Vacunas antineumocócicas conjugadas: una revisión de las consideraciones éticas e impacto socio-económico / Pneumococcal conjugate vaccines: a review of ethical considerations and socio-economic impact

Introducción: Desde hace más de 15 años, las vacunas antineumocócicas conjugadas (PCVs) están disponibles en muchas partes del mundo, y son efectivas en la prevención de las enfermedades neumocócicas en niños. La OMS recomienda la inclusión de las PCVs en los programas de inmunización infantil en todo el mundo. Objetivo: Valorar el abordaje ético y el impacto socioeconómico de las vacunas antineumocócicas conjugadas para la decisión de uso en diferentes contextos. Material y Métodos: Se realizó una búsqueda bibliográfica en las bases de datos PubMed y SciELO, considerando informes de la web de la OMS. Desarrollo: Está globalmente considerado que para la reglamentación, el desarrollo y el uso de las PCVs，se deben tener en cuenta aspectos regulatorios, resultados de investigaciones y el consentimiento informado (CI) de los sujetos. En el contexto de países como China，la PCV13 de la empresa Pfizer es de la Clase II debido a su alto precio de importación, en otros contextos como Cuba no se ha introducido la vacunación contra neumococo por limitaciones financieras. Los equipos de investigación trabajan en el desarrollo de las PCVs para reducir el coste de la importación de estas vacunas, haciendo realidad la inclusión de las PCVs en el programa nacional de inmunización. A pesar de complejidad cada vez mayor de la investigación vacunológica, los investigadores seguirán obligados a adherirse a los principios éticos. Conclusiones: Es necesario una vacuna antineumocócica conjugada más económica para tener un impacto socio-económico más alto. Los profesionales sanitarios tienen la obligación de ser éticos y rigurosos en las investigaciones vacunológicas. Además, estas investigaciones requieren de la revisión por parte de un consejo de revisión ética a escala nacional y su seguimiento debe ser sistemático. Cabe señalar que los estudios en población infantil deben ser fuertemente regulados y controlados(AU)

Introduction: Pneumococcal conjugate vaccines (PCVs) have been available in many parts of the world for more than 15 years and are effective in preventing pneumococcal diseases in children. The WHO recommends the inclusion of PCVs in childhood immunization programmes worldwide. Objective: To value the approach to ethics and the socioeconomic impact of the conjugate pneumococcal vaccines. Material and Methods: A bibliographic review was carried out in databases such as PubMed and SciELO, considering reports from the WHO website. Development: It is globally considered that regulatory aspects, research results and informed consent (IC) of the subjects should be taken into account for the regulation, development and use of PCVs. In the context of countries such as China，the PCV13 of the Pfizer company is Class II due to its high import price. In other contexts, such as Cuba, pneumococcal vaccination has not been introduced due to financial limitations. Research teams are working on the development of PCVs to reduce the cost of importing these vaccines, making the inclusion of PCVs in the national immunization program a reality. Despite the increasing complexity of vaccinology research, researchers will continue to be obliged to adhere to ethical principles. Conclusions: A cheaper pneumococcal conjugate vaccine would be needed to have a higher socioeconomic impact. Healthcare professionals have the obligation to be ethical and rigorous in vaccinology research. In addition, such research requires review by a national ethical review board and should be systematically monitored. It should be noted that studies in the pediatric population should be strongly regulated and controlled(AU)

La humanidad enfrenta un desastre: la resistencia antimicrobiana / Humanity faces disaster: antimicrobial resistance

