RESUMO
Atopic dermatitis (AD) is a chronic, inflammatory skin disease affecting all age groups, particularly children. This systematic review provides an overview of the humanistic and economic disease burden in the pediatric population with AD in Spain. The evidence, collected from 11 observational studies published over the past 10 years, exhibits the most common characteristics of the patients, disease burden, patient-reported outcomes, use of resources, and treatment patterns. The burden of AD extends beyond physical symptoms, with associated comorbidities such as asthma and impaired health-related quality of life and mental health disorders, particularly in severe cases. Traditional therapies, primarily topical corticosteroids, face adherence and efficacy challenges. Despite promising innovative treatments and available biological therapies, their use is still limited in the pediatric population. The findings of the present review highlight the scarce scientific evidence on the economic burden of pediatric AD, as well as the most updated humanistic evidence on this disease. At the same time, the need for individualized care and innovative therapeutic interventions to address the multifaceted challenges of pediatric AD in Spain is evident.
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BACKGROUND: Moderate-severe atopic dermatitis (AD) has a significant impact on patients' lives, with many requiring systemic treatment to manage symptoms (e.g., pruritus). Several drugs are used off-label to treat AD. This study describes sociodemographic/clinical characteristics, treatment patterns, health resource use (HRU) and costs in adults with AD who initiated systemic treatment or phototherapy in routine practice. METHODS: This retrospective observational study of electronic medical records in the BIG-PAC database identified adults with prior diagnosis of AD (ICD-9: 691.8 or 692.9) starting oral corticosteroids, immunosuppressants, biologics or phototherapy between 01/01/2012 and 31/12/2016. Patients were followed for 3 years from treatment initiation, up to 31/12/2019. Data on patient characteristics, treatment patterns, HRU and costs were analyzed descriptively. RESULTS: Patients (N=1995) had a mean age of 60 years, 64% were female, with a mean time of 23 years since diagnosis (84% were ≥18 years at AD onset). Main comorbidities were anxiety (38%), arterial hypertension (36%) and dyslipidemia (35%). Most patients used oral corticosteroids as first systemic (84%; median duration 29 days) and immunosuppressants in 13% of patients (median duration 117 days, 5% cyclosporine and 4% methotrexate). Half of patients required a second line systemic and 12% a third line. The use of immunosuppressants and biologics increased with treatment lines. About 13% of patients received systemic treatments continuously over the 3-year follow-up. The average 3-year per patient cost was 3835 euros, with an average annual cost of 1278 euros. CONCLUSIONS: Results suggest a high comorbidity and economic burden in this real-world adult population with AD, and the need for systemic treatments indicated for use in AD.
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Dermatite Atópica , Adulto , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Dermatite Atópica/tratamento farmacológico , Espanha/epidemiologia , Imunossupressores/uso terapêutico , Ciclosporina/uso terapêutico , Corticosteroides/uso terapêuticoRESUMO
BACKGROUND: Moderate-severe atopic dermatitis (AD) has a significant impact on patients' lives, with many requiring systemic treatment to manage symptoms (e.g., pruritus). Several drugs are used off-label to treat AD. This study describes sociodemographic/clinical characteristics, treatment patterns, health resource use (HRU) and costs in adults with AD who initiated systemic treatment or phototherapy in routine practice. METHODS: This retrospective observational study of electronic medical records in the BIG-PAC database identified adults with prior diagnosis of AD (ICD-9: 691.8 or 692.9) starting oral corticosteroids, immunosuppressants, biologics or phototherapy between 01/01/2012 and 31/12/2016. Patients were followed for 3 years from treatment initiation, up to 31/12/2019. Data on patient characteristics, treatment patterns, HRU and costs were analyzed descriptively. RESULTS: Patients (N = 1995) had a mean age of 60 years, 64% were female, with a mean time of 23 years since diagnosis (84% were ≥18 years at AD onset). Main comorbidities were anxiety (38%), arterial hypertension (36%) and dyslipidemia (35%). Most patients used oral corticosteroids as first systemic (84%; median duration 29 days) and immunosuppressants in 13% of patients (median duration 117 days, 5% cyclosporine and 4% methotrexate). Half of patients required a second line systemic and 12% a third line. The use of immunosuppressants and biologics increased with treatment lines. About 13% of patients received systemic treatments continuously over the 3-year follow-up. The average 3-year per patient cost was 3835 euros, with an average annual cost of 1278 euros. CONCLUSIONS: Results suggest a high comorbidity and economic burden in this real-world adult population with AD, and the need for systemic treatments indicated for use in AD.
