Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 13.036
Filtrar
1.
Urol Clin North Am ; 48(2): 259-268, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33795060

RESUMEN

The Quality Payment Program was established by the Medicare Access and CHIP Reauthorization Act (MACRA) legislation in response to repeated efforts to create a permanent so-called doc fix in response to the failures of the sustainable growth formula. This article examines the history leading up to MACRA, the current pathways associated with the Quality Payment Program, and future expectation both from the Centers for Medicare and Medicaid Services, stakeholders, and patients.


Asunto(s)
Medicare/economía , Planes de Incentivos para los Médicos/economía , Reembolso de Incentivo/economía , Urólogos/economía , Centers for Medicare and Medicaid Services, U.S. , Predicción , Humanos , Indicadores de Calidad de la Atención de Salud , Estados Unidos
2.
Vaccimonitor (La Habana, Print) ; 30(1)ene.-abr. 2021. tab, graf
Artículo en Español | LILACS, CUMED | ID: biblio-1150248

RESUMEN

Frente a la creciente demanda de producción de la vacuna Antihepatitis B recombinante, constituye un reto para el Centro Nacional de Biopreparados aumentar la fabricación del producto, para lo cual el proceso de llenado aséptico requirió de una inversión. En el trabajo se presenta la selección de la nueva máquina llenadora y se calculan los indicadores económicos asociados a la inversión, la que se recupera en el cuarto año con una ganancia de $2.655.300. Luego de la inversión se evaluó el desempeño de la nueva máquina y se comparó con los resultados anteriores a la inversión. Se compararon los valores de volumen dispensado por vial, velocidad de llenado, rendimiento operacional, principales defectos detectados en los lotes de llenado, tiempo promedio de llenado de un lote, costo de producción y comportamiento del monto resarcido al cliente por rechazos de producto. El volumen dispensado por vial resulta más exacto, reduciendo las pérdidas de producto. La velocidad de llenado aumenta 1,7 veces respecto a la máquina anterior. El rendimiento operacional aumenta en un 13,63 percent. Disminuyen los rechazos de producto en 40.897 viales, representando un ahorro de $24.538 ingresados en 73 lotes producidos. Se ahorra en energía eléctrica un total de $14.718 en un mes. El costo unitario del proceso de llenado disminuye en 0,0648 $/vial(AU)


National Center for Biopreparations must increase the production of the recombinant hepatitis B vaccine because of its growing demand. In order to fulfill this challenge, the aseptic filling process required an investment. This work, presents the selection of the new filling machine and the economic indicators that support the investment. Inversion cost is recovered in the fourth year with a profit equivalent to $2,655,300. After the investment, the performance of the new machine was compared with the previous one. Volume dispensed per vial, filling speed, operational performance, major defects detected in filling batches, average filling time for a batch, production cost and payments to customers due to rejected products were compared. The control of the volume dispensed per vial is more accurate, reducing product losses. The filling speed increases 1.7 times compared to the previous machine. Operational performance increases by 13.63 percent. Product rejections are reduced by 40,897 vials, saving $24,538 for the 73 batches. Electricity consumption diminished, saving $14,718 monthly. The unit cost of the filling process decreases by $0.0648/vial(AU)


Asunto(s)
Pichia , Proteínas Recombinantes , Virus de la Hepatitis B , Vacunas
3.
Int J Qual Health Care ; 33(1)2021 Mar 03.
Artículo en Inglés | MEDLINE | ID: mdl-33620065

