La importancia de la evaluación de tecnologías sanitarias: estado del arte / The importance of health technology assessment: state of the art / A importância da avaliação da tecnologia em saúde: o estado da arte

En un contexto de atención médica en constante evolución, la evaluación de tecnologías sanitarias se ha vuelto esencial. Este proceso evalúa la efectividad, seguridad y costo-efectividad de las tecnologías médicas, desde medicamentos hasta dispositivos. La evaluación respalda decisiones clínicas informadas, reduciendo la variabilidad en la práctica y mejorando la atención al paciente. Además, desempeña un papel crucial en las políticas de salud al guiar la asignación eficiente de recursos y promover el acceso equitativo a las tecnologías sanitarias. Como conclusión se puede decir que la evaluación de tecnologías sanitarias es esencial para garantizar sistemas de salud sostenibles y una atención de calidad.

In an ever-evolving healthcare environment, health technology assessment has become essential. This process evaluates the effectiveness, safety and cost-effectiveness of medical technologies, from drugs to devices. The assessment supports informed clinical decisions, reducing practice variability and improving patient care. It also plays a crucial role in health policy by guiding the efficient allocation of resources and promoting equitable access to health technologies. In conclusion, health technology assessment is essential to ensure sustainable health systems and quality care.

Em um contexto de saúde em constante evolução, a avaliação da tecnologia da saúde tornou-se essencial. Esse processo avalia a eficácia, a segurança e a relação custo-benefício das tecnologias médicas, de medicamentos a dispositivos. A avaliação apóia decisões clínicas fundamentadas, reduzindo a variabilidade na prática e melhorando o atendimento ao paciente. Ela também desempenha um papel fundamental na política de saúde, orientando a alocação eficiente de recursos e promovendo o acesso equitativo às tecnologias de saúde. Em conclusão, a avaliação da tecnologia em saúde é essencial para garantir sistemas de saúde sustentáveis e atendimento de qualidade.

Multicenter international assessment of a SARS-CoV-2 RT-LAMP test for point of care clinical application.

Continued waves, new variants, and limited vaccine deployment mean that SARS-CoV-2 tests remain vital to constrain the coronavirus disease 2019 (COVID-19) pandemic. Affordable, point-of-care (PoC) tests allow rapid screening in non-medical settings. Reverse-transcription loop-mediated isothermal amplification (RT-LAMP) is an appealing approach. A crucial step is to optimize testing in low/medium resource settings. Here, we optimized RT-LAMP for SARS-CoV-2 and human ß-actin, and tested clinical samples in multiple countries. "TTTT" linker primers did not improve performance, and while guanidine hydrochloride, betaine and/or Igepal-CA-630 enhanced detection of synthetic RNA, only the latter two improved direct assays on nasopharygeal samples. With extracted clinical RNA, a 20 min RT-LAMP assay was essentially as sensitive as RT-PCR. With raw Canadian nasopharygeal samples, sensitivity was 100% (95% CI: 67.6% - 100%) for those with RT-qPCR Ct values ≤ 25, and 80% (95% CI: 58.4% - 91.9%) for those with 25 < Ct ≤ 27.2. Highly infectious, high titer cases were also detected in Colombian and Ecuadorian labs. We further demonstrate the utility of replacing thermocyclers with a portable PoC device (FluoroPLUM). These combined PoC molecular and hardware tools may help to limit community transmission of SARS-CoV-2.

Determinants of Aedes mosquito density as an indicator of arbovirus transmission risk in three sites affected by co-circulation of globally spreading arboviruses in Colombia, Ecuador and Argentina.

BACKGROUND: The global impact of Zika virus in Latin America has drawn renewed attention to circulating mosquito-borne viruses in this region, such as dengue and chikungunya. Our objective was to assess socio-ecological factors associated with Aedes mosquito vector density as a measure of arbovirus transmission risk in three cities of potentially recent Zika virus introduction: Ibagué, Colombia; Manta, Ecuador; and Posadas, Argentina, in order to inform disease mitigation strategies. METHODS: We sampled Aedes mosquito populations in a total of 1086 households, using indoor and peridomestic mosquito collection methods, including light traps, resting traps, traps equipped with chemical attractant and aspirators. For each sampled household, we collected socio-economic data using structured questionnaires and data on microenvironmental conditions using iButton data loggers. RESULTS: A total of 3230 female Aedes mosquitoes were collected, of which 99.8% were Aedes aegypti and 0.2% were Aedes albopictus. Mean female Aedes mosquito density per household was 1.71 (standard deviation: 2.84). We used mixed-effects generalized linear Poisson regression analyses to identify predictors of Aedes density, using month, neighborhood and country as random-effects variables. Across study sites, the number of household occupants [incidence rate ratio (IRR): 1.08, 95% confidence interval (CI): 1.01-1.14], presence of entry points for mosquitoes into the household (IRR: 1.51, 95% CI: 1.30-1.76) and presence of decorative vegetation (IRR: 1.52, 95% CI: 1.22-1.88) were associated with higher Aedes density; while being in the highest wealth tertile of household wealth (IRR: 0.78, 95% CI: 0.66-0.92), knowledge of how arboviruses are transmitted (IRR: 0.94, 95% CI: 0.89-1.00) and regular emptying of water containers by occupants (IRR: 0.79, 95% CI: 0.67-0.92) were associated with lower Aedes density. CONCLUSIONS: Our study addresses the complexities of arbovirus vectors of global significance at the interface between human and mosquito populations. Our results point to several predictors of Aedes mosquito vector density in countries with co-circulation of multiple Aedes-borne viruses, and point to modifiable risk factors that may be useful for disease prevention and control.

