The burden of the most common rheumatic disease in Colombia.

BACKGROUND: Estimating the burden of rheumatic diseases (RDs) requires proper evaluation of its lethal and nonlethal consequences. In Colombia, it is possible to find local data and Global Burden of Disease (GBD) reports that collect information from varied contexts and apply complex statistical models, but no on-site estimations are available. METHODS: This was a descriptive study on the burden of RD based on occurrence and mortality data in the general population during 2015, including information and prevalence estimations from the Community Oriented Program for the Control of Rheumatic Diseases (COPCORD) study. Disability-adjusted life years (DALYs) were estimated by combining measures of years of life lost (YLL) and years lived with disability (YLDs). For disability weight estimations among cases, different COPCORD responses were mapped using flowcharts to show the severity distribution according to GBD. All model parameters and results were validated through an expert consensus panel. RESULTS: Low back pain (LBP) was the RD with the greatest burden of disease, costing 606.05 (95% CI 502.76-716.58) DALYs per 100,000 inhabitants, followed by osteoarthritis (292.11; 95% CI 205.76-386.85) and rheumatoid arthritis (192.46, 95% CI 109.7-239.69). CONCLUSIONS: The burden of RD is as high in Colombia as in other countries of the region. The results offer an interesting tool for optimizing healthcare system design as well as for planning the distribution of human and economic resources to achieve early diagnosis and adequate care of these diseases.

Metodologías para la priorización en investigación en salud: una revisión sistemática de la literatura

Objetivo. Identificar elementos metodológicos clave para la priorización en investigación en salud, a partir de las metodologías reportadas en la literatura científica. Métodos. Se realizó una búsqueda sistemática en Medline, Embase, LILACS, y fuentes complementarias de literatura gris. Se utilizaron las palabras clave: research, methods y Health priorities, en combinación con términos libres. Dos revisores independientes, de acuerdo con criterios previamente definidos, seleccionaron revisiones de la literatura o documentos metodológicos que presentaran metodologías para priorización en investigación en salud. Se extrajeron las principales características de las metodologías reportadas y se identificaron elementos comunes. Resultados. Se incluyeron siete revisiones y cinco documentos metodológicos, que reportaron cuatro metodologías estructuradas específicas y múltiples aproximaciones metodológicas que combinan elementos diversos. En general, estas metodologías integran la perspectiva de actores clave con información objetiva, mediante la aplicación de técnicas estandarizadas de participación, para establecer un ranking de prioridades, con base en criterios previamente definidos. Se identificaron elementos metodológicos comunes relacionados con pasos del proceso, mecanismos de participación, criterios para priorizar y análisis de resultados. Conclusión. La priorización en investigación en salud requiere el empleo de una metodología definida a priori, que debe contener como mínimo cuatro elementos clave: pasos claros del proceso, criterios para priorizar, técnicas formales de participación y métodos de análisis de resultados. Estos elementos deben ajustarse a las condiciones y necesidades del contexto de aplicación.

Objective. To identify key methodological elements for prioritization in health research, based on the methodologies reported in the scientific literature. Methods. A systematic search was conducted in Medline, Embase, LILACS, and complementary sources of gray literature. Keywords research, methods and health priorities were used in combination with free terms. Two independent reviewers, according to previously defined criteria, selected literature reviews or methodological documents that presented methodologies for prioritization in health research. The main characteristics of the reported methodologies were extracted and common elements were identified. Results. Seven revisions and five methodological documents were included, reporting four specific structured methodologies and multiple methodological approaches combining diverse elements. In general, these methodologies integrate the perspective of key stakeholders with objective information, through the application of standardized participation techniques, to establish a ranking of priorities based on previously defined criteria. Common methodological elements related to process steps, participation mechanisms, criteria for prioritizing and analysis of results were identified. Conclusion. The prioritization in health research requires the use of a methodology defined a priori, which must contain at least four key elements: clear steps of the process, criteria to prioritize, formal techniques of participation and methods for analysis of results. These elements should be tailored to the conditions and needs of the application context.

