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3.
Value Health ; 22(6): 627-641, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31198179

RESUMO

BACKGROUND: We have seen significant advancement in a range of health technologies, some with transformative or curative potential. Nevertheless, it is often unclear how global health systems recognize or reward innovation. OBJECTIVES: To consider what is transformative, challenges for transformative therapies, and downstream health ecosystem effects. METHODS: A systematic review of publications in English between 2012 and 2018 was conducted with a focus on value assessment processes and health system effects of a range of breakthrough health technology categories. After screening 9012 records, 222 unique studies were identified. The study also included an analysis of 100 health technology assessments (HTAs) from 5 markets to consider how and in what ways global HTA bodies evaluate transformative therapies. Global sales and technology/procedure utilization data were also evaluated to gain insights into patient access and commercial impact. RESULTS: This article evaluated uncertainties around evidence of efficacy, safety, and duration of effect, as well as underlying study quality and methodological considerations in the target categories. Although many HTA evaluations had similar approaches to assessing parameters such as safety, there were significant differences across technology categories. Technology-driven trends also surfaced where global HTA and payer systems may not yet be prepared to recognize and reward emerging technology impacts, including use of next-generation diagnostic results to guide care, considering novel impacts on therapy sequencing and clinical pathway management, and changes in payment and health delivery models. CONCLUSIONS: Some trends stemming from rapid evolution of breakthrough therapies will prompt reconsideration of our conventional value assessment and reward models, because health system measurement and management processes have not fully anticipated their effects.


Assuntos
Assistência à Saúde/métodos , Economia/tendências , Assistência à Saúde/economia , Assistência à Saúde/tendências , Saúde Global/normas , Saúde Global/tendências , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
4.
Ágora (Rio J. Online) ; 22(2): 173-179, maio-ago. 2019.
Artigo em Português | LILACS, Index Psicologia - Periódicos técnico-científicos | ID: biblio-1004870

RESUMO

RESUMO: O artigo investiga o lugar ocupado pelo dinheiro na economia psíquica de um ponto de vista pulsional, com base na psicanálise. Trata-se de pesquisa com metodologia bibliográfica e leitura interpretativa na perspectiva psicanalítica. Conclui-se que o dinheiro se constitui como objeto pulsional com injunção estruturante sobre o psiquismo, instituindo-se como cifra da própria constituição do sujeito.


Abstract: This work proposes to investigate the place occupied by money in the psychic economy from a Freud's drive theory. It is a research with bibliographic methodology and interpretive reading in the psychoanalytic perspective. It is concluded that money is constituted as an object of the Freud's drive theory with a structuring injunction on the psyche, establishing itself as a cipher of the subject's own constitution.


Assuntos
Psicanálise , Capitalismo , Economia
5.
World J Microbiol Biotechnol ; 35(5): 78, 2019 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-31087167

RESUMO

The increase in the CO2 concentration in the Earth's atmosphere has been a topic of worldwide concern since anthropogenic emissions of greenhouse gases began increasing considerably during the industrial period. The effects of these mass emissions are probably the main cause of global warming, which has been observed over recent decades. Among the various techniques of CO2 capture, microalgal biofixation by photosynthesis is considered a promising technology due to the efficiency of these microorganisms in converting this gas into organic compounds through its use as a nutrient in the culture medium. Over the years, several research centers have developed studies on this subject, which have focused on mainly the development of bioreactors, the growth conditions that increase the efficiency of the process and the production of biomass with applicability in several areas. The biological mitigation of CO2 by microalgae has many advantages, including reductions in the concentration of an industrially sourced greenhouse gas and the energy or food obtained from the produced photosynthetic biomass. This versatility allows for the cultivation of economically useful biomass while reducing the environmental impacts of industrial facilities. In this context, this mini-review aims to discuss new technologies and strategies along with the main challenges and future prospects in the field and the ecological and economic impacts of CO2 biofixation by microalgae.


Assuntos
Ciclo do Carbono , Dióxido de Carbono/metabolismo , Microalgas/crescimento & desenvolvimento , Microalgas/metabolismo , Biomassa , Reatores Biológicos , Ecologia , Economia , Aquecimento Global , Gases de Efeito Estufa
6.
Science ; 364(6435)2019 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-30948524

RESUMO

As antibiotic consumption grows, bacteria are becoming increasingly resistant to treatment. Antibiotic resistance undermines much of modern health care, which relies on access to effective antibiotics to prevent and treat infections associated with routine medical procedures. The resulting challenges have much in common with those posed by climate change, which economists have responded to with research that has informed and shaped public policy. Drawing on economic concepts such as externalities and the principal-agent relationship, we suggest how economics can help to solve the challenges arising from increasing resistance to antibiotics. We discuss solutions to the key economic issues, from incentivizing the development of effective new antibiotics to improving antibiotic stewardship through financial mechanisms and regulation.