Situación de salud en asentamientos precarios / The health situation of precarious settlements

OBJETIVO: Conocer la situación de salud de los miembros del Campamento Manuel Bustos, en la región de Valparaíso, considerando sus características socioeconómicas y ambientales y la autopercepción del estado de salud. Material y MÉTODO: Se realizó una investigación cuantitativa, descriptiva y no experimental. Se aplicó un cuestionario a través de una entrevista semiestructurada a una muestra de 89 familias del campamento. RESULTADOS: Las familias del campamento se caracterizan principalmente por ser jóvenes, asistir a controles (principalmente el Niño Sano y EMPA), estar casi en su totalidad inscritos en un CESFAM. Las viviendas poseen irregular eliminación de excretas y un 40% de los hogares tiene algún miembro con hipertensión arterial. En promedio, los residentes valoran su estado de salud con nota 5 en una escala de 1 a 7.CONCLUSIÓN: Se observó que la situación de salud de los habitantes del campamento presenta aspectos positivos vinculados a la inscripción en CES-FAM y la asistencia a controles. No obstante, la alta presencia de hipertensión arterial, las precarias condiciones de eliminación de excretas y la presencia de basurales cercanos son factores de riesgo para la salud, que deberán ser atendidas por los organismos gubernamentales y no gubernamentales que trabajan en este territorio.

OBJECTIVE: To explore the health status of members of the Manuel Bustos Settlement, in the region of Valparaiso, in terms of socioeconomic and environmental characteristics and their self-perceived health status. MATERIAL AND METHODS: A descriptive and non-experimental quantitative study was conducted. A questionnaire was applied through semistructured interviews to 89 families in the settlement. RESULTS: Families of the settlement are characterized principally by their young age, for attending regular health appointments (mainly the Well Child check ups and preventative annual physical exam for adults), and, in the case of the majority, for being enrolled in a local community health center. Their houses have irregular human waste disposal and 40% of households have a member with hypertension. On average, the residents valued their health status with a grade of 5, on a scale from 1 to 7. CONCLUSIONS: The health situation of the inhabitants of the settlement presents positive as-pects related to health center enrollment and regular attendance of controls. However, the high prevalence of hypertension, the precarious conditions of eliminating human waste, and the pre-sence of nearby landfills are risk factors for health that must be addressed by government and nongovernmental organizations, which work in this territory.

Evaluation of community-based strategies for Aedes aegypti control inside houses.

INTRODUCTION: Dengue viruses transmitted principally by the urban mosquito Aedes aegypti, cause one of the major public health problems confronting tropical cities. Insecticide spraying has been the mainstay of mosquito control; however, its continuous use has selected for resistance. Other important methods of control involve community participation. OBJECTIVE: This study evaluated two control methods for Ae. aegypti that can be used by the community: Lethal ovitraps (LOs) and Bacillus thuringiensis var israeliensis (Bti) briquettes. MATERIALS AND METHODS: The project study was carried out in four similar neighborhoods within a representative district in the city of Cali, Colombia. Three interventions (LO, Bti, LO+Bti plus education and one control (education only) area were evaluated for efficacy in post-intervention entomological surveys. Additionally, entomological indices were also compared to results from a pre-intervention survey carried out on a sample of city blocks in the same neighborhoods. Relative vector abundance in relation to weather conditions using the same entomological sampling methods was compared. RESULTS: The interventions did not achieve significant differences in vector abundance among the treatments. However, the interventions achieved a significant reduction in entomological indices compared with those observed during the pre-intervention survey: House index 15.1% vs. 8.5%, mean pupae per house 1.15 vs. 0.073, and Adult index 56.3% vs. 34.8% (p < 0.05). CONCLUSIONS: The lack of significant differences among the interventions, and between treated and control blocks suggested that educational activities together with periodic visits to the houses produced similar reductions of immature and adult Aedes aegypti.