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1.
Cochrane Database Syst Rev ; 6: CD015890, 2024 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-38860538

RESUMO

BACKGROUND: Tuberculosis (TB) is a leading cause of mortality due to an infectious disease, with an estimated 1.6 million deaths due to TB in 2022. Approximately 25% of the global population has TB infection, giving rise to 10.6 million episodes of TB disease in 2022. Undernutrition is a key risk factor for TB and was linked to an estimated 2.2 million TB episodes in 2022, as outlined in the World Health Organization (WHO) Global Tuberculosis Report. OBJECTIVES: To determine the prognostic value of undernutrition in the general population of adults, adolescents, and children for predicting tuberculosis disease over any time period. SEARCH METHODS: We searched the literature databases MEDLINE (via PubMed) and WHO Global Index Medicus, as well as the WHO International Clinical Trials Registry Platform (ICTRP) on 3 May 2023 (date of last search for all databases). We placed no restrictions on the language of publication. SELECTION CRITERIA: We included retrospective and prospective cohort studies, irrespective of publication status or language. The target population comprised adults, adolescents, and children from diverse settings, encompassing outpatient and inpatient cohorts, with varying comorbidities and risk of exposure to tuberculosis. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodology and the Quality In Prognosis Studies (QUIPS) tool to assess the risk of bias of the studies. Prognostic factors included undernutrition, defined as wasting, stunting, and underweight, with specific measures such as body mass index (BMI) less than two standard deviations below the median for children and adolescents and low BMI scores (< 18.5) for adults and adolescents. Prognostication occurred at enrolment/baseline. The primary outcome was the incidence of TB disease. The secondary outcome was recurrent TB disease. We performed a random-effects meta-analysis for the adjusted hazard ratios (HR), risk ratios (RR), or odds ratios (OR), employing the restricted maximum likelihood estimation. We rated the certainty of the evidence using the GRADE approach. MAIN RESULTS: We included 51 cohort studies with over 27 million participants from the six WHO regions. Sixteen large population-based studies were conducted in China, Singapore, South Korea, and the USA, and 25 studies focused on people living with HIV, which were mainly conducted in the African region. Most studies were in adults, four in children, and three in children and adults. Undernutrition as an exposure was usually defined according to standard criteria; however, the diagnosis of TB did not include a confirmatory culture or molecular diagnosis using a WHO-approved rapid diagnostic test in eight studies. The median follow-up time was 3.5 years, and the studies primarily reported an adjusted hazard ratio from a multivariable Cox-proportional hazard model. Hazard ratios (HR) The HR estimates represent the highest certainty of the evidence, explored through sensitivity analyses and excluding studies at high risk of bias. We present 95% confidence intervals (CI) and prediction intervals, which present between-study heterogeneity represented in a measurement of the variability of effect sizes (i.e. the interval within which the effect size of a new study would fall considering the same population of studies included in the meta-analysis). Undernutrition may increase the risk of TB disease (HR 2.23, 95% CI 1.83 to 2.72; prediction interval 0.98 to 5.05; 23 studies; 2,883,266 participants). The certainty of the evidence is low due to a moderate risk of bias across studies and inconsistency. When stratified by follow-up time, the results are more consistent across < 10 years follow-up (HR 2.02, 95% CI 1.74 to 2.34; prediction interval 1.20 to 3.39; 22 studies; 2,869,077 participants). This results in a moderate certainty of evidence due to a moderate risk of bias across studies. However, at 10 or more years of follow-up, we found only one study with a wider CI and higher HR (HR 12.43, 95% CI 5.74 to 26.91; 14,189 participants). The certainty of the evidence is low due to the moderate risk of bias and indirectness. Odds ratio (OR) Undernutrition may increase the odds of TB disease, but the results are uncertain (OR 1.56, 95% CI 1.13 to 2.17; prediction interval 0.61 to 3.99; 8 studies; 173,497 participants). Stratification by follow-up was not possible as all studies had a follow-up of < 10 years. The certainty of the evidence is very low due to the high risk of bias and inconsistency. Contour-enhanced funnel plots were not reported due to the few studies included. Risk ratio (RR) Undernutrition may increase the risk of TB disease (RR 1.95, 95% CI 1.72 to 2.20; prediction interval 1.49 to 2.55; 4 studies; 1,475,867 participants). Stratification by follow-up was not possible as all studies had a follow-up of < 10 years. The certainty of the evidence is low due to the high risk of bias. Contour-enhanced funnel plots were not reported due to the few studies included. AUTHORS' CONCLUSIONS: Undernutrition probably increases the risk of TB two-fold in the short term (< 10 years) and may also increase the risk in the long term (> 10 years). Policies targeted towards the reduction of the burden of undernutrition are not only needed to alleviate human suffering due to undernutrition and its many adverse consequences, but are also an important part of the critical measures for ending the TB epidemic by 2030. Large population-based cohorts, including those derived from high-quality national registries of exposures (undernutrition) and outcomes (TB disease), are needed to provide high-certainty estimates of this risk across different settings and populations, including low and middle-income countries from different WHO regions. Moreover, studies including children and adolescents and state-of-the-art methods for diagnosing TB would provide more up-to-date information relevant to practice and policy. FUNDING: World Health Organization (203256442). REGISTRATION: PROSPERO registration: CRD42023408807 Protocol: https://doi.org/10.1002/14651858.CD015890.