Objetivo. Identificar os principais aspectos metodológicos para a priorização em pesquisa em saúde segundo metodologias descritas na literatura científica. Métodos. Foi realizada uma busca sistemática nas bases de dados MEDLINE, Embase, LILACS e fontes complementares da literatura cinzenta. Foram usadas as palavras-chave research, methods e health priorities, em combinação com termos livres. Dois revisores independentes selecionaram, com base em critérios predefinidos, estudos de revisão da literatura ou textos metodológicos que descreviam metodologias para a priorização em pesquisa em saúde. Foram extraídas as principais características das metodologias descritas e identificados os aspectos comuns. Resultados. Foram incluídos sete estudos de revisão e cinco textos metodológicos, que descreviam quatro metodologias estruturadas específicas e vários enfoques metodológicos que combinavam diversos aspectos. As metodologias em geral integram a perspectiva de atores-chave com informação objetiva, com a aplicação de técnicas padronizadas de participação, a fim de determinar a ordem de prioridade segundo critérios predefinidos. Foram identificados aspectos metodológicos comuns relacionados às etapas do processo, mecanismos de participação, critérios para priorização e análise de resultados. Conclusão. A priorização em pesquisa em saúde requer o uso de uma metodologia definida a priori, que no mínimo deve englobar quatro aspectos principais: etapas distintas do processo, critérios para priorização, técnicas formais de participação e métodos de análise de resultados. Estes aspectos devem ser adaptados às condições e necessidades do contexto de aplicação.

Indice compuesto de inequidad en salud para un país de mediano ingreso / Composite Index of health Inequity for a Middle Income Country

RESUMEN Objetivo Desarrollar y validar un índice compuesto de inequidad en salud basado en mortalidad por grupos de causas. Métodos Estudio ecológico en país de mediano ingreso latinoamericano, con indicadores agregados disponibles de municipios y departamentos, que se seleccionaron a partir de observatorios de salud, grupos de investigación y autoridades sanitarias. Se dividen en intolerables y "no completamente evitables" según el avance científico actual, y se agregan en categorías: accidente de tránsito, agresiones, enfermedad renal, infección por VIH, parasitosis intestinal, sífilis, enfermedad de transmisión fecal/oral, tuberculosis, enfermedad transmitidas por vectores, enfermedad respiratoria, eventos hemorrágicos/ isquémicos cerebrales, mortalidad materna, mortalidad menores 5 años, meningitis. Luego de análisis de componentes principales se obtiene índice compuesto multidimensional de inequidad en salud (IIS) para hombres y mujeres. Consistencia interna se evalúa mediante coeficiente Alpha de Cronbach. Se hace validación concurrente con proporción de personas en Necesidades Básicas Insatisfechas (NBI), Índice de Desarrollo Humano (IDH), Expectativa de Vida al Nacer (EVN) entre otros. Resultados Se construye IIS que muestra valores más altos para las mujeres en la mayoría de municipios y departamentos; y para lugares con IDH alto, EVN alta y NBI bajas. El alpha de Cronbach fue 0.6688, IIS-hombres y 0.725, IIS-mujeres. Conclusiones Se obtiene IIS factible, reproducible y mutidimensional. Se destaca el papel de las grandes ciudades en las inequidades en salud, probablemente por el efecto de los intolerables en salud.(AU)

ABSTRACT Objective To develop and validate a composite index of health inequity based on mortality by grouped causes. Methods An ecological study in a middle-income Latin American country, with aggregate indicators available from municipalities and departments, which were selected from health observatories, research groups and health authorities. They were divided into intolerable and "not completely avoidable" according to current scientific progress, and were added in categories: traffic accident, aggression, kidney disease, HIV infection, intestinal parasitic diseases, syphilis, fecal / oral transmission disease, tuberculosis, disease Vector-borne diseases, respiratory disease, cerebral hemorrhagic / ischemic events, maternal mortality, lower mortality 5 years, meningitis. After analysis of main components, a composite index of health inequity (IIS) is obtained for men and women. Internal consistency was evaluated using Cronbach's Alpha coefficient. Concurrent validation was done with proportion of people in Unsatisfied Basic Needs (UBN), Human Development Index (HDI), Life Expectancy at Birth (LEB), among others. Results IIS is built showing higher values for women in most municipalities and departments; And for sites with high HDI, high LEB and low UBN. Cronbach's alpha was 0.6688, IIS-men and 0.725, IIS-women. Conclusions An IIS was obtained, is valid and reproducible. The role of big cities in inequities in health is highlighted, probably due to the effect of intolerable health.(AU)

[Composite Index of health Inequity for a Middle Income Country]. / Indice compuesto de inequidad en salud para un país de mediano ingreso.

