Colonoscopy Screening for Colorectal Cancer — Overview of the Literature

Objective: The aim of our chapter was to perform a systematic review of the clinical practice guidelines, randomized clinical trials, and prospective studies, using total colonoscopy for screening this population for colorectal cancer (CRC) and to evaluate the effectiveness of diagnosis and safety

Índice compuesto de inequidad en salud para un país de mediano ingreso

Objetivo Desarrollar y validar un índice compuesto de inequidad en salud basado en mortalidad por grupos de causas.Métodos Estudio ecológico en país de mediano ingreso latinoamericano, con indicadores agregados disponibles de municipios y departamentos, que se seleccionaron a partirde observatorios de salud, grupos de investigación y autoridades sanitarias. Se dividen en intolerables y “no completamente evitables” según el avance científico actual, y se agregan en categorías: accidente de tránsito, agresiones, enfermedad renal, infección por VIH, parasitosis intestinal, sífilis, enfermedad de transmisión fecal/oral, tuberculosis, enfermedad transmitidas por vectores, enfermedad respiratoria, eventos hemorrágicos/ isquémicos cerebrales, mortalidad materna, mortalidad menores 5 años, meningitis. Luego de análisis de componentes principales se obtiene índice compuesto multidimensional de inequidad en salud (IIS) para hombres y mujeres. Consistencia interna se evalúamediante coeficiente Alpha de Cronbach. Se hace validación concurrente con proporción de personas en Necesidades Básicas Insatisfechas (NBI), Índice de Desarrollo Humano (IDH), Expectativa de Vida al Nacer (EVN) entre otros.Resultados Se construye IIS que muestra valores más altos para las mujeres en la mayoría de municipios y departamentos; y para lugares con IDH alto, EVN alta y NBI bajas. El alpha de Cronbach fue 0.6688, IIS-hombres y 0.725, IIS-mujeres.Conclusiones Se obtiene IIS factible, reproducible y mutidimensional. Se destaca el papel de las grandes ciudades en las inequidades en salud, probablemente por el efecto de los intolerables en salud.Objective To develop and validate a composite index of health inequity based on mortality by grouped causes.Methods An ecological study in a middle-income Latin American country, with aggregate indicators available from municipalities and departments, which were selected from health observatories, research groups and health authorities. They were divided into intolerable and "not completely avoidable" according to current scientific progress, and were added in categories: traffic accident, aggression, kidney disease, HIV infection, intestinal parasitic diseases, syphilis, fecal / oral transmission disease, tuberculosis,disease Vector-borne diseases, respiratory disease, cerebral hemorrhagic / ischemic events, maternal mortality, lower mortality 5 years, meningitis. After analysis of main components, a composite index of health inequity (IIS) is obtained for men and women. Internal consistency was evaluated using Cronbach's Alpha coefficient. Concurrent validation was done with proportion of people in Unsatisfied Basic Needs (UBN), Human Development Index (HDI), Life Expectancy at Birth (LEB), among others.Results IIS is built showing higher values for women in most municipalities and departments; And for sites with high HDI, high LEB and low UBN. Cronbach's alpha was 0.6688, IIS-men and 0.725, IIS-women.Conclusions An IIS was obtained, is valid and reproducible. The role of big cities in inequities in health is highlighted, probably due to the effect of intolerable health

Maternal serum angiopoietin-like 3 levels in healthy and mild preeclamptic pregnant women

