Objective: To estimate the prevalence of depressive symptoms and major depressive disorder, as as... more Objective: To estimate the prevalence of depressive symptoms and major depressive disorder, as assessed in population-based cross-sectional studies of Brazilian adults. Methods: We performed a systematic review of the literature. The major databases were searched up through October 2013. Two researchers selected the studies, extracted the data, and assessed their methodological quality. Meta-analyses were performed using random effects. Results: Of the 2,971 records retrieved, we selected 27 studies that assessed the prevalence of depression morbidity in 464,734 individuals (66% women). Eleven different screening tools were used to assess depression morbidity. The prevalence of depressive symptoms was 14% (95% confidence interval [95%CI] 13-16; I2 = 99.5%), whereas the 1-year prevalence of major depressive disorder was 8% (95%CI 7-10; I2 = 86.7%), and the lifetime prevalence of major depressive disorder was 17% (95%CI 14-19; I2 = 91.6%). All rates were higher in women than in men. No causes of heterogeneity could be identified. Conclusion: Depression morbidity was common among Brazilian adults, and affects more women than men. Inconsistencies across studies highlight the need for standardization of future research. Clinicians should routinely investigate for the presence of depression morbidity in this population.
Aim. The aim of this study was to estimate the prevalence of diabetes and its associated risk fac... more Aim. The aim of this study was to estimate the prevalence of diabetes and its associated risk factors in adults from Brasilia, Brazil. Methods. The present cross-sectional population-based study consisted of interviews with individuals aged 18-65 years. Participants were selected through two-stage probability sampling by clusters and stratified by sex and age. Demographic and clinical data were collected directly with participants from February to May 2012. Self-reported diabetes prevalence was calculated at a 95% confidence interval (CI). Prevalence ratios (PR) were adjusted by Poisson regression with robust variance. Results. In all, 1,820 individuals were interviewed. Diabetes prevalence in the adult population of Brasilia was 10.1% (95% CI, 8.5%-11.6%). Variables associated with diabetes were an age between 35 and 49 years (PR = 1.83; 95% CI, 1.19-2.82) or 50 and 65 years (PR = 1.95; 95% CI, 1.17-3.23), hypertension (PR = 4.04; 95% CI, 2.66-6.13), respiratory disease (PR = 1.67;...
International Journal of Technology Assessment in Health Care
The aim of this study was to summarize and assess economic evaluations of poison centers (PCs) fr... more The aim of this study was to summarize and assess economic evaluations of poison centers (PCs) from the perspectives of society, the payer, and the healthcare system. A systematic review was performed to identify complete economic evaluations regardless of the language or publication status. Two reviewers evaluated the abstracts for eligibility, extracted the data, and assessed the study quality using a standardized tool. In total, 422 non-duplicated studies were retrieved, but only nine met the eligibility criteria. Five of the eligible studies were published in the 1990s, and four were published in the 2000s. Six studies met at least seven of ten quality criteria. In all studies, the presence of PCs was compared with a scenario of their absence. Eight studies used cost-benefit analyses and one used a cost-effectiveness approach. The cost-benefit ratios ranged from 0.76 to 7.67, which indicates that each United States dollar (USD) spent on poison centers can save almost 8 USD on me...
To propose a tool for critical analysis of economic evaluation studies based on a synthesis of ch... more To propose a tool for critical analysis of economic evaluation studies based on a synthesis of checklists and guidelines available in the literature. The following databases were searched: MEDLINE, Embase, Centre for Reviews and Dissemination, and International Society for Pharmacoeconomics and Outcomes Research. Two investigators independently selected the studies and extracted the data of interest. The number of questions that the checklists contained were counted on the following domains: study design, measurement of costs and health outcomes, analysis and interpretation of results, and general information. A matrix containing the items in each domain was constructed, and a tool for critical analysis was built based on that matrix. The literature search retrieved 406 non-duplicated articles, 19 of which were included in the study. Five hundred sixty-six questions were identified in the checklists employed in these studies: 109 (19%) dealt with health outcomes, 93 (16%) with quant...
