Costos hospitalarios por enfermedades prevenibles en la infancia / Hospital costs for preventable diseases in childhood

La infección respiratoria aguda baja, el asma y la enfermedad sibilante bronquial, la gastroenteritis y las causas externas son grupos de enfermedades agudas de posible prevención en la infancia y, en particular, de hospitalizaciones totalmente evitables. Una de las causas fundamentales del número creciente de consultas y egresos hospitalarios de estos grupos de enfermedades es la estrategia deficitaria de la promoción y prevención en salud, generando un mal uso de recursos. Objetivo: Describir los costos de las internaciones de niños y adolescentes por enfermedades de hospitalización prevenible en el Hospital de Niños "Sor María Ludovica" de la ciudad de La Plata (HNLP) y como objetivo específico relacionar el costo de las hospitalizaciones prevenibles con el nivel de cobertura del seguro de salud y el lugar de residencia del paciente en el año 2015. Metodología: Estudio observacional, descriptivo, transversal, retrospectivo. La población de base fueron los egresos por infección respiratoria aguda baja (IRAB), causas externas, gastroenteritis (GEA) y asma con sibilantes bronquiales recurrentes (SBR). Muestreo aleatorio estratificado de 30 pacientes por patología. Se analizaron variables costo hospitalario y cobertura del servicio de salud, utilizando los nomencladores públicos nacional, provincial y de la obra social de la Pcia. Bs. As. Los costos fueron analizados por paciente y por día de internación. Resultados:Los egresos por enfermedades de hospitalización prevenibles correspondieron al 41.2%. El asma fue el 16.8, las causas externas 12.2%, IRAB 7.8% y la GEA 4.4%. El 64% de los egresos de EP fueron internados en las salas de baja complejidad, el 33 % en terapias intermedias y el 3% en alta complejidad. El total de días de internación por enfermedades de hospitalización prevenible 23.123. El 72% no tenían un seguro de salud y residían en el 2do cordón del conglomerado. El valor promedio de los tres nomencladores por nivel de complejidad de un día de internación fue 212 dólares en baja complejidad, 299 dólares en complejidad intermedia y 497 dólares en alta complejidad. Conclusión: Hubo un alto porcentaje de egresos por enfermedades de hospitalizaciones prevenibles. La baja complejidad y los pocos días de internación refuerzan su revisibilidad. La baja condición socioeconómica por lugar de residencia y falta de seguro de salud son factores de riesgo asociados. Los altos costos demostrados por hospitalizaciones prevenibles pueden aminorarse con políticas certeras de promoción y prevención en salud especialmente en poblaciones vulnerables

Acute lower respiratory infection, asthma and bronchial wheezing disease, gastroenteritis and external causes are groups of acute diseases of possible prevention in childhood and, in particular, of totally avoidable hospitalizations. One of the fundamental causes of the growing number of consultations and hospital discharges of these groups of diseases is the deficient strategy of health promotion and prevention, generating a misuse of resources. Objective: Describe the costs of hospitalizations of children and adolescents for preventable hospitalization diseases at the "Sor María Ludovica" Children's Hospital in the city of La Plata (HNLP) and as a specific objective to relate the cost of preventable hospitalizations with the level of health insurance coverage and the patient's place of residence in 2015. Methodology: Retrospective cross-sectional, observational, descriptive study. The base population was discharges for acute lower respiratory infection (IRAB), external causes, gastroenteritis (GEA) and asthma with recurrent bronchial wheezing (SBR). Stratified random sampling of 30 patients by pathology. Variables hospital cost and health service coverage were analyzed, using the national,provincial and social work public nomenclators of the Pcia. Bs. As. Costs were analyzed per patient and per day of hospitalization. Results: Discharges for preventable hospitalization diseases were 41.2%: Asthma was 16.77%, external causes 12.2%, IRAB 7.8% and GEA 4.4%. Sixty four percent of these discharges were hospitalized in low complexity rooms, 33% in intermediate therapies and 3% in high complexity. The total number of days of hospitalization for preventable hospitalization diseases was 23,123. SEventy two percent did not have health insurance and reside in the 2nd cordon of the conglomerate. The average cost, according to the three nomenclators, per level of complexity of a day of hospitalization is $212 in low complexity, $299 in intermediate complexity and $497 in high complexity. Conclusion: There was a high percentage of discharges for potentially preventable diseases. The low complexity and the few days of hospitalization reinforce its predictability. Low socioeconomic status by place of residence and lack of health insurance are associated risk factors. The high costs demonstrated by preventable hospitalizations can be reduced with accurate health promotion and prevention policies, especially in vulnerable populations

Thermal energy density of dust in dusty plasmas: experiment and theory.

