National Institutes of Health Funding in Plastic Surgery: A Crisis?

BACKGROUND: Decreasing funding rates and increasing competition for National Institutes of Health research grants have prompted diverse interventions in various fields of biomedicine. Currently, the state of National Institutes of Health funding for plastic surgery research is poorly understood. The purpose of this study was to describe the portfolio of National Institutes of Health grants in academic plastic surgery. METHODS: Plastic surgery faculty at integrated and independent programs were queried individually in the National Institutes of Health RePORTER database for grants awarded in 2014. Funding totals, mechanisms, and institutes were calculated. Abstracts were categorized by research type and field of interest. Characteristics of National Institutes of Health-funded principal investigators were elucidated. RESULTS: Eight hundred sixty-one academic plastic surgeons at 94 programs were queried, and only 18 investigators (2.1 percent) were funded at 12 programs (12.8 percent). National Institutes of Health-funded investigators were predominately male (72 percent), fellowship-trained (61 percent), and aged 49.3 ± 7.8 years. A total of 20 awards amounted to $6,916,886, with an average award of $345,844 ± $222,909. Costs were primarily awarded through the R01 mechanism (77.2 percent). The top three National Institutes of Health institutes awarded 72.9 percent of the entire portfolio. Funding supported clinical (41.1 percent), translational (36.9 percent), and basic science (22.0 percent) research. Craniofacial (20.5 percent), hand (18.7 percent), and breast (16.2 percent) had the greatest funding. CONCLUSIONS: Few programs and faculty drive the National Institutes of Health portfolio of plastic surgery research. These data suggest a tenuous funding situation that may be susceptible to future spending cuts. Future research is needed to identify barriers to National Institutes of Health funding procurement in academic plastic surgery.

Capacidade de autofinanciamento e o gasto em saúde dos municípios do Estado de Pernambuco / Cash flows and spending on health of municipalities in the state of Pernambuco

O estudo descritivo, exploratório e analítico, foi realizado no estado de Pernambuco e objetivou analisar a relação entre a capacidade de autofinanciamento municipal e o gasto em saúde com recursos próprios dos municípios do estado no período de 2006 a 2012. Os recursos próprios vinculados à arrecadação de impostos dos municípios e as transferências constitucionais de impostos foram considerados como aqueles definidos na base de cálculo da lei n0 141 de 12 de janeiro de 2012 os quais correspondem aos dados disponíveis no SIOPS. Para análise estatística da capacidade de autofinanciamento foi utilizado o INFA, adaptado do estudo de Nunes (2004) com base na receita própria municipal e posteriormente um estudo de correlação. Evidenciou-se que durante o período estudado os municípios apresentaram um aumento da capacidade de autofinanciamento municipal, porém, existiram diferenças na taxa de crescimento da receita dos municípios entre si e entre as regiões de saúde. A análise do gasto mostrou uma elevação dos gastos em saúde para 99 por cento dos municípios estudados, no entanto, semelhante à receita própria a taxa de crescimento dos gastos no período variou entre os municípios e entre as regiões de saúde. Ao verificar a correlação entre a receita própria e o gasto em saúde foi encontrada uma associação positiva (r2=0,90) indicando que quanto maior a receita própria, maior o gasto em saúde com recursos próprios. Ao analisar o crescimento da receita própria em relação ao crescimento do gasto com recursos próprios verificou-se que 31 por cento do total de municípios apresentaram um crescimento do gasto com recursos próprios superior ao crescimento da receita própria, sendo a correlação (r2=0,18) entre as taxas fracamente positiva (AU).

Microcredit participation and nutrition outcomes among women in Peru.

