Efficacy of antibiotic prophylaxis to preventing brucellosis in accidental exposure: A systematic review.

BACKGROUND: Antibiotic prophylaxis to prevent brucellosis after accidental exposure to Brucella is an important topic in public health. This study aimed to systematically review the efficacy of antibiotic prophylaxis following accidental exposure to Brucella in preventing human brucellosis disease. METHODS: The study protocol was registered in PROSPERO (CRD42023456812). The outcomes included the incidence of brucellosis disease, adverse events rate, and antibiotic prophylaxis adherence. A comprehensive literature search, conducted until 20 November, 2023, involved Medline, Embase, Cochrane Library, and LILACS databases. Descriptive analysis and meta-analysis using R software were performed, risk of bias was assessed using JBI Critical appraisal tools, and certainty of evidence was assessed using the GRADE tool. RESULTS: Among 3102 initially identified records, eight studies involving 97 individuals accidentally exposed, all focused on high-risk accidental exposure to Brucella in laboratory settings, were included in the review. All studies reported the prophylactic treatment comprising doxycycline at a dosage of 100 mg twice daily, combined with rifampicin at 600 mg, both administered over 21 days. Prophylaxis adherence was reported in 86% of cases, and incidence of brucellosis post-treatment was 0.01. Adverse events, mainly gastrointestinal, occurred in 26% of cases. Critical appraisal revealed limitations in reporting demographics and clinical information. The certainty of evidence was rated as 'very low,' emphasising the need for caution in interpreting the observed outcomes due to study design constraints and the absence of comparative groups. CONCLUSIONS: PEP is an alternative practice reported in the literature, used in accidents with high-risk exposure to Brucella. The currently available evidence of the efficacy of antibiotic prophylaxis is insufficient to support a recommendation for or against the widespread use of antibiotic prophylaxis, so caution is needed in interpreting results due to the very low certainty of evidence, primarily stemming from case series and lack of comparative groups.

Cervical cancer screening in low- and middle-income countries: A systematic review of economic evaluation studies.

Economic assessments are relevant to support the decision to incorporate more cost-effective strategies to reduce Cervical Cancer (CC) mortality. This systematic review analyzes the economic evaluation studies of CC prevention strategies (HPV DNA-based tests and conventional cytology) in low- and middle-income countries. Medline, EMBASE, CRD, and LILACS were searched for economic evaluation studies that reported cost and effectiveness measures of HPV DNA-based tests for CC screening and conventional cytology in women, without age, language, or publication date restrictions. Selection and data extraction were carried out independently. For comparability of results, cost-effectiveness measures were converted to international dollars (2019). Report quality was assessed using the CHEERS checklist. The Dominance Matrix Ranking (DRM) was used to analyze and interpret the results. The review included 15 studies from 12 countries, with cost-effectiveness analyzes from the health system's perspective and a 3% discount rate. The strategies varied in age and frequency of screening. Most studies used the Markov analytical model, and the cost-benefit threshold was based on the per capita GDP of each country. The sensitivity analysis performed in most studies was deterministic. The completeness of the report was considered sufficient in most of the items evaluated by CHEERS. The Dominance Interpretation (DRM) varied; in 6 studies, the HPV test was dominant, 5 studies showed a weak dominance evaluating greater effectiveness of the HPV test at a higher cost, yet in 2 studies conventional cytology was dominant. Although the context-dependent nature of economic evaluations, this review points out the challenge of methodological standardization in the analytical models.

Cervical cancer screening in low- and middle-income countries: A systematic review of economic evaluation studies

Abstract Economic assessments are relevant to support the decision to incorporate more cost-effective strategies to reduce Cervical Cancer (CC) mortality. This systematic review analyzes the economic evaluation studies of CC prevention strategies (HPV DNA-based tests and conventional cytology) in low- and middle-income countries. Medline, EMBASE, CRD, and LILACS were searched for economic evaluation studies that reported cost and effectiveness measures of HPV DNA-based tests for CC screening and conventional cytology in women, without age, language, or publication date restrictions. Selection and data extraction were carried out independently. For comparability of results, cost-effectiveness measures were converted to international dollars (2019). Report quality was assessed using the CHEERS checklist. The Dominance Matrix Ranking (DRM) was used to analyze and interpret the results. The review included 15 studies from 12 countries, with cost-effectiveness analyzes from the health system's perspective and a 3% discount rate. The strategies varied in age and frequency of screening. Most studies used the Markov analytical model, and the cost-benefit threshold was based on the per capita GDP of each country. The sensitivity analysis performed in most studies was deterministic. The completeness of the report was considered sufficient in most of the items evaluated by CHEERS. The Dominance Interpretation (DRM) varied; in 6 studies, the HPV test was dominant, 5 studies showed a weak dominance evaluating greater effectiveness of the HPV test at a higher cost, yet in 2 studies conventional cytology was dominant. Although the context-dependent nature of economic evaluations, this review points out the challenge of methodological standardization in the analytical models.