Objetivo. Propor uma ferramenta para análise crítica de estudos de avaliação econômica a partir d... more Objetivo. Propor uma ferramenta para análise crítica de estudos de avaliação econômica a partir da síntese de roteiros existentes na literatura. Métodos. Foram realizadas buscas em: MEDLINE, Embase, Centre for Reviews and Dissemination e International Society for Pharmacoeconomics and Outcomes Research. Dois pesquisadores selecionaram independentemente os estudos e extraíram os dados de interesse. Quantificou-se o número de perguntas que os roteiros continham sobre os seguintes domínios: delineamento do estudo; mensuração dos custos e dos desfechos em saúde; análise e interpretação dos resultados; e informações gerais. Após elaboração da matriz contendo os itens de cada domínio por estudo, os autores construíram um instrumento para análise crítica. Resultados. Foram localizados 406 artigos não duplicados, dos quais 19 foram incluídos. No total, foram identificadas 566 perguntas nos roteiros desses estudos. Dessas, 109 (19%) tratavam de desfechos em saúde, 93 (16%) de quantificação dos custos, 73 (13%) de modelagem, 54 (10%) de generalização dos resultados e 52 (9%) de incertezas. O roteiro de análise crítica resultante contém 32 perguntas organizadas em quatro domínios: delineamento do estudo, mensuração dos custos e dos desfechos em saúde, análise e interpretação dos resultados e informações gerais. Conclusões. O instrumento de análise crítica proposto pode auxiliar na uniformização do julgamento da qualidade da evidência de todos os tipos de avaliação econômica. Economia da saúde; saúde pública; avaliação da tecnologia biomédica; avaliação da pesquisa em saúde. resumo Palavras-chave Artículo de revisión / Review Rev Panam Salud Publica 35(3), 2014 Artículo de revisión Silva et al. • Avaliação econômica de tecnologias em saúde Silva et al. • Avaliação econômica de tecnologias em saúde Artículo de revisión
To evaluate the effectiveness and safety of correction of pectus excavatum by the Nuss technique ... more To evaluate the effectiveness and safety of correction of pectus excavatum by the Nuss technique based on the available scientific evidence. We conducted an evidence synthesis following systematic processes of search, selection, extraction and critical appraisal. Outcomes were classified by importance and had their quality assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE). The process of selection of items led to the inclusion of only one systematic review, which synthesized the results of nine observational studies comparing the Nuss and Ravitch procedures. The evidence found was rated as poor and very poor quality. The Nuss procedure has increased the incidence of hemothorax (RR = 5.15; 95% CI: 1.07; 24.89), pneumothorax (RR = 5.26; 95% CI: 1.55; 17.92) and the need for reintervention (RR = 4.88; 95% CI: 2.41; 9.88) when compared to the Ravitch. There was no statistical difference between the two procedures in outcomes: general complications...
Ao estudar um tema, frequentemente nos deparamos com resultados contraditórios. Um caminho coeren... more Ao estudar um tema, frequentemente nos deparamos com resultados contraditórios. Um caminho coerente para tentar esclarecer controvérsias é apoiar-se apenas nos estudos de melhor qualidade sobre o assunto. Partindo desse princípio, surgiu um novo delineamento de pesquisa: a revisão sistemática da literatura. Trata-se de um tipo de investigação focada em questão bem definida, que visa identificar, selecionar, avaliar e sintetizar as evidências relevantes disponíveis.
No artigo inicial desta série, discorremos sobre passos para a elaboração de revisão sistemática.... more No artigo inicial desta série, discorremos sobre passos para a elaboração de revisão sistemática. 1 Neste segundo artigo, abordaremos a fase de busca e a de seleção dos estudos.
Objective. To assess the effects of the inactivated influenza virus vaccine on influenza outcomes... more Objective. To assess the effects of the inactivated influenza virus vaccine on influenza outcomes in pregnant women and their infants. Methods. We performed a systematic review of the literature. We searched for randomized controlled trials and cohort studies in the MEDLINE, Embase, and other relevant databases (inception to September 2013). Two researchers selected studies and extracted the data independently. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the quality of the evidence. Results. We included eight studies out of 1,967 retrieved records. Influenza vaccination in pregnant women significantly reduced the incidence of influenza-like illness in mothers and their infants when compared with control groups (high-quality evidence) and reduced the incidence of laboratory-confirmed influenza in infants (moderate-quality evidence). No difference was found with regard to influenza-like illness with fever higher than 38°C (...