A surprising observation in dusty plasma experiments is that the dust thermal energy density, P_{d}∝n_{d}T_{d}, is typically much greater than n_{d}T_{n} (where n_{d} and T_{d} are the dust density and temperature, and T_{n} is the neutral temperature), even though the dust particles would be expected to be in thermal equilibrium with the neutrals. We show here, theoretically and experimentally, that the anomalously high dust thermal energy density can be accounted for if electrostatic interactions between the dust particles and the background plasma are taken into account. Thus, the dust pressure in dusty plasma is mostly of electrostatic origin.

Observations of a structure-forming instability in a dc-glow-discharge dusty plasma.

By adjusting the anode current and axial magnetic strength of a dc-glow-discharge dusty plasma, we have found plasma and dust conditions conducive to dusty plasma structurization, similar to the one discussed theoretically by Morfill and Tsytovich [Plasma Phys. Rep. 26, 682 (2000)]. The structurization instability leads to the formation of a pattern where the dust suspension transforms into alternating stationary regions of high and low dust densities. We have measured the dependence of the wavelength of the nonpropagating dust density structures on neutral pressure and plasma density and discussed the results in terms of the dispersion relation obtained by D'Angelo [Phys. Plasmas 5, 3155 (1998)] for an ionization and ion-drag instability. The observations are also considered in light of a recent theoretical prediction by Khrapak et al. [Phys. Rev. Lett. 102, 245004 (2009)] that under certain conditions the effects of the polarization force on dust particles can cause dust acoustic waves to stop propagating, resulting in the formation of aperiodic, stationary dust density structures.

Laboratory observations of self-excited dust acoustic shocks.

Repeated, self-excited dust acoustic shock waves (DASWs) have been observed in a dc glow discharge dusty plasma using high-speed video imaging. Two major observations are reported: (1) The self-steepening of a nonlinear dust acoustic wave (DAW) into a saw-tooth wave with sharp gradient in dust density, very similar to those found in numerical solutions of the fully nonlinear fluid equations for a nondispersive DAW [B. Eliasson and P. K. Shukla, Phys. Rev. E 69, 067401 (2004)], and (2) the collision and confluence of two DASWs.

Faster-than-Bohm cross-B electron transport in strongly pulsed plasmas.

We report the empirical discovery of an exceptionally high cross-B electron transport rate in magnetized plasmas, in which transverse currents are driven with abruptly applied high power. Experiments in three different magnetic geometries are analyzed, covering several orders of magnitude in plasma density, magnetic field strength, and ion mass. It is demonstrated that a suitable normalization parameter is the dimensionless product of the electron (angular) gyrofrequency and the effective electron-ion momentum transfer time, omega(ge)tau(EFF), by which all of diffusion, cross-resistivity, cross-B current conduction, and magnetic field diffusion can be expressed. The experiments show a remarkable consistency and yield close to a factor of 5 greater than the Bohm-equivalent values of diffusion coefficient D(perpendicular), magnetic-diffusion coefficient D(B), Pedersen conductivity sigma(P), and transverse resistivity eta(perpendicular).

Excitation of ion-acoustic-like waves by subcritical currents in a plasma having equal electron and ion temperatures.

The effect of a magnetic-field-aligned plasma flow with a transverse velocity gradient on the excitation of current-driven ion-acoustic-like waves in a plasma having equal electron and ion temperatures (T(e) = T(i)) was investigated experimentally. In agreement with theoretical predictions, the presence of sheared plasma flow substantially reduces the critical electron drift velocity needed to produce the ion-acoustic instability.

[Laparoscopic ultrasonography in laparoscopic surgery and diagnosis]. / Ecografia laparoscopica in chirurgia e diagnostica laparoscopica.

The authors report their experience with 101 patients examined with laparoscopic ultrasound (LU) using a dedicated 7.5-MHz linear probe which can be introduced through the 10-mm surgical trocars. In the patients undergoing laparoscopic cholecystectomy (77 cases), LU adequately demonstrated gallbladder wall and contents in all cases and visualized the main bile duct in 93.5% of cases; stones of the CBD or cystic duct were demonstrated in two cases. The liver was studied in 18 patients undergoing diagnostic laparoscopy or laparoscopic colonic resection: secondary lesions were identified in two cases, while benign lesions (cysts or angiomas) were seen in 6 cases. In the patients operated on for colonic resection (8 cases), LU was successfully used to localize the enteric tract affected by the tumor and to mark safety margins for excision. The technical features of the exam are reported and the main imaging findings discussed. The authors conclude that LU is a safe method which is easy to perform and does not significantly increase the operating time; the indications of this laparoscopic application of ultrasound are not yet defined but the application area will certainly widen in the future, as operative and diagnostic laparoscopy are more and more frequently used by surgeons.

