Believing is seeing: The link between paranormal beliefs and perceiving signal in noise.

Research suggests that at the core of paranormal belief formation is a tendency to attribute meaning to ambiguous stimuli. But it is unclear whether this tendency reflects a difference in perceptual sensitivity or a decision bias. Using a two-alternative forced choice task, we tested the relationship between paranormal belief and perceptual sensitivity. Participants were shown two stimuli presented in temporal succession. In one interval an ambiguous Mooney Face (i.e., signal) was presented, in the other interval a scrambled version of the image (i.e., noise) was presented. Participants chose in which of the two intervals the face appeared. Our results revealed that participants with stronger beliefs in paranormal phenomena were less sensitive to discriminating signal from noise. This finding builds on previous research using "yes/no" tasks, but importantly disentangles perceptual sensitivity from response bias and suggests paranormal believers perceive things differently.

Multifaceted Public Health Response to a COVID-19 Outbreak Among Meat-Processing Workers, Utah, March-June 2020.

OBJECTIVE: To identify potential strategies to mitigate COVID-19 transmission in a Utah meat-processing facility and surrounding community. DESIGN/SETTING: During March-June 2020, 502 workers at a Utah meat-processing facility (facility A) tested positive for SARS-CoV-2. Using merged data from the state disease surveillance system and facility A, we analyzed the relationship between SARS-CoV-2 positivity and worker demographics, work section, and geospatial data on worker residence. We analyzed worker survey responses to questions regarding COVID-19 knowledge, beliefs, and behaviors at work and home. PARTICIPANTS: (1) Facility A workers (n = 1373) with specimen collection dates and SARS-CoV-2 RT-PCR test results; (2) residential addresses of all persons (workers and nonworkers) with a SARS-CoV-2 diagnostic test (n = 1036), living within the 3 counties included in the health department catchment area; and (3) facility A workers (n = 64) who agreed to participate in the knowledge, attitudes, and practices survey. MAIN OUTCOME MEASURES: New cases over time, COVID-19 attack rates, worker characteristics by SARS-CoV-2 test results, geospatially clustered cases, space-time proximity of cases among workers and nonworkers; frequency of quantitative responses, crude prevalence ratios, and counts and frequency of coded responses to open-ended questions from the COVID-19 knowledge, attitudes, and practices survey. RESULTS: Statistically significant differences in race (P = .01), linguistic group (P < .001), and work section (P < .001) were found between workers with positive and negative SARS-CoV-2 test results. Geographically, only 6% of cases were within statistically significant spatiotemporal case clusters. Workers reported using handwashing (57%) and social distancing (21%) as mitigation strategies outside work but reported apprehension with taking COVID-19-associated sick leave. CONCLUSIONS: Mitigating COVID-19 outbreaks among workers in congregate settings requires a multifaceted public health response that is tailored to the workforce. IMPLICATIONS FOR POLICY AND PRACTICE: Tailored, multifaceted mitigation strategies are crucial for reducing COVID-19-associated health disparities among disproportionately affected populations.

Smoke-Free Air Interventions in Seven Latin American Countries: Health and Financial Impact to Inform Evidence-Based Policy Implementation.