To assess the prevalence of medicine use in adults of Brasilia and to elucidate the associated fa... more To assess the prevalence of medicine use in adults of Brasilia and to elucidate the associated factors. A cross-sectional study was conducted with adults (18 to 65 years) living in Brasilia, who were selected using a two-stage probabilistic sampling and interviewed in their home, from February to May 2012. The primary outcome was the use of medicines in the last 7 days. A Poisson regression with robust variance was employed to adjust for covariates following a hierarchical model. The study included 1820 individuals (11% losses), 60% of which were women, and the mean age was 37 ± 12.6 years. The prevalence of drug consumption was 35.7% (95% confidence interval [95%CI]: 33.5%-37.9%). Medicine consumption was significantly higher in women (prevalence ratio [PR] = 1.54; 95%CI: 1.28-1.85); unemployed or retired people (PR = 1.35; 95%CI: 1.15-1.59); people with hypertension (PR = 2.33; 95%CI: 2.00-2.71), diabetes (PR = 1.46; 95%CI: 1.22-1.74), depression (PR = 1.32; 95%CI: 1.13-1.53), or ...
To assess the effects of problem-based learning (PBL) on the learning achievements of pharmacy st... more To assess the effects of problem-based learning (PBL) on the learning achievements of pharmacy students. We searched for controlled studies that compared PBL to traditional learning in pharmacy courses (graduate and undergraduate) in the major literature databases up to January 2014. Two independent researchers selected the studies, extracted the data, and assessed the quality of the studies. Meta-analyses of the outcomes were performed using a random effects model. From 1,988 retrieved records, five were included in present review. The studies assessed students' impressions about the PBL method and compared student grades on the midterm and final examinations. PBL students performed better on midterm examinations (odds ratio [OR] = 1.46; confidence interval [IC] 95%: 1.16, 1.89) and final examinations (OR = 1.60; IC 95%: 1.06, 2.43) compared with students in the traditional learning groups. No difference was found between the groups in the subjective evaluations. pharmacy stude...
Revista brasileira de psiquiatria (São Paulo, Brazil : 1999), 2014
To estimate the prevalence of depressive symptoms and major depressive disorder, as assessed in p... more To estimate the prevalence of depressive symptoms and major depressive disorder, as assessed in population-based cross-sectional studies of Brazilian adults. We performed a systematic review of the literature. The major databases were searched up through October 2013. Two researchers selected the studies, extracted the data, and assessed their methodological quality. Meta-analyses were performed using random effects. Of the 2,971 records retrieved, we selected 27 studies that assessed the prevalence of depression morbidity in 464,734 individuals (66% women). Eleven different screening tools were used to assess depression morbidity. The prevalence of depressive symptoms was 14% (95% confidence interval [95%CI] 13-16; I2 = 99.5%), whereas the 1-year prevalence of major depressive disorder was 8% (95%CI 7-10; I2 = 86.7%), and the lifetime prevalence of major depressive disorder was 17% (95%CI 14-19; I2 = 91.6%). All rates were higher in women than in men. No causes of heterogeneity cou...
A literature review performed by the EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup hi... more A literature review performed by the EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup highlighted deficiencies in the existing literature, especially the reporting of case studies. Although general reporting guidelines exist for case studies, there are none in the specific field of extracorporeal treatments in toxicology. Our goal was to construct and propose a checklist that systematically outlines the minimum essential items to be reported in a case study of poisoned patients undergoing extracorporeal treatments. Through a modified two-round Delphi technique, panelists (mostly chosen from the EXTRIP workgroup) were asked to vote on the pertinence of a set of items to identify those considered minimally essential for reporting complete and accurate case reports. Furthermore, independent raters validated the clarity of each selected items between each round of voting. All case reports containing data on extracorporeal treatments in poisoning published in Medline in 2011 wer...
Revista da Sociedade Brasileira de Medicina Tropical, 2013
We aimed to assess and synthesize the information available in the literature regarding the treat... more We aimed to assess and synthesize the information available in the literature regarding the treatment of American tegumentary leishmaniasis in special populations. We searched MEDLINE (via PubMed), EMBASE, LILACS, SciELO, Scopus, Cochrane Library and mRCT databases to identify clinical trials and observational studies that assessed the pharmacological treatment of the following groups of patients: pregnant women, nursing mothers, children, the elderly, individuals with chronic diseases and individuals with suppressed immune systems. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. The available evidence suggests that the treatments of choice for each population or disease entity are as follows: nursing mothers and children (meglumine antimoniate or pentamidine), patients with renal disease (amphotericin B or miltefosine), patients with heart disease (amphotericin B, miltefosine or pentamidine), immunosuppressed patients (liposomal amphotericin), the elderly (meglumine antimoniate), pregnant women (amphotericin B) and patients with liver disease (no evidence available). The quality of evidence is low or very low for all groups. Accurate controlled studies are required to fill in the gaps in evidence for treatment in special populations. Post-marketing surveillance programs could also collect relevant information to guide treatment decision-making.
