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1.
Value Health Reg Issues ; 20: 79-85, 2019 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-31082638

RESUMO

BACKGROUND: The increase in obesity prevalence and its relationship with multiple cardiovascular complications have raised the burden of obesity in the general population. Bariatric surgery has shown to be more effective in reducing weight than the traditional pharmacologic and nonpharmacologic treatments. OBJECTIVE: To evaluate the cost-effectiveness of this alternative compared with standard treatment in the Colombian context. METHODS: A Markov single cohort model was used to simulate the incremental cost per quality-adjusted life-year (QALY) gained every year over a base-case 5-year time horizon. The model considers 5 health states: comorbidity, remission, acute myocardial infarction, stroke, and death. Four comorbidity conditions were evaluated separately: diabetes, hypertension, dyslipidemia, and sleep apnea. The model was evaluated from a third-payer perspective. All costs were expressed in 2016 Colombian pesos ($1.00 = 3051 COP). A 5% annual discount rate was applied to both costs and outcomes. RESULTS: In baseline analysis, bariatric surgery was a cost-effective alternative compared with nonsurgical treatment in the diabetes and hypertension cohort with an incremental cost-effectiveness ratio of $6 194 899 and $43 689 527 per QALY gained, respectively. In the sleep apnea cohort, surgery has greater effectiveness and lower costs, which is why it is a dominant strategy. In the dyslipidemia cohort, bariatric surgery is dominated by the nonsurgical approach. CONCLUSION: The current study provides evidence that bariatric surgery is a cost-effective alternative among some cohorts in the Colombian setting. For obese patients with sleep apnea or diabetes, bariatric surgery is a recommendable alternative (dominant and cost-effective, respectively) for the Colombian healthcare system.

2.
Value Health Reg Issues ; 20: 66-72, 2019 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-31035116

RESUMO

OBJECTIVES: To estimate the burden of disease attributable to obesity and overweight conditions using disability-adjusted life-years (DALYs) in Colombia. METHODS: The burden of disease was estimated following an adapted methodology published by the World Health Organization. A selection of diseases was performed in which overweight and obesity are risk factors. DALYs were calculated by obtaining the proportion of cases and deaths of every disease that can be attributable to obesity and overweight conditions. The economic impact of obesity was calculated by multiplying the cost of care per patient for each comorbidity by the number of cases attributable exclusively to obesity. RESULTS: A total of 997 371 DALYs were estimated, 45% of which corresponded to men; 81% of DALYs corresponded to years lived with disability. Conditions with greater attributable DALYs are, in order, hypertension (31.6% of the total DALYs), type 2 diabetes mellitus (28.0%), cardiac ischemic disease (14.6%), and lower back pain (11.2%). An estimation of 20.5 DALYs per 1000 inhabitants was made. The economic impact of care for comorbidities associated with obesity could amount to $2158 million. CONCLUSIONS: Obesity and overweight conditions are related to higher mortality and disability than previously estimated; effective interventions aimed at prevention and treatment will have a high impact on quality of life.

3.
Value Health Reg Issues ; 20: 60-65, 2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-30974312

RESUMO

OBJECTIVES: To evaluate the public health benefits and economic value of live-attenuated yellow fever (YF) 17D vaccine in Colombia. METHODS: A decision tree model was used to assess the theoretical impact of routine YF vaccination of 1-year-olds (no "catch-up") during the interepidemic period from 1980 to 2002, avoiding capturing the impact of YF vaccine introduction in 2003. The vaccine was assumed to be 99% effective, to provide lifetime protection, and to cover 85% of the target population. Costs per disability-adjusted life-year (DALY) averted were computed from payer and societal perspectives. Univariate sensitivity analyses were performed. RESULTS: During the interepidemic period, routine YF vaccination would have averted 2223 nonfatal cases of YF and 65 deaths, leading to an overall reduction of 1365 DALYs. The net cost of this vaccination would have been $25 964 813 (payer's perspective) and $16 535 465 (societal perspective). Cost per DALY averted was $19 022 and $12 114 from payer and societal perspectives, respectively (all costs in 2015 US dollars). Vaccination was considered cost-effective from both perspectives (ie, between 1- and 3-fold the gross domestic product per capita, $7158) and remains so if price per dose was $2.75 or less and $4.66 from payer and societal perspectives, respectively. Underreporting had the largest impact on the results. CONCLUSIONS: Routine toddler YF vaccination in Colombia would have been considered cost-effective in the prevaccination era. This study provides insights on the value of vaccination in an upper middle-income country.

4.
Rev. colomb. obstet. ginecol ; 69(4): 270-302, Oct.-Dec. 2018. tab, graf
Artigo em Inglês | LILACS | ID: biblio-985512

RESUMO

ABSTRACT Objective: To assess the efficacy and safety of atosiban in pregnant women with risk of preterm delivery as compared to nifedipine, indomethacin, terbutaline, fenoterol and placebo. Materials and methods: A systematic literature review was carried out in eight electronic databases, including Medline, Central, and Embase, using free and standardized search terms. Outcomes assessment included time delay until delivery, neonatal mortality, ratio of adverse maternal events, and ratio of neonatal complications. The quality of the evidence was evaluated per study and for the body of evidence and, whenever feasible, the information was synthesized into a meta-analysis. Alternatively, a narrative summary was presented. Results: Eleven studies were included. Atosiban did not show any statistically significant differences in terms of delaying delivery versus other uterine contraction inhibitors. The neonatal mortality was lower compared to indomethacin (RR = 0.21; 95% CI: 0.05 to 0.92), and the percentage of total maternal adverse events was lower compared to fenoterol (RR = 0.16; 95% CI: 0.08 to 0.31), nifedipine (RR = 0.48; 95% CI: 0.3 to 0.78), and terbutaline (RR = 0.44; 95% CI: 0.28 to 0.71). Conclusions: Atosiban has similar efficacy for delivery delay in patients with risk of preterm delivery as compared to other agents (moderate certainty), showing some advantages regarding neonatal mortality (low certainty) versus indomethacin, and compared to fenoterol, nifedipine and terbutaline in terms of maternal adverse events (moderate certainty).