Avaliação da efetividade dos programas de prevenção da obesidade em adolescentes: revisão sistemática e metanálise / Evaluation of the effectieness of prevention programs for obesity in adolescents: systematic review and metanalysis

OBJETIVOS: Identificar, descrever e avaliar a efetividade dos programas de prevenção da obesidade para adolescentes. MÉTODOS: Revisão sistemática, com busca estruturada em nove bases de dados. Foram considerados elegíveis ensaios clínicos randomizados (ECR) e estudos quase-experimentais que relataram a experiência desses programas quando comparado a um controle, sendo o tempo de acompanhamento de no mínimo um ano. Os desfechos dos estudos deveriam incluir medidas relativas à obesidade, a partir das quais metanálises foram realizadas. Foi realizada descrição dos componentes dos programas. RESULTADOS: Dentre 1.614 estudos identificados, 13 atenderam aos critérios de inclusão. As metanálises realizadas para a diferença de média dos desfechos escore Z do IMC, IMC e prevalência de sobrepeso e obesidade foram -0,01, 0,01 e -0,01, respectivamente. A descrição dos programas revelou elementos motivacionais, de educação, de incentivo à alimentação saudável e atividade física e de envolvimento da família. A metanálise realizada mostrou redução do percentual de gordura corporal (diferença média: -2,18). CONCLUSÕES: Observou-se relevância no desfecho percentual de gordura corporal. A descrição mostrou que os programas avaliados possuem amplo leque de intervenções.

OBJECTIVES: To identify, describe and evaluate the effectiveness of obesity prevention programs for adolescents. METHODS: Systematic review with structured search in nine databases. Randomized controlled trials (RCT) and quasi-experimental studies that reported the experience of these programs when compared to a control were eligible, and the follow-up of at least one year. The studies’ outcomes should include measures relating to obesity, from which meta-analyzes would be carried out. It was performed description of programs. RESULTS: Of 1614 identified studies, 13 met the inclusion criteria. Metaanalyzes performed for the mean difference of the Z score outcomes of BMI, BMI and the prevalence of overweight and obesity were -0.01, 0.01 and -0.01, respectively. The description of the programs revealed elements, such as: motivational, education, to encourage healthy eating and physical activity and family involvement. The meta-analysis showed a reduction in body fat percentage (mean difference: -2.18). CONCLUSIONS: There was significance in the outcome percentage of body fat. The description showed that the evaluated programs have wide range of interventions.

Inteligência avaliativa em rede: construindo consenso em Avaliação de Tecnologias em Saúde / /Assessment intelligence network: consensus building in Health Technology Assessment / /Redes de inteligencia evaluativa: la construcción de un consenso sobre laEvaluación de Tecnologías en Salud

A Avaliação de Tecnologias em Saúde (ATS) é um campo multidisciplinar de estudo, que busca analisar as implicações clínicas, sociais, éticas e econômicas do desenvolvimento, difusão e uso da tecnologia em saúde. O processo de definição de diretrizes metodológicas em ATS exige a construção de consenso entre um amplo conjunto de experts e tomadores de decisão na elaboração de um documento com robustez científica. No Brasil, a partir de 2008 com a criação da Rede Brasileira de Avaliação de Tecnologias em Saúde(REBRATS), a elaboração de diretrizes em ATS passou a ser realizada por meio de um processo colaborativo no âmbito da rede. Este processo tem contribuído não apenas para a padronização metodológica em ATS, mas também para a estruturação da inteligência avaliativa em rede no Brasil. Este artigo tem por objetivo discutir a estrutura e a dinâmica desta inteligência avaliativa, bem com sua evolução ao longo do tempo...

Health Technology Assessment (HTA) is a multidisciplinary field of study that seeks to analyze healthtechnologies development, diffusion and use and their clinical, social, economic and ethical implications.The defining process of HTA methodological guidelines requires consensus building among a broad range ofexperts and decision makers in the elaboration of a scientific robust document. In Brazil, since the creationof the Brazilian Network for Health Technology Assessment (REBRATS) in 2008, the elaboration of HTAguidelines has been performed through a collaborative process between network members. This processhas contributed not only to the HTA methodological standardization, but also to structure an assessmentintelligence network in Brazil. This article aims to discuss the structure and dynamics of this evaluativeintelligence and how it has improved over time...

La Evaluación de Tecnologías (HTA) es un campo multidisciplinar de estudio que busca analizar lascaracterísticas clínicas, el desarrollo social, ético y económico, la difusión y el uso de la tecnología en la salud.El proceso de definición de directrices metodológicas en ATS requiere el consenso entre una amplia gamade expertos y tomadores de decisiones en la elaboración de un documento con solidez científica. En Brasil,a partir de 2008 con la creación de la Red Brasileña de Evaluación de Tecnologías Sanitarias (REBRATS)la elaboración de directrices sobre ATS ahora se lleva a cabo a través de un proceso de colaboración dentrode la red. Este proceso ha contribuido no sólo a la estandarización metodológica en ATS, sino también aestructurar la red de inteligencia evaluativa en Brasil. Este artículo tiene como objetivo discutir la estructuray dinámica de esta inteligencia de evaluación, así como su evolución en el tiempo...