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1.
AIDS ; 34(3): 483-486, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31764077

RESUMO

: The pol gene from HIV-2-infected patients from Cape Verde experiencing virologic failure was sequenced and drug resistance mutations were determined. Most patients were taking a first-line regimen of zidovudine (AZT), lamivudine (3TC) and lopinavir/ritonavir (LPV/r). Resistance mutations were found in most patients (11/17; 64.7%) especially I82F (4/7; 57.1%) and M184V (10/17; 58.8%). Resistance to all reverse transcriptase and protease inhibitors was found in 58.8% (10/17) of the patients. Integrase inhibitors are warranted to treat these patients.

2.
BMC Health Serv Res ; 19(1): 762, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660957

RESUMO

BACKGROUND: Public engagement in health technology assessment (HTA) is increasing worldwide. There are several forms of public engagement and it is not always possible to determine which stakeholders participate in the HTA process and how they contribute. Our objective was to investigate which types of social representatives contributed to the public consultation on the incorporation of Trastuzumab for early-stage breast cancer treatment within the public health system in Brazil, held in 2012 by the National Committee for Health Technology Incorporation (CONITEC). METHODS: A mixed methods approach was used to analyze social representativeness and the composition of the corpus from the public consultation, which consisted of 127 contributions. Three types of analysis were performed using IRaMuTeQ software: classic lexical analysis, descending hierarchical classification and specificities analysis. The contributions were clustered according to the main categories of discourse observed, into four social representation categories: 1) patient representation/advocacy; 2) pharmaceutical industry/advocacy; 3) healthcare professionals; and 4) individual contributions. RESULTS: Category 1 contained words related to increased survival due to use of the drug and a low score for words pertaining to studies on Trastuzumab. The word "safety" obtained a positive score only in category 2, which was also the only category that exhibited a negative score for the word "risk". Category 3 displayed the lowest scores for "diagnosis" and "safety". The word "efficacy" had a negative score only in category 4. CONCLUSIONS: Each category exhibited different results for words related to health systems and to key concepts linked to HTA. Our analysis enabled the identification of the most prominent contributions for each category. Despite the promising results obtained, further research is needed to validate this software for use in analyzing public contributions.


Assuntos
Participação da Comunidade , Avaliação da Tecnologia Biomédica/métodos , Trastuzumab/uso terapêutico , Brasil , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Feminino , Humanos , Estadiamento de Neoplasias
3.
PLoS One ; 14(7): e0220131, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31356609

RESUMO

BACKGROUND: The reassessment of technologies and services offered by healthcare systems is recent initiative and still without a widely adopted and evaluated method. To a better understanding of this process in Brazil, we have described the health technology reassessment (HTR) performed by the National Committee for Health Technology Incorporation (Conitec) into Brazilian public health system (SUS). METHODS: A documental, exploratory, descriptive, retrospective study with qualitative-quantitative approach regarding the HTR performed by Conitec from January 2012 to November 2017. RESULTS: After applying the criteria of inclusion and exclusion, we selected 47 technologies for this study. The vast majority of the demands (41 demands) came from the public sector, and only six from the private sector. Most of the requests referred to the exclusion of specific indication; followed by extension of use, withdraw of the technology from SUS, maintenance, and restriction of use. The dimensions of analysis found in the recommendation reports were scientific evidence on efficacy, effectiveness and safety, disease-related issues, issues related to the use of technology, costs, and social participation. However, these dimensions were not included in all analysis, and a standardized structure of the reports has not been observed. The most relevant decision factors considered for decision-making were efficacy, safety and use of the technology. CONCLUSION: During a six-year period of Conitec actuation, we could find some reassessments of technologies that are available in SUS. We observed that these activities had enabled progress, however, they are still not yet structured, with gaps in the selection process, and the assessment since no methodology and criteria for proper conduct were established.

4.
Artigo em Espanhol, Português | PAHO-IRIS | ID: phr-51082

RESUMO

[EXTRACTO]. El enfoque de que la formulación de políticas debe fundamentarse en la evidencia —es decir, que las decisiones en cuanto a las políticas deben sustentarse en el uso sistemático y transparente de datos científicos— atrajo mucha atención internacional en los primeros años del milenio. El movimiento fue incentivado por el Informe mundial sobre el conocimiento orientado a mejorar la salud del 2004 y las declaraciones de las Cumbres Ministeriales sobre Investigación en Salud, celebradas en Ciudad de México en el 2005 y en Bamako (Malí) en el 2008 y convocadas ambas por la Organización Mundial de la Salud. De manera más reciente, en la Agenda 2030 para el Desarrollo Sostenible, de las Naciones Unidas, se presentaron 17 objetivos para el desarrollo mundial, en los cuales las políticas fundamentadas en la investigación desempeñarán un papel clave...