Assuntos
Antibacterianos/farmacologia , Bactérias/efeitos dos fármacos , Assistência à Saúde/economia , Farmacorresistência Bacteriana , Economia , Animais , Gestão de Antimicrobianos/economia , Mudança Climática , Desenvolvimento de Medicamentos/economia , Humanos , Controle Social Formal
7.
San Salvador; s.n; abr. 2019. 59 p. tab, graf, mapas, ilus.
Tese em Espanhol | LILACS | ID: biblio-1007294

RESUMO

OBJETIVO. Determinar los costos de intervención de las Medidas Contingenciales en el marco de la Epidemia de Neumonía Pediátrica Adquirida en la Comunidad, en el Hospital Nacional Santa Teresa de Zacatecoluca, El Salvador, de junio a agosto 2017. DISEÑO. Se realizó un estudio descriptivo, de corte transversal, en los Registros Administrativos y de Costos de todos los pacientes con diagnóstico de Neumonía Adquirida en la Comunidad y que cumplían con los criterios de inclusión establecidos. RESULTADOS. El Costo total de las Medidas Contingenciales implementadas durante la Epidemia de Neumonías Adquiridas en la comunidad fue de $ 53,678.28, lo que constituye un 0.63% del Presupuesto General. Los Costos Directos fueron de $ 38,827.39, lo que implica el 0.46% del Presupuesto General, y los Costos Indirectos fueron de $ 14,850.89, equivalente al 0.17% del Presupuesto. CONCLUSIONES. El porcentaje del Presupuesto utilizado en las Medidas Contingenciales en el marco de la Epidemia de NAC, si se comparan con el total del Presupuesto General, podría no ser significativo, pero si se comparan con el Presupuesto desglosado, el verdadero impacto se hace sentir, ya que constituye una erogación con proporciones altas, las cuales no estaban contempladas dentro del Presupuesto del año 2017 y durante ese período de tiempo se tuvieron que realizar ajustes de tipo administrativocontable para dar respuesta a la situación que se presentó


Assuntos
Humanos , Criança , Pneumonia , Economia da Saúde , Saúde da Criança , Economia , Epidemiologia Descritiva , Estudos Transversais , Administração em Saúde
8.
Artigo em Inglês | MEDLINE | ID: mdl-30935120

RESUMO

Environmental⁻economic efficiency assessment is an effective way to evaluate the degree of coordination between an economy and the environment. Previous studies on environmental⁻economic efficiency have primarily investigated the efficiency of economic production and have often overlooked the efficiency of pollution treatment in overall economic activities. We applied a network data envelopment analysis model to evaluate the environmental⁻economic efficiency of a multistage process with undesirable outputs in 30 Chinese provinces during 2001⁻2017. The multistage process consisted of two sequential stages: economic production and pollution treatment. The results show that the average environmental⁻economic efficiency across all provinces was generally low but demonstrated a gradual upward trend during the study period. The spatial pattern for the 30 provinces showed that provinces with medium or high environmental⁻economic efficiency are mainly located in the eastern regions in China. Finally, few provinces exhibited economic activities with high economic production and pollution treatment efficiency, with most provinces generally having low economic production and pollution treatment efficiency. Hence, provinces with different economic production and pollution treatment efficiency modes should implement targeted improvement strategies according to their characteristics.


Assuntos
Economia , Eficiência Organizacional/normas , Monitoramento Ambiental/métodos , Poluição Ambiental , China , Eficiência Organizacional/economia , Monitoramento Ambiental/economia
9.
Artigo em Inglês | MEDLINE | ID: mdl-30987107

RESUMO

In China, due to decades of the 'one-child policy' and continuous rural-urban labour migration, real population aging in rural areas is increasing more quickly than in urban areas, and the labour inputs in agricultural production are becoming ever more dependent on the elderly. Using CHARLS data, we examine the effect of health on the labour supply of rural elderly people. We construct a latent health stock index (LHSI) to eliminate measurement bias and then use this one-period lagged LHSI and the Heckman two-stage and the Bourguignon-Fournier-Gurand two-stage method to deal with the simultaneous causality of health and labour decisions and sample selectivity in model estimation. The results show that, in the overall level, the labour force participation and work time of rural elderly people increase significantly with the improvement of health. These effects on the males are sharply greater than on the females and are enhanced with age. In the subdivided agricultural and non-agricultural labour supply, health improvement is positively related with labour force participation of rural elderly and brings an employment allocation from agricultural section to non-agricultural section, especially on the males. However, as the work time, these relations are insignificant and invariant with gender and age.


