RESUMEN
BACKGROUND: Pain reduction can be achieved by lowering proinflammatory cytokine levels in the blood. Transcutaneous electrical nerve stimulation (TENS) is a non-invasive physiotherapeutic resource for pain management, but evidence on the effectiveness of this device at reducing proinflammatory cytokines in the blood is unclear. This study systematically reviews the literature on the effect of TENS on proinflammatory cytokines. METHODS: A systematic review protocol was developed based on searches of articles in six electronic databases and references of retrieved articles, contact with authors, and repositories of clinical trials. Eligibility criteria: publication in peer-reviewed journals, randomized clinical trials, use of TENS in the experimental group, and pre- and post-measurements of proinflammatory cytokines in the blood. Selection of the studies and extraction of the data will be carried out by two reviewers independently. Characteristics of the study, participants, interventions and outcomes were extracted and described. Assessments were performed on the risk of bias, level of evidence and the size of the intervention effect in the studies, according to GRADE guidelines and the Cochrane Handbook for Systematic Reviews. Clinical and statistical assessments compared the effects of the interventions (meta-analysis), taking into consideration any influencing characteristics of the studies (e.g., methods and application sites). DISCUSSION: We anticipate that this review will strengthen evidence-based knowledge of the effect of TENS on proinflammatory cytokines and, as a result, direct new studies to benefit patients with specific pathologies. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42017060379 .
Asunto(s)
Citocinas/sangre , Inflamación/prevención & control , Estimulación Eléctrica Transcutánea del Nervio/métodos , Medicina Basada en la Evidencia , Humanos , Manejo del Dolor , Proyectos de Investigación , Revisiones Sistemáticas como AsuntoRESUMEN
Background: Breast cancer affects millions of women worldwide, particularly in Brazil, where public healthcare system is an important model in health organization and the cost of chronic disease has affected the economy in the first decade of the twenty-first century. The aim was to evaluate the role of health policy in the burden of breast cancer in Brazil between 2004 and 2014. Methods: Secondary analysis was performed in 2017 with Brazilian Health Ministry official data, extracted from the Department of Informatics of the National Health System. Age-standardized mortality and the age-standardized incidence of hospital admission by breast cancer were calculated per 100,000 people. Public healthcare costs were converted to US dollars. Regression analysis was performed to estimate the trend of breast cancer rates and healthcare.
costs, and principal component analysis was performed to estimate a cost factor. Stata® 11.0 was utilized.
Results: Between 2004 to 2014, the age-standardized rates of breast cancer mortality and the incidence of hospital
admission and public healthcare costs increased. There was a positive correlation between breast cancer and healthcare
public costs, mainly influenced by governmental strategies.
Conclusions: Governmental strategies are effective against the burden of breast cancer in Brazil