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1.
PLoS One ; 15(1): e0228256, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31986191

RESUMO

BACKGROUND AND AIMS: Ulcerative Colitis (UC) and Crohn's Disease (CD) have a major impact on quality of life and medical costs. The aim of the study was to estimate the prevalence, incidence and clinical phenotypes of Inflammatory Bowel Disease (IBD) cases in Mexico and Colombia. METHODS: We analyzed official administrative and health databases, used mathematical modelling to estimate the incidence and complete prevalence, and performed a case-series of IBD patients at a referral center both in Mexico and Colombia. RESULTS: The age-adjusted complete prevalence of UC per 100,000 inhabitants for 2015/2016 ranged from 15.65 to 71.19 in Mexico and from 27.40 to 69.97 in Colombia depending on the model considered. The prevalence of CD per 100,000 inhabitants in Mexico ranged from 15.45 to 18.08 and from 16.75 to 18.43 in Colombia. In Mexico, the age-adjusted incidence of UC per 100,000 inhabitants per year ranged from 0.90 to 2.30, and from 0.55 to 2.33 in Colombia. The incidence for CD in Mexico ranged from 0.35 to 0.66 whereas in Colombia, the age-adjusted incidence of CD ranged from 0.30 to 0.57. The case-series included 200 IBD patients from Mexico and 204 patients from Colombia. The UC/CD prevalence ratio in Mexico and Colombia was 1.50:1 and 4.5:1 respectively. In Mexico, the female/male prevalence ratio for UC was 1.50:1 and 1.28:1 for CD, while in Colombia this ratio was 0.68:1 for UC and 0.8:1 for CD. In Mexico the relapse rate for UC was 63.3% and 72.5% for CD, while those rates in Colombia were 58.2% for UC and 58.3% for CD. CONCLUSIONS: The estimated burden of disease of IBD in Mexico and Colombia is not negligible. Although these findings need to be confirmed by population-based studies, they are useful for decision-makers, practitioners and patients with this condition.

2.
Cochrane Database Syst Rev ; 12: CD011260, 2019 12 05.
Artigo em Inglês | MEDLINE | ID: mdl-31801180

RESUMO

BACKGROUND: Poliomyelitis mainly affects unvaccinated children under five years of age, causing irreversible paralysis or even death. The oral polio vaccine (OPV) contains live attenuated virus, which can, in rare cases, cause a paralysis known as vaccine-associated paralytic polio (VAPP), and also vaccine-derived polioviruses (VDPVs) due to acquired neurovirulence after prolonged duration of replication. The incidence of poliomyelitis caused by wild polio virus (WPV) has declined dramatically since the introduction of OPV and later the inactivated polio vaccine (IPV), however, the cases of paralysis linked to the OPV are currently more frequent than those related to the WPV. Therefore, in 2016, the World Health Organization (WHO) recommended at least one IPV dose preceding routine immunisation with OPV to reduce VAPPs and VDPVs until polio could be eradicated. OBJECTIVES: To assess the effectiveness, safety, and immunogenicity of sequential IPV-OPV immunisation schemes compared to either OPV or IPV alone. SEARCH METHODS: In May 2019 we searched CENTRAL, MEDLINE, Embase, 14 other databases, three trials registers and reports of adverse effects on four web sites. We also searched the references of identified studies, relevant reviews and contacted authors to identify additional references. SELECTION CRITERIA: Randomised controlled trials (RCTs), quasi-RCTs, controlled before-after studies, nationwide uncontrolled before-after studies (UBAs), interrupted time series (ITS) and controlled ITS comparing sequential IPV-OPV schedules (one or more IPV doses followed by one or more OPV doses) with IPV alone, OPV alone or non-sequential IPV-OPV combinations. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: We included 21 studies: 16 RCTs involving 6407 healthy infants (age range 96 to 975 days, mean 382 days), one ITS with 28,330 infants and four nationwide studies (two ITS, two UBA). Ten RCTs were conducted in high-income countries; five in the USA, two in the UK, and one each in Chile, Israel, and Oman. The remaining six RCTs were conducted in middle-income countries; China, Bangladesh, Guatemala, India, and Thailand. We rated all included RCTs at low or unclear risk of bias for randomisation domains, most at high or unclear risk of attrition bias, and half at high or unclear risk for conflict of interests. Almost all RCTs were at low risk for the remaining domains. ITSs and UBAs were mainly considered at low risk of bias for most domains. IPV-OPV versus OPV It is uncertain if an IPV followed by OPV schedule is better than OPV alone at reducing the number of WPV cases (very low-certainty evidence); however, it may reduce VAPP cases by 54% to 100% (three nationwide studies; low-certainty evidence). There is little or no difference in vaccination coverage between IPV-OPV and OPV-only schedules (risk ratio (RR) 1.01, 95% confidence interval (CI) 0.96 to 1.06; 1 ITS study; low-certainty evidence). Similarly, there is little or no difference between the two schedule types for the number of serious adverse events (SAEs) (RR 0.88, 95% CI 0.46 to 1.70; 4 studies, 1948 participants; low-certainty evidence); or the number of people with protective humoral response P1 (moderate-certainty evidence), P2 (for the most studied schedule; two IPV doses followed by OPV; low-certainty evidence), and P3 (low-certainty evidence). Two IPV doses followed by bivalent OPV (IIbO) may reduce P2 neutralising antibodies compared to trivalent OPV (moderate-certainty evidence), but may make little or no difference to P1 or P2 neutralising antibodies following an IIO schedule or OPV alone (low-certainty evidence). Both IIO and IIbO schedules may increase P3 neutralising antibodies compared to OPV (moderate-certainty evidence). It may also lead to lower mucosal immunity given increased faecal excretion of P1 (low-certainty evidence), P2 and P3 (moderate-certainty evidence) after OPV challenge. IPV-OPV versus IPV It is uncertain if IPV-OPV is more effective than IPV alone at reducing the number of WPV cases (very low-certainty evidence). There were no data regarding VAPP cases. There is no clear evidence of a difference between IPV-OPV and OPV schedules for the number of people with protective humoral response (low- and moderate-certainty evidence). IPV-OPV schedules may increase mean titres of P1 neutralising antibodies compared to OPV alone (low- and moderate-certainty evidence), but the effect on P2 and P3 titres is not clear (very low- and moderate-certainty evidence). IPV-OPV probably reduces the number of people with P3 poliovirus faecal excretion after OPV challenge with IIO and IIOO sequences (moderate-certainty evidence), and may reduce the number with P2 (low-certainty evidence), but not with P1 (very low-certainty evidence). There may be little or no difference between the schedules in number of SAEs (RR 0.92, 95% CI 0.60 to 1.43; 2 studies, 1063 participants, low-certainty evidence). The number of persons with P2 protective humoral immunity and P2 neutralising antibodies are probably lower with most sequential schemes without P2 components (i.e. bOPV) than with trivalent OPV or IVP alone (moderate-certainty evidence). IPV (3)-OPV versus IPV (2)-OPV One study (137 participants) showed no clear evidence of a difference between three IPV doses followed by OPV and two IPV doses followed by OPV, on the number of people with P1 (RR 0.98, 95% CI 0.93 to 1.03), P2 (RR 1.00, 95% CI 0.97 to 1.03), or P3 (RR 1.01, 95% CI 0.97 to 1.05) protective humoral and intestinal immunity; all moderate-certainty evidence. This study did not report on any other outcomes. AUTHORS' CONCLUSIONS: IPV-OPV compared to OPV may reduce VAPPs without affecting vaccination coverage, safety or humoral response, except P2 with sequential schemes without P2 components, but increase poliovirus faecal excretion after OPV challenge for some polio serotypes. Compared to IPV-only schedules, IPV-OPV may have little or no difference on SAEs, probably has little or no effect on persons with protective humoral response, may increase neutralising antibodies, and probably reduces faecal excretion after OPV challenge of certain polio serotypes. Using three IPV doses as part of a IPV-OPV schedule does not appear to be better than two IPV doses for protective humoral response. Sequential schedules during the transition from OPV to IPV-only immunisation schedules seems a reasonable option aligned with current WHO recommendations. Findings could help decision-makers to optimise polio vaccination policies, reducing inequities between countries.

