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1.
Medicine (Baltimore) ; 99(2): e18723, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914087

RESUMEN

Effectiveness, efficacy and safety of biosimilar infliximab (CT-P13) in inflammatory bowel disease (IBD) patients has been shown in previous studies. Limited data exist on health-related quality of life (HRQoL) of switching originator to biosimilar infliximab (IFX) in IBD patients. The objective of this study was to evaluate impact of switching originator to biosimilar IFX on HRQoL, disease activity, and health care costs in IBD maintenance treatment.In this single-center prospective observational study, all IBD patients receiving maintenance IFX therapy were switched to biosimilar IFX. HRQoL was measured using the generic 15D health-related quality of life instrument (15D) utility measurement and the disease-specific Inflammatory Bowel Disease Questionnaire (IBDQ). Crohn Disease Activity Index (CDAI) or Partial Mayo Score (pMayo), and fecal calprotectin (FC) served for evaluation of disease activity. Data were collected at time of switching and 3 and 12 months after switching. Patients' characteristics, clinical background information and costs were collected from patient records and the hospital's electronic database.Fifty-four patients were included in the analysis. No statistically significant changes were observed in 15D, CDAI, pMayo, and FC during 1-year follow-up. IBDQ scores were higher (P = .018) in Crohn disease 3 months after switching than at time of switching. Costs of biosimilar IFX were one-third of costs of originator one. Total costs related to secondary health care (excluding costs of IFX), were similar before and after the onset of biosimilar IFX.HRQoL and disease activity were after switching from originator to biosimilar IFX comparable, but the costs of biosimilar IFX were only one-third of those of the originator one.


Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Biosimilares Farmacéuticos/uso terapéutico , Fármacos Gastrointestinales/uso terapéutico , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Infliximab/uso terapéutico , Calidad de Vida , Adulto , Anticuerpos Monoclonales/economía , Biosimilares Farmacéuticos/economía , Sustitución de Medicamentos/economía , Femenino , Fármacos Gastrointestinales/economía , Recursos en Salud/economía , Servicios de Salud/economía , Servicios de Salud/estadística & datos numéricos , Humanos , Infliximab/economía , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Inducción de Remisión
2.
Epidemiol Psychiatr Sci ; 29: e95, 2020 Jan 28.
Artículo en Inglés | MEDLINE | ID: mdl-31987063

RESUMEN

AIMS: Children with autism spectrum disorder (ASD) tend to suffer from various medical comorbidities. We studied the comorbidity burden and health services' utilisation of children with ASD to highlight potential aetiologies and to better understand the medical needs of these children. METHODS: In this nested case-control study, ASD cases and controls - matched by age, sex and ethnicity in a 1:5 ratio - were sampled from all children born between 2009 and 2016 at a tertiary medical centre. Data were obtained from the hospital's electronic database. Comorbid diagnoses were classified according to pathophysiological aetiology and anatomical/systemic classification of disease. Standard univariate and multivariate statistics were used to demonstrate comorbidities and health services' utilisation patterns that are significantly associated with ASD. RESULTS: ASD children had higher rates of comorbidities according to both pathophysiological and anatomical/systemic classifications (p < 0.001). The most marked significant differences were observed for: hearing impairments (OR = 4.728; 95% CI 2.207-10.127) and other auricular conditions (OR = 5.040; 95% CI 1.759-14.438); neurological (OR = 8.198; 95% CI 5.690-11.813) and ophthalmological (OR = 3.381; 95% CI 1.617-7.068) conditions; and ADD/ADHD (OR = 3.246; 95% CI 1.811-5.818). A subgroup analysis revealed a more profound case-control difference in anaemia rates among girls than in boys (OR = 3.25; 95% CI 1.04-10.19 v. OR = 0.74; 95% CI 0.33-1.64 respectively) and an opposite trend (larger differences in males than in females in cardiovascular diseases (OR = 1.99; 95% CI 1.23-3.23 v. OR = 0.76; 95% CI 0.17-3.45, respectively)). In addition, larger case-control differences were seen among Bedouin children than in Jewish children in a number of medical comorbidities (Breslow-Day test for homogeneity of odds ratio p-value <0.05). Finally, we found that children with ASD tended to be referred to the emergency department and to be admitted to the hospital more frequently than children without ASD, even after adjusting for their comorbidity burden (aOR = 1.28; 95% CI 1.08-1.50 and aOR = 1.28; 95% CI 1.11-1.47 for >1 referrals and admissions per year, respectively). CONCLUSIONS: The findings of this study contribute to the overall understanding of comorbid conditions and health services' utilisation for children with ASD. The higher prevalences of comorbidities and healthcare services' utilisation for children with ASD highlight the additional medical burden associated with this condition.


