Javier Roberti | CONICET - Academia.edu (original) (raw)

Papers by Javier Roberti

Cadernos de Saúde Pública, 2024

The Lancet Global Health, Dec 31, 2023

The premise of health as a human right in Latin America has been challenged by health system frag... more The premise of health as a human right in Latin America has been challenged by health system fragmentation, quality gaps, a growing burden of chronic disease, sociopolitical upheaval, and the COVID-19 pandemic. We characterised inequities in health system quality in Colombia, Mexico, Peru, and Uruguay. We did a cross-sectional telephone survey with up to 1250 adults in each country. We created binary outcomes in coverage, user experience, system competence, and confidence in the system and calculated the slope index of inequality by income and education. Although access to care was high, only a third of respondents reported having a high-quality source of care and 25% of those with mental health needs had those needs met. Two-thirds of adults were able to access relevant preventive care and 42% of older adults were screened for cardiovascular disease. Telehealth access, communication and autonomy in most recent visit, reasonable waiting times, and receiving preventive health checks showed inequalities favouring people with a high income. In Uruguay, inequality between government and social security services explained a substantial proportion of disparities in preventive health access. In other study countries, inequalities were also substantial within government and social security subsectors. Essential health system functions are unequal in these four Latin American countries.

Thyroid, Dec 3, 2023

Background: The optimal cutoff value of calcitonin (Ctn) levels measured using an electrochemilum... more Background: The optimal cutoff value of calcitonin (Ctn) levels measured using an electrochemiluminescence immunoassay (ECLIA) obtained from the washout fluid of fine-needle aspiration (FNA-Ctn) for the diagnosis of medullary thyroid carcinoma (MTC) is currently not established. We evaluated the diagnostic accuracy and clinical utility of FNA-Ctn for the diagnosis and location of MTC in patients with nodular or multinodular goiters. Methods: This was a case-control study nested on a prospective multicenter cohort of patients with nodular or multinodular goiter, normal or elevated serum Ctn, and thyroidectomy indications. Ctn and FNA-Ctn were measured using ECLIA methodology before surgery. From this nested cohort, MTC cases and controls (non-medullary pathology) were identified from the final pathological analysis. Cumulative incidence sampling of controls was randomly performed at a 1:2 ratio. Sensitivity, specificity, and area under the receiver operator curve (AUROC) were calculated for patients and the total number of thyroid nodules. Results: From 1272 patients included in the prospective cohort, 50 MTC cases and 105 controls were included. In this study, 286 thyroid nodules were evaluated (63 MTC and 223 non-MTCs). Median serum Ct was significantly higher in cases [525 pg/mL (IQR, 162.5 - 1.200)] than in controls [1.6 pg/mL (0.5 - 5.6); P<.001]. The median FNA-Ctn was significantly higher in MTC nodules [3.100 pg/mL (IQR, 450 - 45200)] than in non-MTC nodules [0.5 pg/mL (IQR, 0.5 - 0.5), P<0.0001]. In 11 MTC patients with multinodular goiter, FNA-Ctn was significantly higher in non-medullary nodules located in the same lobe where an MTC nodule was diagnosed (P=0.0002). Overall, the FNA-Ctn AUROC was 0.99 (95% CI 0.98-1.0), and a threshold of ≥220 pg/mL showed 100% sensitivity and 98% specificity for MTC diagnosis. Conclusions: The use of FNA-Ctn measured by ECLIA showed adequate diagnostic accuracy for MTC diagnosis. Moreover, it may be clinically useful for localization in multinodular goiter when lobectomy is considered.

Health Policy and Planning

High-quality health systems must provide accessible, people-centred care to both improve health a... more High-quality health systems must provide accessible, people-centred care to both improve health and maintain population trust in health services. Furthermore, accurate measurement of population perspectives is vital to hold health systems accountable and to inform improvement efforts. To describe the current state of such measures in Latin America and the Caribbean (LAC), we conducted a systematic review of facility and population-based assessments that included patient-reported experience and satisfaction measures. Five databases were searched for publications on quantitative surveys assessing healthcare quality in Spanish- or Portuguese-speaking LAC countries, focusing on the domains of processes of care and quality impacts. We included articles published since 2011 with a national sampling frame or inclusion of multiple subnational regions. We tabulated and described these articles, identifying, classifying and summarizing the items used to assess healthcare quality into the doma...

PLOS Medicine, Oct 5, 2023

• People should be at the center of health system performance assessment. Populations can provide... more • People should be at the center of health system performance assessment. Populations can provide critical insight on quality of care, confidence in health services, and health outcomes. • However, today's measurement approaches overlook key dimensions of population perspective such as confidence in the health system. Surveys are rarely standardized to enable crosscountry comparison.