3.
Artigo em Inglês | MEDLINE | ID: mdl-31867689

RESUMO

PURPOSE: To evaluate if the authors of published systematic reviews (SRs) reported the level of quality of evidence (QoE) in the top 5 impact factor infertility journals and to analyze if they used an appropriate wording to describe it. METHODS: This is a cross-sectional study. We searched in PubMed for SRs published in 2017 in the five infertility journals with the highest impact factor. We analyzed the proportion of SRs published in the top 5 impact factor infertility journals that reported the SRs' QoE, and the proportion of those SRs in which authors used consistent wording to describe QoE and magnitude of effect. RESULTS: The QoE was reported in only 21.4% of the 42 included SRs and in less than 10% of the abstracts. Although we did not find important differences in the report of QoE of those that showed statistically significant differences or not, p value was associated with the wording chosen by the authors. We found inconsistent reporting of the size the effect estimate in 54.8% (23/42) and in the level of QoE in 92.9% (39/42). Whereas the effect size was more consistently expressed in studies with statistically significant findings, QoE was better expressed in those cases in which the p value was over 0.05. CONCLUSION: We found that in 2017, less than 25% of the authors reported the overall QoE when publishing SRs. Authors focused more on statistical significance as a binary concept than on methodological limitations like study design, imprecision, indirectness, inconsistency, and publication bias. Authors should make efforts to report the QoE and interpret results accordingly.

4.
Value Health Reg Issues ; 20: 180-190, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31654963

RESUMO

OBJECTIVE: To describe the epidemiology, the consumption of resources and the relevant costs in the management of hepatitis C in four Latin American countries: Argentina, Colombia, Uruguay and Venezuela. STUDY DESIGN: Bibliographic review, study of costs and elicitation by experts METHODS: A literature search was carried out to collect epidemiological and cost data for the management of the disease. Information was additionally elicited with hepatologists from each country using the modified Delphi Panel technique. For the estimation of costs, the perspective of the health system was adopted. The direct medical costs of the different stages associated with the natural history of the disease were considered through micro-costing. RESULTS: Extensive epidemiological and economic information is provided for the four countries under study. The age range between 40 and 60 years was the most affected. The frequency of genotypes showed a predominance of genotype 1 (68 to 88%), genotype 1b having been reported as the most prevalent in Argentina and Colombia and 1a in Uruguay and Venezuela. The costs of drug regimens, associated health events and adverse events present important differences in the four selected countries of Latin America. CONCLUSION: Hepatitis C presents a high burden of disease in the countries under study, and its management imposes significant costs on health systems.

5.
BMC Public Health ; 19(1): 1378, 2019 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-31655600

RESUMO

BACKGROUND: Around 6% of total deaths are related to alcohol consumption worldwide. Mathematical models are important tools to estimate disease burden and to assess the cost-effectiveness of interventions to address this burden. METHODS: We carried out a systematic review on models, searching main health literature databases up to July 2017. Pairs of reviewers independently selected, extracted data and assessed the quality of the included studies. Discrepancies were resolved by consensus. We selected those models exploring: a) disease burden (main metrics being attributable deaths, disability-adjusted life years, quality-adjusted life years) or b) economic evaluations of health interventions or policies, based on models including the aforementioned outcomes. We grouped models into broad families according to their common central methodological approach. RESULTS: Out of 4295 reports identified, 63 met our inclusion criteria and were categorized in three main model families that were described in detail: 1) State transition -i.e Markov- models, 2) Life Table-based models and 3) Attributable fraction-based models. Most studies pertained to the latter one (n = 29, 48.3%). A few miscellaneous models could not be framed into these families. CONCLUSIONS: Our findings can be useful for future researchers and decision makers planning to undertake alcohol-related disease burden or cost-effectiveness studies. We found several different families of models. Countries interested in adopting relevant public health measures may choose or adapt the one deemed most convenient, based on the availability of existing data at the local level, burden of work, and public health and economic outcomes of interest.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Transtornos Relacionados ao Uso de Álcool/prevenção & controle , Promoção da Saúde/economia , Análise Custo-Benefício , Humanos , Modelos Teóricos , Ensaios Clínicos Controlados Aleatórios como Assunto
6.
Cad Saude Publica ; 35(8): e00129118, 2019 Aug 29.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31483047