INTRODUCTION: Disease burden due to tobacco smoking in Latin America remains very high. The objective of this study was to evaluate the potential impact of implementing smoke-free air interventions on health and cost outcomes in Argentina, Bolivia, Brazil, Chile, Colombia, Mexico, and Peru, using a mathematical model. AIMS AND METHODS: We built a probabilistic Monte Carlo microsimulation model, considering natural history, direct health system costs, and quality of life impairment associated with main tobacco-related diseases. We followed individuals in hypothetical cohorts and calculated health outcomes on an annual basis to obtain aggregated 10-year population health outcomes (deaths and events) and costs. To populate the model, we completed an overview and systematic review of the literature. Also, we calibrated the model comparing the predicted disease-specific mortality rates with those coming from local national statistics. RESULTS: With current policies, for the next 10 years, a total of 137 121 deaths and 917 210 events could be averted, adding 3.84 million years of healthy life and saving USD 9.2 billion in these seven countries. If countries fully implemented smoke-free air strategies, it would be possible to avert nearly 180 000 premature deaths and 1.2 million events, adding 5 million healthy years of life and saving USD 13.1 billion in direct healthcare. CONCLUSIONS: Implementing the smoke-free air strategy would substantially reduce deaths, diseases, and health care costs attributed to smoking. Latin American countries should not delay the full implementation of this strategy. IMPLICATIONS: Tobacco smoking is the single most preventable and premature mortality cause in the world. The Framework Convention on Tobacco Control, supported by the World Health Organization, introduced a package of evidence-based measures for tobacco control. This study adds quality evidence on the potential health effects and savings of implementing smoke-free air policies in countries representing almost 80% of the Latin America and the Caribbean population.

STAKEHOLDER INVOLVEMENT IN THE HEALTH TECHNOLOGY ASSESSMENT PROCESS IN LATIN AMERICA.

OBJECTIVES: Latin American countries are taking important steps to expand and strengthen universal health coverage, and health technology assessment (HTA) has an increasingly prominent role in this process. Participation of all relevant stakeholders has become a priority in this effort. Key issues in this area were discussed during the 2017 Latin American Health Technology Assessment International (HTAi) Policy Forum. METHODS: The Forum included forty-one participants from Latin American HTA agencies; public, social security, and private insurance sectors; and the pharmaceutical and medical device industry. A background paper and presentations by invited experts and Forum members supported discussions. This study presents a summary of these discussions. RESULTS: Stakeholder involvement in HTA remains inconsistently implemented in the region and few countries have established formal processes. Participants agreed that stakeholder involvement is key to improve the HTA process, but the form and timing of such improvements must be adapted to local contexts. The legitimization of both HTA and decision-making processes was identified as one of the main reasons to promote stakeholder involvement; but to be successful, the entire system of assessment and decision making must be properly staffed and organized, and certain basic conditions must be met, including transparency in the HTA process and a clear link between HTA and decision making. CONCLUSIONS: Participants suggested a need for establishing clear rules of participation in HTA that would protect HTA producers and decision makers from potentially distorting external influences. Such rules and mechanisms could help foster trust and credibility among stakeholders, supporting actual involvement in HTA processes.

HEALTH TECHNOLOGY ASSESSMENT FOR DECISION MAKING IN LATIN AMERICA: GOOD PRACTICE PRINCIPLES.

OBJECTIVES: The aim of this study was to identify good practice principles for health technology assessment (HTA) that are the most relevant and of highest priority for application in Latin America and to identify potential barriers to their implementation in the region. METHODS: HTA good practice principles proposed at the international level were identified and then explored during a deliberative process in a forum of assessors, funders, and product manufacturers. RESULTS: Forty-two representatives from ten Latin American countries participated. Good practice principles proposed at the international level were considered valid and potentially relevant to Latin America. Five principles were identified as priority and with the greatest potential to be strengthened at this time: transparency in the production of HTA, involvement of relevant stakeholders in the HTA process, mechanisms to appeal decisions, clear priority-setting processes in HTA, and a clear link between HTA and decision making. The main challenge identified was to find a balance between the application of these principles and the available resources in a way that would not detract from the production of reports and adaptation to the needs of decision makers. CONCLUSIONS: The main recommendation was to progress gradually in strengthening HTA and its link to decision making by developing appropriate processes for each country, without trying to impose, in the short-term, standards taken from examples at the international level without adequate adaptation of these to local contexts.

[Health technology assessment for decision-making in Latin America: good practice principles]. / Evaluación de tecnologías sanitarias para la toma de decisiones en Latinoamérica: principios de buenas prácticas.