RESUMEN Objetivo: evaluar la eficacia y seguridad de atosiban en gestantes con amenaza de parto pretérmino comparado con nifedipino, indometacina, terbutalina, fenoterol y placebo. Materiales y métodos: se realizó una revisión sistemática de la literatura en ocho bases de datos electrónicas (Medline, Central, Embase, entre otras), mediante términos de búsqueda libres y estandarizados. Los desenlaces evaluados incluyeron tiempo de retardo del parto, mortalidad neonatal, proporción de eventos adversos maternos y proporción de complicaciones neonatales. Se evaluó la calidad de la evidencia por estudio y para el cuerpo de evidencia, y se sintetizó la información mediante metaanálisis, cuando fue posible; de lo contrario, se resumió de forma narrativa. Resultados: se incluyeron once estudios. Atosiban no mostró diferencias estadísticamente significativas en retardo del parto contra otros uteroinhibidores. Mostró menor mortalidad neonatal que la indometacina (RR = 0,21; IC 95 %: 0,05 a 0,92), y menor proporción de eventos adversos maternos totales que el fenoterol (RR = 0,16; IC 95 %: 0,08 a 0,31), el nifedipino (RR = 0,48; IC 95 %: 0,3 a 0,78) y la terbutalina (RR = 0,44; IC 95 %: 0,28 a 0,71). Conclusiones: atosiban tiene una eficacia similar para retardar el parto ante la amenaza de un parto pretérmino con otros comparadores (certeza moderada), con ventajas frente a indometacina en mortalidad neonatal (certeza baja) y frente a fenoterol, nifedipino y terbutalina en eventos adversos maternos (certeza moderada).


Assuntos
Humanos , Trabalho de Parto Prematuro , Placebos , Terbutalina , Nifedipino , Indometacina , Metanálise , Fenoterol
5.
Artigo em Inglês | PAHO-IRIS | ID: phr-49454

RESUMO

[ABSTRACT]. Objectives. To assess the economic impact of dengue in Latin America and the Caribbean using a systematic review that includes studies not previously considered by other reviews. Methods. Cochrane methodology was used to conduct a systematic review of the cost of dengue in Latin America. PubMed Central, EMBASE, and the Biblioteca Virtual en Salud— which includes scientific, peer-reviewed journals not indexed by other databases—were searched from inception through August 2016. All articles that reported cost of illness data for countries in Latin America were included. Included studies underwent a methodological appraisal using a seven-question instrument designed for cost of illness studies. Extracted data were direct and indirect costs for outpatient and hospitalized cases and total cost of the disease. Values were adjusted to 2015 US dollars using the consumer price index. Results. From a total of 848 initial references, 17 studies were included, mainly from Brazil, Colombia, Cuba, Mexico, and Puerto Rico; costs were available for 39 countries. The methodological appraisal showed that 70% of the studies met more than 70% of the evaluated items. The main economic impact of dengue was due to productivity costs. Average annual cost was more than US$ 3 billion. Direct costs represented over 70% of the total share for hospitalized cases. For outpatients, direct medical costs were low, but social costs were significant since indirect costs may account for up to 80% of the total cost. Conclusions. Dengue fever has a significant economic impact in Latin America. It is essential to develop new public health interventions, such as dengue vaccination, to decrease the propagation of the disease and its total cost.


[RESUMEN]. Objetivos. Evaluar las repercusiones económicas del dengue en América Latina y el Caribe mediante una revisión sistemática que abarcó estudios no considerados en otras revisiones anteriores. Métodos. Se usó la metodología de Cochrane para hacer una revisión sistemática del costo del dengue en América Latina. Se hizo una búsqueda en PubMed Central, EMBASE y la Biblioteca Virtual en Salud, que incluyen revistas científicas arbitradas no indizadas por otras bases de datos, desde su aparición hasta agosto del 2016. Se incluyeron todos los artículos que contenían datos sobre el costo de la enfermedad para los países de América Latina. Los estudios incluidos se sometieron a una evaluación metodológica para la cual se usó un instrumento de siete preguntas diseñado para los estudios sobre los costos de las enfermedades. Los datos extraídos fueron los costos directos e indirectos para los casos de pacientes ambulatorios y hospitalizados y el costo total de la enfermedad. Los valores se ajustaron a dólares de los Estados Unidos del 2015 con base en el índice de precios al consumidor. Resultados. De un total de 848 referencias iniciales, se incluyeron 17 estudios, principalmente de Brasil, Colombia, Cuba, México y Puerto Rico; se encontraron datos sobre los costos en 39 países. La evaluación metodológica indicó que 70% de los estudios reunían más de 70% de los puntos evaluados. La principal repercusión económica del dengue se debió a los costos por pérdida en la productividad. El costo anual promedio fue de más de USD 3.000 millones. Los costos directos representaron más de 70% del total para los casos de pacientes hospitalizados. En cuanto a los pacientes ambulatorios, los costos médicos directos fueron bajos, pero los costos sociales fueron considerables, ya que los costos indirectos pueden representar hasta 80% del costo total. Conclusiones. El dengue tiene importantes repercusiones económicas en América Latina. Es fundamental elaborar nuevas intervenciones en materia de salud pública, como la vacunación contra el dengue, para reducir la propagación de la enfermedad y su costo total.


[RESUMO]. Objetivos. Avaliar o impacto econômico da dengue na América Latina e o Caribe por meio de uma revisão sistemática que incluiu estudos não considerados anteriormente por outras revisões. Métodos. Utilizou-se a metodologia Cochrane para realizar uma revisão sistemática do custo da dengue na América Latina. Foi realizada uma busca dos bancos de dados PubMed Central, EMBASE e Biblioteca Virtual em Saúde— a qual inclui periódicos científicos com avaliação por pares não indexados por outros repositórios— desde sua criação até agosto de 2016. Todos os artigos que relataram dados de custo de doença para países da América Latina foram incluídos. Os estudos incluídos foram submetidos a uma avaliação metodológica usando um instrumento de sete perguntas desenvolvido para estudos de custo de doença. Os dados extraídos foram os custos diretos e indiretos para casos ambulatoriais e hospitalizados e o custo total da doença. Os valores foram ajustados para dólares de 2015, usando-se o índice de preços ao consumidor. Resultados. De 848 referências inicialmente identificadas, 17 estudos foram incluídos, principalmente do Brasil, Colômbia, Cuba, México e Porto Rico; dados sobre custos estavam disponíveis para 39 países. A avaliação metodológica demonstrou que 70% dos estudos apresentavam mais de 70% dos itens avaliados. O principal impacto econômico da dengue foi devido aos custos de produtividade. O custo médio anual foi superior a US$3 bilhões. Para casos que exigiram hospitalização, os custos diretos representaram mais de 70% do custo total. Para pacientes ambulatoriais, os custos médicos diretos foram baixos, mas os custos sociais foram significativos, pois os custos indiretos podem representar até 80% do custo total. Conclusões. A dengue tem impacto econômico considerável na América Latina. É essencial desenvolver novas intervenções de saúde pública, como a vacinação contra a dengue, para diminuir a propagação da doença e seu custo total.


