ABSTRACT
El objetivo de este estudio es valorar, en base a un análisis crítico y estructurado de la evidencia, si el tamizaje mamográfico de cáncer de mama en Perú es una intervención recomendable. El análisis se realizó utilizando los criterios propuestos por el sistema GRADE (Grading of Recommendations Assessment, Development and Evaluation). Se realizó una búsqueda de la literatura en Medline y en otras fuentes de información nacional (literatura gris). Para el desarrollo de la recomendación, a favor o en contra del tamizaje, se utilizó la mejor evidencia disponible sobre los beneficios, riesgos, costos y preferencias de la población. Los resultados incluyeron cinco revisiones sistemáticas (RS) que evaluaron los riesgos y beneficios del tamizaje; dos evaluaciones económicas realizadas en Perú y un estudio que valoró indirectamente las preferencias de las mujeres peruanas. La calidad de la evidencia a partir de las RS fuemoderada a favor del tamizaje en mujeres de 50 a 69 años. El balance entre riesgos y beneficios mostró una mayor probabilidad de sobrediagnóstico comparado con el beneficio en la reducción de la mortalidad. La estrategia más costoefectiva fue la mamografía trienal. La percepción de barreras podría comprometer seriamente la participación de las mujeres. En conclusión, la recomendación a favor del tamizaje mamográfico en Perú es débil, más aun si se tienen en cuenta otras necesidades poblacionales más urgentes. En caso de llevarse a cabo, la estrategia de tamizaje más adecuada para la población peruana consistiría en realizar una mamografía trienal en mujeres de 50 a 69 años.
The aim of this study is to assess the balance between benefits and risks of population-based mammography screening programs in Peruvian women. We followed the criteria proposed by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) working group. A generic search strategy for published studies was performed using Medline and other sources of national data (gray literature). The evidence of benefits, risks, costs and preferences of the population was used in order to state a recommendation in favour, or against, screening. We found five systematic reviews (SR) that evaluated the balance between benefit and risks, two economic evaluations based on Peruvian data, and one study that reported the preferences of Peruvian women. The quality of evidence of the SR was moderate in favour of screening in women aged 50-69 years. The balance of risks and benefits showed a higher probability of overdiagnosis compared with the reduction in mortality. The most cost-effective strategy was the triennial mammography. Perceived barriers could seriously compromise the participation of women. In conclusion, the recommendation of mammography screening for Peruvian women is weak, even more if we take into account other health necessities of the population. However, if implemented, triennial mammography in women aged 50-69 years could be the more suitable screening strategy.
Subject(s)
Middle Aged , Mass Screening , Mammography , Breast Neoplasms , PeruABSTRACT
OBJECTIVES: to analyze the relationship between preoperative emotional state and the prevalence and intensity of postoperative pain and to explore predictors of postoperative pain. METHOD: observational retrospective study undertaken among 127 adult patients of orthopedic and trauma surgery. Postoperative pain was assessed with the verbal numeric scale and with five variables of emotional state: anxiety, sweating, stress, fear, and crying. The Chi-squared test, Student's t test or ANOVA and a multivariate logistic regression analysis were used for the statistical analysis. RESULTS: the prevalence of immediate postoperative pain was 28%. Anxiety was the most common emotional factor (72%) and a predictive risk factor for moderate to severe postoperative pain (OR: 4.60, 95% CI 1.38 to 15.3, p<0.05, AUC: 0.72, 95% CI: 0.62 to 0.83). Age exerted a protective effect (OR 0.96, 95% CI: 0.94-0.99, p<0.01). CONCLUSION: preoperative anxiety and age are predictors of postoperative pain in patients undergoing orthopedic and trauma surgery. .
