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Introducci贸n: Los derechos de los ni帽os, ni帽as y adolescentes prevalecen sobre los derechos de los dem谩s. Sin embargo, pa铆ses de ingreso medio como Colombia tienen una alta tasa de homicidios para este grupo poblacional, esto deja en evidencia que la sociedad no es capaz de proteger efectivamente su derecho fundamental a la vida. Objetivo: Describir la tendencia de los homicidios de los ni帽os, ni帽as y adolescentes en Colombia para el periodo 2010-2020. Materiales y m茅todos: Se utilizaron los microdatos anonimizados de las defunciones no fetales de las estad铆sticas vitales del DANE y calcularon las tasas de homicidios para los menores de 19 a帽os. Resultados: Durante el periodo analizado, los homicidios de los ni帽as, ni帽as y adolescentes en Colombia se redujeron, al pasar de 2485 en el a帽o 2010 a 1360 en el 2020. Discusi贸n: Los resultados de este trabajo muestran que los homicidios tienen diferencias significativas por grupo de edad, sexo y departamento, las cuales tienen determinantes que las explican, pero que es necesario abordar a profundidad en posteriores investigaciones. Conclusiones: Es indispensable seguir con esta tendencia decreciente para lograr garantizar el derecho a la vida de este grupo poblacional.
Introduction: The rights of children and adolescents prevail over others. However, middle-income countries such as Colombia have a high homicide rate for this population group, showing that society is not able to effectively protect their fundamental right to life. Objective: To describe the trend of homicides of children and adolescents in Colombia for the period 2010-2020. Materials and methods: We used anonymized microdata of non-fetal deaths from DANE vital statistics and calculated homicide rates for children under 19 years of age. Outcomes: During the period analyzed, homicides of children and adolescents in Colombia decreased from 2485 in 2010 to 1360 in 2020. Discussion: The results of this study show homicides have significant differences by age group, sex, and department, which have determinants that describe them but need to be addressed in depth in further research. Conclusions: It is essential to continue with this decreasing trend to guarantee the right to life for this population group.
ABSTRACT
resumen est谩 disponible en el texto completo
Abstract Recent studies have reported the occurrence of thrombotic phenomena or coagulopathy in patients with COVID-19. There are divergent positions regarding the prevention, diagnosis, and treatment of these phenomena, and current clinical practice is based solely on deductions by extension from retrospective studies, case series, observational studies, and international guidelines developed prior to the pandemic. In this context, the aim was to generate a group of recommendations on the prevention, diagnosis and management of thrombotic complications associated with COVID-19. Methods: A rapid guidance was carried out applying the GRADE Evidence to Decision (EtD) frameworks and an iterative participation system, with statistical and qualitative analysis. Results: 31 clinical recommendations were generated focused on: a) Coagulation tests in symptomatic adults with suspected infection or confirmed SARS CoV-2 infection; b) Thromboprophylaxis in adults diagnosed with COVID-19 (Risk scales, thromboprophylaxis for outpatient, in-hospital management, and duration of thromboprophylaxis after discharge from hospitalization), c) Diagnosis and treatment of thrombotic complications, and d) Management of people with previous indication of anticoagulant agents. Conclusions: Recommendations of this consensus guide clinical decision-making regarding the prevention, diagnosis, and treatment of thrombotic phenomena in patients with COVID-19, and represent an agreement that will help decrease the dispersion in clinical practices according to the challenge imposed by the pandemic.
Subject(s)
Humans , Male , Female , Adult , SARS-CoV-2 , COVID-19 , Embolism and Thrombosis , Consensus , AnticoagulantsABSTRACT
RESUMEN Objetivos Identificar los comportamientos de riesgo para la salud y describir su relaci贸n con las caracter铆sticas sociodemogr谩ficas en los adolescentes de un colegio del municipio de Tabio, provincia de Sabana Centro, Cundinamarca, Colombia. Metodolog铆a Estudio descriptivo y de corte transversal en poblaci贸n adolescente escolar de 14 a 19 a帽os, durante el a帽o 2018, elegidos por medio de muestreo por conveniencia. Se obtuvo informaci贸n mediante el cuestionario en espa帽ol de la herramienta RAAPS (Rapid Assessment for Adolescent Preventive Services), que evalu贸 los comportamientos de riesgo, previa firma de consentimiento y asentimiento informado. Se realiz贸 an谩lisis estad铆stico en el programa STATA versi贸n 14.0. Resultados Se incluy贸 una muestra de 217 estudiantes, con edad promedio de 15,8 a帽os (53% mujeres y 47% hombres). La mayor铆a de zona rural y estrato 2. Dentro de los comportamientos de riesgo detectados se destacan la falta de uso de cintur贸n de seguridad y casco en casi la mitad de los participantes, s铆ntomas de tristeza en 37,3% (que afecta m谩s a las mujeres), consumo de alcohol en el 45,2% y actividad sexual en el 30,9% (son m谩s frecuentes en el grupo de 17 a 19 a帽os y en el sexo masculino). Conclusi贸n Los hallazgos confirman la presencia de comportamientos de riesgo para la salud en los adolescentes de la poblaci贸n estudiada, que deben ser intervenidos a trav茅s de estrategias preventivas efectivas y que alertan sobre la necesidad de implementar un sistema peri贸dico de vigilancia.
ABSTRACT Objective to identify health-risk behavior and describe their correlation with sociodemo-graphic characteristics in a group of adolescents from a school located in Tabio, Sabana Centro, Cundinamarca. Methodology A descriptive and cross-sectional study was carried out in school adoles-cents from 14 to 19 years of age during 2018; chosen by convenience sampling. The information was collected using the Spanish version of the RAAPS questionnaire (Rapid assessment for preventive services for adolescents) that assesses risk behaviors, signing of informed consent and assent prior. The statistical analysis was performed in the STATA program, version 14.0. Results A sample of 217 students was included, the average age was 15.8 years, 53% were women and 47% were men, most of them from the rural area and socioeconomic status 2. Among the main risk behaviors were never wearing a belt of safety or helmet in almost half of the adolescents, symptoms of sadness in 37.3% with higher prevalence in women, alcohol consumption in 45.2% and sexual activity in 30.9%, both being more fre-quent in the group of 17 to 19 years old and male. Conclusion The results confirmed the presence of health risk behaviors in the adolescents of studied population, who must be intervened through effective preventive strategies and warn about the need to implement a periodic surveillance system.
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Resumen Introducci贸n: debido a la emergencia del coronavirus SARS-CoV-2 desde diciembre del 2019, se ha generado un gran volumen de producci贸n cient铆fica, en alg煤n caso incierta o controvertida especialmente en el manejo farmacol贸gico de los pacientes con esta infecci贸n; por lo tanto, se considera relevante buscar alternativas metodol贸gicas para realizar su s铆ntesis rigurosa, sistem谩tica y de calidad, pero con menor tiempo de ejecuci贸n y menor costo. Objetivo: presentar la evidencia disponible respecto al manejo farmacol贸gico de personas con sospecha o diagn贸stico de infecci贸n respiratoria por SARS-CoV-2 (COVID-19) utilizando el m茅todo de revisiones sistem谩ticas r谩pidas (RS-R) en medicamentos poten- cialmente eficaces para su manejo. Metodolog铆a: se realiz贸 una b煤squeda sistem谩tica y estructurada en Medline, Embase, Scopus, Cochrane Library, Clinical trials y Google Scholar en ingl茅s. Los estudios incluidos fueron gu铆as de pr谩ctica cl铆nica, consensos, revisiones sistem谩ticas, metaan谩lisis, ensayos cl铆nicos y otros estudios primarios. La b煤squeda y extracci贸n de datos se realiz贸 por m煤ltiples revisores, pero ninguna fue pareada. Resultados: dieciseis preguntas de inter茅s cl铆nico fueron resueltas, relacionadas con el uso en COVID-19 de lopinavir/ ritonavir, nelfinavir, oseltamivir, remdesivir, ribavirina, teicoplanina, umifenovir, favipiravir, tocilizumab, ivermectina y plasma convaleciente; tambi茅n se evalu贸 el uso de medicamentos de soporte e incluidos en el manejo como la dexametasona, as铆 como el uso concomitante de medicamentos que generaron dudas como son los AINES, los IECA y los ARA II. Conclusiones: los res煤menes de evidencia se muestran dentro del escenario de la pandemia como una buena alternativa metodol贸gica para ofrecer informaci贸n de calidad a corto plazo para los tomadores de decisiones.
