The landscape of biomedical research funding in Brazil: a current overview

ABSTRACT Objective: The objective of this narrative review is to discuss the current state of research funding in Brazil. Materials and Methods: This study is based on the most recent edition of the course Funding for Research and Innovation in the University of Sao Paulo School of Medicine which was a three-day course with 12 hours of instruction. The course brought together leading experts in the field to comprehensively discuss the current state of research funding in Brazil. Each speaker provided a presentation on a specific topic related to research funding. After the workshop, speakers assembled relevant topics in this manuscript. Results: collaborative research is critical for securing research funding. It optimizes proposal competitiveness, amplifies societal impact, and manages risks effectively. As such, fostering and supporting these collaborations is paramount for both researchers and funding agencies. To maintain the highest integrity in research, investigators involved in these collaborations must disclose any relationships that could potentially influence the outcomes or interpretation of their projects. Conclusions: In Brazil, the mainstay of research funding stems from public entities, with agencies such as CNPq, CAPES, and state bodies like FAPESP, FAPERJ, FAPEMIG and others at the forefront. Concurrently, industry funding offers viable pathways, especially through industry-sponsored studies, investigator-led projects, and collaborative initiatives. The Brazilian funding landscape is further enriched by innovative platforms, including crowdfunding and the contributions of institutions like the Serrapilheira Institute. Internationally, esteemed organizations such as the National Institutes of Health (NIH) and the Bill & Melinda Gates Foundation stand out as potential funders.

Satisfacción con el curso optativo Farmacoeconomía en la carrera de licenciatura en Enfermería

Introducción: El curso optativo de Farmacoeconomía, impartido en el de cuarto año de la carrera licenciatura en Enfermaría, como parte de su habilitación profesional, pone a consideración de los estudiantes, indicadores internacionales de evaluación farmacoeconómica. Objetivo: Determinar la satisfacción de los estudiantes de la carrera de licenciatura en Enfermería con el curso optativo de Farmacoeconomía. Método: Investigación descriptiva de corte transversal, con enfoque mixto, con todos los estudiantes de cuarto año de licenciatura en Enfermería. Las variables medidas fueron: sexo, edad, fuente de ingreso, situación escolar, asistencia a la asignatura, conocimiento previo y satisfacción. Los indicadores fueron divididos en 2: específicos y generales de la asignatura. La validación de los resultados se realizó mediante el análisis del factor de Bayes y el análisis de la diversidad logarítmica. Resultado: En la valoración general de la asignatura el 78,88 % (n= 71) de los estudiantes refirió estar muy satisfecho, el 20 % (n= 18) refirió estar bastante satisfecho y el 1,12 % (n= 1) refirió estar poco satisfecho. Conclusión: Farmacoeconomía como curso optativo del cuarto año de la carrera de licenciatura en enfermería de la Facultad de Enfermería - Tecnología de Santiago de Cuba es valorada por 7 de cada 10 estudiantes de muy satisfactoria.

Introduction: The optional Pharmacoeconomics course, taught in the fourth year of the Higher degree in Nursing, as part of its professional qualification, puts international indicators of pharmacoeconomic evolution for students' consideration. Objective: Determine the satisfaction of undergraduate Nursing students with the optional Pharmacoeconomics course. Method: Cross-sectional descriptive research, with a mixed approach, with all fourth-year nursing students. The variables measured were: sex, age, source of income, school situation, course attendance, prior knowledge and satisfaction. The indicators were divided into 2: specific and general of the subject. The validation of the results was carried out through Bayes factor analysis and logarithmic diversity analysis. Result: In the general assessment of the subject, 78.88% (n= 71) of the students reported being very satisfied, 20% (n= 18) reported being quite satisfied and 1.12% (n= 1) was not very satisfied. Conclusion: Pharmacoeconomics as an optional course in the fourth year of the nursing degree at the Faculty of Nursing-Technology of Santiago de Cuba is rated as very satisfactory by 7 out of 10 students.

Efecto de la deuda económica sobre el bienestar psicológico de los residentes de cirugía: Resultados de un estudio nacional en Colombia / Effect of financial debt on the psychological well-being of surgery residents: Results of a national study in Colombia

Introducción. La deuda económica durante la residencia en cirugía general puede afectar el desempeño profesional, las decisiones de vida y el bienestar psicológico. La información disponible en Colombia es limitada. El objetivo de este estudio fue cuantificar la deuda económica del residente de cirugía general, identificar los factores asociados y evaluar su efecto en el bienestar psicológico. Métodos. Estudio de corte transversal analítico. Se invitó a 380 residentes a diligenciar una encuesta sobre los aspectos relacionados con su deuda económica y se utilizó el WHO-index para evaluar su bienestar psicológico. Resultados. Un total de 259 residentes participaron en el estudio (67,6 %). El 56 % posee una deuda económica promedio de COP $88.000.000 ((US$21.826)). Un alto nivel de endeudamiento se relacionó con el año de residencia, el tipo de institución (privada) y la solicitud de préstamos. Se identificó algún trastorno mental en 14,7 % y un bajo nivel de bienestar psicológico en 56,4 % de los participantes. No se identificó ninguna asociación entre una elevada deuda económica y el bajo bienestar psicológico. Conclusiones. La deuda económica tiene un efecto sobre los residentes. El endeudamiento de los residentes de cirugía en Colombia es altamente prevalente, y no se correlaciona con un pobre bienestar psicológico. La autodeterminación favorece el bienestar psicológico en el posgrado en cirugía general. Existe la necesidad de educación financiera en los residentes. Se requieren nuevos estudios que evalúen las causas del pobre bienestar psicológico.