Asunto(s)
Trastorno del Espectro Autista/terapia , Servicio de Urgencia en Hospital/estadística & datos numéricos , Servicios de Salud/estadística & datos numéricos , Trastorno del Espectro Autista/diagnóstico , Trastorno del Espectro Autista/epidemiología , Estudios de Casos y Controles , Niño , Comorbilidad , Femenino , Humanos , Israel/epidemiología , Masculino , Registros Médicos/estadística & datos numéricos , Prevalencia
4.
Recurso de Internet en Portugués | LIS - Localizador de Información en Salud | ID: lis-LISBR1.1-46925

RESUMEN

O curso conta com uma diversidade de conteúdos e professores de diferentes trajetórias e campos do conhecimento, contribuindo para a construção de uma formação interdisciplinar pelos direitos das pessoas com deficiência. Embora os módulos do curso apresentem uma sequência didática, de modo a facilitar a compreensão do conteúdo, cada um deles possui uma estrutura independente, o que possibilita que o aluno conduza o seu processo de aprendizagem de forma individual e como for mais conveniente. O curso é autoinstrucional e a navegação é sequencial e, ao final de cada módulo, o aluno terá a oportunidade de realizar alguns exercícios visando contribuir para uma maior assimilação do conteúdo. Será ainda disponibilizada uma avaliação final para certificação.


Asunto(s)
Educación Continua , Educación a Distancia , Personas con Discapacidad , Personal de Salud , Relaciones Médico-Paciente , Servicios de Salud
5.
Expert Rev Pharmacoecon Outcomes Res ; 19(6): 749-753, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31825682

RESUMEN

Background: Agreements between payers and pharmaceutical/medical device companies are widely implemented to address financial and clinical uncertainties. We analyzed the main characteristics of these agreements in Israel from 2011-2018.Research design and methods: We reviewed all agreements implemented during the study period. Information regarding the type of agreement, therapeutic indications, its time frame and the total budget involved are presented.Results: A total of 56 agreements were signed since 2011, of which 53 (95%) were financial-based and 50 (89%) referred to pharmaceuticals. The annual number of agreements increased from one in 2011 to 21 in 2018. The main therapeutic areas covered were: oncology (41%), hepatitis C (16%), neurology (11%), respiratory (9%), and cardiovascular (7%). The proportion of the annual budget allocated subject to these agreements increased accordingly from 3% in 2011 to 73% in 2018. The majority (63%) of the agreements were signed for 5 years, 9% were shorter-term and 20% have no time-limit. In 14 (44%) of the financial-based agreements implemented through 2017, the actual utilization exceeded the pre-specified threshold and the companies reimbursed the health-plans accordingly.Conclusions: The number of agreements and the allocated budget subject to these agreements increased substantially in recent years. Most agreements are financial-based that, in many cases, shifted the short-term financial risk from health-plans to the industry.