Abstract Introduction: Due to the emergence of the SARS-CoV-2 coronavirus since December 2019, a large volume of scientific production has been generated, in some cases uncertain or controversial, especially in the pharmacological management of patients with this infection; therefore, it is considered a relevant search for methodological alternatives to carry out its rigorous, systematic and quality synthesis, but with less execution time and lower cost. Objective: To present the available evidence regarding the pharmacological management of people with suspected or diagnosed respiratory SARS-CoV-2 (COVID-19) using the method of rapid systematic reviews (RS-R) in potentially effective drugs for their management. Methodology: A systematic and structured search was conducted in Medline, Embase, Scopus, Cochrane Library, Clinical trials and Google Scholar in English. Studies included clinical practice guidelines, consensus, systematic reviews, meta-analyses, clinical trials, and other primary studies. Data search and extraction were performed by multiple reviewers, but none were paired. Results: Sixteen questions of clinical interest were resolved, related to the use in COVID-19 of lopinavir/ritonavir, nelfinavir, oseltamivir, remdesivir, ribavirin, teicoplanin, umifenovir, favipiravir, tocilizumab, ivermectin, convalescent plasma; the use of support management drugs such as dexamethasone were also evaluated, as well as the concomitant use of drugs that generated doubts, such as NSAIDs, ACEis, and ARA IIs. Conclusions: Summaries of evidence are within the pandemic scenario as a good methodological alternative to offer quality information in the short term for decision-makers.
Subject(s)
Humans , Male , Female , Drug Therapy , COVID-19 , Antiviral Agents , Patients , Therapeutics , Colombia , Severe Acute Respiratory SyndromeABSTRACT
Introduction: Rapid IgM-IgG combined antibody tests can play an important role in the COVID-19 surveillance by supporting the diagnosis of infection, assessing the immune response, and verifying the progress towards herd immunity. Objective: To evaluate the performance of rapid IgM-IgG combined antibody tests in COVID-19 occupational surveillance in a group of Colombian enterprises. Materials and methods: We used the occupational surveillance data from companies that had performed periodic serological tests on all personnel from the end of April to the beginning of July, 2020. Workers were organized in small groups ("social bubbles") to prevent outbreaks and optimize surveillance. The sensitivity was estimated as if the sampling had a prospective design. We describe here the changes in serological testing through periodic rounds. Results: Data were obtained from 4,740 workers, of whom only 23 were symptomatic showing changes from IgM(-)/IgG(-) to IgM(+) and then to IgM(+)/IgG(+) and IgG(+). The sensitivity was 40.94% for IgM(+) and 47.95% for IgM(+)/IgG(+). This implies that a little less than half of the cases can be detected. Conclusion: Antibody rapid tests have a role in the diagnostic process of infection and they must be evaluated taking into account the moment of the epidemic, the type of test purchased, and the populations at risk since their results depend on the number of infections and cases. In the context of a health crisis, they can be optimized by organizing workers into "social bubbles"
Introducci贸n. Las pruebas combinadas de IgM e IgG r谩pidas pueden tener un papel importante en la vigilancia de la COVID-19 y en su diagn贸stico, as铆 como en la evaluaci贸n de la respuesta inmunol贸gica y la verificaci贸n de los avances hacia la inmunidad de reba帽o. Objetivo. Evaluar el desempe帽o de las pruebas r谩pidas de anticuerpos en la vigilancia ocupacional de la COVID-19 en un grupo de empresas colombianas. Materiales y m茅todos. Se usaron datos de la vigilancia ocupacional de empresas que hicieron pruebas serol贸gicas peri贸dicas a todo el personal desde finales de abril hasta comienzos de julio de 2020. Los trabajadores laboraban en grupos peque帽os ("burbujas sociales") para evitar brotes y optimizar la vigilancia. La sensibilidad se estim贸 como si el muestreo respondiera a un dise帽o prospectivo. Se describieron, asimismo, los cambios en las pruebas serol贸gicas por medio de rondas peri贸dicas. Resultados. Se obtuvieron datos de 4.740 trabajadores, de los cuales solo 23 eran sintom谩ticos. En ellos se evidenciaron cambios de IgM(-)/IgG(-) a IgM(+), y luego a IgM(+)/IgG(+) e IgG(+). La sensibilidad fue de 40,94 % para las IgM(+) y 47,95 % para las IgM(+)/IgG(+), lo que implica que se pudo detectar un poco menos de la mitad de los casos. Conclusi贸n. Las pruebas r谩pidas de anticuerpos tienen un papel en el proceso diagn贸stico de la infecci贸n y deben evaluarse teniendo en cuenta el momento de la epidemia, el tipo de prueba comprada y las poblaciones de riesgo, dado que sus resultados dependen del n煤mero de contagios y de casos. En el contexto de la presente crisis sanitaria pueden optimizarse si se organizan los trabajadores en "burbujas sociales".
Subject(s)
Antibodies, Viral/blood , Betacoronavirus/immunology , Clinical Laboratory Techniques , Commerce/statistics & numerical data , Coronavirus Infections/diagnosis , Immunoglobulin G/blood , Immunoglobulin M/blood , Occupational Medicine/methods , Pandemics , Pneumonia, Viral/diagnosis , Adult , Asymptomatic Infections/epidemiology , COVID-19 , COVID-19 Testing , Colombia/epidemiology , Coronavirus Infections/blood , Coronavirus Infections/immunology , Female , Humans , Interpersonal Relations , Male , Pneumonia, Viral/blood , Pneumonia, Viral/immunology , Prospective Studies , SARS-CoV-2 , Sensitivity and Specificity , Symptom AssessmentABSTRACT
Introducci贸n. Las pruebas combinadas de IgM e IgG r谩pidas pueden tener un papel importante en la vigilancia de la COVID-19 y en su diagn贸stico, as铆 como en la evaluaci贸n de la respuesta inmunol贸gica y la verificaci贸n de los avances hacia la inmunidad de reba帽o. Objetivo. Evaluar el desempe帽o de las pruebas r谩pidas de anticuerpos en la vigilancia ocupacional de la COVID-19 en un grupo de empresas colombianas. Materiales y m茅todos. Se usaron datos de la vigilancia ocupacional de empresas que hicieron pruebas serol贸gicas peri贸dicas a todo el personal desde finales de abril hasta comienzos de julio de 2020. Los trabajadores laboraban en grupos peque帽os ("burbujas sociales") para evitar brotes y optimizar la vigilancia. La sensibilidad se estim贸 como si el muestreo respondiera a un dise帽o prospectivo. Se describieron, asimismo, los cambios en las pruebas serol贸gicas por medio de rondas peri贸dicas. Resultados. Se obtuvieron datos de 4.740 trabajadores, de los cuales solo 23 eran sintom谩ticos. En ellos se evidenciaron cambios de IgM(-)/IgG(-) a IgM(+), y luego a IgM(+)/ IgG(+) e IgG(+). La sensibilidad fue de 40,94 % para las IgM(+) y 47,95 % para las IgM(+)/ IgG(+), lo que implica que se pudo detectar un poco menos de la mitad de los casos. Conclusi贸n. Las pruebas r谩pidas de anticuerpos tienen un papel en el proceso diagn贸stico de la infecci贸n y deben evaluarse teniendo en cuenta el momento de la epidemia, el tipo de prueba comprada y las poblaciones de riesgo, dado que sus resultados dependen del n煤mero de contagios y de casos. En el contexto de la presente crisis sanitaria pueden optimizarse si se organizan los trabajadores en "burbujas sociales".
