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1.
Front Microbiol ; 13: 961986, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36262326

RESUMO

Objective: The aim of this study was to estimate the antimicrobial resistance in microorganisms present in periodontal diseases. Methods: A systematic review was conducted according to the PRISMA statement. The MEDLINE (PubMed/Ovid), EMBASE, BVS, CINAHL, and Web of Science databases were searched from January 2011 to December 2021 for observational studies which evaluated the antimicrobial resistance in periodontal diseases in permanent dentition. Studies that allowed the antimicrobial consumption until the time of sample collection, studies that used laboratory acquired strains, studies that only characterized the microbial strain present, assessment of cellular morphological changes, sequencing system validation, and time series were excluded. Six reviewers, working in pairs and independently, selected titles, abstracts, and full texts extracting data from all studies that met the eligibility criteria: characteristics of patients, diagnosis of infection, microbial species assessed, antimicrobial assessed, identification of resistance genes, and virulence factors. "The Joanna Briggs Institute" critical appraisal for case series was adapted to assess the risk of bias in the included studies. Results: Twenty-four studies (N = 2.039 patients) were included. Prevotella and Porphyromonas species were the most cited microorganisms in the included studies, and the virulence factors were related to Staphylococcus aureus. The antimicrobial reported with the highest frequency of resistance in the included studies was ampicillin (39.5%) and ciprofloxacin showed the lowest frequency of resistance (3.4%). The most cited genes were related to macrolides. The quality of the included studies was considered critically low. Conclusion: No evidence was found regarding the profile of antimicrobial resistance in periodontal diseases, requiring further research that should focus on regional population studies to address this issue in the era of increasing antimicrobial resistance. Clinical relevance: The knowledge about the present microorganism in periodontal diseases and their respective antimicrobial resistance profiles should guide dentists in prescribing complementary therapy for these infections. Systematic review registration: [http://dx.doi.org/10.1097/MD.0000000000013158], identifier [CRD42018077810].

2.
Syst Rev ; 11(1): 164, 2022 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-35948934

RESUMO

BACKGROUND: The judicialization of health care can be understood as a societal response to pressing healthcare needs, which probably are not being adequately addressed by the current healthcare system. This phenomenon increases the strain on service resources, both in the health sector and in the judiciary system as well, demanding an institutional reorganization to manage judicial actions. It is believed that each institution has developed strategies for coping with the problem in isolation and with little public disclosure. The purpose of this review will be to identify institutional strategies implemented and to investigate their effects in approaching the judicialization of health care. METHODS: Electronic searches will be conducted up to December 2021 on 11 databases, supplemented with gray literature and references lists of secondary studies. The descriptor "judicialization of health" will be the basis for conducting the main research. Studies describing any strategy implemented by public institutions to approach the judicialization of health care will be included. Results related to the quality of services provided by the implemented strategy reported in the studies and those that report accessibility, usability, and potential adverse effects or harms caused by the implemented strategy will be investigated. In addition, it will be explored if there have been changes related to the value or characteristics of health litigation. Two reviewers will independently screen all citations, abstract data, and full-text papers. The risk of bias in each study will be appraised using a tool suggested by Cochrane Effective Practice and Care Organization Group (EPOC). Subsequently, the reviewers will also extract the data of interest and classify the findings of these studies according to their performance at the institutional level. The results obtained will be described as a narrative synthesis. DISCUSSION: This review may provide evidence on the effects of the strategies implemented to approach the judicialization of health care. It will potentially benefit health care and legal professionals, decision-makers, and researchers by identifying the types and characteristics of strategies that have the potential to improve service delivery in the future. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020160608.


Assuntos
Atenção à Saúde , Setor Público , Instalações de Saúde , Humanos , Revisões Sistemáticas como Assunto
3.
Front Public Health ; 10: 894958, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35979464

RESUMO

Objectives: To identify evidence-based strategies to improve adherence to the preventive measures against the coronavirus disease (COVID-19) at the community level. Method: This is an evidence brief for policy, combining research evidence specific to contextual knowledge from stakeholders. A systematic search was performed in 18 electronic databases, gray literature, and a handle search, including only secondary and tertiary studies that focused on the adherence of the general population to COVID-19 preventive measures in the community. Two reviewers, independently, performed the study selection, data extraction, and assessment of the quality of the studies. Relevant evidence has been synthesized to draft evidence-based strategies to improve adherence. These strategies were circulated for external endorsement by stakeholders and final refinement. Endorsement rates >80%, 60-80% and <60% were considered high, moderate, and low respectively. Results: Eleven studies, with varying methodological qualities were included: high (n = 3), moderate (n = 3), low (n = 1), and critically low (n = 4). Three evidence based strategies were identified: i. Risk communication; ii. Health education to the general public, and iii. Financial support and access to essential supplies and services. The rates of endorsement were: 83% for risk communication, 83% for health education, and 92% for financial support and access to essential supplies and services. The evidence showed that an increase in knowledge, transparent communication, and public awareness about the risks of COVID-19 and the benefits of adopting preventive measures results in changes in people's attitudes and behavior, which can increase adherence. In addition, the guarantee of support and assistance provides conditions for people to adopt and sustain such measures. Conclusions: These strategies can guide future actions and the formulation of public policies to improve adherence to preventive measures in the community during the current COVID-19 pandemic and other epidemics.


