Exploring pre-MRI imaging tests: patient survey reveals potential implications for healthcare efficiency in Israel.

BACKGROUND: Medical imaging tests are vital in healthcare but can be costly, impacting national health expenditures. Magnetic resonance imaging (MRI) is a crucial diagnostic tool for assessing medical conditions. However, the rising demand for MRI scans has frequently strained available resources. This study aimed to estimate the prevalence of different imaging tests in individuals who eventually had an MRI, in the Israeli public health system. METHODS: An online survey of patient experience of scheduling an MRI was conducted in January-February 2023, among 557 Israeli adults, representing all four health maintenance organizations (HMOs). All participants had undergone an MRI in the public health system within the past year. RESULTS: Results showed that 60% of participants underwent other imaging tests before their MRI scan. Of those, computed tomography (CT) scans (43%), X-rays (39%), and ultrasounds (32%) were the most common additional imaging procedures. In addition, of the 60% of participants, 23% had undergone more than one prior imaging examination. CONCLUSIONS: These findings highlight the high prevalence of preliminary imaging tests prior to MRI, with many patients undergoing multiple tests for the same problem. The health system may need to evaluate whether current clinical guidelines defining the use of various imaging tests are cost-effective.

Prevalence of hereditary hemorrhagic telangiectasia in a medical care program organization in Buenos Aires, Argentina.

INTRODUCTION: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant vascular dysplasia that might affect 1/5000-10 000 individuals worldwide. It is a rare and underdiagnosed condition. Population-based epidemiological studies are crucial for comprehending and quantifying the impact of this disease. We aim to estimate the prevalence in a Prepaid Health Care System of Buenos Aires, Argentina. METHODS: A descriptive cross-sectional study was designed, which included all patients over 18 years of age affiliated with the Hospital Italiano Medical Care Program (IHMCP), a prepaid health maintenance organization (HMO) of Buenos Aires. For case inclusion, individuals were required to have a clinical diagnosis of HHT. Case detection included the search in our Institutional Registry. The prevalence was calculated by dividing the number of cases of HHT by the total number of all active affiliates at January 2023. Age and gender specific prevalence rates were estimated. RESULTS: 48 cases were reported. The prevalence was 3.2 in 10 000 (IC 95% 2.4-4.2). Specific prevalence in women was 3.9 in 10 000 (IC 95% 2.8-5.5) and in men 2.1 in 10 000 (IC 95% 1.2-3.6). The average age was 54.8 (19), 35 patients were women (72.9%) with an average age of 55 (19.9), and 55 (17.2) for men. The most common referrals were physicians (60.4%) followed by family history (18.7%). The 48 patients corresponded to 39 families. DISCUSSION: The prevalence identified in our study is higher than the one documented in other studies.

Introducción: La telangiectasia hemorrágica hereditaria (HHT) es una displasia vascular que puede afectar a 1 de 5000 a 10 000 personas en el mundo. Es una afección rara y subdiagnosticada. Los estudios epidemiológicos son fundamentales para comprender y cuantificar el impacto de esta enfermedad. Nuestro objetivo fue estimar la prevalencia en un Sistema Prepago de Atención de la Salud, en Buenos Aires, Argentina. Métodos: Estudio descriptivo transversal en pacientes mayores de 18 años afiliados al Programa de Atención Médica del Hospital Italiano en Buenos Aires (Plan de Salud). Para la inclusión de casos, se requería el diagnóstico de HHT. La detección de casos incluyó su búsqueda en nuestro Registro Institucional. La prevalencia se calculó dividiendo el número de casos por el número total de afiliados activos en enero de 2023. Se estimaron tasas específicas por edad y género. Resultados: Se reportaron 48 casos. La prevalencia fue de 3.2 por 10 000 personas (IC 95% 2.4-4.2). La específica en mujeres fue de 3.9 (IC 95% 2.8-5.5) y en hombres de 2.1 por 10 000 (IC 95% 1.2-3.6). La edad promedio fue de 55 años (19), con 35 pacientes mujeres (72.9%) con una edad promedio de 55 años (19.9) y 55 (17.2) para hombres. La derivación más común fue de médicos (60.4%), seguidas por antecedentes familiares (18.7%). Los 48 pacientes correspondían a 39 familias. Discusión: La prevalencia identificada en nuestro estudio es más alta que la documentada en otros estudios.

"When everyone is responsible, no one takes responsibility": exploring pediatric physiotherapy services in Israel.

