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Abstract Background Self-management interventions (SMIs) are core components of high-quality care in type 2 diabetes mellitus (T2DM). We aimed to identify and summarise the scientific evidence exploring the perspectives of patients with T2DM and their informal caregivers on outcomes of SMIs, and the key themes to enhance T2DM patient-centred care. Methods We conducted a mixed-methods overview of reviews. We searched MEDLINE, CINAHL and PsycINFO, up to June 2021 for systematic reviews (SRs) exploring the perspectives of adults with T2DM and their informal caregivers, regarding self-management. Two reviewers conducted independently study selection, data extraction and quality assessment. We estimated the degree of overlap across SRs. We performed a qualitative analysis using a thematic synthesis approach. Results We identified 54 SRs, corresponding to 939 studies, with a slight overlap. Most SRs (47/54, 87%) were considered high quality. We developed summaries for 22 outcomes and identified six overarching themes: (1) diabetic identity; (2) accessing healthcare; (3) experience of care; (4) engagement with self-management; (5) outcomes awareness; and (6) challenges adhering to self-management. We found important variability in how patients with T2DM and their informal caregivers value critical outcomes influenced by the disease progression and several contextual factors. Conclusions Our findings represent what matters most to patients with T2DM and their informal caregivers regarding outcomes of SMIs. Our results can facilitate the development and evaluation of SMIs, and guide decision-making in diabetes care, including the formulation of decisions and recommendations.

Background The objective is to examine and synthesise the best available experimental evidence about the effect of ambulatory consultation duration on quality of healthcare.Methods We included experimental studies manipulating the length of outpatient clinical encounters between adult patients and clinicians (ie, therapists, pharmacists, nurses, physicians) to determine their effect on quality of care (ie, effectiveness, efficiency, timeliness, safety, equity, patient-centredness and patient satisfaction).Information sources Using controlled vocabulary and keywords, without restriction by language or year of publication, we searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews and Scopus from inception until 15 May 2023.Risk of bias Cochrane Risk of Bias instrument.Data synthesis Narrative synthesis.Results 11 publications of 10 studies explored the relationship between encounter duration and quality. Most took place in the UK’s general practice over two decades ago. Study findings based on very sparse and outdated evidence—which suggested that longer consultations improved indicators of patient-centred care, education about prevention and clinical referrals; and that consultation duration was inconsistently related to patient satisfaction and clinical outcomes—warrant low confidence due to limited protections against bias and indirect applicability to current practice.Conclusion Experimental evidence for a minimal or optimal duration of an outpatient consultation is sparse and outdated. To develop evidence-based policies and practices about encounter length, randomised trials of different consultation lengths—in person and virtually, and with electronic health records—are needed.Trial registration number OSF Registration DOI:10.17605/OSF.IO/EUDK8.

Abstract The objective of this work was to evaluate the efficiency of the stabilization process of swine manure in storage ponds regarding the presence and antibiotic resistance of pathogenic bacteria. The study was carried out in two trials in ten swine farms located in the municipality of Presidente Castello Branco, in the state of Santa Catarina, Brazil. In the first trial, the efficiency in reducing Escherichia coli (EC), non-E. coli coliforms, and Salmonella sp., as well as the resistance of isolates to antimicrobials, was investigated under recommended handling conditions. Sampling was done at three depths and two times. In the second trial, the concentration of total and fecal coliforms (EC) was evaluated under field handling conditions, when the manure was distributed on the field. Sampling depth does not influence the concentration of EC and Salmonella sp., and isolated bacteria are multi resistant to the evaluated antibiotics. Hydraulic retention time is determinant in reducing the population levels of the indicator agents. The obtained results are indicative that swine manure handling must be carried out according to sanitary standards, in order to minimize the propagation risk and antimicrobial resistance of pathogenic microorganisms.