Research Square (Research Square), Feb 28, 2022

Background: Bedside lung ultrasound (LUS) is being adopted in intensive care units (ICU) with a h... more Background: Bedside lung ultrasound (LUS) is being adopted in intensive care units (ICU) with a higher diagnostic accuracy for consolidation, interstitial syndrome, pleural effusion, and pneumothorax than chest radiography (CXR). Aims: To compare the diagnostic performance of LUS and CXR for the detection of pathologic abnormalities in critically ill patients in the ICU using thoracic computed tomography (CT) as the gold standard. Methods. Prospective and descriptive single-center study. Prior to CT, we performed bedside LUS and CXR, evaluated hemithoraces and characterized them as positive or negative for each of four abnormalities (consolidation syndrome, interstitial syndrome, pleural effusion, and pneumothorax). We decided therapeutic intervention after CT. Results. A total of 58 patients and 126 hemithoraces were evaluated by three imaging techniques. LUS and CT did not show signi cant differences in any of the conditions. CRX and CT showed signi cantly different proportions of consolidation, interstitial syndrome and pleural effusion. LUS performed better than CXR, with a higher sensitivity for four pathologies. CXR had a marginally higher speci city than LUS for consolidation, interstitial syndrome and pneumothorax. In 79% of patients, we performed a subsequent action based on the information provided by LUS. Conclusion. In ICU patients, bedside LUS offers a better diagnostic performance than CRX for the diagnosis of common pathologic conditions and could be an alternative to CT.

The international journal of risk and safety in medicine, Nov 2, 2022

BACKGROUND: The patients’ guide by the Batz Patient Safety Foundation promotes patients’ active p... more BACKGROUND: The patients’ guide by the Batz Patient Safety Foundation promotes patients’ active participation in healthcare and a safe hospital experience. OBJECTIVE: The aim was to adapt the Spanish version of the guide to the local context and evaluate its acceptability from healthcare professionals’ and patients’ perspectives in two hospitals in Buenos Aires, Argentina. METHODS: This implementation study had a formative research phase to adapt the guide with input from individual interviews and focus group discussions. The intervention comprised training sessions for professionals on patient-centered care and use of the guide, the appointment of coordinators, and distribution of the guide. The adapted guide (section During Admission) was distributed in two hospitals. Before and after intervention, we administered surveys to explore acceptability, utility, and patient satisfaction. RESULTS: Findings from formative research showed that the Batz guide needed to be shortened and adapted to the local healthcare context Although professionals had agreed on the importance of clinical guidelines; after using the Batz guide, they found it complex and difficult to implement. Patients’ satisfaction with healthcare before and after implementing the guide did not differ significantly. Best scores were found in items related to availability of nurses, staff competence and staff kindness. A 78% of patients found the Batz guide useful. CONCLUSION: It is of critical importance to adapt the guide to the local culture, pilot it, and provide training to promote its implementation, improving acceptability and utility.

Journal of Geriatric Oncology, Nov 1, 2022

PubMed, Dec 1, 2019

Objective: Signet ring cell carcinoma (SRCC) of the prostate is very a rare tumor. It is comprise... more Objective: Signet ring cell carcinoma (SRCC) of the prostate is very a rare tumor. It is comprised of cells that are similar to signet ring cell tumors of the gastrointestinal tract. Diagnosis requires histopathology and also elimination of the adenocarcinomas of other organs. To our knowledge 157 cases have been reported in the literature. Material and methods: We retrospectively searched in tumor registries from Hospital Aleman de Buenos Aires to identify all prostate cancer since 1990. We analyzed the following variables: age at diagnosis, median prostate-specific antigen (PSA) level, stage, global survival, among others. A review of the literature was done and compared with this series of cases. Results: We identified 5 cases. In our series we found: Mean age 77.8 years (SD 3.2), Median PSA level 18 ng/ml (Range 10.6-331 ng/ml), 3/5 (60%) localized disease and 2/5 (40%) with distant disease at diagnosis. Median survival of 23 months. Comparing with other series we found patients of older age and lower median survival. Conclusion: Primary Signet ring cell carcinoma of the prostate is a rare and aggressive histological variant of adenocarcinomas of the prostate. Treatment is the same as classical adenocarcinoma with an emphasis on aggressive multimodal treatment.