BACKGROUND: According to Israel's National Health Insurance Law (1994), the Ministry of Health is responsible for the provision of health services in the country including physiotherapy services; moreover, the Special Education Law (1988), stipulates that physiotherapy services for children with motor disabilities, as well as other allied health services, are provided by the Ministry of Education in educational settings. Thus, children with motor disabilities are entitled PT services under two different laws by two different ministries. METHOD: To describe the physiotherapy services for children with motor disabilities and examine how policymakers view these services, we conducted a qualitative study including in-depth semi-structured interviews with 10 policymakers from the Ministry of Health and the Ministry of Education, and the national directors of physiotherapy services from three of the four health maintenance organizations in Israel. RESULTS: Study results indicate that there is an array of physiotherapy services and providers. Despite the regulation of these services for children with motor disabilities, uncertainty and lack of knowledge were found about various issues. Therefore, the thematic analysis was structured around four descriptive questions: Where do the children receive physiotherapy? Who is eligible for physiotherapy treatment and who receives treatment? What interventions do children with motor disabilities receive? Who provides therapy for children with motor disabilities? CONCLUSIONS: Policymakers are dubious regarding the provision of these services, questioning whether children with motor disabilities receive physiotherapy services according to their needs. In addition, the abundance of suppliers does not necessarily improve the quality of services provided to children with motor disabilities, which may ultimately harm their developmental potential.

Preparation and synbiotic interaction mechanism of microcapsules of Bifidobacterium animalis F1-7 and human milk oligosaccharides (HMO).

Probiotics such as Bifidobacterium spp. generally possess important physiological functions. However, maintaining probiotic viability is a challenge during processing, storage, and digestive transit period. Microencapsulation is widely considered to be an attractive approach. In this study, B. animalis F1-7 microcapsules and B. animalis F1-7-HMO microcapsules were successfully prepared by emulsification/internal gelation with high encapsulation efficiency (90.67 % and 92.16 %, respectively). The current study revealed that HMO-supplemented microcapsules exhibited more stable lyophilized forms and thermal stability. Additionally, a significant improvement in probiotic cell viability was observed in such microcapsules during simulated gastrointestinal (GI) fluids or storage. We also showed that the individual HMO mixtures 6'-SL remarkably promoted the growth and acetate yield of B. animalis F1-7 for 48 h (p < 0.05). The synbiotic combination of 6'-SL with B. animalis F1-7 enhanced SCFAs production in vitro fecal fermentation, decreasing several harmful intestinal bacteria such as Dorea, Escherichia-Shigella, and Streptococcus while enriching the probiotic A. muciniphila. This study provides strong support for HMO or 6'-SL combined with B. animalis F1-7 as an innovative dietary ingredient to bring health benefits. The potential of the synbiotic microcapsules with this combination merits further exploration for future use in the food industry.

Longitudinal quantification of Bifidobacterium longum subsp. infantis reveals late colonization in the infant gut independent of maternal milk HMO composition.

Breast milk contains human milk oligosaccharides (HMOs) that cannot be digested by infants, yet nourish their developing gut microbiome. While Bifidobacterium are the best-known utilizers of individual HMOs, a longitudinal study examining the evolving microbial community at high-resolution coupled with mothers' milk HMO composition is lacking. Here, we developed a high-throughput method to quantify Bifidobacterium longum subsp. infantis (BL. infantis), a proficient HMO-utilizer, and applied it to a longitudinal cohort consisting of 21 mother-infant dyads. We observed substantial changes in the infant gut microbiome over the course of several months, while the HMO composition in mothers' milk remained relatively stable. Although Bifidobacterium species significantly influenced sample variation, no specific HMOs correlated with Bifidobacterium species abundance. Surprisingly, we found that BL. infantis colonization began late in the breastfeeding period both in our cohort and in other geographic locations, highlighting the importance of focusing on BL. infantis dynamics in the infant gut.

Cirurgia bariátrica e a pandemia do novo coronavírus: análise comparativa do impacto em procedimentos do sus e de convênio / Bariatric surgery and the new coronavirus pandemic: comparative analysis of the impact on sus and agreement procedures