Assuntos
Dengue , Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , América Latina , Região do Caribe , Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , América Latina , Região do Caribe , Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Região do Caribe
6.
Rev. cienc. salud (Bogotá) ; 16(2): 219-236, abr.-ago. 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-959695

RESUMO

Abstract Introduction: The aim of this project is to estimate the costs to society of training a doctor at either a public or a private university in Colombia. Materials and methods: Direct and indirect costs were estimated in 2016 Colombian pesos (average exchange rate 3051 COP per US dollar), as was the return on investment, expressed as net present value, return on investment, and internal rate of return. The time required to recover the investment in studying medicine was also determined, and this was contrasted with the counterfactual of studying in another academic program. A discount rate of 12 % was used. A sensitivity analysis was performed with several alternative scenarios. Results: In the baseline scenario, the total cost of training a physician in Colombia is US $80, 971.80 at a private university and US $54, 971.79 at a public university (of which $14, 436.57 is contributed by the State in the latter case). The time to return of investment is 3 years 6 months for study at a public university and 7 years 3 months for study at a public university. Applying discount rates of 5 %, 7.5 %, and 12 %, studying medicine presents a higher return than that obtained by studying in another academic program. Conclusions: The cost of training a medical doctor in Colombia is 70 % higher than the cost of training other professionals, but returns are greater due to subsequent higher income. Net returns are higher for graduates of public universities because their initial investment is smaller and their incomes are similar.


Resumen Introducción: este estudio busca estimar los costos de formar un médico en Colombia, tanto en una universidad pública como privada, desde la perspectiva de la sociedad. Materiales y métodos: se calcularon los costos directos e indirectos en pesos colombianos de 2016 (tasa de cambio promedio 3051 COP por USD), así como el retorno a la inversión, expresado en valor actual neto, retorno sobre la inversión, y tasa interna de retorno y, el periodo de recuperación de la inversión de estudiar medicina frente al contrafactual de estudiar otra carrera. Se empleó una tasa de descuento de 12 %. Se realizó un análisis de sensibilidad con varios escenarios. Resultados: en el escenario base, el costo total de la formación de un médico en Colombia es de $80971.80 USD en una universidad privada y de $54971.79 USD en una pública (de los cuales $14436.57 USD son aportados por el Estado). El tiempo de retorno de la inversión es de 3 años y 6 meses en una universidad pública y 7 años y 3 meses en una privada. Aplicando tasas de descuento de 5 %, 7,5 % y 12 %, estudiar medicina presenta mayor retorno que el obtenido con otra carrera. Conclusiones: el costo de formación de un médico en Colombia es un 70 % mayor al requerido para la formación de otro profesional; sin embargo, los retornos son mayores debido los mayores ingresos percibidos. Los retornos son mayores en los egresados de universidades públicas, debido a que la inversión es menor y los ingresos percibidos son similares.


Resumo Introdução: o objetivo deste trabalho é estimar os custos de formar um médico na Colômbia, tanto em uma universidade pública quanto privada, desde a perspectiva da sociedade. Materiais e métodos: calcularam-se os custos diretos e indiretos em pesos colombianos de 2016 (taxa de câmbio médio 3051 COP por USD) assim como o retorno ao investimento, expressado em valor atual neto, retorno sobre o investimento, e taxa interna de retorno e, o período de recuperação do investimento de estudar medicina frente ao contrafactual de estudar outra carreira. Empregou-se uma taxa de desconto de 12 %. Se realizou uma análise de sensibilidade com vários cenários. Resultados: no cenário base, o custo total da formação de um médico na Colômbia é de $80971.80 USD em uma universidade privada e $54971.79 USD em uma pública (dos quais $14436.57 USD são aportados pelo Estado). O tempo de retorno do investimento é de 3 anos e 6 meses em uma universidade pública e 7 anos e 3 meses em uma privada. Aplicando taxas de desconto de 5 %, 7.5 % e 12 %, estudar medicina apresenta maior retorno que o obtido com outro curso. Conclusões: o custo de formação de um médico na Colômbia é um 70 % maior ao requerido para a formação de outro profissional, no entanto, os retornos são maiores devido aos maiores ingressos percebidos. Os retornos são maiores nos formados de universidades públicas, devido a que o investimento é menor e os ingressos percebidos são similares.

7.
Rev Bras Ginecol Obstet ; 40(5): 242-250, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29913541

RESUMO

OBJECTIVE: To assess the cost-effectiveness of carbetocin versus oxytocin for prevention of postpartum hemorrhage (PPH) due to uterine atony after vaginal delivery/cesarean section in women with risk factors for bleeding. METHODS: A decision tree was developed for vaginal delivery and another one for cesarean, in which a sequential analysis of the results was obtained with the use of carbetocin and oxytocin for prevention of PPH and related consequences. A third-party payer perspective was used; only direct medical costs were considered. Incremental costs and effectiveness in terms of quality-adjusted life years (QALYs) were evaluated for a one-year time horizon. The costs were expressed in 2016 Colombian pesos (1 USD = 3,051 Col$). RESULTS: In the vaginal delivery model, the average cost of care for a patient receiving prophylaxis with uterotonic agents was Col$ 347,750 with carbetocin and Col$ 262,491 with oxytocin, while the QALYs were 0.9980 and 0.9979, respectively. The incremental cost-effectiveness ratio is above the cost-effectiveness threshold adopted by Colombia. In the model developed for cesarean section, the average cost of a patient receiving prophylaxis with uterotonics was Col$ 461,750 with carbetocin, and Col$ 481,866 with oxytocin, and the QALYs were 0.9959 and 0.9926, respectively. Carbetocin has lower cost and is more effective, with a saving of Col$ 94,887 per avoided hemorrhagic event. CONCLUSION: In case of elective cesarean delivery, carbetocin is a dominant alternative in the prevention of PPH compared with oxytocin; however, it presents higher costs than oxytocin, with similar effectiveness, in cases of vaginal delivery.

8.
Rev. gerenc. políticas salud ; 17(34): 112-118, ene.-jun. 2018. tab, graf
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-978527

RESUMO

Resumen Las enfermedades de baja prevalencia requieren modelos de gestión diferentes a los de otras condiciones. Este trabajo buscó recoger las experiencias internacionales. Se realizaron búsquedas en numerosas bases de datos de literatura indexada y de documentos grises. Un panel de expertos de diferentes disciplinas revisó los resúmenes de la literatura y su posible adaptación al contexto colombiano. La búsqueda inicial arrojó 5604 referencias; la búsqueda manual adicionó 31 referencias, finalmente 78 artículos aportaron información útil para el análisis. Los resultados permiten afirmar que existen varios componentes de un modelo de gestión, estos son: políticas, legislación y aspectos administrativos; definición y codificación de enfermedades; investigación y educación; centros especializados, centros de excelencia y redes de atención; diagnóstico, tamizaje, prevención y promoción; inclusión de medicamentos huérfanos; rehabilitación y manejo paliativo; organizaciones de pacientes, grupos o redes de apoyo; y apoyo sociosanitario (inclusión laboral y educativa).