Assuntos
COVID-19 , Pandemias , COVID-19/epidemiologia , COVID-19/prevenção & controle , Comunicação , Humanos , Políticas
4.
Int J Dent ; 2022: 6570812, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35685911

RESUMO

During the COVID-19 pandemic, people worldwide, including the scientific community, were insecure and fearful. The lack of vaccines at the beginning of the pandemic and the high mortality rate led to a search for alternative treatments for COVID-19. Among these proposals, a postulated activity of azithromycin was frequently studied in early treatment. In view of this, many countries saw an increase in the consumption of this antibiotic. Thus, the objective of this study was to evaluate, in Brazil, whether there was an increase in azithromycin prescriptions made by dentists, as they may have been prescribing this antibiotic as a probable treatment for COVID-19. This is an interrupted time series that analyzed antimicrobial prescriptions data between January 2014 and July 2021. The data were taken from the National System of Controlled Products Management, and pre- and postpandemic periods were compared. To assess changes in azithromycin consumption, Joinpoint regression and analysis of variance, followed by Dunnett's test, were used. More than 38 million prescriptions written during the period were analyzed. Amoxicillin (72.3%), azithromycin (18.0%), cephalexin (6.1%), and metronidazole (3.58%) were the most prescribed antibiotics. At the beginning of the pandemic, there was a drop in amoxicillin prescriptions motivated by a decrease in consultations, but conversely, in less than three months, azithromycin prescriptions grew by more than 100%. The exaggerated use of this antibiotic during the pandemic will certainly have consequences in the short and medium term on indicators of bacterial resistance. The use of guidelines and respect for the therapeutic protocols of government agencies should be fundamental for collective and strategic action in the fight against health emergencies.

5.
Medicine (Baltimore) ; 101(25): e29499, 2022 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-35758388

RESUMO

BACKGROUND: The ABCDE (Awakening and Breathing Coordination of daily sedation and ventilator removal trials, Delirium monitoring and management, and Early mobility and exercise) and ABCDEF (Assessment, prevent and manage pain, Both spontaneous awakening and spontaneous breathing trials, Choice of analgesia and sedation, assess, prevent and manage Delirium, Early mobility and exercise, Family engagement) care bundles consist of small sets of evidence-based interventions and are part of the science behind Intensive Care Unit (ICU) liberation. This review sought to analyse the process of implementation of ABCDE and ABCDEF care bundles in ICUs, identifying barriers, facilitators and changes in perception and attitudes of healthcare professionals; and to estimate care bundle effectiveness and safety. METHODS: We selected qualitative and quantitative studies addressing the implementation of ABCDE and ABCDEF bundles in the ICU, identified on MEDLINE, Embase, CINAHL, The Cochrane Library, Web of Science, Epistemonikos, PsycINFO, Virtual Health Library and Open Grey, without restriction on language or date of publication, up to June 2018. The outcomes measured were ICU and hospital length of stay; mechanical ventilation time; incidence and prevalence of delirium or coma; level of agitation and sedation; early mobilization; mortality in ICU and hospital; change in perception, attitude or behaviour of the stakeholders; and change in knowledge of health professionals. Two reviewers independently selected the studies, performed data extraction, and assessed risk of bias and methodological quality. A meta-analysis of random effects was performed. RESULTS: Twenty studies were included, 13 of which had a predominantly qualitative and 7 a quantitative design (31,604 participants). The implementation strategies were categorized according to the taxonomy developed by the Cochrane Effective Practice and Organization of Care Group and eighty strategies were identified. The meta-analysis results showed that implementation of the bundles may reduce length of ICU stay, mechanical ventilation time, delirium, ICU and hospital mortality, and promoted early mobilization in critically-ill patients. CONCLUSIONS: : This study can contribute to the planning and execution of the implementation process of ABCDE and ABCDEF care bundles in ICUs. However, the effectiveness and safety of these bundles need to be corroborated by further studies with greater methodological rigor. PROTOCOL REGISTRATION: PROSPERO CRD42019121307.


Assuntos
Delírio , Pacotes de Assistência ao Paciente , Cuidados Críticos/métodos , Estado Terminal , Delírio/prevenção & controle , Humanos , Unidades de Terapia Intensiva
6.
Rev Panam Salud Publica ; 46: e37, 2022.
Artigo em Português | MEDLINE | ID: mdl-35620177

RESUMO

The association between fast-growing mobile technologies and increasingly more mobile devices has allowed the introduction of virtual environments into daily activities. That includes the health care domain, where concepts such telemedicine, telehealth, eHealth, and mHealth have emerged. In addition to presenting these new concepts, this article aims to discuss the advancements and challenges of mobile health technologies stemming from considerations regarding development, application, legal aspects, and ethics. Because of their innovative nature, mobile health technologies entail the engagement of many actors in the journey to reach end users, covering conception, technical development, sanitary regulations, and design of clinical guidelines, having raised a great deal or interest in terms of monitoring and care across a variety of clinical conditions. However, assessment of the effectiveness and safety of mobile health technologies does not seem to involve the same methodological rigor imposed for clinical trials of drugs and other health products; still, the enthusiasm produced by this innovation counters some of the regulatory and ethics concerns relating to data protection, privacy, access to mobile devices, and technological or social inequality. Despite possible limitations, mobile technologies, as well as other telehealth resources, have produced promising results. Digital healthcare has great potential for expansion and represents an opportunity for the review of traditional practices with selection of mobile technologies for incorporation into the health care system whenever evidence-based benefits are verified.