The Extracorporeal Treatments In Poisoning (EXTRIP) workgroup was formed to provide recommendatio... more The Extracorporeal Treatments In Poisoning (EXTRIP) workgroup was formed to provide recommendations on the use of extracorporeal treatments (ECTR) in poisoning. Here, the workgroup presents its results for tricyclic antidepressants (TCAs). After an extensive literature search, using a predefined methodology, the subgroup responsible for this poison reviewed the articles, extracted the data, summarized findings, and proposed structured voting statements following a predetermined format. A two-round modified Delphi method was chosen to reach a consensus on voting statements and RAND/UCLA Appropriateness Method to quantify disagreement. Blinded votes were compiled, returned, and discussed in person at a meeting. A second vote determined the final recommendations. Seventy-seven articles met inclusion criteria. Only case reports, case series, and one poor-quality observational study were identified yielding a very low quality of evidence for all recommendations. Data on 108 patients, including 12 fatalities, were abstracted. The workgroup concluded that TCAs are not dialyzable and made the following recommendation: ECTR is not recommended in severe TCA poisoning (1D). The workgroup considers that poisoned patients with TCAs are not likely to have a clinical benefit from extracorporeal removal and recommends it NOT to be used in TCA poisoning.
Objective: To estimate the risk of serious adverse reactions to benzathine penicillin in pregnant... more Objective: To estimate the risk of serious adverse reactions to benzathine penicillin in pregnant women for preventing congenital syphilis.
Objective: The aim of the present study was to assess the prevalence of hypertension and cardiova... more Objective: The aim of the present study was to assess the prevalence of hypertension and cardiovascular risk factors among the native indigenous of Jaguapiru village in Dourados, Mato Grosso do Sul, Brazil.
International Journal of Technology Assessment in Health Care, 2012
Objectives: This study reports on the Brazilian experience of developing a specialized bulletin, ... more Objectives: This study reports on the Brazilian experience of developing a specialized bulletin, the Brazilian Health Technology Assessment Bulletin (BRATS), on health technology assessments (HTA). Methods: The editorial process, format, and dissemination strategy of the publication are presented. A critical appraisal of the available issues was made using the checklist for HTA reports of the International Network of Agencies for Health Technology Assessment. The initial impact was estimated based on a retrospective observational measurement of the types of publications that cite the bulletin as a source of information. The publications citing BRATS were identified using Google Scholar. Results: Since June 2008, fourteen issues of the bulletin have been produced. BRATS has not presented any significant limitation that would compromise generalizations of its results within the Brazilian context. The initial impact of the bulletin, however, has been small, which may be due to its exclusively electronic dissemination format and technical language. We found nine publications citing BRATS in Google Scholar. Conclusions: It is hoped that the bulletin will promote the continuity of HTA actions among health-sector managers and professionals in Brazil.
Objective: To estimate the prevalence of depressive symptoms and major depressive disorder, as as... more Objective: To estimate the prevalence of depressive symptoms and major depressive disorder, as assessed in population-based cross-sectional studies of Brazilian adults. Methods: We performed a systematic review of the literature. The major databases were searched up through October 2013. Two researchers selected the studies, extracted the data, and assessed their methodological quality. Meta-analyses were performed using random effects. Results: Of the 2,971 records retrieved, we selected 27 studies that assessed the prevalence of depression morbidity in 464,734 individuals (66% women). Eleven different screening tools were used to assess depression morbidity. The prevalence of depressive symptoms was 14% (95% confidence interval [95%CI] 13-16; I2 = 99.5%), whereas the 1-year prevalence of major depressive disorder was 8% (95%CI 7-10; I2 = 86.7%), and the lifetime prevalence of major depressive disorder was 17% (95%CI 14-19; I2 = 91.6%). All rates were higher in women than in men. No causes of heterogeneity could be identified. Conclusion: Depression morbidity was common among Brazilian adults, and affects more women than men. Inconsistencies across studies highlight the need for standardization of future research. Clinicians should routinely investigate for the presence of depression morbidity in this population.