RESUMO

The prevalence of smoking in Brazil has decreased considerably in recent decades, but the country still has a high burden of disease associated with this risk factor. The study aimed to estimate the burden of mortality, morbidity, and costs for society associated with smoking in 2015 and the potential impact on health outcomes and the economy based on price increases for cigarettes through taxes. Two models were developed: the first is a mathematical model based on a probabilistic microsimulation of thousands of individuals using hypothetical cohorts that considered the natural history, costs, and quality of life of these individuals. The second is a tax model applied to estimate the economic benefit and health outcomes in different price increase scenarios in 10 years. Smoking was responsible for 156,337 deaths, 4.2 million years of potential life lost, 229,071 acute myocardial infarctions, 59,509 strokes, and 77,500 cancer diagnoses. The total cost was BRL 56.9 billion (USD 14.7 billion), with 70% corresponding to the direct cost associated with healthcare and the rest to indirect cost due to lost productivity from premature death and disability. A 50% increase in cigarette prices would avoid 136,482 deaths, 507,451 cases of cardiovascular diseases, 64,382 cases of cancer, and 100,365 cases of stroke. The estimated economic benefit would be BRL 97.9 billion (USD 25.5 billion). In conclusion, the burden of disease and economic losses associated with smoking is high in Brazil, and tax increases are capable of averting deaths, illness, and costs to society.

7.
Value Health Reg Issues ; 20: 142-148, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31426017

RESUMO

BACKGROUND: Acute kidney injury (AKI) is a public health problem that affects millions of hospitalized patients worldwide. In Argentina, evidence suggests that its incidence has risen in recent years. When severe, AKI may require a renal replacement therapy (RRT) where continuous RRT (CRRT) and intermittent RRT (IRRT) are plausible options for patients in the intensive care unit. OBJECTIVE: To evaluate the cost utility of CRRT versus IRRT for the National Institute of Social Services for Retirees and Pensioners, the largest social security health insurance for elders in Argentina. METHODS: This was a model-based cost-utility analysis. Long-term costs and health outcomes were estimated for a hypothetical cohort with a Markov model. Parameters used were obtained from published literature and validated with local experts. Local costs were estimated and expressed in $AR of 2016. Several sensitivity analyses were run to analyze the impact of uncertainty on results. RESULTS: Continuous RRT dominated IRRT by cumulating over the model more quality-adjusted life years and less costs. Total discounted quality-adjusted life years for both cohorts were 1049 and 1034, respectively, and total costs were $95 362 and $103 871. Cost-effectiveness (CE) results reflect these differences in favor of CRRT with a deterministic cost-saving incremental CE ratio and a probability of CRRT being CE of 65.4%, considering a CE threshold of 1 gross domestic product per capita. CONCLUSIONS: Continuous RRT for patients with AKI eligible for CRRT or IRRT would probably be a cost-effective intervention for the National Institute of Social Services for Retirees and Pensioners' view. Nevertheless, there is considerable uncertainty around results, mainly due to the lack of adequate controlled studies and local data on the prognosis of these patients in Argentina.

8.
BMC Cardiovasc Disord ; 19(1): 136, 2019 06 04.
Artigo em Inglês | MEDLINE | ID: mdl-31164089

RESUMO

BACKGROUND: The purpose of this review is to examine the effect of Omega-3 Fatty acids on mortality, morbidity, and adverse events in patients with acute myocardial infarction (AMI). METHODS: Data Sources: MEDLINE, EMBASE, and the Cochrane Library through May 2018. STUDY SELECTION: Randomized Controlled trials (RCT). Certainty of evidence was assessed with the GRADE system. INTERVENTIONS: omega 3 fatty acids against placebo or no treatment. Primary and secondary outcomes: All-cause death, cardiovascular death, new AMI, stroke, need for therapeutic angioplasty or By-pass, new diagnosis of cancer and incidence of adverse events. RESULTS: For the efficacy endpoints we included 10 RCT (24,414 patients). Omega 3 fatty acids probably make little or no difference to all-cause mortality (4 studies 9141 patients RR 1.06 - CI95% 0.90 to 1.27, moderate certainty), cardiovascular mortality (3 studies 4304 patients RR 0.93 - CI95% 0.63 to 1.37, moderate certainty), new AMI (RR 1.24 CI95% 0.71 to 2.14 - moderate certainty), any cardiovascular event (RR 0.95 95%CI 0.86 to 1.05; low certainty due to risk of bias and imprecision), and stroke (RR 1.2 95%CCI 0,66-2,19 - moderate certainty). Regarding adverse events, we are uncertain if Omega 3 fatty acids improve/reduce non severe adverse events (RR 1.39 95% CI 0.36 to 5.34; very low certainty). There is probably little or no difference in the outcome suspension due to adverse events (RR 1.19 CI 95% 0.97 to 1.47; moderate certainty). CONCLUSIONS: For adult patients with AMI, omega 3 fatty-acids probably yield no benefit to patient important outcomes.

9.
Cad Saude Publica ; 35(5): e00092618, 2019 May 20.
Artigo em Espanhol | MEDLINE | ID: mdl-31116251

RESUMO

This study sought to describe experiences, barriers and facilitators to the implementation of interventions for controlling Aedes aegypti in Latin America and the Caribbean. A qualitative approach with semi-structured in-depth interviews with program implementation experts (19 participants in nine countries) was carried out. We used a software to codify the data and created matrices to compare them. Based on our findings, we developed a graphic representation of the theoretical dimensions that encompass the barriers and facilitators to the implementation of interventions. At the global level, the natural and built environment contributed to the mosquito's reproduction. In the health system, the lack of priority given to the problem and the scarcity of material and human resources are the most important obstacles. Sectors other than health must take responsibility for actions directed at improving social determinants of health. There are transversal barriers related to governance, lack of coordination between central and local levels, lack of continuity in terms of interventions and technical groups. The community faces problems such as lack of information, poverty or resistance to recommendations. Public opinion can have a positive or negative impact, indirectly influencing political decisions. This study proposes a framework of analytical dimensions based on our findings; describes factors that influence policy implementation, which can guide future actions from an integrated perspective.