El avance de las tecnologías móviles, junto con la creciente movilidad de los dispositivos, permitió incorporar el entorno virtual a diversas actividades cotidianas, incluso en el ámbito de la salud, al introducir conceptos como telemedicina, telesalud, eSalud y mSalud. Además de presentar estos nuevos conceptos, en el presente artículo se pretende debatir los avances y desafíos de las tecnologías sanitarias móviles a partir de reflexiones sobre el desarrollo, las aplicaciones, la legislación y la ética. Por su carácter innovador, las tecnologías sanitarias móviles llevan a muchos actores a recorrer el camino conducente al usuario final, centrándose en el diseño, el desarrollo técnico, la regulación sanitaria y la elaboración de directrices clínicas; además, han despertado un gran interés para fines de seguimiento y atención en diferentes condiciones clínicas. Sin embargo, al evaluar la eficacia y seguridad de las tecnologías sanitarias móviles no se observa el mismo rigor metodológico exigido en los ensayos clínicos de medicamentos y otros productos sanitarios, y el entusiasmo por la innovación se contrapone a las preocupaciones reguladoras y éticas relacionadas con la protección de datos, la privacidad, el acceso a los dispositivos móviles y las disparidades tecnológicas y sociales. A pesar de las posibles limitaciones, las tecnologías móviles, así como otros recursos de telesalud, han dado resultados prometedores. La atención digital en el ámbito de la salud tiene un gran potencial de expansión y representa una oportunidad para revisar las prácticas tradicionales de salud a partir de la selección e incorporación de las tecnologías móviles a los sistemas de salud, siempre que se registren beneficios basados en la mejor evidencia.

7.
Artigo em Português | PAHO-IRIS | ID: phr-56003

RESUMO

[RESUMO]. O avanço das tecnologias móveis, associado à mobilidade crescente dos dispositivos, permitiu a incorporação do ambiente virtual a diversas atividades cotidianas, inclusive no âmbito da saúde, introduzindo conceitos como telemedicina, telessaúde, eHealth e mHealth. Além de apresentar esses novos conceitos, o presente artigo teve como objetivo discutir os avanços e os desafios das tecnologias móveis em saúde a partir de reflexões sobre desenvolvimento, aplicações, legislação e ética. Por seu caráter inovador, as tecnologias móveis em saúde envolvem muitos atores na jornada até o usuário final, focados na concepção, desenvolvimento técnico, regulação sanitária e elaboração de diretrizes clínicas, e têm despertado grande interesse para fins de monitoramento e cuidados em diferentes condições clínicas. Entretanto, na avaliação da efetividade e da segurança das tecnologias móveis em saúde, não se observa o mesmo rigor metodológico exigido para ensaios clínicos de medicamentos e outros produtos de saúde; ainda, o entusiasmo pela inovação se contrapõe às preocupações regulatórias e éticas relacionadas à proteção de dados, à privacidade, ao acesso aos dispositivos móveis e às disparidades tecnológicas e sociais. Apesar das possíveis limitações, as tecnologias móveis, assim como outros recursos da telessaúde, têm alcançado resultados promissores. A atenção digital em saúde tem grande potencial de expansão e representa uma oportunidade para que as práticas tradicionais de saúde sejam revisadas a partir da seleção e da incorporação das tecnologias móveis aos sistemas de saúde, sempre que sejam observados benefícios embasados nas melhores evidências.


[ABSTRACT]. The association between fast-growing mobile technologies and increasingly more mobile devices has allowed the introduction of virtual environments into daily activities. That includes the health care domain, where concepts such telemedicine, telehealth, eHealth, and mHealth have emerged. In addition to presenting these new concepts, this article aims to discuss the advancements and challenges of mobile health technologies stemming from considerations regarding development, application, legal aspects, and ethics. Because of their innovative nature, mobile health technologies entail the engagement of many actors in the journey to reach end users, covering conception, technical development, sanitary regulations, and design of clinical guidelines, having raised a great deal or interest in terms of monitoring and care across a variety of clinical conditions. However, assessment of the effectiveness and safety of mobile health technologies does not seem to involve the same methodological rigor imposed for clinical trials of drugs and other health products; still, the enthusiasm produced by this innovation counters some of the regulatory and ethics concerns relating to data protection, privacy, access to mobile devices, and technological or social inequality. Despite possible limitations, mobile technologies, as well as other telehealth resources, have produced promising results. Digital healthcare has great potential for expansion and represents an opportunity for the review of traditional practices with selection of mobile technologies for incorporation into the health care system whenever evidence- based benefits are verified.