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Dermatite Atópica , Adulto , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Dermatite Atópica/tratamento farmacológico , Espanha/epidemiologia , Imunossupressores/uso terapêutico , Ciclosporina/uso terapêutico , Corticosteroides/uso terapêuticoRESUMO
Human activities threaten the biodiversity of aquatic mammals across the globe. Conservation of these species hinges on the ability to delineate movements and foraging behaviors of animals, but gaining such insights is hampered by difficulties in tracing individuals over their lives. We determined isotope ratios in teeth (87 Sr/86 Sr, 13 C/12 C, and 18 O/16 O) to examine lifelong movement and resource-use patterns of a unique freshwater population of a wide-ranging pinniped species (harbor seal [Phoca vitulina]) that resides in Iliamna Lake, Alaska (U.S.A.). This population's potentially unique migratory behavior and use of different trophic resources are unknown. The isotope ratios we measured in teeth showed that seals were born in the lake, remained lifelong residents, and relied principally on resources produced from in the lake, even when seasonally abundant and nutrient-dense spawning anadromous fish (i.e., sockeye salmon [Oncorhynchus nerka]) were available in the lake. Our results illustrate how serial isotope records in teeth, particularly 87 Sr/86 Sr ratios, can be used to quantify how coastal mammal populations exploit both freshwater and marine ecosystems. Understanding lifelong patterns of habitat and resource use is essential information when designing effective conservation plans for threatened coastal mammals. We present the Iliamna Lake harbor seals as a unique case study into how isotope records within teeth can help reveal the cryptic ecology of such a population residing in an intact ecosystem. The results also provide critical baseline information for the Kvichak River system, which is facing an uncertain future due to proposed large-scale industrial development and a rapidly changing climate.
Isotopos Dentales y una Población Críptica de Focas Costeras de Agua Dulce Resumen Las actividades humanas amenazan a la diversidad de mamíferos acuáticos en todo el mundo. La conservación de estas especies depende de la habilidad para delinear los movimientos y los comportamientos de búsqueda de alimento de los animales, pero la obtención de dicha información está obstaculizada por las dificultades en el rastreo de individuos a lo largo del transcurso de sus vidas. Determinamos la proporción de isotopos dentales (87 Sr/86 Sr, 13 C/12 C y 18 O/16 O) para examinar el movimiento a lo largo de la vida y los patrones de uso de recursos de una población única de una especie de pinnípedos de agua dulce con una distribución amplia (foca común [Phoca vitulina]), la cual reside en el lago Iliamna, Alaska (E.U.A.). Se desconocen el comportamiento migratorio potencialmente único de esta población y el uso que le dan a los diferentes recursos tróficos. La proporción de isotopos que medimos en los dientes mostró que las focas nacieron en el lago, permanecieron como residentes de toda la vida y dependieron principalmente de los recursos producidos en el lago, incluso cuando estaban disponibles en aquel lugar por razones reproductivas los peces anádromos abundantes estacionalmente y con densidad de nutrientes (es decir, el salmón rojo [Oncorhynchus nerka]). Nuestros resultados ilustran cómo los registros seriales de isotopos dentales, particularmente la proporción 87 Sr/86 Sr, pueden usarse para cuantificar cómo las poblaciones de mamíferos costeros explotan tanto los ecosistemas marinos como los de agua dulce. El entendimiento de los patrones ontogénicos del uso de recursos y de hábitat es esencial cuando se diseñan planes efectivos de conservación para los mamíferos costeros en peligro. Presentamos a las focas comunes del lago Iliamna como un estudio de caso único sobre cómo los registros de isotopos dentales pueden ayudar a revelar la ecología críptica de dicha población que reside en un ecosistema intacto. Los resultados también proporcionan información importante de línea base para el sistema el río Kvichak, el cual está enfrentando un futuro incierto debido a la propuesta de un desarrollo industrial de gran escala y al rápido clima cambiante.
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Ecossistema , Focas Verdadeiras , Alaska , Animais , Conservação dos Recursos Naturais , SalmãoRESUMO
OBJECTIVES: To assess the comorbidity, concomitant medications, healthcare resource use and healthcare costs of chronic hepatitis C virus patients in the Spanish population. PATIENTS AND METHODS: Retrospective, observational, non-interventional study. Patients included were≥18 years of age who accessed medical care between 2010-2013. Patients were divided into 2 groups based on the presence or absence of liver cirrhosis. The follow-up period was 12 months. Main assessment criteria included general comorbidity level (determined by the resource utilisation band score) and prevalence of specific comorbidities, concomitant medications, healthcare resource use and healthcare costs. Statistical analysis was performed using regression models and ANCOVA, P<.05. RESULTS: One thousand fifty-five patients were enrolled, the mean age was 57.9 years and 55.5% were male. A percentage of 43.5 of patients had a moderate level of comorbidity according to the resource utilisation band score. The mean time from diagnosis was 18.1 years and 7.5% of the patients died during the follow-up period. The most common comorbidities were dyslipidaemia (40.3%), hypertension (40.1%) and generalised pain (38.1%). Cirrhosis was associated with cardiovascular events (OR 3.8), organ failures (OR 2.2), alcoholism (OR 2.1), diabetes (OR 1.2) and age (OR 1.2); P<.05. The most commonly used medications were anti-infectives (67.8%) and nervous system medications (66.8%). The mean total cost per patient was 3,198 (71.5% healthcare costs, 28.5% indirect/non-healthcare costs). In the corrected model, the total costs per patient-year were 2,211 for those without cirrhosis and 7,641 for patients with cirrhosis; P<.001. CONCLUSIONS: Chronic hepatitis C virus patients are associated with a high level of comorbidity and the use of concomitant medications, especially in patients with liver cirrhosis. Chronic hepatitis C virus infection represents a substantial economic burden on the Spanish National Health System.
