Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 20
Filtrar
1.
Healthcare (Basel) ; 9(11)2021 Nov 05.
Artículo en Inglés | MEDLINE | ID: mdl-34828554

RESUMEN

The objective of the paper is to evaluate the quality of systemic change management (CHM) and readiness for change in five Central European countries. The secondary goal is to identify trends and upcoming changes in the field of digital innovations in healthcare. The results show that all compared countries (regardless of their historical context) deal with similar CHM challenges with a rather similar degree of success. A questionnaire distributed to hospitals clearly showed that there is still considerable room for improvement in terms of the use of specific CHM tools. A review focused on digital innovations based on the PRISMA statement showed that there are five main directions, namely, data collection and integration, telemedicine, artificial intelligence, electronic medical records, and M-Health. In the hospital environment, there are considerable reservations in applying change management principles, as well as the absence of a systemic approach. The main factors that must be monitored for a successful and sustainable CHM include a clearly defined and widely communicated vision, early engagement of all stakeholders, precisely set rules, adaptation to the local context and culture, provision of a technical base, and a step-by-step implementation with strong feedback.

2.
Artículo en Inglés | MEDLINE | ID: mdl-34639847

RESUMEN

Evidence suggests that changes in alcohol consumption during the first months of the COVID-19 pandemic were unevenly distributed over consumer groups. We investigated possible inter-country differences in how changes in alcohol consumption are contingent on initial consumption (before or at the start of the pandemic), and how changes in consumption translate into possible changes in the prevalence of heavy drinking. We used data from the European Survey on Alcohol use and COVID-19 (ESAC) conducted in Czechia, Denmark, Finland, Germany, Norway, Poland, Spain, and the UK (N = 31921). Past-year alcohol consumption and changes in consumption were measured by AUDIT-C. Drinking habits were compared according to percentiles of pre-pandemic consumption levels, below versus above the 90th percentile. Across countries, drinkers in the highest 10% for pre-pandemic consumption increased their drinking during the pandemic, whereas absolute changes among those initially drinking below this level were modest. The percentage of people reporting >28 alcohol units/week increased significantly in seven of eight countries. During the first months of the COVID-19 pandemic, alcohol consumption in the upper decile of the drinkers increased as did the prevalence of heavy drinkers, in contrast with a declining consumption in other groups in the sample.


Asunto(s)
Intoxicación Alcohólica , COVID-19 , Consumo de Bebidas Alcohólicas/epidemiología , Humanos , Pandemias , SARS-CoV-2
3.
Cent Eur J Public Health ; 29(2): 153-158, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-34245556

RESUMEN

OBJECTIVES: The paper analyses real-world data on cost of treatment in patients after stroke hospitalized in early rehabilitation units within comprehensive stroke centres in the Czech Republic. This is the first study of the kind in the Czech Republic, while such information is extremely rare worldwide. Stroke treatment witnessed a dramatic development in the last years, when the main progress was due to establishment of specialized (comprehensive) stroke units incorporating also early rehabilitation. There is a general agreement among clinicians that early rehabilitation is beneficial for patients after stroke. METHODS: Costs of early rehabilitation after stroke were calculated by the micro-costing method alongside a pragmatic study in three Czech hospitals. Patients were transferred to specialized early rehabilitation units usually on 7th to 14th day after stroke onset and received four hours of interprofessional rehabilitation per day. RESULTS: The analysis of data collected during the prospective observational research of 87 patients proved significant differences between patients. The average costs of hospitalization were determined to be CZK 5,104 (EUR 194) per one day of intensive rehabilitation in seriously affected patients early after stroke. These costs differed significantly between hospitals (p-value < 0.001); the structure of direct costs was quite stable, though. About 60% of these costs were due to nursing and overhead, while no more than 15% were consumed by therapists. CONCLUSIONS: The treatment of patients after stroke in specialized stroke units proved to be beneficial for the patients increasing the number of those re-integrated in family and community life.