Introduction: Rapid IgM-IgG combined antibody tests can play an important role in the COVID-19 surveillance by supporting the diagnosis of infection, assessing the immune response, and verifying the progress towards herd immunity. Objective: To evaluate the performance of rapid IgM-IgG combined antibody tests in COVID-19 occupational surveillance in a group of Colombian enterprises. Materials and methods: We used the occupational surveillance data from companies that had performed periodic serological tests on all personnel from the end of April to the beginning of July, 2020. Workers were organized in small groups ("social bubbles") to prevent outbreaks and optimize surveillance. The sensitivity was estimated as if the sampling had a prospective design. We describe here the changes in serological testing through periodic rounds. Results: Data were obtained from 4,740 workers, of whom only 23 were symptomatic showing changes from IgM(-)/IgG(-) to IgM(+) and then to IgM(+)/IgG(+) and IgG(+). The sensitivity was 40.94% for IgM(+) and 47.95% for IgM(+)/IgG(+). This implies that a little less than half of the cases can be detected. Conclusion: Antibody rapid tests have a role in the diagnostic process of infection and they must be evaluated taking into account the moment of the epidemic, the type of test purchased, and the populations at risk since their results depend on the number of infections and cases. In the context of a health crisis, they can be optimized by organizing workers into "social bubbles".
Subject(s)
Occupational Health , Coronavirus Infections , Epidemics , ImmunityABSTRACT
Introducci贸n estudios recientes han reportado fen贸menos tromb贸ticos o coagulopat铆a en pacientes con COVID-19. Hay posiciones divergentes en cuanto a la prevenci贸n, el diagn贸stico y el tratamiento de estos fen贸menos, y la pr谩ctica cl铆nica actual est谩 basada 煤nicamente en deducciones por extensi贸n a partir de estudios retrospectivos, series de casos, estudios observacionales y gu铆as internacionales desarrolladas previas a la pandemia. Objetivo establecer una serie de recomendaciones sobre prevenci贸n, diagn贸stico y manejo de las complicaciones tromb贸ticas asociadas a COVID-19. M茅todos se desarroll贸 una gu铆a r谩pida en la que se aplic贸 el marco de la evidencia a la decisi贸n (EtD) de GRADE y un sistema de participaci贸n iterativo, con an谩lisis estad铆sticos y cualitativos de sus resultados. Resultados se generaron 31 recomendaciones cl铆nicas enfocadas a: a) Pruebas de coagulaci贸n en adultos sintom谩ticos con sospecha de infecci贸n o infecci贸n confirmada por SARS-CoV-2; b) Tromboprofilaxis en personas adultas con diagn贸stico de COVID-19 (escalas de riesgo, tromboprofilaxis de manejo ambulatorio, intrahospitalario y duraci贸n de tromboprofilaxis despu茅s del egreso de hospitalizaci贸n), c) Diagn贸stico y tratamiento de las complicaciones tromb贸ticas y d) Manejo de personas con indicaci贸n previa a usar agentes anticoagulantes. Conclusiones las recomendaciones cl铆nicas de este consenso orientan la toma de decisiones cl铆nicas respecto a prevenci贸n, diagn贸stico y tratamiento de fen贸menos tromb贸ticos en pacientes con COVID-19, y representan un acuerdo que ayudar谩 a disminuir la dispersi贸n en las pr谩cticas cl铆nicas acorde con el desaf铆o que impone la pandemia.
Abstract Introduction: recent studies have reported the occurrence of thrombotic phenomena or coagulopathy in patients with COVID-19. There are divergent positions regarding the prevention, diagnosis, and treatment of these phenomena, and current clinical practice is based solely on deductions by extension from retrospective studies, case series, observational studies, and international guidelines developed prior to the pandemic. Objective: to generate a group of recommendations on the prevention, diagnosis and management of thrombotic complications associated with COVID-19. Methods: a rapid guidance was carried out applying the GRADE Evidence to Decision (EtD) frameworks and an iterative participation system, with statistical and qualitative analysis. Results: 31 clinical recommendations were generated focused on: a) Coagulation tests in symptomatic adults with suspected infection or confirmed SARS CoV-2 infection; b) Thromboprophylaxis in adults diagnosed with COVID-19 (Risk scales, thromboprophylaxis for outpatient, in-hospital management, and duration of thromboprophylaxis after discharge from hospitalization), c) Diagnosis and treatment of thrombotic complications, and d) Management of people with previous indication of anticoagulant agents. Conclusions: recommendations of this consensus guide clinical decision-making regarding the prevention, diagnosis, and treatment of thrombotic phenomena in patients with COVID-19, and represent an agreement that will help decrease the dispersion in clinical practices according to the challenge imposed by the pandemic.
