Browsing by Author "Rada, Gabriel"

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    Alma-Ata: Rebirth and revision 2 - Supporting the delivery of cost-effective interventions in primary health-care systems in low-income and middle-income countries: an overview of systematic reviews
    (ELSEVIER SCIENCE INC, 2008) Lewin, Simon; Lavis, John N.; Oxman, Andrew D.; Bastias, Gabriel; Chopra, Mickey; Ciapponi, Agustin; Flottorp, Signe; Garcia Marti, Sebastian; Pantoja, Tomas; Rada, Gabriel; Souza, Nathan; Treweek, Shaun; Wiysonge, Charles S.; Haines, Andy
    Strengthening health systems is a key challenge to improving the delivery of cost-effective interventions in primary health care and achieving the vision of the Alma-Ata Declaration. Effective governance, financial and delivery arrangements within health systems, and effective implementation strategies are needed urgently in low-income and middle-income countries. This overview summarises the evidence from systematic reviews of health systems arrangements and implementation strategies, with a particular focus on evidence relevant to primary health care in such settings. Although evidence is sparse, there are several promising health systems arrangements and implementation strategies for strengthening primary health care. However, their introduction must be accompanied by rigorous evaluations. The evidence base needs urgently to be strengthened, synthesised, and taken into account in policy and practice, particularly for the benefit of those who have been excluded from the health care advances of recent decades.
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    ASH, ABHH, ACHO, Grupo CAHT, Grupo CLAHT, SAH, SBHH, SHU, SOCHIHEM, SOMETH, Sociedad Panamena de Hematologia, SPH, and SVH 2021 guidelines for management of venous thromboembolism in Latin America
    (ELSEVIER, 2021) Neumann, Ignacio; Izcovich, Ariel; Aguilar, Ricardo; Leon Basantes, Guillermo; Casais, Patricia; Colorio, Cecilia C.; Guillermo Esposito, Maria Cecilia; Garcia Lazaro, Pedro P.; Meillon Garcia, Luis A.; Pereira, Jaime; Rezende, Suely Meireles; Carlos Serrano, Juan; Tejerina Valle, Mario L.; Vera, Felipe; Karzulovic, Lorena; Rada, Gabriel; Schuenemann, Holger
    Background: Venous thromboembolism (VTE) is a common disease in Latin American settings. Implementing international guidelines in Latin American settings requires additional considerations.
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    Critical analysis of an article: antibiotics in acute media otitis, are they necessary? Is there any subgroup that benefits?
    (SOC MEDICA SANTIAGO, 2012) Rojas, Pamela; Rada, Gabriel
    Background: Acute otitis media (AOM) is one of the most common diseases in early infancy and childhood. Antibiotic use for AOM varies from 56% in the Netherlands to 95% in the USA and Australia. Objectives: To assess the effects of antibiotics for children with AOM. Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2008, issue 2) which contains the Acute Respiratory Infections (ART) Group's Specialized Register; MEDLINE (1966 to June week 42008); OLDMEDLINE (1958 to 1965); EMBASE (January 1990 to July 2008); and Current Contents (1966 to July 2008). Selection criteria: Randomised controlled trials comparing 1) antimicrobial drugs with placebo 2) immediate antibiotic treatment with observational treatment approaches ill children with AOM. Data collection and analysis: Three review authors independently assessed trial quality and extracted data. Main results: We found 10 trials (2928 children) from high income countries with low risk of bias. Pain was not reduced by antibiotics at 24 hours, but was at two to seven days, (relative risk (RR) 0.72; 95% confidence interval 0.62 to 0.83). However four trials (1271 children) comparing antibiotics prescribed immediately rather than initial observation found no difference at three to seven days. Antibiotics did not reduce tympanometry, perforation or recurrence. The only case of mastoiditis was in an antibiotic treated child. Vomiting, diarrhoea or rash was higher in children taking antibiotics (RR 1.37; 95% CI 1.09 to 1.76). Individual patient data meta-analysis of a subset of the included trials found antibiotics to be most beneficial in children: aged less than two; with bilateral AOM and with both AOM and otorrhoea. Authors' conclusions: Antibiotics slightly reduce the number of children with acute middle ear infection experiencing pain after a few days. However, most (78%) settle spontaneously in this time, meaning 16 children must be treated to prevent one suffering ear pain. This benefit must be weighed against the possible harms: 1 in 24 children experience symptoms caused by antibiotics. Antibiotics are most useful in children under two years of age, with bilateral AOM, and with both AOM and discharging ears. For most other children with mild disease, an expectant observational approach seems justified. We have no data on populations with higher risks of complications.
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    Tratamiento de diacereína y artrosis
    (2018) Irarrázaval Domínguez, Sebastián; Alegría Mejias, Anselmo Ignacio; Bravo Soto, Gonzalo Antonio; Rada, Gabriel