Asunto(s)
Hospitalización , Accidente Cerebrovascular , Costos y Análisis de Costo , República Checa , Humanos
4.
Addiction ; 116(12): 3369-3380, 2021 12.
Artículo en Inglés | MEDLINE | ID: mdl-34109685

RESUMEN

AIMS: To investigate changes in alcohol consumption during the first months of the COVID-19 pandemic in Europe as well as its associations with income and experiences of distress related to the pandemic. DESIGN: Cross-sectional on-line survey conducted between 24 April and 22 July 2020. SETTING: Twenty-one European countries. PARTICIPANTS: A total of 31 964 adults reporting past-year drinking. MEASUREMENTS: Changes in alcohol consumption were measured by asking respondents about changes over the previous month in their drinking frequency, the quantity they consumed and incidence of heavy episodic drinking events. Individual indicators were combined into an aggregated consumption-change score and scaled to a possible range of -1 to +1. Using this score as the outcome, multi-level linear regressions tested changes in overall drinking, taking into account sampling weights and baseline alcohol consumption [Alcohol Use Disorder Identification Test (AUDIT-C)] and country of residence serving as random intercept. Similar models were conducted for each single consumption-change indicator. FINDINGS: The aggregated consumption-change score indicated an average decrease in alcohol consumption of -0.14 [95% confidence interval (CI) = -0.18, -0.10]. Statistically significant decreases in consumption were found in all countries, except Ireland (-0.08, 95% CI = -0.17, 0.01) and the United Kingdom (+0.10, 95% CI = 0.03, 0.17). Decreases in drinking were mainly driven by a reduced frequency of heavy episodic drinking events (-0.17, 95% CI = -0.20, -0.14). Declines in consumption were less marked among those with low- or average incomes and those experiencing distress. CONCLUSIONS: On average, alcohol consumption appears to have declined during the first months of the COVID-19 pandemic in Europe. Both reduced availability of alcohol and increased distress may have affected consumption, although the former seems to have had a greater impact in terms of immediate effects.


Asunto(s)
COVID-19 , Pandemias , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Estudios Transversales , Europa (Continente)/epidemiología , Humanos , SARS-CoV-2
5.
BMJ Open ; 11(5): e043037, 2021 05 19.
Artículo en Inglés | MEDLINE | ID: mdl-34011582

RESUMEN

OBJECTIVES: To fill the existing research gap related to long-term costs of postacute care in methanol poisoning survivors, healthcare cost for 6 years after the outbreak has been modelled and estimated. DESIGN: In a prospective longitudinal cohort study, data collected from 55 survivors of the Czech methanol mass poisoning outbreak in 2012 were collected in four rounds (5 months, then 2, 4 and 6 years after the discharge) in the General University Hospital in Prague according to the same predefined study protocol. The collected data were used to inform the cost model. SETTING AND PARTICIPANTS: All 83 patients discharged from a hospital poisoning treatment after the 2012 methanol outbreak were informed about the study and invited to participate. Fifty-five patients (66%) gave their written informed consent and were followed until their death or the last follow-up 6 years later. The costs were modelled from the Czech healthcare service (general health insurance) perspective. MAIN OUTCOME MEASURES: Long-term national budget impact of the methanol poisoning outbreak, frequencies of sequelae and their average costs. RESULTS: The postacute cost analysis concentrated on visual and neurological sequelae that were shown to be dominant. Collected data were used to create process maps portraying gradual changes in long-term sequelae over time. Individual process maps were created for the central nervous system, peripheral nervous system, sequelae detected during eye examinations and sequelae concerning the visual evoked potentials. Based on the process maps the costs of the postacute outpatient care were estimated. CONCLUSIONS: In 2013-2019 the highest costs per patient related to postacute care were found in the first year; the average costs decreased afterwards, and remained almost constant for the rest of the studied period of time. These costs per patient ranged from CZK4142 in 2013 to CZK1845 in 2018, when they raised to CZK2519 in 2019 again.


