A scoping review of cost-effectiveness of screening and treatment for latent tubercolosis infection in migrants from high-incidence countries

BACKGROUND: In low-incidence countries, most tuberculosis (TB) cases occur among migrants and are caused by reactivation of latent tuberculosis infection (LTBI) acquired in the country of origin. Diagnosis and treatment of LTBI are rarely implemented to reduce the burden of TB in immigrants, partly because the cost-effectiveness profile of this intervention is uncertain. The objective of this research is to perform a review of the literature to assess the cost-effectiveness of LTBI diagnosis and treatment strategies in migrants. METHODS: Scoping review of economic evaluations on LTBI screening strategies for migrants was carried out in Medline. RESULTS: Nine studies met the inclusion criteria. LTBI screening was cost-effective according to seven studies. Findings of four studies support interferon gamma release assay as the most cost-effective test for LTBI screening in migrants. Two studies found that LTBI screening is cost-effective only if carried out in immigrants who are contacts of active TB cases. DISCUSSION AND CONCLUSIONS: Our findings support the cost-effectiveness of LTBI diagnostic and treatment strategies in migrants especially if they are focused on young subjects from high incidence countries. These strategies could represent and adjunctive and synergistic tool to achieve the ambitious aim of TB elimination. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12913-015-1045-3) contains supplementary material, which is available to authorized users

Guía de práctica clínica para el manejo de la Enfermedad Renal Crónica estadíos 3b, 4 y 5 en el Seguro Social de Salud del Perú (EsSalud)

Introduction: This article summarizes the clinical practice guideline (CPG) for the management of stage 3b, 4, and 5 chronic kidney disease (CKD) in the Social Security of Peru (EsSalud). Objective: To provide evidence-based clinical recommendations for the management of stage 3b, 4, and 5 CKD in EsSalud. Methods: A guideline development group (GDG) was formed, including specialists and methodologists. The GDG formulated 9 clinical questions. Systematic searches for systematic reviews and primary studies were conducted in PubMed from December 2020 to August 2021. Evidence was selected to answer the clinical questions posed. The certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The GDG used the GRADE methodology to review the evidence and formulate recommendations, points of good clinical practice (GPC), and management flowcharts. Finally, the CPG was approved with Resolution No. 88-IETSI-ESSALUD-2021. Results: This CPG addressed 9 clinical questions. Based on these questions, 17 recommendations (7 strong and 10 conditional), 28 GPC points, and 4 management flowcharts were formulated. Conclusion: This article summarizes the methodology and evidence-based conclusions of the CPG for the management of stage 3b, 4, and 5 CKD in EsSalud.Introducción: El presente artículo resume la guía de práctica clínica (GPC) para el manejo de la enfermedad renal crónica estadíos 3b, 4 y 5 en el Seguro Social del Perú (EsSalud). Objetivo: Proveer recomendaciones clínicas basadas en evidencia para el manejo de pacientes con enfermedad renal crónica estadíos 3b, 4 y 5 en EsSalud. Métodos: Se conformó un grupo elaborador de la guía (GEG) que incluyó especialistas y metodólogos. El GEG formuló 9 preguntas clínicas. Se realizó búsquedas sistemáticas de revisiones sistemáticas y estudios primarios en PubMed entre diciembre del 2020 y agosto del 2021. Se seleccionó la evidencia para responder a las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). El GEG usó la metodología GRADE para revisar la evidencia y formular recomendaciones, los puntos de buena práctica clínica (BPC) y los flujogramas de manejo. Finalmente, la GPC fue aprobada con Resolución N° 88-IETSI-ESSALUD-2021. Resultados: La presente GPC abordó 9 preguntas clínicas. En base a dichas preguntas se formularon 17 recomendaciones (7 fuertes y 10 condicionales), 28 BPC, y 4 flujogramas de manejo. Conclusión: El presente artículo resume la metodología y las conclusiones basadas en evidencias de la GPC para el manejo de la Enfermedad Renal Crónica estadíos 3b, 4 y 5 en EsSalud

Los Bienes Públicos en la Sociedad. Una Institucionalidad Renovada en el Caso del Puerto Público de Rosario