BACKGROUND: Microcredit services--the awarding of small loans to individuals who are too poor to take advantage of traditional financial services--are an increasingly popular scheme for poverty alleviation. Several studies have examined the ability of microcredit programmes to influence the financial standing of borrowers, but only a few studies have examined whether the added household income improves health and nutritional outcomes among household members. This study examined the hypothesis that longer participation in microcredit services would be associated with better nutritional status in women. METHODS: Cross-sectional data were obtained in February 2007 from 1593 female clients of a microcredit organisation in Peru. The primary predictor variable was length of time as a microcredit client measured in number of completed loan cycles (range 0 to 5.5 years, average loan size US$350). The outcome variables were age-adjusted body mass index (BMI), haemoglobin levels (g/dl) and food insecurity measured using the US household food security survey module. Extensive data on demographic and socioeconomic status were also collected. RESULTS: Longer microcredit participation was associated with higher BMI (ß=0.05, p=0.06), higher haemoglobin levels (ß=0.07, p<0.01) and lower food insecurity (ß=-0.13, p<0.01). With the inclusion of demographic and socioeconomic variables, the associations with higher haemoglobin (ß=0.03, p=0.04) and lower food insecurity (ß=-0.08, p<0.01) were sustained. CONCLUSION: This study supports the notion that microcredit participation has positive effects on the nutritional status of female clients. Further research should explore more definitive causal pathways through which these effects may occur and should examine the effects on other household members.

Ranching modernization in tropical Brazil: foreign investment and environment in Mato Grosso, 1900-1950.

Accompanying the expansion of modern beef production in the nineteenth and twentieth centuries were technologies and methods that proponents assumed were applicable to all ecosystems. successes in Europe, the United States, and Argentina convinced ranchers, investors, and animal scientists that these could be applied in the tropical Americas with ease. This assumption contributed to a wave of foreign ranching investment in semi-tropical Mato Grosso, Brazil, beginning in the early twentieth century. However, such a view failed to consider the specific characteristics of such environments and led to difficulties for several ventures and a re-evaluation of the relationship between ecosystems and the type of ranching appropriate to them. Ultimately, local Brazilian practice and experimentation proved more successful in tropical and semi-tropical Brazil, forcing foreign ranching concerns to adapt their techniques. Following the logic of earlier decades, more recently cattle-raising practices developed in Mato Grosso and similar regions have been applied in the tropical Amazon, resulting in widespread ecological devastation. The uneven experiences of foreign entrepreneurs in Mato Grosso offer valuable lessons for understanding the application of modernization technologies to diverse ecosystems; such knowledge can lead to a more sustainable approach to meat production.

End-stage renal failure and national resources: the Brazilian experience.

Brazil is the fifth largest and the fifth most populous nation in the world. Its economy rivals Mexico as the strongest in Latin America and ranks among the 15 largest economies in the world. Despite these achievements, a substantial fraction of the Brazilian population still lives in poverty, and many still have limited access to medical assistance. There are currently about 380 patients on hemodialysis per million populations (pmp), approximately one third of the U.S. prevalence, suggesting that a large fraction of end-stage renal disease (ESRD) patients are not diagnosed and treated properly. In Brazil, access to renal replacement therapy (RRT), including renal transplantation, is universal, and the corresponding costs, including those of medications (immunosuppressors and treatment of ESRD complications), are covered by the Brazilian government. However, given the continuous growth of the ESRD population and of the costs incurred by RRT, the efficacy and reach of this system may be severely limited in years to come. In the current struggle against the ESRD epidemics, the Brazilian medical community and health authorities face a triple challenge: to limit the incidence of renal disease, slow or detain the progression of established chronic nephropathies, and ensure that access to quality RRT remains granted to all those who, despite all efforts, reach ESRD.

Brasil, tempo de crescer / Brazil, time to grow

Brasil, Tempo de Crescer" traz a contribuição de importantes profissionais ao discutir condições e propostas capazes de assegurar a retomada de um crescimento sustentado da economia brasileira. Os textos deste livro registram o compromisso em identificar propostas realistas e eficazes para a superação dos desafios e a exploração das oportunidades que se abrem para a economia brasileira neste início de século. São analisadas questões e obstáculos cuja superação ou equacionamento se mostram fundamentais quando se deseja um quadro de crescimento vigoroso para a economia. Desta forma, temas como o equilíbrio macroeconômico, reformas institucionais, investimentos em infra-estrutura, marco regulatório, custo capital e o funcionamento do investimento, entre outro, são aprofundados pelos autores com uma riqueza de conteúdo e de propostas