Assuntos
Agricultura , Saúde da População Rural , População Rural , Recursos Humanos , Idoso , China , Demografia , Economia , Emprego , Humanos , Masculino , Modelos Estatísticos , Dinâmica Populacional
10.
Environ Sci Pollut Res Int ; 26(12): 12335-12345, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30847812

RESUMO

This study investigates the relationship between financial expenditure and carbon emission reduction using provincial-level dynamic panel data from 1996 to 2010. A positive correlation exists between the scale of financial expenditure and per capita carbon emissions, whereas a negative correlation exists between the composition of financial expenditure and per capita carbon emissions. The effects of subentry spending on the carbon emission reduction differ. An improvement in the relief structure of social security increases per capita carbon emissions, whereas an improvement in the composition of medical treatment and public health has no effect on per capita carbon emissions. Other forms of "pro-carbon emission reduction" spending lead to a reduction in per capita carbon emissions. An improvement in the composition of financial expenditure leads to a reduction in the carbon emissions of the second and third industries only. Meanwhile, the effect of the scale of financial expenditure is widespread across all industries.


Assuntos
Poluição do Ar/estatística & dados numéricos , Carbono/análise , Economia , Renda/estatística & dados numéricos , Poluição do Ar/economia , China , Gastos em Saúde , Saúde Pública
11.
Glob Health Action ; 11(sup3): 1570645, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30890039

RESUMO

BACKGROUND: The right to health was enshrined in the constitution of the World Health Organization (WHO) in 1946 and in the Universal Declaration of Human Rights in 1948. The latter Declaration, which also guaranteed women's rights, was signed by almost all countries in the world. Subsequent international conventions reinforced these rights, requiring that women be able to realize their fundamental freedoms and dignity. Although the value of incorporating gender into health systems has been increasingly acknowledged over the years, gender inequalities in health persist. OBJECTIVE: To introduce a tool to help countries assess their performance in addressing gender inequalities in their health systems, using the example of the Zika virus (ZIKV) in countries of the Americas. METHODS: This paper is based on comprehensive reviews of the literature on the links between gender equality, health systems and human rights, and available scientific evidence about an adequate response to ZIKV. RESULTS: The authors present a simple two-part framework from the human rights perspectives of the health system as duty bearer, incorporating WHO's six health system building blocks, and of its clients as rights holders. The authors apply the framework to ZIKV in the Americas, and identify strengths and weaknesses at every level of the health system. They find that when considering gender, health systems have focused mainly on dichotomous sex differences, failing to consider broader gender relations and processes affecting access to services, quality of care, and health outcomes. CONCLUSIONS: The authors' framework will permit countries to assess progress toward gender equality in health, within the context of their human rights commitments, by examining each health system building block, and the degree to which clients are realizing their rights. By applying the framework to specific health conditions, gender-related achievements and shortcomings can be identified in each health system component, fostering a more comprehensive and gender-sensitive response.


Assuntos
Disparidades em Assistência à Saúde , Direitos Humanos , Direitos da Mulher , Infecção por Zika virus , Américas , Assistência à Saúde , Países em Desenvolvimento , Economia , Feminino , Humanos , Masculino , Assistência Médica , Parto , Gravidez , Fatores Socioeconômicos , Zika virus
12.
Public Health ; 169: 163-172, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30879646

RESUMO

OBJECTIVES: The objective of this study was to identify important gaps in the public health evidence base and consider the implications of these for public health and public health economics. STUDY DESIGN: This was a review and critique of public health policy in the UK. METHODS: Using two key psychological concepts relating to cognitive biases, viz. cognitive dissonance and heuristics, the shortcomings in public health approaches to confronting the prevalence of non-communicable diseases are described. The implications are drawn out. RESULTS: Two cognitive biases in public health thinking are identified. (i) A dissonance between what is known and what is done, resulting in the repetition of solutions that have previously been shown to have had little or no effect. (ii) The habitual use of set of heuristics which mean that simple solutions to complex problems are preferred to undertaking the detailed assessment of how to bring about change. These biases mean that the evidence about the dynamics of populations and the ways that the mechanisms of prevention actually operate seldom feature in the way interventions, policy and practice are undertaken. The evidence base is consequently highly skewed. CONCLUSIONS: Health economics combined with sociological reasoning has potentially an important role to play in developing the ideas that will overcome the problems attaching to the cognitive biases.