Assuntos
Desnutrição , Tuberculose , Humanos , Desnutrição/complicações , Desnutrição/epidemiologia , Fatores de Risco , Criança , Adolescente , Tuberculose/epidemiologia , Adulto , Prognóstico , Estudos Retrospectivos , Estudos Prospectivos
2.
Evid. actual. práct. ambul ; 26(4): e007085, 2023.
Artigo em Espanhol | LILACS, UNISALUD, BINACIS | ID: biblio-1526556

RESUMO

De la mano del envejecimiento poblacional, la demencia o trastorno neurocognitivo mayor afecta a una cantidad cada vez mayor de personas, lo que implica un alto costo para los servicios de salud. Las guías de práctica clínica recomiendan ofrecer terapias de estimulación cognitiva a las personas afectadas y cada vez es más común el empleo de herramientas tecnológicas que permiten su aplicación a gran escala a pesar de la incertidumbre acerca de su beneficio.En este artículo revisamos la evidencia más actualizada sobre la eficacia de las herramientas computarizadas para el entrenamiento cognitivo de pacientes con demencia. Encontramos algunos estudios que sugieren que podría haber una posible mejora cognitiva en los pacientes con demencia y en la calidad de vida de sus cuidadores. Sin embargo, la mayoría de los estudios no fueron de buena calidad metodológica, fueron realizados con un número limitado de pacientes, en periodos poco prolongados, y los desenlaces fueron evaluados a través de múltiples pruebas de difícil interpretación. (AU)


With the increasing population aging, dementia or major neurocognitive disorder affects a growing number of people,incurring a substantial burden on healthcare services. Clinical practice guidelines recommend providing cognitive stimulation therapies to affected individuals, and the use of technological tools for implementing therapies on a large scale is increasingly common despite the uncertainty about their benefits.In this article, we reviewed the most up-to-date evidence on the effectiveness of computerized tools for cognitive training in patients with dementia. We found some studies that suggest that there could be a possible cognitive improvement in patients with dementia and in the quality of life of their caregivers. However, most studies were not of good methodological quality, were carried out with a limited number of patients, in short periods of time, and the outcomes were evaluated through multiple tests that were difficult to interpret. (AU)


Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Demência/terapia , Doença de Alzheimer/terapia , Telerreabilitação , Treino Cognitivo/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Autonomia Pessoal , Computadores de Mão , Aplicativos Móveis , Memória de Curto Prazo
3.
Evid. actual. práct. ambul ; 26(1): e007055, 2023. tab
Artigo em Espanhol | LILACS, UNISALUD, BINACIS | ID: biblio-1427387