Liquid Swine Manure (LSM) has recognized fertilizer potential for agriculture, but excessive and/or prolonged applications of high doses in agricultural systems may cause soil and water pollution. The present paper presents the proposition of a multicriteria model that aims to identify and classify agricultural areas that receive LSM as soil fertilizers, according to the degree of potential risk of contamination of surface waters. The proposal is based on the knowledge of experts, use of Geographic Information Systems (GIS) and the modelling of a decision support system. The determination of environmental risk criteria was performed based on a literature review and its weighting was defined through consultation with specialists from various institutions, research, extension, educational and environmental of the State of Santa Catarina. The model, called SMRISK (Swine Manure Risk), was applied within a watershed with intensive pig farming located in Southern Brazil and proved to be more restrictive compared to the legal regulations used for the environmental licensing of pig farming in the State of Santa Catarina.

After the development and mass commercialization of antibiotics, pathogenic and environmental bacteria have developed resistance to antibiotics since the last century, so that the infection caused by antibiotic-resistant organisms (AROs) could be considered an emerging infection. As a result, its control should be prioritized as a threat to all nations, regardless of territory and economic situation. Increased surveillance in the United States, Europe and East Asia has illustrated the rapid spread leading to an increasing burden of infections caused by AROs. However, the information available in countries of continued development in Latin America is limited. This review describes recent information on AROs surveillance studies in Latin America as well as common sources of AROs and possible strategies for their control.

In 2008, dengue virus serotype 4 (DENV-4) emerged in northeastern Peru, causing a large outbreak and displacing DENV-3, which had predominated for the previous 6 years. Phylogenetic analysis of 2008 and 2009 isolates support their inclusion into DENV-4 genotype II, forming a lineage distinct from strains that had previously circulated in the region.

Successful vaccination strategies against norovirus will require understanding the burden of disease and relevant genotypes in populations. However, few data are available from cohort studies of adults living in low- and middle-income countries (LMIC).We conducted a nested case-control study within a Peruvian military cohort to characterize the burden of norovirus infection, predominant genotypes, and associated symptoms from 2004 through 2011. Randomly selected case and control stools were tested for norovirus, bacteria, and parasites. The odds ratio of the association between norovirus infection and diarrhea was estimated using multiple logistic regression and co-infection adjusted attributable fractions were calculated.Of the 3,818 cohort study participants, 624 developed diarrhea. Overall and norovirus-associated diarrhea incidence rates were 42.3 and 6.0 per 100 person-years, respectively. The most prevalent norovirus genogroup was GII (72.5%, 29/40), which was associated with diarrhea (AOR 3.4, 95% CI: 1.3-8.7, P = 0.012). The co-infection adjusted GII attributable fraction was 6.4%.Norovirus was a frequent cause of diarrhea in an adult population followed longitudinally in an LMIC setting. Vaccine strategies should consider targeting adults in endemic settings and special populations that could serve as community transmission sources.

Long-term disease surveillance data provide a basis for studying drivers of pathogen transmission dynamics. Dengue is a mosquito-borne disease caused by four distinct, but related, viruses (DENV-1-4) that potentially affect over half the world's population. Dengue incidence varies seasonally and on longer time scales, presumably driven by the interaction of climate and host susceptibility. Precise understanding of dengue dynamics is constrained, however, by the relative paucity of laboratory-confirmed longitudinal data.We studied 10 years (2000-2010) of laboratory-confirmed, clinic-based surveillance data collected in Iquitos, Peru. We characterized inter and intra-annual patterns of dengue dynamics on a weekly time scale using wavelet analysis. We explored the relationships of case counts to climatic variables with cross-correlation maps on annual and trimester bases.Transmission was dominated by single serotypes, first DENV-3 (2001-2007) then DENV-4 (2008-2010). After 2003, incidence fluctuated inter-annually with outbreaks usually occurring between October and April. We detected a strong positive autocorrelation in case counts at a lag of ∼ 70 weeks, indicating a shift in the timing of peak incidence year-to-year. All climatic variables showed modest seasonality and correlated weakly with the number of reported dengue cases across a range of time lags. Cases were reduced after citywide insecticide fumigation if conducted early in the transmission season.Dengue case counts peaked seasonally despite limited intra-annual variation in climate conditions. Contrary to expectations for this mosquito-borne disease, no climatic variable considered exhibited a strong relationship with transmission. Vector control operations did, however, appear to have a significant impact on transmission some years. Our results indicate that a complicated interplay of factors underlie DENV transmission in contexts such as Iquitos.