Introduction. Financial debt during surgery residency can affect professional performance, life decisions, and psychological well-being. The information available in Colombia is limited. The objective of this study is to quantify the financial debt of the general surgery resident, identify the associated factors and evaluate their effect on psychological well-being. Methods. A cross-sectional study was carried out. A total of 380 residents were invited to complete a survey on aspects related to their financial debt, and the WHO-index to evaluate their psychological well-being. Results. A total of 259 residents participated in the study (67.6%). 56% have an average economic debt of $88,000,000 COP (US$21,826). High debt was related to level of residence, type of institution (private), and loan application. Some mental disorder was identified in 14.7% and a low level of psychological well-being in 56.4% of the participants. No association was identified between high financial debt and low psychological well-being. Conclusions. Economic debt has an effect on residents. Financial debt among surgical residents in Colombia is highly prevalent; however, it does not correlate with poor psychological well-being. Self-determination favors psychological well-being in the postgraduate course in general surgery. Likewise, the need for financial education in residents is imminent. New studies are required that thoroughly evaluate the causes of poor well-being.

Ejecución presupuestal y disponibilidad de suministros médicos en establecimientos del nivel III de Lima Metropolitana / Budget execution of SIS financial transfers and availability of medical supplies in MINSA level III establishments in Lima

ABSTRACT Objective: Determine the relationship between the budget execution of financial transfers from the SIS (Seguro Integral de Salud) and the availability of medical supplies in third-level establishments of the Ministry of Health of Metropolitan Lima. Material and method: Analytical and cross-sectional study, carried out in the 20 level III establishments of the MINSA in Lima; Likewise, documentary information was used such as Closing Minutes of Financial Supervision of the Macroregional Management of the SIS from which information on budget execution was obtained and the availability of medical supplies was obtained from the Mundo IPRESS web portal (Institutions Providing Health Services). After evaluating normality with the Shapiro-Wilk test, the Spearman correlation test was used. Result: Overall budget execution was not related to the availability of medical supplies (rho=-0.014; p=0.955). The evaluation by components showed that budget execution on medicines was positively related to the availability of supplies (rho=0.417; p=0.045), which was also valid in the segmented analysis only for hospitals (rho: 0.594; p=0.032). Although budget execution in segmented materials and supplies for hospitals was related to the availability of supplies, this relationship was inverse (rho=-0.552; p=0.043). Conclusions: The general budget execution of financial transfers from the SIS was not related to the availability of medical supplies, but the spending component on medicines was.

ABSTRACT Objective: Determine the relationship between the budget execution of financial transfers from the SIS (Seguro Integral de Salud) and the availability of medical supplies in third-level establishments of the Ministry of Health of Metropolitan Lima. Material and method: Analytical and cross-sectional study, carried out in the 20 level III establishments of the MINSA in Lima; Likewise, documentary information was used such as Closing Minutes of Financial Supervision of the Macroregional Management of the SIS from which information on budget execution was obtained and the availability of medical supplies was obtained from the Mundo IPRESS web portal (Institutions Providing Health Services). After evaluating normality with the Shapiro-Wilk test, the Spearman correlation test was used. Result: Overall budget execution was not related to the availability of medical supplies (rho=-0.014; p=0.955). The evaluation by components showed that budget execution on medicines was positively related to the availability of supplies (rho=0.417; p=0.045), which was also valid in the segmented analysis only for hospitals (rho: 0.594; p=0.032). Although budget execution in segmented materials and supplies for hospitals was related to the availability of supplies, this relationship was inverse (rho=-0.552; p=0.043). Conclusions: The general budget execution of financial transfers from the SIS was not related to the availability of medical supplies, but the spending component on medicines was.

Hot spots in study of vascular stent effect and problems in medical quality management:health economics evaluation / 中国组织工程研究

BACKGROUND:Clinical use of vascular stents involves high medical costs,but it may also bring long-term benefits in reducing cardiovascular events and improving the quality of life in patients.Economics evaluation can help decision makers better understand the balance between the cost and benefit of treatment. OBJECTIVE:To analyze the related articles of health economics and discuss the hot spots in the study of the effect and problems of vascular stents in medical quality management. METHODS:The articles concerning health economics evaluation of vascular stents were retrieved from the core set of the Web of Science.The VOSviewer_1.6.19 software was used to make a visualization analysis of the annual publication volume,institutions,countries,keywords,etc.Finally,the research hot spots on the effects and problems of vascular stents were analyzed from the perspective of health economics and medical quality management. RESULTS AND CONCLUSION:(1)120 articles in English were finally included.In the past 10 years,the highest number of articles published in this field was in 2019,with 10 articles.The institution with the largest number of articles published was Harvard University in the United States with 20 articles,and the country with the largest number of articles published was the United States with 58 articles.(2)Keyword cluster analysis demonstrated that the cost-effectiveness analysis of bare metal stents and drug-eluting stents in coronary disease,the cost-effectiveness analysis of angioplasty stent intervention,and the effect of coronary stents in percutaneous coronary intervention are the research hot spots in the field of health economics evaluation of vascular stent research.(3)In the context of medical quality management,the paper further summarized the research hot spots on the therapeutic effect of vascular stents as follows:long-term effect of vascular stents,safety,drug release mechanism research,personalized therapy,restenosis problems,and stent insertion technology.(4)The results of highly cited literature analysis exhibited that drug-eluting stents release drugs to reduce the risk of vascular restenosis,and the restenosis rate is lower than that of bare metal stents,but the cost is usually higher.Biodegradable stents combine the advantages of bare metal stents and drug-eluting stents,that is,avoiding long-term stent existence and reducing the risk of restenosis,but their cost may be higher,and there may be some complications in the short term,and they are not widely used at present.(5)In addition to the direct stent cost,factors that need to be considered when comparing the cost-effectiveness of vascular stents include the risk and cost of stent re-intervention,the risk and cost of complications,the duration and cost of drug therapy,and the quality of life of patients.Therefore,while the initial cost of drug-eluting and biodegradable stents may be higher than bare metal stents,they may lead to better clinical outcomes in the long term,resulting in a more favorable cost effect.(6)Future research directions should focus on making personalized vascular stent treatment decisions,observing the long-term effect of stent treatment,the impact of the stent on patients'quality of life,formulating health policies,rational allocation of medical resources,and the establishment of long-term follow-up mechanisms.

