Manuel Espinoza

Prioridades regionales y nacionales de investigación en salud, Perú 2010-2014: un proceso con enfoque participativo y descentralista

Peru has performed many efforts to identify national health research priorities since 1974 through processes historically planned based on expert opinions, with little impact. It was decided to generate a change in the management of research in order to overcome the weaknesses of the previous processes, applying a methodology with a participative and decentralized approach. In order to establish the regional and national research priorities of the key stakeholders, the Instituto Nacional de Salud (Peru) developed a process of citizenship consult through three phases i) advocacy and workshops in 20 regions; ii) a workshop for the analysis of the Concerted National Health Plan with 200 experts in Lima; iii) the national forum, with 500 representatives in 50 working tables. The research priorities of Peru for the period 2010- 2014 are: research to recognize the problems of health human resources, to recognize the mental health problems, impact evaluations of the social programs for reduction of children malnutrition, impact evaluation of social programs of the actual interventions in maternal mortality and operative research and impact evaluation of interventions in communicable diseases.

The Value of Heterogeneity for Cost-Effectiveness Subgroup Analysis Conceptual Framework and Application

This article develops a general framework to guide the use of subgroup cost-effectiveness analysis for decision making in a collectively funded health system. In doing so, it addresses 2 key policy questions, namely, the identification and selection of subgroups, while distinguishing 2 sources of potential value associated with heterogeneity. These are 1) the value of revealing the factors associated with heterogeneity in costs and outcomes using existing evidence (static value) and 2) the value of acquiring further subgroup-related evidence to resolve the uncertainty given the current understanding of heterogeneity (dynamic value). Consideration of these 2 sources of value can guide subgroup-specific treatment decisions and inform whether further research should be conducted to resolve uncertainty to explain variability in costs and outcomes. We apply the proposed methods to a cost-effectiveness analysis for the management of patients with acute coronary syndrome. This study presents the expected net benefits under current and perfect information when subgroups are defined based on the use and combination of 6 binary covariates. The results of the case study confirm the theoretical expectations. As more subgroups are considered, the marginal net benefit gains obtained under the current information show diminishing marginal returns, and the expected value of perfect information shows a decreasing trend. We present a suggested algorithm that synthesizes the results to guide policy.

Avances y retos en la construcción del sistema nacional de investigación en salud en el Perú

The objective of this paper is to present the situational status of the National Health Research System of Peru (NHRS), the lessons learnt during the building process, the opportunities to improve it and the challenges. A description of the functions of the peruvian NHRS is done, in relation to governance, legal framework, research priorities, funding, creation and sustainability of resources and research production and utilization. It describes that in Peru we excert governance in research, we count with regulations, policy and research priorities, these last developed in the framework of a partipatory, inclusive process. The conclusion reached is that the challenges of the peruvian NHRS are to consolidate the governance and to develop the mechanisms to articulate the stakeholders involved in research, to improve the resources allocation for research and innovation, to ellaborate a plan for the development of human resources dedicated to research, to develop institutions and regional competences in order to perform research, and to link research in order to solve problems and make national research policies sustainable.

The Link Between Information and Communication Technologies and Global Public Health: Pushing Forward

.Global public health (GPH) continues to be a challenging field. It focuses on health-related issues that transcend national boundaries and thus requires global cooperation for implementing solutions to public health problems. Information and communication technologies (ICTs) have the potential to contribute to GPH by improving the quality of healthcare services. The purpose of this commentary article is to discuss the nature and characteristics of the existing link between ICTs and GPH. The key underlying questions discussed in this article are (a) whether ICTs can truly reduce the burden of current GPH problems and (b) how to effectively achieve it. We selected three widely recognized GPH challenges: diarrheal disease among children under 5 years old, malaria, and type 2 diabetes mellitus. These are considered to be examples of salient global issues that, despite the availability of cost-effective preventive and therapeutic interventions, still remain a major burden of morbidity and mortality worldwide. We conclude that there is a growing global interest in ICT-related solutions in GPH. We recommend the development of more transparent frameworks, more theory-informed solutions, and clearer translational links between ICTs and GPH matters. Ten further specific recommendations are also discussed in this article.

