Inflation, Economic Policy Changes, and Access to Essential Drugs by Retirees in Argentina.

This cross-sectional study investigates whether there are associations between inflation, economic policy changes, and retirees' access to medicines in Argentina.

[Data as common good.] / I dati come bene comune.

Data are part of language, intelligence, description, knowledge production, politics, economics, medicine: they are the essential quantitative component of any message. The recent transformation of reality into data, however, has made data an economic commodity. But does the raw material of which knowledge is made - data - belong to the universe of the unalienable rights of the individual and of populations or to the global normativity of economy-goods? The transformation of data into proprietary goods has introduced into the rules of research the artificiality and complication of a contractual logic that transforms the qualitative-contextual component of projects into an unwelcome or disturbing guest and turns attention to formal details into a purely administrative exercise. The only possible solution is not to accept the blackmail of obeying the rigidity of rules that prevent a serious and responsible relationship with the problems of patients and real populations.

[What is a statistical genocide? Memo for an active nursing management of the new reform of the national health system]. / Che cosa è uno statistical genocide? Promemoria per una gestione infermieristica attiva del PNRR.

. What is a statistical genocide? Memo for an active nursing management of the new reform of the national health system. A recent editorial note in a journal which is certainly culturally and not only scientifically relevant as The Lancet, underlines how statistics, a discipline and methodology expected to be highly reliable and needed to produce critical evidences for programming and evaluating health issues and interventions, has become in various scenarios a misleading tool, by its capacity of using data to manipulate epidemiological information which coincides with the specific cancellation of situations of violation of human and health rights. As we live in a time and in contexts where data are becoming the protagonists of the decision-making processes from the digitalisation of all information, to the uncontrollable dependence from algorithms in deciding priorities and 'personalised' care the alarm raised deserves attention: not exclusively to avoid misled behaviour, but more importantly to assure better and truly innovative practices. In the present challenging situation, which sees the nursing profession planned to acquire more substantial autonomy in the production of knowledge, the alarm could and should be interpreted as a 'sentinel provocation' (and concrete model scenarios are proposed) to manage and utilise data which focus and made better targeted populations more exposed to conditions of fragility and marginalisation: the dominance of administrative data directed mainly to monitor economic sustainability, must be integrated and re-directed to a care where the human rights to health are the indicators and the measure of outcomes.

[For a visibility of the subjects of health as a human right/common good]. / Per una visibilità concreta dei soggetti della salute come diritto umano/bene comune.

. For a visibility of the subjects of health as a human right/common good. In order to make the many populations of the national health service visible and to produce data that can be used as a guide for health planning, the fragmentation currently present in the databases, prevents the cross-communication and should be overcomed. Social, economical and health indicators should help to shape subgroups of populations and their needs, to render visible the problems (met and unmet) at community level. The critical step is the move from an epidemiology limited to the description of population problems to one that allows to highlight problems' avoidability.

Inequalities in the Universal Right to Health.

Child health inequalities violate children's rights to optimal wellbeing. Different issues worldwide affect children's physical and mental health as well as their development, influencing their future as adults. Inequities are avoidable inequalities. Despite improvements in the past two decades, the ambitious goals of global agendas have, for the most part, remained as expectations with regard to childhood rights, social justice, and health equity in practice. The concept of social determinants of health has become part of the common language in certain settings, but this is still too little to improve health in practice on a global scale, particularly for underprivileged subgroups of the community, as children and adolescents often are. Pediatric health professionals and their organizations are also responsible for guaranteeing children's and adolescents' right to health and better wellbeing, helping to reduce health inequalities.

[A cultural meta-analysis for post Covid-19 times]. / Una metanalisi culturale per i tempi di post Covid-19.

A cultural meta-analysis for post Covid-19 times. The professional and human experience of the still ongoing emergency which has transformed the structure itself of the lives of world countries has generated a very large and fragmented spectrum of mainly descriptive and narrative publications (from inside the professions involved, as well as on the impact of the pandemia on the society) which defy any tentative of comprehensive understanding. This contribution proposes the results of an unusual, possibly provocative, metanalytic approach adapted to assess the existence, if any, of general evidences which could be assumed as a take home message of the heterogeneous, highly rich, mainly qualitative materials which have been produced so far: on the care aspects of the pandemia as well as on its more general significance for and impact on the society. The predefined biases and limitations of this approach (defined as cultural, i.e.which tries to provide an overall picture beyond the details) are declared to introduce and justify the outcome results of the exercise: a series of keywords is presented and commented as a guide into the future of a nursing profession ready and willing to have a more autonomous and innovative professional identity in the health care scenario and in the society.