Aim. The aim of this study was to estimate the prevalence of diabetes and its associated risk fac... more Aim. The aim of this study was to estimate the prevalence of diabetes and its associated risk factors in adults from Brasilia, Brazil. Methods. The present cross-sectional population-based study consisted of interviews with individuals aged 18-65 years. Participants were selected through two-stage probability sampling by clusters and stratified by sex and age. Demographic and clinical data were collected directly with participants from February to May 2012. Self-reported diabetes prevalence was calculated at a 95% confidence interval (CI). Prevalence ratios (PR) were adjusted by Poisson regression with robust variance. Results. In all, 1,820 individuals were interviewed. Diabetes prevalence in the adult population of Brasilia was 10.1% (95% CI, 8.5%-11.6%). Variables associated with diabetes were an age between 35 and 49 years (PR = 1.83; 95% CI, 1.19-2.82) or 50 and 65 years (PR = 1.95; 95% CI, 1.17-3.23), hypertension (PR = 4.04; 95% CI, 2.66-6.13), respiratory disease (PR = 1.67;...
International Journal of Technology Assessment in Health Care
The aim of this study was to summarize and assess economic evaluations of poison centers (PCs) fr... more The aim of this study was to summarize and assess economic evaluations of poison centers (PCs) from the perspectives of society, the payer, and the healthcare system. A systematic review was performed to identify complete economic evaluations regardless of the language or publication status. Two reviewers evaluated the abstracts for eligibility, extracted the data, and assessed the study quality using a standardized tool. In total, 422 non-duplicated studies were retrieved, but only nine met the eligibility criteria. Five of the eligible studies were published in the 1990s, and four were published in the 2000s. Six studies met at least seven of ten quality criteria. In all studies, the presence of PCs was compared with a scenario of their absence. Eight studies used cost-benefit analyses and one used a cost-effectiveness approach. The cost-benefit ratios ranged from 0.76 to 7.67, which indicates that each United States dollar (USD) spent on poison centers can save almost 8 USD on me...
To propose a tool for critical analysis of economic evaluation studies based on a synthesis of ch... more To propose a tool for critical analysis of economic evaluation studies based on a synthesis of checklists and guidelines available in the literature. The following databases were searched: MEDLINE, Embase, Centre for Reviews and Dissemination, and International Society for Pharmacoeconomics and Outcomes Research. Two investigators independently selected the studies and extracted the data of interest. The number of questions that the checklists contained were counted on the following domains: study design, measurement of costs and health outcomes, analysis and interpretation of results, and general information. A matrix containing the items in each domain was constructed, and a tool for critical analysis was built based on that matrix. The literature search retrieved 406 non-duplicated articles, 19 of which were included in the study. Five hundred sixty-six questions were identified in the checklists employed in these studies: 109 (19%) dealt with health outcomes, 93 (16%) with quant...