Introdução: O tratamento da obesidade envolve diversas abordagens multidisciplinares, incluindo a intervenção cirúrgica. A pandemia de COVID-19 impactou o acesso a ela gerando dificuldades em sua retomada e acentuando as disparidades entre o sistema público e privado. Objetivo: Analisar o impacto da pandemia na cirurgia bariátrica realizada pelo SUS e por convênios médicos no Brasil. Métodos: Os dados foram coletados utilizando as bases de dados TABNET do Sistema de Informações Hospitalares (SIH), do Sistema Único de Saúde (SUS), e o Painel de dados do TISS da Agência Nacional de Saúde Suplementar (ANS), no período de 2015 a 2021 e foi realizada uma análise quantitativa descritiva, calculando-se a média das informações. Além disso, foram realizadas estimativas estatísticas utilizando regressão linear no software SPSS, com intervalo de confiança de 95%. Resultados: Foi identificada correlação significativa e direta entre o aumento do número de procedimentos realizados pelo SUS e o aumento médio de procedimentos ao longo dos anos, enquanto no sistema de convênios não houve correlação significativa. Durante a pandemia, houve queda expressiva no volume cirúrgico em ambos os sistemas, com o sistema público sendo mais afetado. A retomada do volume cirúrgico ainda não alcançou os níveis anteriores à pandemia no sistema público, enquanto o sistema privado apresentou aumento significativo. Conclusão: A pandemia do COVID-19 teve impacto significativo na capacidade do setor público e privado em realizar operações bariátricas no Brasil. Os resultados evidenciam diferenças regionais e socioeconômicas na realização desses procedimentos.

Introduction: The treatment of obesity involves several multidisciplinary approaches, including surgical intervention. The COVID-19 pandemic has impacted access to it, creating difficulties in its resumption and accentuating the disparities between the public and private system. Objective: To analyze the impact of the pandemic on bariatric surgery performed by SUS and medical insurance in Brazil. Methods: Data were collected using the TABNET databases of the Hospital Information System (SIH), of the Unified Health System (SUS), and the TISS data panel of the National Supplementary Health Agency (ANS), in the period of 2015 to 2021 and a descriptive quantitative analysis was performed, calculating the average of the information. In addition, statistical estimates were performed using linear regression in SPSS software, with a 95% confidence interval. Results: A significant and direct correlation was identified between the increase in the number of procedures performed by the SUS and the average increase in procedures over the years, while in the health insurance system there was no significant correlation. During the pandemic, there was a significant drop in surgical volume in both systems, with the public system being more affected. The resumption of surgical volume has not yet reached pre-pandemic levels in the public system, while the private system showed a significant increase. Conclusion: COVID-19 pandemic had a significant impact on the ability of the public and private sector to perform bariatric surgeries in Brazil. The results show regional and socioeconomic differences in the performance of these procedures.

Barreras y factores facilitadores para la accesibilidad a lainterrupción legal del embarazo (ILE) en el subsistema privado y de la seguridad social de Argentina: análisis dela situación institucional en el Hospital Italiano de Buenos Aires / Barriers and facilitating factors for accessibility to legal interruption of pregnancy in Argentina's public health and private subsystem: analysis of the institutional situation at Hospital Italiano de Buenos Aires

Hasta diciembre de 2020, en Argentina el aborto era legal ante determinadas causales. Sin embargo, era común que la implementación de esta legislación se viera entorpecida. El objetivo de esta investigación fue identificar las barreras y los factores facilitadores para la accesibilidad a la interrupción legal de embarazo en una institución del subsistema privado y de la seguridad social. Se realizó una investigación con enfoque cualitativo con entrevistas a profesionales del equipo de salud involucrados en el circuito de atención de interrupción legal de embarazo del Hospital Italiano de Buenos Aires. Los resultados se organizan en cinco ejes temáticos que surgieron luego de un proceso de lectura, interpretación y discusión:1) ausencia de una política institucional explícita, 2) los componentes de la práctica (falta de registro en la historia clínica electrónica, desarrollo de circuitos paralelos para acceder a la medicación: misoprostol), 3) el marco jurídico legal y las causales (falta de leyes claras, diversas interpretaciones en lo que respecta al causal salud), 4) la objeción de conciencia y 5) los aspectos contextuales (movimiento feminista, el proyecto de ley desaprobado en el senado en 2018). A pesar de que el equipo de salud contaba con un marco legal claro, implementar una política institucional interna resulta sumamente necesario. (AU)

Up until December 2020, abortion was legal in Argentina on certain grounds. However, it was common for the implementation of this legislation to be hindered. The purpose of this research was to identify the barriers and facilitating factors for the accessibility to legal abortion in both private and public health care institutions. A qualitative research was carried out with interviews with health professionals involved in the health team at Hospital Italiano de Buenos Aires legal interruption of pregnancy care circuit. The results are organized into five thematic axes that emerged after a process of reading, interpreting and discussing: 1) the absence of an explicit institutional policy, 2) the components of the practice (lack of registration in the electronic health records, development of parallel circuits to access medication: misoprostol), 3) the legal framework and grounds (lack of clear laws, different interpretations regarding health grounds), 4) conscientious objection, and 5) contextual aspects (feminist movement, the bill disapproved in the Senate in 2018). Even though the health teamhad a clear legal framework in place, implementing an internal institutional policy is extremely necessary. (AU)