OBJECTIVE: Identify the most relevant, applicable, and priority good practice principles in health technology assessment (HTA) in Latin America, and potential barriers to implementing them in the region. METHODS: HTA good practice principles postulated worldwide were identified and then explored through a deliberative process in a forum of evaluators, funders, and technology producers. RESULTS: Forty-two representatives from ten Latin American countries participated in the forum. The good practice principles postulated at the international level were considered valid and potentially applicable in Latin America. Five principles were identified as priorities and as having greater potential to be expanded at this time: transparency in carrying out HTA; involvement of stakeholders in the HTA process; existence of mechanisms to appeal decisions; existence of clear mechanisms for HTA priority-setting; and existence of a clear link between assessment and decision-making. The main challenge identified was to find a balance between application of these principles and available resources, to prevent the planned improvements from jeopardizing report production times and failing to meet decision-makers' needs. CONCLUSIONS: The main recommendation was to gradually advance in improving HTA and its link to decision-making by developing appropriate processes for each country, without attempting to impose, in the short term, standards taken from examples at the international level without adequate adaptation to the local context.

[Big Data and Psychiatry]. / "Big data" y psiquiatría.

The popularity of the term "big data" has increased exponentially in recent years. This term is commonly used to refer both to data sets that are too large or complex to be approached with traditional strategies, and to the data science methods used to analyze them. This review synthesizes the literature on the implemented or potential uses of big data in psychiatry. The identifed literature is very diverse, covering a spectrum ranging from the use of data science methods for the prediction of events such as suicidal behavior or psychotic episodes to the emergence of a new interdisciplinary feld called computational psychiatry.

Association Between Cigarette Smoking Prevalence and Income Level: A Systematic Review and Meta-Analysis.

INTRODUCTION: Previous evidence linked low socioeconomic status with higher smoking prevalence. Our objective was to assess the strength of this association in the world population, updating a previous work. METHODS: Systematic review and meta-analysis of observational studies. Subgroup analyses included continents, WHO regions, country mortality levels, gender, age, risk of bias, and study publication date. Independent reviewers selected studies, assessed potential bias and extracted data. We searched MEDLINE, EMBASE, CENTRAL, SOCINDEX, AFRICAN INDEX MEDICUS, and LILACS, and other sources from 1989 to 2013 reporting direct measurements of income and current cigarette smoking. RESULTS: We retrieved 13,583 articles and included 93 for meta-analysis. Median smoking prevalence was 17.8% (range 3-70%). Lower income was consistently associated with higher smoking prevalence (odds ratio [OR]: 1.45; 95% confidence interval [CI]: 1.35-1.56). This association was statistically significant in the subgroup analysis by WHO regions for the Americas (OR: 1.54; 95% CI: 1.42-1.68), South East Asia (OR: 1.53; 95% CI: 1.10-2.00), Europe (OR: 1.45; 95% CI: 1.29-1.63), and Western Pacific (OR: 1.32; 95% CI: 1.02-1.72), and in studies conducted during 1990s (OR: 1.42; 95% CI: 1.24-1.62) and 2000s (OR: 1.48; 95%CI: 1.30-1.64). Likewise, it was noted in low-mortality countries (OR: 1.48; 95% CI: 1.37-1.60) and for both genders. Prevalence was highest in the lowest income levels compared to the middle (OR: 1.69; 95% CI: 1.49-1.92), followed by the middle level compared to the highest (OR: 1.31; 95% CI: 1.20-1.43). CONCLUSIONS: Our results show that current cigarette smoking was significantly associated with lower income worldwide and across subgroups, suggesting a dose-response relationship. IMPLICATIONS: This unique updated systematic review shows a consistent inverse dose-response relationship between cigarette smoking and income level, present among most geographical areas and country characteristics. Public health measures should take into account this potential inequity and consider special efforts directed to disadvantaged populations.

Decision-making impact on adjuvant chemotherapy allocation in early node-negative breast cancer with a 21-gene assay: systematic review and meta-analysis.