Asunto(s)
Metanol , Envenenamiento , Brotes de Enfermedades , Potenciales Evocados Visuales , Costos de la Atención en Salud , Humanos , Estudios Longitudinales , Envenenamiento/epidemiología , Estudios Prospectivos , Atención Subaguda , Sobrevivientes
6.
Int J Methods Psychiatr Res ; 30(3): e1875, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-33951258

RESUMEN

OBJECTIVES: This contribution provides insights into the methodology of a pan-European population-based online survey, performed without external funding during the COVID-19 pandemic. We present the impact of different dissemination strategies to collect data from a non-probabilistic convenience sample and outline post-stratification weighting schemes, to provide guidance for future multi-country survey studies. METHODS: Description and comparison of dissemination strategies for five exemplary countries (Czechia, Germany, Lithuania, Norway, Spain) participating in the Alcohol Use and COVID-19 Survey. Comparison of the sample distribution with the country's actual population distribution according to sociodemographics, and development of weighting schemes. RESULTS: The dissemination of online surveys through national newspapers, paid social media adverts and dissemination with the support of national health ministries turned out to be the most effective strategies. Monitoring the responses and adapting dissemination strategies to reach under-represented groups, and the application of sample weights were helpful to achieve an analytic sample matching the respective general population profiles. CONCLUSION: Reaching a large pan-European convenience sample, including most European countries, in a short time was feasible, with the support of a broad scientific network.


Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , COVID-19/epidemiología , Adolescente , Adulto , República Checa/epidemiología , Femenino , Alemania/epidemiología , Humanos , Lituania/epidemiología , Masculino , Persona de Mediana Edad , Noruega/epidemiología , España/epidemiología , Encuestas y Cuestionarios , Adulto Joven
7.
Subst Abuse Treat Prev Policy ; 16(1): 36, 2021 04 26.
Artículo en Inglés | MEDLINE | ID: mdl-33902668

RESUMEN

BACKGROUND: SARS-CoV-2 reached Europe in early 2020 and disrupted the private and public life of its citizens, with potential implications for substance use. The objective of this study was to describe possible changes in substance use in the first months of the SARS-CoV-2 pandemic in Europe. METHODS: Data were obtained from a cross-sectional online survey of 36,538 adult substance users from 21 European countries conducted between April 24 and July 22 of 2020. Self-perceived changes in substance use were measured by asking respondents whether their use had decreased (slightly or substantially), increased (slightly or substantially), or not changed during the past month. The survey covered alcohol (frequency, quantity, and heavy episodic drinking occasions), tobacco, cannabis, and other illicit drug use. Sample weighted data were descriptively analysed and compared across substances. RESULTS: Across all countries, use of all substances remained unchanged for around half of the respondents, while the remainder reported either a decrease or increase in their substance use. For alcohol use, overall, a larger proportion of respondents indicated a decrease than those reporting an increase. In contrast, more respondents reported increases in their tobacco and cannabis use during the previous month compared to those reporting decreased use. No distinct direction of change was reported for other substance use. CONCLUSIONS: Our findings suggest changes in use of alcohol, tobacco and cannabis during the initial months of the pandemic in several European countries. This study offers initial insights into changes in substance use. Other data sources, such as sales statistics, should be used to corroborate these preliminary findings.


Asunto(s)
COVID-19/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Adolescente , Adulto , Alcoholismo/epidemiología , Estudios Transversales , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Abuso de Marihuana/epidemiología , Persona de Mediana Edad , Pandemias , SARS-CoV-2 , Factores Socioeconómicos , Adulto Joven
8.
Neurol Neurochir Pol ; 55(1): 91-96, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33314016