[RESUMEN]. El avance de las tecnologías móviles, junto con la creciente movilidad de los dispositivos, permitió incorporar el entorno virtual a diversas actividades cotidianas, incluso en el ámbito de la salud, al introducir conceptos como telemedicina, telesalud, eSalud y mSalud. Además de presentar estos nuevos conceptos, en el presente artículo se pretende debatir los avances y desafíos de las tecnologías sanitarias móviles a partir de reflexiones sobre el desarrollo, las aplicaciones, la legislación y la ética. Por su carácter innovador, las tecnologías sanitarias móviles llevan a muchos actores a recorrer el camino conducente al usuario final, centrándose en el diseño, el desarrollo técnico, la regulación sanitaria y la elaboración de directrices clínicas; además, han despertado un gran interés para fines de seguimiento y atención en diferentes condiciones clínicas. Sin embargo, al evaluar la eficacia y seguridad de las tecnologías sanitarias móviles no se observa el mismo rigor metodológico exigido en los ensayos clínicos de medicamentos y otros productos sanitarios, y el entusiasmo por la innovación se contrapone a las preocupaciones reguladoras y éticas relacionadas con la protección de datos, la privacidad, el acceso a los dispositivos móviles y las disparidades tecnológicas y sociales. A pesar de las posibles limitaciones, las tecnologías móviles, así como otros recursos de telesalud, han dado resultados prometedores. La atención digital en el ámbito de la salud tiene un gran potencial de expansión y representa una oportunidad para revisar las prácticas tradicionales de salud a partir de la selección e incorporación de las tecnologías móviles a los sistemas de salud, siempre que se registren beneficios basados en la mejor evidencia.


Assuntos
Tecnologia da Informação , Atenção à Saúde , Telemedicina , Estratégias de eSaúde , Tecnologia sem Fio , Tecnologia da Informação , Atenção à Saúde , Telemedicina , Estratégias de eSaúde , Tecnologia sem Fio , Tecnologia da Informação , Atenção à Saúde , Estratégias de eSaúde , Tecnologia sem Fio , COVID-19
8.
Front Pharmacol ; 13: 844818, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35387351

RESUMO

Background: In 2019, a new type of coronavirus emerged and spread to the rest of the world. Numerous drugs were identified as possible treatments. Among the candidates for possible treatment was azithromycin alone or in combination with other drugs. As a result, many clinicians in Brazil have prescribed azithromycin in an attempt to combat or minimize the effects of COVID19. Aim: This study analyzed the sales data of the main antibiotics prescribed in Brazil to verify the change in consumption trends of these drugs during the COVID-19 pandemic. Methods: This is an interrupted time series that analyzed antimicrobial sales data between January 2014 and July 2021, publicly accessible information obtained from the Brazilian government's website. Monthly means of "defined daily doses of DDDs" (DDDs per 1,000 inhabitants per day) of antibiotics were compared by analysis of variance, followed by the Dunnett Multiple Comparisons Test. Monthly trend changes in antibiotic use were verified using Joinpoint regression. Results: Amoxicillin (31.97%), azithromycin (18.33%), and cefalexin (16.61%) were the most sold antibiotics in Brazil during the evaluation period. Azithromycin consumption rose from 1.40 DDDs in February 2020 to 3.53 DDDs in July 2020. Azithromycin sales showed a significant increase in the pandemic period [Monthly Percent Change (MPC) 5.83%, 95% 1.80; 10.00], whereas there was a fall in amoxicillin sales (MPC -9.00%, 95% CI -14.70; -2.90) and cefalexin [MPC-2.70%, 95% (CI -6.30; -1.10)] in this same period. Conclusion: The COVID-19 pandemic changed the pattern of antibiotic consumption in Brazil, with a decrease in the use of amoxicillin and cefalexin and an increase in the consumption of azithromycin.

9.
Pharmacoepidemiol Drug Saf ; 31(3): 343-352, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34957616

RESUMO

PURPOSE: Drug utilization research (DUR) contributes to inform policymaking and to strengthen health systems. The availability of data sources is the first step for conducting DUR. However, documents that systematize these data sources in Latin American (LatAm) countries are not known. We compiled the potential data sources for DUR in the LatAm region. METHODS: A network of DUR experts from nine LatAm countries was assembled and experts conducted: (i) a website search of the government, academic, and private health institutions; (ii) screening of eligible data sources, and (iii) liaising with national experts in pharmacoepidemiology (via an online survey). The data sources were characterized by accessibility, geographic granularity, setting, sector of the data, sources and type of the data. Descriptive analyses were performed. RESULTS: We identified 125 data sources for DUR in nine LatAm countries. Thirty-eight (30%) of them were publicly and conveniently available; 89 (71%) were accessible with limitations, and 18 (14%) were not accessible or lacked clear rules for data access. From the 125 data sources, 76 (61%) were from the public sector only; 46 (37%) were from pharmacy records; 43 (34%) came from ambulatory settings and; 85 (68%) gave access to individual patient-level data. CONCLUSIONS: Although multiple sources for DUR are available in LatAm countries, the accessibility is a major challenge. The procedures for accessing DUR data should be transparent, feasible, affordable, and protocol-driven. This inventory could permit a comparison of drug utilization between countries identifying potential medication-related problems that need further exploration.


