RESUMO
Objetivo: Conocer las estrategias para asumir la vacunación contra el virus del papiloma humano en América Latina a partir de una revisión temática internacional, para encontrar experiencias que contribuyan a mantener resultados satisfactorios en Colombia. Materiales y métodos: Se realizó una revisión de literatura internacional en español, inglés y portugués sobre el estado de implementación y éxito del programa de vacunación en América Latina en bases de datos: Medline, Embase y Cochrane, portales de Organización Mundial y Panamericana de la Salud, páginas web de entes rectores y sitios electrónicos especializados en control del cáncer. Resultados: Se revisaron 97 referencias. En la región, diez países incorporaron dosis de la vacuna en sus esquemas para niñas entre 9 y 13 años; realizan diversas estrategias a corto plazo para mantener sus tasas de cobertura; siendo la articulación de los sectores salud-educación, el reconocimiento del contexto y la obligatoriedad las más exitosas. Conclusión: La situación en otros países en la implementación de la vacunación contra el VPH, muestra que la alianza entre salud, educación y comunicación es clave para mantener resultados satisfactorios. Educar y sensibilizar puede mantener la articulación con la comunidad. La aceptación o rechazo de la vacunación, depende del grado de información de la población; por tanto, es útil la consulta con profesionales de la salud y la aplicación de consentimiento informado para reducir la incertidumbre
Objective: To know the strategies to take responsibility for vaccination against human papillomavirus infection in Latin America through an international thematic review to find experiences that contribute to maintain satisfactory results in Colombia. Materials and methods: A review of international literature in Spanish, English and Portuguese about the state of implementation and achievement of the vaccination programs used in Latin America was carried out using the Medline, Embase and Cochrane Library electronic databases, portals of the World Health Organization and Pan American Health Organization, governmental websites, and websites specialized in cancer control. Results: Ninety-seven references were reviewed. Ten countries in the region incorporated the vaccine doses in their program among 9 and 13 years old girls. They perform several short-term strategies to maintain their coverage rates, being the articulation between the health-education sectors, the context recognition, and their obligatory nature the most successful. Conclusion: The situation in other countries regarding the implementation of an HPV-vaccination program shows that the alliance between healthcare, education and communication is the key to the sustainability of satisfactory results. Educating and raising awareness can maintain the articulation with the community. The acceptance or rejection of the vaccine depends on the degree of information of the population. Therefore, consultation with health-professionals and the application of informed consent are useful to reduce uncertainty.
Objetivo: Com as estratégias para assumir a vacinação contra o vírus do papiloma humano em América Latina a partir de uma revisão temática internacional, para encontrar experiências que contribuíam a manter resultados satisfatórios em Colômbia. Materiais e métodos: Realizou se uma revisão de literatura internacional em espanhol, inglês e português sobre o estado de implementação e êxito do programa de vacinação em América Latina em bases de dados: Medline, Embase e Cochrane, portais de Organização Mundial e Panamericana da Saúde, páginas web de entes reitores e sites eletrônicos especializados em controle do câncer. Resultados: Conferiram- se 97 referencias. Na região, dez países incluem dosagem da vacina em seus esquemas para meninas entre 9 e 13 anos; realizam diversas estratégias a corto prazo para manter suas taxas de cobertura; sendo a articulação dos setores saúde- educação, o reconhecimento do contexto e a obrigatoriedade com mais sucesso. Conclusão: As situações em outros países incluíram a vacinação contra o VPH, amostra que a união entre saúde, educação e comunicação é clave para manter resultados satisfatórios. Educar e sensibilizar pode manter a articulação com a comunidade. A aceitação o rejeição da vacinação, depende do grau de informação da povoação; por tanto, é útil a consulta com profissionais da saúde e a aplicação de consentimento informado para reduzir a incerteza.
Assuntos
Humanos , Vacina Quadrivalente Recombinante contra HPV tipos 6, 11, 16, 18 , Política Pública , Vacinação , Infecções por PapillomavirusRESUMO
BACKGROUND: Post-dural puncture headache (PDPH) is one of the most common complications of diagnostic and therapeutic lumbar punctures. PDPH is defined as any headache occurring after a lumbar puncture that worsens within 15 minutes of sitting or standing and is relieved within 15 minutes of the patient lying down. Researchers have suggested many types of interventions to help prevent PDPH. It has been suggested that aspects such as needle tip and gauge can be modified to decrease the incidence of PDPH. OBJECTIVES: To assess the effects of needle tip design (traumatic versus atraumatic) and diameter (gauge) on the prevention of PDPH in participants who have undergone dural puncture for diagnostic or therapeutic causes. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, CINAHL and LILACS, as well as trial registries via the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal in September 2016. We adopted the MEDLINE strategy for searching the other databases. The search terms we used were a combination of thesaurus-based and free-text terms for both interventions (lumbar puncture in neurological, anaesthesia or myelography settings) and headache. SELECTION CRITERIA: We included randomized controlled trials (RCTs) conducted in any clinical/research setting where dural puncture had been used in participants of all ages and both genders, which compared different tip designs or diameters for prevention of PDPH DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. MAIN RESULTS: We included 70 studies in the review; 66 studies with 17,067 participants were included in the quantitative analysis. An additional 18 studies are awaiting classification and 12 are ongoing. Fifteen of the 18 studies awaiting classification mainly correspond to congress summaries published before 2010, in which the available information does not allow the complete evaluation of all their risks of bias and characteristics. Our main outcome was prevention of PDPH, but we also assessed the onset of severe PDPH, headache in general and adverse events. The quality of evidence was moderate for most of the outcomes mainly due to risk of bias issues. For the analysis, we undertook three main comparisons: 1) traumatic needles versus atraumatic needles; 2) larger gauge traumatic needles versus smaller gauge traumatic needles; and 3) larger gauge atraumatic needles versus smaller gauge atraumatic needles. For each main comparison, if data were available, we performed a subgroup analysis evaluating lumbar puncture indication, age and posture.For the first comparison, the use of traumatic needles showed a higher risk of onset of PDPH compared to atraumatic needles (36 studies, 9378 participants, risk ratio (RR) 2.14, 95% confidence interval (CI) 1.72 to 2.67, I2 = 9%).In the second comparison of traumatic needles, studies comparing various sizes of large and small gauges showed no significant difference in effects in terms of risk of PDPH, with the exception of one study comparing 26 and 27 gauge needles (one study, 658 participants, RR 6.47, 95% CI 2.55 to 16.43).In the third comparison of atraumatic needles, studies comparing various sizes of large and small gauges showed no significant difference in effects in terms of risk of PDPH.We observed no significant difference in the risk of paraesthesia, backache, severe PDPH and any headache between traumatic and atraumatic needles. Sensitivity analyses of PDPH results between traumatic and atraumatic needles omitting high risk of bias studies showed similar results regarding the benefit of atraumatic needles in the prevention of PDPH (three studies, RR 2.78, 95% CI 1.26 to 6.15; I2 = 51%). AUTHORS' CONCLUSIONS: There is moderate-quality evidence that atraumatic needles reduce the risk of post-dural puncture headache (PDPH) without increasing adverse events such as paraesthesia or backache. The studies did not report very clearly on aspects related to randomization, such as random sequence generation and allocation concealment, making it difficult to interpret the risk of bias in the included studies. The moderate quality of the evidence for traumatic versus atraumatic needles suggests that further research is likely to have an important impact on our confidence in the estimate of effect.