Maria Montes de Oca

Central University of Venezuela, Caracas, Capital, Venezuela

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Publications (95)426.25 Total impact


  • No preview · Article · Sep 2015 · European Respiratory Journal

  • No preview · Article · Sep 2015 · European Respiratory Journal
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    ABSTRACT: ALAT-2014 COPD Clinical Practice Guidelines used clinical questions in PICO format to compile evidence related to risk factors, COPD screening, disease prognosis, treatment and exacerbations. Evidence reveals the existence of risk factors for COPD other than tobacco, as well as gender differences in disease presentation. It shows the benefit of screening in an at-risk population, and the predictive value use of multidimensional prognostic indexes. In stable COPD, similar benefits in dyspnea, pulmonary function and quality of life are achieved with LAMA or LABA long-acting bronchodilators, whereas LAMA is more effective in preventing exacerbations. Dual bronchodilator therapy has more benefits than monotherapy. LAMA and combination LABA/IC are similarly effective, but there is an increased risk of pneumonia with LABA/IC. Data on the efficacy and safety of triple therapy are scarce. Evidence supports influenza vaccination in all patients and anti-pneumococcal vaccination in patients < 65 years of age and/or with severe airflow limitation. Antibiotic prophylaxis may decrease exacerbation frequency in patients at risk. The use of systemic corticosteroids and antibiotics is justified in exacerbations requiring hospitalization and in some patients managed in an outpatient setting.
    No preview · Article · Jun 2015 · Archivos de Bronconeumología
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    ABSTRACT: Patients with chronic obstructive pulmonary disease (COPD) usually complain of symptoms such as cough, sputum, wheezing, and dyspnea. Little is known about clinical symptoms in individuals with restrictive ventilatory impairment. The aim of this study was to compare the prevalence and type of respiratory symptoms in patients with COPD to those reported by individuals with restrictive ventilatory impairment in the Proyecto Latinoamericano de Investigacion en Obstruccion Pulmonar study. Between 2002 and 2004, individuals ≥40 years of age from five cities in Latin America performed pre and post-bronchodilator spirometry and had their respiratory symptoms recorded in a standardized questionnaire. Among the 5315 individuals evaluated, 260 (5.1%) had a restrictive spirometric diagnosis (forced vital capacity (FVC) < lower limit of normal (LLN) with forced expiratory volume in the first second to forced vital capacity ratio (FEV1/FVC) ≥ LLN; American Thoracic Society (ATS)/European Respiratory Society (ERS) 2005) and 610 (11.9%) were diagnosed with an obstructive pattern (FEV1/FVC < LLN; ATS/ERS 2005). Patients with mild restriction wheezed more ((30.8%) vs. (17.8%); p < 0.028). No difference was seen in dyspnea, cough, and sputum between the two groups after adjusting for severity stage. The health status scores for the short form 12 questionnaire were similar in restricted and obstructed patients for both physical (48.4 ± 9.4 vs. 48.3 ± 9.8) and mental (50.8 ± 10.6 vs. 50.0 ± 11.5) domains. Overall, respiratory symptoms are not frequently reported by patients with restricted and obstructed patterns as defined by spirometry. Wheezing was more frequent in patients with restricted pattern compared with those with obstructive ventilatory defect. However, the prevalence of cough, sputum production, and dyspnea are not different between the two groups when adjusted by the same severity stage. © The Author(s) 2015.
    No preview · Article · Jun 2015 · Chronic Respiratory Disease
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    ABSTRACT: COPD is a frequent condition ranking within the top three causes of mortality in the Global Burden of Disease, yet it remains largely underdiagnosed. We assessed the underdiagnosis of COPD and its determinants in national and international surveys of general populations. We analyzed representative samples of adults aged ≥40 years randomly selected from well-defined administrative areas worldwide (44 sites from 27 countries). Post-BD FEV1/FVC<LLN was used to define chronic airflow limitation consistent with COPD. Undiagnosed COPD was considered when participants had post-BD FEV1/FVC<LLN but were not previously diagnosed with COPD. Among 30,874 participants with a mean age of 56 yrs, 55.8% were female, and 22.9% were current smokers. Population prevalence of (spirometrically defined) COPD ranged from 3.6% in Barranquilla, Colombia to 19.0% in Cape Town, SA. Only 26.4% reported a previous lung function test, and only 5.0% reported a previous diagnosis of COPD, while 9.7% had post-BD FEV1/FVC<LLN. Overall, 81.4% of (spirometrically defined) COPD cases were undiagnosed with the highest rate in Ile-Ife, Nigeria (98.3%) and the lowest rate in Lexington, US (50.0%). In multivariate analysis, a greater probability of being underdiagnosed with COPD was associated with male gender, younger age, never and current smoking, lower education, no previous spirometry and less severe airflow limitation. Even with substantial heterogeneity in COPD prevalence, COPD underdiagnosis is universally high. Since effective management strategies are available for COPD, spirometry can help to diagnose COPD at a stage when treatment will lead to better outcomes and improved quality of life.