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Custos de Cuidados de Saúde , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/economia , Adolescente , Adulto , Idoso , Utilização de Instalações e Serviços , Feminino , Recursos em Saúde/estatística & dados numéricos , Hepatite C Crônica/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Polimedicação , Estudos Retrospectivos , Espanha , Adulto JovemRESUMO
Unauthorized use of natural resources is a key threat to many protected areas. Approaches to reducing this threat include law enforcement and integrated conservation and development (ICD) projects, but for such ICDs to be targeted effectively, it is important to understand who is illegally using which natural resources and why. The nature of unauthorized behavior makes it difficult to ascertain this information through direct questioning. Bwindi Impenetrable National Park, Uganda, has many ICD projects, including authorizing some local people to use certain nontimber forest resources from the park. However, despite over 25 years of ICD, unauthorized resource use continues. We used household surveys, indirect questioning (unmatched count technique), and focus group discussions to generate profiles of authorized and unauthorized resource users and to explore motivations for unauthorized activity. Overall, unauthorized resource use was most common among people from poor households who lived closest to the park boundary and farthest from roads and trading centers. Other motivations for unauthorized resource use included crop raiding by wild animals, inequity of revenue sharing, and lack of employment, factors that created resentment among the poorest communities. In some communities, benefits obtained from ICD were reported to be the greatest deterrents against unauthorized activity, although law enforcement ranked highest overall. Despite the sensitive nature of exploring unauthorized resource use, management-relevant insights into the profiles and motivations of unauthorized resource users can be gained from a combination of survey techniques, as adopted here. To reduce unauthorized activity at Bwindi, we suggest ICD benefit the poorest people living in remote areas and near the park boundary by providing affordable alternative sources of forest products and addressing crop raiding. To prevent resentment from driving further unauthorized activity, ICDs should be managed transparently and equitably.
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Conservação dos Recursos Naturais/métodos , Florestas , Recursos Naturais , Conservação dos Recursos Naturais/legislação & jurisprudência , Humanos , Motivação , Parques Recreativos , Fatores Socioeconômicos , Inquéritos e Questionários , UgandaRESUMO
INTRODUCTION: 25.9% of Spanish people suffer from chronic pain. An integrated, interdisciplinary approach is recommended, with pharmacological and non-pharmacological therapies, involving patients in their self-care. OBJECTIVE: To evaluate the effectiveness and impact on resources of a program with non-pharmacological therapies in the control of non-oncological chronic pain in the short and medium term. MATERIAL AND METHODS: Quasi-experimental before-after study, follow-up 3-6 months, measuring: pain, well-being, quality of life, self-esteem, resilience, anxiety/depression (validated scales); patient-reported outcomes of workshop impact on pain management, habits and mood; ED and office visits; drug consumption and employment status. RESULTS: One hundred and forty-two patients completed the program; 131 (92.3%) were women, age: 56.0. Decreased: pain (scale 0-10) (start: 6.0; end of workshop: 4.0; 3 months: 5.0); anxiety (12.9; 10.4; 8.8) and depression (12.3; 7.23; 6.47) (scales 0-21). They increased: well-being (scale 0-10) (4.0; 6.0; 4.0); quality of life (scale 0-1) (0.418; 0.580; 0.536); health status (scale 0-100) (47.5; 60.0; 60.0); self-esteem (scale 9-36) (24.1; 27.5; 26.7); resilience (scale 6-30) (14.8; 17.4; 18.6). Patient-reported outcomes were performed by 136 patients at the end of the workshop and 79 at 3 months: pain decreased (end of program: 104, 76.5%; 3 months: 66, 83.5%); medication decreased (96, 76.2%; 60, 78.9%); habits improved (112, 88.2%; 69, 90.8%). Forty patients (37.4%) reduced visits to the emergency room, 40 (37.4%) reduced scheduled visits. Overall satisfaction: 9.8 out of 10. CONCLUSIONS: Patients learn to mitigate their pain, participate in their self-care and improve their quality of life, self-esteem and emotional state. The effects remained for 3-6 months.
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Dor Crônica , População Europeia , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Dor Crônica/terapia , Dor Crônica/psicologia , Qualidade de Vida , Nível de Saúde , Depressão/terapiaRESUMO
INTRODUCTION: Carbapenem-resistant Gram-negative bacteria (CRGN) are an urgent public health threat because of the limited treatment options, its rapid spreading and high clinical impact and mortality rates. However, the burden and the use of resources of these infections have not been investigated. The aim of the current study is to understand the use of resources associated to the clinical management of CRGN infections in real clinical practice conditions. METHODS: An observational retrospective chart review study was performed. Data regarding patient demographics, clinical management and use of resources associated to hospitalization were retrieved from clinical charts of ICU inpatients with a confirmed CRGN infection. Three reference Spanish hospitals were selected according to their patient volume and geographical coverage. Descriptive analyses of the clinical management and the use of resources and its cost were performed and then total costs by type of resource were calculated. RESULTS: A total of 130 patients were included in the study. The higher number of patients (n=43; 33%) were between 61 and 70 years old. Ninety-four (72%) patients were male and 115 (88%) suffered from comorbidities. The mean total cost associated to the resources used in patients with CRGN infections hospitalized in ICU was 96,878 per patient. These total costs included 84,140 of total hospital stay, 11,021 of treatments (558 of antibiotics; 10,463 of other treatments) and 1717 costs of diagnostic tests. CONCLUSIONS: CRGN infection causes a high use of hospital resources, being the length of stay either in hospital wards or ICU the driver of the total costs. Diagnostic tests and treatments, including antibiotics, represent the lowest part of the use of resources and costs (13% of total costs).