BACKGROUND: Dengue virus (DENV) infection can range in severity from mild dengue fever (DF) to severe dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS). Changes in host gene expression, temporally through the progression of DENV infection, especially during the early days, remains poorly characterized. Early diagnostic markers for DHF are also lacking. METHODOLOGY/PRINCIPAL FINDINGS: In this study, we investigated host gene expression in a cohort of DENV-infected subjects clinically diagnosed as DF (n = 51) and DHF (n = 13) from Maracay, Venezuela. Blood specimens were collected daily from these subjects from enrollment to early defervescence and at one convalescent time-point. Using convalescent expression levels as baseline, two distinct groups of genes were identified: the "early" group, which included genes associated with innate immunity, type I interferon, cytokine-mediated signaling, chemotaxis, and complement activity peaked at day 0-1 and declined on day 3-4; the second "late" group, comprised of genes associated with cell cycle, emerged from day 4 and peaked at day 5-6. The up-regulation of innate immune response genes coincided with the down-regulation of genes associated with viral replication during day 0-3. Furthermore, DHF patients had lower expression of genes associated with antigen processing and presentation, MHC class II receptor, NK and T cell activities, compared to that of DF patients. These results suggested that the innate and adaptive immunity during the early days of the disease are vital in suppressing DENV replication and in affecting outcome of disease severity. Gene signatures of DHF were identified as early as day 1. CONCLUSIONS/SIGNIFICANCE: Our study reveals a broad and dynamic picture of host responses in DENV infected subjects. Host response to DENV infection can now be understood as two distinct phases with unique transcriptional markers. The DHF signatures identified during day 1-3 may have applications in developing early molecular diagnostics for DHF.

BACKGROUND: Knowledge of spatial patterns of dengue virus (DENV) infection is important for understanding transmission dynamics and guiding effective disease prevention strategies. Because movement of infected humans and mosquito vectors plays a role in the spread and persistence of virus, spatial dimensions of transmission can range from small household foci to large community clusters. Current understanding is limited because past analyses emphasized clinically apparent illness and did not account for the potentially large proportion of inapparent infections. In this study we analyzed both clinically apparent and overall infections to determine the extent of clustering among human DENV infections. METHODOLOGY/PRINCIPAL FINDINGS: We conducted spatial analyses at global and local scales, using acute case and seroconversion data from a prospective longitudinal cohort in Iquitos, Peru, from 1999-2003. Our study began during a period of interepidemic DENV-1 and DENV-2 transmission and transitioned to epidemic DENV-3 transmission. Infection status was determined by seroconversion based on plaque neutralization testing of sequential blood samples taken at approximately six-month intervals, with date of infection assigned as the middate between paired samples. Each year was divided into three distinct seasonal periods of DENV transmission. Spatial heterogeneity was detected in baseline seroprevalence for DENV-1 and DENV-2. Cumulative DENV-3 seroprevalence calculated by trimester from 2001-2003 was spatially similar to preexisting DENV-1 and DENV-2 seroprevalence. Global clustering (case-control Ripley's K statistic) appeared at radii of ∼200-800 m. Local analyses (Kuldorf spatial scan statistic) identified eight DENV-1 and 15 DENV-3 clusters from 1999-2003. The number of seroconversions per cluster ranged from 3-34 with radii from zero (a single household) to 750 m; 65% of clusters had radii >100 m. No clustering was detected among clinically apparent infections. CONCLUSIONS/SIGNIFICANCE: Seroprevalence of previously circulating DENV serotypes can be a predictor of transmission risk for a different invading serotype and, thus, identify targets for strategically placed surveillance and intervention. Seroprevalence of a specific serotype is also important, but does not preclude other contributing factors, such as mosquito density, in determining where transmission of that virus will occur. Regardless of the epidemiological context or virus serotype, human movement appears to be an important factor in defining the spatial dimensions of DENV transmission and, thus, should be considered in the design and evaluation of surveillance and intervention strategies.