[EXTRACTO]. A estratégia de formulação de políticas informadas por evidências – na qual as decisões políticas são informadas pelo uso sistemático e transparente de evidências – foi objeto de grande atenção internacional no início do milênio. O movimento foi impulsionado pelo Relatório mundial sobre conhecimentos para melhorar a saúde de 2004 e pelas declarações emitidas nas Reuniões de Cúpula Ministerial de Pesquisa em Saúde na Cidade do México em 2005 e em Bamaco, Mali, em 2008, ambas convocadas pela Organização Mundial da Saúde. Mais recentemente, a Agenda 2030 das Nações Unidas para o desenvolvimento sustentável formulou 17 objetivos para o desenvolvimento global, e as políticas informadas por pesquisa serão essenciais...


Assuntos
Sistemas de Saúde , Saúde Pública , Política Informada por Evidências , Américas , Sistemas de Saúde , Saúde Pública , Política Informada por Evidências
5.
Front Pharmacol ; 10: 302, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31001117

RESUMO

Background: Patients over 65 years of age taking multiple medications face several risks, and pharmaceutical interventions can be useful to improve quality of care and reduce those risks. However, there is still no consensus on the effectiveness of these interventions aimed at promoting changes in clinical, epidemiological, economic, and humanistic outcomes for various service delivery, organizational, financial, and implementation-based interventions. The objective of this overview of systematic reviews was to summarize evidence on the effectiveness of community-level pharmaceutical interventions to reduce the risks associated with polypharmacy in the population over 65 years of age. Method: This overview used a previously described protocol to search for systematic review articles, with and without meta-analysis, and economic evaluations, without any language or time restrictions, including articles published up to May 2018. The following databases were searched: the Cochrane Library, Epistemonikos, Health Evidence, Health Systems Evidence, Virtual Health Library, and Google Scholar. The basic search terms used were "elderly," "polypharmacy," and "pharmaceutical interventions." The findings for outcomes of interest were categorized using a taxonomy for health policies and systems. Equity-related questions were also investigated. The studies were evaluated for methodological quality and produced a narrative synthesis. Results: A total of 642 records were retrieved: 50 from Health Evidence, 197 from Epistemonikos, 194 from Cochrane, 116 from Health Systems Evidence, and 85 from the Virtual Health Library. Of these, 16 articles were selected: 1 overview of systematic reviews, 12 systematic reviews, and 3 economic evaluations. There is evidence of improvement in clinical, epidemiological, humanistic, and economic outcomes for various types of community-level pharmaceutical interventions, but differences in observed outcomes may be due to study designs, primary study sample sizes, risk of bias, difficulty in aggregating data, heterogeneity of indicators and quality of evidence included in the systematic reviews that were assessed. It is necessary to optimize the methodological designs of future primary and secondary studies. Conclusion: Community-level pharmaceutical interventions can improve various clinical, epidemiological, humanistic and economic outcomes and potentially reduce risks associated with polypharmacy in the elderly population.

6.
JBRA Assist Reprod ; 23(4): 418-429, 2019 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-30969739

RESUMO

Advances in the early diagnosis and treatment of cancer have reduced mortality rates and improved patient survival. For this reason, professionals from different areas have strived to implement actions to increase patient quality-of-life during and after cancer treatment. Among these measures, integral attention in reproductive health is one of the main points for the inclusion, safety, and autonomy of female patients. The approach to fertility in these cases should include counseling on fertility preservation and contraceptive options. Oocyte/embryo freezing is an effective technique that does not delay the start of cancer treatment, since controlled ovarian stimulation can be initiated at any stage of the menstrual cycle. At the same time, contraceptive counseling should be conducted based on the eligibility criteria established by the World Health Organization and the Centers for Disease Control and Prevention. However, there is still a lack of studies on (i) the suitability of contraceptives to patients of reproductive age with relatively frequent tumors (lymphoma, leukemia, bone cancer), and (ii) the use of contraceptive concurrently with chemotherapeutic agents. Therefore, the choice of contraceptive method should consider other factors such as tumor type, thrombogenic risk factors linked to cancer/chemotherapy, immunosuppression, blood disorders (thrombocytopenia/anemia), bone mass reduction, metabolic/cardiovascular effects, and drug interaction.