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Carbapenêmicos , Infecções por Bactérias Gram-Negativas , Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Feminino , Carbapenêmicos/uso terapêutico , Estudos Retrospectivos , Pacientes Internados , Espanha , Bactérias Gram-Negativas , Infecções por Bactérias Gram-Negativas/microbiologia , Antibacterianos/uso terapêutico , Hospitais , Unidades de Terapia IntensivaRESUMO
INTRODUCTION: Despite improved survival rates, stroke represents an increasing healthcare and socioeconomic burden. We describe the main characteristics of patients with ischaemic stroke and resource use and associated expenditure one year before and 3 years after stroke, using a population-based dataset. METHODS: The information technology systems of the Catalan Health Service were used to identify patients with ischaemic strokes occurring between January 2012 and December 2016. For each patient, information from one year before the stroke and up to 3 years thereafter was linked across databases. We describe annual and monthly resource use and healthcare expenditure per patient. RESULTS: We identified 36 044 patients with ischaemic stroke (mean age, 74.7 ± 13.3 years). The survival rate at 3 years was 63%. Average expenditure per patient was 3230 the year before stroke, 11 060 for year 1 after stroke, 4104 for year 2, and 3878 for year 3. The greatest determinants of cost in year 1 were hospitalisation (including initial hospitalisation), representing 45% of the difference in expenditure compared to the previous year, and convalescence and rehabilitation services, representing 33% of this difference. After year one, the increase in expenditure was mainly determined by additional hospital admissions and drug treatment. CONCLUSION: After ischaemic stroke, healthcare expenditure increases primarily because of initial hospitalisation. After year one, the expenditure decreases but remains above baseline values. Information from population-based datasets is useful for improving the planning of stroke services.
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Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/terapia , Gastos em Saúde , Hospitalização , Humanos , Pessoa de Meia-Idade , Acidente Vascular Cerebral/terapiaRESUMO
AIMS: To determine the first manifestation of cardiovascular or kidney disease (CVKD) and associated resource use in type 2 diabetes mellitus (T2DM) patients during seven years of follow-up. METHODS: Observational-retrospective secondary data study using medical records of patients aged ≥18 years with T2DM and without prior CVKD between 2013 and 2019. The index date was 01/01/2013 (fixed date). The manifestation of CVKD was defined by the first diagnosis of heart-failure (HF), chronic-kidney disease (CKD), myocardial-infarction (MI), stroke or peripheral-artery disease (PAD). The main variables were baseline characteristics, manifestation of CVKD, mortality, resource use and costs. Descriptive analyses and Cox model were applied to the data. RESULTS: 26,542 patients were selected (mean age: 66.6 years, women: 47.8%, mean duration of T2DM: 17.1 years). 18.7% (N=4974) developed a first CVKD manifestation during the seven years [distribution: HF (22.4%), CKD (36.6%), MI (14.5%), stroke (15.3%) and PAD (11.3%)]. Overall mortality was 8.3% (N=2214). The mortality risk of the group that developed HF or CKD as the first manifestation compared to the CVKD-free cohort was higher [HR: 2.5 (95% CI: 1.8-3.4) and 1.8 (95% CI: 1.4-2.3)], respectively. The cumulative costs per patient of HF (50,942.80) and CKD (48,979.20) were higher than MI (47,343.20) and stroke (47,070.30) and similar to PAD (51,240.00) vs. 13,098.90 in patients who did not develop CVKD, p<0.001. CONCLUSIONS: In T2DM patients, HF and CKD were the first most common manifestations and had higher mortality and re-hospitalisation rates. HF and CKD were associated with the highest resource use and costs for the Spanish National-Health-System.
