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Glujovsky D.,Institute Efectividad Clinica y Sanitaria IECS | Villanueva E.,Gestion del Conocimiento Bioetica e Investigaciones | Reveiz L.,Gestion del Conocimiento Bioetica e Investigaciones | Murasaki R.,Centro Latinoamericano Y Del Caribe Of Informacion En Ciencias Of La Salud
Revista Panamericana de Salud Publica/Pan American Journal of Public Health | Year: 2014

Objective. To evaluate the familiarity of the editors of journals indexed in the LILACS database with the guidelines for reporting on and publishing research-promoted by the EQUATOR Network (Enhancing QUAlity and Transparency Of Health Research)-, the journals' requirements for use of the guidelines, and the editors' opinions regarding the reasons for the low rate of use. Methods. LILACS editors were surveyed by e-mail about the guidelines and their availability at the EQUATOR website, and about the requirements and difficulties in using them. Results. Of 802 editors, 16.4% answered the survey. More than half said they were not aware of the guidelines (especially STROBE and PRISMA) and 30% were familiar with the EQUATOR Network. Conclusions. The first Latin American and Caribbean study on LILACS editors' familiarity with the guidelines revealed that more than half of them were not familiar either with the guidelines or the EQUATOR Network.

PubMed | Region Sanitaria Metropolitana Distrito Central de Francisco Morazan, Hospital Escuela Universitario, Institute Efectividad Clinica y Sanitaria IECS, Hospital Escuela and 2 more.
Type: Journal Article | Journal: Reproductive health | Year: 2016

Although there is increasing evidence for a relationship between symptomatic Zika virus (ZIKV) maternal infection, and microcephaly, a firm causal relation has yet to be established by epidemiologic studies. Studies also need to be conducted in recently infected settings. Our objectives are to assess the frequency of ZIKV infection during pregnancy in Honduras and the association of microcephaly with ZIKV infection.We will perform a prospective study enrolling pregnant women at their first antenatal visit and following them up until delivery. At the time of enrollment, women will be interviewed to collect socio-demographic data, data needed to locate them for potential additional follow-up, and data about ZIKV symptoms during pregnancy. We will also collect maternal blood as soon as possible after enrollment. A probable maternal ZIKV infection will be defined as positive for maternal ZIKV IgM. A confirmed maternal ZIKV infection will be defined as positive for ZIKV IgM confirmed by plaque reduction neutralization test. Microcephaly at birth will be defined as an occipito-frontal circumference <2SD for sex and gestational age. Our objective is to enroll 2000 pregnant women. In a first step, we will follow a case cohort design and only analyze blood samples for cases and a sub-cohort of 200 women randomly selected. Blood samples for the entire population will be analyzed at a later stage if funds are available.This protocol was designed to be implemented with minimal resources. It allows a cohort to be built, which could be a foundation for future in-depth and follow-up studies.

Belizan J.M.,Institute Efectividad Clinica y Sanitaria IECS | Hofmeyr J.,University of Witwatersrand | Buekens P.,Tulane University | Salaria N.,Biomedical Central
Reproductive Health | Year: 2013

Premature birth is the world's leading cause of neonatal mortality with worldwide estimates indicating 11.1% of all live births were preterm in 2010. Preterm birth rates are increasing in most countries with continual differences in survival rates amongst rich and poor countries. Preterm birth is currently an important unresolved global issue with research efforts focusing on uterine quiescence and activation, the 'omics' approaches and implementation science in order to reduce the incidence and increase survival rates of preterm babies. The journal Reproductive Health has published a supplement entitled Born Too Soon which addresses factors in the preconception and pregnancy period which may increase the risk of preterm birth and also outlines potential interventions which may reduce preterm birth rates and improve survival of preterm babies by as much as 84% annually. This is critical in order to achieve the Millennium Development Goal (MDG 4) for child survival by 2015 and beyond. © 2013 Belizán et al.; licensee BioMed Central Ltd.

Poggio R.,Fundacion FLENI | Poggio R.,Institute Efectividad Clinica y Sanitaria IECS | Arazi H.C.,Fundacion FLENI | Giorgi M.,Fundacion FLENI | And 3 more authors.
American Heart Journal | Year: 2010

Background: Peak Vo2 has traditionally been used for prognostic evaluation in systolic heart failure. However, in the past years, VE/Vco 2 slope has been shown to be similar or even superior in many studies. We performed a systematic review and a meta-analysis of diagnostic studies of VE/Vco2 slope to assess its ability to predict cardiovascular events in systolic heart failure. Methods: We searched the published literature in PubMed and ISI Web of Science for VE/Vco2 slope in heart failure, and performed a systematic review and a meta-analysis of diagnostic studies in articles fulfilling previously established selection criteria. End points were serious cardiovascular events defined as death or the combined end point of death, ventricular assist device implantation, or heart transplant. A sub-analysis was also performed with those articles providing enough data to compare VE/Vco2 slope prognostic ability to that of peak Vo2. Results: Four hundred ninety-one articles that are potentially relevant were identified, and 12 studies were selected based on our predefined criteria. No heterogeneity or evidence of publication bias was found. The 12 studies included a total of 2,628 patients with a mean follow-up of 31 months (95% CI 16-46 months). The combined event rate at 1 year was 11.2% (95% CI 7.8%-14.6%). Diagnostic odds ratio and area under the curve for serious cardiovascular events were 5.02 (95% CI 4.06-6.21) and 0.75 (95% CI 0.72-0.78), respectively. Six studies provided sufficient data for VE/Vco2 slope and peak Vo2 comparison. Both variables showed similar performance, although VE/Vco2 did present a trend to superiority. Conclusions: In this meta-analysis, VE/Vco2 slope represents a reasonable ability to predict serious cardiovascular events in systolic heart failure, and is at least as effective as peak Vo2. © 2010 Mosby, Inc.