RESUMEN

BACKGROUND: The effects of an early and prolonged lockdown during the coronavirus disease 2019 (COVID-19) pandemic on cardiovascular intensive care units (CICUs) are not well established. OBJECTIVES: This study analyses patterns of admission, mortality and performance indicators in a CICU before and during the Argentine lockdown in the COVID-19 pandemic. METHODS: This is a retrospective observational cross-sectional study of all consecutive patients aged 18 years or more admitted to the cardiac intensive care unit at a high-volume reference hospital in Buenos Aires, Argentina, comparing hospitalization rates, primary causes of admission, inpatient utilization indicators, pharmacy supplies' expenditures and in-hospital mortality between 5 March and 31 July 2020, with two corresponding control periods in 2019 and 2018. RESULTS: We included 722 female patients [mean age of 61.6 (SD 15.5) years; 237 (32.8%)]. Overall hospitalizations dropped 53.2% (95%CI: 45.3, 61.0%), from 295.5 patients/year over the periods 2018/2019 to 137 patients in 2020. Cardiovascular disease-related admissions dropped 59.9%, while admission for non-cardiac causes doubled its prevalence from 9.6% over the periods 2018/2019 to 22.6% in the study period (P < 0.001).In the period 2020, the bed occupancy rate fell from 82.2% to 77.4%, and the bed turnover rate dropped 50% from 7.88 to 3.91 monthly discharges/bed. The average length of stay doubled from 3.26 to 6.75 days, and the turnover interval increased from 3.8 to 8.39 days in 2020.Pharmacy supplies' expenditures per discharge increased 134% along with a rise in antibiotics usage from 6.5 to 11.4 vials/ampoules per discharge (P < 0.02).Overall mortality increased from 7% (n = 41) to 13.9% (n = 19) (P = 0.008) at the expense of non-cardiac-related admissions (3.6-19.4%, P = 0.01). CONCLUSIONS: This study found a significant reduction in overall and cardiovascular disease-related causes of admission to the cardiac intensive care unit, worse performance indicators and increased in-hospital mortality along the first 5 months of the early and long-lasting COVID-19 lockdown in Argentina. These results highlight the need to foster public awareness concerning the risks of avoiding hospital attendance. Moreover, health systems should follow strict screening protocols to prevent potential biases in the admission of patients with critical conditions unrelated to the COVID-19 pandemic.


Asunto(s)
/epidemiología , Enfermedades Cardiovasculares/epidemiología , Unidades de Cuidados Intensivos/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Adulto , Anciano , Argentina/epidemiología , Ocupación de Camas/estadística & datos numéricos , Estudios Transversales , Femenino , Política de Salud , Mortalidad Hospitalaria/tendencias , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Pandemias , Servicio de Farmacia en Hospital/economía , Servicio de Farmacia en Hospital/estadística & datos numéricos , Estudios Retrospectivos
4.
Santiago; PAHO; 2021-02-11.
en Portugués | PAHO-IRIS | ID: phr-53264

RESUMEN

Durante 2019, 7,4% da população da América Latina e do Caribe conviveu com a fome, o que equivale a 47,7 milhões de pessoas. A situação vem se deteriorando nos últimos 5 anos, com um aumento de 13,2 milhões de pessoas subalimentadas. Se essa tendência continuar, a possibilidade de cumprimento da meta Fome Zero da Meta 2 (ODS2) dos Objetivos de Desenvolvimento Sustentável (ODS) está se afastando. Estima-se que, em 2030, a fome afetará 67 milhões de pessoas na região, número que não inclui as repercussões da pandemia de COVID-19. A população afetada pela insegurança alimentar continuou a aumentar na América Latina durante os últimos 5 anos. Em 2019, quase um terço da população, ou seja, 191 milhões de pessoas, foram afetadas pela insegurança alimentar moderada ou grave. O atraso do crescimento infantil está diminuindo na região e o sobrepeso entre as crianças com menos de 5 anos de idade está aumentando. Informações recentes sobre a desnutrição nos países da região, mostram que cerca de um em cada cinco territórios está muito atrasado, seja devido à baixa estatura ou ao sobrepeso em crianças menores de 5 anos. Os níveis mais altos de atraso no crescimento encontram-se nas áreas rurais que têm alto índice de pobreza, baixa renda, baixa escolaridade, maior grau de informalidade no emprego, menor acesso a serviços e maior proporção de população indígena e afrodescendente. O sobrepeso parece estar distribuído geograficamente de forma mais homogênea. Contudo, os territórios mais atrasados tendem a se concentrar nas áreas urbanas, com maiores rendas, menor pobreza, maior acesso a serviços e maior formalidade de trabalho. Embora a real dimensão do impacto da pandemia de coronavírus ainda seja desconhecida, ela ameaça ampliar essas diferenças e as lacunas entre territórios atrasados e não atrasados. A pandemia atinge especialmente as populações e territórios mais vulneráveis, onde existe um maior número de empregos informais, os rendimentos são mais baixos e os alimentos saudáveis são escassos. Enfrentar o problema da segurança alimentar e nutricional em territórios atrasados requer intervenções multidimensionais que abordem as várias causas da má nutrição de forma integrada e que ofereçam uma resposta coordenada em várias dimensões do desenvolvimento. O Panorama descreve algumas das principais intervenções políticas que são desenvolvidas na região em torno de três grupos de medidas com foco em: 1) melhorar e promover o acesso econômico a alimentação adequada, 2) melhorar o acesso físico aos alimentos e produzir alimentos que promovam uma nutrição adequada e 3) melhorar o uso e a qualidade dos alimentos.


