Cost estimate of hospital stays for premature newborns in a public tertiary hospital in Brazil

OBJECTIVES: To estimate the direct costs of hospital stays for premature newborns in the Interlagos Hospital and Maternity Center in São Paulo, Brazil and to assess the difference between the amount reimbursed to the hospital by the Unified Health System and the real cost of care for each premature newborn. METHODS: A cost-estimate study in which hospital and professional costs were estimated for premature infants born at 22 to 36 weeks gestation during the calendar year of 2004 and surviving beyond one hour of age. Direct costs included hospital services, professional care, diagnoses and therapy, orthotics, prosthetics, special materials, and blood products. Costs were estimated using tables published by the Unified Health System and the Brasindice as well as the list of medical procedures provided by the Brazilian Classification of Medical Procedures. RESULTS: The average direct cost of care for initial hospitalization of a premature newborn in 2004 was $2,386 USD. Total hospital expenses and professional services for all premature infants in this hospital were$227,000 and $69,500 USD, respectively. The costs for diagnostic testing and blood products for all premature infants totaled$22,440 and $1,833 USD. The daily average cost of a premature newborn weighing less than 1,000 g was$115 USD, and the daily average cost of a premature newborn weighing more than 2,500 g was $89 USD. Amounts reimbursed to the hospital by the Unified Health System corresponded to only 27.42% of the real cost of care. CONCLUSIONS: The cost of hospital stays for premature newborns was much greater than the amount reimbursed to the hospital by the Unified Health System. The highest costs corresponded to newborns with lower birth weight. Hospital costs progressively and discretely decreased as the newborns' weight increased.Universidade Federal de São Paulo (UNIFESP) Centro Paulista de Economia da SaúdeUniversidade Federal de São Paulo (UNIFESP) Brazilian Cochrane CenterUNIFESP, Centro Paulista de Economia da SaúdeUNIFESP, Brazilian Cochrane CenterSciEL

Methodological quality of systematic reviews and clinical trials on women's health published in a Brazilian evidence-based health journal

OBJECTIVES: To assess the quality of systematic reviews and clinical trials on women's health recently published in a Brazilian evidence-based health journal. METHOD: All systematic reviews and clinical trials on women's health published in the last five years in the Brazilian Journal of Evidence-based Health were retrieved. Two independent reviewers critically assessed the methodological quality of reviews and trials using AMSTAR and the Cochrane Risk of Bias Table, respectively. RESULTS: Systematic reviews and clinical trials accounted for less than 10% of the 61 original studies on women's health published in the São Paulo Medical Journal over the last five years. All five reviews were considered to be of moderate quality; the worst domains were publication bias and the appropriate use of study quality in formulating conclusions. All three clinical trials were judged to have a high risk of bias. The participant blinding, personnel and outcome assessors and allocation concealment domains had the worst scores. CONCLUSIONS: Most of the systematic reviews and clinical trials on women's health recently published in a Brazilian evidence-based journal are of low to moderate quality. The quality of these types of studies needs improvement

Centro Cochrane do Brasil: 15º aniversário

Universidade Federal de São Paulo (UNIFESP) Program on Internal Medicine and TherapeuticsBrazilian Cochrane CenterDivision of Emergency and Evidence-Based MedicineUNIFESP, Program on Internal Medicine and TherapeuticsSciEL

Adolescent pre-exposure prophylaxis for HIV prevention: current perspectives

Adolescents are a critical population that is disproportionately impacted by the HIV epidemic. More than 2 million adolescents between the age group of 10 and 19 years are living with HIV, and millions are at risk of infection. HIV risks are considerably higher among girls, especially in high-prevalence settings such as eastern and southern Africa. In addition to girls, there are other vulnerable adolescent subgroups, such as teenagers, who use intravenous (IV) drugs, gay and bisexual boys, transgender youth, male sex workers, and people who fall into more than one of these categories. Pre-exposure prophylaxis (PrEP) is a new intervention for people at high risk for acquiring HIV, with an estimated HIV incidence of > 3%. Recent data from trials show evidence of the efficacy of PrEP as a powerful HIV prevention tool in high-risk populations, including men who have sex with men, HIV-1-serodiscordant heterosexual couples, and IV drug users. The reported efficacy in those trials of the daily use of oral tenofovir, alone or in combination with emtricitabine, to prevent HIV infection ranged from 44% to 75% and was heavily dependent on adherence. Despite the proven efficacy of PrEP in adult trials, concerns remain about its feasibility in real-life scenarios due to stigma, cost, and limited clinician experience with PrEP delivery. Recent studies are attempting to expand the inquiry into the efficacy of such HIV prophylaxis approaches in adolescent populations, but there are still many gaps in knowledge, and no country has yet approved it for use with adolescents. The aim of this review was to identify and summarize the evidence from studies on PrEP for adolescents. We have compiled and reviewed published studies focusing on safety, feasibility, adherence to therapeutics, self-perception, and legal issues related to PrEP in people aged between 10 and 24 years.Univ Fed Sao Paulo, Escola Paulista Med, Dept Pediat, Disciplina Infectol Pediat, Rua Pedro de Toledo 928, BR-04039002 Sao Paulo, BrazilUniv Fed Rio de Janeiro, Rio De Janeiro, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Med, Disciplina Med Baseada Evidencias, Sao Paulo, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Pediat, Disciplina Infectol Pediat, Rua Pedro de Toledo 928, BR-04039002 Sao Paulo, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Med, Disciplina Med Baseada Evidencias, Sao Paulo, BrazilWeb of Scienc

