El futuro de la Atención Primaria (NEJM)

El último número de la prestigiosa revista “The New England Journal of Medicine” dedica su sección “Perspectivas” a “El Futuro de la Atención Primaria”, con renombrados referentes de la materia como expositores, entre ellos: Babara Starfield, Allan Goroll, etc.

Aquí les paso el link hacia la revista y sus notas:

THE NEW ENGLAND JOURNAL OF MEDICINE

http://content.nejm.org/current.shtml

Volume 359 — November 13, 2008 — Number 20

PERSPECTIVE

The Future of Primary Care: The Need for Reinvention
T. H. Lee
Extract | FREE Full Text | PDF

The Future of Primary Care: Sustaining Relationships
K. Treadway
Extract | FREE Full Text | PDF

The Future of Primary Care: Transforming Practice
T. Bodenheimer
Extract | FREE Full Text | PDF

The Future of Primary Care: Reforming Physician Payment
A. H. Goroll
Extract | FREE Full Text | PDF

The Future of Primary Care: Refocusing the System
B. Starfield
Extract | FREE Full Text | PDF

The Future of Primary Care: Lessons from the U.K.
M. Roland
Extract | FREE Full Text | PDF

Perspective Roundtable: Redesigning Primary Care
T. H. Lee and Others
Extract | FREE Full Text | PDF

Cáncer de Cuello Uterino: el PAP siempre primero para prevenir

Comunicado de Prensa de la FAMFyG (Federación Argentina de Medicina Familiar y General) sobre la publicidad de la vacuna contra el HPV como prevención del Cancer de Cuello del Utero

Alerta a la población por una campaña publicitaria de la Vacuna contra el HPV.

En las últimas semanas una campaña publicitaria de la Liga Argentina de Lucha contra el Cáncer (Lalcec) exhorta a las mujeres a vacunarse (única palabra destacada) para evitar el cáncer de cuello uterino y no menciona el test de Papanicolaou como recurso preventivo.
De acuerdo a fuentes periodísticas, no desmentidas, dicha campaña pareciera haber sido financiada por la empresa que produce la vacuna, cada una de cuyas tres dosis cuesta entre $400 y $926. Cabe destacar que la vacuna contra el virus del papiloma humano (HPV) no integra el calendario oficial de vacunación.
Ante estos hechos la Federación Argentina de Medicina Familiar y General desea alertar a la población, y manifestar que de acuerdo a las evidencias científicas y los principios de la ética profesional:
1. La realización del test de Papanicolaou anualmente es la única medida que hasta el momento ha demostrado disminuir entre un 20 y un 60% la mortalidad por cáncer de cuello uterino.

2. La vacuna contra el HPV ha demostrado ser efectiva para evitar lesiones relacionadas con el virus y solo en mujeres que no hayan iniciado relaciones sexuales, pero se desconoce su efecto en la aparición y mortalidad por cáncer de cuello uterino, ni su protección y seguridad a mediano y largo plazo.

3. La vacuna sólo cubriría un 65% de los Virus del Papiloma Humano (HPV) relacionados con de las neoplasias de cuello uterino en Latinoamérica y el Caribe.

4. La vacunación ha sido financiada por el Estado Nacional en 15 países desarrollados, al menos parcialmente, pero podría ser impagable y fuera de las prioridades sanitarias en países en vías de desarrollo como la Argentina.

5. Deberían realizarse en Argentina estudios de costo-efectividad y de impacto presupuestario antes de implementar estrategias preventivas masivas. En el caso del cáncer del cuello de útero cualquier medida debería integrarse claramente con programas de detección temprana, siendo el Papanicolaou la prueba de elección.

6. Es objetable desde la ética institucional ofrecer intervenciones preventivas de acceso inequitativo, con información distorsionada y a través de publicidades encubiertas.

7. Es objetable desde la ética profesional las manifestaciones periodísticas de médicos expertos que no declaran conflictos de intereses por recibir financiamiento directo o indirecto de los fabricantes de la vacuna.

Por último deseamos recomendar que aquellas mujeres que decidieran recibir la vacuna deberán continuar realizándose periódicamente un test de Papanicolaou, dado que la vacuna, por lo que conocido hasta la fecha, no le garantiza una protección total contra el cáncer del cuello uterino Comisión Directiva Federación Argentina de Medicina Familiar y General. famfyg@gmail.com

Referencias: [1]Pedro Lipcovich. Vacuna, campanha y polemica. En: http://www.pagina12.com.ar/diario/sociedad/3-113945-2008-10-25.html (acceso 3/11/2008). [2] LA SALUD, ¿UN NEGOCIO? Escrito por: zoe el 28 Oct 2008. En: http://blogs.clarin.com/el-conventillo-de-info/2008/10/26/solo-mujeres- (acceso 3/11/2008). [3] Screening for Cervical Cancer. Recommendations and Rationale. U.S. Preventive Services Task Force (USPSTF). http://www.ahrq.gov/clinic/3rduspstf/cervcan/cervcanrr.htm#clinical (acceso 1/11/2008). [4] Rambout L, Hopkins L, Hutton B, Fergusson D. Prophylactic vaccination against human papillomavirus infection and disease in women: a systematic review of randomized controlled trials. CMAJ 2007;177:469-79. [5] Ciapponi A, Bardach A, Glujovsky D, Picconi MA, Gibbons L. Type-specific HPV prevalence in high grade lesions or cervical cancer in Latin America and the Caribbean: a systematic review of epidemiological studies. 24th International Papillomavirus Conference and Clinical Workshop. – 3 al 9 de Noviembre de 2007. [6] Koulova A, Tsui J, Irwin K, Van Damme P, Biellik R, Aguado MT. A brief report: Country recommendations on the inclusion of HPV vaccines in national immunization programmes among high-income countries, June 2006-January 2008. Vaccine. 2008 Sep 18. [Epub ahead of print] [7] Goldie SJ, Kim JJ, Kobus K, Goldhaber-Fiebert JD, Salomon J, O’shea MK, Xavier Bosch F, de Sanjose S, Franco EL. Cost-effectiveness of HPV 16, 18 vaccination in Brazil. Vaccine. 2007 Aug 14;25(33):6257-70. Epub 2007 Jun 15.