Assuntos
Uso de Medicamentos , Armazenamento e Recuperação da Informação , Humanos , América Latina , Inquéritos e Questionários
10.
Front Psychiatry ; 12: 575108, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33981256

RESUMO

Background: The deinstitutionalization process is complex, long-term and many countries fail to achieve progress and consolidation. Informing decision-makers about appropriate strategies and changes in mental health policies can be a key factor for it. This study aimed to develop an evidence brief to summarize the best available evidence to improve care for deinstitutionalized patients with severe mental disorders in the community. Methods: We used the SUPPORT (Supporting Policy Relevant Reviews and Trials) tools to elaborate the evidence brief and to organize a policy dialogue with 24 stakeholders. A systematic search was performed in 10 electronic databases and the methodological quality of systematic reviews (SRs) was assessed by AMSTAR 2. Results: Fifteen SRs were included (comprising 378 studies and 69,736 participants), of varying methodological quality (3 high-quality SRs, 2 moderate-quality SRs, 7 low-quality SRs, 3 critically low SRs). Six strategies were identified: (i). Psychoeducation; (ii). Anti-stigma programs, (iii). Intensive case management; (iv). Community mental health teams; (v). Assisted living; and (vi). Interventions for acute psychiatric episodes. They were associated with improvements on a global status, satisfaction with the service, reduction on relapse, and hospitalization. Challenges to implementation of any of them included: stigma, the shortage of specialized human resources, limited political and budgetary support. Conclusions: These strategies could guide future actions and policymaking to improve mental health outcomes.

11.
PLoS One ; 16(4): e0248866, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33826610

RESUMO

Evidence on the use of non-steroidal anti-inflammatory drugs (NSAIDs) and corticoids for rheumatoid arthritis (RA) is inconclusive and is not up to date. This systematic review assessed the effectiveness and safety of these anti-inflammatories (AI) in the treatment of RA. COCHRANE (CENTRAL), MEDLINE, EMBASE, CINAHL, Web of Science and Virtual Health Library were searched to identify randomized controlled trials (RCT) with adults which used AI (dose represented in mg/day) compared with placebo or active controls and was carried out up to December of 2019. Reviewers, in pairs and independently, selected studies, performed the data extraction and assessed the risk of bias. The quality of the evidence was assessed by GRADE. Network meta-analyses were performed using the Stata v.14.2. Twenty-six articles were selected (NSAIDs = 21 and corticoids = 5). Naproxen 1,000 improved physical function, reduced pain and the number of painful joints compared to placebo. Etoricoxib 90 reduced the number of painful joints compared to placebo. Naproxen 750 reduced the number of swollen joints, except for etoricoxib 90. Naproxen 1,000, etoricoxib 90 and diclofenac 150 were better than placebo regarding patient assessment. Assessment physician showed that NSAIDs were better than placebo. Meta-analyses were not performed for prednisolone and prednisone. Naproxen 1,000 was the most effective drug and celecoxib 200 showed fewer adverse events. However, the low quality of the evidence observed for the outcomes with NSAIDs, the absence of meta-analyses to assess the outcomes with corticoids, as well as the risk of bias observed, indicate that future RCT can confirm such findings.


Assuntos
Corticosteroides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metanálise em Rede
12.
Int Urogynecol J ; 32(10): 2647-2656, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33704538

RESUMO

INTRODUCTION AND HYPOTHESIS: This systematic review evaluated the rigor of the development of clinical practice guidelines (CPG). METHODS: The searched sources were MEDLINE, EMBASE, Web of Science, Scopus, and specific databases of CPG. Reviewers, organized in triplicate and independently, selected the studies and assessed the quality of the guidelines using the Appraisal of Guidelines Research and Evaluation (AGREE II) instrument, which contains six domains for classification. The classification of the CPGs prioritized the domain 3 (developmental rigor) considering: high (score > 60%), moderate (score 30-60%), or low quality (score < 30%). The results were checked for discrepancies and decided by consensus. The interventions were described. Descriptive statistics presented the results. RESULTS: Of the ten CPGs evaluated, five were of high methodological quality, three were of moderate quality, and two of low quality. Three documents were not recommended for use. The domains with the highest scores were scope and purpose (mean = 90.1%) and clarity of presentation (mean = 88.9%). The domains of editorial independence (mean = 41.4%) and applicability (mean = 29.3%) were those with the lowest score. The most cited interventions in CPGs were the nonpharmacological, such as lifestyle interventions, bladder training, or re-education and pelvic floor muscle training. CONCLUSION: Most guidelines showed rigor in development and were recommended for use; however, editorial independence and applicability were domains that need to be improved in these documents. Our findings can guide the choice of CPG for the treatment of urinary incontinence.