Asunto(s)
Nutrición, Alimentación y Dieta , Alimentos , Hambre , Nutrición de los Grupos de Riesgo , Desarrollo Sostenible , Indicadores de Desarrollo Sostenible , Infecciones por Coronavirus , Coronavirus , Infecciones por Coronavirus , Betacoronavirus , Pobreza , Áreas de Pobreza
5.
Santiago; PAHO; 2021-02-11.
en Inglés | PAHO-IRIS | ID: phr-53263

RESUMEN

During 2019, 7.4 percent of the population in Latin America and the Caribbean (LAC) lived in hunger, which is equivalent to 47.7 million people. The situation has been deteriorating over the past 5 years, with an increase of 13.2 million undernourished people. If this trend continues, the possibility of meeting the Zero Hunger target of Goal 2 (SDG2) of the Sustainable Development Goals (SDG) will be even further away. It is estimated that, in 2030, hunger will affect 67 million people in the region, a figure that does not take into account repercussions of the COVID-19 pandemic. The population affected by food insecurity in Latin America has continued to increase over the past 5 years. In 2019, almost a third of the population, or 191 million people, were affected by moderate or severe food insecurity. In the region, child stunting is decreasing and overweight in children under 5 is increasing. Recent information on malnutrition in the region’s countries shows that nearly one in every 5 territories is lagging in relation to either stunting or overweight in children under 5. The highest lags in relation to stunting are found in rural areas. These territories have high levels of poverty, low income, low schooling rate, a higher presence of informal employment, less access to services and a higher proportion of indigenous and Afro-descendant population. Overweight in children under 5 seems to be geographically distributed in a more homogeneous way. However, highly lagging territories tend to be concentrated in urban areas, with higher incomes, lower poverty, greater access to services and more formal labor. Although the real dimension of the impact of the coronavirus pandemic is still unknown, it threatens to widen these differences and the gaps between lagging and non-lagging territories. The pandemic hits the most vulnerable populations and territories particularly hard, where there are a greater number of informal jobs, incomes are lower and healthy food is scarce. Addressing the problem of food security and nutrition in lagging territories requires multidimensional interventions that address the various causes of malnutrition in an integrated manner, and that offer a coordinated response across various dimensions of development. This Regional Overview describes some of the main policy interventions that are being carried out in the region within three groups of measures focused on: 1) improving and promoting economic access to adequate food, 2) improving physical access to food and the production of food that promotes adequate nutrition, and 3) improving food use and quality.


Asunto(s)
Nutrición, Alimentación y Dieta , Alimentos , Hambre , Nutrición de los Grupos de Riesgo , Desarrollo Sostenible , Indicadores de Desarrollo Sostenible , Infecciones por Coronavirus , Infecciones por Coronavirus , Coronavirus , Betacoronavirus , Pobreza , Áreas de Pobreza
6.
Arch. esp. urol. (Ed. impr.) ; 74(1): 129-134, ene.-feb. 2021. graf
Artículo en Español | IBECS | ID: ibc-199444

RESUMEN

INTRODUCCIÓN: La enfermedad litiásica (EL) presenta una evolución crónica en un alto porcentaje de pacientes. Teniendo en cuenta el alto coste sanitario asociado al tratamiento de esta patología, deberían adaptarse y utilizarse enfoques y estrategias de cronicidad de forma similar a otras enfermedades crónicas. Uno de los modelos aplicados para la gestión de estas enfermedades con importante repercusión en el consumo de recursos sanitarios es el modelo de Kaiser Permanente. MATERIAL Y MÉTODOS: Para el desarrollo de este proyecto de gestión de la enfermedad litiásica se realizó una implementación en tres fases diferentes: Fase 1: identificación de la población objetivo del programa y diseño del modelo de asignación de riesgo. Se consideraron como factores de riesgo, la clasificación del paciente en el modelo CRG (clasificación de grupos de riesgo o carga de morbilidad) como predictor de mayor consumo de recursos, factores de riesgo anatómicos, factores de riesgo litógenos y factores hereditarios asociados a la litiasis. Fase 2: clasificación de los pacientes según riesgo y aplicación de medidas específicas. Las medidas de intervención dependerán del nivel de riesgo asignado: bajo, intermedio o alto riesgo. Fase 3: análisis de indicadores y resultados. RESULTADOS: La aplicación del modelo permitió diseñar el algoritmo y dibujar la pirámide de Kaiser: El 59% de los pacientes se asignaron al grupo de bajo riesgo y el 41% correspondían a pacientes de riesgo alto (36,5%) o muy alto (4,5%). Los resultados preliminares obtenidos a dos años de seguimiento muestran una reducción de la recidiva litiásica global en un 42,2% cuando se comparó con un grupo control (seguimiento clásico). La adherencia global del grupo intervención fue de un 96,4% y la satisfacción de los pacientes incluidos en el programa fue de 9,93/10, superiores estadísticamente al grupo control. CONCLUSIÓN: El modelo de gestión poblacional basado en la pirámide de Kaiser Permanente es factible como modelo de gestión de la condición crónica litiásica. La implantación de este modelo ha demostrado de forma preliminar su eficiencia en pacientes crónicos