OBJECTIVE: To develop and validate a composite index of health inequity based on mortality by grouped causes. METHODS: An ecological study in a middle-income Latin American country, with aggregate indicators available from municipalities and departments, which were selected from health observatories, research groups and health authorities. They were divided into intolerable and "not completely avoidable" according to current scientific progress, and were added in categories: traffic accident, aggression, kidney disease, HIV infection, intestinal parasitic diseases, syphilis, fecal / oral transmission disease, tuberculosis, disease Vector-borne diseases, respiratory disease, cerebral hemorrhagic / ischemic events, maternal mortality, lower mortality 5 years, meningitis. After analysis of main components, a composite index of health inequity (IIS) is obtained for men and women. Internal consistency was evaluated using Cronbach's Alpha coefficient. Concurrent validation was done with proportion of people in Unsatisfied Basic Needs (UBN), Human Development Index (HDI), Life Expectancy at Birth (LEB), among others. RESULTS: IIS is built showing higher values for women in most municipalities and departments; And for sites with high HDI, high LEB and low UBN. Cronbach's alpha was 0.6688, IIS-men and 0.725, IIS-women. CONCLUSIONS: An IIS was obtained, is valid and reproducible. The role of big cities in inequities in health is highlighted, probably due to the effect of intolerable health.

OBJETIVO: Desarrollar y validar un índice compuesto de inequidad en salud basado en mortalidad por grupos de causas. MÉTODOS: Estudio ecológico en país de mediano ingreso latinoamericano, con indicadores agregados disponibles de municipios y departamentos, que se seleccionaron a partir de observatorios de salud, grupos de investigación y autoridades sanitarias. Se dividen en intolerables y "no completamente evitables" según el avance científico actual, y se agregan en categorías: accidente de tránsito, agresiones, enfermedad renal, infección por VIH, parasitosis intestinal, sífilis, enfermedad de transmisión fecal/oral, tuberculosis, enfermedad transmitidas por vectores, enfermedad respiratoria, eventos hemorrágicos/ isquémicos cerebrales, mortalidad materna, mortalidad menores 5 años, meningitis. Luego de análisis de componentes principales se obtiene índice compuesto multidimensional de inequidad en salud (IIS) para hombres y mujeres. Consistencia interna se evalúa mediante coeficiente Alpha de Cronbach. Se hace validación concurrente con proporción de personas en Necesidades Básicas Insatisfechas (NBI), Índice de Desarrollo Humano (IDH), Expectativa de Vida al Nacer (EVN) entre otros. RESULTADOS: Se construye IIS que muestra valores más altos para las mujeres en la mayoría de municipios y departamentos; y para lugares con IDH alto, EVN alta y NBI bajas. El alpha de Cronbach fue 0.6688, IIS-hombres y 0.725, IIS-mujeres. CONCLUSIONES: Se obtiene IIS factible, reproducible y mutidimensional. Se destaca el papel de las grandes ciudades en las inequidades en salud, probablemente por el efecto de los intolerables en salud.

Metodologías para la priorización en investigación en salud: una revisión sistemática de la literatura / Methodologies for prioritization in health research: a systematic review of the literature / Metodologias para a priorização em pesquisa em saúde: uma revisão sistemática da literatura

RESUMEN Objetivo Identificar elementos metodológicos clave para la priorización en investigación en salud, a partir de las metodologías reportadas en la literatura científica. Métodos Se realizó una búsqueda sistemática en Medline, Embase, LILACS, y fuentes complementarias de literatura gris. Se utilizaron las palabras clave: research, methods y health priorities, en combinación con términos libres. Dos revisores independientes, de acuerdo con criterios previamente definidos, seleccionaron revisiones de la literatura o documentos metodológicos que presentaran metodologías para priorización en investigación en salud. Se extrajeron las principales características de las metodologías reportadas y se identificaron elementos comunes. Resultados Se incluyeron siete revisiones y cinco documentos metodológicos, que reportaron cuatro metodologías estructuradas específicas y múltiples aproximaciones metodológicas que combinan elementos diversos. En general, estas metodologías integran la perspectiva de actores clave con información objetiva, mediante la aplicación de técnicas estandarizadas de participación, para establecer un ranking de prioridades, con base en criterios previamente definidos. Se identificaron elementos metodológicos comunes relacionados con pasos del proceso, mecanismos de participación, criterios para priorizar y análisis de resultados. Conclusión La priorización en investigación en salud requiere el empleo de una metodología definida a priori, que debe contener como mínimo cuatro elementos clave: pasos claros del proceso, criterios para priorizar, técnicas formales de participación y métodos de análisis de resultados. Estos elementos deben ajustarse a las condiciones y necesidades del contexto de aplicación.