10.
Cad Saude Publica ; 35(4): e00092918, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30994739

RESUMO

This article presents the results of a dialogue between decision-makers and experts in Latin America and the Caribbean on priority-setting for interventions and studies on Aedes aegypti control. The article is part of a project that included a systematic review of mosquito control strategies and a qualitative study with key informants from the region. Using a collective deliberative process assisted by the results of the above-mentioned projects, a list of priorities was developed by consensus for the implementation of vector control strategies and the development of key regional research lines. It was agreed that the best strategy is integrated vector management, divided into: (a) chemical control; (b) biological control; (c) environmental management; (d) community participation; and (e) integrated surveillance. The workshop highlighted the crucial role of government leadership and inter-sector coordination between government agencies and civil society stakeholders. The proposed priorities for research lines were: Ae. aegypti vector competence and associated factors; community components of interventions; incorporation of technology into vector control and monitoring; most efficient modalities of integrated surveillance; entomological indicators with the best predictive capacity; and resistance to insecticides. The policy dialogue methodology allowed validating and enriching the results of other levels of research, besides establishing priorities for regional research and control strategies.

11.
Rev. argent. salud publica ; 10(38): 8-15, Abril 2019.
Artigo em Espanhol | LILACS, BINACIS, ARGMSAL | ID: biblio-996317

RESUMO

NTRODUCCIÓN: El consumo de alcohol es uno de los principales factores de riesgo. Para relevar las condiciones previas al establecimiento de políticas públicas orientadas a disminuir el consumo de alcohol en Argentina, se fijaron tres objetivos: a) caracterizar la demanda y oferta de bebidas alcohólicas; b) evaluar la situación normativa respecto de políticas de control de publicidad, promoción y patrocinio, y las pautas de publicidad televisiva; c) definir qué modelos de carga de enfermedad atribuible y costo-efectividad de las intervenciones podrían ser aplicables. MÉTODOS: Se analizaron datos de la Encuesta Nacional de Gasto de los Hogares 2004/5 y 2012/3 y de la base Euromonitor Internacional. Se examinaron el marco normativo y las acciones televisivas de publicidad, promoción y patrocinio. Se revisó la literatura sobre modelos de carga de enfermedad y costo-efectividad de intervenciones. RESULTADOS: El consumo de bebidas alcohólicas no se modificó entre 2004/5 y 2012/3, y la industria está muy concentrada. El marco de regulación de la publicidad es laxo; más de la mitad de los avisos de TV se emiten en horario diurno, por lo que se expone a menores y se incumplen los acuerdos internacionales subscritos. Hay tres enfoques principales de modelamiento epidemiológico y económico que podrían ser aplicables. CONCLUSIONES: Se caracterizaron aspectos económicos, jurídico-legales y epidemiológicos útiles para impulsar una agenda pública orientada a disminuir el consumo de alcohol


Assuntos
Humanos , Política Pública , Saúde Pública , Revisão , Publicidade como Assunto , Bebidas Alcoólicas
12.
Trop Med Int Health ; 24(5): 530-552, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30771267

RESUMO

OBJECTIVE: To determine the effectiveness and degree of implementation of interventions for the control of Aedes aegypti in Latin America and the Caribbean (LAC) as reported in scientific literature. METHODS: We searched MEDLINE, EMBASE, CENTRAL, SOCINDEX, and LILACS, for experimental and observational studies, economic assessments and qualitative experiences carried out in LAC from 2000 to 2016. We assessed incidence and morbimortality of Aedes aegypti-related diseases and entomological indices: Breteau (containers), House, and Pupae per Person. We used GRADE methodology for assessing quality of evidence. RESULTS: Of 1826 records retrieved, 75 were included and 9 cluster randomised clinical trials could be meta-analysed. We did not identify any intervention supported by a high certainty of evidence. In consistency with qualitative evidence, health education and community engagement probably reduces the entomological indices, as do the use of insecticide-treated materials, indoor residual spraying and the management of containers. There is low certainty of evidence supporting the use of ovitraps or larvitraps, and the integrated epidemiological surveillance strategy to improve indices and reduce the incidence of dengue. The reported degree of implementation of these vector control interventions was variable and most did not extend to whole cities and were not sustained beyond 2 years. CONCLUSIONS: We found a general lack of evidence on effectiveness of vector control in the region, despite a few interventions that showed moderate to low certainty of evidence. It is important to engage and educate the community, apart from achieving the implementation of integrated actions between the health and other sectors at national and regional level.


Assuntos
Aedes , Participação da Comunidade , Educação em Saúde , Inseticidas , Controle de Mosquitos/métodos , Mosquitos Vetores , /prevenção & controle , Animais , Região do Caribe , Dengue/prevenção & controle , Ecossistema , Humanos , América Latina , Vigilância da População
13.
Artigo em Inglês | MEDLINE | ID: mdl-30649400

RESUMO

Background: Using data from general adult population, this study aims to describe epidemiology of alcohol consumption patterns and their association with cardiovascular risk. Methods: CESCAS I is a population-based study from four mid-sized cities in Argentina, Chile and Uruguay. Associations between diabetes, hypertension, dyslipidemia, cardiovascular disease (CVD) risk and history of CVD and drinking patterns were assessed using crude prevalence odds ratios (ORs) and adjusted OR. Results: A total of 37.2% of the studied population never drank and 18.3% reported to be former drinkers. Among current drinkers, moderate drinking was the most frequent pattern (24.2%). For women with light and moderate consumption, the odds of having >20% CVD risk was ~40% lower than that of never drinkers. The odds of having a history of CVD was 50% lower in those with moderate consumption. For men with heavy consumption, the odds of having >20% CVD risk was about twice as high as for never drinkers. Conclusions: A harmful association was observed between heavy drinking and having >20% CVD risk for men. However, for women, an apparently protective association was observed between light and moderate drinking and having >20% CVD risk and between moderate drinking and having a history of CVD.

14.
Cad. Saúde Pública (Online) ; 35(8): e00129118, 2019. tab, graf
Artigo em Português | LILACS-Express | ID: biblio-1019619

RESUMO

A prevalência do tabagismo no Brasil reduziu sobremaneira nas últimas décadas, mas o país ainda tem uma elevada carga de doença associada a este fator de risco. O objetivo deste trabalho foi estimar a carga de mortalidade, morbidade e custos para a sociedade associada ao tabagismo em 2015 e o potencial impacto gerado em desfechos de saúde e para a economia a partir do aumento de preços dos cigarros por meio de impostos. Foram desenvolvidos dois modelos: o primeiro é um modelo matemático baseado em uma microssimulação probabilística de milhares de indivíduos usando-se coortes hipotéticas que considerou a história natural, custos e a qualidade de vida destes indivíduos. O segundo é um modelo de impostos aplicado para estimar o benefício econômico e em desfechos de saúde de diferentes cenários de aumento de preços em 10 anos. O tabagismo foi responsável por 156.337 mortes, 4,2 milhões de anos de vida perdidos, 229.071 infartos agudos do miocárdio, 59.509 acidentes vasculares cerebrais e 77.500 diagnósticos de câncer. O custo total foi de R$ 56,9 bilhões, dos quais 70% corresponderam ao custo direto associado à assistência à saúde e o restante ao custo indireto devido à perda de produtividade por morte prematura e incapacidade. Um aumento de 50% do preço do cigarro evitaria 136.482 mortes, 507.451 casos de doenças cardiovasculares, 64.382 de casos de câncer e 100.365 acidentes vasculares cerebrais. O benefício econômico estimado seria de R$ 97,9 bilhões. Concluiu-se que a carga da doença e econômica associada ao tabagismo é elevada no Brasil e o aumento de impostos é capaz de evitar mortes, adoecimento e custos para a sociedade.