PubMed | University of the Republic of Uruguay, University of the Frontier, Sanatorio San Carlos, Institute Efectividad Clinica y Sanitaria IECS and 2 more.
Type: Journal Article | Journal: PloS one | Year: 2016

Obesity is a major determinant of cardiovascular disease in South America. However, population-based data are limited.A total of 7,524 women and men, aged 35 to 74 years old, were randomly selected from 4 cities in the Southern Cone of Latin America between February 2010 and December 2011. Obesity clinical measurements and cardiovascular risk factors were measured using standard methodology.The prevalence of obesity and central obesity were 35.7% and 52.9%, respectively. The prevalence of obesity and central obesity were higher in women, and even higher in women with lower education compared with women with higher education. In men and women obesity was associated with a higher prevalence of diabetes, odds ratio (OR) 2.38 (95% Confidence Interval [CI]: 1.86 to 3.05) and 3.01 (95%CI 2.42 to 3.74) respectively, hypertension (OR 2.79 (95%CI 2.32 to 3.36) and 2.40 (95%CI 2.05 to 2.80) respectively, dyslipidemia (OR 1.83 (95%CI 1.50 to 2.24) and 1.69 (95%CI 1.45 to 1.98), respectively, low physical activity (OR 1.38(95%CI 1.14 to 1.68) and 1.38 (95%CI 1.18 to 1.62) respectively and a lower prevalence of smoking (OR, 0.65 (95%CI 0.53 to 0.80) and 0.58(95%CI 0.48 to 0.70) respectively.Obesity and central obesity are highly prevalent in the general population in the Southern Cone of Latin America and are strongly associated with cardiovascular risk factor prevalence. These data suggest that efforts toward prevention, treatment, and control of obesity should be a public health priority in the Southern Cone of Latin America.

Gentile A.,Hospital Of Ninos Gutierrez | Bardach A.,Institute Efectividad Clinica y Sanitaria IECS | Ciapponi A.,Institute Efectividad Clinica y Sanitaria IECS | Garcia-Marti S.,Institute Efectividad Clinica y Sanitaria IECS | And 5 more authors.
International Journal of Infectious Diseases | Year: 2012

Background: This systematic review evaluated the incidence, etiology, and use of resources in bacterial, non-tuberculosis community-acquired pneumonia (CAP) in immune-competent children aged <5 years. Methods: Systematic searches (1980-2008) were performed using MEDLINE, Cochrane Library, EMBASE, LILACS, generic, and academic Internet searches. Regional health ministries, the Pan American Health Organization (PAHO), regional proceedings, doctoral theses, and the reference lists of included studies were also searched, and experts were consulted. Arcsine transformations and the DerSimonian-Laird random-effects model were used for proportion meta-analyses. Results: The search yielded 1220 references; 60 were included in the meta-analysis, giving a total 23 854 CAP episodes with an incidence of 919/100 000 child-years in children aged <5 years. Streptococcus pneumoniae was the most frequently isolated agent (11.08%; 95% confidence interval (CI) 7.63-15.08), and pneumococcal serotype 14 was most prevalent (33.00%; 95% CI 25.95-40.45). Other common agents were Haemophilus influenzae and Mycoplasma pneumoniae. Health economics data on CAP in the region were scarce. About one-fourth of CAP patients required hospitalization (median length of stay 11 days, range 5-13.5 days). Conclusions: The burden of CAP was substantial, with S. pneumoniae, H. influenzae, and M. pneumoniae being the most common pathogens identified. High quality primary studies on disease incidence, use of health resources, and standardized data collection on disease burden and circulating strains are essential to provide baseline data for the future evaluation of vaccine impact. © 2011 International Society for Infectious Diseases.