A controlled trial of elastic fixation and absolute fixation for treatment of ankle fractures with lower tibiofibular instability / 中国组织工程研究

BACKGROUND:Although traditional screw fixation has been successful in treating ankle fractures,rigid fixation solutions tend to restrict ankle movement and delay fracture healing,whereas elastic fixation is more compatible with human mechanics and has unique advantages in patients with ankle fractures. OBJECTIVE:To compare the clinical effectiveness of elastic fixation and absolute fixation in repairing ankle fractures in the elderly with lower tibiofibular instability. METHODS:The clinical data of 108 elderly ankle fractures with lower tibiofibular instability in Hengshui People's Hospital from August 2019 to August 2021 were retrospectively collected.They were divided into screw group and elastic fixation group(n=54 per group)according to the surgical protocol,and traditional screw internal fixation and elastic internal fixation were performed respectively.The perioperative indicators,surgical results,economic benefits,and American orthopedic foot and ankle society scores were collected and compared between the two groups.Serum tumor necrosis factor-α,interleukin-8 levels,ankle cavity width,depth,and lower tibiofibular space were compared before and after surgery. RESULTS AND CONCLUSION:(1)The full weight-bearing time was shorter in the elastic fixation group than that in the screw group;the operating angle was greater in the elastic fixation group than that in the screw group,and the complication rate was lower in the elastic fixation group than that in the screw group(P<0.05).(2)Serum tumor necrosis factor-α and interleukin-8 levels in the elastic fixation group were lower than those in the screw group 3 days after surgery(P<0.05).(3)American orthopedic foot and ankle society scores in the two groups were higher than those before surgery at 6 and 12 months after surgery,and the depth and width of the inferior tibiofibular space and ankle cavity were lower than those before surgery(P<0.05);but no significant difference was detected between the two groups(P>0.05).(4)There was no significant difference in the excellent and good rate between the two groups at 12 months after surgery(P>0.05).(5)There was no significant difference in the comparison of direct non-medical costs,direct medical costs,and total costs between the two groups(P>0.05).(6)It is indicated that elastic fixation for the repair of ankle fractures with lower tibiofibular instability in the elderly can obtain effective outcomes,which can shorten the time of complete weight-bearing,diminish complications,and alleviate inflammatory stress.

Analysis of EQ-5D Application in Health Economics Research in the Field of Traditional Chinese Medicine / 中药新药与临床药理

Objective To investigate the current application of the EQ-5D in health economics research in the field of traditional Chinese medicine(TCM).Methods PubMed,Embase,CNKI,CBM and Wanfang databases were systematically searched.The clinical research literature in the field of TCM such as'Chinese medicine','tuina'and'acupuncture'containing EQ-5D analysis was included.The Excel spreadsheet was used for data extraction,and the extracted information including title,publication year,author,institution,country,conflicts of interest(declaration or involvement of enterprise),study type,participants,interventions,outcomes,research perspectives and measurement methods.The Quality of Health Economic Studies(QHES)was used to evaluate the methodological quality of the included literature.SPSS 18.0 software was used for descriptive analysis of the extracted data.Results A total of 52 articles were included,and the study design was mainly based on randomized controlled trials.The application of EQ-5D-5L was less than that of EQ-5D-3L.Most of the literature used utility value and quality-adjusted life years(QALYs)for cost-utility analysis(CUA).EQ-5D was widely used in the study of musculoskeletal diseases,and Chinese patent medicine and acupuncture were the most commonly used interventions.Chinese patent medicine was used in most systemic diseases,but it was mainly used in musculoskeletal system diseases,which was equivalent to the proportion of massage application.Acupuncture was the most widely used intervention in musculoskeletal diseases,followed by the application of pain diseases.According to the QHES evaluation criteria,the average score of the 37 articles with full text was 73.49.Among them,20 articles were of high quality,14 articles were of general quality,and 3 articles were of low quality.The quality of the research was generally acceptable,but there were problems such as unreasonable or unreported research time limit selection,research result interpretation,conflict of interest,research perspective,utility value and QALYs evaluation.No conflict of interest statement was made in all the studies involving enterprises.Conclusion The application of EQ-5D in the evaluation of health economics in TCM is less,and the quality of literature still needs to be improved.There is still much room for research and application of EQ-5D in this field.