La prevalencia del tabaquismo en Brasil se redujo sobremanera en las últimas décadas, pero el país todavía cuenta con una elevada carga de enfermedad asociada a este factor de riesgo. El objetivo de este trabajo fue estimar la carga de mortalidad, morbilidad y costes para la sociedad, asociada al tabaquismo en 2015, y el impacto potencial generado en los desenlaces de salud y para la economía a partir del aumento de precios del tabaco a través de impuestos. Se desarrollaron dos modelos: el primero es un modelo matemático, basado en una microsimulación probabilística de millares de individuos, a través de cohortes hipotéticas, que consideró la historia natural, costes y calidad de vida de esos individuos. El segundo se trata de un modelo de impuestos aplicado para estimar el beneficio económico y en desenlaces de salud de diferentes escenarios con el aumento de precios durante 10 años. El tabaquismo fue responsable de 156.337 muertes, 4,2 millones de años de vida perdidos, 229.071 infartos agudos de miocardio, 59.509 accidentes vasculares cerebrales y 77.500 diagnósticos de cáncer. El coste total fue de BRL 56,9 billones (USD 14,7 billones), de los cuales un 70% correspondieron al coste directo asociado a la asistencia a la salud y lo restante al coste indirecto, debido a la pérdida de productividad por muerte prematura e incapacidad. Un aumento de un 50% del precio del tabaco evitaría 136.482 muertes, 507.451 casos de enfermedades cardiovasculares, 64.382 de casos de cáncer y 100.365 accidentes vasculares cerebrales. El beneficio económico estimado sería de BRL 97,9 billones (USD 25,5 billones). Se concluyó que la carga de la enfermedad y económica asociada al tabaquismo es elevada en Brasil y el aumento de impuestos es capaz de evitar muertes, enfermedad y costes para la sociedad.


The prevalence of smoking in Brazil has decreased considerably in recent decades, but the country still has a high burden of disease associated with this risk factor. The study aimed to estimate the burden of mortality, morbidity, and costs for society associated with smoking in 2015 and the potential impact on health outcomes and the economy based on price increases for cigarettes through taxes. Two models were developed: the first is a mathematical model based on a probabilistic microsimulation of thousands of individuals using hypothetical cohorts that considered the natural history, costs, and quality of life of these individuals. The second is a tax model applied to estimate the economic benefit and health outcomes in different price increase scenarios in 10 years. Smoking was responsible for 156,337 deaths, 4.2 million years of potential life lost, 229,071 acute myocardial infarctions, 59,509 strokes, and 77,500 cancer diagnoses. The total cost was BRL 56.9 billion (USD 14.7 billion), with 70% corresponding to the direct cost associated with healthcare and the rest to indirect cost due to lost productivity from premature death and disability. A 50% increase in cigarette prices would avoid 136,482 deaths, 507,451 cases of cardiovascular diseases, 64,382 cases of cancer, and 100,365 cases of stroke. The estimated economic benefit would be BRL 97.9 billion (USD 25.5 billion). In conclusion, the burden of disease and economic losses associated with smoking is high in Brazil, and tax increases are capable of averting deaths, illness, and costs to society.

15.
Cad. Saúde Pública (Online) ; 35(4): e00092918, 2019. graf
Artigo em Inglês | LILACS, PIE | ID: biblio-1001645

RESUMO

This article presents the results of a dialogue between decision-makers and experts in Latin America and the Caribbean on priority-setting for interventions and studies on Aedes aegypti control. The article is part of a project that included a systematic review of mosquito control strategies and a qualitative study with key informants from the region. Using a collective deliberative process assisted by the results of the above-mentioned projects, a list of priorities was developed by consensus for the implementation of vector control strategies and the development of key regional research lines. It was agreed that the best strategy is integrated vector management, divided into: (a) chemical control; (b) biological control; (c) environmental management; (d) community participation; and (e) integrated surveillance. The workshop highlighted the crucial role of government leadership and inter-sector coordination between government agencies and civil society stakeholders. The proposed priorities for research lines were: Ae. aegypti vector competence and associated factors; community components of interventions; incorporation of technology into vector control and monitoring; most efficient modalities of integrated surveillance; entomological indicators with the best predictive capacity; and resistance to insecticides. The policy dialogue methodology allowed validating and enriching the results of other levels of research, besides establishing priorities for regional research and control strategies.


Este trabalho apresenta os resultados de um diálogo entre tomadores de decisão e expertos da América Latina e do Caribe sobre a priorização de intervenções e pesquisas para o controle do mosquito Aedes aegypti. Faz parte de um projeto que compreendeu uma revisão sistemática sobre estratégias e controle do mosquito e um estudo qualitativo com informantes chave da região. Através de um processo deliberativo em instâncias coletivas, assistido pelos resultados dos mencionados projetos, foi elaborada uma listagem consensuada de prioridades de implementação de estratégias de controle vetorial e de desenvolvimento regional de linhas essenciais de pesquisa. Foi acordado que a melhor estratégia é a gestão integrada de vetores ou Estratégia de Gestão Integrada, desagregada em: (a) controle químico; (b) controle biológico; (c) gestão ambiental; (d) participação comunitária; (e) vigilância integrada. Foi destacado o rol fundamental e indelegável da direção do estado e a coordenação intersetorial entre agências estaduais com atores da sociedade civil. Foi proposto priorizar como linhas de pesquisa: a capacidade vetorial do Ae. aegypti e fatores associados; componentes comunitários das intervenções; a incorporação de tecnologia para o controle vetorial e para o monitoramento; modos mais eficientes de vigilância integrada; indicadores entomológicos com melhor capacidade preditiva e resistência a pesticidas. A metodologia do diálogo de políticas permitiu validar e enriquecer os resultados de outras áreas de pesquisa, possibilitou estabelecer prioridades a propósito da pesquisa, além de estratégias para o controle regional.