[Carbon dioxide as an intra-arterial contrast agent in echography: a technic for its preparation and the preliminary results in assessing hepatocarcinoma vascularization]. / Anidride carbonica come mezzo di contrasto intraarterioso in ecografia: tecnica di preparazione e risultati preliminari nella valutazione della vascolarizzazione dell'epatocarcinoma.

This paper reports on an original method to prepare a contrast agent consisting of CO2 microbubbles to be injected i.a. during ultrasound examinations (ultrasound angiography-USA), whose value was investigated in the study of tumor neovascularity in HCC patients. Thirty-five HCC patients underwent USA. CO2 was drawn out from a gas container under pressure and, through a sublimation process, made available in predetermined quantities in test tubes. USA was performed during angiography in 9 cases and immediately before arterial chemoembolization in the other 26 cases. In 51 lesions vascularity was evaluated with conventional angiography, USA and lipiodol CT. USA demonstrated lesion hypervascularity in 91% of cases, as confirmed by lipiodol CT (88%), versus 72.4% of angiography. In 3 of 35 patients USA demonstrated 6 more lesions undetected by other modalities: two of them were proved to be HCC and adenomatous hyperplasia at percutaneous biopsy. USA is a cost-effective procedure, which is easy to perform during conventional angiography: it is more sensitive than conventional angiography in the study of lesion neovascularity and can help plan lesion management, anticipating the results of chemoembolization. The role of USA in the diagnosis and treatment of HCC is, however, still to be defined.

Conventional and nonconventional modes of vancomycin administration to decontaminate the internal surface of catheters colonized with coagulase-negative staphylococci.

Using a quantitative in vitro model simulating clinical conditions, we studied the efficacy of conventional and nonconventional 3-day therapies involving vancomycin for treating the internal surface of catheters colonized with a slime-producing strain of Staphylococcus epidermidis. When infused for 1 hr every 8 hr through the catheter at the daily dose recommended for a 10-kg child (450 mg), vancomycin alone reduced bacterial colonization but failed to sterilize the inserts. Vancomycin was more active in combination with netilmicin (25 mg for 1 hr every 8 hr), rifampin (150 mg for 90 min every 12 hr), or fosfomycin (500 mg for 4 hr every 6 hr), but the catheters were inconsistently decontaminated after 3 days of treatment. Two nonconventional modes of antibiotic administration were tested for their capacity to ensure high levels of vancomycin in the catheter lumen over a prolonged time. Vancomycin infused continuously through the catheter at a daily dose of 450 mg had the same poor sterilizing effect as vancomycin administered intermittently. On the contrary, catheters were totally decontaminated when 2.5 mg of vancomycin in a volume of 0.5 ml were injected twice daily into noninfused catheters, confirming that the antibiotic-lock technique is an approach of great interest to sterilize the internal surface of catheters colonized with staphylococci.

[Inspired by Apollo and Asclepio's sons in Homer and Virgil]. / Ispirati da Apollo e figli di Asclepio in Omero e Virgilio.

Important passages of the Homeric and Virgilian epic are regarding the art of divination and the medical science, and underline contextually the figures of the fortune teller and that of the physician. Two roles are associated to one matrix: heroic-aristocratic or royal-sacerdotal. In Homer's epic it is possible to single out surgical and phytotherapeutic knowledge together with remedies for diseases aroused by a solar god, like Apollo is, gods' physician. Pitiful divinities comfort those who have been struck by demoniac and mysterious forms. On the contrary, in Virgil's epic a symbiosis is carried out between the physician's figure and the priest's one, with the very vague outlines of the two arts and however, overloaded by factors which are typically Virgilian. Unusual form of incubation of the Greek rituals has been transplanted in the Latin matrix; and moreover there is a constant recall of words used in their most antique meaning.

In vitro quantitative model of catheter infection during simulated parenteral nutrition.

We developed a quantitative in vitro model of catheter infection. Colonization was initiated by inoculating the catheter lumen with a small number of bacteria (approximately 5 x 10(3) viable organisms). Then the inoculated catheters were used for simulated total parenteral nutrition therapy consisting of infusions for 9 h a day, and bacteria were counted in the effluent fluid against time, enabling us to monitor catheter colonization quantitatively. Bacterial colonization of prosthetic devices is a progressive process, as evidenced by the slow day-to-day increase of bacterial release seen here. On the other hand, bacterial strains of various representative species exhibited significant differences in their ability to infect catheters. These results suggest that the in vitro model presented here is a reliable tool for monitoring the degree of catheter colonization under standardized conditions and could be used for further studying the main factors of catheter-related sepsis or the treatment of this information.