Current Urology Reports, Mar 11, 2021

Purpose of Review To update epidemiological, diagnostic, and therapeutic information on primary s... more Purpose of Review To update epidemiological, diagnostic, and therapeutic information on primary synovial sarcoma of the kidney. Recent Findings A total of 96 studies were analyzed; age at presentation was 38.6±14.2 years, predominant location of tumor was right kidney; frequent reported symptoms at diagnosis were hematuria and pain. For definitive diagnosis, cytogenetic technique was used. Detected oncogene was available in 37.8% cases with fusion of SS18-SSX in most patients. Surgery is treatment of choice, with adjuvant chemotherapy; most frequently ifosfamide-based associated with doxorubicin or epirubicin. Overall median survival was 34 months. Mortality was 29% of the cases which reported death and the recurrence rate was 39.8%. Risk of death was increased in patients with metastases at diagnosis Summary Primary RSS occurs more often in young men. RSS often presents with symptoms and in an advanced stage. Surgical treatment is the most commonly used and chemotherapy for advanced or recurrent treatment.

SN Comprehensive Clinical Medicine, Nov 14, 2022

Journal of Clinical Urology, Feb 5, 2020

Intravesical catheter knotting is a rarely reported event that could lead to serious complication... more Intravesical catheter knotting is a rarely reported event that could lead to serious complications. We present a case that occurred during urodynamic test with two K30 tubes: a 56-year-old female with a double knot of two K30 (8.4 Fr) tubes. This case was resolved by removing the catheters with sustained traction. Because catheter knotting can be a serious complication, we recommend the use of a double-lumen catheter when possible and assessment of a safe insertion length.

Indian Journal of Critical Care Medicine, Jan 31, 2023

Background and aim: Our aim was to assess the feasibility, safety, and utility of implementing tr... more Background and aim: Our aim was to assess the feasibility, safety, and utility of implementing transesophageal echocardiographic screening in patients with coronavirus disease-2019 (COVID-19)-related acute respiratory distress syndrome (ARDS), receiving mechanical ventilation (MV) and in prone position (PP). Methods: Prospective observational study performed in an intensive care unit; patients 18 years, with ARDS, invasive MV, in PP were included. A total of 87 patients were included. Results: There was no need to change ventilator settings, hemodynamic support, or any difficulties with the insertion of the ultrasonographic probe. Mean duration of transesophageal echocardiography (TEE) was 20 minutes. No displacement of the orotracheal tube, vomiting, or gastrointestinal bleeding was observed. Frequent complication was displacement of the nasogastric tube in 41 (47%) patients. Severe right ventricular (RV) dysfunction was detected in 21 (24%) patients and acute cor pulmonale was diagnosed in 36 (41%) patients. Conclusion: Our results show the importance of assessing RV function during the course of severe respiratory distress and the value of TEE for hemodynamic assessment in PP.

Experimental and Clinical Transplantation, Feb 1, 2019

A133 eficiaries who had a diagnosis of hypertension and CKD, aged 67 and above and continuously e... more A133 eficiaries who had a diagnosis of hypertension and CKD, aged 67 and above and continuously enrolled in Medicare Part D from 2008 to 2013 are included. Baseline characteristics examined using a two year lookback period. Adherence to ACEIs, ARBs and other blood pressure/ lipid lowering agents was measured using proportion of days covered (PDC). Multivariate Cox regression models were used to assess the association between medication adherence and progression to end stage renal disease (ESRD) and death. Results: A total of 115,769 hypertensive patients with CKD were included. Approximately 2.5% of them developed ESRD and 57.5% of them died during 2008-2013. Adherence to ACEIs and ARBs was associated with a significant decreased hazard of developing ESRD (Hazard Ratio: 0.29 95%CI [0.25-0.33] p< 0.0001; 0.49 95% CI [0.42, 0.57] p< 0.0001, respectively) after adjusting for demographic and clinical confounders. Patients with increased use of ACEIs and ARBs had reduced risk of death (Hazard Ratio: 0.76 95%CI [0.74-0.78] p< 0.0001; 0.64 95% CI [0.62, 0.66] p< 0.0001, respectively). Increased adherence to diuretics and statins were associated with lower ESRD and mortality risk, while calcium channel blockers and beta blockers were associated with increased ESRD risk and lower mortality risk. ConClusions: Increased adherence to ACEIs and ARBs for elderly patients diagnosed with hypertensive CKD is associated with delay in CKD progression and lower mortality risk. These findings could have significant implications for hypertension management in this population.

Global qualitative nursing research, 2021

Tobacco Control

ObjectiveTo investigate the tobacco-attributable burden on disease, medical costs, productivity l... more ObjectiveTo investigate the tobacco-attributable burden on disease, medical costs, productivity losses and informal caregiving; and to estimate the health and economic gains that can be achieved if the main tobacco control measures (raising taxes on tobacco, plain packaging, advertising bans and smoke-free environments) are fully implemented in eight countries that encompass 80% of the Latin American population.DesignMarkov probabilistic microsimulation economic model of the natural history, costs and quality of life associated with the main tobacco-related diseases. Model inputs and data on labour productivity, informal caregivers’ burden and interventions’ effectiveness were obtained through literature review, surveys, civil registrations, vital statistics and hospital databases. Epidemiological and economic data from January to October 2020 were used to populate the model.FindingsIn these eight countries, smoking is responsible each year for 351 000 deaths, 2.25 million disease e...