Subject(s)
Humans , Adult , Consensus , Diagnosis , COVID-19 , Blood Coagulation Disorders , Embolism and Thrombosis , SARS-CoV-2 , COVID-19 , AnticoagulantsABSTRACT
BACKGROUND: On the American continent, cutaneous and mucocutaneous leishmaniasis (CL and MCL) are diseases associated with infection by several species of Leishmania parasites. Pentavalent antimonials remain the first-choice treatment. There are alternative interventions, but reviewing their effectiveness and safety is important as availability is limited. This is an update of a Cochrane Review first published in 2009. OBJECTIVES: To assess the effects of interventions for all immuno-competent people who have American cutaneous and mucocutaneous leishmaniasis (ACML). SEARCH METHODS: We updated our database searches of the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, LILACS and CINAHL to August 2019. We searched five trials registers. SELECTION CRITERIA: Randomised controlled trials (RCTs) assessing either single or combination treatments for ACML in immuno-competent people, diagnosed by clinical presentation and Leishmania infection confirmed by smear, culture, histology, or polymerase chain reaction on a biopsy specimen. The comparators were either no treatment, placebo only, or another active compound. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Our key outcomes were the percentage of participants 'cured' at least three months after the end of treatment, adverse effects, and recurrence. We used GRADE to assess evidence certainty for each outcome. MAIN RESULTS: We included 75 studies (37 were new), totalling 6533 randomised participants with ATL. The studies were mainly conducted in Central and South America at regional hospitals, local healthcare clinics, and research centres. More male participants were included (mean age: roughly 28.9 years (SD: 7.0)). The most common confirmed species were L. braziliensis, L. panamensis, and L. mexicana. The most assessed interventions and comparators were non-antimonial systemics (particularly oral miltefosine) and antimonials (particularly meglumine antimoniate (MA), which was also a common intervention), respectively. Three studies included moderate-to-severe cases of mucosal leishmaniasis but none included cases with diffuse cutaneous or disseminated CL, considered the severe cutaneous form. Lesions were mainly ulcerative and located in the extremities and limbs. The follow-up (FU) period ranged from 28 days to 7 years. All studies had high or unclear risk of bias in at least one domain (especially performance bias). None of the studies reported the degree of functional or aesthetic impairment, scarring, or quality of life. Compared to placebo, at one-year FU, intramuscular (IM) MA given for 20 days to treat L. braziliensis and L. panamensis infections in ACML may increase the likelihood of complete cure (risk ratio (RR) 4.23, 95% confidence interval (CI) 0.84 to 21.38; 2 RCTs, 157 participants; moderate-certainty evidence), but may also make little to no difference, since the 95% CI includes the possibility of both increased and reduced healing (cure rates), and IMMA probably increases severe adverse effects such as myalgias and arthralgias (RR 1.51, 95% CI 1.17 to 1.96; 1 RCT, 134 participants; moderate-certainty evidence). IMMA may make little to no difference to the recurrence risk, but the 95% CI includes the possibility of both increased and reduced risk (RR 1.79, 95% CI 0.17 to 19.26; 1 RCT, 127 participants; low-certainty evidence). Compared to placebo, at six-month FU, oral miltefosine given for 28 days to treat L. mexicana, L. panamensis and L. braziliensis infections in American cutaneous leishmaniasis (ACL) probably improves the likelihood of complete cure (RR 2.25, 95% CI 1.42 to 3.38), and probably increases nausea rates (RR 3.96, 95% CI 1.49 to 10.48) and vomiting (RR 6.92, 95% CI 2.68 to 17.86) (moderate-certainty evidence). Oral miltefosine may make little to no difference to the recurrence risk (RR 2.97, 95% CI 0.37 to 23.89; low-certainty evidence), but the 95% CI includes the possibility of both increased and reduced risk (all based on 1 RCT, 133 participants). Compared to IMMA, at 6 to 12 months FU, oral miltefosine given for 28 days to treat L. braziliensis, L. panamensis, L. guyanensis and L. amazonensis infections in ACML may make little to no difference to the likelihood of complete cure (RR 1.05, 95% CI 0.90 to 1.23; 7 RCTs, 676 participants; low-certainty evidence). Based on moderate-certainty evidence (3 RCTs, 464 participants), miltefosine probably increases nausea rates (RR 2.45, 95% CI 1.72 to 3.49) and vomiting (RR 4.76, 95% CI 1.82 to 12.46) compared to IMMA. Recurrence risk was not reported. For the rest of the key comparisons, recurrence risk was not reported, and risk of adverse events could not be estimated. Compared to IMMA, at 6 to 12 months FU, oral azithromycin given for 20 to 28 days to treat L. braziliensis infections in ACML probably reduces the likelihood of complete cure (RR 0.51, 95% CI 0.34 to 0.76; 2 RCTs, 93 participants; moderate-certainty evidence). Compared to intravenous MA (IVMA) and placebo, at 12 month FU, adding topical imiquimod to IVMA, given for 20 days to treat L. braziliensis, L. guyanensis and L. peruviana infections in ACL probably makes little to no difference to the likelihood of complete cure (RR 1.30, 95% CI 0.95 to 1.80; 1 RCT, 80 participants; moderate-certainty evidence). Compared to MA, at 6 months FU, one session of local thermotherapy to treat L. panamensis and L. braziliensis infections in ACL reduces the likelihood of complete cure (RR 0.80, 95% CI 0.68 to 0.95; 1 RCT, 292 participants; high-certainty evidence). Compared to IMMA and placebo, at 26 weeks FU, adding oral pentoxifylline to IMMA to treat CL (species not stated) probably makes little to no difference to the likelihood of complete cure (RR 0.86, 95% CI 0.63 to 1.18; 1 RCT, 70 participants; moderate-certainty evidence). AUTHORS' CONCLUSIONS: Evidence certainty was mostly moderate or low, due to methodological shortcomings, which precluded conclusive results. Overall, both IMMA and oral miltefosine probably result in an increase in cure rates, and nausea and vomiting are probably more common with miltefosine than with IMMA. Future trials should investigate interventions for mucosal leishmaniasis and evaluate recurrence rates of cutaneous leishmaniasis and its progression to mucosal disease.
Subject(s)
Leishmaniasis, Cutaneous/therapy , Administration, Oral , Adult , Antiprotozoal Agents/administration & dosage , Antiprotozoal Agents/adverse effects , Azithromycin/administration & dosage , Azithromycin/adverse effects , BCG Vaccine/therapeutic use , Female , Humans , Hyperthermia, Induced , Immunocompetence , Injections, Intramuscular , Injections, Intravenous , Interferon-gamma/therapeutic use , Leishmaniasis Vaccines/therapeutic use , Leishmaniasis, Mucocutaneous/therapy , Male , Meglumine Antimoniate/administration & dosage , Meglumine Antimoniate/adverse effects , Pentoxifylline/administration & dosage , Pentoxifylline/adverse effects , Phosphorylcholine/administration & dosage , Phosphorylcholine/adverse effects , Phosphorylcholine/analogs & derivatives , Randomized Controlled Trials as TopicABSTRACT
INTRODUCTION: In 2013, the PAHO Member States recognized the epidemic of chronic kidney disease of non-traditional causes (CKDnT) as a serious public health problem. This article describes the establishment of research priorities to comprehensively address CKDnT in Central America. METHODS: Following a search of the literature for research studies carried out in Central America and prior research agendas on CKD, a virtual survey was conducted using the Delphi methodology. The respondents were identified from various sources. The first round sought to refine and add research topics and to prioritize those deemed most relevant. The second round prioritized the most relevant topics. A fuzzy-sets analysis was carried out to estimate decision thresholds and scores for each topic. RESULTS: The survey was sent to 83 Spanish-speaking and 38 English-speaking prospective respondents. The response rate was 46.2%. For the second round, the survey was sent to 56 Spanish-speaking and 16 English-speaking first-round respondents. Eighteen topics within 10 research areas were prioritized: public policies, determinants, etiology, diagnosis and treatment of CKD, primary prevention, service delivery, human resources, information systems, and funding. Research on CKDnT was found to be scarce and restricted to certain topics. CONCLUSIONS: In addition to etiological factors, great importance was assigned to aspects related to the health system response, including service delivery approaches, human resources, funding, and occupational and environmental aspects.