    No preview · Article · May 2015 · Chest
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    ABSTRACT: Background: A low FEV1/FVC from post-bronchodilator spirometry is required to diagnose COPD. Both the FEV1 and the FVC can vary over time; therefore, individuals can be given a diagnosis of mild COPD at one visit, but have normal spirometry during the next appointment, even without an intervention. Methods: We analyzed two population-based surveys of adults with spirometry carried out for the same individuals 5-9 years after their baseline examination. We determined the factors associated with a change in the spirometry interpretation from one exam to the next utilizing different criteria commonly used to diagnose COPD. Results: The rate of an inconsistent diagnosis of mild COPD was 11.7% using FEV1/FVC <0.70, 5.9% using FEV1/FEV6 <the lower limit of the normal range, LLN and 4.1% using the GOLD stage 2-4 criterion. The most important factor associated with diagnostic inconsistency was the closeness of the ratio to the LLN during the first examination. Inconsistency decreased with a lower FEV1. Conclusions: Using FEV1/FEV6 <LLN or GOLD stage 2-4 as the criterion for airflow obstruction reduces inconsistencies in the diagnosis of mild COPD. Further improvement could be obtained by defining a borderline zone around the LLN (e.g. plus or minus 0.6 SD), or repeating the test in patients with borderline results.
    Full-text · Article · Mar 2015 · PLoS ONE
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    ABSTRACT: ALAT-2014 COPD Clinical Practice Guidelines used clinical questions in PICO format to compile evidence related to risk factors, COPD screening, disease prognosis, treatment and exacerbations. Evidence reveals the existence of risk factors for COPD other than tobacco, as well as gender differences in disease presentation. It shows the benefit of screening in an at-risk population, and the predictive value use of multidimensional prognostic indexes. In stable COPD, similar benefits in dyspnea, pulmonary function and quality of life are achieved with LAMA or LABA long-acting bronchodilators, whereas LAMA is more effective in preventing exacerbations. Dual bronchodilator therapy has more benefits than monotherapy. LAMA and combination LABA/IC are similarly effective, but there is an increased risk of pneumonia with LABA/IC. Data on the efficacy and safety of triple therapy are scarce. Evidence supports influenza vaccination in all patients and anti-pneumococcal vaccination in patients < 65 years of age and/or with severe airflow limitation. Antibiotic prophylaxis may decrease exacerbation frequency in patients at risk. The use of systemic corticosteroids and antibiotics are justified in exacerbations requiring hospitalization and in some patients managed in an outpatient setting.
    Full-text · Article · Jan 2015 · Archivos de Bronconeumología
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    ABSTRACT: Spirometry is the gold standard for diagnosing chronic obstructive pulmonary disease (COPD). Although there are a number of different guideline criteria for deciding who should be selected for spirometric screening, to date it is not known which criteria are the best based on sensitivity and specificity.Aims:Firstly, to evaluate the proportion of subjects in the PLATINO Study that would be recommended for spirometry testing according to Global initiative for Obstructive Lung Disease (GOLD)-modified, American College of Chest Physicians (ACCP), National Lung Health Education Program (NLHEP), GOLD and American Thoracic Society/European Respiratory Society (ATS/ERS) criteria. Secondly, we aimed to compare the sensitivity, specificity, and positive predictive and negative predictive values, of these five different criteria.Methods:Data from the PLATINO study included information on respiratory symptoms, smoking and previous spirometry testing. The GOLD-modified spirometry indication criteria are based on three positive answers out of five questions: the presence of cough, phlegm in the morning, dyspnoea, age over 40 years and smoking status.Results:Data from 5,315 subjects were reviewed. Fewer people had an indication for spirometry (41.3%) according to the GOLD-modified criteria, and more people had an indication for spirometry (80.4%) by the GOLD and ATS/ERS criteria. A low percentage had previously had spirometry performed: GOLD-modified (14.5%); ACCP (13.2%); NLHEP (12.6%); and GOLD and ATS/ERS (12.3%). The GOLD-modified criteria showed the least sensitivity (54.9) and the highest specificity (61.0) for detecting COPD, whereas GOLD and ATS/ERS criteria showed the highest sensitivity (87.9) and the least specificity (20.8).Conclusion:There is a considerable difference in the indication for spirometry according to the five different guideline criteria. The GOLD-modified criteria recruit less people with the greatest sum of sensitivity and specificity.