Abstract Low prevalence diseases require management models different from those used in other conditions. This work was intended to gather international experiences on this issue. Searches were made in many indexed literature databases as well as in those with gray literature. A panel of experts from different disciplines checked the abstracts and their potential adaptation into the Colombian context. The initial search retrieved 5604 references and the manual search added other 31 references. At the end, 78 articles provided useful information for the analysis. The results allow to state that a management model consists of several components, to wit: policies, legislation and administrative aspects; definition and coding of the diseases; research and education; specialized centers; excellence centers and service networks; diagnosis, screening, prevention, and promotion; orphan drug inclusion; rehabilitation and palliative care; organizations of patients and support groups or networks; and social-sanitary support (labor and educational inclusion).


Resumo As doenças de baixa prevalência requerem modelos de gestão diferentes aos de outras condições. Este trabalho visou coletar experiências internacionais. Realizaram-se pesquisas em numerosos bancos de dados de literatura indexada e documentos cinza. Um painel de expertos de diferentes disciplinas revisou os resumos da literatura e sua possível adaptação no contexto colombiano. A procura inicial resultou em 5604 referências; a procura manual adicionou 31 referências, por fim 78 artigos forneceram informações úteis para a análise. Os resultados permitem afirmar que existem vários componentes de um modelo de gestão, quais são: políticas, legislações e aspetos administrativos; definição e codificação de doenças; pesquisa e ensino; centros especializados, centros de excelência e redes de atendimento; diagnóstico, triagem, prevenção e promoção; inclusão de medicamentos órfãos; reabilitação e cuidados paliativos; organizações de pacientes, grupos ou redes de apoio; e apoio sócio-sanitário (inclusão laboral e educativa).


Assuntos
Humanos , Administração Hospitalar , Organizações de Serviços Gerenciais , Doenças Raras , Medicamentos do Componente Especializado da Assistência Farmacêutica
9.
Rev. bras. ginecol. obstet ; 40(5): 242-250, May 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-958989

RESUMO

Abstract Objective To assess the cost-effectiveness of carbetocin versus oxytocin for prevention of postpartum hemorrhage (PPH) due to uterine atony after vaginal delivery/ cesarean section in women with risk factors for bleeding. Methods A decision treewas developed for vaginal delivery andanother one for cesarean, in which a sequential analysis of the results was obtained with the use of carbetocin and oxytocin for prevention of PPH and related consequences. A third-party payer perspective was used; only directmedical costs were considered. Incremental costs and effectiveness in terms of quality-adjusted life years (QALYs) were evaluated for a one-year timehorizon. The costs were expressed in 2016 Colombian pesos (1 USD = 3,051 Col$). Results In the vaginal delivery model, the average cost of care for a patient receiving prophylaxis with uterotonic agents was Col$ 347,750 with carbetocin and Col$ 262,491 with oxytocin,while theQALYs were 0.9980 and 0.9979, respectively. The incremental costeffectiveness ratio is above the cost-effectiveness threshold adopted by Colombia. In the model developed for cesarean section, the average cost of a patient receiving prophylaxis with uterotonics was Col$ 461,750 with carbetocin, and Col$ 481,866 with oxytocin, and the QALYs were 0.9959 and 0.9926, respectively. Carbetocin has lower cost and is more effective, with a saving of Col$ 94,887 per avoided hemorrhagic event. Conclusion In case of elective cesarean delivery, carbetocin is a dominant alternative in the prevention of PPH compared with oxytocin; however, it presents higher costs than oxytocin, with similar effectiveness, in cases of vaginal delivery.


Resumo Objetivo Avaliar a relação custo-eficácia da carbetocina versus oxitocina para prevenção de hemorragia pós-parto (HPP) vaginal e cesariana devido à atonia uterina em mulheres com fatores de risco para desenvolver sangramento. Métodos Foram desenvolvidos protocolos de manejo para parto vaginal e outra para parto por cesárea e analisados resultados obtidos com carbetocina e oxitocina na prevenção de HPP, assim como, consequências relacionadas à ocorrência do evento hemorrágico. A perspectiva utilizada foi a do terceiro pagador, portanto, apenas os custos médicos diretos foram levados em consideração. Os custos incrementais e a eficácia em termos de anos de vida ajustados pela qualidade (QALY) foram avaliados para um horizonte de tempo de um ano. Os custos foram expressos em pesos colombianos de 2016 (1 USD = 3.051 Col$). Resultados No modelo de parto vaginal, o customédio de cuidados para um paciente que recebeu profilaxia com agentes uterotônicos foi de Col$ 347.750 com carbetocina e Col$ 262.491 com oxitocina, enquanto os QALYs foram 0,9980 e 0,9979, respectivamente. O índice incremental de custo-efetividade está acima do limite de custoefetividade adotado pela Colômbia. No modelo desenvolvido para parto por cesárea, o custo médio do paciente que recebeu profilaxia com terapia uterotônica foi de Col$ 461.750 com carbetocina e Col$ 481.866 com oxitocina e os QALYs foram 0,9959 e 0,9926, respectivamente. A carbetocina foi a alternativa com menor custo e maior efetividade com uma economia de $94.887 por evento hemorrágico evitado. Conclusão A carbetocina no parto eletivo por cesárea é uma alternativa dominante na prevenção da PPH em relação à oxitocina; porém representa custos mais altos com uma eficácia similar à da oxitocina no caso de parto vaginal.