RESUMEN

AIM OF THE STUDY: To evaluate the effectiveness of virtual reality therapy (VRT) Armeo Spring® upper limb exoskeleton (Armeo), in early post-stroke rehabilitation with a focus on the elderly. CLINICAL RATIONALE FOR THE STUDY: Convalescence from a stroke is a complex process driven by a spontaneous recovery supported by multifactorial activation. Novel technology-based rehabilitation methods are being introduced to support brain plasticity. MATERIALS AND METHODS: Using a randomised controlled study design, participants within 30 days after stroke with arm paresis were, in addition to a daily rehabilitation programme, assigned to an intervention group (45 minutes Armeo IG n = 25; mean age 66.5 years) performing VRT, or to a conventional physiotherapy (45 minutes) control group (Armeo CG, n = 25, mean age 68.1 years). Montreal Cognitive Assessment (MoCA), Functional Independence Measure (FIM) and Fugl Mayer Assessment Upper Extremity Scale (FMA-UE) were performed before and after the three-week therapy with 12 therapeutic sessions. Results of participants < 65 and ≥ 65 years old were compared. RESULTS: Paretic upper arm function improved significantly in both the IG and CG groups, the improvement in FMA-UE was significantly higher in the IG compared to the CG (p = 0.02), and patients ≥ 65 years old presented an equal magnitude of improvement in paretic arm function compared to younger patients. CONCLUSIONS AND CLINICAL IMPLICATIONS: Early post-stroke rehabilitation strategies using, in addition to the daily rehabilitation programme, VRT with visual biofeedback is more effective on upper extremity motor performance than conventional physiotherapy, and the effectiveness does not diminish with patient age. This may be a promising addition to conventional physiotherapy in older stroke patients as well as in younger.


Asunto(s)
Dispositivo Exoesqueleto , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Realidad Virtual , Anciano , Humanos , Recuperación de la Función , Accidente Cerebrovascular/complicaciones , Resultado del Tratamiento , Extremidad Superior
9.
Int J Rehabil Res ; 43(4): 376-382, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32991353

RESUMEN

The purpose of this prospective study was to determine whether the cost and cost-effectiveness of early rehabilitation after stroke are associated with the degree of initial disability. The data for cost calculations were collected by the bottom-up (micro-costing) method alongside the standard inpatient care. The total sample included 87 patients who were transferred from acute care to early rehabilitation unit of three participating stroke centers at the median time poststroke of 11 days (range 4-69 days). The study was pragmatic so that all hospitals followed their standard therapeutic procedures. For each patient, the staff recorded each procedure and the associated time over the hospital stay. The cost and cost-effectiveness were compared between four disability categories. The average cost of the entire hospitalization was CZK 114 489 (EUR 4348) with the daily average of CZK 5103 (EUR 194). The cost was 2.4 times higher for the immobile category (CZK/EU: 167 530/6363) than the self-sufficient category (CZK/EUR: 68 825/2614), and the main driver of the increase was the cost of nursing. The motor status had a much greater influence than cognitive status. We conclude that the cost and cost-effectiveness of early rehabilitation after stroke are positively associated with the degree of the motor but not cognitive disability. To justify the cost of rehabilitation and monitor its effectiveness, it is recommended to systematically record the elements of care provided and perform functional assessments on admission and discharge.


Asunto(s)
Evaluación de la Discapacidad , Hospitalización/economía , Rehabilitación de Accidente Cerebrovascular/economía , Adulto , Anciano , Anciano de 80 o más Años , Análisis Costo-Beneficio , República Checa , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos
10.
Artículo en Inglés | MEDLINE | ID: mdl-32635320

RESUMEN

BACKGROUND AND AIMS: The current level of knowledge concerning the effect of socioeconomic status (SES) on internet use, gambling, and substance use in structurally disadvantaged regions is scarce. The objective of this study was an investigation of the relationship between SES and risky internet use, gambling and substance use in a structurally disadvantaged region in Central Europe. METHODS: A cross-sectional survey was conducted among high school students (n = 1063) in a Czech structurally disadvantaged region in autumn 2017. Binary Logistic Regression models were applied to data from the modified Excessive Internet Use scale (mEIUS), a standard tool for measuring the risk of addictive behavior on the internet and the risk of excessive gaming. Other data were collected using the Lie/Bet (problematic gambling), CAGE (acronym of the key words: cut, angry, guilty and eye-opener), and the Cannabis Abuse Screening Test (CAST) (problematic alcohol/cannabis use) tools. RESULTS: There were statistically significant differences between at-risk and not-at-risk groups in addictive behavior on the internet and gaming, while none were found in problematic gambling. Individual dimensions of SES showed significant effects on substance use. Regarding parenting styles, significant differences were found only in the risk of addictive behavior on the internet or gaming between the authoritarian and authoritative styles. Being engaged in behavioral addictions with one´s parents increased the odds of the behavioral addiction risk and decreased the odds of the substance addiction risk. Engagement with one´s parents in substance addictions decreased the odds of the behavioral addiction risk and increased the odds of the substance addiction risk. DISCUSSION AND CONCLUSIONS: The results point at specific relations between SES and the risk of addictive behaviors on the internet and gaming within structurally disadvantaged regions. The results of SES and/or structurally disadvantaged region measures obtained in research, policy-making, and care-provision may improve the focus of actions taken.


