The use of the health technology assessment for technology acquisition in hospitals / El uso de la evaluación de tecnología de salud para la adquisición de tecnología en hospitales / O uso da avaliação de tecnologia de saúde para a aquisição de tecnologia em hospitais

Decision makers at the national and local level of health systems require evidence of effectiveness, safety and costs of health technologies for resource allocation. In this sense Health Technology Assessment (HTA) is a favorable tool considering it is a multidisciplinary process to evaluate the benefits as well as the social, economic, organizational and ethical issues of a health technology. The aim of this study was to review the literature in order to identify the attributes used in the process of technology acquisition. It was analyzed the attributes of HTA with the purpose of classifying them, to see which are the most recommended for acquisition in hospitals. The identified literature indicated that not only the clinical and economic attributes were considered, but also attributes related to the context of the hospital such as the effect of technology on other hospital services and others associated with the organization.

Los tomadores de decisiones a nivel nacional y local de los sistemas de salud requieren evidencia de la efectividad, seguridad y costos de las tecnologías de la salud para la asignación de recursos. En este sentido, la Evaluación de la Tecnología de la Salud (HTA, por sus siglas en inglés) es una herramienta favorable considerando que es un proceso multidisciplinario para evaluar los beneficios, así como las cuestiones sociales, económicas, organizativas y éticas de una tecnología de la salud. El objetivo de este estudio fue revisar la literatura con el fin de identificar los atributos utilizados en el proceso de adquisición de tecnología. Se analizaron los atributos de HTA con el fin de clasificarlos, para ver cuáles son los más recomendados para adquisición en hospitales. La literatura identificada indicó que no sólo se consideraron los atributos clínicos y económicos, sino también atributos relacionados con el contexto del hospital como el efecto de la tecnología en otros servicios hospitalarios y otros asociados con la organización.

Os tomadores de decisões a nível nacional e local dos sistemas de saúde requerem evidência da efetividade, segurança e custos das tecnologias de saúde para a atribuição de recursos. Neste sentido, a Avaliação da Tecnologia da Saúde (HTA) é uma ferramenta favorável considerando que é um processo multidisciplinar para avaliar os benefícios, bem como as questões sociais, económicas, organizativas e éticas de uma tecnologia da saúde. O objetivo deste estudo foi revisar a literatura com o fim de identificar os atributos utilizados no processo de aquisição de tecnologia. Analisaram-se os atributos de HTA com o fim de classificá-los, para ver quais são os mais recomendados para aquisição em Hospitais. A literatura identificada indicou que não só se consideraram os atributos clínicos e económicos, assim como também alguns atributos relacionados com o contexto do hospital como o efeito da tecnologia em outros serviços hospitalários e outros associados com a organização.

Fast analysis of 4-tertoctylphenol, pentachlorophenol and 4-nonylphenol in river sediments by QuEChERS extraction procedure combined with GC-QqQ-MS/MS.

A quick, easy, cheap, effective, rugged and safe (QuEChERS)-based extraction method has been optimized for the determination of pentachlorophenol, 4-tertoctylphenol and 4-nonylphenol in river sediments. The extraction method was followed by gas chromatography-triple quadrupole tandem mass spectrometry (GC-QqQ-MS/MS) analysis, which ensures the reliable identification of the target compounds. The proposed method has been validated allowing the successful determination of the selected compounds, with recoveries ranging from 72 to 96%, when three concentration levels were evaluated (10, 50 and 100µgkg(-1)) and inter-day and intra-day precision, expressed as relative standard deviation (RSD), were lower than 20%. The method showed limits of detection (LODs) and limits of quantification (LOQs) ranging from 0.1 to 2.0µgkg(-1) and from 0.5 to 5.0µgkg(-1), respectively. Finally, 25 real samples from Poland have been analyzed, and only 4-tertoctylphenol was detected at concentrations up to 8.9µgkg(-1) of soil dry weight.

Simultaneous analysis of chlorophenols, alkylphenols, nitrophenols and cresols in wastewater effluents, using solid phase extraction and further determination by gas chromatography-tandem mass spectrometry.

