Comparative cohort analysis of pressure ulcer/injury in intensive care unit patients before and during the COVID-19 pandemic.

COVID-19 has emerged as a global pandemic leading to an increase in hospitalization and intensive care unit (ICU) admissions worldwide. Due to severe acute respiratory distress syndrome (ARDS), many patients require prone positioning, which is associated with increased pressure ulcer/injury (PU/PI) incidence. COVID-19 pathophysiology may favor the occurrence of PU/PI due to hypoxemia, inflammatory status, and vasculopathy. This study aimed to compare the incidence of PU/PI in ICU patients before and during the COVID-19 pandemic. A retrospective cohort study was conducted at a university hospital in Brazil. Data from the medical charts of every adult patient admitted to ICU from March to July 2019 and the same period in 2020 were collected. The group from 2019 included 408 patients admitted due to multiple causes, and the group from 2020 included 229 patients admitted due to COVID-19 infection. The incidence of PU/PI was significantly higher in patients admitted in 2020 compared to 2019 (62,5 vs. 33,8%, respectively). Also, PU/PI location and severity have been different between groups, with the patients with COVID-19 (2020 group) more exposed to stage 3, 4, and non-stageable lesions, as well as more PU/PI on face skin and other less common locations. In conclusion, the COVID-19 pandemic has highlighted a higher PU/PI incidence. ICU patients were older during the pandemic, had higher body mass index and comorbidities, and needed more invasive medical devices and pronation. The occurrence of PU/PI was also associated with prolonged hospitalization and mortality.

Effect of Medication Therapy Management by Pharmaceutical Care on Blood Pressure and Cardiovascular Risk in Hypertension: A Systematic Review, Meta-Analysis, and Meta-Regression.

Medication therapy management by pharmaceutical care (MTM-PC) has been shown to improve the effectiveness of antihypertensive treatments. The aim was to answer the question: what are the MTM-PC models and their impact on hypertensive patients' outcomes? This is a systematic review with meta-analysis. The search strategies were run on 27 September 2022 in the following databases: PubMed, EMBASE, Scopus, LILACs, Central Cochrane Library, Web of Science; and International Pharmaceutical Abstracts. The quality and bias risk was assessed by the Downs and Black instrument. Forty-one studies met the eligibility criteria and were included, Kappa = 0.86; 95% CI, 0.66-1.0; (p < 0.001). Twenty-seven studies (65.9%) had MTM-PC models outlined by the clinical team, showing as characteristics the mean of 10.0 ± 10.7 months of follow-up of hypertensive patients, with 7.7 ± 4.9 consultations. Instruments to assess the quality of life measured the enhancement by 13.4 ± 10.7% (p = 0.047). The findings of the meta-analysis show a mean reduction of -7.71 (95% CI, -10.93 to -4.48) and -3.66 (95% CI, -5.51 to -1.80), (p < 0.001) in mmHg systolic and diastolic pressures, respectively. Cardiovascular relative risk (RR) over ten years was 0.561 (95% CI, 0.422 to 0.742) and RR = 0.570 (95% CI, 0.431 to 0.750), considering homogeneous studies, I² = 0%. This study shows the prevalence of MTM-PC models outlined by the clinical team, in which there are differences according to the models in reducing blood pressure and cardiovascular risk over ten years with the improvement in quality of life.

Validação de face, conteúdo e semântica da escala de avaliação do risco de quedas em pessoas idosas que vivem na comunidade / Face, content and semantic validation of the scale for assessing the risk of falls in community-dwelling elderly people / Validación facial, de contenido y semántica de la escala de evaluación del riesgo de caídas en ancianos residentes en la comunidad

Introdução: quedas em pessoas idosas constituem um sério problema de saúde e geram muitas preocupações para estudiosos e clínicos da geriatria e gerontologia. Objetivo: avaliar a validade de face e de conteúdo e a validade semântica de uma escala de avaliação do risco de quedas em idosos que vivem na comunidade. Método: trata-se de um estudo do tipo metodológico, com realização das seguintes etapas: validade de face e de conteúdo e análise semântica. Na análise de validade de face e de conteúdo, foram convidados sete juízes especialistas na área de saúde da pessoa idosa e do método em questão. Concernente à análise semântica, a referida escala foi aplicada em 20 idosos selecionadas por conveniência. Resultados: dos sete juízes contatados, cinco retornaram com os instrumentos. Na análise de aparência, cinco itens receberam concordância inferior a 80%. Na análise semântica, apenas dois itens foram identificados como de difícil compreensão pelas pessoas idosas. A segunda versão da escala apresentava 43 itens e, após avaliação dos juízes, passou a compor 44 itens. Conclusão: a escala apresenta validade de face, de conteúdo e semântica para o contexto atual e para a população-alvo estudada, sendo importante sua revisão e adequação em momentos pósteros a fim de acompanhar os avanços científicos da geriatria e gerontologia.