Introducción: La resistencia bacteriana pone en peligro la salud y la supervivencia de los seres humanos, aumenta la carga económica de la sociedad y los pacientes. Es un fenómeno global por lo que Cuba no queda exenta. Objetivos: Exponer el impacto social y económico de la resistencia antimicrobiana desde el punto de vista filosófico y describir el rol de una medida preventiva en la contención de la resistencia antimicrobiana. Material y Métodos: Se realizó una revisión de fuentes bibliográficas que fueron localizadas mediante la base de datos Pubmed, Portal Regional de la Biblioteca Virtual de Salud y el motor de búsqueda Google Académico. Desarrollo: Se analizan los aspectos sociales, económicos y éticos relacionados con la resistencia bacteriana y se ejemplifica una medida preventiva en la contención de la resistencia antimicrobiana. Además, se analiza la relación entre fármacos antibacterianos, resistencia bacteriana y medidas de prevención y control desde el punto de vista de ciencia-tecnología-sociedad. Conclusiones: La sociedad humana se desarrolla y progresa constantemente bajo la promoción de la ciencia y la tecnología. En pocas décadas, los antibióticos han pasado de ser "drogas milagrosas de gran impacto para la salud" a ser "un recurso no renovable en vías de extinción". Se deben adoptar las acciones pertinentes para frenar el desarrollo de la resistencia bacteriana con un enfoque multisectorial. Se requiere una gobernanza, optimización del uso de antibióticos, apoyos de políticas de salud y un fortalecimiento de los programas de prevención y control de infecciones(AU)

Introduction: Bacterial resistance endangers the health and survival of human beings and increases the economic burden on society and patients. It is a global phenomenon; therefore, Cuba is not exempted from it. Objective: To present the social and economic impact of antimicrobial resistance from a philosophical point of view as well as to describe the role of a preventive measure to stop antimicrobial resistance. Material and Methods: A review of bibliographic sources was carried out in databases such as PubMed and the Regional Portal of the Virtual Health Library; Google Scholar search engine was also used. Development: Social, economic and ethical aspects related to bacterial resistance are analyzed. A preventive measure to stop antimicrobial resistance is described. In addition, the relationship between antibacterial drugs, bacterial resistance and prevention and control measures is analyzed from the point of view of science-technology-society. Conclusions: Human society is constantly developing and progressing under the promotion of science and technology. In just a few decades, antibiotics have gone from being "miracle drugs of great impact on health" to being "a non-renewable resource in danger of extinction". Necessary measures such as the optimization of the use of antibiotics, a health policy support, and a health strategy for the prevention and control of infections must be taken to stop the development of bacterial resistance(AU)

COVID-19: implications of SARS-CoV-2 in Colombia / COVID-19: implications of SARS-CoV-2 in Colombia

Abstract COVID-19 arrived to Latin America early in March 2020. Currently, strategies are being developed in Colombia focusing on the quarantine and social and economic capital reactivation, whereby the expected results are not being obtained. In this article, we propose to review scientific evidence-based literature where information on the operation and adaptation of health systems, and social, economic and solidarity sectors of Colombia is presented. The purpose is to identify COVID-19 implications in the network that provides health services, quality of life and health-disease prognosis in the country, which is not prepared to face crises of social nature and of health systems, as well as the economic and solidarity impacts that are brought about by pandemics and crude episodes of disease.

Resumen COVID-19 llegó a Latinoamérica a principios de marzo de 2020. Actualmente, en Colombia se desarrollan estrategias enfocadas en la cuarentena y la reactivación del capital social y económico, con las cuales no se están obteniendo los resultados esperados. En este artículo se propone revisar literatura basada en evidencia científica en la que se exponga información del funcionamiento y adaptación de los sistemas de salud, sectores sociales, económicos y solidarios de Colombia. El objetivo es identificar las implicaciones de COVID-19 en la red prestadora de servicios de salud, calidad de vida, pronóstico de salud-enfermedad en el país, el cual no está preparado para afrontar crisis de orden social, de sistemas de salud e impactos económicos y solidarios que conllevan las pandemias y episodios graves de enfermedad.

Trinidad and Tobago: A decade of dementia research / Trinidad e Tobago: uma década de pesquisa dementia

In 2003, academic staff members at The University of the West Indies Faculty of Medical Sciences St Augustine Trinidad and Tobago combined their expertise to make strides in Alzheimers and Dementia research in Trinidad and Tobago. Dr. Nelleen Baboolal, Dr. Gershwin Davis and Professor Amanda McRae began developing a project that has produced significant results by examining not only the epidemiology of dementia, but the associated risk factors; caregiver burden and ultimately establishing biomarkers for the disease. This review is an account of our results from a decade of dementia research and how they are contributing toward mitigating the dementia tsunami in Trinidad and Tobago.