Risk stratification based on results provided by a 21-gene assay (Oncotype DX(®)) in early stage breast cancer can help optimize hormone therapy (HT) and/or chemotherapy (CT) decisions. We performed a systematic review and meta-analysis of decision impact (DI) and net change in CT use before and after assay results, both in the whole studies' population and by recurrence risk score (RS) strata. A systematic search of studies with prospective data collection reported physician's decision on treatment allocation in early stage node-negative breast cancer was performed. DI reflects the proportion of patients whose management was changed, and net change focuses on CT change. A random-effects model is reported. Fifteen studies (N = 2229) met our inclusion criteria: 50.09, 37.35, and 13.38 % of patients with low, intermediate, and high RS. Treatment decision changed in 29.5 % (95 % CI 26.29-32.86). Net reduction of CT use was 12 % (8-17 %). It was 16 % (12.00-19.00) in the low RS group, 0 % (-3.00 to 3.00) in the intermediate RS group, and increased by 2 % (-1.00 to 3.00) in the high RS group. Use of a 21-gene assay showed a significant impact on treatment decisions. From 100 women tested, 30 could have their treatment optimized, and 12 could avoid CT. Its main effects consist of sparing chemotherapy in low risk patients and slightly increasing it in the high risk category. DI could be higher in selected patient populations with greater uncertainty regarding initial treatment decisions.

INEAS's Cost-Effectiveness Analysis of Vemurafenib: Paving the Way for Value-Based Pricing in Tunisia.

The Tunisian Health Technology Assessment (HTA) body, INEAS, conducted a cost-effectiveness analysis (CEA) of vemurafenib in the treatment of locally advanced or metastatic BRAF V600-mutated melanoma. The objective of this analysis was to enable the use of value-based pricing as a new approach to price negotiation. This study was part of a broader HTA report that was prepared in response to a joint request from the regulatory authorities and the CNAM, Tunisia's compulsory insurance scheme. Our analysis was based on a probabilistic Markov cohort model that calculated the costs and quality-adjusted life years (QALY) associated with vemurafenib compared to the standard of care from a public payer perspective. The CEA indicated that vemurafenib provides a gain of 0.38 life years (1.78 vs. 1.4) for an incremental cost of USD 101,106.62 from the perspective of the main public payer (CNAM). This study revealed an incremental cost-effectiveness ratio (ICER) of 163,311.40 USD/QALY and 163,911.46 USD/QALY, respectively, from the CNAM and public health facilities' perspectives. Vemurafenib cannot be considered cost-effective in terms of what has normally been considered a reasonable willingness to pay (WTP) in Tunisia. A significant price reduction would be necessary to bring the incremental cost-effectiveness ratio to an acceptable level.

[Diagnosis and treatment of child and adolescent depression]. / Tratamientos de la depresión en la ninez y adolescencia basados en la evidencia.

The present paper reviews the available literature on the current state of knowledge regarding depression in children and adolescents. Empirically supported psychotherapeutic treatment adjustments for children are described, such as the Self-Control Therapy (CBT), Penn Prevention Program; and other treatments that are experimental phase. Similarly empirically supported psychotherapeutic treatment adjustments for adolescents are described, such as Adolescent Coping with Depression, Interpersonal Psychotherapy; and other treatments that are experimental phase as Biblotherapy and Attachment-Based Family Therapy.

Epidemiology of inflammatory bowel disease in Mexico and Colombia: Analysis of health databases, mathematical modelling and a case-series study.