OBJETIVOS: analisar a relação entre o estado emocional pré-operatório e a prevalência e a intensidade da dor pós-operatória e explorar fatores preditivos de dor pós-operatória. MÉTODO: estudo retrospectivo observacional, realizado com 127 pacientes adultos submetidos a cirurgias ortopédicas e traumatológicas. A dor pós-operatória foi avaliada usando a escala numérica verbal e cinco variáveis do estado emocional: ansiedade, sudorese, estresse, medo e choro. Para a análise estatística, foram utilizados os testes do qui-quadrado, teste t de Student ou análise de variância e uma análise de regressão logística multivariada. RESULTADOS: a prevalência de dor pós-operatória imediata foi de 28%. A ansiedade foi o fator emocional mais comum (72%) e fator preditivo de risco para dor pós-operatória severa (OR: 4,60, IC 95%: 1,38 a 15,3, p<0,05, AUC: 0,72, IC 95%: 0,62 a 0,83). A idade exerceu efeito protetor (OR 0,96, IC 95%: 0,94-0,99, p<0,01). CONCLUSÃO: a ansiedade pré-operatória e a idade são fatores preditivos de dor pós-operatória em pacientes submetidos a cirurgias ortopédicas e traumatológicas. .
OBJETIVOS: analizar la relación entre el estado emocional preoperatorio y la prevalencia e intensidad de dolor postoperatorio inmediato y explorar los factores predictivos de dolor postoperatorio. MÉTODO: estudio observacional y retrospectivo realizado a 127 pacientes adultos de cirugía ortopédica y traumatológica. El dolor postoperatorio se evaluó con la escala verbal numérica y el estado emocional con 5 variables: ansiedad, sudor, tensión, miedo, lloros. Para el análisis estadístico se utilizaron las pruebas de χ2, t de Student o ANOVA y un análisis multivariado con regresión logística. RESULTADOS: la prevalencia de dolor postoperatorio inmediato fue del 28%. La ansiedad fue el factor emocional más frecuente (72%) y un factor de riesgo predictivo para el dolor postoperatorio moderado-intenso (OR: 4,60, IC95%: 1,38-15,3, p<0,05; AUC: 0,72, IC95%: 0,62-0,83). La edad ejercía un efecto protector (OR: 0,96; IC95%: 0,94-0,99, p<0.01). CONCLUSIÓN: la ansiedad prequirúrgica y la edad son factores predictivos del dolor postoperatorio en pacientes sometidos a cirugía ortopédica y traumatológica. .
Subject(s)
Humans , Male , Female , Aged , Pain, Postoperative/epidemiology , Wounds and Injuries/surgery , Orthopedic Procedures , Emotions , Pain, Postoperative/psychology , Prevalence , Retrospective Studies , Preoperative PeriodABSTRACT
Background: A successful cardiovascular prevention program should induce a reduction of risk factors along time. Aim: To assess changes in cardiovascular risk factors among males aged between 35 and 65 years living in Southern Chile. Material and Methods: The results of two cross sectional household surveys, with a probability sampling stratified by socioeconomic status, were analyzed. Two hundred males were evaluated in 1989 and 800 in 2011-12, paired by age for selection. Results: In the second survey, a mean weight increase of 4.5 kg was recorded. Body mass index increased from 27.1 to 28.6 kg/m² (p < 0.01), especially in men younger than 45 years old. No changes in smoking prevalence were observed. The prevalence of hypertension and hypertensive patients in treatment increased from 32.7 to 38.1% and from 17 to 33%, respectively. The number of treated hypertensive patients with a well-controlled blood pressure did not change significantly. In 1989 and 2011-12, mean total cholesterol values were 192 and 201 mg/dl respectively (p < 0.01). The figures for mean non-HDL cholesterol were 152 and 160 mg/dl (p = 0.03). The frequency of people with total cholesterol over 240 mg/dl or using statins increased from 15 to 25% (p < 0.01). The estimated 10 years risk of myocardial infarction and coronary death using Framingham tables was 9,0 in both periods (p = 0.95). Conclusions: In a 22 years period an increase in the prevalence of obesity and elevated total cholesterol was observed. There was a higher proportion of individuals treated for hypertension and dyslipidemia, but without reduction in the estimated cardiovascular risk.