Objective To identify key methodological elements for prioritization in health research, based on the methodologies reported in the scientific literature. Methods A systematic search was conducted in Medline, Embase, LILACS, and complementary sources of gray literature. Keywords research, methods and health priorities were used in combination with free terms. Two independent reviewers, according to previously defined criteria, selected literature reviews or methodological documents that presented methodologies for prioritization in health research. The main characteristics of the reported methodologies were extracted and common elements were identified. Results Seven revisions and five methodological documents were included, reporting four specific structured methodologies and multiple methodological approaches combining diverse elements. In general, these methodologies integrate the perspective of key stakeholders with objective information, through the application of standardized participation techniques, to establish a ranking of priorities based on previously defined criteria. Common methodological elements related to process steps, participation mechanisms, criteria for prioritizing and analysis of results were identified. Conclusion The prioritization in health research requires the use of a methodology defined a priori, which must contain at least four key elements: clear steps of the process, criteria to prioritize, formal techniques of participation and methods for analysis of results. These elements should be tailored to the conditions and needs of the application context.

RESUMO Objetivo Identificar os principais aspectos metodológicos para a priorização em pesquisa em saúde segundo metodologias descritas na literatura científica. Métodos Foi realizada uma busca sistemática nas bases de dados MEDLINE, Embase, LILACS e fontes complementares da literatura cinzenta. Foram usadas as palavras-chave research, methods e health priorities, em combinação com termos livres. Dois revisores independentes selecionaram, com base em critérios predefinidos, estudos de revisão da literatura ou textos metodológicos que descreviam metodologias para a priorização em pesquisa em saúde. Foram extraídas as principais características das metodologias descritas e identificados os aspectos comuns. Resultados Foram incluídos sete estudos de revisão e cinco textos metodológicos, que descreviam quatro metodologias estruturadas específicas e vários enfoques metodológicos que combinavam diversos aspectos. As metodologias em geral integram a perspectiva de atores-chave com informação objetiva, com a aplicação de técnicas padronizadas de participação, a fim de determinar a ordem de prioridade segundo critérios predefinidos. Foram identificados aspectos metodológicos comuns relacionados às etapas do processo, mecanismos de participação, critérios para priorização e análise de resultados. Conclusão A priorização em pesquisa em saúde requer o uso de uma metodologia definida a priori, que no mínimo deve englobar quatro aspectos principais: etapas distintas do processo, critérios para priorização, técnicas formais de participação e métodos de análise de resultados. Estes aspectos devem ser adaptados às condições e necessidades do contexto de aplicação.

Frequency of hemorrhagic complications in plasmapheresis without extracorporeal circuit anticoagulation, in children.

BACKGROUND: The current practice of plasmapheresis at most centers employs anticoagulation of the extracorporeal circuit, which has been associated with complications. There are few studies evaluating the efficacy and safety of using plasmapheresis without any anticoagulation. We report our experience using this strategy in children (1 month to 18 years old) over a period of 5 years. RESULTS: Two hundred forty-three plasmapheresis sessions without anticoagulation of the extracorporeal circuit, in 27 pediatric patients, were analyzed. Of these, 81.4% were female and the predominant age range was 12-18 years (70.3%). One hundred percent of the patients had PRISM III scale low mortality risk, and the main indication of therapy was acute rejection after renal transplantation (25.9%), followed by recurrence of focal segmental sclerosis in the transplanted kidney (17.2%). Filtration lasted more than 3 hours in 86.8% of cases, with bleeding complications in 2.9% of patients requiring early termination due to associated complications in 3.2% of cases. Other complications were paresthesias (0.41%), vomiting (5%), hypertension during (67.4%) and after therapy (64.6%), and hyperchloremia (46.5%). CONCLUSIONS: In our experience, plasmapheresis without circuit anticoagulation in children is safe and effective, with a low frequency of bleeding and hydroelectrolytic complications, allowing the achievement of therapeutic goals without altering therapy duration and efficiency. Prospective studies are needed to corroborate these findings.

Hepatitis C in key populations in Latin America and the Caribbean: systematic review and meta-analysis.