Gasto en el último año de vida para pacientes que mueren con cáncer / Last-year-of-life expenditure of patients diagnosed with cancer

Resumen Objetivo: Estimar el gasto en el último año de vida de los pacientes diagnosticados con cáncer para Colombia. Métodos: Estudio retrospectivo descriptivo con datos de la facturación de dos EPS para los años 2011-2013. Se calculó el gasto en el último año de vida para la cohorte de pacientes fallecidos durante este tiempo. Se identificaron los pacientes que hubieran sido diagnosticados con cáncer en el año de la muerte usando códigos CIE-10. Se define gasto en el último año de vida como servicios prestados desde la fecha de muerte y los 360 días previos. Resultados: El 30,4% de los fallecidos de la cohorte tenían un diagnóstico de cáncer. Del total del gasto de todos los fallecidos en su último año de vida, el 43,6% del gasto correspondía a personas diagnosticadas con cáncer en 2012 y el 40% en 2013. El gasto medio para pacientes fallecidos por cáncer es entre 72% y 76% más alto que aquellos que no. El gasto mensual es más alto en los meses más cercanos a la muerte. Conclusiones: El uso de recursos de los pacientes que fallecen por cáncer podría disminuirse con programas de cuidado paliativo que respetan la calidad de vida de los pacientes.

Abstract Objective: To estimate last-year-of-life expenditure for patients diagnosed with cancer in Colombia. Methods: This is a descriptive retrospective study. Using claims data for two HMO for years 20112013, last-year-of-life expenditure was estimated for all persons dying in 2012-2013. Cancer diagnoses were identified using ICD-10 codes. Last-year-of-life expenditure was defined as allservices provided between the date of death and the 360 days previous. Results: A cancer diagnosis was recorded in 30.4% of the deceased and accounted for 43.6% of total last-year-of-life expenditure in 2012, and 40% in 2013. The mean per deceased expenditure was between 72% and 76% higher for patients with cancer as compared to patients without cancer. Last-year-of-life expenditure increases with the proximity to death. Conclusion: The use of resources for people dying with cancer diagnosis could be reduced with palliative care programs that give patients a quality of life.

Chronic urticaria in a health maintenance organization of Buenos Aires, Argentina - new data that increase global knowledge of this disease

Abstract: Background: In spite of the frequency of chronic urticaria, there are no epidemiological studies on its prevalence in Argentina. Objective: The objective of this study was to define the prevalence and epidemiological characteristics of chronic urticaria patients in Buenos Aires. Methods: The population studied were the members of the Italian Hospital Medical Care Program, a prepaid health maintenance organization located in the urban areas around the Autonomous City of Buenos Aires, Argentina. All patients with diagnosis of chronic urticaria members of the Italian Hospital Medical Care Program, and with at least 12 months of follow up were included in the study. All medical records obtained between January 1st, 2012 and December 31, 2014 were analyzed. The prevalence ratio for chronic urticaria per 100,000 population with 95% CI for December 31, 2014 was calculated. The prevalence rate for the entire population and then discriminated for adults and pediatric patients (less than 18 years old at diagnosis) was assessed. Results: 158,926 members were analyzed. A total of 463 cases of chronic urticaria were identified on prevalence date (68 in pediatrics, 395 in adults), yielding a crude point prevalence ratio of 0.29% (CI 95% 0.26-0.31%). The observed prevalence of chronic urticaria in the adult population was 0.34 % (95% CI 0.31-0.38%), while in pediatrics it was 0.15 % (95% CI 0.11-0.20%). Study limitations: the main weakness is that the results were obtained from an HMO and therefore the possibility of selection bias. Conclusions: chronic urticaria is a global condition. Its prevalence in Buenos Aires is comparable with other countries.