Assuntos
Viés , Cognição , Saúde Pública , Economia , Política de Saúde , Humanos , Sociologia , Reino Unido
13.
Proc Natl Acad Sci U S A ; 116(13): 6001-6006, 2019 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-30858319

RESUMO

Fine particulate matter (PM2.5) air pollution exposure is the largest environmental health risk factor in the United States. Here, we link PM2.5 exposure to the human activities responsible for PM2.5 pollution. We use these results to explore "pollution inequity": the difference between the environmental health damage caused by a racial-ethnic group and the damage that group experiences. We show that, in the United States, PM2.5 exposure is disproportionately caused by consumption of goods and services mainly by the non-Hispanic white majority, but disproportionately inhaled by black and Hispanic minorities. On average, non-Hispanic whites experience a "pollution advantage": They experience ∼17% less air pollution exposure than is caused by their consumption. Blacks and Hispanics on average bear a "pollution burden" of 56% and 63% excess exposure, respectively, relative to the exposure caused by their consumption. The total disparity is caused as much by how much people consume as by how much pollution they breathe. Differences in the types of goods and services consumed by each group are less important. PM2.5 exposures declined ∼50% during 2002-2015 for all three racial-ethnic groups, but pollution inequity has remained high.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Economia/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Exposição por Inalação/efeitos adversos , Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Humanos , Exposição por Inalação/estatística & dados numéricos , Material Particulado/efeitos adversos , Fatores Socioeconômicos , Estados Unidos/epidemiologia
15.
Artigo em Inglês | MEDLINE | ID: mdl-30857193

RESUMO

The Circular Economy is a paradigm shift attempting to replace the end-of-life concept with reducing, reusing, recycling and recovering materials and to slow down, close and narrow material and power loops. This concept is much discussed in the academic literature, but limited progress has been accomplished so far regarding its empirical analysis. The objective of this work is to study circular economy practices and analyze in depth the circular economy behavior in European firms. We find that firms' circular economy behavior is a gradual process where measures are implemented gradually, starting with activities involving control measures and ending with putting preventive practices in place. We discovered also that the most proactive companies in implementing circular economy measures generally come across certain common barriers such as administrative processes, regulations and a lack of human resources to perform these practices, while firms that have not implemented circular economy measures view financing, investment and cost⁻benefit barriers as the most significant. Significant efforts need to be undertaken by firms to accomplished circular economy. Also circular economy regulation should be improved to make it easier for companies to implement strategies that will make them more sustainable.


Assuntos
Economia , Empresa de Pequeno Porte/organização & administração , Europa (Continente) , Inovação Organizacional , Reciclagem , Empresa de Pequeno Porte/economia
16.
Proc Natl Acad Sci U S A ; 116(13): 6045-6050, 2019 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-30837314

RESUMO

A large literature documents how intergenerational mobility-the degree to which (dis)advantage is passed on from parents to children-varies across and within countries. Less is known about the origin or persistence of such differences. We show that US areas populated by descendants to European immigrants have similar levels of income equality and mobility as the countries their forebears came from: highest in areas dominated by descendants to Scandinavian and German immigrants, lower in places with French or Italian heritage, and lower still in areas with British roots. Similar variation in mobility is found for the black population and when analyzing causal place effects, suggesting that mobility differences arise at the community level and extend beyond descendants of European immigrant groups. Our findings indicate that the geography of US opportunity may have deeper historical roots than previously recognized.


Assuntos
Mobilidade Social , Economia , Emigrantes e Imigrantes/estatística & dados numéricos , Europa (Continente)/etnologia , Geografia , Humanos , Renda , Mobilidade Social/economia , Mobilidade Social/estatística & dados numéricos , Fatores Socioeconômicos , Estados Unidos
17.
Public Health ; 169: 10-13, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30771721

RESUMO

OBJECTIVE: The aim of the study is to review evidence of the negative consequences of international economic sanctions on population health in Iran and pathways via which the sanctions affect health. STUDY DESIGN: This is a narrative review. METHODS: Data from the World Bank and the Central Bank of Iran were gathered to clarify economic consequences of sanctions. Moreover, the literature was reviewed for published data on health consequences of economic sanctions in Iran and economic crisis in other parts of the world. Finally, some mechanisms via which economic sanctions could affect health were reviewed. RESULTS: Iran experienced 11.8% reduction in gross domestic production growth in 2012 compared with 2011, besides 40% inflation and 200% depreciation of Iranian currency. Ultimately, it resulted in increased living costs and unemployment. One year after termination of sanctions, Iran's gross domestic production growth increased by 14.1% in 2016. Data revealed that mental health has been affected during sanctions. Moreover, access to essential and lifesaving medication has been compromised, similar to other countries during economic recession. CONCLUSION: Economic sanctions have had negative consequences on population health in Iran by impairing social determinants of health and access to medication and care. These sanctions widen economic inequality and health gap.


