Intervenciones conductuales para la prevención de infecciones de transmisión sexual y embarazo no deseado: revisión de revisiones sistemáticas / Behavioral Interventions for Preventing Sexually Transmitted Infections and Unintended Pregnancies: An Overview of Systematic Reviews

INTRODUCCIÓN: En los últimos decenios se han desarrollado muchos programas de educación sexual en todo el mundo. Los datos epidemiológicos no indican una mejoría en las tasas de infecciones de transmisión sexual y embarazo no deseado. OBJETIVOS: Sintetizar la evidencia de las revisiones sistemáticas de mayor calidad sobre la eficacia de las intervenciones conductuales para la prevención de infecciones de transmisión sexual y embarazo no deseado. MÉTODOS: Se diseñó una «revisión de revisiones» seleccionando revisiones sistemáticas que cumpliesen unos criterios de calidad mínimos (en función del diseño de los estudios que incluyen). Se compararon los resultados obtenidos al evaluar los efectos de las intervenciones mediante criterios objetivos (datos biológicos) con los conseguidos al evaluarlos mediante criterios subjetivos (autoinforme), así como en función de si se trataba o no de una revisión Cochrane. RESULTADOS: Se identificaron 55 revisiones sistemáticas. En el 72,5% no se observó efecto global de las intervenciones en la conducta sexual de los participantes, evaluada mediante variables objetivas. Cuando se evaluaban las intervenciones mediante resultados subjetivos, no se detectó efecto global en el 48,1% de las revisiones. El 86,6% de las revisiones Cochrane no observaron efecto al usar variables objetivas, y el 70,5% no lo detectaron mediante variables subjetivas. CONCLUSIÓN: No hay evidencia de que las intervenciones conductuales modifiquen las tasas de infección de transmisión sexual (incluyendo el virus de la inmunodeficiencia humana) ni de embarazo no deseado, sobre todo cuando se evalúan mediante resultados biológicos objetivos. Es importante reevaluar las estrategias de prevención primaria en infecciones de transmisión sexual y embarazo no deseado

BACKGROUND: Countless sex education programs have been implemented worldwide in recent decades, but epidemiological data show no improvement in rates of sexually transmitted infections or unintended pregnancies. OBJECTIVE: To summarize the evidence from higher-quality systematic reviews on the efficacy of behavioral interventions for the prevention of sexually transmitted infections and unintended pregnancies. METHODS: We conducted an overview of reviews by selecting systematic reviews that met minimum quality criteria in terms of the design of the studies reviewed. We compared the results obtained when the effects of interventions were assessed on the basis of objective criteria (biological data) to those obtained when outcomes were assessed on the basis of subjective criteria (self-reports). The results of Cochrane and non-Cochrane reviews were also compared. RESULTS: We identified 55 systematic reviews. No overall effect on the sexual behavior of program participants was observed in 72.5% of the reviews that used objective criteria and in 48.1% of the reviews based on subjective criteria. In the Cochrane reviews, no evidence of an overall effect was observed in 86% of reviews based on objective variables and in 70.5% of those based on subjective variables. CONCLUSIONS: There is no evidence that behavioral interventions modify rates of sexually transmitted infections (including human immunodeficiency virus infections) or unintended pregnancies, particularly when effects are assessed using objective, biological data. Primary prevention strategies for sexually transmitted infections and unintended pregnancies need to be re-evaluated

Behavioral Interventions for Preventing Sexually Transmitted Infections and Unintended Pregnancies: An Overview of Systematic Reviews. / Intervenciones conductuales para la prevención de infecciones de transmisión sexual y embarazo no deseado: revisión de revisiones sistemáticas.

BACKGROUND: Countless sex education programs have been implemented worldwide in recent decades, but epidemiological data show no improvement in rates of sexually transmitted infections or unintended pregnancies. OBJECTIVE: To summarize the evidence from higher-quality systematic reviews on the efficacy of behavioral interventions for the prevention of sexually transmitted infections and unintended pregnancies. METHODS: We conducted an overview of reviews by selecting systematic reviews that met minimum quality criteria in terms of the design of the studies reviewed. We compared the results obtained when the effects of interventions were assessed on the basis of objective criteria (biological data) to those obtained when outcomes were assessed on the basis of subjective criteria (self-reports). The results of Cochrane and non-Cochrane reviews were also compared. RESULTS: We identified 55 systematic reviews. No overall effect on the sexual behavior of program participants was observed in 72.5% of the reviews that used objective criteria and in 48.1% of the reviews based on subjective criteria. In the Cochrane reviews, no evidence of an overall effect was observed in 86% of reviews based on objective variables and in 70.5% of those based on subjective variables. CONCLUSIONS: There is no evidence that behavioral interventions modify rates of sexually transmitted infections (including human immunodeficiency virus infections) or unintended pregnancies, particularly when effects are assessed using objective, biological data. Primary prevention strategies for sexually transmitted infections and unintended pregnancies need to be re-evaluated.

[Analysis of the reasons for consultation and dermatology care cost in a primary care site]. / Análisis de los motivos de consulta y de su coste en la asistencia dermatológica en un centro de Atención Primaria.