INTRODUCTION: Stone disease is a chronic condition in a high percentage of patients. Due to the high healthcare costs associated with the treatment of this pathology, chronicity approaches and strategies should be adapted and used in a similar way to other chronic diseases. One of the models applied for the management of these diseases with a significant impact on the consumption of health resources is the Kaiser Permanente model. MATERIAL AND METHODS: A chronic stone disease management project was developed and carried out in three different phases: Phase 1: identification of the target population of the program and design of the risk allocation model. The risk factors considered were CRG model (classification of risk groups or burden of morbidity) as a predictor of greater consumption of resources, anatomical risk factors, lithogenic risk factors, and hereditary factors associated with lithiasis. Phase 2: classification of patients according to risk and application of specific measures. The intervention measures will depend on the level of risk assigned: low, intermediate or high risk. Phase 3: analysis of indicators and results. RESULTS: An algorithm of risk allocation was designed, and a Kaiser pyramid drawn. A total of 59% of the patients were assigned to the low-risk group and 41% corresponded to high-risk (36.5%) or very high-risk patients (4.5%). Preliminary results obtained at two years of follow-up show a reduction in global stone recurrence by 42.2% when compared with a control group (classic follow-up). The overall adherence of the intervention group was 96.4% and the satisfaction of the patients included in the program was 9.93/10. CONCLUSIONS: A management model for chronic stone disease based on the Kaiser Permanente pyramid is feasible. The implantation of this model has preliminarily demonstrated its efficiency in chronic patients


Asunto(s)
Humanos , Prestación de Atención de Salud , Enfermedad Crónica/epidemiología , Modelos Económicos , Factores de Riesgo , Algoritmos
7.
J Med Econ ; 24(1): 308-317, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33555956

RESUMEN

OBJECTIVE: The aims of this study were to evaluate health outcomes and the economic burden of hospitalized COVID-19 patients in the United States. METHODS: Hospitalized patients with a primary or secondary discharge diagnosis code for COVID-19 (ICD-10 code U07.1) from 1 April to 31 October 2020 were identified in the Premier Healthcare COVID-19 Database. Patient demographics, hospitalization characteristics, and concomitant medical conditions were assessed. Hospital length of stay (LOS), in-hospital mortality, hospital charges, and hospital costs were evaluated overall and stratified by age groups, insurance types, and 4 COVID-19 disease progression states based on intensive care unit (ICU) and invasive mechanical ventilation (IMV) usage. RESULTS: Of the 173,942 hospitalized COVID-19 patients, the median age was 63 years, 51.0% were male, and 48.5% were covered by Medicare. The most prevalent concomitant medical conditions were cardiovascular disease (73.5%), hypertension (64.8%), diabetes (40.7%), obesity (27.0%), and chronic kidney disease (24.2%). Approximately one-fifth (21.9%) of the hospitalized COVID-19 patients were admitted to the ICU and 16.9% received IMV; most patients (73.6%) did not require ICU admission or IMV, and 12.4% required both. The median hospital LOS was 5 days, in-hospital mortality was 13.6%, median hospital charges were $43,986, and median hospital costs were $12,046. Hospital LOS and in-hospital mortality increased with ICU and/or IMV usage and age; hospital charges and costs increased with ICU and/or IMV usage. Patients with both ICU and IMV usage had the longest median hospital LOS (15 days), highest in-hospital mortality (53.8%), and highest hospital charges ($198,394) and hospital costs ($54,402). LIMITATIONS: This retrospective administrative database analysis relied on coding accuracy and a subset of admissions with validated/reconciled hospital costs. CONCLUSIONS: This study summarizes the severe health outcomes and substantial hospital costs of hospitalized COVID-19 patients in the US. The findings support the urgent need for rapid implementation of effective interventions, including safe and efficacious vaccines.