An analytical methodology has been developed for the simultaneous extraction of 13 phenolic compounds, including chlorophenols (CPs), nitrophenols (NTPs), cresols and alkylphenols (APs) in different types of wastewater (WW) effluents. A solid-phase extraction (SPE) method has been optimized prior to the determination by gas chromatography coupled to triple quadrupole tandem mass spectrometry (GC-QqQ-MS/MS). Due to the complexity of the matrix, a comparison study of matrix-matched-calibration (MMC) and standard addition calibration (SAC) was carried out for quantification purposes. The optimized procedure was validated using the SAC approach since it provided the most adequate quantification results (in terms of recovery and precision values). Recoveries were in the range 60-135% (0.5 µg L(-1)), 70-115% (1 µg L(-1)), and 78-120% (5 µg L(-1)), with precision values (expressed as relative standard deviation, RSD) ≤ 30% (except for 2-nitrophenol) involving intra-day and inter-day precision studies. Limits of detection (LODs) and quantification (LOQs) were also evaluated, and LOQs ranged from 0.03 µg L(-1) to 2.5 µg L(-1). The proposed method was applied to the analysis of 8 real WW effluent samples, finding some phenolic compounds (e.g. 2-chlorophenol, 2,4,6-trichlorophenol and 4-tert-octylphenol) at concentrations higher than the established LOQs.

Enterophages, a group of phages infecting Enterococcus faecalis, and their potential as alternate indicators of human faecal contamination.

We have developed a method for the detection of viruses in environmental samples that we have called enterophages, that specifically infect Enterococcus faecalis. This method has allowed us to determine the prevalence and to study the ecology of this group of phages. The enterophages replicate at 37 degrees C, and at 41 degrees C. The presence of NaN(3) in the media inhibits the growth of background microbiota and allows an accurate, specific and rapid detection of these viruses. Enterophages were present in raw domestic sewage at lower concentrations (average 1.8 x 10(2) PFU/100 mL) than those of coliphages (average 1.7 x 10(5) PFU/100 mL). Phages were characterised by transmission electron microscopy showing icosahedral capsids, some with non-contractile tails as well as icosahedral non-tailed capsids. Different isolates had capsid sizes ranging from 20 nm to about 75 nm in diameter. These data describe a new group of phages that may serve as alternate indicators of human faecal pollution, especially in recreational waters. The ecology of these enterophages indicates that these may be strictly of human origin.

Comparison of ultrasonic and pressurized liquid extraction for the analysis of polycyclic aromatic compounds in soil samples by gas chromatography coupled to tandem mass spectrometry.

A pressurized liquid extraction (PLE) method has been optimized for the determination of polycyclic aromatic hydrocarbons (PAHs) in soil samples and it was compared with ultrasonic extraction. The extraction step was followed by gas chromatography-triple quadrupole mass spectrometry (GC-QqQ-MS/MS) analysis. Parameters such as type of solvent, extraction time, extraction temperature and number of extractions were optimized. There were no significant differences among the two extraction methods although better extraction efficiencies were obtained when PLE was used, minimizing extraction time and solvent consumption. PLE procedure was validated, obtaining limits of detection (LODs) ranging from 0.02 to 0.75 microg kg(-1) and limits of quantification (LOQs) ranging from 0.07 to 2.50 microg kg(-1) for the selected PAHs. Recoveries were in the range of 59-110%, except for naphthalene, which was the most volatile PAH. Finally, the method was applied to real soil samples from Southeast of Spain. PAHs concentrations were low, and phenanthrene, pyrene, fluorene, benzo[a]pyrene and chrysene were the most frequently detected analytes in the samples.

Interferon gamma-secreting HCV-specific CD8+ T cells in the liver of patients with chronic C hepatitis: relation to liver fibrosis--ANRS HC EP07 study.

