Browsing by Author "Awad, Camila"
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Publication Barriers and Facilitators in Access to Diabetes, Hypertension, and Dyslipidemia Medicines: A Scoping Review(2022) Castillo-Laborde, Carla; Hirmas Adauy, Macarena; Matute, María Isabel; Jasmen, Anita; Urrejola, Oscar; Molina, Xaviera; Awad, Camila; Frey, Catalina; Pumarino, Sofia; Descalzi, Fernando; Ruiz, Tomás; Plass, BarbaraObjective: Identify barriers and facilitators in access to medicines for diabetes, hypertension, and dyslipidemia, considering patient, health provider, and health system perspectives. Methods: Scoping review based on Joanna Briggs methodology. The search considered PubMed, Cochrane Library, CINAHL, Academic Search Ultimate, Web of Science, SciELO Citation Index, and grey literature. Two researchers conducted screening and eligibility phases. Data were thematically analyzed. Results: The review included 219 documents. Diabetes was the most studied condition; most of the evidence comes from patients and the United States. Affordability and availability of medicines were the most reported dimension and specific barrier respectively, both cross-cutting concerns. Among high- and middle-income countries, identified barriers were cost of medicines, accompaniment by professionals, long distances to facilities, and cultural aspects; cost of transportation emerges in low-income settings. Facilitators reported were financial accessibility, trained health workers, medicines closer to communities, and patients' education. Conclusion: Barriers and facilitators are determined by socioeconomic and cultural conditions, highlighting the role of health systems in regulatory and policy context (assuring financial coverage and free medicines); providers' role bringing medicines closer; and patients' health education and disease management.Publication Double trouble: Long COVID-19 and the onset of type 2 diabetes mellitus - a systematic review(2024) Awad, Camila; Carvalho, Alessandra; Hirmas Adauy, MacarenaObjective: This systematic review aims to clarify COVID-19’s impact on the onset of T2D in adults. Material and methods: Following PRISMA guideli-nes, this systematic review sourced data from multiple databases from 2019 to April 20th, 2023. Two reviewers handled screening, with a third-party resolving disagreement. The focus was on COVID-19 cases with post-infection T2D symptoms persisting for two or more months. Exclusions included those outside the 18-70 age range, prior T2D history, pregnancy, and animal studies. Rayyan software facilitated article screening, STATA 18 performed meta-analysis, and bias was assessed using JBI tools. The study is registered in PROSPERO (ID: CRD42023414096). Results: A total of 173 articles were retrieved, of which 23 (11.6%) remained for extraction. 13 cohort studies with 11.551.026 participants were included for the meta-analysis, which found that the COVID-19 population had 1.4 greater risk of being diagnosed with T2D in comparison with the population without COVID-19or with other respiratory diseases. The other study designs were narratively analyzed, describing similar results as the meta-analysis. Discussion: New onset T2D is a potential consequence of LC. While T2D increases COVID-19 complications, the relationship appears bidirectional. Given the novelty of the topic and potential newer studies, further reviews are needed to understand LC’s impact on chronic diseases like T2D globally. Further studies should be carried out on this specific topic that could raise the burden of T2D between all the other symptoms that may be caused by LC. In addition, it is necessary to adapt the interventions according to each country’s possibilities. Objetivo: El objetivo de esta revisión es aclarar el impacto del COVID-19 en nuevos diagnósticos de DM2. Material y Métodos: Esta revisión se elaboró en base a las guías PRISMA. Dos revisores realizaron una búsqueda en bases de datos, incluyendo artículos desde el 2019 hasta el 20 de abril de 2023 en adultos, diagnosticados al menos una vez con COVID-19, sin diagnóstico previo de DM2. Excluyeron: embarazadas, niños y diabetes mellitus I. Esta revisión se registró en PROSPERO (ID: CRD42023414096) el 6 de abril de 2023. Resultados: Un total de 173 artículos se obtuvieron luego de la búsqueda, de los cuales 23 (11,6%) quedaron para extracción. 