BACKGROUND AND AIMS: Ulcerative Colitis (UC) and Crohn's Disease (CD) have a major impact on quality of life and medical costs. The aim of the study was to estimate the prevalence, incidence and clinical phenotypes of Inflammatory Bowel Disease (IBD) cases in Mexico and Colombia. METHODS: We analyzed official administrative and health databases, used mathematical modelling to estimate the incidence and complete prevalence, and performed a case-series of IBD patients at a referral center both in Mexico and Colombia. RESULTS: The age-adjusted complete prevalence of UC per 100,000 inhabitants for 2015/2016 ranged from 15.65 to 71.19 in Mexico and from 27.40 to 69.97 in Colombia depending on the model considered. The prevalence of CD per 100,000 inhabitants in Mexico ranged from 15.45 to 18.08 and from 16.75 to 18.43 in Colombia. In Mexico, the age-adjusted incidence of UC per 100,000 inhabitants per year ranged from 0.90 to 2.30, and from 0.55 to 2.33 in Colombia. The incidence for CD in Mexico ranged from 0.35 to 0.66 whereas in Colombia, the age-adjusted incidence of CD ranged from 0.30 to 0.57. The case-series included 200 IBD patients from Mexico and 204 patients from Colombia. The UC/CD prevalence ratio in Mexico and Colombia was 1.50:1 and 4.5:1 respectively. In Mexico, the female/male prevalence ratio for UC was 1.50:1 and 1.28:1 for CD, while in Colombia this ratio was 0.68:1 for UC and 0.8:1 for CD. In Mexico the relapse rate for UC was 63.3% and 72.5% for CD, while those rates in Colombia were 58.2% for UC and 58.3% for CD. CONCLUSIONS: The estimated burden of disease of IBD in Mexico and Colombia is not negligible. Although these findings need to be confirmed by population-based studies, they are useful for decision-makers, practitioners and patients with this condition.

Epidemiología, consumo de recursos y costos del manejo médico de la Hepatitis C en Argentina, Colombia, Uruguay y Venezuela.

OBJECTIVE: To describe the epidemiology, the consumption of resources and the relevant costs in the management of hepatitis C in four Latin American countries: Argentina, Colombia, Uruguay and Venezuela. STUDY DESIGN: Bibliographic review, study of costs and elicitation by experts METHODS: A literature search was carried out to collect epidemiological and cost data for the management of the disease. Information was additionally elicited with hepatologists from each country using the modified Delphi Panel technique. For the estimation of costs, the perspective of the health system was adopted. The direct medical costs of the different stages associated with the natural history of the disease were considered through micro-costing. RESULTS: Extensive epidemiological and economic information is provided for the four countries under study. The age range between 40 and 60 years was the most affected. The frequency of genotypes showed a predominance of genotype 1 (68 to 88%), genotype 1b having been reported as the most prevalent in Argentina and Colombia and 1a in Uruguay and Venezuela. The costs of drug regimens, associated health events and adverse events present important differences in the four selected countries of Latin America. CONCLUSION: Hepatitis C presents a high burden of disease in the countries under study, and its management imposes significant costs on health systems.

Burden of Heart Failure in Latin America: A Systematic Review and Meta-analysis.

INTRODUCTION AND OBJECTIVES: Heart failure is a major public health concern. The aim of this review was to estimate the burden of heart failure in Latin America. METHODS: Systematic review and meta-analysis following a search in MEDLINE, EMBASE, LILACS, and CENTRAL for articles published between January 1994 and June 2014, with no language restrictions. We included experimental and observational studies with at least 50 participants aged ≥ 18 years. RESULTS: In total, 143 of the 4792 references retrieved were included in the study. Most studies had been conducted in South America (92%), and mainly in Brazil (64%). The mean age of the patients was 60 ± 9 years, and mean ejection fraction was 36% ± 9%. The incidence of heart failure in the single population study providing this information was 199 cases per 100000 person-years. The prevalence of heart failure was 1% (95% confidence interval [95%CI], 0.1%-2.7%); hospital readmission rates were 33%, 28%, 31%, and 35% at 3, 6, 12, and 24 to 60 months of follow-up, respectively; and the median duration of hospitalization was 7.0 days. The 1-year mortality rate was 24.5% (95%CI, 19.4%-30.0%). In-hospital mortality was 11.7% (95%CI, 10.4%-13.0%), and the rate was higher in patients with a reduced ejection fraction, ischemic heart disease, or Chagas disease. CONCLUSIONS: Few studies have evaluated the incidence and prevalence of heart failure in Latin America. High mortality and hospitalization rates were found, and the main limitation was heterogeneity between studies. The results presented provide useful epidemiologic information for decision-making related to this disease. Further studies with standardized methods and representative populations are needed in this line.