Health Economic Evaluation of Neonatal Phenylketonuria(PKU)Screening in Dongguan/ / 中国卫生经济

Objective:To acquire the implementation effect of the neonatal Phenylketonuria(PKU)Screening Project in Dong-guan,and evaluate its economic effectiveness,so as to provide references for the prevention and control policies of genetic defects in newborns.Methods:Choosing PKU children born in Dongguan from January 2012 to December 2021(excluding BH4 deficien-cy)as the subjects,conduct the cost-benefit and cost-effectiveness analysis on the prevention and treatment of PKU.The relevant data was gained from questionnaire surveys,statistical data,medical service prices of non-profit medical institutions in Dongguan,and relevant literature materials.Results:In the past 10 years,1 245 243 newboms were screened for PKU in Dongguan,the average screening rate is 93.32％.Among them,29 were diagnosed with PKU,with a positive rate of 1:42939.During continuous follow-up,23 cases were diagnosed.Among the 23 follow-up cases,only 1 had intelligence at the critical value,while the rest were normal.The total cost of screening is 29.728 7 million,and the total benefit is 14.239 9 million.The cost-effectiveness ratio is 102.51:1,the cost-benefit ratio is 1:4.79.Conclusion:Neonatal phenylketonuria(PKU)screening in Dongguan has significant social and economic benefits.It's necessary to continue and improve the screening work,especially the policy which can benefit the PKU's full life.

The construction and its implication of the cancer life-cycle prevention and control system in Japan / 中国卫生政策研究

As the country with the largest number of new cancer cases and deaths,China faces a serious situation with a large cancer population base,low relative survival rate,and low adherence to cancer screening.Neighboring Japan,which has the longest life expectancy in the world,has a much higher relative survival rate than China,despite having a similarly high cancer rate,due to its well-established system of cancer prevention and control.Being an Asian country,the major prevalent cancers in China and Japan are similar in spectrum and can be referred to more.This article introduces the construction of Japan's cancer life-cycle prevention and control system of"cancer prevention","cancer care",and"coexistence with cancer"starting from the three major goals of Japan's cancer prevention and control program,and focuses on the improvement of cancer screening in Japan and the improvement of cancer survival in China.It also highlights the means and methods used to increase the cancer screening rate in Japan,with a view to providing suggestions for cancer prevention and control in China.

Burden of metabolic syndrome on primary healthcare costs among older adults: A cross-sectional study

ABSTRACT BACKGROUND: The impact of metabolic syndrome (MetS) on healthcare costs remains unclear in the literature. OBJECTIVES: To determine the impact of MetS on primary healthcare costs of adults, as well as to identify the impact of physical activity and other covariates on this phenomenon. DESIGN AND SETTING: This cross-sectional study was conducted in the city of Presidente Prudente, State of São Paulo/Brazil, in 2016. METHODS: The sample comprised 159 older adults (> 50 years) of both sexes (110 women) who were identified from their medical records in the Brazilian National Health Service. Healthcare costs (US$) were assessed through medical records and divided into medical consultations, medications, laboratory tests, and total costs. MetS was assessed using medical records. RESULTS: The Brazilian National Health Service spent more on consultations (US$ 22.75 versus US$ 19.39; + 17.3%) and medication (US$ 19.65 versus US$ 8.32; + 136.1%) among adults with MetS than among those without MetS, but the costs for laboratory tests were similar (P = 0.343). Total costs were 53.9% higher in adults with MetS than in those without the diagnosis of the disease (P = 0.001). Regarding total costs, there was an increase of US$ 38.97 when five components of MetS were present (P = 0.015), representing an increase of approximately 700%, even after adjusting for sex, age, and physical activity. CONCLUSION: In conclusion, the presence of the MetS is responsible for increasing primary care costs among older adults, especially in those related to medicines.

Determinantes de la gestión del riesgo en salud en el Régimen Subsidiado en Colombia: estudio cualitativo

Introducción: El Régimen Subsidiado (RS) del sistema de salud colombiano tiene problemáticas estructurales que no han sido solucionadas y son pocos los estudios que profundizan en la explicación de estas. Objetivo: Explorar la experiencia en la dirección estratégica y gestión operativa y financiera de este régimen, sus aspectos operativos y de gestión del riesgo en esta población, así como las diferencias percibidas frente al Régimen Contributivo. Metodología: Estudio cualitativo. Se utilizó el análisis del discurso desde la perspectiva sociohermenéutica como técnica analítica. Se entrevistaron diez participantes, entre directivos de aseguradoras del RS y gestores del sistema de salud. Las entrevistas fueron grabadas y anonimizadas, previo consentimiento informado. Resultados: Emergen tres patrones discursivos que explican la gestión del riesgo en el RS y su diferenciación con el contributivo. Estos patrones se conectan por medio del rol de los determinantes sociales de la salud como ordenador principal de los procesos de salud-enfermedad y de atención en este régimen. A su vez, estas condiciones de vida son las que determinan de manera importante el perfil epidemiológico, acceso, costo de la atención y en general la forma cómo se consumen los servicios de salud por la población afiliada. Discusión: La literatura del aseguramiento en salud reporta que la gestión del riesgo es una función central y supone un ejercicio estratégico para el adecuado manejo de la siniestralidad para optimizar el uso de la Unidad de Pago por Capitación (UPC) asignada. Los hallazgos muestran que los determinantes sociales de la salud no están siendo tenidos en cuenta como ordenador para la atención, por lo tanto, la gestión del riesgo se centra en la atención de patologías en estados avanzados. Conclusiones: los actores perciben que en general, la situación de salud de los afiliados en este régimen es más grave, más complicada y con mayor carga, lo cual genera una tensión en materia de suficiencia de la unidad per cápita. Existe una ausencia discursiva sobre el rol del modelo de atención y su correlación con las necesidades de esta población.