Assuntos
Economia , Políticas , Saúde da População , Acesso aos Serviços de Saúde , Humanos , Irã (Geográfico) , Determinantes Sociais da Saúde
18.
Chemosphere ; 222: 688-695, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30735969

RESUMO

Metformin has been widely used as an oral drug for the treatment of diabetes mellitus. However, its consumption can be influenced by many economic and social factors. In this study, we investigated the spatial consumption pattern of metformin in China through wastewater-based epidemiology (WBE) approach. Influent wastewater samples were collected from 21 wastewater treatment plants (WWTPs) in 19 cities of the northeast China. A method using solid-phase extraction combined with N-Methyl-bis (trifluoroacetamide) derivatization for GC-MS detection was applied for metformin analysis. In 21 days, metformin showed high stability in wastewater at 24 °C and -20 °C. The mean concentrations of metformin in all WWTPs ranged from 2.42 µg L-1 to 53.6 µg L-1. The consumption of metformin was 0.66-15.6 mg d-1 capita-1 with the mean value of 5.54 ±â€¯4.28 mg d-1 capita-1. The prevalence of metformin ranged from 0.09% to 2.10% with an average of 0.74%. Both the consumption and prevalence of metformin displays significant spatial variations in northeast China. A statistical correlation analysis indicated that the consumption of metformin increases with the decrease of per capita disposable income of urban residents. To further predict the use of metformin in China, we developed a regress model and depicted a consumption map. The annual consumption of urban residents in Chinese provinces range from 1085-63,828 kg yr-1 with mean value of 25,347 kg yr-1, which would provide a certain reference value for public health care and diabetes control.


Assuntos
Metformina/análise , Águas Residuárias/química , Poluentes Químicos da Água , China , Cidades , Economia/estatística & dados numéricos , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Hipoglicemiantes/análise , Renda/estatística & dados numéricos , Extração em Fase Sólida , Distribuições Estatísticas , Poluentes Químicos da Água/análise , Purificação da Água
19.
J Fam Psychol ; 33(3): 338-348, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30742465

RESUMO

We followed 402 African American young adults from ages 24 to 29, a period of emerging committed relationships, to examine the association of contextual stress (CS), for example, experiences of financial strain, victimization, and racial discrimination, with inflammation, and to test predictions that greater perceived relationship warmth and support (PRWS) at age 29 would moderate the association between earlier CS and inflammation, using a multiplex assessment of cytokines to construct an index of the ratio between predominantly proinflammatory cytokines versus predominantly anti-inflammatory cytokines. CS experienced at age 24 was associated with greater inflammation at age 29 in the full sample (b = .112, p = .004). PRWS at age 29 moderated the association of earlier CS with inflammation (b = -.114, p = .011), but there was no significant main effect of PRWS (b = -.053, p = .265). Finally, using an internal moderator approach, we compared the association of CS with inflammation among those not in a committed relationship to those in more or less supportive relationships, showing a significant and stronger association of CS with inflammation for those with low PRWS (-1 SD; b = .182, p < .001), a weaker and nonsignificant association of CS with inflammation among those with higher PRWS (+1 SD; b = -.002, p = .975), and an intermediate and nonsignificant association of CS with inflammation among those with no committed romantic relationship (b = .077, p = .227). Results were robust to number of cytokines included in the inflammation index. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Afro-Americanos/psicologia , Vítimas de Crime/psicologia , Inflamação/imunologia , Inflamação/psicologia , Racismo/psicologia , Parceiros Sexuais/psicologia , Apoio Social , Estresse Psicológico/imunologia , Adulto , Citocinas/imunologia , Citocinas/metabolismo , Economia , Feminino , Humanos , Mediadores da Inflamação/imunologia , Estudos Longitudinais , Masculino , Percepção Social , Fatores Socioeconômicos , Estresse Psicológico/psicologia , Adulto Jovem
20.
JAMA ; 321(5): 516, 2019 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-30721285
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