Comprehensive, longitudinal field studies that monitor both disease and vector populations for dengue viruses are urgently needed as a pre-requisite for developing locally adaptable prevention programs or to appropriately test and license new vaccines.We report the results from such a study spanning 5 years in the Amazonian city of Iquitos, Peru where DENV infection was monitored serologically among approximately 2,400 members of a neighborhood-based cohort and through school-based absenteeism surveillance for active febrile illness among a subset of this cohort. At baseline, 80% of the study population had DENV antibodies, seroprevalence increased with age, and significant geographic variation was observed, with neighborhood-specific age-adjusted rates ranging from 67.1 to 89.9%. During the first 15 months, when DENV-1 and DENV-2 were co-circulating, population-based incidence rates ranged from 2-3 infections/100 person-years (p-years). The introduction of DENV-3 during the last half of 2001 was characterized by 3 distinct periods: amplification over at least 5-6 months, replacement of previously circulating serotypes, and epidemic transmission when incidence peaked at 89 infections/100 p-years.Neighborhood-specific baseline seroprevalence rates were not predictive of geographic incidence patterns prior to the DENV-3 introduction, but were closely mirrored during the invasion of this serotype. Transmission varied geographically, with peak incidence occurring at different times among the 8 geographic zones in approximately 16 km(2) of the city. The lag from novel serotype introduction to epidemic transmission and knowledge of spatially explicit areas of elevated risk should be considered for more effective application of limited resources for dengue prevention.

BACKGROUND: Arthropod-borne viruses (arboviruses) are among the most common agents of human febrile illness worldwide and the most important emerging pathogens, causing multiple notable epidemics of human disease over recent decades. Despite the public health relevance, little is know about the geographic distribution, relative impact, and risk factors for arbovirus infection in many regions of the world. Our objectives were to describe the arboviruses associated with acute undifferentiated febrile illness in participating clinics in four countries in South America and to provide detailed epidemiological analysis of arbovirus infection in Iquitos, Peru, where more extensive monitoring was conducted. METHODOLOGY/FINDINGS: A clinic-based syndromic surveillance system was implemented in 13 locations in Ecuador, Peru, Bolivia, and Paraguay. Serum samples and demographic information were collected from febrile participants reporting to local health clinics or hospitals. Acute-phase sera were tested for viral infection by immunofluorescence assay or RT-PCR, while acute- and convalescent-phase sera were tested for pathogen-specific IgM by ELISA. Between May 2000 and December 2007, 20,880 participants were included in the study, with evidence for recent arbovirus infection detected for 6,793 (32.5%). Dengue viruses (Flavivirus) were the most common arbovirus infections, totaling 26.0% of febrile episodes, with DENV-3 as the most common serotype. Alphavirus (Venezuelan equine encephalitis virus [VEEV] and Mayaro virus [MAYV]) and Orthobunyavirus (Oropouche virus [OROV], Group C viruses, and Guaroa virus) infections were both observed in approximately 3% of febrile episodes. In Iquitos, risk factors for VEEV and MAYV infection included being male and reporting to a rural (vs urban) clinic. In contrast, OROV infection was similar between sexes and type of clinic. CONCLUSIONS/SIGNIFICANCE: Our data provide a better understanding of the geographic range of arboviruses in South America and highlight the diversity of pathogens in circulation. These arboviruses are currently significant causes of human illness in endemic regions but also have potential for further expansion. Our data provide a basis for analyzing changes in their ecology and epidemiology.

