Burden of disease due to amphetamines, cannabis, cocaine, and opioid use disorders in South America, 1990-2019: a systematic analysis of the Global Burden of Disease Study 2019.

BACKGROUND: South America's substance use profile, poverty, income inequality, and cocaine-supplier role make it a unique place for substance use research. This study investigated the burden of disease attributable to amphetamine use disorder, cannabis use disorder (CAD), cocaine use disorder, and opioid use disorder (OUD) in South America from 1990 to 2019, on the basis of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. METHODS: GBD 2019 estimated the incidence, prevalence, mortality, years of life lost (YLL), years of life lived with disability (YLD), and disability-adjusted life-years (DALYs) due to substance use disorders in each of the 12 South American countries (Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Guyana, Paraguay, Peru, Suriname, Uruguay, and Venezuela). Data were modelled using standardised tools (ie, the Cause of Death Ensemble model, spatio-temporal Gaussian process regression, and disease modelling meta-regression) to generate estimates of each quantity of interest by sex, location, and year. The analysis included comparisons by sex and country, and against regional and global estimates. FINDINGS: In 2019, the highest amphetamine use disorder burden per 100 000 population in South America was in Peru (66 DALYs). CAD DALY rates per 100 000 in South America were stable between 1990 and 2019, except in Chile and Colombia, which had the highest rates in 2019 (19 DALYs for Chile and 18 DALYs for Colombia). OUD DALYs per 100 000 increased during the period in Brazil and Peru, which in 2019 had the highest rates in South America (82 DALYs for Brazil and 70 DALYs for Peru). In 2019, Brazil had the highest cocaine use disorder DALYs per 100 000 (45 DALYs), nearly double its rate in 1990. DALY rates were higher in males than females for each substance use disorder, except in Paraguay. The overall burden of substance use disorders was higher in males than in females, mainly because of cocaine use disorder and CAD, whereas for amphetamine use disorder, the difference between sexes was minimal, and for OUD there was no difference. For males and females, the highest rate of substance use disorders DALYs per 100 000 was for OUD except in Argentina (in males, 58 DALYs for cocaine use disorder vs 52 DALYs for OUD) and in Paraguay (in females, 77 for amphetamine use disorder vs 50 for OUD). CAD DALY rates were generally the lowest among the substance use disorders for males and females. Amphetamine use disorder YLD rates were reasonably stable throughout the period and were highest in Peru, Paraguay, and Uruguay (>40 YLD per 100 000). For CAD, YLD rates were stable in all countries except Chile and Colombia. Cocaine use disorder YLD rates per 100 000 for the top four countries (Argentina, Uruguay, Chile, and Brazil) increased from 1990 to 2010 (eg, from 19 to 33 in Brazil), but decreased between 2010 and 2019 (eg, from 36 to 31 in Chile). For OUD, YLD rates showed a slight increase in most countries apart from Brazil, which increased from 52 in 1990 to 80 in 2019 and was top among the countries. Amphetamine use disorder YLL rates per 100 000 were highest in Suriname and Peru during the period, although in Suriname it increased from 2·7 in 2010 to 3·2 in 2019, whereas in Peru it decreased from 2·1 to 1·7. The highest YLL rate for cocaine use disorder was in Brazil, which increased from 3·7 in 1990 to 18·1 in 2019. Between 2000 and 2019, Chile and Uruguay showed the highest OUD YLL rates (11·6 for Chile and 10·9 for Uruguay). A high incidence of CAD was found in Chile, Colombia, Guyana, and Suriname. There were high incidences of amphetamine use disorder in Paraguay, cocaine use disorder in Argentina, and OUD in Ecuador. A decrease in annual prevalence for substance use disorders during the period was observed in Venezuela (amphetamine use disorder, CAD, and OUD), Brazil (CAD and amphetamine use disorder), Colombia (amphetamine use disorder and cocaine use disorder), Peru (amphetamine use disorder and cocaine use disorder), Chile and Suriname (amphetamine use disorder), Uruguay (CAD), and Bolivia (OUD). Overall, the cocaine use disorder burden stabilised then decreased. OUD was less prevalent than other substance use disorders but its burden was the highest. INTERPRETATION: The decrease in the burden of cocaine use disorder probably reflects the success of national standardised treatment programmes. Programmes for amphetamine use disorder, CAD, and OUD management should be improved. We did not find an increase in CAD burden in Uruguay, the country with the highest degree of cannabis decriminalisation in the region. Countries in South America should improve monitoring of substance use disorders, including regular surveys to provide more accurate data on which to base policy decisions. FUNDING: The Bill & Melinda Gates Foundation.

