Randomized control trial of ultrasound-guided erector spinae block versus shoulder periarticular anesthetic infiltration for pain control after arthroscopic shoulder surgery: Study protocol clinical trial (SPIRIT compliant).

INTRODUCTION: Moderate to severe postoperative pain and associated opioid use may interfere with patients' well-being and course of recovery. Regional anesthetic techniques provide an opportunity for opioid sparing and improved patient outcomes. A new regional technique called the erector spinae plane (ESP) block has the potential to provide effective analgesia after shoulder arthroscopy with minimal risks and decreased opioid consumption. Our primary objective is to determine whether, in patients who undergo arthroscopic shoulder surgery, a preoperative ESP block reduces pain scores as compared to periarticular infiltration at the end of surgery. Additionally, we will also examine other factors such as opioid consumption, sensory block, adverse events, patient satisfaction, and persistent pain. METHODS: This is a 2-arm, single-center, parallel-design, double-blind randomized controlled trial of 60 patients undergoing arthroscopic shoulder surgery. Eligible patients will be recruited in the preoperative clinic. Using a computer-generated randomization, with a 1:1 allocation ratio, patients will be randomized to either the ESP or periarticular infiltration group. Patients will be followed in hospital in the postanesthesia care unit, at 24 hours, and at 1 month. The study with be analyzed as intention-to-treat. DISCUSSION: This study will inform an evidence-based choice in recommending ESP block for shoulder arthroscopy, as well as providing safety data. The merits of the study include its double dummy blinding to minimize observer bias, and its assessment of patient important outcomes, including pain scores, opioid consumption, and patient satisfaction. This study will also help provide an estimate of the incidence of side effects and complications of the ESP block. TRIAL REGISTRATION NUMBER: NCT03691922; Recruited Date of registration: October 2, 2018.

The world on a collision course and the need for a new economy.

The first part of the paper is an attempt to demonstrate that what we are going through at the present time is not just an economic-financial crisis, but a crisis of humanity. It seems that for the first time in human history several crises converge to simultaneously reach their maximum level of tension. The dominant economic model is to a great degree responsible for the world's collision course. Hence a number of myths that sustain the model are listed and analyzed. It is argued that a new economy, coherent with the problematiques of the twenty first century, needs urgently to be devised. The second part proposes the foundations for a new economy based on five fundamental postulates that allow the construction of transdisciplinary, holistic, and systemic visions to adequately understand the interdependence of all the elements that sustain life. It is stressed that it is no longer acceptable that Universities still teach economic theories of the nineteenth century in order to tackle twenty first century problems that have no precedence.

Do socio-economic factors, elderly population size and service development factors influence the development of specialist mental health programs for older people?

BACKGROUND: Despite the increase in the proportion of older people in the population, little is known about factors that facilitate the development of specialist mental health services for older people. METHODS: The relationship between the presence of specialist mental health programs for older people and elderly population size, proportion of older people in the population, gross national domestic product (GDP), and various parameters of health funding, mental health funding and mental health service provision was examined in an ecological study using data from the World Health Organization. RESULTS: The presence of specialist mental health programs for older people was significantly associated with higher GDP, higher expenditure on healthcare and mental healthcare, the presence of a national mental health policy and a national mental health program, the availability of mental health care in primary care and the community, and higher density of psychiatric beds, psychiatrists, psychiatric nurses, psychologists and social workers. CONCLUSION: The challenge will be to persuade policy-makers in low and medium income countries, where the increase in the elderly population is most rapid, to develop specialist mental health services for older people.

[Health care financing: is it enough and appropriate?]. / Es la financiación sanitaria suficiente y adecuada?

INTRODUCTION: The object of this short paper is to present the results of Spanish public health care expenditures projections until 2013 according to the expected impact of the main demographic and technological health cost drivers. MATERIAL AND METHODS: Future annual health expenditures are estimated using a simple method based on the decomposition of the past main growth factors in two scenarios. The main cost drivers considered were the following: demography, which includes the increasing number of people and the impact of population ageing; the increase in the price of health care inputs above the general price level; and the impact of changes in medical practice related with expanding medical technology. RESULTS AND DISCUSSION: In 2013, public health care expenditure may be around 5.7% and 6% of gross domestic product (GDP); that is, at least, between 0.24 and 0.53 additional GDP points will be spent on public health care. The main factor responsible for the future expenditure increase will continue to be the increase in the average health service intensity, followed by demographic factors. In the base-case scenario, public expenditure increase until 2013 will be compatible with a real 2.5% annual increase in consumption of non-health goods and services. In order to finance the future costs, the Spanish population will have to devote to public health expenditure less than 7% of income increase until 2013. CONCLUSION AND PERSPECTIVES: Despite being important, the expected Spanish GDP growth until 2013 may be enough to finance the increase in public health expenditure as a result of the impact of demographic changes. Expanding medical technology is expected to continue being the main driver of future costs.

Anuario estadístico de la República Argentina / Statistical yearbook of the República Argentina

El Instituto Nacional de Estadística y Censos (INDEC), dependiente de la Secretaría de Programación Económica del Ministerio de Economía y Obras y Servicios Públicos, reinicia con esta obra la publicación del Anuario Estadístico de la República Argentina. De esta manera se da respuesta a la creciente demanda de información actualizada tanto del sector público como del privado. El Anuario consta de un capítulo de información general y geográfica sobre el país y de ocho capítulos que agrupan estadísticas sobre distintos aspectos demográficos, sociales y económicos, incluido las cuentas nacionales, cuyo detalle se encuentra en el índice general. Los cuadros contienen datos anuales para el total del país y, según los temas, también desagregados por provincia. El contenido de este Anuario está asimismo disponible en soporte magnético

Anuario estadístico de la República Argentina / Statistical yearbook of the República Argentina

El Instituto Nacional de Estadística y Censos (INDEC), dependiente de la Secretaría de Programación Económica del Ministerio de Economía y Obras y Servicios Públicos, reinicia con esta obra la publicación del Anuario Estadístico de la República Argentina. De esta manera se da respuesta a la creciente demanda de información actualizada tanto del sector público como del privado. El Anuario consta de un capítulo de información general y geográfica sobre el país y de ocho capítulos que agrupan estadísticas sobre distintos aspectos demográficos, sociales y económicos, incluido las cuentas nacionales, cuyo detalle se encuentra en el índice general. Los cuadros contienen datos anuales para el total del país y, según los temas, también desagregados por provincia. El contenido de este Anuario está asimismo disponible en soporte magnético