Introduction: The subsidized regime (SR) of the Colombian health system has structural problems that have not yet been resolved and there is a lack of studies that allow the understanding of most of them. The aim of this study was to explore with stakeholders of the subsidized regime the experience about strategic, financial, and health risk management and the differences perceived with the contributory regime. Methods: A qualitative study was performed; the analytic technique used was the discourse analysis under socio-hermeneutic perspective. 10 participants were interviewed, among them directors of insurance companies of SR and health care system managers. The interviews were recorded, prior informed consent, and analyzed according to the discourse analysis. Finding: Three discursive patterns emerged that explain risk management in SR and its differentiation from contributory regime. These patterns are connected through the role of the social determinants of health as the main axis that explain the health-disease and care processes in this regimen. At the same time, these living conditions are what determine the epidemiological profile, access, cost of care and, in general, the way in which health services are consumed by the affiliated population. Discussion: The health insurance literature reports that risk management is a central function, and it is a strategic exercise for the proper management of claims to optimize the use of resources, however, the findings show that the social determinants of health are not being taken into account as a key element for healthcare organization, therefore, risk management focuses on care for pathologies in advanced stages. Conclusions: The actors perceive that the health situation in this regime is more severe, more complicated and with a greater burden disease, which generates a tension in terms of sufficiency of the Per Capita Unit. There is a discursive absence on the role of the care model and its correlation with the needs of this population.

Equidade em saúde para a população em situação de rua: uma revisão crítica / Health equity for homelessness: a critical review

RESUMO A noção de equidade em saúde se manifesta nas sociedades modernas por meio de diferentes ideias e propostas operacionais. No que diz respeito às pessoas em situação de rua, a equidade dialoga com a igualdade e a justiça para mobilizar diversas aplicações na saúde: enquanto a concepção liberal de equidade em saúde busca favorecer as condições de saúde dessa população sem romper com o modo de produção vigente, a concepção crítica almeja ampliar as condições e as necessidades de saúde na luta por uma sociedade emancipada. Com o objetivo de caracterizar as concepções de equidade em saúde expressas na literatura científica sobre essa população, este estudo realizou uma revisão crítica dos artigos disponíveis em portais de busca on-line. 1.716 publicações foram identificadas na amostragem inicial e 35 artigos foram incluídos na revisão após aplicação de procedimentos metodológicos. Os artigos foram caracterizados com relação às ideias e aplicações da equidade em saúde para a população em situação de rua, discutindo-se a respeito de metodologia, justiça e igualdade, distinção entre as concepções, processo saúde-doença, políticas públicas e pandemia da Covid-19. Aponta-se para a dominância da concepção liberal na literatura sobre essa população e a necessidade de investigações a partir da concepção crítica.

ABSTRACT The notion of equity in health manifests itself in modern societies through different ideas and operational proposals. Concerning homeless persons, equity dialogues with equality and justice to mobilize several applications in health: while the liberal conception of equity in health seeks to favor the health conditions of this population without breaking with the current mode of production, the critical conception aims to expand health conditions and needs in the struggle for an emancipated society. With the aim of characterizing the conceptions of equity in health expressed in the scientific literature on this population, this study carried out a critical review of the articles available on online search portals databases. 1,716 publications were identified in the initial sample and 35 articles were included in the review after application of methodological procedures. The articles were characterized in relation to the ideas and applications of equity in health for the homeless population, discussing methodology, justice and equality, distinction between conceptions, health-disease process, public policies and the COVID-19 pandemic. It points to the dominance of the liberal conception in the literature on this population and the need for investigations from the critical conception.

Costo-efectividad de la calidad del control prenatal con respecto al bajo peso al nacer en el Cauca / Antenatal control quality cost-effectiveness regarding low birth weight in Cauca

Antecedentes: El departamento del Cauca en Colombia es multiétnico, multicultural y biodiverso, también con grandes diferencias en bajo peso al nacer (BPN), mortalidad perinatal y mortalidad neonatal tardía entre municipios. Objetivo: Determinar la relación de costo-efectividad del control prenatal (CPN) cuando ha tenido buena calidad frente al que ha tenido calidad deficiente con respecto al BPN en el departamento del Cauca entre 2018 y 2020. Método: Evaluación económica con diseño epidemiológico de una cohorte histórica desde la perspectiva de la institución pagadora. Se calculó la razón incremental de costo-efectividad (RICE), análisis de sensibilidad e impacto presupuestal. Resultados: La incidencia de BPN fue del 8,3% (348/4182). La calidad deficiente en el CPN incrementó el riesgo de BPN (OR: 3,38; IC95%: 1,05-8,2) y la buena calidad tuvo una mejor relación de costo-efectividad (RICE: USD 2727,75), con posición dominante frente a la calidad deficiente (6,14 veces el PIB per cápita de ahorro) y con un impacto presupuestal de USD 2.904.392. Conclusiones: La buena calidad del CPN en el departamento del Cauca durante 2018-2020 fue costo-efectiva y dominante por ser de menor costo y mayor efectividad.

