This unique updated systematic review shows a consistent inverse dose-response relationship between cigarette smoking and income level, present among most geographical areas and country characteristics. Public health measures should take into account this potential inequity and consider special efforts directed to disadvantaged populations.

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were conducted in South America (92%), particularly in Brazil (64%). The mean age was 60 ± 9 years and the mean ejection fraction was 36 ± 9%. Most studies evaluated more than one etiology (79%) but the etiology more studies exclusively was Chagas disease (13%). The incidence of HF ranged from 199 to 557 cases per 100,000 person-years and the pooled prevalence was 1%, being higher in older populations. Hospitalization rates in patients with HF ranged from 28 to 31% at different time points, and the median length of stay was 7.0 days. In-hospital mortality was 11.7%, being higher in patients with worse ejection fraction, with ischemic and with Chagas disease. Mortality at one year was 24.52% (95%CI 19.42 to 30.02). ConClusions: This SR of HF in Latin America, could help decision-makers to design better preventive strategies, and guide effective patient-centered care.

Context Pediatric palliative care randomized controlled trials (PPC-RCTs) are uncommon. Objectives To evaluate the feasibility of conducting a PPC-RCT in pediatric cancer patients. Methods This was a cohort study embedded in the Pediatric Quality of Life and Evaluation of Symptoms Technology (PediQUEST) Study (NCT01838564). This multicenter PPC-RCT evaluated an electronic patient-reported-outcomes system. Children ≥2-years-old, with advanced cancer, and potentially eligible for the study were included. Outcomes included: pre-inclusion attrition (patients not approached, refusals); post-inclusion attrition (drop-out, elimination, death, and intermittent attrition (IA; missing surveys) over 9 months of follow-up); child/teenager self-report rates; and, reasons to enroll/participate. Results Over five years, of the 339 identified patients, 231 were eligible (in 22 we could not verify eligibility); 84 eligible patients were not approached and 43 declined participation. Patients not approached were more likely to die or have brain tumors. We enrolled 104 patients. Average enrollment rate was one patient/site/month; shortening follow-up from nine to three months (with optional re-enrollment) increased recruitment by 20%. Eighty-seven patients completed the study (24 died) and 17 dropped out. Median intermittent attrition was 41% in the first 20 weeks of follow-up, and over 60% in the eight weeks preceding death. Child/teenager self-report was 94%. Helping others, low burden procedures, incentives, and staff attitude were frequent reasons to enroll/ participate. Conclusion A PPC-RCT in children with advanced cancer was feasible, post-inclusion retention adequate; many families participated for altruistic reasons. Strategies that may further PPC-RCT feasibility include: increasing target population through large multicenter studies, approaching sicker patients, preventing exclusion of certain patient groups, and improving data collection at end of life.

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Risk stratification based on results provided by a 21-gene assay (Oncotype DX(®)) in early stage breast cancer can help optimize hormone therapy (HT) and/or chemotherapy (CT) decisions. We performed a systematic review and meta-analysis of decision impact (DI) and net change in CT use before and after assay results, both in the whole studies' population and by recurrence risk score (RS) strata. A systematic search of studies with prospective data collection reported physician's decision on treatment allocation in early stage node-negative breast cancer was performed. DI reflects the proportion of patients whose management was changed, and net change focuses on CT change. A random-effects model is reported. Fifteen studies (N = 2229) met our inclusion criteria: 50.09, 37.35, and 13.38 % of patients with low, intermediate, and high RS. Treatment decision changed in 29.5 % (95 % CI 26.29-32.86). Net reduction of CT use was 12 % (8-17 %). It was 16 % (12.00-19.00) in the low RS group, 0 % (-3.00 to 3.00) in the intermediate RS group, and increased by 2 % (-1.00 to 3.00) in the high RS group. Use of a 21-gene assay showed a significant impact on treatment decisions. From 100 women tested, 30 could have their treatment optimized, and 12 could avoid CT. Its main effects consist of sparing chemotherapy in low risk patients and slightly increasing it in the high risk category. DI could be higher in selected patient populations with greater uncertainty regarding initial treatment decisions.

The main recommendation was to progress gradually in strengthening HTA and its link to decision making by developing appropriate processes for each country, without trying to impose, in the short-term, standards taken from examples at the international level without adequate adaptation of these to local contexts.