Cochrane highlights

Brazilian Cochrane Ctr, Sao Paulo, BrazilUniv Fed Sao Paulo, Escola Paulista Med Unifesp EPM, Sao Paulo, BrazilUniv Fed Sao Paulo, Escola Paulista Med Unifesp EPM, Sao Paulo, BrazilWeb of Scienc

Práticas de produção, armazenamento e utilização do plasma rico em plaquetas e produtos relacionados no Brasil: estudo transversal

Introduction: Platelet-rich plasma (PRP) is a technology with potential application in several areas of Medicine and Dentistry. The high    variability observed during the  production process imposes a challenge for the regulation of its production and use. Objectives: To evaluate current practices of production, storage and use of platelet-rich plasma and related products in Brazil, allowing the identification of operational variability throughout these processes. Method: Crosssectional study with data collection carried out by using a self-applied electronic questionnaire,with protection of anonymity. Questions were defined based on a literature review and consultation with a specialist in the field. The study questionnaire was sent to researchers and professionals who are producing PRP identified by different strategies, such as previous participation in events and publications in the area. Results: 64 responses were obtained, with 36 complete responses (56.3%) and 28 partial responses (43.7%). The rate of respondents could not be calculated, considering the means for dispatching the questionnaire. For PRP, there was a predominance of use of protocols with double centrifugation and platelet activation by different methods. Most respondents reported using PRP in the areas of orthopedics, physiatry and sports medicine. For fibrin-rich plasma (PRF), there was a predominance of responses using a single centrifugation protocol, without the use of platelet activation methods. Most respondents indicate the use of PRF in areas of dentistry. Variability of procedures and usage profile were observed for all platelet concentrates. Analyses were carried out comparatively according to the three main types of platelet concentrates. Conclusions: Findings corroborate the need to develop regulatory norms aiming at reducing variability and at promoting safety along the production and use of platelet concentrates.Introdução: O plasma rico em plaquetas (PRP) é uma tecnologia com potencial aplicação em diversas áreas da medicina e odontologia. A alta variabilidade no processo de produção   desta tecnologia e de tecnologias relacionadas desafiam a regulamentação de sua produção, do controle de qualidade e do uso. Objetivo: Avaliar práticas de produção, armazenamento e utilização do PRP e produtos relacionados no Brasil, permitindo a identificação de variabilidade operacional ao longo destes processos. Método: Estudo transversal com coleta de dados realizadas por meio de um questionário eletrônico, autoaplicado e com preservação de anonimato. As perguntas foram definidas a partir de revisão de literatura e por consulta a especialista da área. O questionário foi encaminhado a pesquisadores e a profissionais de várias áreas atualmente envolvidas na produção do PRP. Esses profissionais foram identificados por diferentes estratégias, tais como participação prévia em eventos relacionados e publicações na área. Resultados: Foram obtidas 64 respostas, sendo 36 respostas completas (56,3%) e 28 respostas parciais (43,7%). A taxa de respondentes não pôde ser calculada, considerando-se as formas de divulgação do questionário. Para a produção de PRP, as respostas indicaram predomínio de protocolos com centrifugação dupla e utilização de métodos variados para ativação plaquetária. A maioria dos respondentes referiu utilizar o PRP nas áreas de ortopedia, fisiatria e medicina esportiva. Para a produção do plasma rico em fibrina (PRF), houve predomínio de respostas indicando utilização de protocolo de centrifugação única, sem utilização de métodos de ativação plaquetária. A maioria dos respondentes indicou utilizar o PRF em áreas da odontologia. No geral, observou-se grande variabilidade nos procedimentos de obtenção e do perfil de utilização entre os principais tipos de concentrados de plaquetas. Conclusões: Os achados corroboram a necessidade do desenvolvimento de medidas regulatórias com foco nos pontos críticos identificados, visando promover a segurança durante a produção e utilização dos concentrados de plaqueta

Hydroxychloroquine and chloroquine for COVID-19 infection. Rapid systematic review

CONTEXT: Based on the results of preliminary studies, the off-label use of hydroxychloroquine for COVID-19 infection has been observed in practice. OBJECTIVES: To identify, systematically assess and summarize the best available evidence on the efficacy and safety of the use of hydroxychloroquine and chloroquine for COVID-19 infection. METHODS: Rapid systematic review. RESULTS: After the selection process, 30 studies were included: one open-label randomized trial, one open-label non-randomized trial and 28 ongoing studies. The outcome 'detection of viral load in oral swab' (surrogate outcome) was evaluated by both studies, involving a total of 72 participants. The findings of the studies were discordant: one study observed a higher frequency of negative viral load associated with hydroxychloroquine on day-7, while the other study did not observe any difference between hydroxychloroquine and the control group (standard treatment) on day-6. Both studies have methodological limitations when evaluated by specific tools according to study design (Cochrane Bias Risk Table and ROBINS-I). CONCLUSION: This rapid systematic review identified two clinical studies (with available data), with limited methodological quality, that evaluated the effects of hydroxychloroquine for COVID-19 infection. Based on the findings of these two studies, the efficacy and safety of hydroxychloroquine and chloroquine in patients with COVID-19 is still uncertain (very low evidence certainty) and its routine use for this situation should not be recommended until the results of ongoing studies could provide a proper assessment of their effects