Este trabajo presenta los resultados de un diálogo entre tomadores de decisión y expertos de América Latina y el Caribe sobre la priorización de intervenciones e investigaciones para el control del mosquito Aedes aegypti. Forma parte de un proyecto que comprendió una revisión sistemática sobre estrategias control del mosquito y un estudio cualitativo con informantes clave de la región. Mediante un proceso deliberativo en instancias colectivas, asistido por los resultados de los mencionados proyectos, se elaboró un listado consensuado de prioridades de implementación de estrategias de control vectorial y de desarrollo regional de líneas clave de investigación. Se convino en que la mejor estrategia es el manejo integrado de vectores o Estrategia de Gestión Integrada, desagregada en: (a) control químico; (b) control biológico; (c) manejo ambiental; (d) participación comunitaria; y (e) vigilancia integrada. Se destacó el fundamental e indelegable rol de rectoría del estado y la coordinación intersectorial entre agencias estatales y con actores de la sociedad civil. Se propuso priorizar como líneas de investigación: la capacidad vectorial del Ae. aegypti y factores asociados; componentes comunitarios de las intervenciones; la incorporación de tecnología al control vectorial y al monitoreo; los modos más eficientes de vigilancia integrada; indicadores entomológicos con mejor capacidad predictiva y resistencia a insecticidas. La metodología del diálogo de políticas permitió validar y enriquecer los resultados de otras instancias de investigación, y permitió establecer prioridades sobre investigación y estrategias para el control regional.


Assuntos
Humanos , Aedes , Mosquitos Vetores , Planejamento em Saúde/organização & administração , Conferências de Consenso como Assunto , Região do Caribe/epidemiologia
16.
Cad. Saúde Pública (Online) ; 35(5): e00092618, 2019. graf
Artigo em Espanhol | LILACS-Express | ID: biblio-1001661

RESUMO

El objetivo fue describir experiencias, barreras y facilitadores en la implementación de intervenciones de control del Aedes aegypti en América Latina y Caribe. Fue realizado un abordaje cualitativo con entrevistas en profundidad semiestructuradas a expertos en implementación de programas (19 participantes de nueve países). Se utilizó un software para la codificar los datos y se confeccionaron matrices para su comparación. En base a los hallazgos desarrollamos una representación gráfica de dimensiones teóricas que agrupan las barreras y facilitadores para la implementación de intervenciones. A nivel global, el ambiente natural y construido contribuye a la reproducción del mosquito. En el sistema de salud, la falta de priorización del problema y la escasez de recursos materiales y humanos representan los obstáculos más importantes. Se necesita que otros sectores diferentes al de salud se responsabilicen de las acciones para mejorar los determinantes sociales de la salud. Existen barreras transversales relacionadas con la gobernanza, como la descoordinación entre los niveles centrales y locales, falta de continuidad de las intervenciones y de los grupos técnicos. La comunidad enfrenta problemas como la falta de información, pobreza o resistencias a recomendaciones. La opinión pública puede tener un impacto positivo o negativo, influyendo indirectamente en las decisiones políticas. Este estudio propone un marco de dimensiones de análisis construido desde los hallazgos; describe factores influyentes en la implementación de políticas que pueden orientar las acciones futuras desde un enfoque integrado.


This study sought to describe experiences, barriers and facilitators to the implementation of interventions for controlling Aedes aegypti in Latin America and the Caribbean. A qualitative approach with semi-structured in-depth interviews with program implementation experts (19 participants in nine countries) was carried out. We used a software to codify the data and created matrices to compare them. Based on our findings, we developed a graphic representation of the theoretical dimensions that encompass the barriers and facilitators to the implementation of interventions. At the global level, the natural and built environment contributed to the mosquito's reproduction. In the health system, the lack of priority given to the problem and the scarcity of material and human resources are the most important obstacles. Sectors other than health must take responsibility for actions directed at improving social determinants of health. There are transversal barriers related to governance, lack of coordination between central and local levels, lack of continuity in terms of interventions and technical groups. The community faces problems such as lack of information, poverty or resistance to recommendations. Public opinion can have a positive or negative impact, indirectly influencing political decisions. This study proposes a framework of analytical dimensions based on our findings; describes factors that influence policy implementation, which can guide future actions from an integrated perspective.


O objetivo foi descrever experiências, barreiras e facilitadores na implementação de intervenções de controle do Aedes aegypti na América Latina e no Caribe. Uma abordagem qualitativa foi realizada com entrevistas semiestruturadas em profundidade com especialistas na implementação do programa (19 participantes de nove países). Foi usado um software para codificar os dados e foram feitas matrizes para comparação. Com base nos resultados, desenvolvemos uma representação gráfica das dimensões teóricas que agruparam as barreiras e facilitadores para a implementação das intervenções. Em nível global, o ambiente natural e construído contribui para a reprodução do mosquito. No sistema de saúde, a falta de priorização do problema e a escassez de recursos materiais e humanos representam os obstáculos mais importantes. É necessário que outros setores, além do setor saúde, assumam ações de melhoria dos determinantes sociais da saúde. Existem barreiras transversais relacionadas à governança, como a falta de coordenação entre os níveis central e local e a falta de continuidade das intervenções e dos grupos técnicos. A comunidade enfrenta problemas como falta de informação, pobreza ou resistência a recomendações. A opinião pública pode ter um impacto positivo ou negativo, influenciando indiretamente as decisões políticas. Este estudo propõe um quadro de dimensões de análise construído a partir dos resultados; descreve fatores influentes na implementação de políticas que podem orientar ações futuras a partir de uma abordagem integrada.