Introduction: falls in elderly people constitute a serious health problem and generate many concerns for scholars and clinicians in geriatrics and gerontology. Objective: to evaluate the face and content validity and semantic validity of a scale to assess the risk of falls in community-dwelling elderly people. Method: this is a methodological study, with the following stages: face and content validity and semantic analysis. For the face and content validity analysis, seven judges, experts in the area of elderly health and the method in question, were invited. Regarding the semantic analysis, the scale was applied to 20 elderly people selected by convenience. Results: of the seven judges contacted, five returned with the instruments. In the appearance analysis, five items received less than 80% agreement. In the semantic analysis, only two items were identified as difficult to understand by the elderly. The second version of the scale had 43 items and, after the judges' evaluation, it became 44 items. Conclusion: the scale presents face, content and semantic validity for the current context and for the target population studied, being important its revision and adequacy in later moments in order to follow the scientific advances in geriatrics and gerontology.

Introducción: las caídas en ancianos constituyen un grave problema de salud y generan muchas preocupaciones a los estudiosos y clínicos en geriatría y gerontología. Objetivo: evaluar la validez facial y de contenido y la validez semántica de una escala para evaluar el riesgo de caídas en ancianos residentes en la comunidad. Método: se trata de un estudio metodológico, con las siguientes etapas: validez facial y de contenido y análisis semántico. Para el análisis de la validez facial y de contenido se invitó a siete jueces, expertos en el ámbito de la salud de las personas mayores y en el método en cuestión. En cuanto al análisis semántico, la escala se aplicó a 20 ancianos seleccionados por conveniencia. Resultados: de los siete jueces contactados, cinco devolvieron los instrumentos. En el análisis de apariencia, cinco ítems recibieron menos del 80% de acuerdo. En el análisis semántico, sólo dos ítems fueron identificados como difíciles de entender por las personas mayores. La segunda versión de la escala tenía 43 ítems y, tras la evaluación de los jueces, pasó a tener 44 ítems. Conclusión: la escala presenta validez facial, de contenido y semántica para el contexto actual y para la población objetivo estudiada, siendo importante su revisión y adecuación en momentos posteriores para acompañar los avances científicos en geriatría y gerontología.

COSTS ANALYSIS OF SPINAL COLUMN METASTASES SURGICAL TREATMENT.

Introduction: End-of-life cancer treatment is associated with substantial healthcare costs. Objective: This study aimed to analyze the surgical treatment cost of spinal metastasis and epidural compression patients undergoing surgical treatment. Methods: A retrospective cost analysis of 81 patients with spinal metastasis and epidural compression undergoing surgical treatment. Cost evaluation was defined in the following categories: medications, laboratory and imaging tests, nursery, recovery room, intensive care unit, surgical procedure, and consigned material. The cost of pain improvement, functional activity, and survival was also evaluated. Results: The total cost of surgical treatment for 81 patients was $3,604,334.26, and the average value for each patient was $44,497.95. The highest costs were related to implants (41.1%), followed by hospitalization (27.3%) and surgical procedure (19.7%). Conclusion: The cost of surgical treatment for spinal metastases is one of the most expensive bone complications in cancer patients. The cost of treatment related to outcomes showed differences according to the outcome analyzed. Hospital stay, tests, drugs, and intensive care play an important role in some of the costs related to the specific outcome. Level of Evidence II, Retrospective Study .

Introdução: O tratamento do câncer em fim de vida está associado a custos substanciais em saúde. Objetivo: O objetivo do estudo foi analisar o custo do tratamento cirúrgico de pacientes com metástase espinhal e compressão peridural submetidos ao tratamento cirúrgico. Métodos: Uma análise retrospectiva de custos de 81 pacientes com metástase espinhal e compressão peridural submetidos a tratamento cirúrgico. A avaliação de custos foi definida nas seguintes categorias: medicamentos, exames laboratoriais e de imagem, enfermaria, sala de recuperação, unidade de terapia intensiva, procedimento cirúrgico e material consignado. O custo relacionado à melhora da dor, atividade funcional e sobrevida também foi avaliado. Resultados: O custo total do tratamento cirúrgico de 81 pacientes foi de R $ 3.604.334,26 e o valor médio de cada paciente foi de R $ 44.497,95. Os maiores gastos foram relacionados com implantes (41,1%), seguidos de internação (27,3%) e procedimento cirúrgico (19,7%). Conclusão: O custo do tratamento cirúrgico para metástases espinhais é um dos mais caros entre as complicações ósseas em pacientes com câncer. O custo do tratamento relacionado aos desfechos apresentou diferença de acordo com o desfecho analisado e a permanência hospitalar, exames, medicamentos e terapia intensiva tem papel importante em alguns dos custos relacionados ao desfecho específico. Nível de Evidência II, Estudo retrospectivo .

