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The Federal District in Brazil has about 2.9 million inhabitants and the public health system is focused on medical specialties, with one university hospital and twenty regional hospitals. This ecosystem is favorable for fostering health technology assessment (HTA) to improve the efficiency and effectiveness of health care. The objective was to identify institutions that could form a HTA network to support decision-oriented evidence in the public health system.
Stakeholders from the hospitals and training/research institutions in the Federal District were surveyed. An online questionnaire (Google Docs) was developed to identify the potential and capacity of institutions to analyze or produce clinical and economic evidence. Two HTA seminars were held to spread knowledge about HTA and to encourage stakeholders to complete the survey.
The questionnaire response rate was thirty-five percent (25/70). Fifteen institutions were cited by the respondents as having the potential to build a HTA network. Twelve of the institutions produced rapid reviews and clinical guidelines, but only three of these had an organized priority setting process or produced assessments at the request of the hospital manager. The challenges identified were training and willingness of decision makers to organize HTA units in the hospitals.
An executive group was created which defined a strategy to support the implementation of HTA units as part of the HTA National Network (REBRATS). A regulation proposal was also created to encourage decision makers to activate a HTA network in the Federal District.
São Paulo city in Brazil has implemented social and health care for homeless people with pulmonary tuberculosis since 2007. We conducted a health technology assessment (HTA) of the interventions provided based on a national theoretical model using 2015 data and an overview of systematic reviews. The HTA was requested by national policymakers. The results demonstrated that the interventions for pulmonary tuberculosis were satisfactory. The municipal secretariat implemented actions to improve the national treatment recommendations and adopted incentives to increase adherence to treatments. Our objective was to describe the feedback process for the Health Secretariat.
The feedback was categorized as: (i) an executive abstract with key messages (i.e. ninety-seven percent of notified cases underwent sputum smears, nineteen percent were hospitalized, and fifty-nine percent were cured) reported to policymakers involved in the surveillance program; and (ii) three meetings were organized jointly by the research group and local policymakers.
In 2016 we conducted a meeting to present the results. Thirty-nine professionals involved in the primary care team working on the streets (thirty-five percent) and the Tuberculosis Surveillance and Control Program (five percent) were present. The main barriers presented by the professionals were issues of human resources (i.e. suboptimal professional staff and having two different social organizations responsible for health care). The main facilitators presented by professionals were: (i) using homeless-peers as healthcare workers; (ii) having a network linking the primary care and surveillance programs; and (iii) periodic training.
In addition to the positive results, the HTA presented an opportunity to discuss the sustainability of incentives for adhering to treatments adopted by the policymakers, such as meal allowances and housing support, to improve social conditions among the homeless.
The aim of the present study was to examine the association between nutritional status and the incidence of disability regarding instrumental activities of daily living (IADL) among older adults.
The study is part of the longitudinal SABE (Saúde, Bem-Estar e Envelhecimento; Health, Wellbeing and Ageing) Study that began in 2000 (first wave) with a multistage, clustered, probabilistic sample (n 2143) of older adults (≥60 years). The second wave was carried out in 2006, when 1115 elders were re-interviewed. The dependent variable was the occurrence of disability in 2006 (report of difficulty on ≥1 IADL). Nutritional status (measured at baseline) was classified on the basis of BMI: ≤23·0 kg/m2 (underweight); >23·0 and <28·0 kg/m2 (ideal range – reference); ≥28·0 and <30·0 kg/m2 (overweight); and ≥30·0 kg/m2 (obesity).
São Paulo, Brazil.
One thousand and thirty-four individuals without difficulties regarding IADL in 2000 were selected, 611 of whom were re-interviewed in 2006.
In the multiple logistic regression analysis adjusted for baseline variables (gender, age, number of chronic diseases, stroke, osteoarthritis and cognitive status), underweight (OR = 2·03; P = 0·034) and obesity (OR = 1·79; P = 0·022) remained associated with disability.
Both underweight and obesity are associated with an increased risk of developing disability regarding IADL among older adults, in an independent fashion of other risk factors. Thus, adequate nutritional status is a key point to consider in the establishment of preventive measures.
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