Asunto(s)
Industria Farmacéutica/organización & administración , Accesibilidad a los Servicios de Salud/economía , Programas Nacionales de Salud/organización & administración , Prorrateo de Riesgo Financiero/organización & administración , Presupuestos , Industria Farmacéutica/economía , Servicios de Salud/economía , Humanos , Israel , Programas Nacionales de Salud/economía , Mecanismo de Reembolso/economía , Prorrateo de Riesgo Financiero/economía , Incertidumbre
8.
Artículo en Ruso | MEDLINE | ID: mdl-31884760

RESUMEN

The issues of assessing medical and demographic processes and improving public health are very actual in Russia. The article analyzes the current state and regional characteristics of medical and demographic development using the example of the Republic of Dagestan. The positive tendency of the main fertility indicators was determined, including the analysis of the age structure of the population and population size alterations.


Asunto(s)
Prestación de Atención de Salud , Demografía , Servicios de Salud , Daguestán , Dinámica Poblacional , Federación de Rusia
9.
Rev Med Chil ; 147(7): 870-876, 2019 Jul.
Artículo en Español | MEDLINE | ID: mdl-31859985

RESUMEN

BACKGROUND: Frailty has a great impact in the wellbeing of older people. AIM: To evaluate the quality of life of older people with and without frailty. MATERIAL AND METHODS: We assessed sociodemographic variables, health, integral geriatric assessment, quality of life using the WHOQoL-BREF questionnaire and the level of fragility using the Tilburg Frailty Indicator (TFI) in 538 participants. RESULTS: Three hundred and five participants aged 73 ± 7 years (229 women) were classified as fragile and 233 aged 72 ± 6 years (125 women) as not having frailty. Compared with their non-fragile counterparts, frail participants had a lower number of years attending school (5.9 and 7.4 respectively), a lower Barther index (93.6 and 98.3 respectively), a lower mini mental score (21.9 and 22.8 respectively) and a higher Yessavage depression score (2.0 and 0.8 respectively). Also, frail participants had a significantly lower total quality of life score and significantly lower scores in the physical and psychological domains. No differences were observed for the social and environmental domains. Older frail participants used health services more frequently than their non-fragile counterparts. CONCLUSIONS: In this sample, frailty was associated with a lower quality of life and worse scores in several geriatric assessment tools.


Asunto(s)
Anciano Frágil/psicología , Anciano Frágil/estadística & datos numéricos , Evaluación Geriátrica , Servicios de Salud/estadística & datos numéricos , Calidad de Vida/psicología , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Factores Socioeconómicos , Encuestas y Cuestionarios
10.
ABCS health sci ; 44(3): 172-179, 20 dez 2019. tab
Artículo en Inglés, Portugués | LILACS | ID: biblio-1047748

RESUMEN

INTRODUÇÃO: A conscientização das gestantes é fundamental para experiências positivas de parto. OBJETIVO: Avaliar o grau de conhecimento das gestantes em dois serviços públicos sobre parto humanizado. Caracterizar epidemiologicamente a população estudada. MÉTODOS: Estudo descritivo realizado entre julho e agosto de 2017. Amostra com 297 gestantes foram selecionadas 200 após aplicação dos critérios de exclusão. Utilizados testes estatísticos de associações de variáveis (Qui-quadrado e Exato de Fisher). RESULTADOS: A média de idade das gestantes foi 26,6 anos. A maioria era procedente do interior do estado (72,5%), com renda até um salário mínimo (90,5%), e com mais de oito anos de estudo (62,5%). 71% iniciaram pré-natal até o primeiro trimestre e o pré-natal foi conduzido por médico em 72% dos casos. 71% preferiam parto normal e 44% tinha medo de cesárea. Profissional pré-natalista não ofereceu informações para 66,5%. 30,5% conhecia parto humanizado, destas 83,6% apresentaram conceito adequado. Houve associação entre conhecimento sobre parto humanizado e procedência (Aracaju) (p=0,03), maior renda (p=0,02), menor ocorrência de aborto (p=0,04), médico pré-natalista (p=0,04) preferência pelo parto vaginal (p=0,04). Dentre as que não conheciam o parto humanizado houve associação de respostas corretas com a maior renda (p=0,03) e anos estudados (p=0,02) e médico pré-natalista (p=0,01). CONCLUSÃO: A maioria desconhecia o parto humanizado, era procedente do interior com menor renda, preferência por parto normal, sem informações quanto aos tipos de parto pelo profissional executante (na maioria médicos), quem conhecia adequadamente. Conceitos adequados sobre parto humanizado mesmo na ausência de informação prévia associaram-se às variáveis socioeconômico e pré-natal.