The cost of total hip replacement: a multicentric TDABC comparison in Brazil / O custo da artroplastia de quadril: uma comparação multicêntrica TDABC no Brasil

Objective: Monitoring costs is critical in searching for a more effective healthcare system. This study aimed to comprehend the care pathway and measure the costs associated with hip replacement surgeries in different hospitals in Brazil. Methods: The time-driven activity-based costing method was applied for cost data collection and analyses. Data on 62 patients were retrieved from five public hospitals. A descriptive cost analysis was followed by a comprehensive analysis of the variability in each hospital's care process, leading to suggestions for cost-saving opportunities along with the surgical care pathway. As a final analysis, the cost of surgical treatment was contrasted with the national reimbursement fee. Results: The mean cost per patient of the total sample was $5,784 (MIN-MAX $2,525.9-$9,557.8). Pre- and post-surgery hospitalization periods demonstrated the highest variability in length of time and resource consumption among centers. Compared to the national best practice fee, the average cost per inpatient total hip arthroplasty (THA) pathway from all six hospitals was approximately 7x the national reimbursement. Conclusion: The application of the TDABC allowed us to identify differences in the surgical care pathway among hospitals, which could be explored in further studies aimed at designing a benchmark surgical pathway. Differences in how the treatment is delivered to patients also justified the high-cost variability among centers.

Objetivo: O custo do monitoramento é um elemento-chave na busca contínua por um sistema de saúde mais eficaz. O objetivo deste estudo foi compreender a trajetória assistencial e mensurar os custos associados às cirurgias de artroplastia do quadril em diferentes hospitais do Brasil. Métodos: O método de custeio baseado em atividades orientado pelo tempo foi aplicado para a coleta e análise de dados de custos. Os dados de 62 pacientes foram recuperados de cinco hospitais públicos. Uma análise descritiva de custos foi seguida por uma análise abrangente da variabilidade no processo de atendimento de cada hospital, levando a sugestões de oportunidades de redução de custos junto com a via de atendimento cirúrgico. Como análise final, o custo do tratamento cirúrgico foi contrastado com o valor de reembolso nacional. Resultados: O custo médio por paciente da amostra total foi de $ 5.784 (MIN-MAX $ 2.525,9-$ 9.557,8). Os períodos de internação pré e pós-operatórios demonstraram a maior variabilidade no tempo e no consumo de recursos entre os centros. Em comparação com o reembolso nacional de melhores práticas, o custo médio por cirurgia de prótese de quadril de paciente internado de todos os seis hospitais foi de aproximadamente 7x o reembolso nacional. Conclusão: A aplicação do TDABC nos permitiu identificar diferenças na via de atendimento cirúrgico entre hospitais, o que poderia ser explorado em estudos futuros que visem projetar uma via cirúrgica de referência. As diferenças na forma como o tratamento está sendo entregue aos pacientes também contribuíram para justificar a alta variabilidade dos custos entre os centros.

Moving the Brazilian ischaemic stroke pathway to a value-based care: introduction of a risk-adjusted cost estimate model for stroke treatment.

The unsustainable increases in healthcare expenses and waste have motivated the migration of reimbursement strategies from volume to value. Value-based healthcare requires detailed comprehension of cost information at the patient level. This study introduces a clinical risk- and outcome-adjusted cost estimate model for stroke care sustained on time-driven activity-based costing (TDABC). In a cohort and multicentre study, a TDABC tool was developed to evaluate the costs per stroke patient, allowing us to identify and describe differences in cost by clinical risk at hospital arrival, treatment strategies and modified Rankin Score (mRS) at discharge. The clinical risk was confirmed by multivariate analysis and considered patients' National Institute for Health Stroke Scale and age. Descriptive cost analyses were conducted, followed by univariate and multivariate models to evaluate the risk levels, therapies and mRS stratification effect in costs. Then, the risk-adjusted cost estimate model for ischaemic stroke treatment was introduced. All the hospitals collected routine prospective data from consecutive patients admitted with ischaemic stroke diagnosis confirmed. A total of 822 patients were included. The median cost was I$2210 (interquartile range: I$1163-4504). Fifty percent of the patients registered a favourable outcome mRS (0-2), costing less at all risk levels, while patients with the worst mRS (5-6) registered higher costs. Those undergoing mechanical thrombectomy had an incremental cost for all three risk levels, but this difference was lower for high-risk patients. Estimated costs were compared to observed costs per risk group, and there were no significant differences in most groups, validating the risk and outcome-adjusted cost estimate model. By introducing a risk-adjusted cost estimate model, this study elucidates how healthcare delivery systems can generate local cost information to support value-based reimbursement strategies employing the data collection instruments and analysis developed in this study.

Predictors of hospital readmission within 30 days after surgery for thoracolumbar fractures: A mixed approach.