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Diabetes Mellitus Tipo 2 , Insuficiência Cardíaca , Infarto do Miocárdio , Insuficiência Renal Crônica , Acidente Vascular Cerebral , Adolescente , Adulto , Idoso , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/epidemiologia , Humanos , Infarto do Miocárdio/epidemiologia , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Espanha/epidemiologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologiaRESUMO
BACKGROUND AND OBJECTIVES: Epidemiologic and disease burden data are essential for disease control and optimal health care resource planning. The aims of this study were to estimate the epidemiologic burden of psoriasis and evaluate associated comorbidities, health care utilization, and sick leave. MATERIAL AND METHODS: We collected data from the 2016 Catalan Health Survey (ESCA), the Catalan Registry of Morbidity and Utilization of Health Care Services (MUSSCAT) (2016), and the database of the Catalan Medical Evaluations Institute (ICAM) (2012-2016). RESULTS: The prevalence of psoriasis in Catalonia according to 2016 ESCA data is approximately 1.8%. The MUSSCAT registry data indicate that the incidence has remained stable in recent years. The most common comorbidities associated with psoriasis are hypertension (35%) and diabetes (15%). Forty percent of patients with psoriasis have a moderate to high risk for death or high health resource utilization. Annual use of resources by psoriasis patients is high: they make a mean of 8.7 primary care visits, 2.8 outpatient visits, 0.5 emergency and day hospital visits, 0.2 mental health visits, and use 6.1 medications. Sick leave due to psoriasis or psoriatic arthritis accounted for 0.04% of all cases. CONCLUSIONS: The prevalence of psoriasis in Catalonia is high at 1.8%. The disease burden is also high, both in terms of comorbidities and health care utilization.
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Psoríase , Licença Médica , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Psoríase/epidemiologia , Estudos Retrospectivos , Espanha/epidemiologiaRESUMO
BACKGROUND: There is little information of intensive care unit (ICU) performance when it's relocated to a totally new and equipped area. OBJECTIVE: To analyze the clinical performance and use of resources of a new respiratory-ICU (nRICU) in a large third-level care hospital. METHOD: Cross-sectional, comparative study using prospective data of patients admitted from July 17, 2017 to July 17, 2018. The Rapoport adjusted method was used to obtain the standardized clinical performance index (SCPI) and the standardized resource use index (SRUI). RESULTS: Out of 354 patients, those who were readmissions or remained hospitalized and those whose treatment was withheld or withdrawn where excluded from the analysis. In 301 patients, the observed survival at hospital discharge was 63% while the expected survival was 67.7%. Values of SCPI and SRUI were -1.03 and 0.05 respectively, placing results in coordinates within two standard deviations when plotted in the Rapoport chart. There was a statistically significant difference in survival when comparing the study period with outcomes obtained in the RICU before its relocation (63% vs. 55%, p = 0.01). CONCLUSIONS: In its 1st year of operation, the nRICU had better clinical performance compared to the former RICU, with no change in the use of resources.
ANTECEDENTES: Existe poca información acerca del desempeño de una unidad de cuidados intensivos (UCI) cuando es reubicada en un área totalmente nueva y equipada. OBJETIVO: Analizar el rendimiento clínico y el uso de recursos de la nueva UCI respiratoria (UCIR) de un hospital grande de tercer nivel. MÉTODO: Estudio transversal, comparativo, con datos prospectivos de pacientes ingresados del 17 de julio de 2017 al 17 de julio de 2018. Se usa el método ajustado de Rapoport para obtener el índice de rendimiento clínico estandarizado (IRCE) y el índice de uso de recursos estandarizado (IRURE). RESULTADOS: De 354 pacientes fueron excluidos los reingresos, los pacientes aún hospitalizados y aquellos a quienes se limitó o retiró el tratamiento. En 301 pacientes la sobrevida hospitalaria fue del 63%, mientras que la sobrevida esperada fue del 67.7%. El IRCE fue −1.03 y el IRURE fue 0.05, situando el resultado en coordenadas dentro de dos desviaciones estándar en el gráfico de Rapoport. Hubo una diferencia estadísticamente significativa en la sobrevida comparando el periodo de estudio con resultados de la UCIR obtenidos antes de su reubicación (63 vs. 55%, p = 0.01). CONCLUSIONES: En su primer año de funcionamiento, la nueva UCIR tuvo mejor rendimiento clínico que la antigua, sin modificación en el uso de recursos.
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Arquitetura Hospitalar , Unidades de Terapia Intensiva/organização & administração , Adulto , Idoso , Cuidados Críticos/organização & administração , Estudos Transversais , Grupos Diagnósticos Relacionados , Equipamentos e Provisões Hospitalares/estatística & dados numéricos , Feminino , Recursos em Saúde/estatística & dados numéricos , Arquitetura Hospitalar/estatística & dados numéricos , Hospitais Gerais/organização & administração , Hospitais Gerais/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , México , Pessoa de Meia-Idade , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/estatística & dados numéricos , Resultado do Tratamento , Desempenho Profissional , Adulto JovemRESUMO
INTRODUCTION: Despite improved survival rates, stroke represents an increasing healthcare and socioeconomic burden. We describe the main characteristics of patients with ischaemic stroke and resource use and associated expenditure one year before and 3 years after stroke, using a population-based dataset. METHODS: The information technology systems of the Catalan Health Service were used to identify patients with ischaemic strokes occurring between January 2012 and December 2016. For each patient, information from one year before the stroke and up to 3 years thereafter was linked across databases. We describe annual and monthly resource use and healthcare expenditure per patient. RESULTS: We identified 36,044 patients with ischaemic stroke (mean age, 74.7±13.3 years). The survival rate at 3 years was 63%. Average expenditure per patient was 3,230 the year before stroke, 11,060 for year one after stroke, 4,104 for year 2, and 3,878 for year 3. The greatest determinants of cost in year one were hospitalisation (including initial hospitalisation), representing 45% of the difference in expenditure compared to the previous year, and convalescence and rehabilitation services, representing 33% of this difference. After year one, the increase in expenditure was mainly determined by additional hospital admissions and drug treatment. CONCLUSION: After ischaemic stroke, healthcare expenditure increases primarily because of initial hospitalisation. After year one, the expenditure decreases but remains above baseline values. Information from population-based datasets is useful for improving the planning of stroke services.