Un índice neutrófilo/linfocito elevado se asocia a peor pronóstico en cáncer de colon etapa II resecado

The neutrophil/lymphocyte ratio is an effective marker of inflammation and can have prognostic value in surgical patients. Aim: To evaluate the effect of an increased neutrophil/lymphocyte ratio (NLR) on perioperative complications ana overall ana disease-free survival in patients undergoing elective resection for stage II colon cancer. Material and Methods: Data was obtained from clinical charts, preoperative blood results and hospital records of all patients undergoing an elective curative resection for colon cancer, between 2000 and 2007. Preoperative NLR was calculated. Follow-up was obtained from a prospectively maintained colorectal cancer database, clinical records and questionnaires. Uni and multivariable analysis were performed to identify associations, and survival analysis was performed using Kaplan-Meier curves. Results: One hundred twenty two patients with a mean age of 69years (52% males), were evaluated. Median follow-up was 73 months, and overall survival for 1 and 5 years was 95% and 68%, respectively. On a multivariable analysis after adjusting for age, sex, tumor depth invasion, use of adjuvant therapies and American Society of Anesthesiology preoperative risk score, an NLR > 5 was associated with an increased perioperative complication rate (odds ratio: 3,06, p = 0,033). Kaplan-Meier survival analysis showed a worse overall and disease-free survival for patients with NLR greater than five. Conclusions: A preoperative NLR of five or more is associated with greater perioperative morbidity and worse oncological outcomes in patients undergoing resection for elective stage II colon cancerBACKGROUND The neutrophil/lymphocyte ratio is an effective marker of inflammation ana can have prognostic value in surgical patients. AIM To evaluate the effect of an increased neutrophil/lymphocyte ratio (NLR) on perioperative complications ana overall ana disease-free survival in patients undergoing elective resection for stage II colon cancer. MATERIAL AND METHODS Data was obtained from clinical charts, preoperative blood results and hospital records of all patients undergoing an elective curative resection for colon cancer, between 2000 and 2007. Preoperative NLR was calculated. Follow-up was obtained from a prospectively maintained colorectal cancer database, clinical records and questionnaires. Uni and multivariable analysis were performed to identify associations, and survival analysis was performed using Kaplan-Meier curves. RESULTS One hundred twenty two patients with a mean age of 69 years (52% males), were evaluated. Median follow-up was 73 months, and overall survival for 1 and 5 years was 95% and 68%, respectively. On a multivariable analysis after adjusting for age, sex, tumor depth invasion, use of adjuvant therapies and American Society of Anesthesiology preoperative risk score, an NLR > 5 was associated with an increased perioperative complication rate (odds ratio: 3.06, p = 0.033). Kaplan-Meier survival analysis showed a worse overall and disease-free survival for patients with NLR greater than five. CONCLUSIONS A preoperative NLR of five or more is associated with greater perioperative morbidity and worse oncological outcomes in patients undergoing resection for elective stage II colon cancer.

¿Cómo se ha medido la posición social en investigación en salud?: una revisión de la literatura internacional

Social status (SS) is a multidimensional variable that is used widely in health research. There is no single optimal method for estimating social status. Rather, in each case the measurement may vary depending on the research subject, the base theory considered, the population of interest, the event of interest and, in some cases, the available information. This literature review develops the following topics related to SS measurement, based on the international scientific sources available electronically: i) identification of the role of SS in the context of social epidemiology research, ii) description of the principal indicators and methodological approaches used to measure SS in health research, and iii) analysis of the distinct difficulties of SS measurement in specific populations such as ethnic groups, women, children, the elderly, and in rural vs. urban contexts. The review finally makes it possible to describe some of the implications of SS measurement in Latin American countries.

Cost Effectiveness of Daclatasvir/Asunaprevir Versus Peginterferon/Ribavirin and Protease Inhibitors for the Treatment of Hepatitis c Genotype 1b Naïve Patients in Chile

Introduction Daclatasvir and Asunaprevir (DCV/ASV) have recently been approved for the treatment of chronic hepatitis C virus infection. In association, they are more effective and safer than previous available treatments, but more expensive. It is unclear if paying for the additional costs is an efficient strategy considering limited resources. Methods A Markov model was built to estimate the expected costs in Chilean pesos (CL

SOUTH AMERICAN COLLABORATION IN SCIENTIFIC PUBLICATIONS ON LEISHMANIASIS: BIBLIOMETRIC ANALYSIS IN SCOPUS (2000-2011)

) and converted to US dollars (US

La investigación traslacional y su aporte para la toma de decisiones en políticas de salud

) and benefits in quality adjusted life years (QALYs) in a hypothetic cohort of naive patients receiving DCV/ASV compared to protease inhibitors (PIs) and Peginterferon plus Ribavirin (PR). Efficacy was obtained from a mixed-treatment comparison study and costs were estimated from local sources. Utilities were obtained applying the EQ-5D survey to local patients and then valued with the Chilean tariff. A time horizon of 46 years and a discount rate of 3% for costs and outcomes was considered. The ICERs were estimated for a range of DCV/ASV prices. Deterministic and probabilistic sensitivity analyses were performed. Results PIs were extendedly dominated by DCV/ASV. The ICER of DCV/ASV compared to PR was US

Did Socioeconomic Inequality in Self-Reported Health in Chile Fall after the Equity-Based Healthcare Reform of 2005? A Concentration Index Decomposition Analysis.

16,635/QALY at a total treatment price of US