Em 2003, os membros da equipe acadêmica da Faculdade de Ciências Médicas St Augustine, da Universidade de West Indies, Trinidad e Tobago, combinaram seus conhecimentos para promover avanços nas pesquisas sobre doença de Alzheimer e demência em Trinidad e Tobago. Dr. Nelleen Baboolal, Dr. Gershwin Davis e Professora Amanda McRae começaram a desenvolver um projeto que tem produzido resultados significativos através da análise não só da epidemiologia da demência, mas também dos fatores de risco associados, sobrecarga do cuidador e, ultimamente, estabelecendo biomarcadores para a doença. Esta avaliação representa um relato de nossos resultados de uma década de pesquisa demência e como eles estão contribuindo para mitigar o tsunami de demência em Trinidad e Tobago.

Prevención del daño: impacto económico y social / Damage prevention: socioeconomic impact

To prevent the damage, successful interventions were implemented to protect the child during the early years. As a result, 98% of children less than 5 years of age grew and developed according to WHO guidelines. This created a "domino effect" in older children reflected by the increased demands in education and health care followed by a period of rapid socioeconomic development. We can conclude that investment in prevention of undernutrition in the early years of life has been highly profitable. The example of Chile can be used as a model for other countries who still suffer from undernutrition and poverty.

Para prevenir el daño se implantaron exitosas intervenciones, destinada a proteger al niño durante los primeros períodos de la vida. Como resultado, el 98% de los menores de cinco años en el país, está creciendo y desarrollándose dentro de parámetros normales establecidos por la OMS. En los años sucesivos, el impacto (efecto dominó) fue repercutiendo en edades posteriores, exteriorizándose en el incremento de las demandas educacionales y de salud, que culminaron con un posterior período de rápido desarrollo social y económico. Se concluye que la inversión en la prevención de la desnutrición de los primeros períodos de la vida, ha sido altamente rentable y no comparable con ninguna otra. El ejemplo de lo ocurrido en Chile durante este periodo, puede ser de utilidad para otros países de la región que aún padecen de similares problemas nutricionales y de pobreza.

Saneamento rural no Brasil: impacto da fossa séptica biodigestora / Rural sanitation in Brazil: impact analysis of the septic tank digester

O Brasil tem mais de 23 milhões de pessoas na zona rural sem coleta ou tratamento de esgoto, o que corresponde a 75% da população rural. Este estudo teve como objetivo mensurar os impactos social, ambiental e econômico decorrente da atual falta de saneamento rural no país em relação à implementação de uma proposta tecnológica de tratamento do esgoto, a fossa séptica biodigestora. Foi observado que, ao ano, a construção desse sistema de saneamento poderia evitar cerca de 250 mortes e 5,5 milhões de infecções causados por doenças diarreicas; reduzir a poluição dos cursos d'água em cerca de 129 mil toneladas de resíduos; e que cada R$ 1,00 investido na implementação da alternativa tecnológica avaliada poderia causar um retorno para a sociedade de R$ 1,6 em renda interna bruta. Além disto, a construção da fossa séptica biodigestora promoveria a geração de cerca de 39 mil empregos.

Brazil has more than 23 million rural people with unimproved sanitation, which corresponds to about 75% of rural population. This study aimed to measure the social, environmental and economic impacts caused by the implementation of a technological proposal for sanitation, the septic cesspool biodigester. It was observed that, per year, the implementation of this technology in rural homes with unimproved sanitation could reduce about 250 deaths and 5.5 million infections caused by diarrheal diseases; reduce pollution of waterways by about 129 thousand tons of sediment; and that every R$ 1.00 invested in the implementation of the alternative technology evaluated could cause a return to the society of R$ 1.6 in gross domestic product. Moreover, the implementation of septic cesspool biodigesters would promote the creation of 39 thousand jobs.