Asunto(s)
Conducta Adictiva/epidemiología , Juego de Azar/epidemiología , Internet , Trastornos Relacionados con Sustancias/epidemiología , Juegos de Video , Adolescente , Estudios Transversales , Europa (Continente) , Femenino , Humanos , Masculino , Clase Social , Poblaciones Vulnerables
11.
Cent Eur J Public Health ; 27 Suppl: S29-S39, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31901190

RESUMEN

OBJECTIVES: The study focuses on the 2012 methanol outbreak in the Czech Republic. The main goal of the present study was to apply analytical and descriptive tools to selected qualitative and quantitative processes related to the 2012 methanol outbreak in the Czech Republic. The secondary goal was to study and evaluate in detail their potential for creating integrated conceptual national policies aimed at eliminating the risk of methanol poisoning in the future. METHODS: The presented qualitative analysis focused on the content of documents published by Czech public authorities - the Ministry of Health, the Ministry of the Interior, the Czech Agriculture and Food Inspection Authority, and the Regional Public Health Authorities - as well as the content of the relevant legal regulations. Moreover, statistical data concerning the number of hospitalisations and deaths due to the methanol intoxication were used to provide a background to a detailed description of the relevant facts. RESULTS: In procedural terms, most of the analysed measures focused on a strongly restrictive regulation of sales, regular information channels designed to protect consumers on the national as well as international level, and elimination of further health and economic risks stemming from the dangerous alcoholic products that had already entered distribution networks. The health, social and economic consequences of such activities are quantified at a highly aggregated level. The analysed institutional ties are evaluated also in the context of international documents: the European Action Plan to Reduce Harmful Use of Alcohol 2012-2020 and the Global Strategy to Reduce Harmful Use of Alcohol, and their current potential for steering public policies is assessed. CONCLUSION: The analysis and evaluation of procedural activities carried out after the methanol outbreak have laid the foundations for a multidimensional study that can contribute to integrated national policy concepts aimed at preventing these and similar negative health, societal and economic consequences. Six years after the methanol outbreak, national and regional health policies have reflected no findings concerning the experience of patients whose health was impaired due to methanol, and the economic cost of the event has not been calculated. The quality of life of these patients has greatly decreased due to permanent or partial incapacity and serious upheavals of their and their families' economic and social conditions. This opens the question of researching and evaluating multiple aspects of health, social and economic impacts of harmful use of alcohol and setting up processes to mitigate these impacts.


Asunto(s)
Brotes de Enfermedades , Metanol/envenenamiento , Envenenamiento/epidemiología , Política Pública , República Checa/epidemiología , Humanos , Investigación Cualitativa
12.
Cent Eur J Public Health ; 27 Suppl: S66-S73, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31901194

RESUMEN

OBJECTIVES: The Czech Republic ranks among countries with the highest alcohol consumption per capita. Several older studies discuss Czech media portrayal of health effects of alcohol, but we found no recent analysis of media portrayal of harms caused by alcohol consumption. Our analysis aims to fill this gap in. METHODS: The dataset of texts (n = 903) consisting of articles from press, radio, television and the internet published within a 30-day interval in 2017 (Newton Media computerized database) was coded and analyzed using mixed quantitative and qualitative approach to content analysis. The frequency of references to acute and long-term alcohol harms of various types were counted, and the results were compared to the classification of (alcohol) harms by the Independent Scientific Committee of Drugs (ISCD). RESULTS: The short-term intoxication effects in the areas of crime and road safety, in particular reports on traffic accidents, are over-represented, while topics describing the impact of alcohol use on health, family and society, as well as economic costs or environmental issues seem to be marginal. That corresponds to the fact that police and courts were the information source in more than half of the articles, while information sourced from physicians, sociologists and drug field professionals was rather scarce. CONCLUSIONS: Media portrayal of the harms caused by alcohol use does not match up to real harm effects on the society. In terms of public health, it is imperative to strengthen media presentation of the impact of alcohol use on health and social issues.