10.
Biomedica ; 38(1): 77-85, 2018 Mar 15.
Artigo em Espanhol | MEDLINE | ID: mdl-29668137

RESUMO

Introducción. El citomegalovirus es la causa más frecuente de infección en pacientes con trasplante renal. Existen dos estrategias de similar efectividad para prevenirlo: la profilaxis universal con valganciclovir durante 90 días o el tratamiento anticipado verificando la carga viral semanal y aplicándolo solo si esta es positiva.Objetivo. Determinar cuál de estas dos estrategias sería más costo-efectiva en pacientes de riesgo intermedio en Colombia.Materiales y métodos. Se diseñó un árbol de decisiones bajo la perspectiva del tercer pagador considerando únicamente los costos médicos directos en pesos colombianos (COP) del 2014 durante un periodo de un año en una población de pacientes con riesgo intermedio para citomegalovirus (donante positivo y receptor positivo, o donante negativo y receptor positivo). Las probabilidades de transición se extrajeron de los estudios clínicos y se validaron con expertos mediante el método Delphi.Los costos de los procedimientos se basaron en el manual tarifario ISS 2001, con un incremento del 33 % a partir del índice de precios al consumidor (IPC) en salud de 2014, en tanto que los de los medicamentos se extrajeron de las circulares del Ministerio de Salud y del Sistema de Información de Medicamentos (Sismed).Resultados. La profilaxis universal con valganciclovir resultó ser menos costosa y se asoció con una menor probabilidad de infección. El costo promedio del primer año de tratamiento anticipado sería de COP$ 30'961.290, mientras que el universal sería de COP$ 29'967.834, es decir, un costo 'incremental' de COP$ 993.456.Conclusiones. Para los pacientes de riesgo intermedio con trasplante renal en Colombia, la profilaxis universal es la mejor estrategia por ser menos costosa y reducir el riesgo de infección.


Assuntos
Análise Custo-Benefício , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/virologia , Colômbia , Transplante de Rim
11.
Biomédica (Bogotá) ; 38(1): 77-85, ene.-mar. 2018. tab, graf
Artigo em Espanhol | LILACS-Express | ID: biblio-888550

RESUMO

Resumen Introducción. El citomegalovirus es la causa más frecuente de infección en pacientes con trasplante renal. Existen dos estrategias de similar efectividad para prevenirlo: la profilaxis universal con valganciclovir durante 90 días o el tratamiento anticipado verificando la carga viral semanal y aplicándolo solo si esta es positiva. Objetivo. Determinar cuál de estas dos estrategias sería más costo-efectiva en pacientes de riesgo intermedio en Colombia. Materiales y métodos. Se diseñó un árbol de decisiones bajo la perspectiva del tercer pagador considerando únicamente los costos médicos directos en pesos colombianos (COP) del 2014 durante un periodo de un año en una población de pacientes con riesgo intermedio para citomegalovirus (donante positivo y receptor positivo, o donante negativo y receptor positivo). Las probabilidades de transición se extrajeron de los estudios clínicos y se validaron con expertos mediante el método Delphi. Los costos de los procedimientos se basaron en el manual tarifario ISS 2001, con un incremento del 33 % a partir del índice de precios al consumidor (IPC) en salud de 2014, en tanto que los de los medicamentos se extrajeron de las circulares del Ministerio de Salud y del Sistema de Información de Medicamentos (Sismed). Resultados. La profilaxis universal con valganciclovir resultó ser menos costosa y se asoció con una menor probabilidad de infección. El costo promedio del primer año de tratamiento anticipado sería de COP$ 30'961.290, mientras que el universal sería de COP$ 29'967.834, es decir, un costo 'incremental' de COP$ 993.456. Conclusiones. Para los pacientes de riesgo intermedio con trasplante renal en Colombia, la profilaxis universal es la mejor estrategia por ser menos costosa y reducir el riesgo de infección.


Abstract Introduction: Cytomegalovirus (CMV) is the most frequent opportunistic infection after renal transplantation. There are two strategies for its prevention: Universal prophylaxis, with valganciclovir for 90 days, and anticipated therapy, using weekly viral load surveillance, and therapy only if positive. Meta-analysis directly comparing both strategies have shown them to have similar effectiveness. Objective: To determine which strategy is more cost-effective in intermediate risk patients in Colombia. Materials and methods: We designed a third-party payer perspective decision tree, considering only direct medical costs in 2014 Colombian pesos (COP) (USD$ 1=COP$ 2,000) and a time horizon of one year. The target population was intermediate CMV risk patients (positive receptor). Transition probabilities were extracted from clinical studies, validated with a Delphi expert panel method; procedural costs were obtained from the ISS 2001 manual with a 33% increment based on the Consumer Price Index for 2014, while medication costs were obtained from the official Ministry of Health information system. Results: Universal prophylaxis with valganciclovir was dominant, with lower costs and less probability of infection. The average cost of the first year in anticipated therapy would be COP$ 30,961,290, whereas in the case of universal therapy the cost would be COP$ 29,967,834 (incremental cost of COP$ 993,456). Conclusions: For Colombian renal transplant patients at intermediate risk for CMV infection, universal prophylaxis strategy is the best option.

12.
Acta méd. peru ; 35(1): 55-59, ene. 2018. ilus
Artigo em Espanhol | LILACS-Express | ID: biblio-1010886

RESUMO

Desde su llegada al país a mediados del siglo XVII, la fiebre amarilla jugó un papel importante en la historia patria, primero con epidemias en los puertos del Caribe, y luego, con la navegación a vapor, remontando los ríos principales, sobre todo el Magdalena. Tanto el descubrimiento de los vectores involucrados en la transmisión como el desarrollo de la vacuna delegaron la preocupación a un segundo plano. Los brotes epidémicos de fiebre amarilla, esporádicos y en regiones apartadas, siguieron ocurriendo, para recrudecerse en 2016, en paralelo con lo que ocurre en países vecinos como Perú y Brasil. El vector principal, el Aedes aegypti, involucrado en la transmisión de otros arbovirus, se adapta y se extiende en muchos entornos urbanos del continente. Se cuenta, sin embargo, con una vacuna de relativo bajo costo y de alta efectividad que podría contribuir a la erradicación de la enfermedad


Since its arrival to Colombia in the middle XVII century, yellow fever played an important role in its history; first with epidemics in the Caribbean ports, and later, when steamboats became available, by navigating upstream the Magdalena River. Both the discovery of the vectors involved in its transmission as well as the development of an effective vaccine led concerns about the disease to a secondary plane. Epidemic outbreaks of yellow fever continued occurring, particularly in very distant regions and also with prolonged time intervals. However, since 2016 there has been a recrudescence of such outbreaks, in parallel with what is going in our neighbor countries, Peru and Brazil. The main vector, Aedes aegypti, is also involved in the transmission of other arbovirus infections, and it is capable of adapting and extending its presence in many urban areas in South America. Nonetheless, a low-cost and highly effective vaccine is available, which may contribute to eradicate the disease