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OBJECTIVE: To determine resource usage and costs associated with atopic dermatitis in adults according to severity and comorbid conditions in daily clinical practice. PATIENTS AND METHODS: We performed an observational, retrospective study based on a review of registries of patients aged ≥18 years who sought health care in 2013 and 2014 in an area of Catalonia, Spain, with a population of 215,634 persons. We established 3 classes of severity depending on the treatment prescribed. The variables evaluated were total comorbid conditions, concomitant/specific medication, and direct/indirect health care costs. The statistical analysis was based on multiple regression models. Statistical significance was set at P<.05. RESULTS: We included 6,186 patients with a diagnosis of atopic dermatitis (mean age, 47.1 years; women, 61.6%). We established 3 groups based on severity, as follows: mild (n=3,445 [55.7%]); moderate (n=2,361 [38.2%]); and severe (n=380 [6.1%]). Severe atopic dermatitis was associated with risk of presenting comorbid conditions (ß=0.192), namely, asthma (ß=0.138), depression (ß=0.099), cardiovascular events (ß=0.087), obesity (ß=0.085), and smoking (ß=0.025); P<.001. Costs reached 9.3 million (health care costs, 75.5%; loss of productivity, 24.5%), with an average unit cost of 1,504 per year. The corrected average unit cost (ANCOVA) was greater in severe atopic dermatitis compared with moderate and mild disease (3,397 vs. 2,111 vs. 885; P<.001), respectively. CONCLUSIONS: Severe atopic dermatitis generates considerable usage of health care resources and high costs for the National Health System. These are in proportion with the severity of the disease. General comorbid conditions and asthma were the factors with the greatest impact on health care costs.
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Dermatite Atópica/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Comorbidade , Dermatite Atópica/epidemiologia , Feminino , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/economia , Estudos Retrospectivos , Fatores Socioeconômicos , Espanha , Adulto JovemRESUMO
OBJECTIVE: To evaluate therapeutic persistence, healthcare resources, medical costs and adverse events of oxybutynin and mirabegron treatments in patients with overactive bladder in routine medical practice. PATIENTS AND METHODS: An observational, retrospective, multicentre study was carried out using the records of patients attended to in 3 different geographic locations (Barcelona, Girona, Asturias). An analysis was made on the 2 study groups (oxybutynin and mirabegron). Follow-up time was one year. Persistence was defined as the time (months), without discontinuation of the initial treatment, or without change of treatment at least 60 days after the initial prescription. Primary endpoints: comorbidity, healthcare resources used, and adverse events. The data was analysed using the SPSSWIN Program, with a significance of P<.05. RESULTS: Of the total of1,277 patients included in the study, 42.9% were on oxybutynin and 57.1% mirabegron. The mean age was 69.3 years and 53.2% were female. Demographic characteristics and morbidity were similar between the drugs and had a similar persistence (35.0% oxybutynin vs. 32.2% mirabegron, P=.294), although their costs were lower (1,151.2 vs. 1,809.6, P<.001). The biggest differences were observed in the price of medication (279.2 vs. 692.3, P<.001; a variation of: -413.1); and adverse events (9.7 vs. 4.9%, P<.001). CONCLUSIONS: Patients treated with oxybutynin vs. mirabegron for overactive bladder had similar persistence with the treatment, lower healthcare costs, but with higher oxybutynin vs. mirabegron adverse reaction rates.