    Full-text · Article · Oct 2014 · npj Primary Care Respiratory Medicine
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    ABSTRACT: Objective To determine whether the presence of chronic obstructive lung disease (COPD) and reduction of lung function parameters were predictors of mortality in a cohort. Materials/Patients and Methods Population based cohorts were followed in Montevideo, Santiago and Sao Paulo during 5, 6 and 9 years, respectively. Outcomes included all-cause, cardiovascular, respiratory and cancer mortality; exposures were COPD, forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). Cox regression was used for analyses. Sensitivity, specificity, positive and negative predictive values, receiver operator characteristics curves and Youden's index were calculated. Results Main causes of death were cardiovascular, respiratory and cancer. Baseline COPD was associated with overall mortality (HR = 1.43 for FEV1/FVC<LLN; 2.01 for GOLD 2-4; 1.46 for GOLD 1-4; 1.50 for FEV1/FEV6 <LLN). For cardiovascular mortality, significant associations were found with GOLD 2-4 (HR = 2.68) and with GOLD 1-4 (HR = 1.78) for both genders together (not among women). Low FEV1 was risk for overall and respiratory mortality (both genders combined). FVC was not associated with overall mortality. For most COPD criteria sensitivity was low and specificity high. The area under the curve for FEV1 was greater than for FVC for overall and cardiovascular mortality. Answer to the Question COPD and low FEV1 are important predictors for overall and cardiovascular mortality in Latin America.
    Full-text · Article · Oct 2014 · PLoS ONE
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    ABSTRACT: Antecedentes El estudio basal del PLATINO, llevado a cabo entre 2003 y 2005 en 5 ciudades latinoamericanas (São Paulo, Ciudad de México, Montevideo, Santiago, Caracas), mostró una prevalencia elevada de la enfermedad pulmonar obstructiva crónica (EPOC). Métodos/diseño Se llevó a cabo un estudio de seguimiento en 3 de los 5 centros (Montevideo, Santiago y São Paulo) después de un periodo de 5, 6 y 9 años, respectivamente, con el objetivo de verificar la estabilidad del diagnóstico de EPOC a lo largo del tiempo, la evolución de la enfermedad en cuanto a supervivencia, morbilidad y función respiratoria, y análisis de los biomarcadores genéticos e inflamatorios en sangre. Se añadieron algunas preguntas adicionales al cuestionario original y se obtuvieron los certificados de defunción a partir de los registros oficiales nacionales. Resultados El trabajo de campo se ha completado en los 3 centros. De las muestras originales de la fase i del PLATINO pudimos localizar y entrevistar al 85,6% en Montevideo, al 84,7% en Santiago y al 77,7% en São Paulo. Los individuos no localizados se caracterizaban por un mayor nivel de estudios en Brasil y era más probable que fueran fumadores actuales en Santiago y São Paulo que en Montevideo. La calidad global de las espirometrías fue ≥ 80% según los criterios de la American Thoracic Society. El número de muertes fue de 71 (Montevideo), 95 (Santiago) y 135 (São Paulo), y se obtuvieron los certificados de defunción a partir de los registros de mortalidad nacionales del 76,1, del 88,3 y del 91,8% de los casos en Montevideo, Santiago y São Paulo, respectivamente. Conclusiones Este estudio muestra que es posible realizar estudios longitudinales de base poblacional en Latinoamérica, con tasas de seguimiento elevadas y una alta calidad de los datos de espirometría. La idoneidad de los registros de mortalidad nacionales varía en los distintos centros de Latinoamérica.