An analysis of death trends in Argentina, 1990-2017, with emphasis on the effects of economic crises.

BACKGROUND: Economic crises have heterogeneous effects on population-level mortality between high- and low- or middle-income countries. Argentina - a middle income country- has suffered economic crises repeatedly over the past 30 years and is a model case study for the effects of economic crises on mortality. METHODS: Over 28 years (1990-2017), all death records in Argentina were analysed at the most disaggregated level possible (departments, that is, second-level administrative divisions). Age-and-sex-standardized all-cause mortality, premature death (<75 years) and the probability of death at different ages for both the entire population and each socio-economic quintile were calculated by level of unsatisfied basic needs (UBNs). Standardized rates are reported as biannual average and 95% confidence interval. RESULTS: Considered globally since the beginning of the series and using the 1990-1 biennium as a reference category, the standardized death rate was significantly reduced from biennium 2 (1992-3) to biennium 14 (2016-7), interrupted by two statistically significant increases in mortality, in years 2002-3 and 2016-7. In 2002-3, women had greater increase in mortality than men, and in 2016-7, even more so. The probability of dying before 75 years of age increased significantly in the last biennium, mostly among people between 50 and 74 years in the most deprived quintiles. CONCLUSIONS: Despite significant overall improvement over time, economic crises impose severe increases in mortality, especially among vulnerable groups such as the poor, the elderly, and women.

[When, how, why and whom for there will be an "after" Covid-19?] / Ci sarà - quando, come, perché, per chi - un "dopo" - Covid 19?

. When, how, why and whom for there will be an "after" Covid-19? The announced, but unpredicted, radical and global experience of the Covid-19 pandemia has revealed the degree of ignorance, fragmentation, inadequacy of the national and international knowledge and strategies of intervention and, even more substantially, of coordination across all the critical areas of prevention and care. The importance of the nursing component of the organisation and of the technical and cultural aspects of health care delivery and accessibility has been underlined as a protagonist of the resistance and resilience during the worst period of the emergency, and should be specifically involved in this renewal, where a profound modification of the interactions, hierarchies, roles of various professions is required. A long term, widespread, flexible experimentation of country specific and international solutions must be envisaged and timely activated. The 'grammar' and the major concrete characteristics of the methodology which could be usefully adopted to guarantee the feasibility and effectiveness of this 'systemic' experimentation are proposed and exemplified.

[Notes of method to imagine an education tailored to the future]. / Appunti di contenuto-metodo per immaginareun percorso formativo a misura del futuro.

. Notes of method to imagine an education tailored to the future. Health and social inequalities represent a problem not only from an ethical point of view but also from the point of view of public and social health. Unfortunately, this issue remains confined to conferences and debates and is not yet the subject of a serious reflection on how to constructively and permanently incorporate it in the education of health professionals, to provide the skill to read and interpret data, and to make research. This contribution, in addition to providing some reflections, launches an initiative that aims at incorporating these contents in the basic education, to make the message of Florence Nightingale real: wounds, suffering, dying and the absurdity of disability can be taken care of, be part of the care, only if you learn to recognize the causes, which are not only in the medical domain.

[I promotori di salute come attori-protagonisti delle cure primarie nel controllo delle malattie comunicabili e non comunicabili e nell' empowerment delle comunità. Esperienza e risultati di lungo periodo in aree marginali in Ecuador dal 1980 al 2018.] / The community health promoters as protagonist actorsof primary health care and community empowerment:a long term field-report from 1980 to 2018.