17.
Rev. peru. med. exp. salud publica ; 35(4): 599-609, oct.-dic. 2018. tab, graf
Artigo em Espanhol | LILACS-Express | ID: biblio-985793

RESUMO

RESUMEN Objetivos. Estimar la carga de enfermedad asociada al consumo de tabaco en Paraguay y evaluar el potencial efecto económico y sanitario del aumento de precio mediante impuestos. Materiales y métodos. Se diseñó un modelo de microsimulación de Monte Carlo que incorporó la historia natural, costos y calidad de vida de enfermedades asociadas al tabaquismo para el 2015. Asimismo, se estimó el impacto en varios escenarios de aumento de impuestos sobre la prevalencia de tabaquismo y la recaudación fiscal. Resultados. 3354 personas mueren al año en Paraguay por consecuencia del tabaquismo. El 19 % de las muertes son por enfermedad isquémica cardíaca, el 15 % por accidentes cerebrovasculares. El 77 % de las muertes por enfermedad pulmonar obstructiva crónica y el 83 % de cáncer de pulmón son atribuibles al tabaquismo. Estas enfermedades en Paraguay representan un costo médico directo anual de más de 1,5 x 106 millones de guaraníes, mientras la recaudación impositiva por la venta de cigarrillos apenas llega a cubrir un 20 % de este gasto. Un aumento en el precio de los cigarrillos del 50 % vía impuestos, podría llevar a evitar 2507 muertes en diez años y generar recursos por 2,4 x 106 millones por ahorro en gastos sanitarios y aumento de recaudación. Conclusiones. El costo y la carga de enfermedad asociado al consumo de tabaco en el sistema de salud es elevado en Paraguay. Un aumento del precio de los cigarrillos a través de los impuestos tendría importantes beneficios sanitarios y podría compensar parcialmente los costos sanitarios.


ABSTRACT Objectives . To consider the burden of disease associated to tobacco consumption in Paraguay and to evaluate the potential economic and health effect of price increase through taxes. Materials and Methods . A Monte Carlo simulation model was designed incorporating natural history, costs, and quality of life of diseases associated to smoking for 2015. Also, several scenarios were considered for the impact of tax raises on the prevalence of smoking and fiscal collection. Results . In Paraguay, 3,354 people die every year as a consequence of smoking. Nineteen percent of deaths are due to cardiac ischemia, 15% due to stroke. 77% of deaths due to chronic obstructive pulmonary disease (COPD), and 83% of lung cancer can be attributed to smoking. These diseases in Paraguay represent an annual direct medical cost of more than 1.5 trillion PYG, while the tax collection from cigarette sales barely covers 20% of this expense. A 50% increase in the price of cigarettes via taxes could avoid 2507 deaths in ten years and generate resources by 2.4 trillion in savings in health expenses and tax of collection. Conclusions . The cost and the burden of disease associated to tobacco consumption is high in the health system in Paraguay. An increase in cigarette price through taxes could have significant health benefits and could offset health costs in part.

18.
s.l; IECS; jul. 2018. ilus, tab.
Não convencional em Espanhol | BRISA/RedTESA | ID: biblio-947431

RESUMO

CONTEXTO CLÍNICO: La degeneración macular asociada a la edad (DMAE) se caracteriza por una serie de alteraciones a nível de la mácula, (zona de mejor visión), que evolucionan frecuentemente a una disminución de la agudeza visual, pudiendo ser causa de ceguera. Afecta al 4% de la población mayor de 55 años, y su prevalência alcanza el 8% en mayores de 75 años. Las formas precoces se caracterizan por la presencia de geodas (manchas amarillentas en el fondo de ojo que son producto del depósito de glicoproteínas entre la retina y la coroides, a nivel de la membrana de Bruch), y áreas de hiper y/o hipopigmentación del epitelio pigmentario, siendo estos cambios benignos y su presencia no implica necesariamente la evolución a estadíos más avanzados. Entre las formas avanzadas se describen dos tipos: una forma seca (90%) y otra, húmeda o exudativa (10%). TECNOLOGÍA: El bevacizumab es un anticuerpo monoclonal completo (porción Fc y Fab) dirigido contra el factor de crecimiento derivado del endotelio (FCEV), capaz de unirse a todas sus isoformas, inhibiendo parcialmente la angiogénesis. Fue desarrollado para el tratamiento de diversos tumores como pulmón, colon y riñón. 6 Si bien hasta hace unos meses no contaba con la aprobación para su uso intravítreo, su uso off label se encuentra extendido mundialmente desde el primer reporte de su utilización para DMAE en 2005, circunstancia promovida por el alto costo de otros agentes antiangiogénicos. OBJETIVO: El objetivo del presente informe es evaluar la evidencia disponible acerca de la eficacia, seguridad y aspectos relacionados a las políticas de cobertura del uso de bevacizumab para degeneración macular asociada a la edad. MÉTODOS: Se realizó una búsqueda en las principales bases de datos bibliográficas, en buscadores genéricos de internet, y financiadores de salud. Se priorizó la inclusión de revisiones sistemáticas (RS), ensayos clínicos controlados aleatorizados (ECAs), evaluaciones de tecnologías sanitarias (ETS), evaluaciones económicas, guías de práctica clínica (GPC) y políticas de cobertura de diferentes sistemas de salud. RESULTADOS: Se incluyeron una RS, tres GPC, seis informes de ETS, y ocho informes de políticas de cobertura de bevacizumab para degeneración macular asociada a la edad. CONCLUSIONES: Evidencia de moderada calidad sugiere que Bevacizumab mejora la agudeza visual y retrasa la progresión de la degeneración macular asociada a la edad. Asimismo, no muestra diferencias em mortalidad, ni eventos trombóticos, aunque tendría mayor probabilidad de presentar al menos um evento adverso serio al compararlo con ranibizumab y aflibercept. Las guías de práctica clínica relevadas coinciden en que su eficacia y seguridad es similar a otros agentes antiangiogénicos. Se encuentra aprobado solo por las agencias regulatorias de Brasil y Canadá, las cuales financian su uso para esta indicación. Sin embargo, su uso off-label ha sido sustentado por la evidencia y ampliamente utilizado dado su similar efecto y menor costo que comparadores. También presta cobertura un financiador privado de salud estadounidense. Si bien no se encontraron estudios de costo-efectividad o análisis de impacto presupuestario em nuestro país, el costo es marcadamente inferior al de sus comparadores.