BACKGROUND: Readmission followed by surgery to treat spinal fractures has a substantial impact on patient care costs and reflects a hospital's quality standards. This article analyzes the factors associated with hospital readmission followed by surgery to treat spinal fractures. METHODS: This was a cross-sectional study with time-series analysis. For prediction analysis, we used Cox proportional hazards and machine-learning models, using data from the Healthcare Cost and Utilization Project, Inpatient Database from Florida (USA). RESULTS: The sample comprised 215,999 patients, 8.8% of whom were readmitted within 30 days. The factors associated with a risk of readmission were male sex (1.1 [95% confidence interval 1.06-1.13]) and >60 years of age (1.74 [95% CI: 1.69-1.8]). Surgeons with a higher annual patient volume presented a lower risk of readmission (0.61 [95% CI: 0.59-0.63]) and hospitals with an annual volume >393 presented a lower risk (0.92 [95% CI: 0.89-0.95]). CONCLUSION: Surgical procedures and other selected predictors and machine-learning models can be used to reduce 30-day readmissions after spinal surgery. Identification of patients at higher risk for readmission and complications is the first step to reducing unplanned readmissions.

Time-driven activity-based costing as a strategy to increase efficiency: An analyses of interventional coronary procedures.

Monitoring the costs is one of the key components underlying value-based health care. This study aimed to evaluate the cost-saving opportunities of interventional coronary procedures (ICPs). Data from 90 patients submitted to elective ICP were evaluated in five Brazilian hospitals. Time-driven activity-based costing, that guides the cost estimates using the time consumed and the capacity cost rates per resource as the data input, was used to assess costs and the time spent over the care pathway. Descriptive cost analyses were followed by a labour cost-saving estimate potentially achieved by the redesign of the ICP pathway. The mean cost per patient varied from $807 to $2639. The length of the procedure phase per patient was similar among the hospitals, while the post-procedure phase presented the highest variation in length. The highest direct cost saving opportunities are concentrated in the procedure phase. By comparing the benchmark service with the most expensive one, it was estimated that redesigning physician practices could decrease 51% of the procedure cost. This application is pioneered in Brazil and demonstrates how detailed cost information can contribute to driving health care management to value by identifying cost-saving opportunities.

Costs analysis of spinal column metastases surgical treatment / Análise dos custos do tratamento cirúrgico das metástases da coluna vertebral

ABSTRACT Introduction End-of-life cancer treatment is associated with substantial healthcare costs. Objective This study aimed to analyze the surgical treatment cost of spinal metastasis and epidural compression patients undergoing surgical treatment. Methods A retrospective cost analysis of 81 patients with spinal metastasis and epidural compression undergoing surgical treatment. Cost evaluation was defined in the following categories: medications, laboratory and imaging tests, nursery, recovery room, intensive care unit, surgical procedure, and consigned material. The cost of pain improvement, functional activity, and survival was also evaluated. Results The total cost of surgical treatment for 81 patients was $3,604,334.26, and the average value for each patient was $44,497.95. The highest costs were related to implants (41.1%), followed by hospitalization (27.3%) and surgical procedure (19.7%). Conclusion The cost of surgical treatment for spinal metastases is one of the most expensive bone complications in cancer patients. The cost of treatment related to outcomes showed differences according to the outcome analyzed. Hospital stay, tests, drugs, and intensive care play an important role in some of the costs related to the specific outcome. Level of Evidence II, Retrospective Study.

RESUMO Introdução O tratamento do câncer em fim de vida está associado a custos substanciais em saúde. Objetivo O objetivo do estudo foi analisar o custo do tratamento cirúrgico de pacientes com metástase espinhal e compressão peridural submetidos ao tratamento cirúrgico. Métodos Uma análise retrospectiva de custos de 81 pacientes com metástase espinhal e compressão peridural submetidos a tratamento cirúrgico. A avaliação de custos foi definida nas seguintes categorias: medicamentos, exames laboratoriais e de imagem, enfermaria, sala de recuperação, unidade de terapia intensiva, procedimento cirúrgico e material consignado. O custo relacionado à melhora da dor, atividade funcional e sobrevida também foi avaliado. Resultados O custo total do tratamento cirúrgico de 81 pacientes foi de R $ 3.604.334,26 e o valor médio de cada paciente foi de R $ 44.497,95. Os maiores gastos foram relacionados com implantes (41,1%), seguidos de internação (27,3%) e procedimento cirúrgico (19,7%). Conclusão O custo do tratamento cirúrgico para metástases espinhais é um dos mais caros entre as complicações ósseas em pacientes com câncer. O custo do tratamento relacionado aos desfechos apresentou diferença de acordo com o desfecho analisado e a permanência hospitalar, exames, medicamentos e terapia intensiva tem papel importante em alguns dos custos relacionados ao desfecho específico. Nível de Evidência II, Estudo retrospectivo.