INTRODUCTION: The awareness of pregnant women is fundamental to positive birth experiences. OBJECTIVE: To analyze the level of knowledge on humanized birth of pregnant women from two public services and characterize the sample epidemiologically. METHODS: Descriptive study using questionnaire between June and August 2017. Sample with 297 pregnant women being selected 200 after applying the exclusion criteria. Association test of variables were used (Chi-square and Fisher's exact test). RRESULTS: Mean age was 26.6 years. Majority were from countryside (72.5%), income up to a minimum wage (90.5%) and more of eight years of education (62.5%). 71% started prenatal care in the first trimester and it was conducted by physician in 71% of cases. 71% preferred vaginal delivery and 44% related fear of cesarean. Prenatal professional in charge did not provide information for 66.5%. 30.5% have heard about humanized childbirth, among these, 83.6% showed adequate concepts. Associations were observed between prior knowledge of humanized childbirth and origin (Aracaju) (p=0.03), higher income (p=0.02), lower abortion incidence (p=0.04), prenatal physician (p=0.04) and preference for normal childbirth (p=0.04). Among women without previous knowledge on humanized childbirth there association of correct concept with higher income (p=0.03), schooling (p=0.02) and prenatal physician (p=0.01). CONCLUSION: The majority did not know about humanized delivery, were from the countryside with lower income, preference for normal birth, were not informed on the types of delivery by the professional practitioner (in majority doctors), whom knew properly. Adequate concepts about humanized childbirth, even in the absence of prior information, were associated to socio-economic and prenatal variables.


Asunto(s)
Humanos , Femenino , Embarazo , Niño , Adolescente , Adulto , Persona de Mediana Edad , Conocimiento , Servicios Básicos de Salud , Parto Humanizado , Parto Obstétrico , Mujeres Embarazadas , Humanización de la Atención , Servicios de Salud , Atención Primaria de Salud , Funciones Esenciales de la Salud Pública , Comunicación en Salud
12.
Harefuah ; 158(11): 755-759, 2019 Nov.
Artículo en Hebreo | MEDLINE | ID: mdl-31721522

RESUMEN

INTRODUCTION: Today, the introduction of a new medicine or vaccine or the clinical trial of some new potion requires the approval of a variety of bodies in accordance with Helsinki Agreement rules, National Health Laws and Health Ministry regulations. The creation of the World Health Organization (WHO) in 1946 added another essential layer to the firm base of principles governing the conduct of clinical trials that exist today. Its main contribution was to create a new reality following The Second World War and the subsequent Nuremberg Trials. The Declaration of Helsinki was only adopted eighteen years later, in 1964. In its first years of independence the infant State of Israel was attacked by a serious outbreak of polio which claimed many victims - mostly children and youngsters. Infantile paralysis - poliomyelitis (polio) was then considered as being untreatable. The disease affected 0.1% of the population of Israel. In 1950, out of a total population of 1.2 million, 1,500 were infected by polio. The epidemic struck over three successive seasons and affected more than 3,000 victims. The mortality rate stood at 10%. Experts, charlatans and fame seekers all presented their inventions to the country - creams, medicines and research projects all designed to bring relief to the sick children. Against all these stood the newly formed Ministry of Health, determined to bring order to the chaos. The only trial conducted by the Health Ministry was unsuccessful, but it was accompanied by the most stringent controls that would not have shamed even today's researchers. The clinical trials of Zibaline were conducted in the early 60's, after the polio vaccine had been introduced and the epidemic had passed. The purpose of this paper is to examine the influence of medical ethics, norms and morals on the way that medical practice dealt with the epidemic at a time when there were no laws or rules.