Objective: Angiopoietin-like protein 3(ANGPTL3) is an important regulator of lipoprotein metabolism in the fed state by inhibiting the enzyme lipoprotein lipase in oxidative tissues. However, the possible role of ANGPTL3 throughout gestation and its relationship with hormonal and biochemical variables are still unknown. The aim of this study was to determinate serum ANGPTL3 level in healthy non-pregnant women, during healthy and preeclamptic pregnancy and postpartum. Methods: Serum ANGPTL3 was analyzed by enzyme-linked immunosorbent assay (ELISA), in a prospective cohort of healthy pregnant women (n = 52) and women with mild preeclampsia (n = 21), and women at three months postpartum (n = 20) and healthy non-pregnant women (n = 20). The results obtained were correlated with biochemical, hormonal and anthropometric variables and insulin resistance indices. Results: Levels of ANGPTL3 were not different between the follicular and the luteal phases of the cycle in healthy non-pregnant women. There was a significant reduction in serum ANGPTL3 levels from the first to the third trimester in healthy pregnant women compared with healthy non-pregnant and postpartum women (p 0.05) Conclusions: We describe for the first time the profile of ANGPTL3 throughout pregnancy and postpartum as well as and discussed about explore their potential contribution interactions with lipoprotein metabolism throughout pregnancy and postpartum. Thus, low levels of ANGPTL3 during pregnancy might favor lipid uptake in oxidative tissues as the main maternal energy source, while may helping to preserve glucose for use by the fetus and placenta.Fil: Garces, María Fernanda. Universidad Nacional de Colombia; ColombiaFil: Rodriguez Navarro, Haiver Antonio. Universidad Nacional de Colombia; ColombiaFil: Buell Acosta, Julieth Daniela. Universidad Nacional de Colombia; ColombiaFil: Burgos Cardenas, Alvaro Javier. Universidad Nacional de Colombia; ColombiaFil: Franco Vega, Roberto. Universidad Nacional de Colombia; ColombiaFil: Maldonado Acosta, Luis Miguel. Universidad Nacional de Colombia; ColombiaFil: Eslava Schmalbach, Javier. Universidad Nacional de Colombia; ColombiaFil: Parada Baños, Arturo José. Universidad Nacional de Colombia; ColombiaFil: Castro Pinzon, Andres. Universidad Nacional de Colombia; ColombiaFil: Sanchez, Elizabeth. Universidad Nacional de Colombia; ColombiaFil: Angel Muller, Edith. Universidad Nacional de Colombia; ColombiaFil: Lacunza, Ezequiel. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Centro de Investigaciones Inmunológicas Básicas y Aplicadas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; ArgentinaFil: Castaño, Justo P.. Universidad de Córdoba; EspañaFil: Dieguez, Carlos. Universidad de Santiago de Compostela; EspañaFil: Nogueiras, Rubén. Universidad de Santiago de Compostela; EspañaFil: Ruiz Parra, Ariel Ivan. Universidad Nacional de Colombia; ColombiaFil: Caminos, Jorge Eduardo. Universidad Nacional de Colombia; Colombi

Análisis de costo-efectividad de las estrategias de tamización de cáncer colorrectal en Colombia

Q4190-200Objective To evaluate the cost-effectiveness of different screening strategies for colorectal cancer in Colombia. Methods We designed a Markov model to compare the clinical and economic impact in terms of reducing the incidence and mortality from colorectal cancer (CRC). Six screening strategies for adults were compared: fecal occult blood (FOBT) immunochemical and guaiac type, conventional colonoscopy, flexible sigmoidoscopy, and FOBT guaiac and immunochemical type more sigmoidoscopy. We used the third-party payer perspective, including only direct costs, the time horizon was the life expectancy of the Colombian population. We estimated cost-effectiveness ratios (CERs) and incremental cost-effectiveness (ICER). Were performed deterministic sensitivity analysis and probabilistic. We applied a discount rate of 3% in the costs and health outcomes. Results The screening strategy more cost-effective was the FOBT biennial guaiac type. The cost per life year gained was US$10,347.37, US$18,380.64, and US$45,158.05. For FOBT guaiac biennial, FOBT guaiac annual and FOBT inmunoquímica biennial respectively. The ICER is sensitive to the percentage of false positive test for FOBT guaiac type values greater than 10%, and the cost of the test. Conclusions The screening strategy more cost-effective for Colombia is the FOBT biennial guaiac type, using as a threshold the gross domestic product (GDP) per capita in Colombia