Usefulness of C-Reactive Protein and Clinical Characteristics in Identifying Severe Bacterial Infection in Children with Fever without Source.

OBJECTIVE: Fever continues to be the most frequent cause of care in the pediatric population. The uses of invasive and unnecessary tests result in discomfort to the patients. Local epidemiological data could help to refine screening strategies, especially in low resources settings. The present study aims to describe the prevalence of serious bacterial infections in infants with fever without source and to evaluate the usefulness of clinical and laboratory parameters in the identification of serious bacterial infections. MATERIALS AND METHODS: We included all children aged 0-36 months presenting with fever without source between January 2015 and December 2017. Demographic and clinical characteristics, investigations, and management procedures were recorded at the time of inclusion. Potential predictors of serious bacterial infections were compared between patients with and without serious bacterial infections. RESULTS: In total, 137 patients were included. Serious bacterial infections were diagnosed in 41 patients (29.9%; 95% CI, 22%-38%). The most frequent diagnosis in serious bacterial infection patients was urinary tract infection (78%). Serum C-reactive protein levels greater than 80 mg/L (odds ratio, 2.79 [1.14,6.86]) and total days with fever (odds ratio, 2.56 [1.81,3.62]) showed a significant association to predict serious bacterial infections. CONCLUSION: Most infants with fever without source presented self-limited febrile syndromes without evidence of severe bacterial infection. C-reactive protein levels greater than 80 mg/L and the number of previous days with fever were variables associated with the presence of serious bacterial infections. Our results need to be validated in other tropical countries.

Deep learning representations to support COVID-19 diagnosis on CT slices. / Representaciones basadas en aprendizaje profundo como apoyo del diagnóstico de la COVID-19 en cortes de tomografía computarizada

INTRODUCTION: The coronavirus disease 2019 (COVID-19) has become a significant public health problem worldwide. In this context, CT-scan automatic analysis has emerged as a COVID-19 complementary diagnosis tool allowing for radiological finding characterization, patient categorization, and disease follow-up. However, this analysis depends on the radiologist's expertise, which may result in subjective evaluations. OBJECTIVE: To explore deep learning representations, trained from thoracic CT-slices, to automatically distinguish COVID-19 disease from control samples. MATERIALS AND METHODS: Two datasets were used: SARS-CoV-2 CT Scan (Set-1) and FOSCAL clinic's dataset (Set-2). The deep representations took advantage of supervised learning models previously trained on the natural image domain, which were adjusted following a transfer learning scheme. The deep classification was carried out: (a) via an end-to-end deep learning approach and (b) via random forest and support vector machine classifiers by feeding the deep representation embedding vectors into these classifiers. RESULTS: The end-to-end classification achieved an average accuracy of 92.33% (89.70% precision) for Set-1 and 96.99% (96.62% precision) for Set-2. The deep feature embedding with a support vector machine achieved an average accuracy of 91.40% (95.77% precision) and 96.00% (94.74% precision) for Set-1 and Set-2, respectively. CONCLUSION: Deep representations have achieved outstanding performance in the identification of COVID-19 cases on CT scans demonstrating good characterization of the COVID-19 radiological patterns. These representations could potentially support the COVID-19 diagnosis in clinical settings.

Introducción. La enfermedad por coronavirus (COVID-19) es actualmente el principal problema de salud pública en el mundo. En este contexto, el análisis automático de tomografías computarizadas (TC) surge como una herramienta diagnóstica complementaria que permite caracterizar hallazgos radiológicos, y categorizar y hacer el seguimiento de pacientes con COVID-19. Sin embargo, este análisis depende de la experiencia de los radiólogos, por lo que las valoraciones pueden ser subjetivas. Objetivo. Explorar representaciones de aprendizaje profundo entrenadas con cortes de TC torácica para diferenciar automáticamente entre los casos de COVID-19 y personas no infectadas. Materiales y métodos. Se usaron dos conjuntos de datos de TC: de SARS-CoV-2 CT (conjunto 1) y de la clínica FOSCAL (conjunto 2). Los modelos de aprendizaje supervisados y previamente entrenados en imágenes naturales, se ajustaron usando aprendizaje por transferencia. La clasificación se llevó a cabo mediante aprendizaje de extremo a extremo y clasificadores tales como los árboles de decisiones y las máquinas de soporte vectorial, alimentados por la representación profunda previamente aprendida. Resultados. El enfoque de extremo a extremo alcanzó una exactitud promedio de 92,33 % (89,70 % de precisión) para el conjunto 1 y de 96,99 % (96,62 % de precisión) para el conjunto-2. La máquina de soporte vectorial alcanzó una exactitud promedio de 91,40 % (precisión del 95,77 %) para el conjunto-1 y del 96,00 % (precisión del 94,74 %) para el conjunto 2. Conclusión. Las representaciones profundas lograron resultados sobresalientes al caracterizar patrones radiológicos usados en la detección de casos de COVID-19 a partir de estudios de TC y demostraron ser una potencial herramienta de apoyo del diagnóstico.

