Measurement complexity of adherence to medication

Dayani Galato, Fabiana Schuelter-Trevisol, Anna Paula PiovezanMaster Program in Health Sciences, University of Southern Santa Catarina (Unisul) Tubarão, Santa Catarina, BrazilAdherence to pharmacologic therapy is a major challenge for the rational use of medicines, particularly when it comes to antiretroviral drugs that require adherence to at least 95% of prescribed doses.1 Studies in this area are always important and contribute to medication adherence understanding, even though there is no reference test for measuring this. Recently, an article was published in this journal that proposes the determination of lamivudine plasma concentration to validate patient self-reported adherence to antiretroviral treatment.2 In that study, serum levels obtained after 3 hours of ingestion of the last dose of the drug were compared with patient reports that were classified into different levels of adherence, based on their recall of missed doses in the previous 7 days.It was hypothesized by the authors that the use of a biological marker for drug adherence was extremely important, given the relevance of the topic. However, we would like to draw attention to some points that may determine the success of the use of similar methods for this purpose. The formation of groups with similar anthropometric characteristics is relevant since the dose of lamivudine may have to be changed, depending, for example, on sex, weight, and age.3 Even information considered important by the authors of that study was not provided. There is a need for greater clarity on the eligibility criteria, especially with regard to the clinical stage of the disease, CD4 counts and viral load, associated diseases, and comorbidity, as well as the evaluation of kidney function and other medications used that can affect lamivudine pharmacokinetics.3View original paper by Minzi and colleague

Análise de custos da atenção hospitalar a recém-nascidos de risco: uma comparação entre Unidade Intermediária Convencional e Unidade Canguru

O objetivo deste estudo foi realizar uma análise comparativa entre o custo da Unidade Canguru e da Unidade Intermediária Convencional sob a perspectiva do SUS, no Município do Rio de Janeiro, Brasil. A população de referência é de recém-nascidos estáveis clinicamente, que podem receber assistência nas duas modalidades de cuidado. Um modelo de análise de decisão para uma coorte hipotética de mil recém-nascidos elegíveis foi elaborado para comparar os custos em cada estratégia avaliada. As probabilidades dos eventos e o consumo de recursos de saúde foram incorporados ao modelo com base na literatura e consulta a especialistas. O custo da diária foi de R$343,53 para a 2ª etapa da Unidade Canguru e de R$394,22 para a Unidade Intermediária Convencional. O custo para a coorte hipotética foi de R$5.710.281,66 para a assistência na 2ª e 3ª etapa da Unidade Canguru e de R$7.119.865,61 para a Unidade Intermediária Convencional. A Unidade Intermediária Convencional apresentou custos 25% superiores aos da Unidade Canguru. O estudo pode contribuir para a tomada de decisão na área da saúde, além de fornecer subsídios para pesquisas relacionadas à avaliação econômica na área neonatal.The aim of this study was to compare the direct costs of implementation of the Kangaroo Method and an Intermediate Neonatal Care Unit, from the perspective of the Brazilian Unified National Health System (SUS) in Rio de Janeiro, Brazil. Newborns were eligible for inclusion if they were clinically stable and were able to receive care in those two modalities. A decision tree model was developed that incorporated baseline variables and costs into a hypothetical cohort of 1,000 newborns, according to the literature and expert opinions. Daily cost was BR$343.53 for the second stage of the Kangaroo Unit and BR$394.22 for the Intermediate Neonatal Care Unit. The total cost for the hypothetical cohort was BR$5,710,281.66 for the second and third stages of the Kangaroo Unit and R$7,119,865.61 for the Intermediate Neonatal Care Unit. The Intermediate Neonatal Care Unit cost 25% more than the Kangaroo Unit. The study can contribute to decision-making in health, in addition to providing support for studies related to economic evaluation in neonatal health.El objetivo de este estudio fue realizar un análisis comparativo entre el coste de la Unidad Canguro y la Unidad Intermedia Convencional, dentro de la perspectiva del Sistema Único de Salud (SUS) en el municipio de Río de Janeiro, Brasil. La población de referencia son los recién nacidos clínicamente estables, que pueden recibir asistencia en ambas modalidades de atención. Se diseñó un modelo de análisis de decisión para una cohorte hipotética de 1.000 bebés elegibles, con el fin de comparar los costes de cada estrategia evaluada. Las probabilidades de ocurrencias y consumo de recursos sanitarios se incorporaron al modelo de la literatura y la consulta con expertos. El coste diario fue de R$343,53 en la 2ª etapa de la Unidad Canguro y R$394,22 en la Unidad Intermedia Convencional. El coste de la cohorte hipotética fue R$5,710,281.66 para la asistencia en la segunda y tercera etapa de la Unidad Canguro y R$7,119,865.61 para la Unidad Intermedia Convencional. La Unidad Intermedia Convencional tiene costes un 25% más altos que la Unidad Canguro. El presente estudio puede contribuir a la toma de decisiones en el cuidado de la salud