    No preview · Article · Jan 2014 · Archivos de Bronconeumología
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    ABSTRACT: Introducción La enfermedad pulmonar obstructiva crónica (EPOC) se asocia a comorbilidades que influyen en el estado de salud y en el pronóstico de los pacientes. El estudio PLATINO aporta datos sobre comorbilidades autorreportadas y percepción del estado general de salud (EGS) en la EPOC. Métodos PLATINO es un estudio poblacional, sobre prevalencia de EPOC en 5 ciudades de Latinoamérica. El diagnóstico de EPOC se realizó según el criterio de GOLD (FEV1/FVC < 0,70 post-broncodilatador). Se recogió información sobre las siguientes comorbilidades: cardíaca, hipertensión, diabetes, accidente cerebrovascular (ACV), úlcera y asma. El EGS se evaluó mediante el cuestionario SF-12, con la pregunta: «En general ¿diría usted que su salud es: excelente, muy buena, buena, regular o pobre?». Sumando las comorbilidades, se elaboró un índice de comorbilidad. Resultados Sobre una población total de 5.314 individuos se realizó diagnóstico de EPOC en 759. Las comorbilidades reportadas en orden decreciente fueron: cualquier tipo de enfermedad cardiovascular, hipertensión, úlcera péptica, enfermedad cardíaca, diabetes, ACV, asma y cáncer de pulmón. Los sujetos con EPOC tuvieron mayor índice de comorbilidad, prevalencia de cáncer de pulmón (p < 0,0001) y asma (p < 0,0001), así como mayor tendencia a hipertensión (p = 0,0652) y ACV (p = 0,0750). Los factores asociados a comorbilidad en EPOC fueron la edad, el índice de masa corporal (IMC) y el género femenino. Con el deterioro del EGS aumenta el número de comorbilidades. Conclusiones En población no seleccionada los individuos con EPOC presentan más comorbilidades. La edad, el sexo femenino y mayor IMC son los principales factores asociados a comorbilidad en estos pacientes. Independientemente de la condición de EPOC, un mayor número de comorbilidades se asocia a peor EGS.
    No preview · Article · Nov 2013 · Archivos de Bronconeumología
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    ABSTRACT: Introduction Comorbidities are common in patients with chronic obstructive pulmonary disease (COPD), and have a significant impact on health status and prognosis. The PLATINO study provides data on self-reported comorbidities and perceived health status in COPD subjects. Methods PLATINO is a population-based study on COPD prevalence in five Latin American cities. COPD diagnosis was defined by GOLD criteria (FEV1/FVC < .70 post-bronchodilator). Information was collected on the following comorbidities: heart disease, hypertension, diabetes, cerebrovascular disease, peptic ulcer and asthma. Health status was evaluated using the SF-12 questionnaire, derived from the question: «In general, would you say your health is excellent, very good, good, fair or poor?». A simple comorbidity score was calculated by adding the total number of comorbid conditions. Results Of a total population of 5314 individuals, 759 had COPD. Reported comorbidities by decreasing frequency were: any cardiovascular disease, hypertension, peptic ulcer, heart disease, diabetes, cerebrovascular disease, asthma and lung cancer. COPD patients had a higher comorbidity score and prevalence of lung cancer (P < .0001) and asthma (P < .0001), as well as a higher tendency to have hypertension (P = .0652) and cerebrovascular disease (P = .0750). Factors associated with comorbidities were age, body mass index (BMI) and female gender. The number of comorbidities increased as the health status deteriorated. Conclusions In the PLATINO population-based study, COPD individuals had an increased number of comorbidities. Age, female gender and higher BMI were the factors associated with comorbidity in these patients. Comorbid conditions were associated with impaired health status, independently of the COPD status.
    No preview · Article · Nov 2013 · Archivos de Bronconeumología
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    ABSTRACT: Several COPD phenotypes have been described; the COPD-Asthma overlap is one of the most recognized. Aim: to evaluate the prevalence of three subgroups (asthma, COPD and COPD-Asthma overlap) in the PLATINO study population, to describe their main characteristics and to determine the association of the COPD-Asthma overlap group with exacerbations, hospitalizations, limitations due to physical health and perception of general health status (GHS). The PLATINO study is a multicenter population-based survey carried out in five Latin American cities. Outcomes were self-reported exacerbations (defined by deterioration of breathing symptoms that affected usual daily activities or caused missed work), hospitalizations due to exacerbations, physical health limitations and patients' perception of their GHS obtained by questionnaire. Subjects were classified in three specific groups: COPD - a post-bronchodilator (BD) FEV1/FVC ratio of < 0.70; asthma - presence of wheezing in the last year and a minimum post-BD increase in FEV1 or FVC of 12% and 200 ml; overlap COPD-Asthma - the combination of the two. Out of 5,044 subjects, 767 were classified as COPD (12%), asthma (1.7%) and COPD-Asthma overlap (1.8%). Subjects with COPD-Asthma overlap had more respiratory symptoms, worse lung function, used more respiratory medication, more hospitalization and exacerbations, and worse GHS. After adjusting for confounders, the COPD-Asthma overlap was associated with higher risks for exacerbations (PR 2.11; 95%CI 1.08-4.12), hospitalizations (PR 4.11; 95%CI 1.45-11.67) and worse GHS (PR 1.47; 95%CI 1.18-1.85), compared to those with COPD. The coexisting COPD-Asthma phenotype is possibly associated with increased disease severity.