BACKGROUND: Acute respiratory illnesses and influenza-like illnesses (ILI) are a significant source of morbidity and mortality worldwide. Despite the public health importance, little is known about the etiology of these acute respiratory illnesses in many regions of South America. In 2006, the Peruvian Ministry of Health (MoH) and the US Naval Medical Research Center Detachment (NMRCD) initiated a collaboration to characterize the viral agents associated with ILI and to describe the clinical and epidemiological presentation of the affected population. METHODOLOGY/PRINCIPAL FINDINGS: Patients with ILI (fever > or =38 degrees C and cough or sore throat) were evaluated in clinics and hospitals in 13 Peruvian cities representative of the four main regions of the country. Nasal and oropharyngeal swabs, as well as epidemiological and demographic data, were collected from each patient. During the two years of this study (June 2006 through May 2008), a total of 6,835 patients, with a median age of 13 years, were recruited from 31 clinics and hospitals; 6,308 were enrolled by regular passive surveillance and 527 were enrolled as part of outbreak investigations. At least one respiratory virus was isolated from the specimens of 2,688 (42.6%) patients, with etiologies varying by age and geographical region. Overall the most common viral agents isolated were influenza A virus (25.1%), influenza B virus (9.7%), parainfluenza viruses 1, 2, and 3, (HPIV-1,-2,-3; 3.2%), herpes simplex virus (HSV; 2.6%), and adenoviruses (1.8%). Genetic analyses of influenza virus isolates demonstrated that three lineages of influenza A H1N1, one lineage of influenza A H3N2, and two lineages of influenza B were circulating in Peru during the course of this study. CONCLUSIONS: To our knowledge this is the most comprehensive study to date of the etiologic agents associated with ILI in Peru. These results demonstrate that a wide range of respiratory pathogens are circulating in Peru and this fact needs to be considered by clinicians when treating patients reporting with ILI. Furthermore, these data have implications for influenza vaccine design and implementation in South America.

Enzootic strains of Venezuelan equine encephalitis virus (VEEV) have been isolated from febrile patients in the Peruvian Amazon Basin at low but consistent levels since the early 1990s. Through a clinic-based febrile surveillance program, we detected an outbreak of VEEV infections in Iquitos, Peru, in the first half of 2006. The majority of these patients resided within urban areas of Iquitos, with no report of recent travel outside the city. To characterize the risk factors for VEEV infection within the city, an antibody prevalence study was carried out in a geographically stratified sample of urban areas of Iquitos. Additionally, entomological surveys were conducted to determine if previously incriminated vectors of enzootic VEEV were present within the city. We found that greater than 23% of Iquitos residents carried neutralizing antibodies against VEEV, with significant associations between increased antibody prevalence and age, occupation, mosquito net use, and overnight travel. Furthermore, potential vector mosquitoes were widely distributed across the city. Our results suggest that while VEEV infection is more common in rural areas, transmission also occurs within urban areas of Iquitos, and that further studies are warranted to identify the precise vectors and reservoirs involved in urban VEEV transmission.

Después del desarrollo y la comercialización en masa de los antibióticos, las bacterias patógenas y ambientales han desa- rrollado resistencia a los antibióticos desde el siglo pasado, de modo que la infección causada por organismos resistentes a los antibióticos (ORAs) podría ser considerada como una infección emergente. Debido a ello, su control debe ser priorizado ya que constituye una amenaza para todas las naciones, sin reparar en su territorio y situación económica. El incremento de la vigilancia en Estados Unidos de América, Europa y Asia Oriental ha ilustrado lo rápido que pueden diseminarse, trayendo como consecuencia un incremento en la carga de infecciones causadas por los ORAs, sin embargo, la información disponible en los países de continuo desarrollo en América Latina es limitada. Esta revisión describe información reciente de estudios de vigilancia de ORAs en América Latina, así como también fuentes comunes de ORAs y posibles estrategias para su control.

Después del desarrollo y la comercialización en masa de los antibióticos, las bacterias patógenas y ambientales han desa- rrollado resistencia a los antibióticos desde el siglo pasado, de modo que la infección causada por organismos resistentes a los antibióticos (ORAs) podría ser considerada como una infección emergente. Debido a ello, su control debe ser priorizado ya que constituye una amenaza para todas las naciones, sin reparar en su territorio y situación económica. El incremento de la vigilancia en Estados Unidos de América, Europa y Asia Oriental ha ilustrado lo rápido que pueden diseminarse, trayendo como consecuencia un incremento en la carga de infecciones causadas por los ORAs, sin embargo, la información disponible en los países de continuo desarrollo en América Latina es limitada. Esta revisión describe información reciente de estudios de vigilancia de ORAs en América Latina, así como también fuentes comunes de ORAs y posibles estrategias para su control.