Tapping into non-English-language science for the conservation of global biodiversity

The widely held assumption that any important scientific information would be available in English underlies the underuse of non-English-language science across disciplines. However, non-English-language science is expected to bring unique and valuable scientific information, especially in disciplines where the evidence is patchy, and for emergent issues where synthesising available evidence is an urgent challenge. Yet such contribution of non- English-language science to scientific communities and the application of science is rarely quantified. Here, we show that non-English-language studies provide crucial evidence for informing global biodiversity conservation. By screening 419,679 peer-reviewed papers in 16 languages, we identified 1,234 non-English-language studies providing evidence on the effectiveness of biodiversity conservation interventions, compared to 4,412 English-language studies identified with the same criteria. Relevant non-English-language studies are being published at an increasing rate in 6 out of the 12 languages where there were a sufficient number of relevant studies. Incorporating non-English-language studies can expand the geographical coverage (i.e., the number of 2° × 2° grid cells with relevant studies) of English-language evidence by 12% to 25%, especially in biodiverse regions, and taxonomic coverage (i.e., the number of species covered by the relevant studies) by 5% to 32%, although they do tend to be based on less robust study designs. Our results show that synthesising non-English-language studies is key to overcoming the widespread lack of local, context-dependent evidence and facilitating evidence-based conservation globally. We urge wider disciplines to rigorously reassess the untapped potential of non-English-language science in informing decisions to address other global challenge

Tapping into non-English-language science for the conservation of global biodiversity

The widely held assumption that any important scientific information would be available in English underlies the underuse of non-English-language science across disciplines. However, non-English-language science is expected to bring unique and valuable scientific information, especially in disciplines where the evidence is patchy, and for emergent issues where synthesising available evidence is an urgent challenge. Yet such contribution of non- English-language science to scientific communities and the application of science is rarely quantified. Here, we show that non-English-language studies provide crucial evidence for informing global biodiversity conservation. By screening 419,679 peer-reviewed papers in 16 languages, we identified 1,234 non-English-language studies providing evidence on the effectiveness of biodiversity conservation interventions, compared to 4,412 English-language studies identified with the same criteria. Relevant non-English-language studies are being published at an increasing rate in 6 out of the 12 languages where there were a sufficient number of relevant studies. Incorporating non-English-language studies can expand the geographical coverage (i.e., the number of 2° × 2° grid cells with relevant studies) of English-language evidence by 12% to 25%, especially in biodiverse regions, and taxonomic coverage (i.e., the number of species covered by the relevant studies) by 5% to 32%, although they do tend to be based on less robust study designs. Our results show that synthesising non-English-language studies is key to overcoming the widespread lack of local, context-dependent evidence and facilitating evidence-based conservation globally. We urge wider disciplines to rigorously reassess the untapped potential of non-English-language science in informing decisions to address other global challenge

Role of the Immune system in chronic pain

During the past two decades, an important focus of pain research has been the study of chronic pain mechanisms, particularly the processes that lead to the abnormal sensitivity - spontaneous pain and hyperalgesia - that is associated with these states. For some time it has been recognized that inflammatory mediators released from immune cells can contribute to these persistent pain states. However, it has only recently become clear that immune cell products might have a crucial role not just in inflammatory pain, but also in neuropathic pain caused by damage to peripheral nerves or to the CN