Asunto(s)
Epidemias , Poliomielitis , Niño , Brotes de Enfermedades , Epidemias/historia , Servicios de Salud , Historia del Siglo XX , Humanos , Lactante , Israel , Poliomielitis/diagnóstico , Poliomielitis/epidemiología , Poliomielitis/terapia
13.
Retina ; 39(12): e59-e60, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31725529
15.
Lima; Perú. Ministerio de Salud; 20191100. 45 p. ilus, tab.
Monografía en Español | LILACS, LIPECS | ID: biblio-1024810

RESUMEN

El documento contiene una serie de criterios para la definición de costos de procedimientos médicos o procedimientos sanitarios en las IPRESS, los cuales de encuentran concordados con la normativa nacional e internacional de contabilidad para el Sector Público.


Asunto(s)
Atención Primaria de Salud , Asignación de Costos , Instituciones de Salud , Servicios de Salud
16.
BMC Health Serv Res ; 19(1): 692, 2019 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-31615509

RESUMEN

BACKGROUND: Given the considerable efforts and resources required to develop practice guidelines, developers need to prioritize what topics and questions to address. This study aims to identify and describe prioritization approaches in the development of clinical, public health, or health systems guidelines. METHODS: We searched Medline and CINAHL electronic databases in addition to Google Scholar. We included papers describing prioritization approaches in sufficient detail allowing for reproducibility. We synthesized findings in a semi-quantitative way. We followed an iterative process to develop a common framework of prioritization criteria that captures all of the criteria reported by each included study. RESULTS: Our search captured 33,339 unique citations out of which we identified 10 papers reporting prioritization approaches for guideline development. All of the identified approaches focused on prioritizing guideline topics but none on prioritizing recommendation questions or outcomes. The two most frequently reported steps of the development process for these approaches were reviewing the grey literature (9 out of 10, 90%) and engaging various stakeholders (9 out of 10, 90%). We derived a common framework of 20 prioritization criteria that can be used when prioritizing guideline topics. The most frequently reported criteria were the health burden of disease which was included in all of the approaches, practice variation (8 out of 10, 80%), and impact on health outcomes (7 out of 10, 70%). Two of the identified approaches stood out as being comprehensive and detailed. CONCLUSIONS: We described 10 prioritization approaches in the development of health practice guidelines. There is a need to assess the effectiveness, efficiency and transparency of the identified approaches and to develop standardized and validated priority setting tools.


Asunto(s)
Prioridades en Salud , Servicios de Salud/normas , Guías de Práctica Clínica como Asunto/normas , Salud Pública/normas , Humanos , Reproducibilidad de los Resultados
17.
Health Syst Transit ; 21(2): 1-166, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31596240

RESUMEN

This analysis of the Finnish health system reviews developments in its organization and governance, financing, provision of services, health reforms and health system performance. Finland is a welfare state witha high standard of social and living conditions and a low poverty rate. Its health system has a highly decentralized administration, multiple funding sources, and three provision channels for statutory services in first-contact care: the municipal system, the national health insurance system, and occupational health care. The core health system is organized by the municipalities (i.e. local authorities) which are responsible for financing primary and specialized care. Health financing arrangements are fragmented, with municipalities, the health insurance system, employers and households all contributing substantial shares. The health system performs relatively well, as health services are fairly effective, but accessibility may be an issue due to long waiting times and relatively high levels of cost sharing. For over a decade, there has been broad agreement on the need to reform the Finnish health system, but reaching a feasible policy consensus has been challenging.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Financiación de la Atención de la Salud , Calidad de la Atención de Salud , Prestación de Atención de Salud/métodos , Finlandia , Reforma de la Atención de Salud , Política de Salud , Servicios de Salud/estadística & datos numéricos , Humanos , Seguro de Salud/organización & administración , Política
18.
Rev Infirm ; 68(254): 42-43, 2019 Oct.
Artículo en Francés | MEDLINE | ID: mdl-31587853

RESUMEN

The health service, which came into effect in September 2018, concerns all health-care students. Nursing students were among the first to get involved in nursing fields in a variety of settings where the population could get involved in raising awareness of healthy behaviours. A group of nursing students from a school in Île-de-France attests to their involvement in this innovation.