Background: The department of Cauca in Colombia is multiethnic, multicultural, and biodiverse, also with large differences in low birth weight (LBW), perinatal mortality, and late neonatal mortality among municipalities. Objective: To determine the cost-effectiveness relationship of antenatal care (ANC) when it has had good quality compared to that which has had poor quality with respect to low birth weight in the department of Cauca between 2018 and 2019. Method: Economic evaluation with epidemiological cohort design historical from the perspective of the payer institution. Incremental cost-effectiveness ratio (RICE), sensitivity analysis, and budgetary impact were calculated. Results: The incidence of LBW was 8.3% (348/4182). Poor quality in ANC increased the risk of LBW (OR: 3.38; CI95%: 1.05-8.2), good quality had a better cost-effectiveness ratio (RICE: USD 2727.75), with dominant position against poor quality (6.14 times the GDP/capita savings) with a budgetary impact of USD 2,904,392. Conclusions: The good quality of the ANC in the department of Cauca during 2018-2020 was cost-effective and dominant because it is lower cost and more effective.

Use of hand-held ultrasound to perform E-FAST by general surgery residents in a trauma reference center: First experience in the Colombian Caribbean region / Uso de ecografía portátil para realizar E-FAST por residentes de cirugía general en un centro de referencia en trauma: primera experiencia en la región del Caribe colombiano

Introduction. Extended focused assessment with sonography for trauma (E-FAST) can be performed with minimal training and achieve ideal results. It allows easy transport and use in austere environments such as the Colombian Caribbean, where many centers do not have 24-hour radiology services. The objective of this study was to determine the performance of the use of E-FAST in the evaluation of trauma by second-year general surgery residents in the emergency department. Methods. Retrospective observational study that evaluated the diagnostic performance of E-FAST with Butterfly IQ, in patients with thoracoabdominal trauma, who attended a referral center in the Colombian Caribbean between November 2021 and July 2022. Sensitivity, specificity, and positive and negative predictive values were evaluated, compared with intraoperative findings or conventional imaging. Results. A total of 46 patients were included, with a mean age of 31.2 ± 13.8 years, 87.4% (n=39) were male. The main mechanism of trauma was penetrating (n=32; 69.5%). It was found that 80.4% (n=37) of the patients had a positive E-FAST result, and of these, 97% (n=35) had a positive intraoperative finding. Sensitivity, specificity, positive predictive value and negative predictive value were 92.1%, 75%, 94.6%, and 66.6%, respectively. The positive likelihood ratio was 3.68, while the negative likelihood ratio was 0.10. Conclusion. General surgery residents have the competence to perform accurate E-FAST scans. The hand-held ultrasound device is an effective diagnostic tool for trauma and acute care surgery patients.

Introducción. La evaluación enfocada extendida con ecografía en trauma (E-FAST, extended focused assessment with sonography for trauma) puede realizarse con entrenamiento mínimo y lograr resultados ideales. Su fácil transporte permite usarla en entornos austeros, como el Caribe colombiano, donde muchos centros no disponen de servicio radiológico las 24 horas. El objetivo de este estudio fue determinar el rendimiento del uso de E-FAST por residentes de cirugía general de segundo año en la evaluación del paciente con trauma en urgencias. Métodos. Estudio observacional retrospectivo que evaluó el rendimiento diagnóstico de E-FAST con Butterfly IQ, en pacientes con trauma toracoabdominal que acudieron a un centro de referencia del Caribe colombiano, entre noviembre de 2021 y julio de 2022. Se evaluaron sensibilidad, especificidad, valores predictivos positivo y negativo, comparando la descripción de la ecografía con los hallazgos intraoperatorios o imagenología convencional. Resultados. Se incluyeron un total de 46 pacientes, con una media de edad de 31,2 ± 13,8 años, siendo el 87,4 % (n=39) hombres. El principal mecanismo de trauma fue penetrante (n=32; 69,5 %). Se encontró que el 80,4 % (n=37) de los pacientes tuvo resultado E-FAST positivo, y que, de estos, el 97 % (n=35) tuvo un hallazgo positivo intraoperatorio. Se calculó una sensibilidad de 92,1 %, especificidad de 75 %, valor predictivo positivo de 94,6 % y negativo de 66,6 %; la razón de verosimilitud positiva fue de 3,68 y la negativa de 0,10. Conclusión. Los residentes de cirugía general están capacitados para realizar exploraciones E-FAST precisas. El ecógrafo portátil es una herramienta de diagnóstico eficaz para pacientes traumatizados.

Impacto econômico da implementação de políticas públicas para distúrbios de sono no Brasil: uma revisão integrativa / Economic impact of the implementation of public policies for sleep disorders in Brazil: an integrative review

Objetivo: Identificar estudos sobre políticas públicas, ações de saúde e análises econômicas relacionados aos distúrbios de sono no Brasil e discutir os seus resultados para o sistema de saúde, gestores de políticas públicas e a sociedade. Métodos: Revisão integrativa da literatura nas bases de dados Lilacs (via BVS), SciELO e PubMed (via Medline), incluindo estudos publicados nos idiomas português, inglês e espanhol, entre os anos de 1960-2023; foram excluídos estudos que não apresentaram a perspectiva brasileira ou aqueles cuja versão integral não estava disponível (seja gratuitamente ou na versão paga). Resultados: A busca retornou 536 resultados, dos quais apenas dois atendiam aos critérios de inclusão e mais cinco trabalhos foram incluídos manualmente, após consulta com especialistas de sono (todos abordaram apneia obstrutiva do sono, sendo: um relato sobre alteração na legislação de trânsito focada em prevenção de acidentes por sonolência excessiva; uma revisão de escopo sobre análises de custo-efetividade do tratamento da doença com uso de CPAP; dois relatos sobre linha de cuidado em um município e outros três em Secretarias Estaduais de Saúde). Conclusões: A revisão integrativa encontrou poucas evidências acerca do tema e aponta para a necessidade de futuros estudos que visem a suprir essa lacuna científica e de que seja necessário o desenvolvimento de futura linha de cuidado que amplie o acesso ao tratamento de doenças do sono no Sistema Único de Saúde.