    No preview · Article · Oct 2013 · Chest
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    ABSTRACT: Latin America is made up of a number of developing countries. Demographic changes are occurring in the close to 600million inhabitants, in whom a significant growth in population is combined with the progressive ageing of the population. This part of the world poses great challenges for general and respiratory health. Most of the countries have significant, or even greater, rates of chronic respiratory diseases or exposure to risk. Human resources in healthcare are not readily available, particularly in the area of respiratory disease specialists. Academic training centers are few and even non-existent in the majority of the countries. The detailed analysis of these conditions provides a basis for reflection on the main challenges and proposals for the management and training of better human resources in this specialist area.
    No preview · Article · Oct 2013 · Archivos de Bronconeumología
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    ABSTRACT: A 6-second spirometry test is easier than full exhalations. We compared the reliability of the ratio of the Forced expiratory volume in 1 second/Forced expiratory volume in 6 seconds (FEV1/FEV6) to the ratio of the FEV1/Forced vital capacity (FEV1/FVC) for the detection of airway obstruction. The PLATINO population-based survey in individuals aged 40 years and over designed to estimate the prevalence of post-Bronchodilator airway obstruction repeated for the same study participants after 5-9 years in three Latin-American cities. Using the FEV1/FVC<Lower limit of normal (LLN) index, COPD prevalence apparently changed from 9.8 to 13.2% in Montevideo, from 9.7 to 6.0% in São Paulo and from 8.5 to 6.6% in Santiago, despite only slight declines in smoking prevalence (from 30.8% to 24.3%). These changes were associated with differences in Forced expiratory time (FET) between the two surveys. In contrast, by using the FEV1/FEV6 to define airway obstruction, the changes in prevalence were smaller: 9.7 to 10.6% in Montevideo, 8.6 to 9.0% in São Paulo, and 7.5 to 7.9% in Santiago. Changes in the prevalence of COPD with criteria based on FEV1/FVC correlated strongly with changes in the FET of the tests (R(2) 0.92) unlike the prevalence based on a low FEV1/FEV6 (R(2) = 0.40). The FEV1/FEV6 is a more reliable index than FEV1/FVC because FVC varies with the duration of the forced exhalation. Reporting FET and FEV1/FEV6<LLN helps to understand differences in prevalence of COPD obtained from FEV1/FVC-derived indices.
    Full-text · Article · Aug 2013 · PLoS ONE
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    ABSTRACT: We aimed to describe the distribution of self-reported sleep duration in adults over the age of 40years and to analyze the associated risk factors, comorbid conditions, and quality of life (QoL). Our study was constructed as a cross-sectional population-based study and is part of the PLATINO (Spanish acronym for the Latin American Project for Research in Pulmonary Obstruction) study. It includes data from Mexico City (Mexico), Montevideo (Uruguay), Santiago (Chile), and Caracas (Venezuela). Data from 4533 individuals were analyzed using a single questionnaire entitled, PLATINO, which was designed to collect data on self-reported sleep symptoms. Spirometry also was performed in accordance with international standards. All statistical analyses took the study design into consideration with adjustments for each city. The prevalence of subjects who reported sleeping <7h was 38.4%, ⩾7 to <9h was 51.4%, and ⩾9h was 10.2%. In the multivariate analysis, individuals with shorter sleep duration had higher frequencies of insomnia, increased forced expiratory volume in one second in liters and percentage/forced vital capacity in liters (FEV1/FVC) of predicted ratios, and a higher presence of coughing and phlegm. The main risk factor associated with longer duration of sleep was the number of comorbidities. Self-reported sleep duration discriminated among groups that differed in sleep-related symptoms, respiratory symptoms, QoL and comorbid conditions.