Deep learning representations to support COVID-19 diagnosis on CT slices / Representaciones basadas en aprendizaje profundo como apoyo del diagnóstico de la COVID-19 en cortes de tomografía computarizada

Introduction: The coronavirus disease 2019 (COVID-19) has become a significant public health problem worldwide. In this context, CT-scan automatic analysis has emerged as a COVID-19 complementary diagnosis tool allowing for radiological finding characterization, patient categorization, and disease follow-up. However, this analysis depends on the radiologist's expertise, which may result in subjective evaluations. Objective: To explore deep learning representations, trained from thoracic CT-slices, to automatically distinguish COVID-19 disease from control samples. Materials and methods: Two datasets were used: SARS-CoV-2 CT Scan (Set-1) and FOSCAL clinic's dataset (Set-2). The deep representations took advantage of supervised learning models previously trained on the natural image domain, which were adjusted following a transfer learning scheme. The deep classification was carried out: (a) via an end-to-end deep learning approach and (b) via random forest and support vector machine classifiers by feeding the deep representation embedding vectors into these classifiers. Results: The end-to-end classification achieved an average accuracy of 92.33% (89.70% precision) for Set-1 and 96.99% (96.62% precision) for Set-2. The deep feature embedding with a support vector machine achieved an average accuracy of 91.40% (95.77% precision) and 96.00% (94.74% precision) for Set-1 and Set-2, respectively. Conclusion: Deep representations have achieved outstanding performance in the identification of COVID-19 cases on CT scans demonstrating good characterization of the COVID-19 radiological patterns. These representations could potentially support the COVID-19 diagnosis in clinical settings.

Introducción. La enfermedad por coronavirus (COVID-19) es actualmente el principal problema de salud pública en el mundo. En este contexto, el análisis automático de tomografías computarizadas (TC) surge como una herramienta diagnóstica complementaria que permite caracterizar hallazgos radiológicos, y categorizar y hacer el seguimiento de pacientes con COVID-19. Sin embargo, este análisis depende de la experiencia de los radiólogos, por lo que las valoraciones pueden ser subjetivas. Objetivo. Explorar representaciones de aprendizaje profundo entrenadas con cortes de TC torácica para diferenciar automáticamente entre los casos de COVID-19 y personas no infectadas. Materiales y métodos. Se usaron dos conjuntos de datos de TC: de SARS-CoV-2 CT (conjunto 1) y de la clínica FOSCAL (conjunto 2). Los modelos de aprendizaje supervisados y previamente entrenados en imágenes naturales, se ajustaron usando aprendizaje por transferencia. La clasificación se llevó a cabo mediante aprendizaje de extremo a extremo y clasificadores tales como los árboles de decisiones y las máquinas de soporte vectorial, alimentados por la representación profunda previamente aprendida. Resultados. El enfoque de extremo a extremo alcanzó una exactitud promedio de 92,33 % (89,70 % de precisión) para el conjunto 1 y de 96,99 % (96,62 % de precisión) para el conjunto-2. La máquina de soporte vectorial alcanzó una exactitud promedio de 91,40 % (precisión del 95,77 %) para el conjunto-1 y del 96,00 % (precisión del 94,74 %) para el conjunto 2. Conclusión. Las representaciones profundas lograron resultados sobresalientes al caracterizar patrones radiológicos usados en la detección de casos de COVID-19 a partir de estudios de TC y demostraron ser una potencial herramienta de apoyo del diagnóstico.