Cost-effectiveness analysis of natural birth and elective C-section in supplemental health / Análise de custo-efetividade do parto vaginal e da cesariana eletiva na saúde suplementar

ABSTRACT OBJECTIVE To conduct a cost-effectiveness analysis of natural childbirth and elective C-section for normal risk pregnant women. METHODS The study was conducted from the perspective of supplemental health, a health subsystem that finances private obstetric care, represented in Brazil by health plan operators. The reference populations were normal risk pregnant women, who could undergo natural childbirth or elective C-section, subdivided into primiparous and multiparous women with previous uterine scar. A decision analysis model was constructed including choice of delivery types and health consequences for mother and newborn, from admission for delivery to maternity hospital discharge. Effectiveness measures were identified from the scientific literature, and cost data obtained by consultation with health professionals, health plan operators' pricing tables, and pricing reference publications of health resources. RESULTS Natural childbirth was dominant compared with elective C-section for primiparous normal risk pregnant women, presenting lower cost (R$5,210.96 versus R$5,753.54) and better or equal effectiveness for all evaluated outcomes. For multiparous women with previous uterine scar, C-section presented lower cost (R$5,364.07) than natural childbirth (R$5,632.24), and better or equal effectiveness; therefore, C-section is more efficient for this population. CONCLUSIONS It is necessary to control and audit C-sections without clinical indication, especially with regard to primiparous women, contributing to the management of perinatal care.

RESUMO OBJETIVO Realizar uma análise de custo-efetividade do parto vaginal e da cesariana eletiva para gestantes de risco habitual. MÉTODOS A perspectiva adotada foi a da saúde suplementar, subsistema de saúde financiador da assistência obstétrica privada, representado no Brasil por operadoras de planos de saúde. As populações de referência foram as gestantes de risco habitual, que poderiam ser submetidas ao parto vaginal ou à cesariana eletiva, subdivididas em primíparas e multíparas com uma cicatriz uterina prévia. Foi construído um modelo de decisão analítico que incluiu a escolha pelos tipos de parto, consequências em saúde para mãe e recém-nascido da internação para o parto à alta da maternidade. As medidas de efetividade foram identificadas a partir da literatura científica. Os dados de custos foram obtidos pela consulta aos profissionais de saúde, tabelas das operadoras dos planos de saúde e publicações de referências de preços de recursos de saúde. RESULTADOS O parto vaginal foi dominante em comparação com a cesariana eletiva para gestantes de risco habitual primíparas e apresentou menor custo (R$5.210,96 versus R$5.753,54) e melhor ou igual efetividade para todos os desfechos avaliados. Para multíparas com uma cicatriz uterina prévia, a cesariana mostrou-se com custo inferior (R$5.364,07) ao do parto vaginal (R$5.632,24) e melhor ou igual efetividade, portanto mais eficiente para essa população. CONCLUSÕES É necessário o controle e a auditoria das cesarianas sem indicação clínica, destacadamente em primíparas, contribuindo para a gestão da atenção perinatal.

Procesos de expansión y límites a la privatización de la atención de la salud en América Latina: más allá de las tipologías / Processes of expansion and limits to privatization of healthcare in Latin America: beyond typologies / Processos de expansão e limites a privatização da atenção à saúde na América Latina: além das tipologias

Resumen: El objetivo fue realizar una revisión bibliográfica sobre los sistemas de salud y estudios comparados en políticas y sistemas de salud para identificar los principales aportes de los mismos en el análisis de la privatización, especialmente, el papel de las organizaciones que comercializan planes y seguros de salud en los sistemas nacionales de salud en países de América Latina. La revisión se centró en analizar la adecuación de perspectivas o propuestas teórico-metodológicas y de sus indicadores para dimensionar la participación del sector privado, y su interacción con los sistemas nacionales de salud. De este modo, buscamos problematizar la adecuación, los límites y las potencialidades de los mismos, en el estudio de los procesos de privatización en los sistemas de salud de países de América Latina. El análisis comparado de algunos elementos específicos, como el análisis de gastos, la capacidad instalada, la población cubierta con planes y seguros privados en los sistema de salud, nos permitió identificar matices, contradicciones existentes en los sistemas, respecto a la relación público-privada, así como cuestionarnos el uso de clasificaciones tradicionales con las que se definieron diversos sistemas de salud en nuestra región. Nuestro desafío fue romper con algunas explicaciones lineales o ausentes de contradicciones sobre los análisis de los sistemas de salud. Desde esa perspectiva, es necesario cuestionar categorías o tipologías que se han desarrollado y utilizado de manera recurrente, con el fin de que se discutan y repiensen para poder avanzar en una comprensión más rigurosa de nuestras realidades, así como estimular nuevos debates y explicaciones.