Epidemiology of chronic disease related to arsenic in Argentina: A systematic review.

Four million people in Argentina are exposed to arsenic contamination from drinking waters of several center-northern provinces. A systematic review to examine the geographical distribution of arsenic-related diseases in Argentina was conducted, searching electronic databases and gray literature up to November 2013. Key informants were also contacted. Of the 430 references identified, 47 (mostly cross-sectional and ecological designs) referred to arsenic concentration in water and its relationship with the incidence and mortality of cancer, dermatological diseases and genetic disorders. A high percentage of the water samples had arsenic concentrations above the WHO threshold value of 10µg/L, especially in the province of Buenos Aires. The median prevalence of arsenicosis was 2.6% in exposed areas. The proportion of skin cancer in patients with arsenicosis reached 88% in case-series from the Buenos Aires province. We found higher incidence rate ratios per 100µg/L increment in inorganic arsenic concentration for colorectal, lung, breast, prostate and skin cancer, for both genders. Liver and skin cancer mortality risk ratios were higher in regions with medium/high concentrations than in those with low concentrations. The relative risk of mortality by skin cancer associated to arsenic exposure in the province of Buenos Aires ranged from 2.5 to 5.2. In the north of this province, high levels of arsenic in drinking water were reported; however, removal interventions were scarcely documented. Arsenic contamination in Argentina is associated with an increased risk of serious chronic diseases, including cancer, showing the need for adequate and timely actions.

Feasibility of Conducting a Palliative Care Randomized Controlled Trial in Children With Advanced Cancer: Assessment of the PediQUEST Study.

CONTEXT: Pediatric palliative care randomized controlled trials (PPC-RCTs) are uncommon. OBJECTIVES: To evaluate the feasibility of conducting a PPC-RCT in pediatric cancer patients. METHODS: This was a cohort study embedded in the Pediatric Quality of Life and Evaluation of Symptoms Technology Study (NCT01838564). This multicenter PPC-RCT evaluated an electronic patient-reported outcomes system. Children aged two years and older, with advanced cancer, and potentially eligible for the study were included. Outcomes included: pre-inclusion attrition (patients not approached, refusals); post-inclusion attrition (drop-out, elimination, death, and intermittent attrition (IA; missing surveys) over nine months of follow-up); child/teenager self-report rates; and, reasons to enroll/participate. RESULTS: Over five years, of the 339 identified patients, 231 were eligible (in 22, we could not verify eligibility); 84 eligible patients were not approached and 43 declined participation. Patients not approached were more likely to die or have brain tumors. We enrolled 104 patients. Average enrollment rate was one patient per site per month; shortening follow-up from nine to three months (with optional re-enrollment) increased recruitment by 20%. A total of 87 patients completed the study (24 died) and 17 dropped out. Median IA was 41% in the first 20 weeks of follow-up and more than 60% in the eight weeks preceding death. Child/teenager self-report was 94%. Helping others, low burden procedures, incentives, and staff attitude were frequent reasons to enroll/participate. CONCLUSION: A PPC-RCT in children with advanced cancer was feasible, post-inclusion retention adequate; many families participated for altruistic reasons. Strategies that may further PPC-RCT feasibility include: increasing target population through large multicenter studies, approaching sicker patients, preventing exclusion of certain patient groups, and improving data collection at end of life.