CDC: información sobre cáncer en español

CDC’s Division of Cancer Prevention and Control is pleased to announce the availability of a greatly expanded Web site for cancer information in Spanish, Prevención y control del cáncer.

The expanded Web site provides accurate, evidence-based information in Spanish on some of the most common types of cancer including breast cancer, prostate cancer, colorectal cancer, gynecologic cancers, hematologic (blood) cancers, lung cancer, and skin cancer, as well as information about cancer survivorship and health disparities in cancer.

For more information, please visit these cancer health topics:

• Acerca de la DCPC
• Pruebas de detección
• Cáncer colorrectal
• Cánceres ginecológicos
• Cánceres hematológicos (de la sangre)
• Cáncer de mama
• Cáncer de piel
• Cáncer de próstata
• Cáncer de pulmón
• Disparidades de salud del cáncer
• Supervivencia del cáncer

CDC’s Cancer Web site!

Guías Práctica Clínica (GPC): algunas actualizaciones

Mayo Clinic Proceedings

Chronic Obstructive Pulmonary Disease: An Evidence-Based Approach

to Treatment With a Focus on Anticholinergic Bronchodilation
http://www.mayoclinicproceedings.com/pdf%2F8311%2F8311r1.pdf

 

Management of Syncope in Adults: An Update

http://www.mayoclinicproceedings.com/pdf%2F8311%2F8311scd.pdf

USPSTF

The Task Force Finds Several Methods Equally Effective For Colorectal Cancer Screening

The Task Force now recommends that adults age 50 to 75 be screened for colorectal cancer using annual high-sensitivity fecal occult blood testing, sigmoidoscopy every five years with fecal occult testing between sigmoidoscopic exams, or colonocopy every 10 years.  According to the Task Force, good evidence exists that using these methods saves lives.  The Task Force recommended against routine colorectal cancer screening in adults between the ages of 76 and 85 because the benefits of regular screening were small compared with the risks.  The Task Force also recommended that adults over the age of 85 not be screened at all because the harms of screening may be significant, and other conditions may be more likely to affect their health or well-being.  The recommendations and accompanying summary of evidence were posted in the Annals of Internal Medicine online at www.annals.org and will appear in the November 4 print edition of the journal. 

New recommendations on behavioral counseling to prevent sexually transmitted infections

The Task Force recommends high-intensity behavioral counseling to prevent sexually transmitted infections (STIs) for all sexually active adolescents and for adults at increased risk for STIs.  The Task Force also concluded that evidence is insufficient to assess the balance of benefits and harms of behavioral counseling to prevent STIs in non-sexually active adolescents and in adults not at increased risk for STIs.  Despite advances in screening, diagnosis and treatment of STIs, they remain an important cause of death in the U.S.  An estimated 19 million new STIs occur in the United States, almost half among people from 15 to 24 years of age.  Common sexually transmitted infections include chlamydia, hepatitis B, hepatitis, C, herpes, HIV and syphilis.  Direct medical costs are estimated at $15 billion annually.  The recommendation appeared in the October 7 issue of the Annals of Internal Medicine www.annals.org.

The Task Force is the leading independent panel of experts in prevention and primary care.  The Task Force, which is supported by AHRQ, conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling and preventive medications.  Its recommendations are considered the gold standard for clinical preventive services.  More information about these recommendations are available on the AHRQ Web site at http://www.ahrq.gov/clinic/prevenix.htm 

 

 

 

Medicina Basada en la Evidencia y práctica clínica: Guías de Nueva Zelandia

http://www.nzgg.org.nz/newsletter/pdfs/080829%20Bulletin%20August%202008%20-%20pdf.pdf August 2008   Vol. 9 No. 4 International   Bandolier: the latest online Bandolier, an online journal about evidence-based health care, features updates about substance abuse: Stopping smoking Alcohol addiction Cocaine addiction Opioid addiction Cannabis addiction Reviews on other topics can found in the Knowledge Library section of their website. Behind the Headlines The UK’s National Library for Health, Behind the Headlines, latest articles are on: Cholesterol-lowering drug and cancer Combining painkillers for children Can computer games keep you fit? Birth weight and child behaviour Informed Health Online Informed Health Online is published by Germany’s Institute for Quality and Efficiency in Health Care. The latest evidence-based topic is on insomnia. To find other topics, use the menu on the right of the home page. Online guide to evidence-based health care The Library of the Health Sciences Peoria at the University of Illinois at Chicago has an online guide to evidence-based health care for professionals and students. It covers PICO, levels of evidence, searching Medline and other databases, as well as clinical filters. It also has a link to other evidence-based medical resources on the internet. Online tutorial: introduction to evidence-based medicine An online tutorial by staff at Duke University Medical Center Library and the University of North Carolina at Chapel Hill Health Science Library guides you through: defining evidence-based medicine identifying the parts of a well-built clinical question identifying EBM searching strategies that could improve MEDLINE retrieval identifying key issues that help determine the validity of the results of a study.