Abstract: The aim was to conduct a literature review on health systems and comparative studies of health policies and systems to identify the leading contributions to the analysis of privatization, especially the role of health maintenance organizations and health insurance companies in national health systems in Latin America. The review focused on analyzing the adequacy of theoretical and methodological perspectives or proposals and their indicators to measure the private health sector's participation and interaction with national health systems. We thus seek to problematize the adequacy, limits, and potentialities of such perspectives for investigating the privatization processes in Latin American health systems. The comparative analysis of some specific elements such as health expenditures, installed capacity, and population covered by health plans and health insurance allowed us to identify contradictions in the systems regarding public-private relations, as well as to question the use of traditional classifications for defining various health systems in the region. Our challenge was to break with linear, non-contradictory explanations for analyzing health systems. This perspective requires questioning categories and typologies that have been developed and used repeatedly in order to discuss and rethink to move forward with a more rigorous understanding of our realities, as well as to encourage new debates and explanations.

Resumo: O estudo teve como objetivo fazer uma revisão bibliográfica sobre os sistemas de saúde e estudos comparados em políticas e sistemas de saúde para identificar os principais aportes dos mesmos na análise da privatização, especialmente, no papel das organizações que comercializam planos e seguros de saúde nos sistemas nacionais de saúde em países da América Latina. A revisão foi focada em analisar a adequação das perspectivas ou propostas teórico-metodológicas de seus indicadores para dimensionar a participação do sector privado da saúde, e sua interação com os sistemas nacionais de saúde. Deste modo, procuramos problematizar a adequação, os limites e as potencialidades dos mesmos, estudando os processos de privatização nos sistemas de saúde de países da América Latina. As análises comparadas de alguns elementos específicos, como as análises de custos em saúde, a capacidade instalada, a população coberta com planos e seguros de saúde, nos permitiu identificar as vinculações e contradições existentes nos sistemas, ao respeito das relações com o sistema público-privado, além de questionarmos o uso das classificações tradicionais com as quais foram definidos os diferentes sistemas de saúde em nossa região. Nosso desafio foi romper com algumas explicações lineares o carentes de contradições sobre as análises dos sistemas de saúde. Desde essa perspectiva, é necessário questionar as categorias ou tipologias que foram desenvolvidas e usadas de forma recorrente, com o fim de discuti-las e repensa-las a fim de avançar numa compreensão mais rigorosa das nossas realidades, assim como estimular novos debates e explicações sobre esta questão.

EPIDEMIOLOGÍA DE LA URTICARIA AGUDA EN UN SISTEMA DE SALUD PREPAGO DE LA CIUDAD DE BUENOS AIRES, ARGENTINA / Epidemiology of acute urticaria in a health maintenance organization of Buenos Aires, Argentina

Antecedentes. A pesar de la frecuencia de la urticaria aguda (UA), no existen estudios epidemiológicos sobre su prevalencia y distribución en Argentina. Objetivo. Determinar la prevalencia y otras características epidemiológicas de la UA en los miembros de una organización privada de salud de Buenos Aires, la mayor área poblada de Argentina. Marco de referencia: Hospital Italiano (HIBA) de la Ciudad de Buenos Aires, Argentina. Diseño: Cohorte retrospectivo. Población. Pacientes con diagnóstico de UA miembros del HIBA, y con al menos 12 meses de seguimiento. Métodos. Se analizaron todos los registros médicos para calcular las tasas de prevalencia de UA por 100.000 habitantes con intervalo de confianza del 95% (IC95%) para el período comprendido entre el 1 de enero de 2013 y el 31 de diciembre de 2014. La tasa de prevalencia se calculó para toda la población y luego se discrimino para pacientes adultos y pediátricos (menores de 18 años en el momento del diagnóstico). Resultados. Se analizaron 158.926 miembros de la prepaga. Se identificó un total de 2100 casos de UA en el período analizado (1151 en pediatría, 949 en adultos), con una tasa de prevalencia de 1,32% (IC95%: 1,11-1,55%). La prevalencia de UA en la población adulta fue de 0,83% (IC95%: 0,64-0,97%), mientras que en la población pediátrica fue del 2,5% (IC95%: 1,9-2,8%). Conclusiones: este es el primer estudio que describe la prevalencia de UA en una población cerrada de Argentina y de la región.(AU)

