa, realización de test piloto, realización de test avanzado, diseminación o ampliación para otros contextos. Se constató que el proyecto analizado tiene varios aspectos positivos: promueve cambios sutiles en el comportamiento de los niños y sensibiliza a los padres y profesores para que estimulen conductas pre-sociales. Por otro lado, permitió detectar que la no utilización de una estrategia efectiva de reclutamiento y retención de los participantes puede comprometer la transformación de este proyecto en un programa.(AU)

Avaliação de programas preventivos: relato de experiência / Preventive programs evaluation: experience story / Evaluación de programas preventivos: relato de experiencia

A análise criteriosa de um projeto permite refiná-lo identificando seus aspectos dificultadores e facilitando a inclusão de estratégias efetivas para correção dos problemas. Alguns autores sugerem que a avaliação de programas preventivos seja feita considerando-se as etapas: análise do problema, delineamento do programa, realização de teste-piloto, realização de teste avançado, disseminação ou ampliação para outros contextos. O presente artigo, observando as referidas etapas, procurou avaliar um projeto preventivo que visa a estimular o desenvolvimento de habilidades sociais em crianças de 6 a 8 anos. Constatou-se que o projeto analisado tem vários aspectos positivos: promove mudanças sutis no comportamento das crianças e sensibiliza os pais para que estimulem condutas pró-sociais. Por outro lado, permitiu detectar que a não-utilização de uma estratégia efetiva de recrutamento e retenção dos participantes pode comprometer a transformação deste projeto em um programa.

A critical analysis of a project allows refining it by identifying the aspects that make it difficult in order to facilitate the inclusion of effective strategies for the correction of the problems. Some authors suggest that the evaluation of preventive programs is made, considering the stages: analysis of the problem, delineation of the program, accomplishment of test-pilot, accomplishment of advanced test, dissemination or enlargement for other contexts. The objective of this paper is to evaluate a preventive project that aim to stimulate the development of social abilities in children from 6 to 8 years old. It was observed that the analyzed project has some positive aspects: it promotes subtle changes in the behavior of the children and sensitizes the parents in order to stimulate pro-social behaviors. On the other hand, it allowed to detect that a non use of an effective strategy of recruitment and retention of the participants can compromise the transformation of this project in a program.

El análisis riguroso de un proyecto permite refinarlo, identificando aspectos dificultadores del mismo y facilitando la inclusión de estrategias efectivas para corrección de los problemas. El presente artículo procuró evaluar un proyecto preventivo que busca estimular el desarrollo de habilidades sociales en niños de 6 a 8 años. El análisis fue hecho tomando por base las etapas: análisis del problema, delineamiento del programa, realización de test piloto, realización de test avanzado, diseminación o ampliación para otros contextos. Se constató que el proyecto analizado tiene varios aspectos positivos: promueve cambios sutiles en el comportamiento de los niños y sensibiliza a los padres y profesores para que estimulen conductas pre-sociales. Por otro lado, permitió detectar que la no utilización de una estrategia efectiva de reclutamiento y retención de los participantes puede comprometer la transformación de este proyecto en un programa.