13.
Rev. panam. salud pública ; 42: e111, 2018. tab, graf
Artigo em Inglês | LILACS | ID: biblio-961829

RESUMO

ABSTRACT Objectives To assess the economic impact of dengue in Latin America and the Caribbean using a systematic review that includes studies not previously considered by other reviews. Methods Cochrane methodology was used to conduct a systematic review of the cost of dengue in Latin America. PubMed Central, EMBASE, and the Biblioteca Virtual en Salud—which includes scientific, peer-reviewed journals not indexed by other databases—were searched from inception through August 2016. All articles that reported cost of illness data for countries in Latin America were included. Included studies underwent a methodological appraisal using a seven-question instrument designed for cost of illness studies. Extracted data were direct and indirect costs for outpatient and hospitalized cases and total cost of the disease. Values were adjusted to 2015 US dollars using the consumer price index. Results From a total of 848 initial references, 17 studies were included, mainly from Brazil, Colombia, Cuba, Mexico, and Puerto Rico; costs were available for 39 countries. The methodological appraisal showed that 70% of the studies met more than 70% of the evaluated items. The main economic impact of dengue was due to productivity costs. Average annual cost was more than US$ 3 billion. Direct costs represented over 70% of the total share for hospitalized cases. For outpatients, direct medical costs were low, but social costs were significant since indirect costs may account for up to 80% of the total cost. Conclusions Dengue fever has a significant economic impact in Latin America. It is essential to develop new public health interventions, such as dengue vaccination, to decrease the propagation of the disease and its total cost.


RESUMEN Objetivos Evaluar las repercusiones económicas del dengue en América Latina y el Caribe mediante una revisión sistemática que abarcó estudios no considerados en otras revisiones anteriores. Métodos Se usó la metodología de Cochrane para hacer una revisión sistemática del costo del dengue en América Latina. Se hizo una búsqueda en PubMed Central, EMBASE y la Biblioteca Virtual en Salud, que incluyen revistas científicas arbitradas no indizadas por otras bases de datos, desde su aparición hasta agosto del 2016. Se incluyeron todos los artículos que contenían datos sobre el costo de la enfermedad para los países de América Latina. Los estudios incluidos se sometieron a una evaluación metodológica para la cual se usó un instrumento de siete preguntas diseñado para los estudios sobre los costos de las enfermedades. Los datos extraídos fueron los costos directos e indirectos para los casos de pacientes ambulatorios y hospitalizados y el costo total de la enfermedad. Los valores se ajustaron a dólares de los Estados Unidos del 2015 con base en el índice de precios al consumidor. Resultados De un total de 848 referencias iniciales, se incluyeron 17 estudios, principalmente de Brasil, Colombia, Cuba, México y Puerto Rico; se encontraron datos sobre los costos en 39 países. La evaluación metodológica indicó que 70% de los estudios reunían más de 70% de los puntos evaluados. La principal repercusión económica del dengue se debió a los costos por pérdida en la productividad. El costo anual promedio fue de más de USD 3.000 millones. Los costos directos representaron más de 70% del total para los casos de pacientes hospitalizados. En cuanto a los pacientes ambulatorios, los costos médicos directos fueron bajos, pero los costos sociales fueron considerables, ya que los costos indirectos pueden representar hasta 80% del costo total. Conclusiones El dengue tiene importantes repercusiones económicas en América Latina. Es fundamental elaborar nuevas intervenciones en materia de salud pública, como la vacunación contra el dengue, para reducir la propagación de la enfermedad y su costo total.


RESUMO Objetivos Avaliar o impacto econômico da dengue na América Latina e o Caribe por meio de uma revisão sistemática que incluiu estudos não considerados anteriormente por outras revisões. Métodos Utilizou-se a metodologia Cochrane para realizar uma revisão sistemática do custo da dengue na América Latina. Foi realizada uma busca dos bancos de dados PubMed Central, EMBASE e Biblioteca Virtual em Saúde— a qual inclui periódicos científicos com avaliação por pares não indexados por outros repositórios—desde sua criação até agosto de 2016. Todos os artigos que relataram dados de custo de doença para países da América Latina foram incluídos. Os estudos incluídos foram submetidos a uma avaliação metodológica usando um instrumento de sete perguntas desenvolvido para estudos de custo de doença. Os dados extraídos foram os custos diretos e indiretos para casos ambulatoriais e hospitalizados e o custo total da doença. Os valores foram ajustados para dólares de 2015, usando-se o índice de preços ao consumidor. Resultados De 848 referências inicialmente identificadas, 17 estudos foram incluídos, principalmente do Brasil, Colômbia, Cuba, México e Porto Rico; dados sobre custos estavam disponíveis para 39 países. A avaliação metodológica demonstrou que 70% dos estudos apresentavam mais de 70% dos itens avaliados. O principal impacto econômico da dengue foi devido aos custos de produtividade. O custo médio anual foi superior a US$3 bilhões. Para casos que exigiram hospitalização, os custos diretos representaram mais de 70% do custo total. Para pacientes ambulatoriais, os custos médicos diretos foram baixos, mas os custos sociais foram significativos, pois os custos indiretos podem representar até 80% do custo total. Conclusões A dengue tem impacto econômico considerável na América Latina. É essencial desenvolver novas intervenções de saúde pública, como a vacinação contra a dengue, para diminuir a propagação da doença e seu custo total.


Assuntos
Humanos , Custos de Cuidados de Saúde , Efeitos Psicossociais da Doença , Dengue/prevenção & controle , Dengue/transmissão , Região do Caribe , América Latina
14.
Value Health Reg Issues ; 14: 35-40, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29254540

RESUMO

BACKGROUND: Diabetes treatment includes very diverse drugs. It is essential to identify which drugs offer the best value for their costs. OBJECTIVES: To estimate comparative cost effectiveness for treating diabetes mellitus with dulaglutide, liraglutide, or glargine in Colombia. METHODS: A Markov model including diabetic microvascular and macrovascular complications was used to estimate cost-effectiveness. We used annual cycles, a 5-year time horizon, 5% discount rate, and third-party payer's perspective. Main outcomes were quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). Transition probabilities were obtained from primary studies and costs from local databases and studies. We used a threshold of 3 times the Colombian per capita gross domestic product (US $17,270 for 2015; US $1 = 2,743 Columbian pesos) to assess cost effectiveness. RESULTS: Total costs related to dulaglutide, liraglutide, and glargine were US $8,633, US $10,756, and US $5,783, yielding 3.311 QALYs, 3.229 QALYs, and 3.156 QALYs, respectively. Dulaglutide dominated liraglutide given lower total costs and higher QALYs. The estimated ICER for dulaglutide compared with glargine was US $18,385, greater than the accepted threshold. Sensibility analysis shows that decreased dulaglutide cost, increased consumption of glargine, nondaily injection, and number and cost of glucometry could result in ICERs lower than the threshold. Probabilistic sensitivity analysis showed consistent results. CONCLUSIONS: This estimation indicates that dulaglutide dominates liraglutide. Its ICER is, however, greater than the accepted threshold for Colombia in base case compared with glargine. By increasing population weight or glargine consumption, dulaglutide becomes cost effective compared with glargine, which could identify a niche where dulaglutide is the best option.


