How can we improve the use of essential evidence-based interventions?

Between 250,000-280,000 women die worldwide during pregnancy and childbirth each year and children in low- and middle-income countries are 56 times more likely to die before the age of 5 than children in high-income countries. This Editorial discusses the publishing of a supplement within Reproductive Health titled Essential interventions for maternal, newborn and child health which aims to provide a scientific basis to the recommended interventions along with implementation strategies and proposed packages of care.Fil: Belizan, Jose. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Salaria, Natasha. BioMed Central; Reino UnidoFil: Valanzasca, Pilar. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Mbizvo, Michael. University of Zimbabwe; Zimbabu

Preconception care: it’s never too early

The preconception window has been recognized as one of the earliest sensitive windows of human development, and interventions that focus on this period have the potential to affect not only pregnancy but long term outcomes as well. The journal Reproductive Health has published a supplement entitled ‘Preconception Interventions’ which includes a series of systematic reviews regarding the impact of public health interventions during the preconception period on maternal and child health. These articles describe the role that poor preconception health plays in creating health disparities across the globe. The reviews highlight our current understanding (or lack thereof) regarding how both maternal and paternal preconception health and knowledge shapes the long-term health of not only children, but of families, communities, and nations. Researchers and healthcare workers should take particular note of these interventions, as the preconception time period may be as important as the pregnancy and post-pregnancy periods, and is critical in terms of bridging the gap in the continuum of care, particularly for adolescents.Fil: Mumford, Sunni L.. National Institutes of Health; Estados UnidosFil: Michels, Kara A.. National Institutes of Health; Estados UnidosFil: Salaria, Natasha. BioMed Central; Reino UnidoFil: Valanzasca, Pilar. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Belizan, Jose. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Quality of evidence matters: is it well reported and interpreted in infertility journals?

Purpose: To evaluate if the authors of published systematic reviews (SRs) reported the level of quality of evidence (QoE) in the top 5 impact factor infertility journals and to analyze if they used an appropriate wording to describe it. Methods: This is a cross-sectional study. We searched in PubMed for SRs published in 2017 in the five infertility journals with the highest impact factor. We analyzed the proportion of SRs published in the top 5 impact factor infertility journals that reported the SRs’ QoE, and the proportion of those SRs in which authors used consistent wording to describe QoE and magnitude of effect. Results: The QoE was reported in only 21.4% of the 42 included SRs and in less than 10% of the abstracts. Although we did not find important differences in the report of QoE of those that showed statistically significant differences or not, p value was associated with the wording chosen by the authors. We found inconsistent reporting of the size the effect estimate in 54.8% (23/42) and in the level of QoE in 92.9% (39/42). Whereas the effect size was more consistently expressed in studies with statistically significant findings, QoE was better expressed in those cases in which the p value was over 0.05. Conclusion: We found that in 2017, less than 25% of the authors reported the overall QoE when publishing SRs. Authors focused more on statistical significance as a binary concept than on methodological limitations like study design, imprecision, indirectness, inconsistency, and publication bias. Authors should make efforts to report the QoE and interpret results accordingly.Fil: Glujovsky, Demian. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Sueldo, Carlos E.. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Bardach, Ariel Esteban. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: del Pilar Valanzasca, María. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Comandé, Daniel. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Ciapponi, Agustín. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentin

Serie sobre hospitalizaciones evitables y fortalecimiento de la atención primaria en salud: El caso de Argentina

Las hospitalizaciones por Condiciones Sensibles a la Atención Primaria (HECSAP) identifican problemas de salud cuya internación podría evitarse a través de mejores cuidados en atención primaria (APS). A partir de la información de egresos hospitalarios del sector público de 2000 a 2008, se convocaron 32 expertos para que definieran por medio de paneles de consenso un listado de HECSAP totales, en niños y adultos. Este indicador se construyó como porcentaje de egresos totales y como tasa de egresos por población sin cobertura para el país y las provincias, analizándose también su tendencia secular. Se construyeron modelos robustos de regresión lineal múltiple para determinar predictores de APS asociados a las HECSAP, ajustados por covariables demográficas y socioeconómicas. Las HECSAP representaron 26,9%, 27,4%, 26,9%, 27,8% y 26,8% de las hospitalizaciones en 2000, 2005, 2006, 2007 y 2008, respectivamente. Este indicador fue mayor en los niños que en los adultos. Las provincias más pobres presentaron mayores diferencias en las HECSAP en adultos con respecto a los niños, en comparación a los promedios del país. La programación de las consultas y la falta de atención domiciliaria en los CAPS fueron los predictores más estables de reducción de las HECSAP. Si bien las HECSAP como indicador de desempeño de los servicios de APS han demostrado validez empírica, aún faltan desarrollar instrumentos para la evaluación de constructos que midan estructura, procesos y resultados de la APS y que puedan funcionar como predictores de manera válida y confiable.