Assuntos
Incontinência Urinária , Bibliometria , Bases de Dados Factuais , Fosfatos de Dinucleosídeos , Humanos , Estilo de Vida , Incontinência Urinária/terapia
14.
Rev Panam Salud Publica ; 44: e48, 2020.
Artigo em Português | MEDLINE | ID: mdl-32973900

RESUMO

OBJECTIVE: To determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in animals used to produce foods in the Americas. METHOD: A systematic literature review was performed in the following databases: Scopus, Web of Science, MEDLINE, EMBASE, and Virtual Health Library. Articles published in the past 10 years, without language limits, were selected. The outcome of interest was the prevalence of MRSA in food-producing animals. Prevalence rates were meta-analyzed in grouped random effects models using the DerSimonian and Laird method. The geographic distribution of MRSA and the time trend of resistance were also analyzed. RESULTS: Of 19 studies included, 11 were performed in the United States and 11 analyzed pig samples. Five studies were performed in South America. The samples analyzed in the studies were collected in farming, processing, and retail sites. MRSA prevalence in the Americas was 7.6% (95%CI: 5.6-9.5%), and was higher in pigs [12.6% (95%CI: 7.0-18.2%)] followed by bovine cattle [2.4% (95%CI: 1.2-3.7%)] and poultry [1.8% (95CI%: 0.3-3.4%)]. MRSA prevalence was higher in pigs in North America and bovine cattle in Latin America. There was no significant variation in MRSH prevalence along the 10-year period analyzed. CONCLUSIONS: MRSA prevalence in food-producing animals in the Americas was higher in pigs, without significant changes across time.


OBJETIVO: Determinar la prevalencia de Staphylococcus aureus resistente a la meticilina (MRSA por su sigla en inglés) en animales destinados a la producción de alimentos en la Región de las Américas. MÉTODOS: Se realizó una revisión sistemática en las siguientes bases de datos: Scopus, Web of Science, MEDLINE, EMBASE y Biblioteca Virtual de Salud (BVS). Se seleccionaron artículos publicados en los últimos diez años, sin restricción en cuanto al idioma. El resultado de interés fue la prevalencia de MRSA en animales destinados a la producción de alimentos. Las tasas de prevalencia se agruparon en metanálisis de efectos aleatorios por el método de DerSimonian y Laird. También se analizaron la distribución geográfica de los microorganismos resistentes y las tendencias de resistencia con el transcurso del tiempo. RESULTADOS: De los 19 estudios incluidos, 11 se realizaron en Estados Unidos y en 11 se analizaron muestras tomadas de cerdos. Se efectuaron cinco estudios en América del Sur. Las muestras analizadas se recogieron en lugares de cría, sacrificio y venta. La prevalencia de MRSA en la Región de las Américas fue de 7,6% (IC95%: 5,6-9,5%) con una tasa mayor en cerdos [12,6% (IC95%: 7,0-18,2%)], seguidos por bovinos [2,4% (IC95%: 1,2-3,7%)] y aves [1,8% (IC95%: 0,3-3,4%)]. Se observó una mayor prevalencia de MRSA en la población porcina de América del Norte y en la población bovina de América Latina. No hubo variación significativa de la prevalencia de resistencia en los diez años analizados. CONCLUSIONES: La prevalencia de MRSA en animales destinados a la producción de alimentos en la Región de las Américas fue mayor en cerdos, sin variación significativa de la prevalencia con el transcurso del tiempo.

15.
BMJ Open ; 10(9): e038646, 2020 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-32938601

RESUMO

INTRODUCTION: The number of clinical practice guidelines (CPGs) have increased substantially mainly in the paediatric area of mental health. However, little is known about the quality or how recommendations for the treatment of disorders such as schizophrenia in children and adolescents have changed over time. The aim of this study will be to assess the quality of the development of CPGs for the treatment and management of schizophrenia in children and adolescents over time using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool and to compare the recommendations and interventions described in these documents. METHODS AND ANALYSIS: CPGs will be identified using a prospective protocol through a systematic search of multiple databases (Medline, Embase, Health Systems Evidence, Epistemonikos, Lilacs, etc) and guideline websites from 2004 to December 2020. The quality of the guidelines will be assessed by three reviewers, independently using the AGREE II. CPGs will be considered of high-quality if they scored ≥60% in four or more domains of the AGREE II instrument. Non-parametric tests will be used to test for the change of quality over time. We will summarise the different evidence grading systems and compare the recommendations. ETHICS AND DISSEMINATION: Ethical approval is not required since it is a literature-based study. Future results of the research can be submitted for publication in scientific journals of high impact, peer reviewed and also published in national and international conferences. The results derived from this study will contribute to the improvement of health institutions and policies, informing about existing recommendation guidelines and about deficiencies and qualities found in those. This study may also identify key areas for future research. This study may guide the search and choice for high quality CPGs by health policy makers and health professionals and subsidise future adaptations. PROTOCOL REGISTRATION NUMBER: CRD42020164899.


Assuntos
Esquizofrenia , Adolescente , Criança , Bases de Dados Factuais , Humanos , Saúde Mental , Estudos Prospectivos , Esquizofrenia/terapia , Inquéritos e Questionários
16.
Rev Panam Salud Publica ; 44, sept. 2020
Artigo em Português | PAHO-IRIS | ID: phr-52320