RESUMO

La violencia por cuestiones de género es un fenómeno histórico, complejo y prevalente a nivel mundial. Definida por la Organización de las Naciones Unidas como 'todo acto de violencia basado en la pertenencia al sexo femenino, que tenga o pueda tener como resultado un daño o sufrimiento físico, sexual o psicológico para la mujer, así como las amenazas detales actos, la coacción o la privación arbitraria de la libertad, tanto si se producen en la vida pública como en la privada', la violencia contra la mujer constituye una violación de los derechos humanos y por lo tanto, una cuestión de Estado. Las autoras de este artículo repasan el marco legal que aborda este problema en la Argentina, las dificultades del sistema sanitario (a nivel institucional e individual) en la detección y asistencia de las personas que lo padecen y la necesidad desensibilización y capacitación de los profesionales de la salud. (AU)


Gender-based violence is a historical, complex and prevalent phenomenon worldwide. Defined by the United Nations as 'any act of female-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, as well as threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or private life', violence against women is a violation of human rights, and therefore a matter of State. The authors of this article review the legal frame that addresses this problem in Argentina, the difficulties of the health system (at institutional and individual level) in the detection and care of people who suffer from it, and the need for raising awareness and training healthcare professionals. (AU)


Assuntos
Humanos , Feminino , Sistemas de Saúde , Violência Doméstica/legislação & jurisprudência , Violência contra a Mulher , Violência de Gênero/legislação & jurisprudência , Argentina , Prevalência , Pessoal de Saúde/educação , Violência Doméstica/estatística & dados numéricos , Violação de Direitos Humanos , Violência de Gênero/estatística & dados numéricos
4.
Evid. actual. práct. ambul ; 25(3): e002144, 2022. tab
Artigo em Espanhol | LILACS, UNISALUD, BINACIS | ID: biblio-1398442

RESUMO

Lograr un adecuado nivel de anticoagulación con antagonistas orales de la vitamina K suele ser un desafío frecuente en la práctica clínica, dado que su estrecho rango terapéutico suele verse afectado por diversas interacciones farmacológicas,alimentos y condiciones clínicas. A partir de un caso de un paciente anticoagulado que presenta una hemorragia gastro-intestinal posterior a realizar un tratamiento antibiótico, la autora de este artículo revisó la evidencia sobre el riesgo desangrado secundario a la interacción entre este tipo de anticoagulantes y antibióticos orales. Su conclusión tras realizar una búsqueda bibliográfica y seleccionar la mejor evidencia disponible, es que existe un aumento del riesgo relativo desangrado en pacientes anticoagulados que reciben antibióticos, por lo que deberían evitarse aquellos antibióticos con conocido potencial de interacción. Si ello no fuera posible, se recomienda monitorizar el estado de anticoagulación con dosaje de la razón internacional normatizada (RIN) posterior a la introducción del antibiótico. (AU)


Achieving an adequate level of anticoagulation with oral vitamin K antagonists is often a frequent challenge in clinical practice, given that their narrow therapeutic range is often affected by various drug interactions, food, and clinical conditions. Based on a case of an anticoagulated patient who presented gastrointestinal bleeding after antibiotic treatment, the authorof this article reviewed the evidence on the risk of secondary bleeding due to the interaction between this type of anticoagulants and oral antibiotics. Their conclusion, after performing a literature search and selecting the best available evidence, is that there is an increased relative risk of bleeding in anticoagulated patients receiving antibiotics, so antibiotics with known potential for interaction should be avoided. If it weren't possible, it is recommended to monitor the anticoagulation status with International Normalized Ratio (INR) dosing after the introduction of the antibiotic. (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Vitamina K/antagonistas & inibidores , Varfarina/efeitos adversos , Hemorragia/induzido quimicamente , Acenocumarol/efeitos adversos , Antibacterianos/efeitos adversos , Anticoagulantes/efeitos adversos , Varfarina/farmacologia , Varfarina/farmacocinética , Fatores de Risco , Medição de Risco , Coeficiente Internacional Normatizado , Interações Medicamentosas , Acenocumarol/farmacologia , Acenocumarol/farmacocinética , Antibacterianos/farmacologia , Anticoagulantes/farmacologia , Anticoagulantes/farmacocinética
5.
Evid. actual. práct. ambul ; 25(1): e006997, 2022. tab
Artigo em Espanhol | LILACS, UNISALUD, BINACIS | ID: biblio-1367297