Diferencias biomecánicas del remate de voleibol en jugadoras prejuveniles y juveniles / Biomechanical differences in volleyball spike by female junior and youth players

Introducción: La técnica del remate es un fundamento técnico-táctico ofensivo primordial en el voleibol, ayudando al equipo a conseguir puntos, y por ende imprescindible para la victoria. Potenciar el hábito motriz implica optimizar la preparación deportiva en todos los niveles. Objetivo: Analizar biomecánicamente las fases del remate de voleibol y variables mecánicas relacionadas en jugadores prejuveniles y juveniles de la Concentración Deportiva de Pichincha. Métodos: Bajo un muestreo intencional no probabilístico, se estudió a 19 voleibolistas del sexo femenino (11 prejuveniles y 8 juveniles) probando biomecánicamente 5 fases del movimiento técnico del remate. Se ensayó el Tiempo Total del Remate, el Tiempo de la Preparación hasta el Golpe y el Ángulo del Cuerpo en Relación al Centro de Gravedad. Resultados: En las 5 fases de la técnica del remate solo existió una diferencia significativa entre los grupos independientes estudiados (Fase 4: p= 0,001) perteneciente al ángulo del codo en la fase de golpeo al balón (menor rango promedio el grupo juvenil: 5,38), el resto no indicó diferencias significativas, aunque los rangos promedios fueron menores en el grupo prejuvenil en la fase 1, 2, 3, y mayores en el mismo grupo para el caso de la 5ta fase (ángulo de la columna: 11,91). Por otra parte, solo se evidenció diferencias significativas en TTR (p= 0,033), y no significativas en el Tiempo de la Preparación hasta el Golpe (TPG: p= 0,717) y el ángulo del cuerpo en relación al centro de gravedad (ACCG: p= 0,717). Conclusiones: Los ángulos de la columna no influyen significativamente en la técnica del remate; no obstante, en los ángulos del codo se observó influencia para una mejor flexión de codo y colocación de la mano, pudiendo generar un mayor impacto al balón y por ende mayores dificultades a la defensa oponente(AU)

Introduction: Spike technique is a fundamental technical-tactical offensive movement in volleyball. It helps the team score points and is therefore essential to win. Strengthening motor skills implies optimizing sport preparation on all levels. Objective: Biomechanically analyze volleyball spike phases and mechanical variables as performed by junior and youth players from Pichincha sports complex. Methods: Nineteen female volleyball players (11 junior and 8 youth) were selected by intentional non-probabilistic sampling to conduct a biomechanical study of the five phases of the technical movement of spike, alongside Total Spike Time (TST), Preparation Time Before the Blow (PTBB), and Body Angle in Relation to the Center of Mass (BARCM). Results: Only one significant difference was found in the five phases of the spike technique in the two independent groups studied (Phase 4: p= 0.001), which had to do with the elbow angle in the ball hitting phase (a smaller average range in the youth group: 5.38). No other significant differences were found, though average ranges were smaller in the junior group in phases 1, 2, 3, and greater in the fifth phase (spine angle: 11.91). Additionally, significant differences were only found in TST (p= 0.033), and non-significant differences in the Preparation Time Before the Blow (PTBB: p= 0.717) and the Body Angle in Relation to the Center of Mass (BARCM: p= 0.717). Conclusions: Spine angles do not exert a significant influence on spike technique. However, elbow angles played a role in better elbow flexion and hand positioning, potentially generating a stronger impact on the ball and therefore greater difficulties for the opponent's defense(AU)

Implications of global pricing policies of pharmaceuticals for access the innovative drugs: the case of trastuzumab in seven Latin American countries

Background: Differential pricing (DP) on the basis of countries' purchasing power has been recommended by the WHO to secure more affordably priced medicines. However, in developing counties (DC) many innovative drugs have similar or even higher prices than in high-income countries (HIC). We conducted a cost-effectiveness (CE) analysis to estimate the impact of this pricing policy on the CE of trastuzumab in Latin-America (LA). Methods: Model structure and a common methodology for identifying costs and resource use were agreed with country teams. A Markov model was designed to evaluate life years (LY), quality adjusted life years (QALYs) and costs \r\nfrom a health care sector perspective. A systematic search on effectiveness, local epidemiology and costs studies was undertaken to populate the model. A base case scenario using transition probabilities from trastuzumab clinical trials, and two alternative scenarios with transition probabilities adjusted to reflect breast cancer epidemiology in each country, were built to better fit local cancer prognosis. Findings: Incremental discounted benefits and costs of the trastuzumab strategy ranged from 0·87 to 1·00 LY, 0·51 to 0·60 QALY and $24,683 to $60,835 (2012 US dollars). Incremental CE ratios ranged from $42,104 to $110,283 per QALY, equivalent to 3·6 gross domestic products per capita (GDPc) per QALY in Uruguay to up to 35·5 GDPc per QALY in Bolivia. The probabilistic sensitivity analysis showed a 0% probability that trastuzumab is CE if the willingness-to-pay (WTP) threshold is one GDPpc per QALY, and remains 0% at a WTP threshold of three GDPc except in Chile and Uruguay (probability 4·3% and 26·6% respectively). Conclusion: Despite its proven CE in other settings, trastuzumab was not CE in LA at its current price. Better cooperation between the public and private sectors is still needed to make innovative drugs available and affordable in DC.