Background. In spite of the frequency of acute urticaria (AU), there are no epidemiological studies on its prevalence and distribution in Argentina. Objetive. Was to estimate the prevalence and other epidemiological characteristics of AU in the members of a health maintenance organization of Buenos Aires, the largest populated area in Argentina. Setting: Italian Hospital, Buenos Aires, Argentina. Design. Retrospective cohort. Population. All patients with diagnosis of AU who are members of the IHMCP, and with at least 12 months of follow up were included in the study. Methods. All medical records were analyzed to calculate the prevalence rates for AU per 100,000 population with 95% CI for the period of January 1, 2013 and December 31, 2014. Prevalence rate was calculated for the entire population and then discriminated for adults and pediatric members (less than 18 years old at diagnosis). Results. 158,926 members were analyzed. A total of 2100 cases of AU were identified on prevalence period (1151 in pediatrics, 949 in adults), yielding a prevalence rate of 1.32% (CI 95% 1.11-1.55%). The prevalence of AU in adult population observed was 0.83 % (95% CI 0.64-0.97%), while in pediatrics it was 2.5 % (95% CI 1.9-2.8%). Conclusions. This is the first study to describe the prevalence of AU in a closed population of Argentina and the region(AU)

Acute Coronary Syndrome Treatment Costs from the Perspective of the Supplementary Health System / Custos de Tratamento da Síndrome Coronariana Aguda sob a Perspectiva do Sistema de Saúde Suplementar

AbstractBackground:Acute coronary syndrome (ACS) is defined as a “group of clinical symptoms compatible with acute myocardial ischemia”, representing the leading cause of death worldwide, with a high clinical and financial impact. In this sense, the development of economic studies assessing the costs related to the treatment of ACS should be considered.Objective:To evaluate costs and length of hospital stay between groups of patients treated for ACS undergoing angioplasty with or without stent implantation (stent+ / stent-), coronary artery bypass surgery (CABG) and treated only clinically (Clinical) from the perspective of the Brazilian Supplementary Health System (SHS).Methods:A retrospective analysis of medical claims of beneficiaries of health plans was performed considering hospitalization costs and length of hospital stay for management of patients undergoing different types of treatment for ACS, between Jan/2010 and Jun/2012.Results:The average costs per patient were R$ 18,261.77, R$ 30,611.07, R$ 37,454.94 and R$ 40,883.37 in the following groups: Clinical, stent-, stent+ and CABG, respectively. The average costs per day of hospitalization were R$ 1,987.03, R$ 4,024.72, R$ 6,033.40 and R$ 2,663.82, respectively. The average results for length of stay were 9.19 days, 7.61 days, 6.19 days and 15.20 days in these same groups. The differences were significant between all groups except Clinical and stent- and between stent + and CABG groups for cost analysis.Conclusion:Hospitalization costs of SCA are high in the Brazilian SHS, being significantly higher when interventional procedures are required.

Fundamento:Síndrome coronariana aguda (SCA) é definida como um “grupo de sintomas clínicos compatíveis com isquemia miocárdica aguda”, representando a principal causa de óbito no mundo, com elevado impacto clínico e financeiro. Nesse sentido, o desenvolvimento de estudos econômicos que avaliem os custos despendidos no tratamento da SCA deve ser considerado.Objetivo:Avaliar custos e tempo de internação hospitalar entre grupos de pacientes que trataram SCA, submetidos a procedimentos de angioplastia com ou sem implante de stent (stent+ / stent-), revascularização (Revasc) e tratados apenas clinicamente (Clínico), sob a perspectiva do sistema de saúde suplementar (SSS) brasileiro.Métodos:Realizou-se uma análise retrospectiva de contas médicas de beneficiários de planos de saúde considerando dados de custos de internação e tempo de permanência hospitalar para o manejo de pacientes submetidos a diferentes tipos de tratamento para SCA, no período entre 1/2010 e 6/2012.Resultados:Os custos médios por paciente foram de R$ 18.261,77, R$ 30.611,07, R$ 37.454,94 e R$ 40.883,37 nos grupos Clínico, stent-, stent+ e Revasc, respectivamente. Os custos médios por dia de internação foram de R$ 1.987,03, R$ 4.024,72, R$ 6.033,40 e R$ 2.663,82, respectivamente. Os tempos médios de internação foram de 9,19 dias, 7,61 dias, 6,19 dias e 15,20 dias nesses mesmos grupos. As diferenças foram estatisticamente significativas entre todos os grupos, exceto Clínico e stent- e entre os grupos stent + e Revasc, para a análise de custos.Conclusão:O custo hospitalar da SCA é elevado no SSS brasileiro e significativamente mais alto quando há a necessidade da realização de procedimentos intervencionistas.