7.
BIS, Bol. Inst. Saúde (Impr.) ; 20(2): 23-36, Dez. 2019. ilus
Artigo em Português | Sec. Est. Saúde SP, SESSP-ISPROD, Sec. Est. Saúde SP, SESSP-ISACERVO | ID: biblio-1021858

RESUMO

O interesse em como fortalecer o uso de evidências de pesquisa em processos de tomada de decisão teve um rápido crescimento em muitos cenários. A formulação de políticas informadas por evidências tornou-se amplamente institucionalizada no setor da saúde e também vem sendo implementada em muitas outras áreas de política social. A evidência qualitativa - dados empíricos extraídos de pesquisa que utiliza métodos qualitativos de coleta e análise de dados - pode desempenhar um papel crítico na formulação de políticas informadas por evidências porque esse tipo de evidência pode capturar as opiniões e as experiências daqueles afetados por uma intervenção ou opção.


Assuntos
Humanos , Tomada de Decisões , Pesquisa Qualitativa , Política Informada por Evidências
8.
BIS, Bol. Inst. Saúde (Impr.) ; 20(2): 77-88, Dez. 2019.
Artigo em Português | Sec. Est. Saúde SP, SESSP-ISPROD, Sec. Est. Saúde SP, SESSP-ISACERVO | ID: biblio-1022213

RESUMO

Trata-se de uma Síntese de Evidências cujo problema priorizado foi a prevenção e controle do pé diabético (PD) na Atenção Primária a Saúde (APS). Utilizou-se a ferramenta SUPPORT (Supporting Policy Relevant Reviews and Trials) da Rede para políticas Informadas por Evidências . A busca pelas opções ocorreu em fevereiro de 2016 e foi atualizada em outubro de 2018, na Biblioteca Virtual em Saúde, Health Systems Evidence, PubMed e Cochane Library. A estratégia de busca deu-se com os termos "pé diabético" and "prevenção". A busca resultou em 41 textos e 11 foram selecionados para análise.


Assuntos
Humanos , Atenção Primária à Saúde , Pé Diabético , Prevenção de Doenças , Política Informada por Evidências
9.
BIS, Bol. Inst. Saúde (Impr.) ; 20(2): 96-104, Dez. 2019.
Artigo em Português | Sec. Est. Saúde SP, SESSP-ISPROD, Sec. Est. Saúde SP, SESSP-ISACERVO | ID: biblio-1022249

RESUMO

A sífilis atinge mais de 12 milhões de pessoas em todo o mundo e os homens são importante fonte de transmissão para suas parcerias, quando inadequadamente diagnosticados e tratados. Fatores individuais relacionados aos homens podem ser importantes barreiras para buscar e aderir ao tratamento adequado. O objetivo deste estudo foi descrever aspectos relacionados ao tratamento de homens com diagnóstico de sífilis, na percepção deles de suas parcerias e de profissionais de saúde.Foi conduzida uma síntese rápida de evidências qualitativas, a partir da análise de estudos primários qualitativos e posterior descrição dos resultados.


Assuntos
Humanos , Sífilis Congênita , Medicina Baseada em Evidências , Saúde do Homem
10.
BIS, Bol. Inst. Saúde (Impr.) ; 20(2): 105-113, Dez. 2019.
Artigo em Português | Sec. Est. Saúde SP, SESSP-ISPROD, Sec. Est. Saúde SP, SESSP-ISACERVO | ID: biblio-1022258

RESUMO

Este estudo teve como objetivo sintetizar as evidências sobre motivações, pensamentos e experiências de adolescentes brasileiros com ideação suicida. A busca foi realizada em Medline, Embase, Lilacs, PsycInfo, Google Scholar e Google. A seleção de artigos, a extração de dados e a avaliação da qualidade metodológica foram realizadas por dois pesquisadores independentes. De 3.496 artigos identificados, quatro foram incluídos. As principais motivações para a ideação suicida foram a fragilidade dos vínculos, quadro depressivo e carência afetiva. Os sentimentos predominantes foram solidão, tristeza, desamparo e desesperança. Os pensamentos relacionados com a crença de estar só no mundo e de não enxergar solução para seus sofrimentos e conflitos foram relatados.