OBJECTIVES: Summarize hepatitis C virus (HCV) prevalence in injecting (IDU) and non-injecting drug users (NIDU), men who have sex with men (MSM), sex workers, and prison inmates in Latin America and the Caribbean (LAC). METHODS: Systematic review on HCV prevalence in sub-populations in LAC. Databases searched from 1-1-2000 to 10-30-2013. INCLUSION CRITERIA: prevalence studies in sub-populations in LAC. HCV-antibody was marker for prevalence of current/past HCV infection and HCV-RNA for prevalence of HCV current infection. RESULTS: IDU HCV current/past infection presented highest prevalence, from 1.7 % in Colombia to over 95 % in Ciudad Juarez and Tijuana, Mexico and pooled regional anti-HCV prevalence was 49 % (CI 95 % 22.6-76.3 %). NIDU, MSM and sex workers anti-HCV prevalence was below 10 %, and pooled regional prevalence of 4 % (CI 95 % 2.6-4.5 %), 3 % (CI 95 % 1.7-4.5 %) and 2 % (CI 95 % 1.0-3.4 %), respectively. Prison inmates presented higher values, but prevalence decreased over the 15-year time span (p < 0.001). Current HCV infection from three countries showed prevalence under 10 % in prison inmates and 1-46 % among drug users. CONCLUSIONS: Disease burden is high and surveillance, prevention and treatment should target these groups in LAC.

Characteristics of randomized trials published in Latin America and the Caribbean according to funding source.

INTRODUCTION: Few studies have assessed the nature and quality of randomized controlled trials (RCTs) in Latin America and the Caribbean (LAC). METHODS AND FINDINGS: The aims of this systematic review are to evaluate the characteristics (including the risk of bias assessment) of RCT conducted in LAC according to funding source. A review of RCTs published in 2010 in which the author's affiliation was from LAC was performed in PubMed and LILACS. Two reviewers independently extracted data and assessed the risk of bias. The primary outcomes were risk of bias assessment and funding source. A total of 1,695 references were found in PubMed and LILACS databases, of which 526 were RCTs (N = 73.513 participants). English was the dominant publication language (93%) and most of the RCTs were published in non-LAC journals (84.2%). Only five of the 19 identified countries accounted for nearly 95% of all RCTs conducted in the region (Brazil 70.9%, Mexico 10.1%, Argentina 5.9%, Colombia 3.8%, and Chile 3.4%). Few RCTs covered priority areas related with Millennium Development Goals like maternal health (6.7%) or high priority infectious diseases (3.8%). Regarding children, 3.6% and 0.4% RCT evaluated nutrition and diarrhea interventions respectively but none pneumonia. As a comparison, aesthetic and sport related interventions account for 4.6% of all trials. A random sample of RCTs (n = 358) was assessed for funding source: exclusively public (33.8%); private (e.g. pharmaceutical company) (15.3%); other (e.g. mixed, NGO) (15.1%); no funding (35.8%). Overall assessments for risk of bias showed no statistically significant differences between RCTs and type of funding source. Statistically significant differences favoring private and others type of funding was found when assessing trial registration and conflict of interest reporting. CONCLUSION: Findings of this study could be used to provide more direction for future research to facilitate innovation, improve health outcomes or address priority health problems.

Trial registration in Latin America and the Caribbean's: study of randomized trials published in 2010.

OBJECTIVE: To determine the prevalence of trial registration in randomized controlled trials (RCTs) published in 2010 (PUBMED/LILACS) from Latin America and the Caribbean's (LAC) and to compare methodological characteristics between registered and nonregistered RCTs. STUDY DESIGN AND SETTING: A search for detecting RCTs in which at least the first/contact author had a LAC's affiliation was made. We determined if RCTs were registered in the International Clinical Trial Registry Platform (ICTRP). Data were independently extracted by two authors. The risk of bias (RoB) was assessed in all registered RCTs (n=89) and in a sample of nonregistered RCTs (n=237). RESULTS: The search identified 1,695 references; 526 RCTs from 19 countries were included. 16.9% (89/526) of RCTs were registered in the ICTRP; however, only 21 (4.0%) were prospectively registered. A significant difference was found in the overall assessment of the RoB between registered and nonregistered RCTs. Overall, registered RCTs were multinational, had larger sample size and longer follow-up, and reported more frequently information on funding, conflict of interests, and ethic issues. No significant differences were found when analyzing prospectively registered RCTs. CONCLUSION: This study shows that trial registration rates are still low in LAC and the quality of reporting needs to be improved.