. INTRODUCTION: Against the increasing recognition of the critical importance of a direct participation of community members to assure effective health care in peripheral areas of Middle and Low Income Countries (MLIC), representative field experiences of their essential role are only occasionally available. AIMS AND METHODS: We report a narrative, factual documentation of a spectrum of projects covering the basic and specific health needs of the disperse communities in Ecuador, a model MLIC, and discuss the broader implications of the role and performance of HPs over a long period, 1980-2018, in the project activation, implementation and monitoring. RESULTS: The role of 60 HPs, with the coordination of a small core group of professionals of the Centro de Epidemiologia Comunitaria y Medicina Tropical (CECOMET) is documented through their main achievements which include: infectious diseases and in particular Neglected Tropical Diseases (eradication of onchocerciasis and yaws; virtual elimination of malaria and of strongyloidiasis; identification and control of a new focus of Chagas Disease; control of tuberculosis), mother and child health, reproductive health, hypertension (as model of the emergence of non-transmissible, chronic diseases). The most effective and sustainable strategies and methods are discussed also in terms of their more general transferability, already partially tested in programs in Bolivia, Burkina Faso, undeserved areas of Argentina. CONCLUSIONS: The systematic availability of non-professional, trained HPs should be recommended as a sustainable and reliable component of health care strategies and interventions targeted to marginalized settings, to assure a concrete accessibility to the fundamental human right to life.

Adverse drug events identified in hospitalized patients in Brazil by International Classification of Diseases (ICD-10) code listings.

Studies of adverse drug events (ADEs) are important in order not to jeopardize the positive impact of pharmacotherapy. These events have substantial impact on the population morbidity profiles, and increasing health system operating costs. Administrative databases are an important source of information for public health purposes and for identifying ADEs. In order to contribute to learning about ADE in hospitalized patients, this study examined the potential of applying ICD-10 (10th revision of the International Classification of Diseases) codes to a national database of the public health care system (SIH-SUS). The study comprised retrospective assessment of ADEs in the SIH-SUS administrative database, from 2008 to 2012. For this, a list of ICD-10 codes relating to ADEs was built. This list was built up by examining lists drawn up by other authors identified by bibliographic search in the MEDLINE and LILACS and consultations with experts. In Brazil, 55,604,537 hospital admissions were recorded in the SIH-SUS, between 2008 and 2012, of which 273,440 (0.49%) were related to at least one ADE. The proportions and rates seem to hold constant over the study period. Fourteen out of 20 most frequent ADEs were identified in codes relating to mental disorders. Intoxications figure as the second most frequently recorded group of ADEs in the SIH-SUS, comprising 76,866 hospitalizations. Monitoring of ADEs in administrative databases using ICD-10 codes is feasible, even in countries with information systems under construction, and can be an innovative tool to complement drug surveillance strategies in place in Brazil, as well as in others countries.

Adverse drug events identified in hospitalized patients in Brazil by International Classification of Diseases (ICD-10) code listings / Eventos adversos a medicamentos identificados em pacientes hospitalizados no Brasil de acordo com códigos da Classificação Internacional de Doenças (CID-10) / Eventos Adversos por Medicamentos identificados en pacientes hospitalizados en Brasil según los listados de códigos de la Clasificación Internacional de Enfermedades (CIE-10)

Studies of adverse drug events (ADEs) are important in order not to jeopardize the positive impact of pharmacotherapy. These events have substantial impact on the population morbidity profiles, and increasing health system operating costs. Administrative databases are an important source of information for public health purposes and for identifying ADEs. In order to contribute to learning about ADE in hospitalized patients, this study examined the potential of applying ICD-10 (10th revision of the International Classification of Diseases) codes to a national database of the public health care system (SIH-SUS). The study comprised retrospective assessment of ADEs in the SIH-SUS administrative database, from 2008 to 2012. For this, a list of ICD-10 codes relating to ADEs was built. This list was built up by examining lists drawn up by other authors identified by bibliographic search in the MEDLINE and LILACS and consultations with experts. In Brazil, 55,604,537 hospital admissions were recorded in the SIH-SUS, between 2008 and 2012, of which 273,440 (0.49%) were related to at least one ADE. The proportions and rates seem to hold constant over the study period. Fourteen out of 20 most frequent ADEs were identified in codes relating to mental disorders. Intoxications figure as the second most frequently recorded group of ADEs in the SIH-SUS, comprising 76,866 hospitalizations. Monitoring of ADEs in administrative databases using ICD-10 codes is feasible, even in countries with information systems under construction, and can be an innovative tool to complement drug surveillance strategies in place in Brazil, as well as in others countries.

