ObjectiveTo evaluate the psychometric properties of the Oral Heath Impact Profile to measure oral health in children. Methods
O objetivo deste estudo foi avaliar custos de implantação e manutenção da assistência odontológica no setor público. Os custos foram atualizados/depreciados de acordo com a vida útil e considerados na perspectiva do serviço e da sociedade. Os resultados mostraram que, para o serviço, o custo total de implantação de uma unidade odontológica com sete consultórios foi de R$ 860.643,67 no primeiro ano e R$ 545.419,23 para manutenção, sendo clínica geral a especialidade mais cara. Para a sociedade, o custo total foi de R$ 990.065,06 (implantação) e R$ 668.369,55 (manutenção) e a especialidade mais cara foi prevenção. Custos de capital representaram um pequeno percentual dos custos de uma unidade odontológica, entretanto, deveriam ser considerados, pois podem modificar os resultados. Devido ao alto custo, intervenções preventivo-promocionais realizadas no ambiente clínico não deveriam ser recomendadas, devendo ser substituídas por ações populacionais amplas e de menor custo, uma vez que valores consideráveis necessitam ser desembolsados pela população de baixa renda para participar de programas públicos gratuitos.
OBJECTIVE:To evaluate the validity of the Qualis database in identifying the levels of scientific evidence and the quality of randomized controlled trials indexed in the Lilacs database.METHODS:We selected 40 open‐access journals and performed a page‐by‐page hand search, to identify published articles according to the type of study during a period of six years. Classification of studies was performed by independent reviewers assessed for their reliability. Randomized controlled trials were identified for separate evaluation of risk of bias using four dimensions: generation of allocation sequence, allocation concealment, blinding, and incomplete outcome data. The Qualis classification was considered to be the outcome variable. The statistical tests used included Kappa, Spearman's correlation, Kendall‐tau and ordinal regressions.RESULTS:Studies with low levels of scientific evidence received similar Qualis classifications when compared to studies with high levels of evidence. In addition, randomized controlled trials with a high risk of bias for the generation of allocation sequences and allocation concealment were more likely to be published in journals with higher Qualis levels.DISCUSSION:The hierarchy level of the scientific evidence as classified by type of research design, as well as by the validity of studies according to the bias control level, was not correlated or associated with Qualis stratification.CONCLUSION:Qualis classifications for journals are not an approximate or indirect predictor of the validity of randomized controlled trials published in these journals and are therefore not a legitimate or appropriate indicator of the validity of randomized controlled trials.
CONTEXT AND OBJECTIVE: Well-conducted randomized controlled trials (RCTs) represent the highest level of evidence when the research question relates to the effect of therapeutic or preventive interventions. However, the degree of control over bias between RCTs presents great variability between studies. For this reason, with the increasing interest in and production of systematic reviews and meta-analyses, it has been necessary to develop methodology supported by empirical evidence, so as to encourage and enhance the production of valid RCTs with low risk of bias. The aim here was to conduct a methodological analysis within the field of dentistry, regarding the risk of bias in open-access RCTs available in the Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde) database. DESIGN AND SETTING:This was a methodology study conducted at Universidade Federal de São Paulo (Unifesp) that assessed the risk of bias in RCTs, using the following dimensions: allocation sequence generation, allocation concealment, blinding, and data on incomplete outcomes. RESULTS:Out of the 4,503 articles classified, only 10 studies (0.22%) were considered to be true RCTs and, of these, only a single study was classified as presenting low risk of bias. The items that the authors of these RCTs most frequently controlled for were blinding and data on incomplete outcomes. CONCLUSION:The effective presence of bias seriously weakened the reliability of the results from the dental studies evaluated, such that they would be of little use for clinicians and administrators as support for decision-making processes.RESUMO CONTEXTO E OBJETIVO: Ensaios controlados randomizados (ECRs) bem conduzidos representam o mais alto nível de evidência quando a pergunta de pesquisa é sobre o efeito de intervenções terapêuticas ou preventivas. No entanto, o grau de controle de viés entre os ECRs apresenta grande variabilidade entre estudos. Por esta razão, com o aumento do interesse e produção das revisões sistemáticas e metanálises, foi necessário desenvolver metodologia suportada por evidência empírica, para incentivar e valorizar a produção de ECRs válidos e com baixo risco de viés.O objetivo deste trabalho foi realizar uma análise metodológica da área de odontologia quanto ao risco de viés de ECRs de acesso aberto, disponibilizados no banco de dados do Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde). TIPO DE ESTUDO E LOCAL:Trata-se de um estudo sobre metodologia conduzido na Universidade Federal de São Paulo (Unifesp) que avaliou o risco de viés dos ECRs, utilizando as seguintes dimensões: geração da sequência de alocação, sigilo da alocação, cegamento e dados sobre desfechos incompletos.RESULTADOS: Dos 4.503 artigos classificados somente 10 (0,22%) estudos foram considerados verdadeiros ECR e, destes, somente um estudo foi classificado como sendo de baixo risco de viés. Os itens mais frequentemente controlados pelos autores dos ECR foram cegamento e dados sobre desfechos incompletos.CONCLUSÃO: A presença efetiva de ...
Publicly available information on EUnetHTA JAs for individual drugs were identified along with the associated appraisal by NICE, SMC, TLV, HAS, AIFA, SMC, NCPE, ZIN, Medicinradet, AOTM and NOMA (to 12/06/2019). HTA recommendation rates and time to positive appraisal were compared between comparative clinical efficacy (CCE) markets (HAS and Medicinradet) and other (non-CCE) markets (costeffectiveness or budget impact payer archetypes) Results: Eight EUnetHTA JAs were identified, 5/8 were for oncology indications and 2/8 were orphan drugs. Forty-one corresponding national HTA appraisals were identified, ten of which were produced by a CCE market (HAS: seven; Medicinradet: three). Of these 7/10 (70%) received a positive appraisal, which did not significantly differ from non-CCE markets 20/31 (65%). CCE-appraised products had a significantly lower mean delay from ECapproval to national HTA publication in comparison to non-CCE markets (223 days and 324 days respectively; p=0.025) Conclusions: To date, drugs appraised under EUnetHTA JAs have been assessed in a shorter time by CCE markets in comparison to those appraised by non-CCE markets with a similar rate of positive appraisal. This may reflect a greater alignment between the JA clinical framework to CCE market HTA decision-drivers than the non-CCE markets or, may rather reflect natural assessment timelines of the HTA bodies involved. If the pan-clinical HTA proposals come to fruition, their impact may be limited by economic evaluations representing the primary focus of many payer bodies.
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