INTRODU脟脙O: Em 2013, os Estados Membros da OPAS reconheceram a epidemia de doen莽a renal cr么nica associada a causas n茫o tradicionais como um s茅rio problema de sa煤de p煤blica. Este artigo descreve a determina莽茫o de prioridades em pesquisa para uma abordagem ampla da doen莽a renal cr么nica associada a causas n茫o tradicionais na Am茅rica Central. M脡TODOS: Foi estruturada uma pesquisa virtual com o uso da metodologia Delphi e foi feita uma busca dos estudos realizados na Am茅rica Central e das agendas de pesquisa anteriores sobre doen莽a renal cr么nica. Os entrevistados eram provenientes de fontes diversas. Na primeira rodada, buscou-se refinar e acrescentar t贸picos de pesquisa e priorizar os mais relevantes. Na segunda rodada, foram priorizados os t贸picos mais relevantes. Foi realizada uma an谩lise com o uso de conjuntos nebulosos para estimar limiares de decis茫o e pontua莽玫es por t贸pico. RESULTADOS: A pesquisa foi enviada primeiramente a 83 indiv铆duos falantes da l铆ngua espanhola e 38 falantes da l铆ngua inglesa, com taxa de resposta de 46,2%. Na segunda rodada, a pesquisa foi enviada aos 56 falantes da l铆ngua espanhola e 16 falantes da l铆ngua inglesa que haviam respondido a primeira rodada da pesquisa. Foram priorizados 18 t贸picos de pesquisa distribu铆dos em 10 谩reas: pol铆ticas p煤blicas, determinantes, etiologia, diagn贸stico e tratamento da doen莽a renal cr么nica, preven莽茫o prim谩ria, presta莽茫o de servi莽os, recursos humanos, sistemas de informa莽茫o e financiamento. Foi verificado que a pesquisa em doen莽a renal cr么nica associada a causas n茫o tradicionais 茅 escassa e est谩 restrita a determinados t贸picos. CONCLUS脮ES: Al茅m dos fatores etiol贸gicos, foi dada grande relev芒ncia a aspectos relacionados 脿 resposta dos sistemas de sa煤de, incluindo o m茅todo de presta莽茫o de servi莽os, recursos humanos, financiamento e aspectos ocupacionais e ambientais.
ABSTRACT
Objetivo: El prop贸sito de este resumen de evidencias para pol铆tica (policy brief) fue sintetizar en un formato amigable, la evidencia de investigaci贸n de mejor calidad disponible respecto al uso de sistemas electr贸nicos con o sin dispensaci贸n de nicotina y similares, y sobre los efectos de cuatro opciones de abordaje de regulaci贸n seleccionadas por el Ministerio de Salud y Protecci贸n Social. Estas intervenciones podr铆an mejorar lo que actualmente se est谩 haciendo en materia de regulaci贸n de sistemas electr贸nicos con o sin dispensaci贸n de nicotina y similares en Colombia, especialmente para la protecci贸n de grupos vulnerables como son los ni帽os y adolescentes quienes actualmente pueden acceder a estos dispositivos sin ninguna restricci贸n, exponi茅ndose a temprana edad a sustancias como la nicotina y el propilenglicol, las cuales est谩n asociadas con c谩ncer y otras enfermedades. El presente documento da cuenta de cuatro opciones de abordaje en t茅rminos de sus beneficios, da帽os y consideraciones acerca de la implementaci贸n, monitoreo, evaluaci贸n y equidad: 芒聙垄 Opci贸n 1: regulaci贸n de los SEAN, los SSSN y similares como productos suced谩neos del tabaco, en el marco de la legislaci贸n vigente; 芒聙垄 Opci贸n 2: regulaci贸n de los SEAN y similares como medicamentos para la cesaci贸n tab谩quica; 芒聙垄 Opci贸n 3: regulaci贸n espec铆fica para los SEAN, los SSSN y similares como productos de consumo humano; 芒聙垄 Opci贸n 4: prohibici贸n total para la fabricaci贸n, exportaci贸n, importaci贸n, comercializaci贸n, uso, consumo, publicidad, promoci贸n y patrocinio de los SEAN, los SSSN y similares.
Subject(s)
Colombia , Electronic Nicotine Delivery Systems , Policy Making , Social Control, Formal , Risk Groups , Child , AdolescentABSTRACT
RESUMEN Introducci贸n En 2013, los Estados Miembros de la OPS reconocieron la epidemia de enfermedad renal cr贸nica de causas no tradicionales (ERCnT) como un grave problema de salud p煤blica. Este art铆culo describe el establecimiento de prioridades de investigaci贸n para abordar de manera integral la ERCnT en Centroam茅rica. M茅todos Se estructur贸 una encuesta virtual utilizando la metodolog铆a Delphi mediante una b煤squeda de estudios de investigaci贸n efectuados en Centroam茅rica y de agendas de investigaci贸n previas sobre la ERC. Los encuestados se identificaron en diversas fuentes. La primera ronda busc贸 refinar y a帽adir t贸picos de investigaci贸n y priorizar los m谩s relevantes. La segunda ronda prioriz贸 los t贸picos m谩s relevantes. Se realiz贸 un an谩lisis por fuzzy sets para estimar umbrales de decisi贸n y puntajes por t贸pico. Resultados La encuesta se envi贸 a 83 personas de habla hispana y 38 de habla inglesa y respondi贸 46,2%. Para la segunda ronda, se envi贸 la encuesta a 56 personas en espa帽ol y 16 en ingl茅s que hab铆an contestado a la la primera. Se priorizaron 18 t贸picos de investigaci贸n enmarcados en 10 谩reas: pol铆ticas p煤blicas, determinantes, etiolog铆a, diagn贸stico y tratamiento de la ERC, prevenci贸n primaria, prestaci贸n de servicios, recursos humanos, sistemas de informaci贸n y financiamiento. Se comprob贸 que la investigaci贸n en ERCnT es escasa y est谩 restringida a ciertos t贸picos. Conclusiones Adem谩s de los factores etiol贸gicos, se dio gran relevancia a aspectos relacionados con la respuesta de los sistemas de salud, incluidos el abordaje de la prestaci贸n de servicios, los recursos humanos, el financiamiento y aspectos ocupacionales y ambientales.
ABSTRACT Introduction In 2013, the PAHO Member States recognized the epidemic of chronic kidney disease of non-traditional causes (CKDnT) as a serious public health problem. This article describes the establishment of research priorities to comprehensively address CKDnT in Central America. Methods Following a search of the literature for research studies carried out in Central America and prior research agendas on CKD, a virtual survey was conducted using the Delphi methodology. The respondents were identified from various sources. The first round sought to refine and add research topics and to prioritize those deemed most relevant. The second round prioritized the most relevant topics. A fuzzy-sets analysis was carried out to estimate decision thresholds and scores for each topic. Results The survey was sent to 83 Spanish-speaking and 38 English-speaking prospective respondents. The response rate was 46.2%. For the second round, the survey was sent to 56 Spanish-speaking and 16 English-speaking first-round respondents. Eighteen topics within 10 research areas were prioritized: public policies, determinants, etiology, diagnosis and treatment of CKD, primary prevention, service delivery, human resources, information systems, and funding. Research on CKDnT was found to be scarce and restricted to certain topics. Conclusions In addition to etiological factors, great importance was assigned to aspects related to the health system response, including service delivery approaches, human resources, funding, and occupational and environmental aspects.