Este trabajo revaloriza la importancia del territorio en la determinación y la gestión para el crecimiento regional, poniendo el acento en la actualización de los bienes públicos, a ser garantizados desde el Estado. Las mejoras en productividad están significativamente asociadas a la oferta y aseguramiento de los servicios requeridos, donde las instituciones del medio juegan un rol fundamental en tratar de llevar a buen término la actividad y capitalizar la disponibilidad de los servicios en favor del medio. En Puerto Rosario, se encuentran evidencias que indican la implementación de cambios en la institucionalidad y avances en la construcción de una comunidad para respaldar el desarrollo de la actividad.Raposo, Isabel María; Facultad de Ciencias Económicas y Estadística, Universidad Nacional de RosarioLiendo, Mónica; Facultad de Ciencias Económicas y Estadística, Universidad Nacional de RosarioMartínez, Adriana Mónica; Facultad de Ciencias Económicas y Estadística, Universidad Nacional de RosarioAguirre, Carola; Facultad de Ciencias Económicas y Estadística, Universidad Nacional de Rosari

Conocimientos de los alumnos de últimos años de Medicina y residentes sobre indicadores de riesgo epidemiológico utilizados en ensayos clínicos Knowledge of epidemiological risk indicators used in clinical trials among medical students in advanced years and medical residents

Estudio que evaluó el conocimiento de 182 estudiantes de los dos últimos años de medicina y 70 residentes de un hospital nacional de Perú, sobre los indicadores de riesgo utilizados en la presentación de resultados en ensayos clínicos. Se realizó un estudio transversal en el que se aplicó un cuestionario que evaluó la capacidad de reconocer y calcular los indicadores de riesgo epidemiológico más utilizados en la literatura médica. El 19,4% no reconoció ninguno de los indicadores y el 81,4% no logró calcularlos. La reducción de riesgo relativo fue el indicador más reconocido (55,2%), seguida del número necesario a tratar (51,6%); reducción de riesgo absoluto (26,6%), y hazard ratio (9,5%). En conclusión, los alumnos de los dos últimos años de medicina y los residentes, no reconocen ni calculan adecuadamente los indicadores de riesgo utilizados en ensayos clínicos.<br>A cross-sectional study evaluated 182 students in the last two years of medical school and 70 residents of a national hospital in Peru on the risk indicators used for reporting results in clinical trials. A questionnaire was used to assess the ability to recognize and calculate risk indicators most widely used in the epidemiological literature. From the participants, 19.4% did not recognize any of the indicators and 81.4% was not able to calculate them. The relative risk reduction was the most recognized indicator (55.2%), followed by the number needed to treat (51.6%), the absolute risk reduction (26.6%), and the hazard ratio (9.5%). In conclusion, medical students in the last two years of school and medical residents do not recognize or are able to calculate properly the risk indicators used in clinical trials

High prevalence of clustered tuberculosis cases in Peruvian migrants in Florence, Italy

Tuberculosis is a leading cause of morbidity for Peruvian migrants in Florence, Italy, where they account for about 20% of yearly diagnosed cases. A retrospective study on cases notified in Peruvian residents in Florence in the period 2001-2010 was carried out and available <em>Mycobacterium tuberculosis</em> strains were genotyped (MIRU-VNTR-24 and Spoligotyping). One hundred thirty eight cases were retrieved. Genotyping performed in 87 strains revealed that 39 (44.8%) belonged to 12 clusters. Assuming that in each cluster the transmission of tuberculosis from the index case took place in Florence, a large proportion of cases could be preventable by improving early diagnosis of contagious cases and contact tracing

Additional file 1: Table S1. of A scoping review of cost-effectiveness of screening and treatment for latent tuberculosis infection in migrants from high-incidence countries

Different assumptions concerning progression rate and sensitivity as well as specificity of the TST and IGRAs applied in the different papers. Table S2. Clinical trials referring to economic evaluations. (DOCX 22 kb

A scoping review of cost-effectiveness of screening and treatment for latent tuberculosis infection in migrants from high-incidence countries

BACKGROUND: In low-incidence countries, most tuberculosis (TB) cases occur among migrants and are caused by reactivation of latent tuberculosis infection (LTBI) acquired in the country of origin. Diagnosis and treatment of LTBI are rarely implemented to reduce the burden of TB in immigrants, partly because the cost-effectiveness profile of this intervention is uncertain. The objective of this research is to perform a review of the literature to assess the cost-effectiveness of LTBI diagnosis and treatment strategies in migrants. METHODS: Scoping review of economic evaluations on LTBI screening strategies for migrants was carried out in Medline. RESULTS: Nine studies met the inclusion criteria. LTBI screening was cost-effective according to seven studies. Findings of four studies support interferon gamma release assay as the most cost-effective test for LTBI screening in migrants. Two studies found that LTBI screening is cost-effective only if carried out in immigrants who are contacts of active TB cases. DISCUSSION AND CONCLUSIONS: Our findings support the cost-effectiveness of LTBI diagnostic and treatment strategies in migrants especially if they are focused on young subjects from high incidence countries. These strategies could represent and adjunctive and synergistic tool to achieve the ambitious aim of TB elimination