Os estudos sobre eventos adversos a medicamentos (EAMs) são importantes para evitar de prejudicar o efeito positivo da farmacoterapia. Os EAMs têm impacto substancial nos perfis de morbidade da população e no aumento dos custos operacionais do sistema de saúde. As bases de dados administrativos representam uma fonte de informação importante para fins de saúde pública em geral e especificamente para identificar os EAMs. No intuito de contribuir para o conhecimento sobre EAMs em pacientes hospitalizados, o estudo examinou a aplicabilidade dos códigos da CID-10 (10ª revisão da Classificação Internacional de Doenças) ao Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH-SUS). O estudo integrou uma avaliação retrospectiva de dados administrativos do SIH-SUS referentes aos anos de 2008 a 2012. Para tanto, foi elaborada uma lista de códigos da CID-10 relacionados a EAMs. A lista foi produzida a partir de uma consulta às listas projetadas por outros autores e identificadas através de uma busca em MEDLINE e LILACS e consultas com especialistas. No Brasil, foram registradas 55.604.537 internações hospitalares no SIH-SUS entre 2008 e 2012, das quais 273.440 (0,49%) estiveram relacionadas a pelo menos um EAM. As proporções e taxas de EAMs permaneceram constantes ao longo do período estudado. Quatorze dos vinte EAMs mais frequentes foram identificados através de códigos relacionados a transtornos psiquiátricos. As intoxicações figuram como o segundo grupo mais frequente de EAMs registrados no SIH-SUS, com 76.866 internações. O monitoramento dos EAMs com o uso dos códigos da CID-10 mostrou ser uma metodologia viável, mesmo em países com sistemas de informação ainda incompletos, e pode ser uma ferramenta inovadora para complementar as estratégias atuais de vigilância farmacológica no Brasil, assim como, em outros países.

Los estudios sobre eventos adversos por medicamentos (EAMs) son importantes, para no comprometer el impacto positivo de la farmacoterapia. Estos eventos tienen un impacto sustancial en los perfiles de morbilidad de la población e incrementan los costes operativos del sistema de salud. Las bases de datos administrativas son una importante fuente de información por motivos de salud pública y para identificar EAMs. Con el fin de contribuir al aprendizaje sobre EAM en pacientes hospitalizados, este estudio examinó el potencial de aplicar códigos CIE-10 (10ª revisión de la Clasificación Internacional de Enfermedades) a una base datos nacional del sistema de salud público (SIH-SUS). Este estudio estuvo constituido por una evaluación retrospectiva de EAMs, en la base de datos administrativa del SIH-SUS, desde 2008 a 2012. Para ello, se desarrolló la lista de la CIE-10 con códigos para EAMs. Esta lista se creó examinando listas diseñadas por otros autores, identificados a través de búsquedas bibliográficas en MEDLINE, LILACS y consultas con expertos. En Brasil, se registraron 55.604.537 admisiones hospitalarias en el SIH-SUS, entre 2008 y 2012, de las cuales 273.440 (0,49%) sufrieron al menos un EAM. Los porcentajes y tasas parecieron mantenerse constantes durante el periodo de estudio. Catorce de los 20 más frecuentes EAMs fueron identificados con códigos relacionados con enfermedades mentales. Las intoxicaciones fueron el segundo grupo registrado más común de EAMs en el SIH-SUS, representando 76.866 hospitalizaciones. La supervisión de EAMs en las bases de datos administrativas, usando los códigos CIE-10, es factible, incluso en países cuyos sistemas de información se encuentran en proceso de construcción, y puede ser un herramienta innovadora como complemento de las actuales estrategias de supervisión sobre medicamentos en Brasil, así como en otros países.

Social and economic determinants of pediatric health inequalities: the model of chronic kidney disease.