13 estudios de cohorte con 11.551.026 participantes se incluyeron en el metaanálisis, que encontraron que la población que tuvo COVID tiene un 1,4 veces más riesgo de ser diagnosticados con DM2 en comparación a quienes no tuvieron el diagnóstico o fueron diagnosticados con otra patología respiratoria. Los diseños de estudio se describieron narrativamente, describiendo resultados similares a los del metaanálisis. Discusión: El nuevo diagnóstico de DM2 es una potencial consecuencia de LC. Mientras aumenta la DM2, aumentan las complicaciones de COVID-19, la relación aparenta ser bidireccional. Ya que estos hallazgos son medianamente recientes, no existe mucha evi-dencia disponible al respecto, por lo tanto, se requiere un mayor número de estudios al respecto, además de la creación de nuevas políticas de salud pública ad hoc a las posibilidades de cada país.Item HABIT: Heparin and Aspirin on Birth in Inherited Thrombophilia, an International Multicenter Phase IIb Randomized Triple Blinded Clinical Trial(2023) Carvalho, Alessandra; Awad, Camila; Gallucci, Alessia; Flores, Ana; La Riva, Anibal; Díaz, Daniel; Da Silva, Deivid; Saraceno, Taylor; Rivera, Oswaldo; Fricke, Stephan; Garcia, Regina; Zhou, Steven; Bazan, María; Castellaro, María; Alencar, Luiza; Blanco, Pedro; Teixeira, Eliluane; Gonçalves, Roberta; Etchebehere, Priscila; Gonzalez, Jessica; Abdallah, Tasneem; Hamad, Malaz; Ahmed, Shiema; Méndez, Paola; Faisal, Saif; Robladillo, Devy; Gutiérrez, Judith; Guidetti, Matteo; Abu, NebalIntroduction: In pregnant women with inherited thrombophilia (IT) and recurrent pregnancy loss, there is no higher-level evidence proving the beneficial effects of anticoagulation or platelet inhibition in preventing miscarriages. We hypothesize that anticoagulation with low molecular weight heparin (LMWH) and/or platelet aggregation inhibition with aspirin will increase the proportion of live birth in this population. Methods: In this phase IIb, factorial, randomized, triple blinded, placebo-controlled (double dummy) clinical trial, pregnant women aged 18 to 40 with a history of IT and 2 or more previous miscarriages, will be randomized and stratified by age and number of miscarriages in a 2x2 factorial design will be allocated equally to one of the four arms. The primary outcome of live birth will be analyzed through logistic regression analysis, controlling for strata, and results will be reported as odds ratio (OR) and 95% confidence intervals (CIs). Similarly, the secondary outcomes will include pregnancy loss, maternal mortality, major bleeding events, medication-associated adverse events, placental abruption, preterm birth, and gestational age at delivery. We will perform subgroup analysis for smoking status, weight, age, number of miscarriages, and type of thrombophilia. Discussion: There is lack of evidence for the use of anticoagulants to prevent pregnancy loss in women with inherited thrombophilia, despite the common diverging prescribing practice predominantly extrapolated from observations in acquired thrombophilia. We aim to provide an evidence base to create a standard of care in cases of recurrent pregnancy loss in women with IT.Item La ruta del medicamento en Chile(2022) Castillo, Carla; Aguilera, Ximena; Matute, Isabel; Aguilera, Ximena; Awad, Camila; Castillo, Carla; González Wiedmaier, Claudia; Hirmas, Macarena; Matute, Isabel; Olea, AndreaRuta del medicamento en Chile: principales actores, instituciones y procesos relacionados con el acceso a medicamentos. El presente documento se propone abordar el acceso a los medicamentos desde una mirada de los procesos, instituciones y actores relacionados, describiendo y analizando el camino que recorren, desde que se producen o importan, hasta su consumo por parte de la población.