Abstract Introduction Biological monoclonal antibodies play a pivotal role in cancer treatment, with biosimilars significantly enhancing their accessibility. In Brazil’s ethnically diverse setting, real-world evidence is crucial for assessing the effectiveness and applicability of these therapies in routine clinical practice. Methods We performed a multicentric, observational, prospective real-world study on biosimilar trastuzumab-dkst for adjuvant treatment of early HER2-positive breast cancer in Brazilian patients. Data were collected using a case-report form. Results Of the 176 recruited, we present data from the first 59 patients (mean age 51.7 ± 12.9 years) who had completed treatment with trastuzumab-dkst. The mean time from diagnosis to the first adjuvant treatment with trastuzumab-dkst was 5.5 ± 2.7 months. Of the patients, 59% of patients achieved at least a 30-month follow-up. The 31.7-month invasive disease-free survival rate (IDFS) was 94.5% (95% CI 83.9–98.2%) and median IDFS was not achieved, since only three patients had invasive disease recurrence. The overall survival rate was 100% until the last assessment. The observed adverse events were similar to those presented by other studies using biosimilar or reference trastuzumab. Four serious adverse events (8.5%) were observed. A reduction in left ventricular ejection fraction of at least 10% was observed in 16.9% of participants. There was no treatment interruption, and three participants (5.1%) had their trastuzumab-dkst dose reduced. Conclusion Our study reinforces the existing pivotal data, underscoring the real-world efficacy and safety of biosimilar trastuzumab-dkst in the adjuvant treatment for early HER2-positive breast cancer. The preliminary long-term effectiveness and safety data we present further validate trastuzumab-dkst’s role as a cost-saving alternative in oncological care. These findings have important implications for improving patient access to crucial treatments and for the more efficient use of healthcare resources. ClinicalTrials.gov Registration NCT03892655.

The interaction between intensive animal production and the environment is complex and depends on the location and management practices. The waste generated from intensive animal production may represent a triggering factor for environmental pressures in the function of the volume and the characteristics, degrading environmental quality and affecting ecosystem services. The objective of this study was to develop a conceptual framework for the environmental description of the impacts caused by the accumulation of the waste from intensive animal production, integrating the causal-chain approach of the driver–pressure–status–impact–response (DPSIR) model with the causal network and ecosystem services. Therefore, a conceptual framework was developed that makes possible a comprehensive description of a set of structures and functions that interact in complex ways. The conceptual framework was validated through a case study performed within the scope of a hydrographic microbasin with intensive pig production. The conceptual framework developed made it possible to establish connections among the DPSIR components, including environmental perceptions and changes in the socioeconomic system. The impacts caused by the waste were considered as changes in the provision of ecosystem services and the socioeconomic system, identifiable in the proposed conceptual framework. The application of the conceptual framework identified the primary drivers that exert pressure on the system and has an impact on the ecosystem services, affecting the provision and regulation services. The development of this environmental conceptual framework contributes to the selection of the indicators and ecosystem services involved. This can aid in the promotion of environmental sustainability, providing subsidies for more adequate environmental policies obtained from indicators that reflect local conditions.

The steam reforming of ethanol, methanol, and other oxygenates (e.g., bio-oil and olive mill wastewater) using Ni-based catalysts have been studied by the scientific community in the last few years. This process is already well studied over the last years, being the critical point, at this moment, the choice of a suitable catalyst. The utilization of these oxygenates for the production of “green” H2 is an interesting alternative to fuel fossils. For this application, Ni-based catalysts have been extensively studied since they are highly active and cheaper than noble metal-based materials. In this review, a comparison of several Ni-based catalysts reported in the literature for the different above-mentioned reactions is carried out. This study aims to understand if such catalysts demonstrate enough catalytic activity/stability for application in steam reforming of the oxygenated compounds and which preparation methods are most adequate to obtain these materials. In summary, it aims to provide insights into the performances reached and point out the best way to get better and improved catalysts for such applications (which depends on the feedstock used).