RESUMO Introdu莽茫o Em 2013, os Estados Membros da OPAS reconheceram a epidemia de doen莽a renal cr么nica associada a causas n茫o tradicionais como um s茅rio problema de sa煤de p煤blica. Este artigo descreve a determina莽茫o de prioridades em pesquisa para uma abordagem ampla da doen莽a renal cr么nica associada a causas n茫o tradicionais na Am茅rica Central. M茅todos Foi estruturada uma pesquisa virtual com o uso da metodologia Delphi e foi feita uma busca dos estudos realizados na Am茅rica Central e das agendas de pesquisa anteriores sobre doen莽a renal cr么nica. Os entrevistados eram provenientes de fontes diversas. Na primeira rodada, buscou-se refinar e acrescentar t贸picos de pesquisa e priorizar os mais relevantes. Na segunda rodada, foram priorizados os t贸picos mais relevantes. Foi realizada uma an谩lise com o uso de conjuntos nebulosos para estimar limiares de decis茫o e pontua莽玫es por t贸pico. Resultados A pesquisa foi enviada primeiramente a 83 indiv铆duos falantes da l铆ngua espanhola e 38 falantes da l铆ngua inglesa, com taxa de resposta de 46,2%. Na segunda rodada, a pesquisa foi enviada aos 56 falantes da l铆ngua espanhola e 16 falantes da l铆ngua inglesa que haviam respondido a primeira rodada da pesquisa. Foram priorizados 18 t贸picos de pesquisa distribu铆dos em 10 谩reas: pol铆ticas p煤blicas, determinantes, etiologia, diagn贸stico e tratamento da doen莽a renal cr么nica, preven莽茫o prim谩ria, presta莽茫o de servi莽os, recursos humanos, sistemas de informa莽茫o e financiamento. Foi verificado que a pesquisa em doen莽a renal cr么nica associada a causas n茫o tradicionais 茅 escassa e est谩 restrita a determinados t贸picos. Conclus玫es Al茅m dos fatores etiol贸gicos, foi dada grande relev芒ncia a aspectos relacionados 脿 resposta dos sistemas de sa煤de, incluindo o m茅todo de presta莽茫o de servi莽os, recursos humanos, financiamento e aspectos ocupacionais e ambientais.
Subject(s)
Humans , Renal Insufficiency, Chronic/prevention & control , Health Services Research , Occupational Health Services/organization & administration , Local Health Systems , Health PrioritiesABSTRACT
OBJECTIVE: To generate and evaluate an indicator of the health system's performance in the area of maternal and reproductive health in Colombia. MATERIALS AND METHODS: An indicator was constructed based on variables related to the coverage and utilization of healthcare services for pregnant and reproductive-age women. A factor analysis was performed using a polychoric correlation matrix and the states were classified according to the indicator's score. A path analysis was used to evaluate the relationship between the indicator and social determinants, with the maternal mortality ratio as the response variable. RESULTS: The factor analysis indicates that only one principal factor exists, namely "coverage and utilization of maternal healthcare services" (eigenvalue 4.35). The indicator performed best in the states of Atlantic, Bogota, Boyaca, Cundinamarca, Huila, Risaralda and Santander (Q4). The poorest performance (Q1) occurred in Caqueta, Choco, La Guajira, Vichada, Guainia, Amazonas and Vaupes. The indicator's behavior was found to have an association with the unsatisfied basic needs index and women's education (脽 = -0.021; 95%CI -0031 to -0.01 and 脽 0.554; 95%CI 0.39 to 0.72, respectively). According to the path analysis, an inverse relationship exists between the proposed indicator and the behavior of the maternal mortality ratio (脽 = -49.34; 95%CI -77.7 to -20.9); performance was a mediating variable. DISCUSSION: The performance of the health system with respect to its management of access and coverage for maternal and reproductive health appears to function as a mediating variable between social determinants and maternal mortality in Colombia.
Subject(s)
Maternal Health Services , Reproductive Health , Adult , Colombia , Female , Humans , Maternal Health Services/statistics & numerical data , Maternal Mortality , Patient Acceptance of Health Care/statistics & numerical data , Pregnancy , Reproductive Health/statistics & numerical data , Socioeconomic Factors , Young AdultABSTRACT
OBJECTIVE: To describe strategies that contribute to the comprehensive approach to the judicialization of health in countries of Latin America and the Caribbean. METHODS: A search was structured to identify articles presenting strategies to approach the judicialization of health. A survey was designed, which included actors of the health system and judiciary sector. We prioritized the strategies qualified by more than the 50.0% of the participants as "very relevant". Strategies were categorized according to: governance, provision of services, human resources, information systems, financing, and medical products. RESULTS: We included 64 studies, which identified 50 strategies, related to the sub-functions and components of health systems. Of the 165 people who answered the survey, 80.0% were aged 35-64 years. The distribution of men and women was homogeneous. Half of the respondents were from Colombia (20.0%), Uruguay (16.9%), and Argentina (12.7%). We prioritized strategies that addressed aspects of generation of useful scientific evidence for decision making according to the health needs of the population, empowerment for the society, and creating spaces for discussion of measures of inclusion or exclusion of health technologies. The executive and judiciary decision makers prioritized questions that dealt with strategies that would ensure accountability. CONCLUSIONS: The results of this study contribute to the identification of effective strategies to approach the phenomenon of judicialization of health, guaranteeing the right to health. OBJETIVO: Describir estrategias que contribuyan al abordaje integral de la judicializaci贸n de la salud en pa铆ses de Am茅rica Latina y El Caribe. M脡TODOS: Se estructur贸 una b煤squeda para identificar art铆culos que presentaran estrategias para el abordaje de la judicializaci贸n en salud. Se dise帽贸 una encuesta, en donde se incluyeron actores del sistema de salud y del sector judicial. Se priorizaron las estrategias calificadas por m谩s del 50,0% de los participantes como "muy relevantes". Se categorizaron las estrategias seg煤n: gobernanza, prestaci贸n de servicios, recursos humanos, sistemas de informaci贸n, financiaci贸n y productos m茅dicos. RESULTADOS: Se incluyeron 64 estudios en los cuales se identificaron 50 estrategias, relacionadas con las sub-funciones y componentes de los sistemas de salud. De las 165 personas que respondieron la encuesta, el 80,0% ten铆an entre 35-64 a帽os. La distribuci贸n de hombres y mujeres fue homog茅nea. La mitad de los respondientes fue de Colombia (20,0%), Uruguay (16,9%) y Argentina (12,7%). Se priorizaron mayormente las estrategias que abordaron los aspectos de generaci贸n de evidencia cient铆fica 煤til para toma de decisi贸n seg煤n las necesidades de salud de la poblaci贸n, el empoderamiento para la sociedad, y la generaci贸n de espacios de discusi贸n de las medidas de inclusi贸n o exclusi贸n de tecnolog铆as de salud. Los tomadores de decisi贸n de la rama ejecutiva y judicial priorizaron las preguntas que abordaron las estrategias que garantizaran la rendici贸n de cuentas. CONCLUSIONES: Los resultados de este estudio contribuyen a la identificaci贸n de estrategias efectivas para el abordaje del fen贸meno de la judicializaci贸n en salud, garantizando el derecho a la salud.