Objective: To identify studies on public policies, health actions, and economic analyses related to sleep disorders in Brazil and discuss their results for public policy managers and society. Methods: Integrative literature review using Lilacs (via BVS), SciELO, and PubMed (via Medline) databases, including studies published in Portuguese, English, and Spanish languages, between years of 1960-2023; studies that did not present the Brazilian perspective or whose full version was not available were excluded (free or paid version). Results: The search returned 536 results, of which only two met the inclusion criteria, and five more studies were included manually after consulting sleep experts (all addressing obstructive sleep apnea, namely: a report on changes in traffic legislation focused on preventing accidents caused by excessive sleepiness; a scoping review on cost-effectiveness analysis of CPAP for sleep apnea treatment; two reports on care lines in one municipality and another three in State Secretariats). Conclusions: The integrative review found few evidences on the topic and points to the need for future studies aimed at filling this scientific gap and the development of a care line that expands access to sleep disorder treatment in Brazilian Public Health System.

Economía del comportamiento y empujoncitos, en la promoción y prevención de la Salud Pública. Revisión sistemática / Behavioral economics and nudges in the promotion and prevention of public health. Systematic review

OBJETIVO: Evaluar sistemáticamente literatura sobre uso y efectividad los empujoncitos basados en la Economía del Comportamiento (EC). MÉTODOS: Se realizaron búsquedas en PubMed, Web of Science, Lilacs y SciELO; estudios publicados en inglés, portugués y español entre 2017-2021 que examinaran aspectos de la EC; la calidad se evaluó con la Effective Public Health Practice Project. RESULTADOS: Se examinaron 81 estudios, cumpliendo los criterios 17. La mayoría se realizaron en Estados Unidos, publicados entre 2019-2021, con calidad fuerte (n = 12) y moderada (n = 5); con una diversidad de intervenciones practicadas y diferencias en los métodos de implementación. Demostrando la efectividad de las estrategias basadas en la EC en la salud de los sujetos de estudio. CONCLUSIONES: En materia de toma de decisiones, el comportamiento es un proceso complejo que requiere de análisis constante desde la EC, la que representa un enfoque pormetedor para apoyar intervenciones en materia de salud pública más efectivas.

OBJECTIVE: To systematically evaluate the literature on the use and effectiveness of nudges based on Behavioral Economics (BE). METHODS: PubMed, Web of Science, Lilacs, and SciELO were searched; studies published in English, Portuguese, and Spanish between 2017-2021 that examined aspects of BE; quality was assessed using the Effective Public Health Practice Project. RESULTS: 81 studies were examined, 17 meeting the criteria. Most were conducted in the United States and published between 2019-2021, with strong (n = 12) and moderate (n = 5) quality, with a diversity of interventions practiced and differences in implementation methods. The selected studies demonstrated the effectiveness of strategies based on BE in the study subjects' health. CONCLUSIONS: In decision-making, behavior is a complex process requiring constant analysis from the BE, and BE is a promising approach to support more effective public health interventions.

Evolución de la eficiencia y la productividad del sistema de salud público chileno entre 2010 y 2019 / Efficiency and productivity of the Chilean public health system between 2010 and 2019

INTRODUCCIÓN: Frente al fuerte incremento del gasto en salud, es necesario indagar si ha venido acompañado de aumentos proporcionales en la producción de atenciones de salud dirigidas a los beneficiarios del Fondo Nacional de Salud. MÉTODOS: En esta investigación observacional, descriptiva y longitudinal retrospectiva estimamos la eficiencia técnica del Sistema Nacional de Servicios de Salud a través del costo medio de producción y la productividad media del trabajo en el periodo de 2010 a 2019. RESULTADOS: Durante la década estudiada, la producción ha aumentado en torno al 6% anual; la dotación de trabajadores aumentó (mayormente en el estamento médico) 61%; el gasto en remuneraciones aumentó 106% real; el gasto en bienes y servicios de consumo ha aumentado 25% real; la eficiencia del gasto ha disminuido 21% y la productividad es el elemento menos dinámico del sistema con 0,6% de crecimiento medio anual. Tras sustraer el componente de exámenes diagnósticos, el escenario empeora. CONCLUSIONES: Los resultados muestran que el mayor gasto en salud no ha venido aparejado de aumentos proporcionales en producción, traduciéndose en una caída en la eficiencia del gasto sanitario y aumentos magros o caídas en productividad, según cómo se mida la producción. Esto hace que la estrategia de crecimiento del sector público dependa principalmente de aumentos en la dotación de trabajadores. Esta baja productividad constituye una limitante seria para mejorar el acceso de los beneficiarios del Fondo Nacional de Salud a las atenciones de salud y contribuye a incrementar las listas de espera. Especial atención debiera brindarse a los costos medios de producción y a la productividad media del trabajo en un escenario de menor dinamismo en el crecimiento del gasto público en salud y de reforma del sistema de salud.