Burden and typing of rotavirus group A in Latin America and the Caribbean: systematic review and meta-analysis.

The efficacy of licensed rotavirus vaccines has only been shown against certain rotavirus group A (RV-A) types. It is critical to understand the burden of rotavirus gastroenteritis (RVGE) and its prevalent types to assess the potential impact of these vaccines in Latin America and the Caribbean (LA&C). We performed a systematic review and meta-analyses of all the available evidence reported from 1990 to 2009 on the burden of rotavirus disease and strains circulating in LA&C. Eligible studies--185 country-level reports, 174 951 faecal samples--were selected from MEDLINE, Cochrane Library, EMBASE, LILACS, regional Ministries of Health, PAHO, regional proceedings, doctoral theses, reference lists of included studies and consulting experts. Arc-sine transformations and DerSimonian-Laird random-effects model were used for meta-analyses. The proportion of gastroenteritis cases due to rotavirus was 24.3% (95%CI 22.3-26.4) and the incidence of RVGE was 170 per 1000 children-years (95%CI 130-210). We estimated a global annual mortality for 22 countries of 88.2 (95%CI 79.3-97.1) deaths per 100 000 under 5 years (47 000 deaths).The most common G type detected was G1 (34.2%), followed by G9 (14.6%), and G2 (14.4%). The most common P types detected were P[8] (56.2%), P[4] (22.1%) and P[1] 5.4%, and the most prevalent P-G type associations were P[8]G1 17.9%, P[4]G2 9.1% and P[8]G9 8.8%. In the last 10 years, G9 circulation increased remarkably and G5 almost disappeared. More recently, G12 appeared and P[4]G2 re-emerged. To our knowledge, this is the first meta-analysis of rotavirus infection and burden of disease in LA&C.

Prescripción de medicamentos en pacientes atendidos en instituciones de mediano y alto nivel de complejidad / Drug prescription patterns in patients attended at a middle- and high-complexity level institution

Objetivo Determinar los patrones de prescripción de medicamentos ambulatorios autorizados en pacientes afiliados a una EPS y atendidos por IPS de mediano y alto nivel de complejidad. Métodos Se realizo un estudio analítico transversal donde se evaluaron las prescripciones de medicamentos en 331 IPS de segundo y tercer nivel de complejidad en 27 departamentos durante el 2006. Resultados Se analizaron 38 863 prescripciones de medicamentos de 3 663 pacientes. El 61,4 por ciento de estas provienen de IPS de tercer nivel de complejidad y principalmente de pacientes afiliados al régimen contributivo. El promedio de medicamentos por formula medica fue de 2,2 (IC 95 por ciento: 2,1 a 2,2 por ciento), la proporción de antibióticos por fórmula médica del 29,2 por ciento (IC 95 por ciento: 28,7-29,6), de medicamentos POS del 64,2 por ciento (IC 95 por ciento 63,7-64,6 por ciento) y de inyectables del 22,1 por ciento (IC 95 por ciento 21,7-25,5 por ciento). Más de la mitad de los medicamentos, 62,1 por ciento (IC 95 por ciento 61,5-62,7 por ciento), corresponden a agentes anti-infecciosos, antineoplasicos y del tracto alimentario .El consumo de medicamentos fue de 8,39 Dosis Diarias Definidas (DDD) /1 000 usuarios/día y el costo por DDD fue de $ 5 216 Conclusión Este análisis permitió identificar medicamentos cuya frecuencia de formulación no se correlaciono con el perfil epidemiológico como agentes inmunomoduladores y hormona de crecimiento. Existen diferencias en la frecuencia y cantidad de DDD de medicamentos autorizados por régimen de afiliación lo cual pude ser evidencia de barreras de acceso a los medicamentos en la población.