Subject(s)
Delivery of Health Care/legislation & jurisprudence , Health Priorities/legislation & jurisprudence , Adolescent , Adult , Aged , Caribbean Region , Female , Health Policy/legislation & jurisprudence , Humans , Latin America , Male , Middle Aged , Young AdultABSTRACT
Introducci贸n: Ha aumentado la sobrevida de los neonatos cr铆ticamente enfermos, lo que ha llevado a los profesionales encargados del cuidado de estos beb茅s a enfrentar frecuentemente decisiones 茅ticas. En el presente trabajo se plantea el objetivo de caracterizar las situaciones 茅ticas que enfrentan, el criterio que utilizan y la forma en que se toman las decisiones en los dilemas 茅ticos por parte de los pediatras y neonat贸logos. M茅todos: Se realiz贸 un estudio de corte transversal. Se invitaron a participar 87 neonat贸logos y/o pediatras que quisieran contestar de forma voluntaria la encuesta para la caracterizaci贸n y trabajaran en unidades neonatales de Ch铆a y Bogot谩 entre el 1 de octubre de 2014 y 31 de enero de 2015, de los cuales aceptaron participar 45 profesionales (51.7%). Se realiz贸 un an谩lisis exploratorio de los datos, utilizando estad铆stica descriptiva. Resultados: De los profesionales que contestaron la encuesta, el 100.0% se ha enfrentado a problemas 茅ticos, el 60.0% han recibido alg煤n tipo de capacitaci贸n en bio茅tica, 33.0% se apoya en comit茅s de 茅tica, 98.0% tienen alg煤n l铆mite de viabilidad para iniciar reanimar y el 93.0% ha limitado el esfuerzo terap茅utico; el 98.0% incluye a los padres en las decisiones y registra la decisi贸n en la historia cl铆nica. Conclusiones: Son frecuentes los conflictos 茅ticos en la unidad neonatal. La mayor铆a cuenta con capacitaci贸n y comit茅 de 茅tica para la toma de decisiones. Entre los especialistas hay opiniones heterog茅neas sobre ciertos problemas 茅ticos en las unidades neonatales.
The survival of critically ill neonates has increased, which has led to professional caregivers of these babies to face ethical decisions about it. This paper outlines the aim of characterizing ethical situations that caregivers face, the criterion they use and how decisions on ethical dilemmas are taken by Pediatricians and Neonatologists. Methodology: A cross-sectional study was performed. 87 neonatologists and/or Pediatricians, who work in neonatal care units in Chia and Bogota between October 1 of 2014 and January 31 of 2015, were invited to participate and answer a characterization survey voluntarily, but only 45 professionals (51.7%) agreed to take part in it. An exploratory data analysis was performed by using descriptive statistics. Results: Professionals who answered the survey, 100.0% of them has faced ethical problems, 60.0% of them has received some training in bioethics, 33.0% relies on ethics committee, 98.0% has a viability limit to start reanimating and 93.0% has limited the therapeutic effort; 98.0% includes parents in decisions and registers the decision in the medical record. Conclusions: Ethical conflicts in the neonatal care unit are frequent. Most professionals have training and an ethics committee for decision-making. Among the specialists there are heterogeneous views on certain ethical problems in neonatal care units.
Introdu莽茫o: O aumento da sobreviv锚ncia de rec茅m-nascidos criticamente doentes, o que levou a cuidadores profissionais para esses beb锚s muitas vezes enfrentam decis玫es 茅ticas. Objetivo: Neste trabalho 茅 caracterizar as situa莽玫es 茅ticas e os crit茅rios utilizados por pediatras e neonatologistas no jeito como tomam as decis玫es, frente aos dilemas 茅ticos surgidos. M茅todos: O estudo realizado foi de tipo transversal. De 87 neonatologistas e / ou pediatras convidados a participar no estudo realizado entre 01 de outubro de 2014 e 31 de janeiro de 2015, 45 profissionais (51,7%), que trabalham nas unidades neonatais de Chia e Bogot谩 (Colȏmbia), aceitaram livremente responder as perguntas. Os dados foram estudados por meio de estat铆stica descritiva. Resultados: As respostas da pesquisa mostraram que 100,0% dos professionais tem enfrentado problemas 茅ticos, 60,0% receberam alguma prepara莽茫o em bio茅tica, 33,0% se apoia na comiss茫o de 茅tica, 98,0% t锚m um limite de viabilidade para come莽ar a reanima莽茫o e 93,0% tem limitado o esfor莽o terap锚utico; 98,0% inclui os pais nas decis玫es e o registra no prontu谩rio. Conclus玫es: Os conflitos 茅ticos s茫o frequentes na unidade neonatal. A maioria tem forma莽茫o e conta com a comiss茫o de 茅tica para tomar as decis玫es. Entre os especialistas h谩 pontos de vista heterog锚neos sobre certos problemas 茅ticos nas unidades neonatais.
Subject(s)
Humans , Intensive Care, Neonatal , Terminal Care , Neonatology , Infant, Newborn , Ethics, ClinicalABSTRACT
Introducci贸n: el c谩ncer de cuello uterino es en Colombia el segundo c谩ncer con mayor frecuencia y mortalidad en mujeres. Las vacunas contra el virus del papiloma humano (VPH) han mostrado efectividad para prevenir la infecci贸n por el virus y las lesiones precancerosas asociadas, sin embargo, se han reportado eventos negativos en salud, posiblemente asociados con la aplicaci贸n de la vacuna. Objetivo: examinar la seguridad del uso de la vacuna profil谩ctica contra el VPH. Metodolog铆a: se realiz贸 una b煤squeda sistem谩tica en MEDLINE, EMBASE, Cochrane Database, IBECS, LILACS y fuentes complementarias. La selecci贸n de estudios se realiz贸 por dos revisores independientes de acuerdo con criterios de elegibilidad predefinidos. Se incluyeron estudios experimentales, observacionales anal铆ticos y observacionales descriptivos que reportaran desenlaces de seguridad y efectividad de la vacuna contra el VPH. La calidad de los estudios anal铆ticos fue valorada mediante herramientas previamente definidas, de acuerdo a cada dise帽o. Los estudios descriptivos fueron considerados con alta probabilidad de sesgo. La calidad de la evidencia fue evaluada para cada desenlace reportado mediante la etodolog铆a Grading of Recommendations Assessment, Development and Evaluation (GRADE). Los resultados por cada desenlace fueron reportados de forma narrativa y presentados en perfiles de evidencia GRADE (estudios anal铆ticos) y tablas de evidencia gen茅ricas (estudios descriptivos). Resultados: fueron seleccionados 112 estudios que reportaron 305 resultados de desenlaces de seguridad reportados \r\nposterior a la aplicaci贸n de la vacuna contra el VPH, que incluyeron desenlaces para los cuales la vacunaci贸n mostr贸 asociaci贸n estad铆sticamente significativa como factor de riesgo, desenlaces para los cuales la vacunaci贸n no mostr贸 asociaci贸n como factor de riesgo, y desenlaces para los cuales la vacunaci贸n mostr贸 resultados inconsistentes. La calidad de la evidencia fue baja y muy baja para la mayor铆a de los resultados reportados. Discusi贸n y conclusi贸n: Las principales debilidades de la evidencia identificada fueron falta de periodos adecuados de seguimiento para eventos de aparici贸n tard铆a, falta de precisi贸n de los resultados, y limitaciones en la medici贸n de los desenlaces, verificaci贸n del periodo de latencia de \r\nlos mismos y control de los potenciales factores de confusi贸n. Los determinantes m谩s relevantes de \r\nla calidad fueron la falta de precisi贸n de los resultados, probablemente por la baja frecuencia de los \r\neventos, y el car谩cter observacional de los estudios que evaluaron la mayor parte de los desenlaces \r\nreportados. Los resultados de asociaci贸n reportados no permiten establecer causalidad entre los \r\neventos y la vacunaci贸n. La baja calidad de la evidencia no implica que los resultados no sustenten \r\nla existencia, o no, de las asociaciones evaluadas; ni que los resultados no sean suficientes para \r\norientar decisiones; sino que es probable que estudios con mayor rigor metodol贸gico muestren \r\nresultados diferentes. La mejor evidencia disponible hasta la fecha sustenta un adecuado perfil de \r\nseguridad de la vacuna contra el VPH, similar al reportado por la OMS para otras vacunas, que apoya \r\nsu utilizaci贸n teniendo en cuenta los beneficios reportados en la literatura; sin que sea posible descartar la ocurrencia de eventos adversos graves raros, por lo cual es recomendable la \r\nimplementaci贸n de un sistema de vigilancia posvacunaci贸n, que garantice un apropiado reporte, \r\ndiagn贸stico, seguimiento, an谩lisis y retroalimentaci贸n a los usuarios, de los posibles eventos adversos de la vacunaci贸n, con enfoque en los eventos descritos en esta evaluaci贸n. (AU)
