Cost-Utility Analysis of Magnetic Resonance Imaging Management of Patients with Acute Ischemic Stroke in a Spanish Hospital.

INTRODUCTION: Stroke has a high rate of long-term disability and mortality and therefore has a significant economic impact. The objective of this study was to determine from a social perspective, the cost-utility of magnetic resonance imaging (MRI) compared to computed tomography (CT) as the first imaging test in acute ischemic stroke (AIS). METHODS: A cost-utility analysis of MRI compared to CT as the first imaging test in AIS was performed. Economic evaluation data were obtained from a prospective study of patients with AIS ≤12 h from onset in one Spanish hospital. The measure of effectiveness was quality-adjusted life-years (QALYs) calculated from utilities of the modified Rankin Scale. Both hospital and post-discharge expenses were included in the costs. The incremental cost-effectiveness ratio (ICER) was calculated and sensitivity analysis was carried out. The costs were expressed in Euros at the 2004 exchange rate. RESULTS: A total of 130 patients were analyzed. The first imaging test was CT in 87 patients and MRI in 43 patients. Baseline variables were similar in the two groups. The mean direct cost was €5830.63 for the CT group and €5692.95 for the MRI group (P = not significant). The ICER was €11,868.97/QALY. The results were sensitive when the indirect costs were included in the analysis. CONCLUSION: Total direct costs and QALYs were lower in the MRI group; however, this difference was not statistically significant. MRI was shown to be a cost-effective strategy for the first imaging test in AIS in 22% of the iterations according to the efficiency threshold in Spain.

Intestinal parasites in children, in highly deprived areas in the border region of Chiapas, Mexico.

OBJECTIVE: To assess the prevalence of intestinal parasitic infections among children in highly deprived areas, and its possible association with demographic and socioeconomic indicators. MATERIAL AND METHODS: From March to September 1998 in a convenience sample of 32 communities of the border region of Chiapas, Mexico, selected at random based on the level of poverty and distance from the community to the nearest health care unit (< 1 hour; 1 hour or more), one of every four households with children under 15 years of age was randomly selected to provide three stool samples from their children (n 1478). Bivariate and multivariate (generalized linear models for correlated binary data), analysis were performed. RESULTS: The global prevalence of intestinal parasitosis was 67% (95% confidence interval [CI] 64-70%). Sixty percent had multiple parasites. The prevalence of Entamoeba histolytica/E dispar was 51.2%, that of Giardia lamblia 18.3%, and that of Ascaris lumbricoides 14.5%. Multivariate analysis showed that age and speaking an indigenous language were significantly associated with the presence of E histolytical E dispar and Giardia lamblia. Source of water and lacking a refrigerator and electricity were associated with the presence of Ascaris lumbricoides. CONCLUSIONS: Measures should be taken to improve water quality, sewage disposal, and domestic hygiene. Furthermore, health programs should be established to promote breast-feeding, and education policies aimed at reinforcing the use of indigenous languages by physicians in the health services.

Intestinal parasites in children, in highly deprived areas in the border region of Chiapas, Mexico

OBJETIVO: Estimar la prevalencia de parasitosis intestinal en niños de zonas de alta marginación y su asociación con indicadores demográficos y socioeconómicos de interés. MATERIAL Y MÉTODOS: En una muestra de 1478 menores de edad, de entre 1 a 14 años, provenientes de 32 comunidades de la región fronteriza de Chiapas, México, de marzo a septiembre de 1998, se recolectaron tres muestras de heces fecales, seleccionadas aleatoriamente a partir del grado de marginación (alto y muy alto) del municipio al que pertenecen, y distancia de la unidad de salud más cercana a la comunidad (<1 hora; 1 hora o más). En una de cada cuatro viviendas con niños menores de 15 años de edad, seleccionadas aleatoriamente, se obtuvieron tres muestras de heces fecales de éstos. Se efectuaron análisis bivariados con la prueba de ji cuadrada y multivariados con modelos lineales generalizados. RESULTADOS: La prevalencia global de parasitosis fue de 67 por ciento (intervalo de confianza IC 95 por ciento 64-70 por ciento). Sesenta por ciento de los niños estaban multiparasitados. La prevalencia de Entamoeba histolytica/E dispar fue de 51.2 por ciento, de Giardia lamblia, 18.3 por ciento y de Ascaris lumbricoides, 14.5 por ciento. La mayor prevalencia de E histolytica/E dispar se asoció con la edad y hablar algún idioma indígena; la de Ascaris lumbricoides con el sitio de obtención de agua y la carencia de refrigerador y electricidad. CONCLUSIONES: Es necesario hacer intervenciones locales de salud (calidad del agua, sistemas de desagüe), programas de educación sanitaria (promoción de la lactancia materna y medidas higiénicas) y promoción del habla de idiomas indígenas entre los médicos de la región

Bienestar social y servicios de salud en la Región Frayseca de Chiapas: el uso de servicios de atención prenatal / Social welfare and health services in the Fraylesca Region in Chiapas: The use of antenatal care services

Objetivo. Analizar el uso de servicios de atención prenatal (AP) en la región Fraylesca de Chiapas, México, e identificar grupos con menor probabilidad de recibir AP. Material y métodos. En 1994 se realizó una encuesta en una muestra aleatoria de 1100 viviendas en la que se recopiló información sociodemográfica y sobre AP del último embarazo ocurrido en los dos años previos al estudio (n=297 mujeres de 15 a 49 años). La identificación de grupos con menor probabilidad de recibir AP adecuada (cinco o más consultas) se realizó mediante un modelo log-lineal. Resultados. Cuarenta y dos por ciento de las mujeres recibió AP inadecuada (0 a 4 consultas). Las mujeres en "mejor situación socioeconómica" fueron las de mayor probabilidad de recibir AP adecuada: RM 2.47 (IC 95 por ciento 1.12 - 5.44), respecto a las mujeres ubicadas en "peor condición socioeconómica". Conclusiones. Es menester aumentar la calidad de la atención de los servicios, apoyar la labor de las parteras y mejorar las condiciones socioeconómicas de la población

Objective. To analyze the use of antenatal care services (ACS) in the Fraylesca Region of Chiapas, Mexico, and to identify groups with lower probability of receiving ACS. Material and methods. In 1994, a health survey was performed on a random sample of 1 100 households, which compiled sociodemographic information and on the use of ACS during the last pregnancy within the two years previous to the study (n= 297 women from 15 to 49 years of age). The groups with lower probability of receiving adequate ACS (5 or more visits) were identified with a log-linear model. Results. Forty-two percent of women received inadequate ACS (0 to 4 visits). Women with better socioeconomic status had higher probability of using ACS adequately than women with lower socioeconomic status: OR 2.47 (CI 95% 1.12-5.44). Conclusions. Results provide evidence of the need to improve the quality of ACS, to support the traditional midwives and to improve living conditions of the population.