RESUMO

[RESUMO]. Objetivo. Determinar a prevalência de Staphylococcus aureus resistente à meticilina (MRSA) em animais destinados à produção de alimentos na região das Américas. Métodos. Foi realizada uma revisão sistemática nas seguintes bases de dados: Scopus, Web of Science, MEDLINE, EMBASE e Biblioteca Virtual de Saúde (BVS). Foram selecionados artigos publicados nos últimos 10 anos, sem restrição quanto ao idioma. O desfecho de interesse foi a prevalência de MRSA em animais destinados à produção de alimentos. As prevalências foram agrupadas em metanálises de efeitos aleatórios pelo método de DerSimonian e Laird. A distribuição geográfica dos microrganismos resistentes e o decurso temporal das tendências de resistência também foram analisados. Resultados. Dos 19 estudos incluídos, 11 foram conduzidos nos Estados Unidos e 11 analisaram amostras em suínos. Cinco estudos foram realizados na América do Sul. As amostras analisadas foram coletadas em locais de criação, de abate e de venda. A prevalência de MRSA na região das Américas foi de 7,6% (IC95%: 5,6 a 9,5%) e apresentou-se maior em suínos [12,6% (IC95%: 7,0 a 18,2%)], seguidos por bovinos [2,4% (IC95%: 1,2 a 3,7%)] e aves [1,8% (IC95%: 0,3 a 3,4%)]. Observou-se maior prevalência de MRSA na população de suínos da América do Norte e de bovinos da América Latina. Não houve variação significativa da prevalência de resistência nos 10 anos analisados. Conclusões. A prevalência de MRSA em animais destinados à produção de alimentos na região das Américas foi maior em suínos, sem variação significativa da prevalência no decurso temporal.


[ABSTRACT]. Objective. To determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in animals used to produce foods in the Americas. Method. A systematic literature review was performed in the following databases: Scopus, Web of Science, MEDLINE, EMBASE, and Virtual Health Library. Articles published in the past 10 years, without language limits, were selected. The outcome of interest was the prevalence of MRSA in food-producing animals. Prevalence rates were meta-analyzed in grouped random effects models using the DerSimonian and Laird method. The geographic distribution of MRSA and the time trend of resistance were also analyzed. Results. Of 19 studies included, 11 were performed in the United States and 11 analyzed pig samples. Five studies were performed in South America. The samples analyzed in the studies were collected in farming, processing, and retail sites. MRSA prevalence in the Americas was 7.6% (95%CI: 5.6-9.5%), and was higher in pigs [12.6% (95%CI: 7.0-18.2%)] followed by bovine cattle [2.4% (95%CI: 1.2-3.7%)] and poultry [1.8% (95CI%: 0.3-3.4%)]. MRSA prevalence was higher in pigs in North America and bovine cattle in Latin America. There was no significant variation in MRSH prevalence along the 10-year period analyzed. Conclusions. MRSA prevalence in food-producing animals in the Americas was higher in pigs, without significant changes across time.


[RESUMEN]. Objetivo. Determinar la prevalencia de Staphylococcus aureus resistente a la meticilina (MRSA por su sigla en inglés) en animales destinados a la producción de alimentos en la Región de las Américas. Métodos. Se realizó una revisión sistemática en las siguientes bases de datos: Scopus, Web of Science, MEDLINE, EMBASE y Biblioteca Virtual de Salud (BVS). Se seleccionaron artículos publicados en los últimos diez años, sin restricción en cuanto al idioma. El resultado de interés fue la prevalencia de MRSA en animales destinados a la producción de alimentos. Las tasas de prevalencia se agruparon en metanálisis de efectos aleatorios por el método de DerSimonian y Laird. También se analizaron la distribución geográfica de los microorganismos resistentes y las tendencias de resistencia con el transcurso del tiempo. Resultados. De los 19 estudios incluidos, 11 se realizaron en Estados Unidos y en 11 se analizaron muestras tomadas de cerdos. Se efectuaron cinco estudios en América del Sur. Las muestras analizadas se recogieron en lugares de cría, sacrificio y venta. La prevalencia de MRSA en la Región de las Américas fue de 7,6% (IC95%: 5,6-9,5%) con una tasa mayor en cerdos [12,6% (IC95%: 7,0-18,2%)], seguidos por bovinos [2,4% (IC95%: 1,2-3,7%)] y aves [1,8% (IC95%: 0,3-3,4%)]. Se observó una mayor prevalencia de MRSA en la población porcina de América del Norte y en la población bovina de América Latina. No hubo variación significativa de la prevalencia de resistencia en los diez años analizados. Conclusiones. La prevalencia de MRSA en animales destinados a la producción de alimentos en la Región de las Américas fue mayor en cerdos, sin variación significativa de la prevalencia con el transcurso del tiempo.


Assuntos
Resistência Microbiana a Medicamentos , Staphylococcus aureus Resistente à Meticilina , Revisão Sistemática , América , Resistência Microbiana a Medicamentos , Staphylococcus aureus Resistente à Meticilina , América , Revisão Sistemática , Resistência Microbiana a Medicamentos , Staphylococcus aureus Resistente à Meticilina , América , Revisão Sistemática
17.
Front Pharmacol ; 11: 1128, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32848747