Assuntos
Análise Custo-Benefício , Diabetes Mellitus Tipo 2/tratamento farmacológico , Quimioterapia Combinada , Peptídeos Semelhantes ao Glucagon/análogos & derivados , Hipoglicemiantes/administração & dosagem , Fragmentos Fc das Imunoglobulinas/administração & dosagem , Insulina Glargina/administração & dosagem , Liraglutida/administração & dosagem , Proteínas Recombinantes de Fusão/administração & dosagem , Colômbia , Diabetes Mellitus Tipo 2/economia , Peptídeos Semelhantes ao Glucagon/administração & dosagem , Hemoglobina A Glicada , Humanos , Hipoglicemiantes/economia , Anos de Vida Ajustados por Qualidade de Vida
15.
Rev. colomb. psiquiatr ; 46(4): 237-242, oct.-dic. 2017. graf
Artigo em Inglês | LILACS-Express | ID: biblio-960144

RESUMO

Abstract Objective: Due to the high rates of suicide reported among many ethnic minorities, a systematic review is presented on suicide in indigenous populations of Latin America. Methods: Systematic review in PubMed, Scopus, PsycNET, SciELO and Scholar Google. Results: From an initial total of 1862 articles, 41were included for data extraction. They include 21 from Brazil, 13 from Colombia, 2 from Chile, 1 from Peru, and 4 articles grouped from different countries. Suicide is a public health issue in many communities. Lifestyle changes, industrialisation, environmental degradation, and alcohol have led the indigenous population experiencing what has been described as "cultural death."


Resumen Objetivo: Se han reportado altas tasas de suicidio en algunas minorías étnicas, entre ellas comunidades indígenas en Latinoamérica. Este fenómeno se considera un problema de salud pública. Realizamos una revisión sistemática para describirlo. Métodos: Se realizó una búsqueda sistemática en las bases de datos de PubMed, Scopus, PscycNET, SciELO y Google Scholar. Resultados: Se encontró un total inicial de 1.862 referencias; de estos artículos, se incluyeron 41 para extracción de datos según los criterios de inclusión, de los que 21 hacen referencia a Brasil,13 a Colombia, 2 a Chile,1a Perú y 4 artículos a diferentes países agrupados. Las comunidades indígenas están pasando por un fenómeno de «muerte cultural¼ en el que los cambios en las culturas, los estilos de vida, la industrialización, la invasión del medio ambiente y el consumo de alcohol se convierten en desencadenantes del suicidio.

16.
Rev. colomb. reumatol ; 24(4): 230-236, Oct.-Dec. 2017. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-960233

RESUMO

Abstract Introduction: Achenbach's syndrome is a vascular disorder of the hands and feet. It is of unknown etiology and has a benign course. Because of its low prevalence, available literature is limited, and most publications are case reports. No Latin-American publications were found on the subject. The case of a 58 year-old man is presented, along with a systematic review of the literature to describe its clinical characteristics. Methods: A literature search was conducted in PubMed, Embase and Lilacs using free terms and controlled vocabulary (MeSH, Emtree, and DeCS). Results: An analysis was made on a total of 23 articles, 19 of which were case reports, with a total of 46 patients, 43 women and 3 men, from 7 countries. The disorder occurs most often in women over 50 years, and is manifested by the sudden appearance of a blue coloration of the palmar surface of the fingers. It is less common in the feet. Conclusions: Achenbach's syndrome is benign, and does not require medical intervention. Diagnostic methods are of little use. Therefore, identification is important to avoid unnecessary procedures.


Resumen Introducción: El síndrome de Achenbach es un trastorno vascular de manos y pies, de etiología desconocida y de curso benigno. Dada su baja frecuencia de presentación, la literatura disponible es escasa; la mayoría son reportes de casos. No se encontraron publicaciones latinoamericanas sobre el tema. Aquí se presenta un caso clínico, en un hombre de 58 anos, y se hace una revisión sistemática de la literatura para describir sus características clínicas. Métodos: Se realizó una búsqueda de literatura en PubMed, Embase y Lilacs utilizando términos libres y vocabulario controlado (MeSH, Emtree y DeCS). Resultados: Se evaluaron 23 artículos de los cuales 19 fueron reportes de caso. Los reportes de caso muestran la historia de 46 pacientes, 43 mujeres y 3 hombres, en 7 países. El trastorno se presenta más frecuentemente en mujeres mayores de 50 anos y se manifiesta por la aparición súbita de una coloración azul de la cara palmar de los dedos y menos frecuente en los pies. Conclusiones: El síndrome de Achenbach es benigno y no requiere intervenciones médicas. Los métodos diagnósticos son de poca utilidad. Es necesario reconocerlo para evitar procedimientos innecesarios.

17.
Rev Colomb Psiquiatr ; 46(4): 237-242, 2017 Oct - Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29122231

RESUMO

OBJECTIVE: Due to the high rates of suicide reported among many ethnic minorities, a systematic review is presented on suicide in indigenous populations of Latin America. METHODS: Systematic review in PubMed, Scopus, PsycNET, Scielo and Scholar Google. RESULTS: From an initial total of 1862 articles, 41 were included for data extraction. They include 21 from Brazil, 13 from Colombia, 2 from Chile, 1 from Peru, and 4 articles grouped from different countries. Suicide is a public health issue in many communities. Lifestyle changes, industrialisation, environmental degradation, and alcohol have led the indigenous population experiencing what has been described as "cultural death."