INTRODUCTION: In view of the strong increase in health expenditure, it is necessary to investigate whether proportional increases in healthcare production for the beneficiaries of the National Health Fund have corresponded to this increase. METHODS: In this observational, descriptive, and retrospective longitudinal research, we estimate the technical efficiency of the National Health Services System through the average cost of production and average labor productivity in the period from 2010 to 2019. RESULTS: During the studied decade, production has increased by approximately 6% annually; the number of workers increased (mostly physicians) by 61%; spending on salaries increased by 106% in real terms; spending on consumer goods and services has increased by 25% in real terms; the efficiency of spending has decreased by 21%, and productivity is the least dynamic element of the system with an average annual growth rate of 0.6%. After subtracting the diagnostic tests component, this scenario worsens. CONCLUSIONS: The results show that higher health expenditure has not been matched by commensurate increases in output, translating into a fall in the efficiency of healthcare expenditure and meager increases or falls in productivity, depending on how the output is measured. This means that the public sector's growth strategy depends mainly on increases in the number of workers. This low productivity is a serious constraint to improving healthcare access for National Health Fund beneficiaries and contributes to increasing waiting lists. Special attention should be paid to average production costs and average labor productivity in a scenario of less dynamic growth in public health spending and health system reform.

La economía feminista. Camino hacia la construcción de un paradigma alternativo. Ideas para seguir debatiendo / The feminist economy. Path towards the construction of an alternative paradigm. Ideas for further discussion

El abordaje onto epistémico de este ensayo se desarrolla en tres grandes miradas: un desarrollo gnoseológico orientado a precisar diferentes posicionamientos de la economía feminista como un movimiento político, herramienta de lucha y resistencia para enfrentar un modelo económico misógino, patriarcal, excluyente y a espaldas de la vida. Seguidamente, se precisan aspectos relevantes de su historicidad, partiendo de las figuras más resaltantes de la economía neoclásica. El hombre dentro de esta perspectiva (Homus Economicus), es el motor de la producción de riqueza, el agente económico por excelencia. Modelo donde no aparecen las relaciones sociales, las mujeres, la vida… Solo producir y consumir. Finalmente, se destaca toda una serie de avances y desafíos. Dentro de estas nuevas perspectivas, se pone especial atención a las relaciones de cuidado y afecto que se producen en los hogares como trabajo no remunerado. El cuidado de la vida humana toma el escenario, exigiendo nuevas perspectivas de análisis y la ampliación de fronteras a fin de destacar su relevancia social y económica; a partir de la utilización de estrategias para la valoración de la producción doméstica incorporando nuevas propuestas sobre el manejo de las estadísticas con lentes de género. El presupuesto gubernamental, se debe presentar desagregado y analizado el efecto de políticas de gastos e ingresos de manera diferenciada y situada(AU)

The ontologic epistemic approach in this essay is developed in three main perspectives: a gnoseological development aimed at specifying different positions of feminist economics as a political movement, a tool of struggle and resistance to face a misogynistic, patriarchal, exclusionary economic model behind the back of life. Next, relevant aspects of its historicity are specified, starting from the most outstanding figures of neoclassical economics. Man within this perspective (Homus Economicus), is the engine of the production of wealth, the economic agent par excellence. Model where social relationships, women, life do, not appear... Just produce and consume. Finally, a whole series of advances and challenges are highlighted. Within these new perspectives, special attention is paid to the relationships of care and affection that occur in households as unpaid work. The care of human life takes the stage, demanding new perspectives of analysis and the expansion of borders in order to highlight its social and economic relevance; from the use of strategies for the valuation of domestic production, incorporating new proposals on the management of statistics with gender lenses. The government Budget, should be presented disaggregated, and the effect of expenditure and revenue policies should be analyzed in a differentiated and situated manner(AU)

Perioperative costs of local or regional anesthesia versus general anesthesia in the outpatient setting: a systematic review of recent literature

Abstract Background and objectives: In this systematic review, we carried out an assessment of perioperative costs of local or regional anesthesia versus general anesthesia in the ambulatory setting. Methods: A systematic literature search was conducted to find relevant data on costs and cost-effectiveness analyses of anesthesia regimens in outpatients, regardless of the medical procedure they underwent. The hypothesis was that local or regional anesthesia has a lower economic impact on hospital costs in the outpatient setting. The primary outcome was the average total cost of anesthesia calculated on perioperative costs (drugs, staff, resources used). Results: One-thousand-six-hundred-ninety-eight records were retrieved, and 28 articles including 27,581 patients were selected after reviewing the articles. Data on the average total costs of anesthesia and other secondary outcomes (anesthesia time, recovery time, time to home readiness, hospital stay time, complications) were retrieved. Taken together, these findings indicated that local or regional anesthesia is associated with lower average total hospital costs than general anesthesia when performed in the ambulatory setting. Reductions in operating room time and postanesthesia recovery time and a lower hospital stay time may account for this result. Conclusions: Despite the limitations of this systematic review, mainly the heterogeneity of the studies and the lack of cost-effectiveness analysis, the economic impact of the anesthesia regimes on healthcare costs appears to be relevant and should be further evaluated.