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Acetanilidas/administração & dosagem , Ácidos Mandélicos/administração & dosagem , Tiazóis/administração & dosagem , Bexiga Urinária Hiperativa/tratamento farmacológico , Agentes Urológicos/administração & dosagem , Acetanilidas/efeitos adversos , Acetanilidas/economia , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Custos de Cuidados de Saúde , Humanos , Masculino , Ácidos Mandélicos/efeitos adversos , Ácidos Mandélicos/economia , Adesão à Medicação , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha , Tiazóis/efeitos adversos , Tiazóis/economia , Bexiga Urinária Hiperativa/economia , Agentes Urológicos/efeitos adversos , Agentes Urológicos/economia , Adulto JovemRESUMO
INTRODUCTION AND OBJECTIVES: To evaluate the use of health care resources and their cost according to the effects of kidney failure in heart failure patients during 2-year follow-up in a population setting. METHODS: Observational retrospective study based on a review of medical records. The study included patients ≥ 45 years treated for heart failure from 2008 to 2010. The patients were divided into 2 groups according to the presence/absence of KF. Main outcome variables were comorbidity, clinical status (functional class, etiology), metabolic syndrome, costs, and new cases of cardiovascular events and kidney failure. The cost model included direct and indirect health care costs. Statistical analysis included multiple regression models. RESULTS: The study recruited 1600 patients (prevalence, 4.0%; mean age 72.4 years; women, 59.7%). Of these patients, 70.1% had hypertension, 47.1% had dyslipidemia, and 36.2% had diabetes mellitus. We analyzed 433 patients (27.1%) with kidney failure and 1167 (72.9%) without kidney failure. Patients with kidney failure were associated with functional class III-IV (54.1% vs 40.8%) and metabolic syndrome (65.3% vs 51.9%, P<.01). The average unit cost was 10,711.40. The corrected cost in the presence of kidney failure was 14,868.20 vs 9,364.50 (P=.001). During follow-up, 11.7% patients developed ischemic heart disease, 18.8% developed kidney failure, and 36.1% developed heart failure exacerbation. CONCLUSIONS: Comorbidity associated with heart failure is high. The presence of kidney failure increases the use of health resources and leads to higher costs within the National Health System.
Assuntos
Custos de Cuidados de Saúde/tendências , Recursos em Saúde/tendências , Insuficiência Cardíaca/economia , Insuficiência Renal/etiologia , Adulto , Idoso , Feminino , Seguimentos , Insuficiência Cardíaca/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal/economia , Estudos Retrospectivos , Fatores Socioeconômicos , Espanha/epidemiologiaRESUMO
OBJECTIVE: To explore the relationship between the severity of urinary urge incontinence (UUI) on healthcare resources utilization (HRU) and loss of labor productivity of subjects with overactive bladder (OAB) in the general population in Spain. METHODS: Secondary analysis of a cross-sectional web-based study conducted in the general population >18 years, through a battery of HRU questions asked using an online method. Probable OAB subjects were identified using a previously validated algorithm and a score >8 in the OAB-V8 questionnaire. HRU questions included an assessment of concomitant medication used as a consequence of OAB/UUI, pad utilization, and medical office visits. Patients were grouped according to the number of UUI episodes into 0, 1, 2-3 or 4+ episodes. RESULTS: Of a total of 2,035 subjects participating from the general population, 396 patients [52.5% women, mean age: 55.3 (11.1) years, OAB-V8 mean score: 14.5 (7.9)] were analyzed; 203 (51.3%) with 0 episodes, 119 (30.1%) with 1, 52 (13.1%) with 2 or 3, and 22 (5.6%) with 4 or more episodes. A linear and significant adjusted association was observed between the number of UUI episodes and HRU; the higher the number of daily episodes the higher the HRU. Subjects with more episodes had medical visits more frequently at the primary care (P = .001) and specialist (P = .009) level as well. Consumption of day (P < .001) and night (P < .001) urinary absorbents, anxiolytic medicines (P = .021) and antibiotics (P = .05) was higher in patients with more UUI episodes. CONCLUSION: The severity of OAB in terms of frequency of daily urge incontinence episodes was significantly and linearly associated with higher healthcare resources utilization and a decrease in labor productivity in subjects with probable OAB in Spain.
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Eficiência , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Bexiga Urinária Hiperativa/terapia , Incontinência Urinária de Urgência/terapia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Bexiga Urinária Hiperativa/complicações , Incontinência Urinária de Urgência/etiologiaRESUMO
OBJECTIVE: To evaluate the use of resources and health costs in vulnerable elderly institutionalized patients with overactive bladder (OAB) treated with fesoterodine, tolterodine or solifenacin in routine medical practice. MATERIAL AND METHODS: A multicenter retrospective study, from the records of patients treated during 2008-2010 in three geographical locations and starting treatment with antimuscarinic (fesoterodine, solifenacin and tolterodine) for OAB. The attribute of vulnerability was based on collecting at least 3 of the Vulnerable Elders Survey criteria-13, age>75 years, poor/average age for health and difficulty in at least one daily physical activity. MAIN MEASURES: morbidity, persistence and resource use and costs. Monitoring of patients was conducted over 52 weeks. A general linear model with covariates and bootstraping (1000) at random was used to construct the 95% CI of the cost differences between drugs. RESULTS: Records of 552 patients (50.8% women, mean age: 80.2 years) were analyzed. Treated with fesoterodine (N=58), solifenacin (N=252) or tolterodine (N=212). The use of absorbent was 20.7%, 29.4% and 33.0% (P=.186), respectively. Persistence to treatment was slightly greater with fesoterodine. The patient healthcare costs/year were lower with fesoterodine, 1,775 (1550-2014) vs. solifenacin 2,062 (1911-2223) and tolterodine 2,149 (1,978-2,307), P=.042, as a result of lower utilization visits and concomitant medication. CONCLUSIONS: Despite the potential limitations of the study, the vulnerable elderly non institutionalized patients with OAB treated with fesoterodine, compared to solifenacin or tolterodine were associated with lower resource utilization and healthcare costs.