Assuntos
Índios Sul-Americanos/estatística & dados numéricos , Saúde Pública , Suicídio/estatística & dados numéricos , Características Culturais , Humanos , América Latina/epidemiologia , Estilo de Vida
18.
Rev. colomb. cardiol ; 24(3): 277-285, mayo-jun. 2017. tab
Artigo em Espanhol | LILACS-Express | ID: biblio-900528

RESUMO

Resumen Objetivo: analizar los suplementos nutricionales con ácidos grasos de cadena larga, micronutrientes y antioxidantes en la población adulta, como posibles modificadores del riesgo cardiovascular en pacientes con diagnóstico de síndrome metabólico, o alguno de sus componentes. Métodos: Se realizó una revisión de la literatura en las bases de datos Medline y Embase, utilizando los términos ''Metabolic Syndrome'' AND ''Dietary supplements'' y 'Metabolic Syndrome'/exp AND 'Dietary supplement'/exp, respectivamente, sobre el papel de los suplementos nutricionales en la modificación del riesgo cardiovascular en adultos con síndrome metabólico o alguno de sus componentes. Resultados: De 475 artículos depurados, se seleccionaron 37 que estudiaran el posible beneficio de los suplementos nutricionales en el síndrome metabólico. Algunos estudios muestran un potencial de ácidos grasos de cadena larga y antioxidantes (vitamina D, vitamina E) para reducir el riesgo cardiovascular de pacientes con síndrome metabólico, evidenciado en la reducción de parámetros como colesterol total, glucemia, índice de masa corporal y perímetro abdominal. Conclusión: El uso de suplementos nutricionales con ácidos grasos de cadena larga y antioxidante podría tener efectos benéficos en la disminución de riesgo cardiovascular en pacientes con diagnóstico de síndrome metabólico o alguno de sus componentes. El uso de suplementos con otros componentes debe estudiarse a mayor profundidad para efectuar recomendaciones.


Abstract Objective: To analyze dietary supplements with long chain fatty acids, micronutrients and antioxidants in adult population as possible modifiers of cardiovascular risk in patients diagnosed with metabolic syndrome or any of its components. Methods: Literature review of databases Medline and Embase using terms ''Metabolic Syndrome'' AND ''Dietary supplements'' and 'Metabolic Syndrome'/exp AND 'Dietary supplement'/exp, respectively, on the role of dietary supplements in modifying cardiovascular risk in adults with metabolic syndrome or any of its components. Results: Out of 475 articles, the 37 selected studied the possible benefit of dietary supplements in metabolic syndrome. Some studies reveal a potential in long chain fatty acids and antioxidants (vitamin D, vitamin E) in reducing cardiovascular risk of patients with metabolic syndrome, evidenced in the decrease of parameters such as total cholesterol, blood sugar, body mass index and abdominal perimeter. Conclusion: The use of dietary supplements with long chain fatty acids and antioxidants could have beneficial effects in reducing cardiovascular risk in patients diagnosed with metabolic syndrome or any of its components. The use of supplements with other components must be studied more deeply to make further recommendations.

19.
Acta neurol. colomb ; 33(1): 37-45, ene.-mar. 2017. tab
Artigo em Espanhol | LILACS | ID: biblio-886421

RESUMO

RESUMEN OBJETIVOS: Evaluar los efectos del consumo de ácidos grasos omega 3 en forma de suplementos, complementos o alimentos sobre la función cognitiva de los adultos. MÉTODOS: Se realizó una revisión de la literatura en las bases de datos Medline y Embase, buscando ensayos clínicos, estudios observacionales, revisiones sistemáticas y estudios experimentales que relacionaran los ácidos grasos omega 3 con función cognitiva y Alzheimer. RESULTADOS: La mayoría de los estudios relacionó la suplementación de cápsulas con omega 3, el consumo de pescado u otros alimentos con contenido de omega 3, con resultados en pruebas de función cognitiva, desenlace de enfermedad o imágenes diagnósticas, encontrando en general efectos benéficos, que parecen ser mayores en personas sanas y con mejor función cognitiva de base. Hubo diferencias en los resultados encontrados en los ensayos clínicos y revisiones sistemáticas, que podrían atribuirse a la variabilidad en las dosis de la suplementación, el tiempo de seguimiento y la manera en que se midió la función y el deterioro cognitivo. CONCLUSIÓN: El consumo de ácidos grasos omega 3 en forma de suplementos, complementos o alimentos ricos en estos como el pescado parece tener efectos benéficos en la función cognitiva de las personas adultas.


SUMMARY OBJECTIVES: To evaluate the effects of omega 3 fatty acids consumption in the form of dietary supplement, complement or food-products presentation on adult cognitive function. METHODS: A literature review in two databases (Medline and Embase) was undertaken, searching for clinical trials, observational studies, systematic reviews and experimental studies concerning omega-3 fatty acids and their relation with cognitive function and Alzheimer's disease. RESULTS: Most studies linked supplementation with omega-3 capsules and consumption of fish and other omega-3 containing foods with results in cognitive function testing, outcomes in diseases or diagnostic imaging and found beneficial effects, which seem to be stronger in healthier persons with better cognitive function at baseline. There were differences in the results found in clinical trials and systematic reviews, which could be attributable to the variability in the supplementation dose, the length of follow-up and the methods used to assess cognitive function and decline. CONCLUSION: The use of omega-3 fatty acids in supplement, complement or food-products presentation seems to have beneficial effects in the cognitive function of healthy adults.


Assuntos
Ácido Eicosapentaenoico , Cognição , Ácidos Graxos , Doença de Alzheimer
20.
Rev. colomb. gastroenterol ; 32(2): 141-149, 2017. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-900687

RESUMO

Resumen Introducción: el síndrome de intestino irritable (SII) y la enfermedad inflamatoria intestinal (EII), son motivos de consulta frecuente. Usualmente su tratamiento se hace en primer nivel de atención, con ajuste de estilo de vida y cambios dietéticos. Los tratamientos farmacológicos tienen eficacia limitada e importantes efectos secundarios, por lo que existe un interés creciente en terapias diferentes, como el uso de probióticos. Métodos: se realizó una revisión de la literatura en las bases de datos Medline y Embase buscando estudios que asociaran suplementos nutricionales con SII o EII, haciendo énfasis en probióticos. Resultados: de un total de 1598 referencias, 43 cumplieron criterios finales de inclusión. El uso de probióticos en SII y EII sugiere ser una terapia que ayuda a mantener los períodos de remisión de la enfermedad, mejorar la calidad de vida y atenuar el proceso fisiopatológico. Conclusiones: el uso de probióticos y prebióticos podría ser una alternativa de soporte nutricional en pacientes seleccionados.


Abstract Introduction: Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are frequent reasons for medical consultation. Usually they are treated at the first level of attention with adjustment of lifestyle and dietary changes. Pharmacological treatments have limited efficacy and significant side effects, so there is growing interest in other therapies such as the use of probiotics. Methods: This is literature review of studies associating nutritional supplements with IBS or IBD that have an emphasis on probiotics and which found in the Medline and Embase databases. Results: Of a total of 1,598 references, 43 met the final inclusion criteria. The use of probiotics in IBS and IBD suggests a therapy that helps maintain periods of disease remission, improvement of quality of life and attenuation of the pathophysiological process. Conclusions: The use of probiotics and prebiotics could be alternative nutritional support for selected patients.


Assuntos
Doenças Inflamatórias Intestinais , Estado Nutricional , Suplementos Nutricionais , Síndrome do Intestino Irritável , Probióticos
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