Eficiencia de los sistemas sanitarios / No disponible

Fundamentos: A pesar de la disponibilidad de indicadores de gasto sanitario y resultados en salud en la práctica totalidad de los países desarrollados, pocos estudios han comparado la eficiencia entre los dos sistemas de salud preponderantes en las últimas décadas (Sistemas de Seguro Social -SSSy Sistemas Nacionales de Salud -SNS-) utilizando indicadores de salud ajustados por el gasto sanitario. Métodos: El presente trabajo compara los dos tipos de sistemas en 18 países en 2010: 10 con SNS (Portugal, Grecia, Italia, España, Finlandia, Reino Unido, Irlanda, Suecia, Dinamarca y Noruega) y 8 con SSS (Israel, Bélgica, Francia, Alemania, Austria, Luxemburgo, Países Bajos y Suiza). Resultados: No se han encontrado diferencias estadísticamente significativas entre los sistemas, pero sí ciertas tendencias favorables a los SNS en mortalidad infantil (3,2%o frente a 3,6 %o en SSS, p=0,2) y contención del gasto, como el gasto en sanidad per cápita (3567$ frente a 4232$ en SSS, p=0,10) y porcentaje del PIB destinado a sanidad (9,8% frente a 10,4% en SSS, p=0,14). Esta tendencia se mantiene al analizar los ratios beneficio-gasto como la esperanza de vida (2,2 en SNS frente a 1,2 en SSS en varones, p=0,10) y la esperanza de vida saludable (1,9 frente a 1,7 en ambos sexos, p=0,10). Conclusiones: Estos datos, referidos al pasado reciente, podrían contribuir a informar el debate actual de las reformas sanitarias en Europa y a interpretar futuros estudios de los resultados de los sistemas de salud

Background: Despite the availability of indicators of health expenditure and health outcomes in almost all developed countries, few studies have compared the efficiency between the two main health systems in the last few decades (Social Health Insurance -SHI- and National Health System -NHS-) using health indicators adjusted by health expenditure. Method: This work compares the two types of systems in 18 countries in 2010: 10 with NHS (Portugal, Greece, Italy, Spain, Finland, United Kingdom, Ireland, Sweden, Denmark and Norway) and 8 with SHI (Israel, Belgium, France, Germany, Austria, Luxembourg, The Netherlands and Switzerland). Results: We did not find statistically significant differences between the systems, nevertheless some favorable trend in NHS-based countries were observed: in infant mortality (3.2%o vs. 3.6 %o in SHI, p=0.12) and cost containment such as health expenditure per cápita (3567$ versus 4232$ in SHI, p=0.10) and percentage of the GDP for health (9.8% versus 10.4% in SHI, p=0.14). This trend remained when analyzing benefit-expenditure ratios, i.e. life expectancy (2.2 in NHS vs. 1.2 in SHI in men, p=0.10) and healthy life expectancy (1.9 versus 1.7 in both sexes, p=0.10). Conclusions: These recent-past data might contribute to inform the current debate around health systems reforms in Europe and to the interpretation of future studies of the health systems results

[Diffuse large B cell lymphoma presenting with a bilateral serous macular detachment]. / Desprendimiento seroso macular bilateral como forma de presentación de linfoma B difuso de célula grande.

CLINICAL CASE: A 42 year-old male was assessed for a subacute, bilateral and progressive visual loss. His medical history included chronic hepatitis C infection and Evans syndrome. On fundal examination, multiple areas of neurosensorial and retinal pigmented epithelium detachment were observed in the region of both macula. A few days later, his general health deteriorated and he was noted to have a high fever and adenopathy. Biopsy of an enlarged lateral cervical lymph node demonstrated the existence of a diffuse large B cell lymphoma. After several cycles of chemotherapy, he experienced a progressive and bilateral improvement of his vision, which was accompanied by a reattachment of the previously detached areas. DISCUSSION: A bilateral and serous macular detachment may be the initial manifestation of a diffuse large B cell lymphoma. The prognosis of these retinal lesions may be favourable if lymphoma remission is achieved.

Desprendimiento seroso macular bilateral como forma de presentación de linfoma B difuso de célula grande / Diffuse large B cell lymphoma presenting with a bilateral serous macular detachment

Caso clínico: Un varón de 42 años fue atendido por pérdida visual bilateral subaguda. Como antecedentes presentaba una hepatitis C crónica activa y un síndrome de Evans. Mediante funduscopia se observaron múltiples focos de desprendimiento neurosensorial y de EPR en ambas polos posteriores. A los pocos días empeoró su estado general (fiebre alta y múltiples adenopatías). La biopsia de las adenopatías laterocervicales objetivó un linfoma B difuso de células grandes. Se le trató con quimioterapia y experimentó una paulatina reaplicación de los focos de desprendimiento seroso con mejoría visual progresiva. Discusión: El desprendimiento seroso macular bilateral puede ser una manifestación precoz de un linfoma B difuso de célula grande. El curso de estas lesiones intraoculares puede ser favorable con la remisión del linfoma

Clinical case: A 42 year-old male was assessed for a subacute, bilateral and progressive visual loss. His medical history included chronic hepatitis C infection and Evans syndrome. On fundal examination, multiple areas of neurosensorial and retinal pigmented epithelium detachment were observed in the region of both macula. A few days later, his general health deteriorated and he was noted to have a high fever and adenopathy. Biopsy of an enlarged lateral cervical lymph node demonstrated the existence of a diffuse large B cell lymphoma. After several cycles of chemotherapy, he experienced a progressive and bilateral improvement of his vision, which was accompanied by a reattachment of the previously detached areas. Discussion: A bilateral and serous macular detachment may be the initial manifestation of a diffuse large B cell lymphoma. The prognosis of these retinal lesions may be favourable if lymphoma remission is achieved