Evaluación de tecnologías sanitarias para la toma de decisiones en Latinoamérica: principios de buenas prácticas / Health technology assessment for decision-making in Latin America: good practice principles / Avaliação de tecnologias em saúde para a tomada de decisão na América Latina: princípios de boas práticas

RESUMEN Objetivo Identificar los principios de buenas prácticas en la Evaluación de las Tecnologías Sanitarias (ETESA) más relevantes, aplicables y prioritarios en Latinoamérica; y las potenciales barreras para implementarlos en la región. Métodos Se identificaron los principios de buenas prácticas en ETESA postulados a nivel mundial y luego se exploraron mediante un proceso deliberativo en un Foro de evaluadores, financiadores y productores de tecnologías. Resultados El Foro contó con la participación de 42 representantes de diez países Latinoamericanos. Los principios de buenas prácticas postulados a nivel internacional fueron considerados válidos y potencialmente aplicables en Latinoamérica. Cinco principios fueron identificados como prioritarios y con mayor potencial para ser profundizados en estos momentos: transparencia en los procesos de realización de ETESA; Involucramiento de actores relevantes en el proceso de ETESA; existencia de mecanismos de apelación de las decisiones; existencia de mecanismos claros para el establecimiento de prioridades en ETESA; y existencia de un vínculo claro entre la evaluación y la toma de decisión. El principal reto identificado fue encontrar un equilibrio entre la aplicación de estos principios y los recursos disponibles para prevenir que las mejoras a introducir atenten contra los tiempos de producción de informes y la adecuación a las necesidades de los decisores. Conclusiones La principal recomendación fue avanzar gradualmente en mejorar la ETESA y su vínculo con la toma de decisión desarrollando procesos apropiados para cada país, sin pretender imponer a corto plazo estándares tomados de ejemplos a nivel internacional sin la adecuada adaptación al contexto local.

ABSTRACT Objective Identify the most relevant, applicable, and priority good practice principles in health technology assessment (HTA) in Latin America, and potential barriers to implementing them in the region. Methods HTA good practice principles postulated worldwide were identified and then explored through a deliberative process in a forum of evaluators, funders, and technology producers. Results Forty-two representatives from ten Latin American countries participated in the forum. The good practice principles postulated at the international level were considered valid and potentially applicable in Latin America. Five principles were identified as priorities and as having greater potential to be expanded at this time: transparency in carrying out HTA; involvement of stakeholders in the HTA process; existence of mechanisms to appeal decisions; existence of clear mechanisms for HTA priority-setting; and existence of a clear link between assessment and decision-making. The main challenge identified was to find a balance between application of these principles and available resources, to prevent the planned improvements from jeopardizing report production times and failing to meet decision-makers' needs. Conclusions The main recommendation was to gradually advance in improving HTA and its link to decision-making by developing appropriate processes for each country, without attempting to impose, in the short term, standards taken from examples at the international level without adequate adaptation to the local context.

RESUMO Objetivo Identificar os princípios das boas práticas na avaliação de tecnologias em saúde (ATS) mais relevantes, aplicáveis e prioritárias na América Latina e as potenciais barreiras para implementação destes princípios na Região. Métodos Foram identificados os princípios das boas práticas na ATS propostos ao nível mundial e explorados em um processo deliberativo em um fórum de examinadores, financiadores e produtores de tecnologia. Resultados O fórum teve a participação de 42 representantes de 10 países latino-americanos. Considerou-se que os princípios das boas práticas propostos ao nível internacional são válidos e potencialmente aplicáveis na América Latina. Identificaram-se cinco princípios prioritários com maior potencial para serem aprofundados: transparência nos processos de ATS; envolvimento de atores relevantes no processo de ATS; disponibilidade de mecanismos de apelação das decisões; mecanismos distintos para determinação das prioridades em ATS; e vínculo evidente entre avaliação e tomada de decisão. Verificou-se que o principal desafio é encontrar um equilíbrio entre a aplicação dos princípios e os recursos disponíveis a fim de evitar que as melhorias a serem introduzidas sejam um obstáculo ao tempo de produção de relatórios e à adequação às necessidades dos responsáveis pela tomada de decisão. Conclusões A principal recomendação é avançar gradualmente para aperfeiçoar a ATS e o vínculo com a tomada de decisão, desenvolvendo processos adaptados a cada país, sem pretender impor a curto prazo padrões tidos como exemplares ao nível internacional sem a correta adaptação ao contexto local.