RESUMO

En Argentina, tres de las vacunas contra el COVID-19 autorizadas por la entidad regulatoria local se aplican en menores de edad: la vacuna desarrollada por Sinopharm (BBIBP-CorV) para niños de 3 años o más, y las desarrolladas por Moderna (ARNm 1273) y Pfizer (BNT162b2) a partir de los 12 años. Dado que estas recomendaciones no coinciden exactamente con las emitidas por diferentes organismos internacionales y debido al corto plazo de seguimiento de los ensayos publicados, surgieron dudas fundamentalmente en relación a su seguridad. En este artículo, los autores sintetizan la evidencia disponible hasta el momento sobre las vacunas aplicadas en niños, niñas y adolescentes en nuestro país, basada en informes preliminares de ensayos clínicos y reportes de vigilancia epidemiológica. (AU)


In Argentina, three of the COVID-19 vaccines authorized by the local regulatory entity are applied to minors: the vaccine developed by Sinopharm (BBIBP-CorV) for children 3 years of age or older, and those developed by Moderna (RNAm1273) and Pfizer (BNT162b2) from the age of 12 and onwards. Given that these recommendations do not coincide exactly with those issued by different international organizations and due to the short follow-up period of the published trials, doubts arose fundamentally in relation to their safety. In this article, the authors summarize the evidence available to date on vaccines applied to children and adolescents in our country, based on preliminary studies of clinical trials and epidemiological surveillance reports. (AU)


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Vacinas contra COVID-19/farmacologia , COVID-19/imunologia , COVID-19/prevenção & controle , Argentina , Ensaios Clínicos como Assunto , Monitoramento Epidemiológico , SARS-CoV-2
6.
Evid. actual. práct. ambul ; 25(4): e007049, 2022. tab
Artigo em Espanhol | LILACS, UNISALUD, BINACIS | ID: biblio-1416833

RESUMO

Los controles periódicos de salud son aquellos cuidados médicos realizados a intervalos regulares, motivados por la necesidad de evaluar la salud en general y prevenir enfermedades a futuro. Se presume que comenzaron a ponerse en práctica durante el siglo XIX para la detección precoz de la tuberculosis y otras enfermedades contagiosas. A principios del siglo XX fueron difundidos los programas de examinación médica en el contexto de la estimación del riesgo de enfermedad y/o muerte previo a la contratación de seguros de vida. El desarrollo tecnológico posterior a la Segunda Guerra mundial fomentó el interés en estas examinaciones periódicas con la implementación de pruebas masivas de rastreo, lo que aumentó de manera considerable de la mano de los servicios de medicina prepaga. En los últimos años se han realizado múltiples esfuerzos por cuantificar los beneficios de estos controles. Si bien existen diversas opiniones respecto a su utilidad, pareciera ser que el enfoque actual del control periódico de salud implica tener en cuenta las necesidades de las personas, el riesgo individual y la relación médico-paciente como eje de la discusión. (AU)


Periodic health check-ups are medical care performed at regular intervals, motivated by the need to assess general health and prevent future diseases. It is presumed that they began to be implemented in the 19thcentury for the early detection of tuberculosis and other contagious diseases, and later spread in the early 20thcentury in the context of estimating the risk of illness and/or death prior to taking out life insurance. The technological development after the World War II encouraged interest in these periodic examinations with the implementation of mass screening tests, which increased considerably with the introductionof prepaid medical services. In recent years, multiple efforts have been made to quantify the benefits of such controls. While there are varying opinionsas to their usefulness, it appears that the current approach to periodic health check-ups is to take into account the needs of individuals, their individual risk, and the doctor-patient relationship at the core of the discussion. (AU)


Assuntos
Humanos , Prevenção Primária/história , Cuidados Médicos/história , Relações Médico-Paciente , Prevenção Primária/tendências , Programas de Rastreamento/tendências , Cuidados Médicos/tendências , Promoção da Saúde
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