Purpose of this review is to deal with priorities and strategies to significantly tackle inequalities in the management of pediatric diseases in low-middle-income countries. This issue has become a focal point of epidemiological and public health, with special reference to chronic nontransmissible diseases. We will provide our readership with an essential overview of the cultural, institutional, and political events, which have occurred over the last 20 y and which have produced the current general framework for epidemiology and public health. Then the most recent epidemiological data will be evaluated, in order to quantify the interaction between the medical components of the disease profiles and their socioeconomic determinants. Finally, a focus will be added on models of pediatric chronic kidney diseases, which are in our opinion amongst the most sensitive markers of the interplay between health and society. Collaborative, pediatrician-initiated, multicentre projects in these fields should be given priority in calls for grants supported by public agencies. The involvement of a critical mass of those working in the "fringes" of pediatric care is a final, essential mean by which significant results can be produced under the sole responsibility and research interest of centers of excellence.

Registro Absorb Italiano (BVS-RAI): an investigators-owned and -directed, open, prospective registry of consecutive patients treated with the Absorb™ BVS: study design.

BACKGROUND: The Absorb™ BVS is a bioresorbable, everolimus-eluting scaffold approved and marketed for coronary use. Published data on long-term results after treatment are limited to a small number of patients, most of them with elective PCI of simple lesions. The importance of scaffold resorption is variably appreciated among cardiologists, and indications for use from health technology assessment bodies or guidelines are missing. Instruments are needed to collect, share and assess the experience being accumulated with this new device in several centres. METHODS/DESIGN: The BVS-RAI Registry is a spontaneous initiative of a group of Italian interventional cardiologists in cooperation with Centro di Ricerche Farmacologiche e Biomediche "Mario Negri" Institute, and is not recipient of funding or benefits originating from the BVS manufacturer. It is a prospective registry with 5-year follow-up of all consecutive patients who have undergone successful implantation of 1 or more coronary BVS following the indications, techniques and protocols used in each of the participating institutions. Outcome measures are BVS target lesion failure within one year and device-oriented major adverse cardiac events within 5years. The registry started in October 2012 and will extend enrolment throughout 2015, with the aim to include about 1000 patients. ClinicalTrials.gov identifier is CT02298413. CONCLUSIONS: The BVS-RAI Registry will contribute observational knowledge on the long-term safety and efficacy of the Absorb™ BVS as used in a number of Italian interventional centres in a broad spectrum of settings. Unrewarded and undirected consecutive patient enrolments are key-features of this observation, which is therefore likely to reflect common clinical practice in those centres.

On the hypothetical universal use of statins in primary prevention: an observational analysis on low-risk patients and economic consequences of a potential wide prescription rate.

PURPOSE: Recent guidelines expand indications for statins. However, research on practical economic feasibility and cost-effectiveness in low-risk people is lacking. We aimed to describe the incidence of cardiovascular events (CVE), their total direct costs and the hypothetical effects of wide provision of statins on those rates and expenditures. METHODS: We conducted a population-based cohort study using administrative data among low risk individuals. Estimators of effects of statins were taken from Cholesterol Treatment trialist metaanalysis and from Heart Protection Study trial. Two statin prices were used for analyses: National Italian Health System (€ 0.36) and the International Drug Price Indicator (€ 0.021). RESULTS: Overall, 920,067 persons at low risk were identified and 14,849 CVE were registered (incidence rate 27.3 per 10,000 person-years). Direct costs for hospitalizations for CVE were 143 M €. Universal provision of statins would result in a significant decrease in CVE rates, from 27.3 to 17.5 per 10,000 person-years (PY) (95% confidence interval (CI): 15.8-19.4). Universal prescription of simvastatin 20 mg would cost 802 M €. Otherwise, provision of simvastatin at International Drug Price Indicator's prices would be both clinically effective and cost saving in men older than age 44 (observed expenditures 120 M €, expected 97.4 M €) but not in women (observed expenditures 22.7 M €, expected 36.5 M €). CONCLUSIONS: Among a low-risk population, hypothetical universal provision of low-cost simvastatin to men over 44 years could be both clinically effective and a cost-saving strategy.

[Unconnected, possibly irrelevant for the nursing profession, but mandatory readings not to lose the focus in 2015, and beyond]. / Due letture tra loro scollegate, e non pertinenti per la professione: e tuttavia indispensabili per orientarsi in questa fine 2015.