Seasonal variations in incidence of femoral fractures in the state of Rio Grande do Sul, southern Brazil / Variações sazonais na incidência de fraturas do fêmur no estado do Rio Grande do Sul, sul do Brasil

Abstract Introduction Femoral fractures are a major cause of morbidity and mortality, mainly among older people. Objective To examine the effect of seasonality on hospitalizations due to femur fracture among people residing in the Rio Grande do Sul state, southern Brazil, from 2008 to 2019. Methods Ecological study based on secondary data from the SUS Hospital Information System (SIH/SUS). A total of 74,374 reports of hospital admissions was considered. The generalized additive model (GAM) approach was employed to assess the seasonality of the time series, with stratification by sex and age groups and considering the monthly average number of events of femoral fractures per day as a dependent variable. Results A considerably higher incidence of femoral fractures in women aged 70 years or more was described. Among people aged less than 50 years, there is not an apparent seasonal effect. Men aged 70 years or older and women aged 50 years or older have a higher frequency of hospitalizations due to femur fractures in the colder months. Conclusion Among older people, more femoral fractures occurred during the winter compared to summer. This supports findings from other studies, although reasons for this seasonal variation are uncertain. The knowledge of these seasonal variations can help to plan the health care in the public health system.

Resumo Introdução As fraturas de fêmur são uma das causas principais de morbidade e mortalidade, principalmente entre as pessoas idosas. Objetivo Examinar o efeito da sazonalidade nas hospitalizações devido à fratura do fêmur entre residentes do estado do Rio Grande do Sul, sul do Brasil, de 2008 a 2019. Métodos Trata-se de um estudo ecológico baseado em dados secundários do Sistema de Informação Hospitalar do SUS (SIH/SUS). Um total de 74.374 relatórios de internações hospitalares foi considerado. O modelo aditivo generalizado (GAM) foi usado para avaliar a sazonalidade da série temporal, com estratificação por sexo e grupos etários e considerando a média mensal de eventos de fraturas do fêmur por dia como uma variável dependente. Resultados Descreveu-se uma incidência consideravelmente maior de fraturas do fêmur em mulheres com 70 anos de idade ou mais. Entre as pessoas com menos de 50 anos de idade, não há um efeito sazonal aparente. Homens com idade de 70 anos ou mais e mulheres com 50 anos ou mais têm maior frequência de hospitalizações devido a fraturas do fêmur nos meses mais frios. Conclusão Entre as pessoas mais idosas, as fraturas do fêmur ocorreram mais frequentemente durante o inverno em comparação ao verão. Isto reafirma os resultados de outros estudos, embora as razões para esta variação sazonal sejam incertas. O conhecimento destas variações sazonais pode ajudar no planejamento da assistência médica no sistema público de saúde.

Intradermal methylene blue administration on the progression of burn injuries.

OBJECTIVE: A burn injury has two defined areas: central necrosis and an adjacent area of ischaemia, which may or may not progress to necrosis. The concentration of nitric oxide (NO) increases after burn injury and may originate from potent oxidising agents. Methylene blue (MB) may act as an antioxidant and is supposed to reduce burn progression. This investigation was carried out to evaluate the effects of intradermal MB on necrosis progression in burns. METHODS: Full-thickness burn injuries were performed by applying a heated metal comb on the shaved back of male Wistar rats. The animals were divided into three groups: Control (C, n=7); MB (2mg/kg) one hour after burn injury (MB1h, n=11); and MB (2mg/kg) six hours after burn injury (MB6h, n=8). After seven days the lesions were photographed for visual assessment of burn necrosis; full-thickness cuts of lesions were dyed with Masson and Giemsa for microscopic histopathology; and tissue fragments of unburned interspaces were processed for chemiluminescence with nitrite/nitrate (NOX) and malondialdehyde (MDA) as oxidative stress markers. RESULTS: No statistically significant differences between groups were observed during visual analysis and NOX dosage. However, in microscopic analysis, the MB1h and MB6h groups showed smaller areas of necrosis, less inflammatory infiltration, and a more significant extension of interspaces. Furthermore, the dosage of MDA revealed that the MB1h group showed lower values when compared with the control group (p=0.001). CONCLUSIONS: The study provided good evidence that MB intradermal injection can reduce necrosis progression in ischaemic perilesional areas and suggests an alternative to treating burns.

Comorbidities and the risk of death among individuals infected by COVID-19 in Espírito Santo, Brazil.

INTRODUCTION: We investigated the association of self-reported comorbidities with fatality risk among individuals infected with Coronavirus disease 2019 (COVID-19) in Espírito Santo State, Brazil. METHODS: We included 212,620 individuals, ≥30 years old. The data were obtained from the COVID-19 panel. Kaplan-Meier curves and Cox regression model were used. RESULTS: COVID-19-positive individuals presenting with chronic conditions were at a higher risk of fatality than individuals without these comorbidities. Age had a significant effect on these relationships. CONCLUSIONS: Comorbidities were associated with an increased risk of fatality. Middle-aged people (30-59 years) with comorbidities should also be considered as a vulnerable group.

Pharmacoeconomic Analysis of Sitagliptin/Metformin for the Treatment of Type 2 Diabetes Mellitus: A Cost-Effectiveness Study.