Asunto(s)
Consumo de Bebidas Alcohólicas/efectos adversos , Medios de Comunicación de Masas/estadística & datos numéricos , Accidentes de Tránsito , Crimen , República Checa , Humanos
13.
Health Econ Rev ; 8(1): 27, 2018 Oct 22.
Artículo en Inglés | MEDLINE | ID: mdl-30349986

RESUMEN

BACKGROUND: Health technology assessment (HTA) is currently one of the major challenges in assessing medical innovations and healthcare systems. In Europe, the European Network for Health Technology Assessment (EUnetHTA) has been aspiring to develop and implement standards for international sharing of HTA results and studies. Slovakia and many other EU countries do not have an established HTA system yet. This paper is focused on an exact description of the EUnetHTA Core Model individual domains applied to the process of selecting patients in the terminal stage of prostate cancer for Radium-223 treatment under particular conditions of the Institute of Nuclear and Molecular Medicine (INMM) in Kosice, Slovakia. RESULTS: We produced the first pilot HTA report using the HTA Core Model in Slovakia. The main objective was to collect all relevant information on the particular technology, and provide its summary to the interested stakeholders on one spot. Rather than applying detailed individual items, i.e. assessment elements and assessment element cards, we concentrated on the content of individual domains and tried to fill them with the best country, facility and intervention related data. The dataset consisted of 52 patients that finished the treatment in the period 2015-2017. The patients were carefully selected according to the Radium-223 producer's criteria. Only 33 patients received the full therapy consisting of six applications; their average survival was 10.5 months from the application of the last dose. CONCLUSIONS: Based on the results of our analyzes, we recommended several changes to the INMM processes and patient follow-up checks during the treatment process in order to make the therapy more effective. The greatest benefit is expected after the implementation of a 68Ge/68Ga generator in 2018, as the selection of patients suitable for the Radium-223 treatment will improve. We showed that the HTA Core Model can be implemented in Slovakia, even under conditions of no formal HTA support or institutionalization.

14.
Cent Eur J Public Health ; 26(4): 289-297, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30660140

RESUMEN

OBJECTIVE: The objective of this research was to determine the prevalence of problematic and risky sexual behaviour after alcohol consumption and the correlation between this prevalence and sex, behavioural factors, problematic drinking, and alcohol consumption characteristics. METHODS: A survey of students was carried out at four faculties. Data were gathered via internet and self-administered paper-pencil questionnaires. The analysis employed Pearson's chi-squared test, gross odds ratios and logistic regression to calculate the adjusted odds ratios (OR) and their confidence interval (CI). RESULTS: Problematic drinking was detected by the CAGE test. Sixteen percent of students reached the CAGE score of 2, which indicates a potential threat of addiction, while 6% of students reached even higher problematic scores (3 or 4). Among those respondents who did drink alcohol, 23% had unprotected sex and 21% had sex which they later regretted. There were some differences between male and female respondents with men reporting more instances of risky behaviour. Among university students, problematic and risky sexual behaviour after alcohol use is associated with sex, the intensity of problematic drinking, first drunkenness, the place of alcohol use, and attitude to alcohol use. CONCLUSIONS: Problematic drinking and risky sexual behaviour after alcohol consumption exist among students and deserve special attention and response in the form of suitable measures. Problematic and risky sexual behaviour after alcohol consumption among university students is associated with behavioural factors and characteristics of alcohol use that allow a targeted approach to preventive efforts.