SUMMARY: Unconnected, possibly irrelevant for the nursing profession, but mandatory readings not to lose the focus in 2015, and beyond. The recent, and chronologically concomitant publication of two reports - on the specific and dramatic violence against women in war situations; on the experience and results of resilience of cultural, health, academic palestinian institutions under Israeli State repression - has suggested their joint, very synthetic presentation, which explains the somehow henigmatic formulation of the title, and provides the opportunity for possibly relevant comments for the nursing profession and research. Two main points are underlined: a) beyond their clear heterogeneity, in terms of content and format, the two publications have a common, reciprocally complementary objective and message: the importance, and the concrete rarity, of visibility for scenarios which are most of the time left to the fragmentation of the chronicle, though they touch the roots of the interests of those who are working in fields which are close to the rights to life and dignity. b) The specific relevance of becoming aware of strategies contrasting massive violations of fundamental rights could and should be tested by the nursing profession with cultural and field projects targeted to the populations who in many scenarios of care and life are threatened by the violence of marginalization.

Social network intervention in patients with schizophrenia and marked social withdrawal: a randomized controlled study.

OBJECTIVE: To evaluate the efficacy and feasibility of actions intended to implement or improve patients' social network within the Italian National Health Service community mental health services. METHODS: We conducted a randomized clinical trial through a network of 47 community mental health services on patients with a diagnosis in the schizophrenia spectrum (F20 in the International Classification of Diseases, 10th Revision), who were young (aged younger than 45 years), and with a poor social network (less than 5 relationships). In addition to routine treatments, for the experimental group, the staff identified possible areas of interest for individual patients and proposed social activities taking place outside the services' resources and with members of the community. The main outcome was an improvement in the patients' social network; secondary end points were clinical outcome, abilities of daily living, and work. RESULTS: One- and 2-year outcomes of 345 and 327, respectively, of the 357 patients randomized were analyzed by intention-to-treat. A social network improvement was observed at year 1 in 25% of the patients allocated to routine treatment and in 39.9% of those allocated to the experimental arm (OR 2.0, 95% CI 1.3 to 3.1; adjusted OR 2.4, 95% CI 1.4 to 3.9). The difference remained statistically significant at year 2. No significant differences emerged for any of the other end points. However, patients with 1 or more other areas of improvement at year 1 and 2 showed a statistically significant social network improvement. CONCLUSIONS: The activation of social networks as an activity integrated with standard psychiatric care is practicable, without added economic and organizational costs, and appears to produce an effect persisting well beyond its implementation.

Objectif : Évaluer l'efficacité et la faisabilité de mesures destinées à mettre en œuvre ou à améliorer le réseau social des patients au sein des services de santé mentale du Service national de la santé communautaire italien. Méthodes : Nous avons mené un essai clinique randomisé dans un réseau de 47 services de santé mentale communautaires avec des patients ayant un diagnostic du spectre de la schizophrénie (F20 dans la Classification internationale des maladies, 10e révision), qui étaient jeunes (moins de 45 ans), et dont le réseau social était médiocre (moins de 5 relations). Outre les traitements réguliers, pour le groupe expérimental, le personnel a cerné des champs d'intérêt possibles pour les patients individuels et proposé des activités sociales qui avaient lieu en dehors des ressources des services, avec les membres de la communauté. Le résultat principal a été l'amélioration du réseau social des patients; les indicateurs de résultats secondaires étaient un résultat clinique, les aptitudes à la vie quotidienne et le travail. Résultats : Les résultats à 1 an et 2 ans, de 345 et 327 respectivement, sur les 357 patients randomisés ont été analysés selon le principe de vouloir traiter. Une amélioration du réseau social a été observée à l'an 1 chez 25 % des patients affectés au traitement régulier et chez 39,9 % de ceux affectés au volet expérimental (RC 2,0; IC à 95 % 1,3 à 3,1; RC corrigé 2,4; IC à 95 % 1,4 à 3,9). La différence demeurait statistiquement significative à l'an 2. Aucune différence significative n'est apparue pour aucun des autres indicateurs de résultats. Cependant, les patients ayant amélioré 1 ou plusieurs domaines à l'an 1 et 2 présentaient une amélioration statistiquement significative de leur réseau social. Conclusions : L'activation des réseaux sociaux comme activité intégrée dans des soins psychiatriques standards est réalisable, sans frais économiques et organisationnels additionnels, et semble produire un effet qui persiste bien au-delà de sa mise en œuvre.