Objetivo. Propor uma ferramenta para análise crítica de estudos de avaliação econômica a partir d... more Objetivo. Propor uma ferramenta para análise crítica de estudos de avaliação econômica a partir da síntese de roteiros existentes na literatura. Métodos. Foram realizadas buscas em: MEDLINE, Embase, Centre for Reviews and Dissemination e International Society for Pharmacoeconomics and Outcomes Research. Dois pesquisadores selecionaram independentemente os estudos e extraíram os dados de interesse. Quantificou-se o número de perguntas que os roteiros continham sobre os seguintes domínios: delineamento do estudo; mensuração dos custos e dos desfechos em saúde; análise e interpretação dos resultados; e informações gerais. Após elaboração da matriz contendo os itens de cada domínio por estudo, os autores construíram um instrumento para análise crítica. Resultados. Foram localizados 406 artigos não duplicados, dos quais 19 foram incluídos. No total, foram identificadas 566 perguntas nos roteiros desses estudos. Dessas, 109 (19%) tratavam de desfechos em saúde, 93 (16%) de quantificação dos custos, 73 (13%) de modelagem, 54 (10%) de generalização dos resultados e 52 (9%) de incertezas. O roteiro de análise crítica resultante contém 32 perguntas organizadas em quatro domínios: delineamento do estudo, mensuração dos custos e dos desfechos em saúde, análise e interpretação dos resultados e informações gerais. Conclusões. O instrumento de análise crítica proposto pode auxiliar na uniformização do julgamento da qualidade da evidência de todos os tipos de avaliação econômica. Economia da saúde; saúde pública; avaliação da tecnologia biomédica; avaliação da pesquisa em saúde. resumo Palavras-chave Artículo de revisión / Review Rev Panam Salud Publica 35(3), 2014 Artículo de revisión Silva et al. • Avaliação econômica de tecnologias em saúde Silva et al. • Avaliação econômica de tecnologias em saúde Artículo de revisión
To evaluate the effectiveness and safety of correction of pectus excavatum by the Nuss technique ... more To evaluate the effectiveness and safety of correction of pectus excavatum by the Nuss technique based on the available scientific evidence. We conducted an evidence synthesis following systematic processes of search, selection, extraction and critical appraisal. Outcomes were classified by importance and had their quality assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE). The process of selection of items led to the inclusion of only one systematic review, which synthesized the results of nine observational studies comparing the Nuss and Ravitch procedures. The evidence found was rated as poor and very poor quality. The Nuss procedure has increased the incidence of hemothorax (RR = 5.15; 95% CI: 1.07; 24.89), pneumothorax (RR = 5.26; 95% CI: 1.55; 17.92) and the need for reintervention (RR = 4.88; 95% CI: 2.41; 9.88) when compared to the Ravitch. There was no statistical difference between the two procedures in outcomes: general complications...
Ao estudar um tema, frequentemente nos deparamos com resultados contraditórios. Um caminho coeren... more Ao estudar um tema, frequentemente nos deparamos com resultados contraditórios. Um caminho coerente para tentar esclarecer controvérsias é apoiar-se apenas nos estudos de melhor qualidade sobre o assunto. Partindo desse princípio, surgiu um novo delineamento de pesquisa: a revisão sistemática da literatura. Trata-se de um tipo de investigação focada em questão bem definida, que visa identificar, selecionar, avaliar e sintetizar as evidências relevantes disponíveis.
No artigo inicial desta série, discorremos sobre passos para a elaboração de revisão sistemática.... more No artigo inicial desta série, discorremos sobre passos para a elaboração de revisão sistemática. 1 Neste segundo artigo, abordaremos a fase de busca e a de seleção dos estudos.
Objective. To assess the effects of the inactivated influenza virus vaccine on influenza outcomes... more Objective. To assess the effects of the inactivated influenza virus vaccine on influenza outcomes in pregnant women and their infants. Methods. We performed a systematic review of the literature. We searched for randomized controlled trials and cohort studies in the MEDLINE, Embase, and other relevant databases (inception to September 2013). Two researchers selected studies and extracted the data independently. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the quality of the evidence. Results. We included eight studies out of 1,967 retrieved records. Influenza vaccination in pregnant women significantly reduced the incidence of influenza-like illness in mothers and their infants when compared with control groups (high-quality evidence) and reduced the incidence of laboratory-confirmed influenza in infants (moderate-quality evidence). No difference was found with regard to influenza-like illness with fever higher than 38°C (...
To assess the prevalence of medicine use in adults of Brasilia and to elucidate the associated fa... more To assess the prevalence of medicine use in adults of Brasilia and to elucidate the associated factors. A cross-sectional study was conducted with adults (18 to 65 years) living in Brasilia, who were selected using a two-stage probabilistic sampling and interviewed in their home, from February to May 2012. The primary outcome was the use of medicines in the last 7 days. A Poisson regression with robust variance was employed to adjust for covariates following a hierarchical model. The study included 1820 individuals (11% losses), 60% of which were women, and the mean age was 37 ± 12.6 years. The prevalence of drug consumption was 35.7% (95% confidence interval [95%CI]: 33.5%-37.9%). Medicine consumption was significantly higher in women (prevalence ratio [PR] = 1.54; 95%CI: 1.28-1.85); unemployed or retired people (PR = 1.35; 95%CI: 1.15-1.59); people with hypertension (PR = 2.33; 95%CI: 2.00-2.71), diabetes (PR = 1.46; 95%CI: 1.22-1.74), depression (PR = 1.32; 95%CI: 1.13-1.53), or ...
