Luz Gibbons

Inequities in the use of cesarean section deliveries in the world

OBJECTIVE The purpose of this study was to describe the unequal distribution in the performance of cesarean section delivery (CS) in the world and the resource-use implications of such inequity. STUDY DESIGN We obtained data on the number of CSs performed in 137 countries in 2008. The consensus is that countries should achieve a 10% rate of CS; therefore, for countries that are below that rate, we calculated the cost to achieve a 10% rate. For countries with a CS rate of >15%, we calculated the savings that could be made by the achievement of a 15% rate. RESULTS Fifty-four countries had CS rates of <10%, whereas 69 countries showed rates of >15%. The cost of the global saving by a reduction of CS rates to 15% was estimated to be

Women's preference for caesarean section: a systematic review and meta-analysis of observational studies

2.32 billion (US dollars); the cost to attain a 10% CS rate was

Argentine Valuation of the EQ-5D Health States

432 million (US dollars). CONCLUSION CSs that are potentially medically unjustified appear to command a disproportionate share of global economic resources.

Prepregnancy weight status and the risk of adverse pregnancy outcome

Please cite this paper as: Mazzoni A, Althabe F, Liu N, Bonotti A, Gibbons L, Sánchez A, Belizán J. Women’s preference for caesarean section: a systematic review and meta‐analysis of observational studies. BJOG 2011;118:391–399.

Type-Specific HPV Prevalence in Cervical Cancer and High-Grade Lesions in Latin America and the Caribbean: Systematic Review and Meta-Analysis

OBJECTIVE To develop a set of health state values based on EuroQol EQ-5D instrument for the Argentine general population. METHODS Consecutive subjects attending six primary care centers in Argentina were selected based on quota sampling and were interviewed using the EuroQol Group protocol for measurement and valuation of health studies. Initially, the respondents were randomly assigned a unique card set; however, to improve efficiency, the subjects were later randomly assigned to one of three fixed sets of EQ-5D states. Using the visual analog scale (VAS) and time-trade off (TTO) responses for these states, we estimated a valuation model using ordinary least squares regression clustered by respondent. Predicted values for EQ-5D health states are compared with published values for the United States. RESULTS Six hundred eleven subjects were interviewed by 14 trained interviewers, rendering 6887 TTO and 6892 VAS responses. The model had an R(2) of 0.897 and 0.928 for TTO and VAS, respectively. The mean absolute difference between observed and predicted values was 0.039 for TTO and 0.020 for VAS, each showing a Lins concordance coefficient more than 0.98. Argentine and US TTO-predicted values were highly correlated (Pearsons rho = 0.963), although the average absolute difference was clinically meaningful (0.06), rejecting the US values for nearly two-thirds of the states (62.8%). The Argentine population placed lower values on mild states and higher values on severe states. CONCLUSION This study provides an Argentine value set that could be used locally or regionally, with meaningful and significant differences with that of the United States. Health policy in Latin America must incorporate local values for sovereignty and validity.

Estimation of the burden of cardiovascular disease attributable to modifiable risk factors and cost-effectiveness analysis of preventative interventions to reduce this burden in Argentina

Objective. To examine the association between maternal pre‐pregnancy weight status and the risk of stillbirth, pre‐eclampsia and preterm delivery. Design. Hospital‐based cohort study using prospectively recorded data. Setting. Ten public hospitals in Buenos Aires, Argentina. Population. 46,964 pregnant women who had a delivery during 2003–2006. Methods. Prepregnancy body mass index (BMI) was used to categorize women in four weight categories from underweight to obese. The reference group were women with BMI between 18.5 and 24.9. Crude and adjusted odds ratios were calculated using multiple logistic regression analysis. Main Outcome. Preterm birth, pre‐eclampsia and stillbirth. Results. The risk of preterm delivery decreased with increasing BMI, with the highest risk among underweight women (OR: 1.45; 95% CI: 1.26–1.67), and the lowest risk among the overweight. The risk of pre‐eclampsia was highest among overweight (OR: 1.55; 95%CI: 1.30–1.86) and obese women (OR: 3.10; 95%CI: 2.54–3.78). Obese or overweight women did not have an increased risk of stillbirth in this study. Conclusions. Overweight and obese women have an increased risk for pre‐eclampsia, while underweight women have an increased risk for preterm delivery. There is a high prevalence of overweight women in the obstetric population in Buenos Aires.