Santesso N.,McMaster University | Rader T.,University of Ottawa | Nilsen E.S.,Norwegian Branch of the Nordic Cochrane Center | Glenton C.,Norwegian Branch of the Nordic Cochrane Center | And 7 more authors.
Journal of Clinical Epidemiology | Year: 2015

Objectives To evaluate a new format of a summary, which presents research from synthesized evidence to patients and the public. Study Design and Setting We conducted a randomized controlled trial in 143 members of the public from five countries (Canada, Norway, Spain, Argentina, and Italy). Participants received either a new summary format (a plain language summary [PLS]) or the current format used in Cochrane systematic reviews. The new PLS presents information about the condition and intervention, a narrative summary of results, and a table of results with absolute numbers for effects of the intervention and quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation. Results With the new PLS, more participants understood the benefits and harms and quality of evidence (53% vs. 18%, P < 0.001); more answered each of the five questions correctly (P≤ 0.001 for four questions); and they answered more questions correctly, median 3 (interquartile range [IQR]: 1-4) vs. 1 (IQR: 0-1), P < 0.001). Better understanding was independent of education level. More participants found information in the new PLS reliable, easy to find, easy to understand, and presented in a way that helped make decisions. Overall, participants preferred the new PLS. Conclusion This new PLS format for patients and the public is a promising tool to translate evidence from synthesized research. ©2015 The Authors.

PubMed | University of the Republic of Uruguay, Tulane University, Montevideo Clinical and Epidemiological Research Unit and Institute Efectividad Clinica y Sanitaria IECS
Type: Journal Article | Journal: International journal of environmental research and public health | Year: 2016

Argentina and Uruguay have a high prevalence of smoking during pregnancy, as well as of secondhand smoke (SHS) exposure. In this secondary analysis of a trial to implement brief smoking cessation counseling during antenatal care in Argentina and Uruguay, we aim to evaluate the effects of the intervention on the rates of self-reported SHS exposure at home and at work, and on attitudes recalled by non-smoker women enrolled in the intervention group compared with the control group. We randomly assigned (1:1) 20 antenatal care clusters in Argentina and Uruguay to receive a multifaceted intervention to implement brief smoking cessation counseling, which also included questions and counseling regarding SHS exposure, or to receive the standard of care. There was not a statistically significant difference between groups of the interventions effect (reduction of exposure to SHS) on any of the three exposure outcome measures (exposure at home, work or other indoor areas) or on the attitudes of women regarding exposure (avoiding breathing SHS and having rooms where smoking is forbidden). This analysis shows that we should not expect reductions in SHS exposure with this modest intervention alone. To achieve such reductions, strategies engaging partners and other household members may be more effective.

Rey-Ares L.,Institute Efectividad Clinica y Sanitaria IECS | Ciapponi A.,Institute Efectividad Clinica y Sanitaria IECS | Ciapponi A.,Hospital Italiano Of Buenos Aires | Pichon-Riviere A.,Institute Efectividad Clinica y Sanitaria IECS | Pichon-Riviere A.,University of Buenos Aires
Archivos Argentinos de Pediatria | Year: 2012

Introduction. Cervical cancer is the third most common cancer worldwide. The human papilloma virus (HPV) has been identified as the etiologic agent of cervical and other anogenital cancers. The aim was to perform a systematic review and meta-analysis to evaluate the efficacy and safety of HPV vaccines in preventing cervical intraepithelial neoplasias (CIN) grades 2 and 3, adenocarcinoma in situ (CIN2+) and cervical cancer. Materials and Methods. Major bibliographic databases were searched in July 2011 without any temporal nor language restrictions. Randomized-controlled trials that evaluated the efficacy of HPV vaccines against CIN2+ and cervical cancer were included. Results. Four of the 168 publications found were included in a meta-analysis. Among vaccinated women, the relative risk (RR) of developing CIN2+ lesions was 0.45 (95% CI 0.38 to 0.54) for HPV 16, 0.14 (0.08 to 0.25) for HPV 18, and 0.79 (0.68 to 0.93) for oncogenic serotypes not included in the vaccines 31/33/45/52/58. All studies had acceptable safety profiles. Conclusions. Vaccines currently available are effective, safe and capable of preventing CIN2+ lesions, although long term efficacy has not yet been fully tested.

PubMed | Fondo Nacional de Recursos, Institute Efectividad Clinica y Sanitaria IECS and The EuroQol Research Foundation
Type: Journal Article | Journal: Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation | Year: 2016

To derive a value set from Uruguayan general population using the EQ-5D-5L questionnaire and report population norms.General population individuals were randomly assigned to value 10 health states using composite time trade off and 7 pairs of health states through discrete choice experiments. A stratified sampling with quotas by location, gender, age and socio-economic status was used to respect the Uruguayan population structure. Trained interviewers conducted face-to-face interviews. The EuroQol valuation technology was used to administer the protocol as well as to collect the data. OLS and maximum likelihood robust regression models with or without interactions were tested.We included 794 respondents between 20 and 83years. Their characteristics were broadly similar to the Uruguayan population. The main effects robust model was chosen to derive social values. Values ranged from -0.264 to 1. States with a misery index=6 had a mean predicted value of 0.965. When comparing the Uruguayan population with the Argentinian EQ-5D-5L crosswalk value set, the prediction for states which differed from full health only in having one of the dimensions at level 2 were about 0.05 higher in Uruguay. The mean index value, using the selected Uruguayan EQ-5D-5L value set, for the general population in Uruguaywas 0.895. In general, older people had worse values and males had slightly better values than females.We derived the EQ-5D-5L Uruguayan value set, the first in Latin America. These results will help inform decision-making using economic evaluations for resource allocation decisions.

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