Assuntos
Humanos , Inibidores da Angiogênese/uso terapêutico , Bevacizumab/uso terapêutico , Ranibizumab/uso terapêutico , Degeneração Macular/tratamento farmacológico , Avaliação da Tecnologia Biomédica , Fatores Etários , Análise Custo-Benefício
19.
Arch. argent. pediatr ; 116(3): 392-400, jun. 2018. tab, graf
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-950017

RESUMO

El tabaquismo es considerado la principal causa de muerte prevenible en el mundo. La mayoría de los fumadores inician esta adicción durante edades tempranas, especialmente, durante la adolescencia. El objetivo del estudio fue identificar los determinantes de consumo adolescente y evaluar el impacto de una intervención educativa en la prevalencia del tabaquismo. Métodos. Estudio antes-después controlado, realizado durante los años 2010-2012 en dos colegios secundarios de la ciudad de La Plata. En ambos, se realizó una encuesta basal seguida de dos mediciones posteriores; en uno de ellos, se implementó una intervención educativa dirigida a jóvenes de 12 y 13 años. Se utilizaron modelos de regresión múltiple para identificar las variables asociadas al tabaquismo y evaluar el impacto de la intervención. Resultados. Se incluyeron 1911 encuestas (Colegio A: 617; Colegio B: 1294). Las variables asociadas al tabaquismo adolescente fueron la tenencia de un hermano fumador (odds ratio -OR- 2,55), madre fumadora (OR 2,32), años de edad (OR 1,92) y el sexo femenino (OR 1,75). El OR ajustado por dichos determinantes para ser fumador actual en el colegio intervención versus el control fue 0,54 (intervalo de confianza -IC- del 95%: 0,35-0,83) en el primer año de seguimiento y 0,98 (IC 95%: 0,60-1,61) en el segundo año. Conclusiones. La tenencia de una madre o un hermano fumador, la edad y el sexo femenino se correlacionaron fuertemente con el consumo de cigarrillos. La intervención educativa tuvo un efecto positivo en el primer año de seguimiento, pero luego no se mantuvo.


Smoking is considered the main cause of preventable death worldwide. Most smokers start using tobacco at an early age, especially during adolescence. The objective of this study was to identify the determinants of adolescent use of tobacco and assess the impact of an educational intervention on the prevalence of smoking. Methods. Controlled, before and after study conducted between 2010 and 2012 at two secondary schools in the city of La Plata. A baseline survey was administered at both schools followed by two subsequent measurements; an educational intervention aimed at youth aged 12 and 13 years was implemented in one of the schools. Multiple regression models were used to identify the outcome measures associated with smoking and assess the impact of the intervention. Results. A total of 1911 surveys were included (school A: 617; school B: 1294). The outcome measures associated with adolescent smoking were having a sibling who smokes (odds ratio -amp;#91;OR-amp;#93;: 2.55), a mother who smokes (OR: 2.32), age (OR: 1.92), and female sex (OR: 1.75). The OR adjusted for these determinants to be a current smoker at the intervention school versus the control school was 0.54 (95% confidence interval -amp;#91;CI-amp;#93;: 0.35-0.83) in the first year of follow-up and 0.98 (95% CI: 0.60-1.61) in the second year. Conclusions. Having a mother or a sibling who smokes, age, and female sex were strongly correlated to cigarette smoking. The educational intervention had a positive effect in the first year of follow-up, which was not maintained over time.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Educação em Saúde/métodos , Fumar Cigarros/epidemiologia , Prevenção do Hábito de Fumar/métodos , Mães/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Fatores de Tempo , Fatores Sexuais , Prevalência , Inquéritos e Questionários , Análise de Regressão , Fatores de Risco , Seguimentos , Fatores Etários , Comportamento do Adolescente/psicologia , Irmãos , Estudos Controlados Antes e Depois
20.
s.l; IECS; jun. 2018. tab.
Não convencional em Espanhol | BRISA/RedTESA | ID: biblio-947426

RESUMO

CONTEXTO CLÍNICO: En Argentina los tumores malignos representan la segunda causa de muerte, registrándose durante el año 2015 un total de 62.625 muertes por cáncer, constituyendo aproximadamente el 18% del total de los fallecimientos ocurridos. Los principales sitios tumorales responsables de la mayor mortalidad por cáncer en hombres durante el año 2014 en Argentina correspondieron a pulmón, colon, recto, y próstata. En las mujeres los principales sitios estuvieron representados por mama, pulmón, colon, recto y cuello uterino. La Tomografía por Emisión de Positrones (PET, del inglés "Positron Emission Tomography") es um método de imágenes utilizado, entre otras indicaciones, para la estadificación, re-estadificación y seguimiento de pacientes con sospecha de recurrencia y/o progresión tumoral. OBJETIVO: El objetivo del presente informe es evaluar la evidencia disponible acerca de la eficacia, seguridad y aspectos relacionados a las políticas de cobertura del uso del PET/TC para seguimiento de pacientes con cáncer de mama, pulmón, colorrectal, próstata y cuello uterino. MÉTODOS: Se realizó una búsqueda en las principales bases de datos bibliográficas, en buscadores genéricos de internet, y financiadores de salud. Se priorizó la inclusión de revisiones sistemáticas (RS), ensayos clínicos controlados aleatorizados (ECAs), evaluaciones de tecnologías sanitarias (ETS), evaluaciones económicas, guías de práctica clínica (GPC) y políticas de cobertura de diferentes sistemas de salud. RESULTADOS: No se encontró evidencia de alta calidad que evalúe el uso de la PET en el seguimiento de pacientes con cáncer que hayan completado el tratamiento primario con intención curativa y se encuentren asintomáticos. Se incluyeron 22 GPC, una evaluación económica, y 18 informes de políticas de cobertura del uso rutinario de la PET en el seguimiento de pacientes con cáncer que hayan completado el tratamento primario y se encuentren asintomáticos. CONCLUSIONES: No se encontró evidencia de buena calidad acerca del uso rutinario de la tomografía por emisión de positrones (PET) en el seguimiento de pacientes con cáncer (mama, pulmón, colorrectal, próstata o cuello uterino) que hayan completado el tratamiento primario con intención curativa y no presenten signos ni síntomas sugestivos de recurrencia o metástasis. Existe consenso entre las guías de práctica clínica o recomendaciones de expertos y financiadores públicos y privados, tanto de América Latina como de países de altos ingresos, en no contemplar el uso rutinario de la PET dentro de los estudios utilizados para el seguimiento de estos pacientes.


Assuntos
Humanos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Mama/diagnóstico por imagem , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias do Colo do Útero/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/métodos , Neoplasias Pulmonares/diagnóstico por imagem , Argentina , Avaliação da Tecnologia Biomédica , Análise Custo-Benefício
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