INTRODUCTION: The objective of the study was to the visits for esthetic reasons in an out-patient dermatology consultation and their cost and calculate the invoicing of these visits for a site other than the medical specialist consulted. METHOD: Prospective study in an out-patient dermatology clinic for 12 random days in February 2005. Endpoints of age, gender, diagnosis, cost per visit, cryotherapy and electrocoagulation were collected. Patients were divided into 3 groups: request for esthetic treatment (A), request for dermatology visit (B) and did not come (C). RESULTS: Group B was the largest, with 205 users (46 %), followed by C with 134/455 (29 %) and by A with 116/455 (25 %). In the latter group, the diagnoses were: seborrheic keratosis 39/455 (9 %), acrocordons 21/455 (5 %), remaining diagnoses (intradermal melanocytic nevi, cherry angioma, solar lentigos): 56/116 (11 %). The cost of these visits was 2,528. 8 euros in the 12 days analyzed and treatment of a subgroup of 85 patients (18.75 %) with cryotherapy or electrocoagulation increased it up to 5,043.80 euros. Estimated cost for one year would be 82,950 euros. Calculation of the invoicing for a non-public supplier site to the National Health Service would be: 8769.60 euros/month and 97,875 euros/year. If we add the treatments described, we go from 28,403.40 euros/month to 317,113.80 euros/year. CONCLUSIONS: These data and daily experience should make us think about the ethical consequences (do all the patients have to wait the same time?) as well as legal and collective ones (what type of dermatology do we want to specialize in?).

Análisis de los motivos de consulta y de su coste en la asistencia dermatológica en un centro de Atención Primaria / Analysis of the reasons for consultation and dermatology care cost in a primary care site

Introducción. El objetivo del presente estudio fue conocer las visitas por motivos estéticos en una consulta de dermatología ambulatoria y su coste y estimar la facturación que estas visitas supondrían a un centro proveedor diferente al Institut Català de la Salut (ICS). Método. Estudio prospectivo en una consulta de Dermatología ambulatoria durante 12 días aleatorios de febrero de 2005. Se recogieron variables de edad, sexo, diagnóstico, coste por visita, crioterapia y electrocoagulación. Se dividieron los pacientes en 3 grupos: demanda de tratamiento estético (A), demanda de visita dermatológica (B) y no acude (C). Resultados. El grupo B resultó el mayor, con 205 usuarios (46 %), seguido del C con 134/455 (29 %) y por el A con 116/455 (25 %). En este último grupo los diagnósticos fueron: queratosis seborreica 39/455 (9 %), acrocordones 21/455 (5 %), resto de diagnósticos (nevus melanocíticos intradérmicos, puntos rubí y lentigos solares) 56/116 (11 %). El coste de estas visitas fue de 2.528,8 euros en los 12 días analizados, y el tratamiento de un subgrupo de 85 pacientes (18,7 %) con crioterapia o electrocoagulación lo elevó hasta los 5.043,8 euros. El coste estimado para un año sería de 82.950 euros. La estimación de la facturación de un centro proveedor que no fuera de titularidad pública al Sistema Nacional de Salud (SNS) sería: 8.769,6 euros/mes y 97.875 euros/año. Si añadimos los tratamientos descritos, pasamos a 28.403,4 euros/mes y a 317.113,8 euros/año. Conclusiones. Estos datos y la experiencia diaria deben hacernos reflexionar sobre las consecuencias éticas (¿tienen que esperar todos los pacientes lo mismo?), jurídicas y colectivas (¿a qué tipo de dermatología queremos dedicarnos?)

Introduction. The objective of the study was to the visits for esthetic reasons in an out-patient dermatology consultation and their cost and calculate the invoicing of these visits for a site other than the medical specialist consulted. Method. Prospective study in an out-patient dermatology clinic for 12 random days in February 2005. Endpoints of age, gender, diagnosis, cost per visit, cryotherapy and electrocoagulation were collected. Patients were divided into 3 groups: request for esthetic treatment (A), request for dermatology visit (B) and did not come (C). Results. Group B was the largest, with 205 users (46 %), followed by C with 134/455 (29 %) and by A with 116/455 (25 %). In the latter group, the diagnoses were: seborrheic keratosis 39/455 (9 %), acrocordons 21/455 (5 %), remaining diagnoses (intradermal melanocytic nevi, cherry angioma, solar lentigos): 56/116 (11 %). The cost of these visits was 2,528. 8 euros in the 12 days analyzed and treatment of a subgroup of 85 patients (18.75 %) with cryotherapy or electrocoagulation increased it up to 5,043.80 euros. Estimated cost for one year would be 82,950 euros. Calculation of the invoicing for a non-public supplier site to the National Health Service would be: 8769.60 euros/month and 97,875 euros/year. If we add the treatments described, we go from 28,403.40 euros/month to 317,113.80 euros/year. Conclusions. These data and daily experience should make us think about the ethical consequences (do all the patients have to wait the same time?) as well as legal and collective ones (what type of dermatology do we want to specialize in?)