OBJECTIVES: To assess the cost-effectiveness and cost utility of sitagliptin/metformin for the treatment of type 2 diabetes mellitus compared to those of glibenclamide/metformin in a semiprivate hospital and to compare the cost-effectiveness and cost utility of sitagliptin/metformin in a semiprivate hospital to those in the public health system (PHS) of Ecuador in 2019. METHODS: A cost-effectiveness study considering the probability of cardiovascular death as the outcome and quality-adjusted life-year as a measure of utility, estimating direct medical costs in US dollars by a model case from the perspective of the third payer. The results will be presented as an incremental cost-effectiveness ratio. One-way and 2-way sensitivity analyses with tornado diagrams were performed. RESULTS: Direct medical costs were lower at the hospital than from the PHS in Ecuador. Considering the drugs metformin/sitagliptin, the total cost was $35.69 less in the hospital ($880.38) than from the comparator ($916.07). The highest percentage of direct medical costs corresponded to drugs (between 63.94% and 84.65%). An ICER of -$19 131.61 was obtained at the Hospital Un Canto a la Vida and -$1621.85 at PHS. In addition, the cost per quality-adjusted life-year earned was $611.11. Sensitivity analysis showed that the probability of drug use and the relative risk of cardiovascular death associated with such prescription were parameters that most affected the model. CONCLUSIONS: The combination therapy metformin/sitagliptin compared to metformin/glibenclamide was shown not to be cost-effective in the Hospital Un Canto a la Vida, and highly cost-effective in the PHS.

Epidemiology of pertussis among adolescents, adults, and older adults in selected countries of Latin American: a systematic review.

We aimed to describe the impact of pertussis on adolescents, adults, and older adults over 2007-2018 in selected Latin American countries by reviewing the literature. We searched the Medline, Embase, Scopus, LILACS, Scielo, Google Scholar, CAPES Journals Web-portal, and Cochrane databases for observational epidemiological studies, clinical trials, and systematic reviews of primary studies. Data were extracted and analyzed for all individuals aged ≥10 years. Of 6,891 studies identified only 25 were eligible. Studies were conducted in Brazil (14), Argentina (4), Colombia (4), Mexico (2) and Chile (1). Epidemiological data among target population were limited. No studies clearly assessed the status of asymptomatic or oligosymptomatic B. pertussis carriers in these age groups. Among all pertussis cases identified, the percentage of patients ≥10 years-old ranged between 2.1% and 66.7% depending on country and sample characteristics. The definition of cases, diagnostic methods, and age groups were not consistent across studies.

Meningococcal disease epidemiology in Brazil (2005-2018) and impact of MenC vaccination.

BACKGROUND: Meningococcal disease (MD) presents a substantial public health problem in Brazil. Meningococcal C conjugate (MenC) vaccination was introduced into the routine infant immunization program in 2010, followed by adolescent vaccination in 2017. We evaluated changes in national and regional MD incidence and mortality between 2005 and 2018, serogroup distribution and vaccine coverage. METHODS: Data were obtained from national surveillance systems from 2005 to 2018. Age-stratified incidence and mortality rates were calculated and a descriptive time-series analysis was performed comparing rates in the pre-(2005-2009) and post-vaccination (2011-2018) periods; MD due to specific meningococcal serogroups were analyzed in the pre-(2007-2009) and post-vaccination (2011-2018) periods. RESULTS: From 2005 to 2018, 31,108 MD cases were reported with 6496 deaths; 35% of cases and deaths occurred in children < 5 years. Incidence and mortality rates declined steadily since 2012 in all age-strata, with significantly lower incidence and mortality in the post-vaccine introduction period in children aged < 1-year, 1-4 years, 5-9 years and 10-14 years. A significant decline in MenC disease in children < 5 years was observed following MenC vaccine introduction; infants < 1 year, from 3.30/100,000 (2007-2009) to 1.08/100,000 (2011-2018) and from 1.44/100,000 to 0.42/100,000 in 1-4-year-olds for these periods. Reductions in MenB disease was also observed. MenW remains an important cause of MD with 748 cases reported across 2005-2018. While initial infant vaccination coverage was high (>95% nationwide), this has since declined (to 83% in 2018); adolescent uptake was < 20% in 2017/18). Regional variations in outcomes and vaccine coverage were observed. CONCLUSION: A substantial decline in incidence and mortality rates due to MD was seen following MenC vaccine introduction in Brazil, especially among children < 5 years chiefly driven by reductions in MenC serogroup. While these benefits are considerable, the prevalence of MD due to other serogroups such as MenW and MenB remains a concern. A video summary linked to this article can be found on Figshare: https://doi.org/10.6084/m9.figshare.13379612.v1.