Interest of pregnant women in the use of SMS (short message service) text messages for the improvement of perinatal and postnatal care

Background Cervical cancer is a major public health problem in Latin America and the Caribbean (LA&C), showing some of the highest incidence and mortality rates worldwide. Information on HPV type distribution in high-grade cervical lesions (HSIL) and invasive cervical cancer (ICC) is crucial to predict the future impact of HPV16/18 vaccines and screening programmes, and to establish an appropriate post-vaccinal virologic surveillance. The aim was to assess the prevalence of HPV types in HSIL and ICC in studies in LA&C. Methods and Findings We performed a systematic review, following the MOOSE guidelines for systematic reviews of observational studies, and the PRISMA statement for reporting systematic reviews and meta-analyses. Inclusion criteria were at least ten cases of HSIL/ICC, and HPV-type elicitation. The search, without language restrictions, was performed in MEDLINE, Cochrane Library, EMBASE, LILACS from inception date to December 2009, proceedings, reference lists and consulting experts. A meta-analysis was performed using arc-sine transformations to stabilize the variance of simple proportions. Seventy-nine studies from 18 countries were identified, including 2446 cases of HSIL and 5540 of ICC. Overall, 46.5% of HSIL cases harbored HPV 16 and 8.9% HPV18; in ICC, 53.2% of cases harbored HPV 16 and13.2% HPV 18. The next five most common types, in decreasing frequency, were HPV 31, 58, 33, 45, and 52. Studys limitations comprise the cross-sectional design of most included studies and their inherent risk of bias, the lack of representativeness, and variations in the HPV type-specific sensitivity of different PCR protocols. Conclusions This study is the broadest summary of HPV type distribution in HSIL and ICC in LA&C to date. These data are essential for local decision makers regarding HPV screening and vaccination policies. Continued HPV surveillance would be useful, to assess the potential for changing type-specific HPV prevalence in the post-vaccination era in Latin America.

TLR4 genotype and environmental LPS mediate RSV bronchiolitis through Th2 polarization

BackgroundCardiovascular disease (CVD) is the primary cause of mortality and morbidity in Argentina representing 34.2% of deaths and 12.6% of potential years of life lost (PYLL). The aim of the study was to estimate the burden of acute coronary heart disease (CHD) and stroke and the cost-effectiveness of preventative population-based and clinical interventions.MethodsAn epidemiological model was built incorporating prevalence and distribution of high blood pressure, high cholesterol, hyperglycemia, overweight and obesity, smoking, and physical inactivity, obtained from the Argentine Survey of Risk Factors dataset. Population Attributable Fraction (PAF) of each risk factor was estimated using relative risks from international sources. Total fatal and non-fatal events, PYLL and Disability Adjusted Life Years (DALY) were estimated. Costs of event were calculated from local utilization databases and expressed in international dollars (I

Adverse maternal and perinatal outcomes in adolescent pregnancies: The Global Network’s Maternal Newborn Health Registry study

). Incremental cost-effectiveness ratios (ICER) were estimated for six interventions: reducing salt in bread, mass media campaign to promote tobacco cessation, pharmacological therapy of high blood pressure, pharmacological therapy of high cholesterol, tobacco cessation therapy with bupropion, and a multidrug strategy for people with an estimated absolute risk > 20% in 10 years.ResultsAn estimated total of 611,635 DALY was lost due to acute CHD and stroke for 2005. Modifiable risk factors explained 71.1% of DALY and more than 80% of events. Two interventions were cost-saving: lowering salt intake in the population through reducing salt in bread and multidrug therapy targeted to persons with an absolute risk above 20% in 10 years; three interventions had very acceptable ICERs: drug therapy for high blood pressure in hypertensive patients not yet undergoing treatment (I

Differential Gender Response to Respiratory Infections and to the Protective Effect of Breast Milk in Preterm Infants

2,908 per DALY saved), mass media campaign to promote tobacco cessation amongst smokers (I