    Full-text · Article · Jul 2013 · Sleep Medicine
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    ABSTRACT: Background: The quality and potential impact of available clinical guidelines for asthma management have not been systematically evaluated. We, therefore, evaluated the quality of clinical practice guidelines (CPGs) for asthma. Methods: We performed a systematic search of scientific literature published between 2000 and 2010 to identify and select CPGs related to asthma management. We searched guideline databases, guideline developers' websites, and the MEDLINE database of the US National Library of Medicine. Four independent reviewers assessed the eligible guidelines using the Appraisal of Guidelines Research & Evaluation (AGREE) II instrument. We calculated the overall agreement among reviewers with the intraclass correlation coefficient (ICC). Results: Eighteen CPGs published between the years 2000 and 2010 were selected from a total of 1,005 references. The overall agreement among reviewers was moderate (ICC: 0.78; 95% CI, 0.62-0.90). The mean scores for each AGREE domain were: scope and purpose, 44.1% (range: 10.0%-79.0%); stakeholder involvement, 33.8% (range: 4.0%-66.0%); rigor of development, 32.4% (range: 8.0%-64.0%); clarity and presentation, 52.1% (range: 17.0%-85.0%); applicability, 21.1% (range: 3%-55%); and editorial independence, 25% (range: 0%-58%). None of the appraised guidelines had a score > 60% (recommended). One-half of the appraised guidelines were recommended with modifications (nine of 18) or not recommended (nine of 18) for use in clinical practice. We observed improvement over time in overall quality of the guidelines (P = .01; guidelines published in the period 2001-2006 vs 2007-2009). Conclusions: The quality of guidelines for asthma care is low, although it has improved over time. Greater efforts are needed to provide high-quality guidelines that can be used as reliable tools for clinical decision-making in this field.
    No preview · Article · Feb 2013 · Chest
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    ABSTRACT: Latin America is made up of a number of developing countries. Demographic changes are occurring in the close to 600 million inhabitants, in whom a significant growth in population is combined with the progressive ageing of the population. This part of the world poses great challenges for general and respiratory health. Most of the countries have significant, or even greater, rates of chronic respiratory diseases or exposure to risk. Human resources in healthcare are not readily available, particularly in the area of respiratory disease specialists. Academic training centers are few and even non-existent in the majority of the countries. The detailed analysis of these conditions provides a basis for reflection on the main challenges and proposals for the management and training of better human resources in this specialist area.
    No preview · Article · Jan 2013
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    ABSTRACT: Background The PLATINO baseline study, conducted from 2003-2005 in five Latin American cities (São Paulo, Mexico City, Montevideo, Santiago, Caracas), showed a high prevalence of chronic obstructive pulmonary disease (COPD). Methods/design A follow-up study was conducted in three out of the five centers (Montevideo, Santiago, and São Paulo) after a period of 5, 6 and 9 years, respectively, aimed at verifying the stability of the COPD diagnosis over time, the evolution of the disease in terms of survival, morbidity and respiratory function, and the analyses of inflammatory and genetic biomarkers in the blood. Some questions were added to the original questionnaire and death certificates were obtained from the national official registries. Results The fieldwork has been concluded in the three centers. From the original samples in the PLATINO study phase i, we were able to locate and interview 85.6% of patients in Montevideo, 84.7% in Santiago and 77.7% in São Paulo. Individuals who could not be located had higher education levels in Brazil, and were more likely to be current smokers in Santiago and São Paulo than in Montevideo. The overall quality of spirometries was ≥ 80% according to American Thoracic Society criteria. The number of deaths was 71 (Montevideo), 95 (Santiago) and 135 (São Paulo), with death certificates obtained from the national mortality registries for 76.1%, 88.3% and 91.8% of cases in Montevideo, Santiago and São Paulo, respectively. Conclusions This study shows that is possible to perform population-based longitudinal studies in Latin American with high follow-up rates and high-quality spirometry data. The adequacy of national mortality registries varies among centers in Latin America.
    No preview · Article · Jan 2013 · Archivos de Bronconeumología
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    María Montes de Oca · Maria Victorina Lopez

    Preview · Article · Nov 2012 · European Respiratory Journal

Publication Stats

4k Citations
426.25 Total Impact Points

Institutions

  • 1997-2015
    • Central University of Venezuela
      • • Facultad de Medicina
      • • Instituto de Medicina Experimental
      Caracas, Capital, Venezuela
  • 2004-2011
    • Hospital Universitario de Caracas
      Caracas, Capital, Venezuela
  • 2007
    • Instituto Nacional de Enfermedades Respiratorias
      Ciudad de México, The Federal District, Mexico
  • 1996
    • Boston Medical Center
      Boston, Massachusetts, United States