Asunto(s)
Consumo de Bebidas Alcohólicas/psicología , Asunción de Riesgos , Conducta Sexual/psicología , Estudiantes/psicología , Femenino , Humanos , Masculino , Estudiantes/estadística & datos numéricos , Encuestas y Cuestionarios , Universidades , Sexo Inseguro/estadística & datos numéricos
15.
Vnitr Lek ; 63(4): 242-248, 2017.
Artículo en Checo | MEDLINE | ID: mdl-28520447

RESUMEN

The paper summarizes the criticisms of the QALY concept utilization in health-economic evaluations that has been growing stronger in the last years. Despite of its limitations, the QALY concept has been routinely used in many countries incl. the Czech Republic. However, some states disapproved QALYs as an optimizing criterion at the level of their political decisions. The critical reflection concerns both the theoretical and the experimental issues. Based on a literary review, fundamental arguments against the concept are summarized, and a synthesis of material objections is presented. The critical arguments focus on the foundations of the QALY concept in the economic theory, some ethical principles, inconsistencies and technical imperfections of the quality-of-life measurement tools used in QALY calculations, the substitution rule, differences between various diagnoses, and disregarding some other important parameters. As a whole, the critics´ arguments can be judged as quite strong. The future will show whether the critical arguments summarized in this paper will lead to a development of alternative tools that have a potential of eliminating imperfections in QALYs, and consequently provide more complex data for the decision process.Key words: cost-effectiveness - health technology assessment - HTA - QALY - utility measure for medical interventions.


Asunto(s)
Análisis Costo-Beneficio , Años de Vida Ajustados por Calidad de Vida , República Checa , Política de Salud , Humanos , Modelos Económicos , Calidad de Vida
16.
Cas Lek Cesk ; 156(2): 88-92, 2017.
Artículo en Checo | MEDLINE | ID: mdl-28508660

RESUMEN

In the Czech environment, the WHOQOL-BREF (WHO Quality of Life-BREF) questionnaire has been rather frequently used for quality-of-life assessment in the case of different diseases or different health limitations. The questionnaire exists in two Czech translations with different wording. The differences are so considerable that they might cause interpretation shifts in research based on this instrument. Also the reverse scales in three questions may cause problems, because processing of these scores is not described correctly in some methodological materials. The authors recommend to strictly use the version published by Dragomirecká and Bartonová of the Prague Psychiatric Centre.


Asunto(s)
Calidad de Vida , Encuestas y Cuestionarios , República Checa , Reproducibilidad de los Resultados , Organización Mundial de la Salud
17.
Cas Lek Cesk ; 155(5): 247-253, 2016.
Artículo en Checo | MEDLINE | ID: mdl-27696889

RESUMEN

Currently, the cross-border healthcare still represents a marginal part of the Czech healthcare system's performance, though. Compared to the total healthcare expenditures in the Czech Republic that accounted for CZK 299.9 billion in 2014, the costs of the treatment provided to Czech patients abroad constitute mere 0.27%, and the (subsequently refunded) costs of the treatment provided to foreign patients in the Czech Republic 0.24%.Although data on changes in the volume and reimbursements of healthcare due to the Directive 2011/24/EU have not been published yet, we can expect rather evolutionary than revolutionary development of cross-border healthcare volumes. Taking into account all available data, we can conclude that the cross-border healthcare, as specified by the directive currently in force, is important in our conditions above all in relation to our neighbours, i. e. Germany, Austria, Slovakia and Poland.Key words: cross-border healthcare, patient mobility, international reimbursements EU health policy, Directive 2011/24/EU.


Asunto(s)
Emigración e Inmigración/legislación & jurisprudencia , Emigración e Inmigración/estadística & datos numéricos , Política de Salud/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Austria , República Checa , Unión Europea , Alemania , Costos de la Atención en Salud/legislación & jurisprudencia , Costos de la Atención en Salud/estadística & datos numéricos , Política de Salud/economía , Accesibilidad a los Servicios de Salud/economía , Humanos , Eslovaquia
18.
Cas Lek Cesk ; 155(5): 254-259, 2016.
Artículo en Checo | MEDLINE | ID: mdl-27696890

RESUMEN

Hospital-based HTA (HB-HTA) consists in implementation of assessment activities "in" or "for" hospitals; hence, it covers processes and methods supporting organization and execution of health technology assessment (HTA) at the level of individual hospitals. This process is multidisciplinary, systematic and evidence-based.HB-HTA objectives and methods differ from the classic utilization of HTA at the national regulator level. Most experience and information concerning HB-HTA has originated in two large recent projects: activities of the HB-HTA Interest Group of the HTAi international association established in 2006, and the AdHopHTA European research project (20122015).This paper describes four basic organizational models of HB-HTA, their characteristics and utilization in various countries and hospital types. Results of the AdHopHTA project are analyzed, and recommendations for HB-HTA implementation in Czech hospitals are formulated.Key words: hospital-based HTA, medical device, implementation, hospital strategy.