Objective Determining prescription patterns for outpatient medication authorised for patients affiliated to an EPS and assisted by medium- and high-level complexity IPS. Methods This was a cross-sectional study where medication prescription was evaluated in 331 second- and third-level complexity hospitals from 27 Colombian departments during 2006. Results 38 863 prescriptions for 3 663 patients’ medication were analysed. 61,4 percent came from third-level complexity hospitals, mainly for patients affiliated to contribution-based regimes. Average prescribed medication per person was 2,2 (2,1-2,2 95 percent CI), the percentage of antibiotics formulated by prescription was 29,2 percent (28,7-29,6 95 percent CI), essential prescribed medicines accounted for 64,2 percent (63,7-64,6 95 percent CI) and injectable medicines was 22,1 percent (21,7-25,5 percent). More than half the medications (62,1 percent; 61,5-62,7 95 percent CI) were in ATC groups such as anti-infectious agents, immunomodulating agents and medications for the alimentary and metabolic tract. DU90 percent consisted of 64 medications, medication consumption being 8,39 daily de-fined doses (DDD)/1 000 patients, costing 5 216 Colombian pesos per DDD. Conclusions This analysis led to identifying medications whose formulation frequency did not correlate with an epidemiologic profile as immunomudulator and growth-hormone (somatotropin) agents. There were differences in the frequency and quantity of DDD medications authorised by type of affiliation which could thus be providing evidence of obstacles to the population having access to drugs/medicaments.

[Drug prescription patterns in patients attended at a middle- and high-complexity level institution]. / Prescripción de medicamentos en pacientes atendidos en instituciones de mediano y alto nivel de complejidad.

OBJECTIVE: Determining prescription patterns for outpatient medication authorised for patients affiliated to an EPS and assisted by medium- and high-level complexity IPS. METHODS: This was a cross-sectional study where medication prescription was evaluated in 331 second- and third-level complexity hospitals from 27 Colombian departments during 2006. RESULTS: 38 863 prescriptions for 3 663 patients' medication were analysed. 61,4 % came from third-level complexity hospitals, mainly for patients affiliated to contribution-based regimes. Average prescribed medication per person was 2,2 (2,1-2,2 95 % CI), the percentage of antibiotics formulated by prescription was 29,2 % (28,7-29,6 95 % CI), essential prescribed medicines accounted for 64,2 % (63,7-64,6 95 % CI) and injectable medicines was 22,1 % (21,7-25,5 %). More than half the medications (62,1 %; 61,5-62,7 95 % CI) were in ATC groups such as anti-infectious agents, immunomodulating agents and medications for the alimentary and metabolic tract. DU90% consisted of 64 medications, medication consumption being 8,39 daily de-fined doses (DDD)/1 000 patients, costing 5 216 Colombian pesos per DDD. CONCLUSIONS: This analysis led to identifying medications whose formulation frequency did not correlate with an epidemiologic profile as immunomudulator and growth-hormone (somatotropin) agents. There were differences in the frequency and quantity of DDD medications authorised by type of affiliation which could thus be providing evidence of obstacles to the population having access to drugs/medicaments.

Using systematic reviews for evidence-based health promotion: basic methodology issues

Systematic reviews and evidence-based recommendations are becoming increasingly important for decision-making in health and medicine. Systematic reviews of population-health interventions are challenging and methods will continue evolving. This paper provides an overview of how evidence-based approaches in public health and health promotion are being reviewed to provide a basis for Colombian Guide to Health Promotion, analysing limitations and recommendations for future reviews.

La importancia de las revisiones sistemáticas y de las recomendaciones basadas en la evidencia está aumentando cada vez más, para la toma de decisiones en salud y medicina. Las revisiones sistemáticas de intervenciones poblacionales están aun en crecimiento y sus métodos en continuo desarrollo. Este artículo provee una mirada de cómo una aproximación de salud publica y promoción de la salud basada en la evidencia es útil para la formulación de guías nacionales en promoción de la salud; analizando sus limitaciones y recomendaciones para futuras revisiones.

Using systematic reviews for evidence-based health promotion: basic methodology issues.

Systematic reviews and evidence-based recommendations are becoming increasingly important for decision-making in health and medicine. Systematic reviews of population-health interventions are challenging and methods will continue evolving. This paper provides an overview of how evidence-based approaches in public health and health promotion are being reviewed to provide a basis for Colombian Guide to Health Promotion, analysing limitations and recommendations for future reviews.