Asunto(s)
Servicios de Salud , Estudiantes de Enfermería/psicología , Difusión de Innovaciones , Francia , Humanos , Facultades de Enfermería
19.
Rev Bras Epidemiol ; 22Suppl 1(Suppl 1): e190006, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31576982

RESUMEN

INTRODUCTION: Knowing the factors associated with periodic HIV testing among female sex workers (FSW) is essential to expand testing coverage and to broaden programs of treatment as prevention. METHODS: We used data from 4,328 FSWs recruited by the respondent-driven sampling (RDS) method in 12 Brazilian cities in 2016. Data analysis considered the complex sampling design. The prevalence of HIV testing in the last year and periodic HIV test were estimated. Factors associated with regular HIV testing were identified through logistic regression models. RESULTS: The testing coverage in the last year was 39.3%. Only 13.5% of FSW reported having performed a periodic HIV test in the last year. Among the factors associated with the higher probability of HIV testing in the last year were a better level of education, living with a partner, working indoors, consistent use of condoms, and regular use of public and private health services stood out. DISCUSSION: Periodic HIV testing allows early diagnosis and immediate treatment of cases, reducing the chances of spreading the infection to the population. However, factors such as stigma and discrimination hinder the use of regular health services. CONCLUSION: It is necessary to expand awareness campaigns, especially among FSWs with low educational level and greater vulnerability, in order to broaden the perception of risk and the importance of periodic testing, in addition to encouraging regular health care.


Asunto(s)
Serodiagnóstico del SIDA/estadística & datos numéricos , Infecciones por VIH/diagnóstico , Trabajadores Sexuales/estadística & datos numéricos , Adolescente , Adulto , Brasil , Condones/estadística & datos numéricos , Escolaridad , Femenino , Servicios de Salud/estadística & datos numéricos , Humanos , Renta/estadística & datos numéricos , Análisis Multivariante , Conducta Sexual , Adulto Joven
20.
Rev Bras Epidemiol ; 22Suppl 1(Suppl 1): e190008, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31576984

RESUMEN

OBJECTIVE: To analyze the distribution of health care services for viral hepatitis and reported cases of viral hepatitis according to the health regions of Northern Brazil. METHOD: It is an evaluative, descriptive and quantitative research considering viral hepatitis care services and reported cases in the Northern region of Brazil, using data collected from the National Registry of Health Establishments and the Notifiable Diseases Information System. Descriptive statistics and georeferencing, through software, were used to demonstrate the spatial distribution of services and reported cases. RESULTS: Viral hepatitis health services are distributed in a differentiated way; rapid tests are capillaries in the states; confirmatory tests and treatment are performed in some health regions, with a greater grouping of services in the capitals and their surroundings. Cases were reported across all regions, with areas of higher concentration near services. CONCLUSION: The availability of services can favor access to prevention, diagnosis and monitoring of cases. However, organizational peculiarities of the health system and services highlight fragilities that have repercussions on the access and entirety of viral hepatitis care.


Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud/estadística & datos numéricos , Hepatitis Viral Humana/epidemiología , Brasil/epidemiología , Notificación de Enfermedades/estadística & datos numéricos , Geografía , Investigación sobre Servicios de Salud , Hepatitis Viral Humana/diagnóstico , Humanos , Factores Socioeconómicos , Carga Viral/estadística & datos numéricos
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