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Compostos Benzidrílicos/economia , Compostos Benzidrílicos/uso terapêutico , Custos de Cuidados de Saúde , Recursos em Saúde/estatística & dados numéricos , Antagonistas Muscarínicos/economia , Antagonistas Muscarínicos/uso terapêutico , Succinato de Solifenacina/economia , Succinato de Solifenacina/uso terapêutico , Tartarato de Tolterodina/economia , Tartarato de Tolterodina/uso terapêutico , Bexiga Urinária Hiperativa/tratamento farmacológico , Bexiga Urinária Hiperativa/economia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Estudos Retrospectivos , Populações VulneráveisRESUMO
Los alcances acumulativos de la acción humana, aunados al poderío tecno-científico, llevan hoy a que nuestra especie no solo se cuestione los límites de la capacidad que tiene la Tierra para asimilar y reciclar luego los desechos de la actividad humana, sino también los límites de nuestro especieísmo en la trama de la existencia. No ha sido la excepción, sino más bien la regla, que en una constante nuestra especie haya aumentado en población, sobreutilizando el entorno y malogrando un desarrollo que deteriora el medio ambiente cada vez más. El ser humano ha escrito la historia de la humanidad de forma especieísta, ensalzando su rol histórico que ha hecho obra contra el ser ecológico. Sin embargo, aisladas y frágiles treguas entre animales humanos y no humanos posibilitan cuestionarnos el sentido y significado filosófico del conservacionismo en eras del más crudo especieísmo.
The cumulative scope of human action, combined with the techno-scientific power nowadays take our species not only to question the limits of the Earth capacity to assimilate and recycle the waste products of human activities, but also the limits of speciesism within the weave of existence. It has not been the exception but rather the rule, that our species has constantly increased its population, overusing the environment and ruining a development that deteriorates the environment increasingly. Human beings have written the history of humanity in a speciesist form, extolling their historic role which has made work against the ecological being. However, isolated and fragile truces between human and nonhuman animals allow questioning the meaning and philosophical significance of conservationism in an age of the crudest speciesism.
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Humanos , Biodiversidade , Direitos dos Animais , Conservação dos Recursos Naturais , Minimização de Prejuízos AmbientaisRESUMO
This study was conducted in three communities of artisanal fishermen from Ilhabela, located on the northern coast of São Paulo, Brazil. The objective was to analyze the preferences, taboos and medicinal indications of fish and thus representing one of the interactions of fishermen with fish stocks. Data collection was conducted through interviews with the aid of semi-structured questionnaires. We interviewed 25 families, 29 residents in three communities studied during our fieldwork for data collection. Five interviews were done in Jabaquara Beach, 6 in Fome Beach and 14 Serraria Beach. During the interviews, 18 species were cited as preferred for consumption, 11 species considered to be taboo (food prohibited), 5 species were cited as avoided as food, and 4 species indicated in case of illness. The families of fishermen prefer to consume finfish and do not consume puffer fish, the latter probably due to its toxic characteristic. Fish such as little tunny, largehead hairtail, shark, serra mackerel and king mackerel are avoided by unhealthy people and in cases of wounds, inflammation, pregnancy and postpartum. Other fish, such as sea chubs, silver porgy, bluefish and grouper are reported as medicinal in these situations. Aspects related to fish consumption are part of the knowledge of fishermen and their families and provide a wealth of information that combined to biological information is useful for the conservation of fishery resources. Data such as those presented in this study, regarding the use of aquatic animals for treatment of diseases, could serve as a basis for future studies on substances that contain active elements in curing diseases.
Este trabalho foi realizado em três comunidades de pescadores artesanais de Ilhabela, localizadas no litoral norte do Estado de São Paulo, Brasil. O objetivo foi analisar as preferências, os tabus e as indicações medicinais dos peixes e, desta forma, representar as interações dos pescadores com os recursos pesqueiros, visando entender os aspectos biológicos e culturais envolvidos. A coleta dos dados foi realizada através de entrevistas com o auxílio de questionários semi-estruturados. Foram entrevistadas 25 famílias, das 29 residentes nas três comunidades estudadas durante a coleta de dados, sendo que 5 delas foram realizadas na Praia do Jabaquara, 6 na Praia da Fome e 14 na Praia da Serraria. Foram citadas 18 consideradas preferidas para o consumo, 11 espécies consideradas como tabus, 5 espécies evitadas e 4 indicadas no caso de doenças. As famílias de pescadores preferem consumir peixes de escama e não consomem o baiacu, este último provavelmente devido a sua característica tóxica. Peixes como bonito, espada, cação, sororoca e cavala são evitados em casos como feridas, inflamações, gravidez e pós parto e outros como pirajica, marimba, anchova e garoupa são indicados como peixes medicinais nestas situações. Aspectos relativos ao consumo de pescado fazem parte do corpo de conhecimento dos pescadores e suas famílias e constituem um acervo rico de informações que somadas as informações biológicas são úteis para a conservação dos recursos pesqueiros. Dados como os apresentados nesse estudo, com relação ao uso de animais aquáticos para tratamento de doenças, podem servir de base para estudos futuros sobre substâncias que contenham elementos ativos na cura de doenças.