Repetir la sangre oculta en heces como estrategia útil para evitar colonoscopias normales en el cribado poblacional de cáncer colorrectal

Introducción: El programa de cribado de cáncer colorrectal (CCR) se basa en la realización de una sangre oculta en heces (SOH) en la población entre los 50 y 69 años. En todos los resultados positivos se recomienda realizar una colonoscopia, que en un 35% de los casos es normal. Por ello se buscan estrategias que permitan reducir el número de exploraciones normales sin afectar a la rentabilidad diagnóstica del test, reduciendo así las listas de espera de los servicios de endoscopia. Objetivo: Estudiar si una primera SOH débilmente positiva (Métodos: Se realizó un estudio descriptivo, de sensibilidad, especificidad, valor predictivo positivo (VPP), valor predictivo negativo (VPN), área bajo la curva ROC (AUROC) y regresión logística con 324 pacientes entre 50-69 años con una primera SOH positiva, una colonoscopia completa y que aportaron una segunda SOH válida. Resultados: El total de pacientes incluidos fue 289, con una mediana de edad de 58 años. 117 fueron mujeres (40.5%) y 172 hombres (59.5%). Un 67.8% de la muestra tenían un resultado negativo en la segunda SOH, con un VPN para CCR y AA del 86.1% cuando la primera era Conclusión: La realización de dos pruebas SOH para el cribado de CCR es una herramienta útil para reducir las colonoscopias normales, pudiendo evitar su realización en pacientes con una primera SOH <br /

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension

Hacia un sistema equitativo de cobertura universal

"La gran mayoría de países de América Latina tiene recursos suficientes para garantizar el acceso a una amplia gama de servicios de salud a todos sus ciudadanos. Colombia no es la excepción. Sin embargo, y a pesar del gran aumento en el gasto en salud (más que triplicado) a partir de la aprobación de la ley 100 y de que se ha incrementado el número de pacientes asegurados a través del régimen contributivo y del régimen subsidiado, persisten inequidades importantes en la distribución de los recursos de salud, la cobertura y en el acceso a los servicios. Además, muchos coinciden en que la red de servicios de salud pública se ha deteriorado y que la calidad de los servicios de salud podría estarse deteriorando a consecuencia de los incentivos económicos que ofrecen las diversas compañías aseguradoras a los prestadores de servicios...

Las reformas neoliberales del sector de la salud: déficit gerencial y alienación del recurso humano en América Latina Neoliberal health sector reforms in Latin America: unprepared managers and unhappy workers

<abstract language="eng">This work analyzes the neoliberal health sector reforms that have taken place in Latin America, the preparation of health care workers for the reforms, the reforms' impacts on the workers, and the consequences that the reforms have had on efficiency and quality in the health sector. The piece also looks at the process of formulating and implementing the reforms. The piece utilizes secondary sources and in-depth interviews with health sector managers in Bolivia, Colombia, Costa Rica, the Dominican Republic, Ecuador, El Salvador, and Mexico. Neoliberal reforms have not solved the human resources problems that health sector evaluations and academic studies had identified as the leading causes of health system inefficiency and low-quality services that existed before the reforms. The reforms worsened the situation by putting new pressures on health personnel, in terms of both the lack of necessary training to face the challenges that came with the reforms and efforts to take away from workers the rights and benefits that they had gained during years of struggles by unions, and to replace them with temporary contracts, reduced job security, and lower benefits. The secrecy with which the reforms were developed and applied made workers even more unified. In response, unions opposed the reforms, and in some countries they were able to delay the reforms. The neoliberal reforms have not improved the efficiency or quality of health systems in Latin America despite the resources that have been invested. Nor have the neoliberal reforms supported specific changes that have been applied in the public sector and that have demonstrated their ability to solve important health problems. These specific changes have produced better results than the neoliberal reforms, and at a lower cost

Las reformas de salud neoliberales en América Latina: una visión crítica a través de dos estudios de caso Neoliberal reforms in health services in Latin America: a critical view from two case studies

Neoliberal reforms have promoted privatization and decentralization as strategies to improve equity, efficiency, and the quality of health services. In this piece the impact of these reforms in Latin America is critically analyzed, and the impacts of privatization in Colombia and of decentralization in Mexico are detailed. These two cases show that after 10 years of privatization in Colombia and 20 years of decentralization in Mexico the reforms have had the opposite of the desired effect: They have not improved equity, have increased health expenditures, have not increased efficiency, and have not shown a positive impact on quality. Public health programs in Colombia have deteriorated, while decentralization in Mexico has had a very high cost, without achieving the proposed objectives. It is officially accepted that decentralization in Mexico has increased inequity, and that new reforms implemented in 2003 promote vertical programs. Health systems based on regulated competition are not the most suitable ones for Latin America. Latin American countries should improve their health systems in line with the principles stated in the Declaration of Alma Ata and according to their own national experiences