Olive oil mill wastewater (OMW) is a polluting stream derived from the production of olive oil and is a source of environmental pollution; this is relevant in many countries around the world, but particularly in all the Mediterranean region where major producers are located. In this effluent, several pollutants are present—namely, sugars, fatty acids, and polyphenols, among others. Nowadays, to reduce the pollutant load, several treatment techniques are applied, but these technologies have numerous cost and efficiency problems. For this reason, the steam reforming of the OMW (OMWSR) presents as a good alternative, because this process decreases the pollutant load of the OMW and simultaneously valorizes the waste with the production of green H2, which is consistent with the perspective of the circular economy. Currently, the OMWSR is an innovative treatment alternative in the scientific field and with high potential. In the last few years, some groups have studied the OMWSR and used innovative reactor configurations, aiming to improve the process’ effectiveness. In this review, the OMW treatment/valorization processes, the last developments on catalysis for OMWSR (or steam reforming of similar species present in the effluent), as well as the last advances on OMWSR performed in multi-functional reactors are addressed.

Introdução No Brasil, a CONITEC recentemente definiu um limiar de custo-efetividade a ser considerado nas avaliações para incorporação de tecnologias em saúde no SUS. No documento que apresenta a construção e os detalhes desta ferramenta, a Comissão aborda a necessidade de discussão de um novo tipo de limiar, o de impacto orçamentário. Adotado em alguns países, esse limiar, quando alcançado, sinalizaria a necessidade de discussões de alternativas, sejam de acordos comerciais, seja de extensão do prazo de incorporação ou restrição de uso da tecnologia. O objetivo deste estudo é sintetizar os métodos de definição do limiar de impacto orçamentário disponíveis na literatura e nas principais agências de Avaliação de Tecnologias de Saúde (ATS) do mundo. Métodos De acordo com a metodologia do Joanna Briggs Institute e com o PRISMA-ScR, uma revisão rápida de escopo foi empreendida para alcançar o objetivo do estudo. A pergunta de pesquisa foi definida seguindo o acrônimo “PCC”, em quê o “P” são os participantes e são as agências de ATS do Reino Unido, Canadá, Austrália, Argentina, EUA e Brasil; “C” representa o conceito; e por fim, o último “C” represento o contexto. A revisão considerou estudos qualitativos, revisões sistemáticas e uma amplitude de fontes alinhadas aos critérios de inclusão. Os softwares utilizados para gerenciamento das citações e duplicatas foram o Mendeley e Rayyan. Resultados De um total de 406 estudos e registros encontrados nas bases de dados e sites das agências de ATS, 11 foram incluídos na análise final. Apesar do uso de limiar de impacto orçamentário como critério para a forma ou decisão de incorporação no Reino Unido e Austrália, apenas para os EUA o método foi apresentado de forma reprodutível. O Institute for Clinical and Economic Review (ICER), instituto de pesquisa americano não-governamental, define o limiar em um cálculo que considera o crescimento da economia do país, os gastos totais em saúde e em medicamentos, e o número médio anual de medicamentos aprovados pelo FDA nos últimos cinco anos. O limiar calculado para o período de 2022/2023 foi de U$ 777 milhões. Segundo a organização, o objetivo não é sugerir um limite nos gastos, mas sinalizar ao sistema de saúde que acordos especiais devem ser buscados. Em nota técnica elaborada pelo Banco Interamericano de Desenvolvimento (BID), uma metodologia foi definida para adaptar um limiar de impacto orçamentário de acordo com a fração do gasto per capta em saúde experienciada em países já com o uso desse limiar. Segundo o BID, para o Brasil o valor seria cerca de U$ 34 milhões a uma taxa de 2016. Discussão e conclusões O racional de definição do limiar não foi apresentado por nenhuma agência, exceto pelo ICER, o que revela uma fragilidade na transparência metodológica dessa construção. O valor calculado pelo BID para o Brasil deve ser olhado com cautela por adaptar valores de limiares construídos em outros contextos, mas com incertezas quanto à transparência metodológica. Nos locais onde o limiar foi definido, se ultrapassado, um gatilho é disparado para a construção de acordos especiais e negociações, ou para a aprovação de uma instância superior de governo, revelando-se não necessariamente um limitador da incorporação, mas um alerta para a sustentabilidade do sistema de saúde. A revisão rápida tem sido usada para pesquisas em políticas de saúde, mas sua limitação na cobertura de todo o espectro de produção do tema deve ser considerada.