Association of congenital anomalies in live births with their obstetric-neonatal and sociodemographic profiles / Asociación entre anomalías congénitas en nacidos vivos y sus perfiles obstétrico-neonatal y sociodemográfico / Associação de anomalias congênitas em nascidos vivos com seus perfis obstétrico-neonatal e sociodemográfico

ABSTRACT Objective: to identify the association of congenital anomalies in live births with the obstetric-neonatal and sociodemographic profile. Methods: an ecological study, conducted in 2019, with 251,444 live births, identified through the database of the Live Birth Information System of the Minas Gerais Health Secretariat. Descriptive statistics and binary logistic regression were adopted for the analysis. Results: 1,865 cases of anomalies (0.7%) were found, with predominance of deformity of the musculoskeletal system in 789 (42.3%) live births. The variables that presented a significant association with congenital anomalies were single mothers, age ≥35 years old, inadequately performed prenatal care initiated in the third trimester of pregnancy, double (or more) pregnancy, preterm births, cesarean delivery, fetal breech presentation, exclusive assistance by the medical professional during delivery, newborn with high-risk 5-minute Apgar score, low birth weight, and male gender. Conclusion: in 2019, the congenital malformations in the state of Minas Gerais were associated with single women, aged ≥35 years old, who underwent inadequate and late prenatal care, and with double or more pregnancies. In relation to the newborns, the malformations were associated with a high risk for late sequelae, weight between ≤1,000 g and <2.500 g, and male gender.

RESUMEN Objetivo: identificar la asociación entre las anomalías congénitas en nacidos vivos y el perfil obstétrico-neonatal y sociodemográfico. Métodos: estudio ecológico realizado en el año 2019 con 251.444 nacidos vivos, identificados por medio de la base de datos del Sistema de Información sobre Nacidos Vivos de la Secretaría de Salud de Minas Gerais. Para el análisis, se adoptaron estadística descriptiva y regresión logística binaria. Resultados: se encontraron 1.865 casos de anomalías (0,7%), con predominio de deformidad del sistema osteomuscular en 789 (42,3%) nacidos vivos. Las variables que presentaron una asociación significativa con las anomalía congénitas fueron las siguientes: madres solteras, edad ≥35 años, cursar atención pre-natal inadecuada e iniciada en el tercer trimestre de embarazo, embarazo de gemelos o más bebés, nacimientos prematuros, parto por cesárea, presentación fetal pelviana, asistencia exclusiva de un médico durante el parto, recién nacido con Apgar de alto riesgo al quinto minuto, bajo peso al nascer y sexo masculino. Conclusión: en el año 2019, las malformaciones congénitas en el estado de Minas Gerais estuvieron asociadas a mujeres solteras, con edad ≥35 años, que cursaron atención pre-natal inadecuada y tardía, con embarazos de gemelos o más bebés. En relación con los recién nacidos, las malformaciones estuvieron asociadas con alto riesgo de secuelas tardías, peso entre ≤1.000 g y <2.500 g y ser del sexo masculino.

RESUMO Objetivo: identificar a associação das anomalias congênitas em nascidos vivos com o perfil obstétrico-neonatal e sociodemográfico. Método: estudo ecológico, realizado em 2019, com 251.444 nascidos vivos, identificados por meio do banco de dados do Sistema de Informações de Nascidos Vivos da Secretaria de Saúde de Minas Gerais. Para análise, adotaram-se a estatística descritiva e a regressão logística binária. Resultados: foram encontrados 1.865 casos de anomalias (0,7%), com predominância de deformidade do sistema osteomuscular em 789 (42,3%) nascidos vivos. As variáveis que apresentaram associação significativa com a anomalia congênita foram mães solteiras, idade ≥35 anos, pré-natal realizado de forma inadequada, iniciado no terceiro trimestre de gestação, gestação dupla ou mais, nascimentos pré-termo, parto cesárea, apresentação fetal pélvica, assistência exclusiva do profissional médico durante o parto, recém-nascido com Apgar de alto risco no quinto minuto, baixo peso ao nascer e sexo masculino. Conclusão: em 2019, as malformações congênitas no estado de Minas Gerais associaram-se às mulheres solteiras, com idade ≥35 anos, que realizaram pré-natal inadequado e tardio, com gestações duplas ou mais. Em relação aos recém-nascidos, as malformações foram associadas com alto risco para sequelas tardias, peso entre ≤1.000g e <2.500g e ser do sexo masculino.

Comorbidities and the risk of death among individuals infected by COVID-19 in Espírito Santo, Brazil

Abstract INTRODUCTION: We investigated the association of self-reported comorbidities with fatality risk among individuals infected with Coronavirus disease 2019 (COVID-19) in Espírito Santo State, Brazil. METHODS: We included 212,620 individuals, ≥30 years old. The data were obtained from the COVID-19 panel. Kaplan-Meier curves and Cox regression model were used. RESULTS: COVID-19-positive individuals presenting with chronic conditions were at a higher risk of fatality than individuals without these comorbidities. Age had a significant effect on these relationships. CONCLUSIONS: Comorbidities were associated with an increased risk of fatality. Middle-aged people (30-59 years) with comorbidities should also be considered as a vulnerable group.