Emergency Medicine Journal

BackgroundHyperbaric oxygen (HBO2) therapy has been proposed to treat hypoxaemia and reduce infla... more BackgroundHyperbaric oxygen (HBO2) therapy has been proposed to treat hypoxaemia and reduce inflammation in COVID-19. Our objective was to analyse safety and efficacy of HBO2in treatment of hypoxaemia in patients with COVID-19 and evaluate time to hypoxaemia correction.MethodsThis was a multicentre, open-label randomised controlled trial conducted in Buenos Aires, Argentina, between July and November 2020. Patients with COVID-19 and severe hypoxaemia (SpO2≤90% despite oxygen supplementation) were assigned to receive either HBO2treatment or the standard treatment for respiratory symptoms for 7 days. HBO2treatment was planned for ≥5 sessions (1 /day) for 90 min at 1.45 atmosphere absolute (ATA). Outcomes were time to normalise oxygen requirement to SpO2≥93%, need for mechanical respiratory assistance, development of acute respiratory distress syndrome and mortality within 30 days. A sample size of 80 patients was estimated, with a planned interim analysis after determining outcomes on...

Rev. argent. salud publica, 2021

Vaccine, 2022

In 2020, the World Health Organization launched the Immunization Agenda 2030: A Global Strategy t... more In 2020, the World Health Organization launched the Immunization Agenda 2030: A Global Strategy to Leave No One Behind, which prioritizes high equitable immunization coverage at the national level and in all districts. Achieving high and homogenous immunization coverage, which is all the more important within the current context of the COVID-19 pandemic and vaccine rollout, requires the strengthening of existing immunization activities and innovative approach to immunization promotion. This research applied a descriptive case study methodology to document the implementation of strategic multi-level alliances to promote equitable immunization access and demand in Colombia, Guyana, and Sucre, Bolivia. Data collection, carried out between September 2019 and March 2020, included documentary reviews, semi-structured interviews, focus groups, and site visits accompanied by discussions with relevant stakeholders. Case studies provide valuable examples of people-centered, partnership-based, country-owned, and data-guided approaches to promoting equitable immunization coverage, including multi-level partnerships to build technical capacity for the identification and measurement of social inequalities impacting immunization in Colombia; intersectoral and community collaboration for pro-equity emergency response to regional vaccine preventable disease outbreaks in Guyana; and strategic alliances with the education sector and civil society organizations for the introduction of the human papilloma virus (HPV) vaccine in Sucre, Bolivia. Lessons learned highlight avenues for improving the impact of multi-level, equity-focused capacity building, particularly at the local level; optimizing the use of data and resources, partnerships, and community and stakeholder education and empowerment. While impact studies are needed to better understand the quantitative contributions of such strategic alliances, these case studies illustrate their practical significance and reinforce the value of multi-level, intersectoral collaboration for enhancing equitable immunization access and demand. The experiences of Colombia, Guyana, and Sucre, Bolivia provide evidence-based insight to support pro-equity immunization program planning to ensure that no one is left behind and that everyone, everywhere receives the benefits of vaccines, both routine and for COVID-19.

Archivos españoles de urología, 2019

espanolOBJETIVO: El carcinoma de celulas en anillo de sello (CPAS) de la prostata es un tumor muy... more espanolOBJETIVO: El carcinoma de celulas en anillo de sello (CPAS) de la prostata es un tumor muy raro y agresivo. Esta compuesto por celulas que son similares a los tumores de celulas del anillo de sello del tracto gastrointestinal. El diagnostico requiere histopatologia y tambien la eliminacion de los adenocarcinomas de otros organos. Hasta donde sabemos se han publicado 157 casos en la literatura. MATERIAL Y METODOS: Realizamos una busqueda retrospectiva en los registros de tumores del Hospital Aleman de Buenos Aires para identificar todos los tumores de prostata desde 1990. Analizamos las siguientes variables: edad de presentacion, mediana de antigeno prostatico especifico (PSA), estadio oncologico al diagnostico y supervivencia global entre otras. Tambien se reviso los tratamientos instaurados y se comparo esta serie de casos con la literatura existente. RESULTADOS: Identificamos 5 casos con CPAS. En nuestra serie encontramos: edad promedio de 77,8 anos (DE 3,2), mediana de PSA...