Interchangeability between Pneumococcal Conjugate Vaccines: A Systematic Review and Meta-Analysis

Objectives: To assess the efficacy, cost-effectiveness, immunogenicity, and safety related to the interchangeability between pneumococcal conjugate vaccines (PCVs) and vaccination schedules in pediatric population. Methods: Systematic searches were conducted in December 2010 and April 2015 for economic evaluations in MEDLINE, EMBASE, LILACS, and Cochrane Central Register of Controlled Trials. Web sites and databases from medical societies, experts, and associations related to the topic, proceedings or congressional annals, and doctoral theses were also searched. No language or temporal restriction was applied. We included randomized controlled trials, economic evaluations, and systematic reviews evaluating antibody response, cost-effectiveness, and effectiveness of PCVs' interchangeability. A Strengthening the Reporting of Observational Studies in Epidemiology-based checklist was used to assess the risk of bias in observational studies and a Cochrane approach for experimental/quasi-experimental studies. Pairs of reviewers independently selected (through the Web-based Early Reviewer Organizer Software), assessed the quality, and extracted the data of the studies. Discrepancies were resolved by consensus. We planned to perform meta-analysis whenever appropriate. Results: Forty-six of 202 studies were included. There was no direct information available on the interchangeability between PCVs. The immunogenicity and safety between the 10-valent PCV (PCV10) and the 7-valent PCV were similar when both vaccines were coadministered with other routine pediatric vaccines. PCV10 and 13-valent PCV (PCV13) were consistently more cost-effective than 7-valent PCV. Conclusions: There was no direct comparative information available on the interchangeability among PCVs, but they have pretty similar immunogenicity and safety. PCV10 versus PCV13 cost-effectiveness varied according to price, indirect effects, and indirect costs. PCV10 gains more quality-adjusted life-years because of the prevention of more frequent yet less severe events such as otitis media, and PCV13 prevents less frequent but more costly events such as invasive diseases.Fil: Ciapponi, Agustín. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Lee, Alison. Instituto de Efectividad Clínica y Sanitaria; Argentina. Centro de Excelencia en Salud Cardiovascular para América del Sur; ArgentinaFil: Bardach, Ariel Esteban. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Glujovsky, Demián. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Rey Ares, Lucila. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Luisa Cafferata, María. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Valanzasca, Pilar. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: García Martí, Sebastián. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Epidemiology of Malaria in Latin America and the Caribbean from 1990 to 2009: Systematic Review and Meta-Analysis

AbstractObjectiveThe objective of this study was to evaluate the burden of malaria in Latin America and the Caribbean countries through a systematic review and meta-analysis of published literature, gray literature, and information from countries’ public health authorities for the period 1990 to 2009.MethodsThe random-effects meta-analysis of the prospective studies, carried out in very highly endemic areas, showed an annual incidence rate of 409.0 malaria episodes/1000 person-years (95% confidence interval [CI] 263.1–554.9), considering all ages, which was 40-fold the one estimated from areas with passive surveillance only.ResultsOverall, the most prevalent species was Plasmodium vivax (77.5%; 95% CI 75.6–79.4) followed by Plasmodium falciparum (20.8%; 95% CI 19.0–22.6) and Plasmodium malariae (0.08%; 95% CI 0.07–0.010). Data from regional ministries of health yielded an estimated pooled crude annual mortality rate of 6 deaths/100,000 people, mainly associated with P. falciparum.ConclusionThis study represents the first systematic review of the burden of malaria in Latin America and the Caribbean, with data from 21 countries