Evaluación de Sitagliptina para el tratamiento de pacientes adultos con diabetes mellitus tipo 2: revisión sistemática de costo-efectividad / Evaluation of Sitagliptin for the treatment of adult patients with type 2 diabetes mellitus: a systematic review of cost-effectiveness

Introducción: La diabetes mellitus tipo 2 es un problema de salud pública mundial y es una de las principales causas de mortalidad en Ecuador. La Sitagliptina fue el primer fármaco potenciador del sistema de las incretinas comercializado localmente. Los países no tienen recursos ilimitados para atender las necesidades de salud de su población, por lo que deben adoptar las intervenciones sanitarias más adecuadas, considerando los costos que un país pueda asumir y sostener. Objetivo: Sintetizar los resultados de estudios de costo-efectividad de la sitagliptina para el tratamiento oral combinado de pacientes adultos con diabetes tipo 2 en comparación con sulfonilureas. Metodología: Se realizó una revisión sistemática sin metaanálisis basado en las recomendaciones PRISMA. Los términos de búsqueda se estructuraron en base a la estrategia PICO y la pesquisa se realizó en las bases de datos: Pubmed, Tripdatabase y Pubmed Central para artículos de evaluaciones de tecnologías sanitarias, evaluaciones económicas y guías de práctica clínica, y para las políticas de cobertura se utilizó HTAiVortal y Google avanzado. Resultados: Se seleccionaron 3 ensayos clínicos y 8 revisiones sistemáticas-metaanálisis, 2 estudios de cohorte, 3 políticas de cobertura y 1 estudio de costo-efectividad. Tres revisiones sistemáticas establecieron pocos efectos modestos en cuanto a los efectos hipoglicemiantes de sitagliptina en adultos y adultos mayores; con un bajo riesgo de hipoglicemia. Un metaanálisis de 25 ensayos clínicos reportó mayor riesgo cardiovascular en los pacientes tratados con sitagliptina. Una revisión sistemática con evaluación económica mostró que la sitagliptina con metformina fue una alternativa costo-efectiva versus añadir una sulfonilurea o roziglitazona. Conclusiones: Por el perfil de costo-efectividad podría considerarse a la sitagliptina como segundo fármaco para pacientes que no consiguen control glicémico con dosis máximas de metformina, o en donde su asociación a una sulfonilurea no sea factible (por riesgos de hipoglicemia o adultos mayores).

Introduction: Type 2 diabetes mellitus is a global public health problem, being one of the main causes of mortality in Ecuador. Sitagliptin was the first locally marketed incretin-enhancing drug. Countries do not have unlimited resources to meet the health needs of their population, so they must adopt the most appropriate health interventions, considering the costs that a country can assume and sustain. Objective: To synthesize the results of cost-effectiveness studies of sitagliptin for combined oral treatment of adult patients with type 2 diabetes, compared with sulfonylureas.Methodology: This is a systematic review study without meta-analysis, conducted on PRISMA recommendations. The in-formation search was structured under the PICO strategy and the searches were conducted in Pubmed, Tripdatabase and Pubmed Central for articles on health technology evaluations, economic evaluations and clinical practice guides and for coverage policies HTAiVortal and advanced Google were used.Results: 3 clinical trials and 8 systematic reviews-meta-analysis, 2 cohort studies, 3 coverage policies and 1 cost-effectiveness study were selected. Three systematic reviews establish few effects regarding the hypoglycemic effects of sitagliptin in adults and elderly, with a low risk of hypoglycemia. A meta-analysis of 25 clinical trials reported an increased cardiovascular risk in patients treated with sitagliptin. A systematic review with economic evaluation showed that sitagliptin with metformin was a cost-effective alternative, versus adding a sulfonylurea or roziglitazone.Conclusions: Due to its cost-effectiveness profile, sitagliptin could be considered as a second drug for patients who do not achieve glycemic control with maximum doses of metformin, or where its association with a sulfonylurea is not feasible (due to risks of hypoglycemia or elderly).

Long-term forecasts of the COVID-19 epidemic: a dangerous idea.

INTRODUCTION: Mathematical models have been used to obtain long-term forecasts of the COVID-19 epidemic. METHODS: The daily COVID-19 case count in two Brazilian states was used to show the potential limitations of long-term forecasting through the application of a mathematical model to the data. RESULTS: The predicted number of cases at the end of the epidemic and at the moment that the peak occurs, is highly dependent on the length of the time series used in the predictive model. CONCLUSIONS: Predictions obtained during the course of the COVID-19 pandemic need to be viewed with caution.

Clinical response to antibiotics in indigenous versus non-indigenous children under 5 years old with community-acquired pneumonia in Otavalo, Ecuador.

INTRODUCTION: Community-acquired pneumonia (CAP) is an important cause of morbidity and mortality worldwide. This study compares the clinical response to antimicrobials between indigenous and non-indigenous Kichwa children under 5 years old with CAP in Otavalo, Ecuador. METHODS: All children with CAP who met the inclusion criteria and were admitted at the San Luis de Otavalo Hospital between March 2017 and June 2018 were evaluated. RESULTS: No significant differences were observed in clinical responses between indigenous and non-indigenous children. CONCLUSIONS: The improved healthcare access of the Otavalo's Kichwa population may have contributed to the observed clinical response to CAP treatment.