Carga de enfermedad de la insuficiencia cardiaca en América Latina: revisión sistemática y metanálisis / Burden of heart failure in Latin America: a systematic review and meta-analysis

Introducción y objetivos: La insuficiencia cardiaca es un grave problema de salud pública. El objetivo de la revisión es estimar la carga de insuficiencia cardiaca en Latinoamérica. Métodos: Revisión sistemática y metanálisis, tras búsqueda en MEDLINE, EMBASE, LILACS y CENTRAL desde enero de 1994 a junio de 2014, sin restricción de idioma. Se incluyeron estudios experimentales y observacionales con al menos 50 participantes de edad ≥ 18 años. Resultados: Se incluyeron 143 de las 4.792 referencias recuperadas. La mayoría de los estudios se realizaron en Sudamérica (92%), principalmente en Brasil (64%). La media de edad era 60 ± 9 años y la fracción de eyección media, del 36 ± 9%. La incidencia de insuficiencia cardiaca en el único estudio poblacional identificado fue de 199/100.000 personas-años; la prevalencia, del 1% (intervalo de confianza del 95% [IC95%], 0,1-2,7%); las tasas de rehospitalización, del 33, el 28, el 31 y el 35% a 3, 6, 12 y 24-60 meses de seguimiento respectivamente, y la mediana de estancia hospitalaria, 7,0 días. La tasa de mortalidad al año fue del 24,5% (IC95%, 19,4-30,0%). La mortalidad intrahospitalaria fue del 11,7% (IC95%, 10,4-13,0%), y aumentaba en pacientes con fracción de eyección reducida, cardiopatía isquémica y enfermedad de Chagas. Conclusiones: Pocos estudios han evaluado la incidencia y la prevalencia de insuficiencia cardiaca en Latinoamérica. Se hallaron altas tasas de mortalidad y de hospitalización, y la heterogeneidad es su principal limitación. Este estudio brinda la información epidemiológica disponible para la toma de decisiones sobre esta enfermedad. Se requieren más estudios con metodologías estandarizadas y en poblaciones representativas (AU)

Introduction and objectives: Heart failure is a major public health concern. The aim of this review was to estimate the burden of heart failure in Latin America. Methods: Systematic review and meta-analysis following a search in MEDLINE, EMBASE, LILACS, and CENTRAL for articles published between January 1994 and June 2014, with no language restrictions. We included experimental and observational studies with at least 50 participants aged ≥ 18 years. Results: In total, 143 of the 4792 references retrieved were included in the study. Most studies had been conducted in South America (92%), and mainly in Brazil (64%). The mean age of the patients was 60 ± 9 years, and mean ejection fraction was 36% ± 9%. The incidence of heart failure in the single population study providing this information was 199 cases per 100 000 person-years. The prevalence of heart failure was 1% (95% confidence interval [95%CI], 0.1%-2.7%); hospital readmission rates were 33%, 28%, 31%, and 35% at 3, 6, 12, and 24 to 60 months of follow-up, respectively; and the median duration of hospitalization was 7.0 days. The 1-year mortality rate was 24.5% (95%CI, 19.4%-30.0%). In-hospital mortality was 11.7% (95%CI, 10.4%-13.0%), and the rate was higher in patients with a reduced ejection fraction, ischemic heart disease, or Chagas disease. Conclusions: Few studies have evaluated the incidence and prevalence of heart failure in Latin America. High mortality and hospitalization rates were found, and the main limitation was heterogeneity between studies. The results presented provide useful epidemiologic information for decision-making related to this disease. Further studies with standardized methods and representative populations are needed in this line (AU)