To assess the effects of problem-based learning (PBL) on the learning achievements of pharmacy st... more To assess the effects of problem-based learning (PBL) on the learning achievements of pharmacy students. We searched for controlled studies that compared PBL to traditional learning in pharmacy courses (graduate and undergraduate) in the major literature databases up to January 2014. Two independent researchers selected the studies, extracted the data, and assessed the quality of the studies. Meta-analyses of the outcomes were performed using a random effects model. From 1,988 retrieved records, five were included in present review. The studies assessed students' impressions about the PBL method and compared student grades on the midterm and final examinations. PBL students performed better on midterm examinations (odds ratio [OR] = 1.46; confidence interval [IC] 95%: 1.16, 1.89) and final examinations (OR = 1.60; IC 95%: 1.06, 2.43) compared with students in the traditional learning groups. No difference was found between the groups in the subjective evaluations. pharmacy stude...
Revista brasileira de psiquiatria (São Paulo, Brazil : 1999), 2014
To estimate the prevalence of depressive symptoms and major depressive disorder, as assessed in p... more To estimate the prevalence of depressive symptoms and major depressive disorder, as assessed in population-based cross-sectional studies of Brazilian adults. We performed a systematic review of the literature. The major databases were searched up through October 2013. Two researchers selected the studies, extracted the data, and assessed their methodological quality. Meta-analyses were performed using random effects. Of the 2,971 records retrieved, we selected 27 studies that assessed the prevalence of depression morbidity in 464,734 individuals (66% women). Eleven different screening tools were used to assess depression morbidity. The prevalence of depressive symptoms was 14% (95% confidence interval [95%CI] 13-16; I2 = 99.5%), whereas the 1-year prevalence of major depressive disorder was 8% (95%CI 7-10; I2 = 86.7%), and the lifetime prevalence of major depressive disorder was 17% (95%CI 14-19; I2 = 91.6%). All rates were higher in women than in men. No causes of heterogeneity cou...
A literature review performed by the EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup hi... more A literature review performed by the EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup highlighted deficiencies in the existing literature, especially the reporting of case studies. Although general reporting guidelines exist for case studies, there are none in the specific field of extracorporeal treatments in toxicology. Our goal was to construct and propose a checklist that systematically outlines the minimum essential items to be reported in a case study of poisoned patients undergoing extracorporeal treatments. Through a modified two-round Delphi technique, panelists (mostly chosen from the EXTRIP workgroup) were asked to vote on the pertinence of a set of items to identify those considered minimally essential for reporting complete and accurate case reports. Furthermore, independent raters validated the clarity of each selected items between each round of voting. All case reports containing data on extracorporeal treatments in poisoning published in Medline in 2011 wer...
Revista da Sociedade Brasileira de Medicina Tropical, 2013
We aimed to assess and synthesize the information available in the literature regarding the treat... more We aimed to assess and synthesize the information available in the literature regarding the treatment of American tegumentary leishmaniasis in special populations. We searched MEDLINE (via PubMed), EMBASE, LILACS, SciELO, Scopus, Cochrane Library and mRCT databases to identify clinical trials and observational studies that assessed the pharmacological treatment of the following groups of patients: pregnant women, nursing mothers, children, the elderly, individuals with chronic diseases and individuals with suppressed immune systems. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. The available evidence suggests that the treatments of choice for each population or disease entity are as follows: nursing mothers and children (meglumine antimoniate or pentamidine), patients with renal disease (amphotericin B or miltefosine), patients with heart disease (amphotericin B, miltefosine or pentamidine), immunosuppressed patients (liposomal amphotericin), the elderly (meglumine antimoniate), pregnant women (amphotericin B) and patients with liver disease (no evidence available). The quality of evidence is low or very low for all groups. Accurate controlled studies are required to fill in the gaps in evidence for treatment in special populations. Post-marketing surveillance programs could also collect relevant information to guide treatment decision-making.