Subject(s)
Humans , Papillomaviridae , Uterine Cervical Neoplasms/drug therapy , Papillomavirus Vaccines/administration & dosage , Papillomavirus Vaccines/adverse effects , Immunization , Treatment Outcome , Colombia , Biomedical Technology , Drug EvaluationABSTRACT
Objetivo: Determinar la frecuencia de asistencia a la consulta odontol贸gica durante el embarazo de las mujeres que asisten al primer control neonatal y que tuvieron su parto en la misma instituci贸n, y explorar asociaciones entre h谩bitos de higiene oral, h谩bitos de salud, conocimientos y creencias, y la asistencia a la consulta odontol贸gica. Materiales y m茅todos: Estudio de corte transversal descriptivo. Se incluyeron 682 mujeres que asistieron al primer control neonatal y cuyo parto fue atendido en la misma instituci贸n entre los a帽os 2011 y 2012, en un hospital de segundo nivel de complejidad, ubicado en una localidad de ingreso socioecon贸mico bajo en la ciudad de Bogot谩. Se midieron variables sociodemogr谩ficas, factores relacionados con comportamientos de salud oral, estilos de vida, conocimientos sobre la salud oral y el embarazo; se explor贸 el conocimiento sobre el efecto del embarazo en la salud oral y sobre el efecto de una pobre salud oral en el desenlace del embarazo. Se realiz贸 un modelo de regresi贸n log铆stica para explorar asociaciones entre h谩bitos de higiene oral, h谩bitos de salud, conocimientos y creencias, y la asistencia a la consulta odontol贸gica. Resultados: La prevalencia de asistencia al odont贸logo fue 75,9 %; la variable que m谩s asociaci贸n positiva tuvo, respecto a la asistencia a la consulta odontol贸gica, fue remisi贸n al odont贸logo (OR = 25,90; IC 95 %: 14,60-45,96). La variable que tuvo mayor asociaci贸n negativa fue desconocimiento sobre el efecto de la enfermedad periodontal en los resultados perinatales (OR= 0,61; IC 95 %: 0,38-0,97) y la no asistencia regular al odont贸logo antes del embarazo (OR= 0,49; IC 95 %: 0,29-0,82). Conclusiones: La prevalencia de asistencia a la consulta odontol贸gica durante el embarazo fue elevada. Es importante educar a la paciente sobre las posibles consecuencias de la mala salud oral sobre el buen curso del embarazo.
Objective: To determine the frequency of attendance to the dental care clinic during pregnancy in women coming to their first neonatal follow-up visit in the same institution where they were delivered, and to explore associations between oral hygiene habits, health habits, knowledge and beliefs, and attendance to dental care appointments. Materials and methods: Descriptive, cross-sectional study that included 682 women coming to the first neonatal follow-up visit and who were delivered in the same Level II institution located in a low-income area in Bogot谩, during 2011 and 2012. The variables measured included social and demographic factors, factors associated with oral health, life-style, knowledge about oral health and pregnancy. The knowledge about the effect of pregnancy on oral health and about the effect of poor oral health on the outcome of pregnancy was explored. A logistic regression model was used to explore associations between oral hygiene habits, health habits, knowledge and beliefs, and attendance to the dental care clinic. Results: Prevalence of attendance to the dental care clinic was 75.9 %. The variable with the highest positive association with attendance to the dental clinic was referral to the dentist (OR = 25,90; 95 % CI: 14.60-45.96). The variable with the highest negative association was lack of knowledge of the impact of periodontal disease on perinatal outcomes (OR= 0.61; 95 % CI: 0.38-0.97) and failure to visit the dentist regularly before pregnancy (OR= 0.49; 95 % CI: 0.29-0.82). Conclusions: The prevalence of attendance to the dental care clinic during pregnancy was high. It is important to educate patients regarding the potential consequences of poor oral health for the good course of the pregnancy.
Subject(s)
Female , Pregnancy , Adult , Dentistry , Prenatal CareABSTRACT
ABSTRACT OBJECTIVE To describe strategies that contribute to the comprehensive approach to the judicialization of health in countries of Latin America and the Caribbean. METHODS A search was structured to identify articles presenting strategies to approach the judicialization of health. A survey was designed, which included actors of the health system and judiciary sector. We prioritized the strategies qualified by more than the 50.0% of the participants as "very relevant". Strategies were categorized according to: governance, provision of services, human resources, information systems, financing, and medical products. RESULTS We included 64 studies, which identified 50 strategies, related to the sub-functions and components of health systems. Of the 165 people who answered the survey, 80.0% were aged 35-64 years. The distribution of men and women was homogeneous. Half of the respondents were from Colombia (20.0%), Uruguay (16.9%), and Argentina (12.7%). We prioritized strategies that addressed aspects of generation of useful scientific evidence for decision making according to the health needs of the population, empowerment for the society, and creating spaces for discussion of measures of inclusion or exclusion of health technologies. The executive and judiciary decision makers prioritized questions that dealt with strategies that would ensure accountability. CONCLUSIONS The results of this study contribute to the identification of effective strategies to approach the phenomenon of judicialization of health, guaranteeing the right to health.
RESUMEN OBJETIVO Describir estrategias que contribuyan al abordaje integral de la judicializaci贸n de la salud en pa铆ses de Am茅rica Latina y El Caribe. M脡TODOS Se estructur贸 una b煤squeda para identificar art铆culos que presentaran estrategias para el abordaje de la judicializaci贸n en salud. Se dise帽贸 una encuesta, en donde se incluyeron actores del sistema de salud y del sector judicial. Se priorizaron las estrategias calificadas por m谩s del 50,0% de los participantes como "muy relevantes". Se categorizaron las estrategias seg煤n: gobernanza, prestaci贸n de servicios, recursos humanos, sistemas de informaci贸n, financiaci贸n y productos m茅dicos. RESULTADOS Se incluyeron 64 estudios en los cuales se identificaron 50 estrategias, relacionadas con las sub-funciones y componentes de los sistemas de salud. De las 165 personas que respondieron la encuesta, el 80,0% ten铆an entre 35-64 a帽os. La distribuci贸n de hombres y mujeres fue homog茅nea. La mitad de los respondientes fue de Colombia (20,0%), Uruguay (16,9%) y Argentina (12,7%). Se priorizaron mayormente las estrategias que abordaron los aspectos de generaci贸n de evidencia cient铆fica 煤til para toma de decisi贸n seg煤n las necesidades de salud de la poblaci贸n, el empoderamiento para la sociedad, y la generaci贸n de espacios de discusi贸n de las medidas de inclusi贸n o exclusi贸n de tecnolog铆as de salud. Los tomadores de decisi贸n de la rama ejecutiva y judicial priorizaron las preguntas que abordaron las estrategias que garantizaran la rendici贸n de cuentas. CONCLUSIONES Los resultados de este estudio contribuyen a la identificaci贸n de estrategias efectivas para el abordaje del fen贸meno de la judicializaci贸n en salud, garantizando el derecho a la salud.