Implantes cocleares: aspectos tecnológicos e papel socioeconômico / Cochlear implants: technological aspects and socioeconomic role

INTRODUÇÃO: O grande número de deficientes auditivos faz da perda auditiva um sério problema social, econômico e de saúde pública. Próteses auditivas e implantes cocleares representam os principais dispositivos utilizados como paliativos por pessoas com deficiência auditiva, sendo que os implantes cocleares são muitas vezes a única opção nos casos de deficiência auditiva severa e profunda. Nesse artigo discute-se de maneira geral os diferentes aspectos envolvendo implantes cocleares, tanto de âmbito tecnológico como seu papel socioeconômico. MÉTODOS: Baseado em dados do SUS, IBGE e outras fontes, um levantamento qualitativo e quantitativo é feito pela primeira vez especificamente para a população brasileira. O artigo discute ainda o estado da arte das tecnologias envolvidas no implante coclear, com base em literatura científica e informações de fabricantes, bem como as perspectivas para as próximas gerações de implantes cocleares. CONCLUSÃO: Há potencial e demanda para evoluções nos implantes atuais. A implantação precoce é benéfica para pacientes e sociedade, compensando os custos econômica e socialmente. No entanto, as políticas públicas de reabilitação necessitam se adequar para atender com eficácia à crescente população afetada pela deficiência auditiva.

INTRODUCTION: Due to the great number of affected people, hearing loss is considered a serious social, economic and public health problem. Hearing aids and cochlear implants are the primary devices used as palliatives for people with hearing loss, and cochlear implants are often the only option in cases of severe to profound hearing impairment. This paper covers both technological and socio-economic aspects of cochlear implant, which is considered as one of most recommended treatments to alleviate severe to profound hearing loss. METHODS: Brazilian unified health system data is used to display qualitative and quantitative analysis impact on Brazilian population and government. A state-of-art review based on scientific literature and manufacturer data is provided, as well as perspectives for the next cochlear implant generation. CONCLUSION: There is potential and demand for evolutions in current implants. Early implantation is beneficial for patients and society, compensating the costs economic and socially. However, public programs need to adapt in order to efficiently attend the increasing affected population.

Impacto económico en las familias de niños que presentan caries de infancia temprana atendidos en el Servicio de Atención del Infante de Instituto Nacional del Niño, Lima-Perú 2009 / Economic impact on families of children's early childhood caries attended at National Institute Child Heath, Lima-Peru 2009

Objetivo: determinar el impacto que genera la caries de infancia temprana sobre la economía en las famílias de niños que sufren caries de infancia temprana. Material y métodos: se empleó una muestra probabilística de 629 niños entre 0 a 36 meses de edad, todos ellos pertenecientes al Instituto Nacional de Salud de Salud del Niño en Lima- Perú. Resultados: se determinó que el impacto es alto, siendo 7 veces más costosa la terapia curativa que la terapia preventiva. El gasto económico de las famílias en prevención por un año es de S/. 39.21 y en tratamientos curativos es de es de S/. 282.10. Pero estos costos son subvencionados por el hospital, el costo real ser¡a de S/. 310.36 y de S/. 1269.08, respectivamente. Las famílias con vulnerabilidad económica se ven beneficiados por el subsídio otorgado por el Estado. El nível de adherencia de la fase de mantenimiento es bajo con un 26%. Los costos indirectos que afectan a estas famílias por ausencia laboral representa en promedio 9 días de semana al trabajo, representando S/. 259.60, si a esto se calcula en base al total de niños afectados en el Perú corresponde a S/. 306 141.217 millones de soles. Conclusiones: las medidas preventivas son altamente más económicas. Los tratamientos curativos son 7 veces más costosos que la terapia preventiva. Las caries de infancia temprana constituyen un importante problema de salud pública que ocasiona gastos directos e indirectos por ausentismo laboral, que afecta el desarrollo de la economía.

Objective: to determine the impact that early childhood caries generates on the economy on families of children suffering early childhood caries. Material and methods: we used a nonrandom sample of 629 children between 0-36 months of age; all of them are from the National Institute of Child Health in Lima. Peru. Results: we found that the impact is high, being 7 times more expensive the curative therapy than the preventive therapy. The economic spending of families in prevention for one year is S/. 39.21 And curative treatments is S/. 310.36 And S/. 1269.08, respectively. Families with economic vulnerability are benefiting for the subsidy provided by the state. The level of adherence to the maintenance phase is low at 26%. Indirect costs that effect these families for absenteeism represents an average of 9 days work per week, representing S/. 259.60, if this is calculated based on the total number of children affected in Peru corresponds to S/. 306,141.217 million soles. Conclusion: preventive measures are highly cheaper. The cures treatments are 7 times more expensive than preventive therapy. Early childhood caries area significant public health problem that causes direct and indirect cost from work absenteeism, affecting the development of regional and national economy.