The Extracorporeal Treatments In Poisoning (EXTRIP) workgroup was formed to provide recommendatio... more The Extracorporeal Treatments In Poisoning (EXTRIP) workgroup was formed to provide recommendations on the use of extracorporeal treatments (ECTR) in poisoning. Here, the workgroup presents its results for tricyclic antidepressants (TCAs). After an extensive literature search, using a predefined methodology, the subgroup responsible for this poison reviewed the articles, extracted the data, summarized findings, and proposed structured voting statements following a predetermined format. A two-round modified Delphi method was chosen to reach a consensus on voting statements and RAND/UCLA Appropriateness Method to quantify disagreement. Blinded votes were compiled, returned, and discussed in person at a meeting. A second vote determined the final recommendations. Seventy-seven articles met inclusion criteria. Only case reports, case series, and one poor-quality observational study were identified yielding a very low quality of evidence for all recommendations. Data on 108 patients, including 12 fatalities, were abstracted. The workgroup concluded that TCAs are not dialyzable and made the following recommendation: ECTR is not recommended in severe TCA poisoning (1D). The workgroup considers that poisoned patients with TCAs are not likely to have a clinical benefit from extracorporeal removal and recommends it NOT to be used in TCA poisoning.
Objective: To estimate the risk of serious adverse reactions to benzathine penicillin in pregnant... more Objective: To estimate the risk of serious adverse reactions to benzathine penicillin in pregnant women for preventing congenital syphilis.
Objective: The aim of the present study was to assess the prevalence of hypertension and cardiova... more Objective: The aim of the present study was to assess the prevalence of hypertension and cardiovascular risk factors among the native indigenous of Jaguapiru village in Dourados, Mato Grosso do Sul, Brazil.
International Journal of Technology Assessment in Health Care, 2012
Objectives: This study reports on the Brazilian experience of developing a specialized bulletin, ... more Objectives: This study reports on the Brazilian experience of developing a specialized bulletin, the Brazilian Health Technology Assessment Bulletin (BRATS), on health technology assessments (HTA). Methods: The editorial process, format, and dissemination strategy of the publication are presented. A critical appraisal of the available issues was made using the checklist for HTA reports of the International Network of Agencies for Health Technology Assessment. The initial impact was estimated based on a retrospective observational measurement of the types of publications that cite the bulletin as a source of information. The publications citing BRATS were identified using Google Scholar. Results: Since June 2008, fourteen issues of the bulletin have been produced. BRATS has not presented any significant limitation that would compromise generalizations of its results within the Brazilian context. The initial impact of the bulletin, however, has been small, which may be due to its exclusively electronic dissemination format and technical language. We found nine publications citing BRATS in Google Scholar. Conclusions: It is hoped that the bulletin will promote the continuity of HTA actions among health-sector managers and professionals in Brazil.
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Papers by Tais Galvao
Methods: We performed a systematic review of the literature. The major databases were searched up through October 2013. Two researchers selected the studies, extracted the data, and assessed their methodological quality. Meta-analyses were performed using random effects.
Results: Of the 2,971 records retrieved, we selected 27 studies that assessed the prevalence of depression morbidity in 464,734 individuals (66% women). Eleven different screening tools were used to assess depression morbidity. The prevalence of depressive symptoms was 14% (95% confidence interval [95%CI] 13-16; I2 = 99.5%), whereas the 1-year prevalence of major depressive disorder was 8% (95%CI 7-10; I2 = 86.7%), and the lifetime prevalence of major depressive disorder was 17% (95%CI 14-19; I2 = 91.6%). All rates were higher in women than in men. No causes of heterogeneity could be identified.
Conclusion: Depression morbidity was common among Brazilian adults, and affects more women than men. Inconsistencies across studies highlight the need for standardization of future research. Clinicians should routinely investigate for the presence of depression morbidity in this population.
Methods: We performed a systematic review of the literature. The major databases were searched up through October 2013. Two researchers selected the studies, extracted the data, and assessed their methodological quality. Meta-analyses were performed using random effects.
Results: Of the 2,971 records retrieved, we selected 27 studies that assessed the prevalence of depression morbidity in 464,734 individuals (66% women). Eleven different screening tools were used to assess depression morbidity. The prevalence of depressive symptoms was 14% (95% confidence interval [95%CI] 13-16; I2 = 99.5%), whereas the 1-year prevalence of major depressive disorder was 8% (95%CI 7-10; I2 = 86.7%), and the lifetime prevalence of major depressive disorder was 17% (95%CI 14-19; I2 = 91.6%). All rates were higher in women than in men. No causes of heterogeneity could be identified.
Conclusion: Depression morbidity was common among Brazilian adults, and affects more women than men. Inconsistencies across studies highlight the need for standardization of future research. Clinicians should routinely investigate for the presence of depression morbidity in this population.