RESUMO

BACKGROUND: The judicialization of health care is a social claim concerning the right to the access to health care. It usually occurs due to gaps in public policy or failures in its application. In Brazil, several public institutions have implemented strategies to approach this phenomenon. However, these strategies have not yet been systematized into functional categories. OBJECTIVE: To categorize and analyze the strategies implemented by public institutions in Brazil to approach the judicialization of health care. METHOD: A systematic scoping review was developed following the method proposed by the Joanna Briggs Institute. The descriptor 'judicialization of health' was used to conduct the searches for studies in 18 electronic databases and other types of documents in the gray literature until March 2019. Documents containing the reports of strategies implemented in public institutions to approach the judicialization of health care in Brazil were included. Two independent reviewers assessed the eligibility of the documents and extracted the data. The strategies identified were categorized using definitions from the World Health Organization and existing Brazilian legislation. RESULTS: Seventy eight implemented strategies were identified and organized into nine categories: i. Technical support to the judiciary; ii. State health committees; iii. Organization of assistance; iv. Compliance with court orders, v. Computerized information systems; vi. Administrative proceeding; vii. Defense of the public authority; viii. Pharmacy and therapeutics committee; ix. Alternative dispute resolution. These categories are not mutually exclusive and often act in concert or complement each other's activities. They represent services either existing or provided for in legal provisions by the public administration to meet various types of demands. CONCLUSIONS: The categories proposed to approach the judicialization of health care represent some of the recommendations for qualifying public administration or are provided for in Brazilian legislation, or both. The existence of recommendations and legislation facilitate, but do not guarantee, the implementation of strategies by public institutions.

19.
PLoS One ; 15(4): e0231444, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32298300

RESUMO

Acupuncture is one of the therapeutic resources used for the management of chronic pain. Variability in outcome measurements in randomized clinical trials of non-oncologic chronic pain (RCT-NOCP) generates inconsistencies in determining effects of treatments. The objective of this survey was to assess the adherence to the recommendations made by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) in the measurement of RCT-NOCP of acupuncture. This methodological research made a systematic search for eligible studies from different sources of information. Eligible studies included those with number of patients ≥100, who randomized and allocated patients with chronic non-oncologic pain to be treated with acupuncture or with "sham" acupuncture, or non-acupuncture. This research included the recommendations for IMMPACT in the measurement of RCT-NOCP: presence of outcomes pain, physical function, emotional state and improvement perception of patient, the source of the outcome information pain and the tools used to measure such domains. From a total of 1,386 studies, 24 were included in this survey. Eleven studies presented low risk of bias. Pain outcome was measured in 23 studies, physical function in 22 studies, emotional state in 14 studies and improvement perception of patient in one study. As for the pain outcome, the patient was the information source in 50% of the studies. The measurement tools recommended for IMMPACT were included in eight studies (35%) that evaluated pain, one study that evaluated the emotional state (7%), and one study that evaluated the improvement perception and satisfaction of patient. It was observed that studies which did not adhere to the recommendations had more favorable results for acupuncture in the outcome pain. This study concludes that randomized clinical trials that used acupuncture to manage chronic pain failed to adhere to IMMPACT recommendations. Clinical societies and IMMPACT do not share the same recommendations. This fact reflects in the diversity of outcomes and instruments adopted in the studies, making it difficult to compare the results.


Assuntos
Analgesia por Acupuntura/métodos , Dor Crônica/terapia , Medição da Dor/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/normas , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Inquéritos e Questionários
20.
Front Pharmacol ; 10: 965, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31572173

RESUMO

Background: Biological agents used for the treatment of psoriatic arthritis (PsA) and rheumatoid arthritis (RA) are associated with serious adverse effects (SAEs). Although several biologics have demonstrated good efficacy and tolerability in short-term trials, treatment guidelines recommend them as third line therapies due to a relative lack of long-term safety data. Objective: To determine the frequency and severity of adverse effects associated with the long-term use of biologics in the treatment of PsA and RA, and possible risk factors for such events in a real-life setting. Methods: We conducted a longitudinal study in PsA and RA patients only taking long-term biological agents from 2003 to 2011. Sources of information included dispensing pharmacy data and interviews with patients. Research staff conducted telephone interviews with patients inquiring about any apparent medication-related adverse drug reactions (ADRs) or SAEs. ADR/SAE's data was based on pharmacy reports. We conducted a multivariate analysis to identify the factors associated with the risk of ADRs. Results: Of the 305 patients identified, we interviewed 268 patients. Most of these were taking adalimumab 127 (47.4%), 52 (19.4%) etanercept, 42 (15.7%) infliximab, 25 (9.3%) rituximab, 10 (3.7%) abatacept, 9 (3.4%) efalizumab, and 3 (1.1%) tocilizumab. Of the 268 patients, 116 (43.3%) experienced one or more adverse events related to biological agents with 1.6 events per patient, and of these 29 (25%) experienced one or more SAEs, with majority subjected to hospitalizations. The most frequently reported ADRs were administration site reactions as observed in 73 patients (27.2%), infections in 30 patients (11.2%), effects on nervous system in 22 patients (8.2%), and 15 (5.6%) patients withdrew due to ADRs. The use of rituximab was related with less risk of ADR [PR 0.42, 95% CI 0.18-0.96; p = 0.04] than other agents. No other predisposing factors were associated with risk of ADR. The monitoring of patients (medical consultation and laboratory test) was only completed by 48 patients (30.4%). Conclusion: These data showed the early biological experience in Brazil that were associated with ADRs, withdrawals due to ADRs and SAEs. The quantification of adverse effects (serious or nonserious) considering close monitoring and patients' perceptions are increasingly important for future decision-making.

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