Little is known about the role of specific hepatitis C virus (HCV) CD8+ T cells in liver damage, especially for the progression of fibrosis, during the highly variable course of chronic C hepatitis. The aim of this study was to investigate the presence of HCV-specific CD8+ T cells in the liver of patients with chronic C hepatitis and to examine their clinical significance by relating the response to liver fibrosis and progression rate, serum viral load, serum aminotransferase levels, inflammatory activity and in situ characteristics of the intrahepatic infiltrate. Fifteen patients were prospectively included in the study. Intrahepatic lymphocytes were tested for interferon gamma (IFNg) production in response to HCV class I-restricted epitopic peptides using enzyme-linked immunospot analysis. Liver biopsy samples were evaluated for fibrosis, fibrosis progression rate, activity, and in situ number of CD8+ cytotoxic lymphocytes and apoptotic cells. An IFNg-specific CD8+ T-cell response was detected in the liver samples of 47% of patients which was significantly related to a lower stage of fibrosis (P = 0.02) and a lower progression rate of fibrosis (P = 0.01). It was neither related to the number of cytotoxic lymphocytes infiltrating the liver nor to hepatocyte apoptosis. In conclusion, our results indicate that the presence of HCV-specific IFNg-secreting T cells in the liver of patients with chronic C hepatitis is associated with low liver fibrosis and fibrosis progression rate, suggesting that these IFNg-secreting T cells might limit the progression of liver damage.

Cancer risks and prevention practices among Vietnamese refugees.

Although Vietnamese refugees are the fastest-growing Asian minority in the United States, little is known about their health knowledge and practices, especially regarding cancer prevention. To address this problem, we interviewed a randomly selected sample of 215 Vietnamese adults living in the San Francisco Bay Area. Results indicated that 13% had never heard of cancer, 27% did not know that cigarette smoking can cause cancer, and 28% believed that cancer is contagious. Although hepatitis B-related liver cancer is endemic among Vietnamese, 48% had never heard of hepatitis B. Among men (n = 116), 56% were smokers (versus 32% in the general US population). Male cigarette smoking was significantly associated with incomes below the poverty level (P less than .01), residence in the US for 9 years or less (P less than .05), not knowing that smoking causes cancer (P less than .05), and limited English proficiency (P less than .01). Binge drinking was reported by 35% of men. Young Vietnamese of both sexes reported consuming diets higher in fat and lower in fiber than when they lived in Vietnam. Among eligible women, 32% had never had a Papanicolaou test (versus 9% of US women), 28% had never had a breast examination (versus 16%), and 83% had never had a mammogram (versus 62%). Education about cancer and its risk factors, smoking cessation, and cancer screening are high priorities for this population.

The systemic pathology of Venezuelan equine encephalitis virus infection in humans.

The histopathology of fatal Venezuelan equine encephalitis (VEE) in humans has not been well documented. To evaluate the spectrum of disease in man, the histologic slides of the 21 autopsied patients who died with documented VEE infection during the 1962-63 VEE epidemic in Zulia, Venezuela were reviewed. The main histopathologic lesion observed in multiple organs and tissues, especially the brain, gastrointestinal tract, and lungs, was moderate to marked diffuse congestion and edema with hemorrhage. In the central nervous system (CNS), mild or focal mixed inflammatory cell infiltrates were present in the leptomeninges and perivascular spaces (65%). Meningoencephalitis associated with intense necrotizing vasculitis was observed in 2 patients (10%), and cerebritis was observed in 5 cases (25%). There was a striking depletion of lymphocytes with vascular thrombosis and necrosis of follicles in lymph nodes (77%), spleen (69%), and the gastrointestinal tract (90%). Widespread hepatocellular degeneration and individual cell necrosis was observed in 61% of the cases. Most patients (90%) had interstitial pneumonia, frequently complicated by acute bronchopneumonia (33%). Overall, the lesions observed in the CNS and reticuloendothelial tissues are comparable to what is observed in experimental animals; however, extensive hepatocellular degeneration and interstitial pneumonia are not prominent pathologic features of VEE in animals. The findings are consistent with the hypothesis that lymphoid and reticuloendothelial tissues are the targets in VEE virus infection in humans, and that many of the histopathologic changes are attributable to primary lymphoid and endothelial cell injury.