Assuntos
Humanos , Adolescente , Medicina Baseada em Evidências , Ideação Suicida
14.
BMC Med Res Methodol ; 18(1): 51, 2018 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-29884121

RESUMO

BACKGROUND: Rapid response in health technology assessment is a synthesis of the best available evidence prepared in a timely manner to meet specific demands. We build a consensus among Brazilian specialists in health technology assessment to propose guidelines for the development of rapid response. METHODS: Based on a systematic review that proposed eight methodological steps to conduct rapid response, we applied a modified Delphi technique (without open questions in the first round) to reach consensus among Brazilian experts in health technology assessment. Twenty participants were invited to judge the feasibility of each methodological step in a five-point Likert scale. Consensus was reached if the step had 70% positive approval or interquartile range ≤ 1. RESULTS: The achievement of consensus was reached in the second round. Between the first and the second round, we scrutinized all points reported by the experts. The Delphi panel reached consensus of eight steps: definition of the structured question of rapid response (with a restricted scope); definition of the eligibility criteria for study types (preferably systematic reviews); search strategy (language and data limits) and sources of information (minimum two); selection of studies (independently by two responders); critical appraisal of the included studies and the risk of bias for the outcomes of interest; data extraction from the included articles; summary of evidence; and preparation of the report. CONCLUSIONS: The guidelines for rapid response in health technology assessment may help governments to make better decisions in a short period of time (35 days). The adoption of methodological processes should improve both the quality and consistency of health technology assessments of rapid decisions in the Brazilian setting.


Assuntos
Tecnologia Biomédica/normas , Técnica Delfos , Guias como Assunto/normas , Avaliação da Tecnologia Biomédica/normas , Tecnologia Biomédica/métodos , Brasil , Consenso , Humanos , Reprodutibilidade dos Testes , Revisão Sistemática como Assunto , Avaliação da Tecnologia Biomédica/métodos
15.
J Clin Microbiol ; 55(8): 2367-2379, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28515216

RESUMO

HIV plasma viral load is an established marker of disease progression and of response to antiretroviral therapy, but currently there is no commercial assay validated for the quantification of viral load in HIV-2-infected individuals. We sought to make the first clinical evaluation of Cavidi ExaVir Load (version 3) in HIV-2-infected patients. Samples were collected from a total of 102 individuals living in Cape Verde, and the HIV-2 viral load was quantified by both ExaVir Load and a reference in-house real-time quantitative PCR (qPCR) used in Portugal in 91 samples. The associations between viral load and clinical prognostic variables (CD4+ T cell counts and antiretroviral therapy status) were similar for measurements obtained using ExaVir Load and qPCR. There was no difference between the two methods in the capacity to discriminate between nonquantifiable and quantifiable HIV-2 in the plasma. In samples with an HIV-2 viral load quantifiable by both methods (n = 27), the measurements were highly correlated (Pearson r = 0.908), but the ExaVir Load values were systematically higher relative to those determined by qPCR (median difference, 0.942 log10 copies/ml). A regression model was derived that enables the conversion of ExaVir Load results to those that would have been obtained by the reference qPCR. In conclusion, ExaVir Load version 3 is a reliable commercial assay to measure viral load in HIV-2-infected patients and therefore a valuable alternative to the in-house assays in current use.


Assuntos
Infecções por HIV/virologia , HIV-2/isolamento & purificação , Plasma/virologia , Carga Viral/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Portugal , Adulto Jovem
16.
São Paulo; Instituto de Saúde; 2017. 456 p. tab, graf.(Temas em Saúde Pública, 22).
Monografia em Português | LILACS, Redbvs, EMS-Producao, Sec. Munic. Saúde SP, EMS-Acervo | ID: biblio-868301
17.
São Paulo; Instituto de Saúde; 2017. 453 p. tab.(Temas em saúde coletiva, 22).
Monografia em Português | Sec. Est. Saúde SP, SESSP-ISPROD, Sec. Est. Saúde SP, SESSP-ISACERVO | ID: biblio-996637
19.
São Paulo; Instituto de Saúde; 2017. 458 p. (Temas em saúde coletiva, 22).
Monografia em Português | LILACS, PIE | ID: biblio-1007136