SiCKO – SOS Saúde e a mercantilização da vida / SiCKO and the commodification of life / SiCKO y la mercantilización de la vida

SiCKO é um documentário de Michael Moore que critica o sistema de saúde dos Estados Unidos da América e apresenta como negociatas políticas e lobbying de seguradoras de saúde e empresas farmacêuticas mantêm um sistema que trata saúde como mercadoria, martirizando vidas em nome do lucro. O exemplo de outros países que adotaram a medicina socializada serve para mostrar uma proposta alternativa de saúde, entendida como um direito de todos, financiado solidariamente pela sociedade e garantido através de políticas públicas e práticas eficazes...

SiCKO is a Michael Moore’s documentary that criticizes the United States health system and shows howpolitical bargaining and lobbying from health insurers and pharmaceutical companies created a system thattreats health as a commodity, martyring lives to earns profits. The comparison with other countries thathave adopted socialized medicine, highlights an alternative health care proposal, that understands it as acitizen’s right, jointly funded by society and guaranteed by effective public policies and practices...

Sicko es un documental de Michael Moore que critica el sistema de salud de los Estados Unidos, que noslleva a comprender cómo la negociación política y cabildeo de las aseguradoras de salud y compañíasfarmacéutica han creado un sistema que trata a la salud como una mercancía, torturando vidas para obtenerganancias. El ejemplo de otros países que han adoptado la medicina socializada demostra una propuestaalternativa de atención de salud, entendida como un derecho de todos, financiado conjuntamente por laempresa y garantizado por las políticas y prácticas públicas eficaces...

Ten-years of bariatric surgery in Brazil: in-hospital mortality rates for patients assisted by universal health system or a health maintenance organization / Dez anos de cirurgia bariátrica no Brasil: mortalidade intra-hopitalar em pacientes atendidos pelo sistema único de saúde ou por operadora da saúde suplementar

BACKGROUND: Bariatric surgery is an option for sustained weight loss for the morbidly obese patient. In Brazil coexists the Unified Health System (SUS) with universal coverage and from which depend 150 million Brazilians and supplemental health security, predominantly private, with 50 million beneficiaries. AIM: To compare access, in-hospital mortality, length of stay and costs for patients undergoing bariatric surgery, assisted in one or another system. METHODS: Data from DATASUS and IBGE were used for SUS patients' and database from one health plan of southeastern Brazil for the health insurance patients. RESULTS: Between 2001 and 2010 there were 24,342 and 4,356 surgeries performed in SUS and in the health insurance company, respectively. The coverage rates for surgeries performed in 2010 were 5.3 and 91/100.000 individuals in SUS and health insurance respectively. The rate of in-hospital mortality in SUS, considering the entire country, was 0.55 %, 0.44 % considering SUS Southeast, and 0.30 % for the health insurance. The costs of surgery in the SUS and in the health insurance trend to equalization over the years. CONCLUSION: Despite differences in access and characteristics that may compromise the outcome of bariatric surgery, patients treated at the Southeast SUS had similar rate of in-hospital mortality compared to the health insurance patients. .

RACIONAL: A cirurgia bariátrica é uma opção de perda de peso sustentada para o indivíduo obeso mórbido. No Brasil coexistem o Sistema Único de Saúde, de cobertura universal do qual dependem 150 milhões de brasileiros e a saúde suplementar, de caráter predominantemente privado, com 50 milhões de beneficiários. OBJETIVO: Comparar acesso, mortalidade intra-hospitalar, tempo de permanência e custos para pacientes submetidos à cirurgia bariátrica, assistidos por um ou outro sistema. MÉTODOS: Foi utilizado o sistema TabNet do DATASUS e IBGE para pacientes SUS e banco de dados de uma operadora da região sudeste do Brasil para a saúde suplementar. RESULTADOS: Entre 2001 e 2010 foram 24.342 e 4.356 operações pelo SUS e operadora, respectivamente. Taxas operatórias realizadas em 2010 foram de 5,3 e 91/100.000 indivíduos no SUS e na operadora na saúde suplementar respectivamente. A taxa de mortalidade intra-hospitalar no SUS, considerando todo o Brasil, foi de 0,55%, na região sudeste 0,44%, e na operadora 0,30%. Os custos das operações no SUS e na saúde suplementar tendem à equiparação ao longo dos anos. CONCLUSÃO: Apesar da diferença no acesso e de características que podem comprometer o resultado da cirurgia bariátrica, os pacientes atendidos no SUS da região sudeste tiveram taxa de mortalidade intra-hospitalar semelhante aos da saúde suplementar. .