Asunto(s)
Hospitales/estadística & datos numéricos , Evaluación de la Tecnología Biomédica/métodos , Evaluación de la Tecnología Biomédica/estadística & datos numéricos , Humanos
19.
BMC Pregnancy Childbirth ; 13: 217, 2013 Nov 22.
Artículo en Inglés | MEDLINE | ID: mdl-24267864

RESUMEN

BACKGROUND: Hypothyroidism and/or autoimmune thyroid disorders (AITD) may contribute to spontaneous abortions (SpA). Cost-effectiveness analyses of thyroid screening in women after SpA are lacking. Our aim was to evaluate the cost-effectiveness of screening for AITD and/or hypothyroidism and their treatment in women after SpA with regard to their reproductive health. METHODS: We performed a cross-sectional non-randomized study with follow-up in 2008-2011 in the settings of Departments of Endocrinology and Obstetrics/Gynecology of a university hospital. We enrolled 258 women after SpA before the 12th gestational week and followed them for a median of 3 years. At enrollment, serum concentrations of thyroid stimulatory hormone (TSH), antibodies to thyroid peroxidase (TPOAb) and free thyroxine (FT4) were measured and thyroid ultrasound performed. Women with overt hypothyroidism were treated with levothyroxine (n = 45; 61.6%) and women with subclinical hypothyroidism or euthyroid AITD were treated (n = 28; 38.4%) or left untreated (n = 38; 14.7%). Euthyroid women without signs of AITD served as controls (n = 147; 57.0%). RESULTS: Of the 38 untreated women with AITD and/or subclinical hypothyroidism, 8 (21.1%) reported secondary infertility as compared to 16/147 (10.9%) controls and 3/73 (4.1%) treated women (p = 0.021). Treatment was associated with an increased rate of successfully completed subsequent pregnancies (increment of 6 newborns/100 women) and a savings of €19,539/100 women. Total costs per successfully completed pregnancy were €1,189 in controls, €1,564 in the treated, and €2,488 in the untreated women. CONCLUSIONS: Screening for thyroid disorders in women after SpA and treatment with levothyroxine is cost-saving and it improves the subsequent pregnancy rate.


Asunto(s)
Aborto Espontáneo/etiología , Enfermedades Autoinmunes/diagnóstico , Hipotiroidismo/diagnóstico , Tamizaje Masivo/economía , Tiroxina/uso terapéutico , Adulto , Autoanticuerpos/sangre , Enfermedades Autoinmunes/complicaciones , Enfermedades Autoinmunes/tratamiento farmacológico , Análisis Costo-Beneficio , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Hipotiroidismo/complicaciones , Hipotiroidismo/tratamiento farmacológico , Infertilidad Femenina/etiología , Yoduro Peroxidasa/inmunología , Embarazo , Índice de Embarazo , Tirotropina/sangre , Tiroxina/sangre , Tiroxina/economía
20.
J Mech Behav Biomed Mater ; 21: 195-201, 2013 May.
Artículo en Inglés | MEDLINE | ID: mdl-23566771

RESUMEN

Science and design are two completely separated areas of expertise with their own specialists. Science analyses the existing world to create new knowledge, design uses existing knowledge to create a new world. This tunnel-vision mentality and narrow-minded approach is dangerous for problem solving, where a broad view on potential solutions is required to realise a high-quality answer on the defined problem. We state that design benefits from scientific methods, resulting in a more effective design process and in better products, while science benefits from a design approach, resulting in more efficient and effective results. Our philosophy is illustrated using examples from the field of biomedical engineering. Both methods can benefit tremendously from each other. By applying scientific methods, superior choices will be made in the design process. With design, more accurate, effective and efficient science will be performed.


Asunto(s)
Diseño de Equipo/métodos , Investigación , Ciencia/métodos
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...