RESUMO

O Instituto de Saúde é uma instituição de ensino e pesquisa da Secretaria de Estado da Saúde de São Paulo, criada em 1969, que tem como missão "produzir conhecimento científico e tecnológico no campo da Saúde Coletiva e promover sua apropriação para o desenvolvimento de políticas públicas, visando à melhoria da qualidade de vida da população, prestando assessoria e colaborando na formação de recursos humanos, em consonância com os princípios do SUS: universalidade, integralidade, equidade e participação social". Em 2009, passamos por uma reorganização na estrutura funcional, quando foi criado o Centro de Tecnologias de Saúde para o SUS-SP, em resposta a novas necessidades da gestão da saúde no estado de São Paulo. As atribuições desse Centro consistem na realização da avaliação de tecnologias de saúde em uso e a serem incorporadas pelo Sistema Único de Saúde, na proposição de parcerias e cooperação técnica para o desenvolvimento da avaliação de tecnologias de saúde, com as diferentes instâncias dos sistemas pertinentes, na difusão do conhecimento produzido, promovendo o fomento e a indução da avaliação de tecnologias de saúde para o SUS/SP, de acordo com a agenda de prioridades definidas pela SES-SP. Para realizar essas atribuições tivemos que buscar meios para rapidamente capacitar pesquisadores em Avaliação de Tecnologias de Saúde (ATS) e em Políticas Informadas por Evidências (PIE). Isso foi possível graças aos cursos presenciais e à distância, patrocinados pelo Ministério da Saúde e seus parceiros. A possibilidade de participarmos como membros da Rede Brasileira de Avaliação de Tecnologias em Saúde (REBRATS) desde 2012, e da Rede para Políticas Informadas por Evidências (EVIPNet Brasil) desde 2014, ampliou sobremaneira nosso aprendizado e capacidade de lidar com esses dois temas.


Assuntos
Humanos , Avaliação da Tecnologia Biomédica/organização & administração , Direito à Saúde/legislação & jurisprudência , Judicialização da Saúde/legislação & jurisprudência , Brasil
20.
Health Res Policy Syst ; 14(1): 83, 2016 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-27884208

RESUMO

BACKGROUND: Rapid reviews have the potential to overcome a key barrier to the use of research evidence in decision making, namely that of the lack of timely and relevant research. This rapid review of systematic reviews and primary studies sought to answer the question: What are the best methodologies to enable a rapid review of research evidence for evidence-informed decision making in health policy and practice? METHODS: This rapid review utilised systematic review methods and was conducted according to a pre-defined protocol including clear inclusion criteria (PROSPERO registration: CRD42015015998). A comprehensive search strategy was used, including published and grey literature, written in English, French, Portuguese or Spanish, from 2004 onwards. Eleven databases and two websites were searched. Two review authors independently applied the eligibility criteria. Data extraction was done by one reviewer and checked by a second. The methodological quality of included studies was assessed independently by two reviewers. A narrative summary of the results is presented. RESULTS: Five systematic reviews and one randomised controlled trial (RCT) that investigated methodologies for rapid reviews met the inclusion criteria. None of the systematic reviews were of sufficient quality to allow firm conclusions to be made. Thus, the findings need to be treated with caution. There is no agreed definition of rapid reviews in the literature and no agreed methodology for conducting rapid reviews. While a wide range of 'shortcuts' are used to make rapid reviews faster than a full systematic review, the included studies found little empirical evidence of their impact on the conclusions of either rapid or systematic reviews. There is some evidence from the included RCT (that had a low risk of bias) that rapid reviews may improve clarity and accessibility of research evidence for decision makers. CONCLUSIONS: Greater care needs to be taken in improving the transparency of the methods used in rapid review products. There is no evidence available to suggest that rapid reviews should not be done or that they are misleading in any way. We offer an improved definition of rapid reviews to guide future research as well as clearer guidance for policy and practice.


Assuntos
Tomada de Decisões , Medicina Baseada em Evidências , Política de Saúde , Projetos de Pesquisa/normas , Literatura de Revisão como Assunto , Pesquisa Médica Translacional/métodos , Humanos
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