Asunto(s)
/economía , Precios de Hospital/estadística & datos numéricos , Hospitalización/economía , Evaluación de Resultado en la Atención de Salud , Anciano , Anciano de 80 o más Años , /mortalidad , Costo de Enfermedad , Progresión de la Enfermedad , Femenino , Mortalidad Hospitalaria , Humanos , Cobertura del Seguro/economía , Unidades de Cuidados Intensivos/economía , Tiempo de Internación/economía , Masculino , Persona de Mediana Edad , Respiración Artificial/economía , Estudios Retrospectivos , Estados Unidos/epidemiología
8.
PLoS One ; 16(2): e0244860, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33524031

RESUMEN

INTRODUCTION: Regional anesthesia offers an alternative to general anesthesia and may be advantageous in low resource environments. There is a paucity of data regarding the practice of regional anesthesia in low- and middle-income countries. Using access data from a free Android app with curated regional anesthesia learning modules, we aimed to estimate global interest in regional anesthesia and potential applications to clinical practice stratified by World Bank income level. METHODS: We retrospectively analyzed data collected from the free Android app "Anesthesiologist" from December 2015 to April 2020. The app performs basic anesthetic calculations and provides links to videos on performing 12 different nerve blocks. Users of the app were classified on the basis of whether or not they had accessed the links. Nerve blocks were also classified according to major use (surgical block, postoperative pain adjunct, rescue block). RESULTS: Practitioners in low- and middle-income countries accessed the app more frequently than in high-income countries as measured by clicks. Users from low- and middle-income countries focused mainly on surgical blocks: ankle, axillary, infraclavicular, interscalene, and supraclavicular blocks. In high-income countries, more users viewed postoperative pain blocks: adductor canal, popliteal, femoral, and transverse abdominis plane blocks. Utilization of the app was constant over time with a general decline with the start of the COVID-19 pandemic. CONCLUSION: The use of an in app survey and analytics can help identify gaps and opportunities for regional anesthesia techniques and practices. This is especially impactful in limited-resource areas, such as lower-income environments and can lead to targeted educational initiatives.


Asunto(s)
Anestesia Local/economía , Educación en Salud/economía , Renta , Aplicaciones Móviles , Telemedicina , Geografía , Humanos , Bloqueo Nervioso , Evaluación de Resultado en la Atención de Salud , Dolor Postoperatorio/etiología
9.
Bull World Health Organ ; 99(2): 102-111B, 2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-33551504

RESUMEN

Objective: To examine countries' engagement with the health impacts of climate change in their formal statements to intergovernmental organizations, and the factors driving engagement. Methods: We obtained the texts of countries' annual statements in United Nations (UN) general debates from 2000 to 2019 and their nationally determined contributions at the Paris Agreement in 2016. To measure countries' engagement, we used a keyword-in-context text search with relevant search terms to count the total number of references to the relationship of health to climate change. We used a machine learning model (random forest predictions) to identify the most important country-level predictors of engagement. The predictors included political and economic factors, health outcomes, climate change-related variables and membership of political negotiating groups in the UN. Findings: For both UN general debate statements and nationally determined contributions, low- and middle-income countries discussed the health impacts of climate change much more than did high-income countries. The most important predictors of engagement were health outcomes (infant mortality, maternal deaths, life expectancy), countries' income levels (gross domestic product per capita), and fossil fuel consumption. Membership of political negotiating groups (such as the Group of 77 and Small Island Developing States) was a less important predictor. Conclusion: Our analysis indicated a higher engagement in countries that carry the heaviest climate-related health burdens, but lack necessary resources to address the impacts of climate change. These countries are shouldering responsibility for reminding the global community of the implications of climate change for people's health.

10.
Lancet Glob Health ; 9(3): e331-e339, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33607031

RESUMEN

BACKGROUND: Many governments have introduced pay-for-performance programmes to incentivise health providers to improve quality of care. Evidence on whether these programmes reduce or exacerbate disparities in health care is scarce. In this study, we aimed to assess socioeconomic inequalities in the performance of family health teams under Brazil's National Programme for Improving Primary Care Access and Quality (PMAQ). METHODS: For this longitudinal study, we analysed data on the quality of care delivered by family health teams participating in PMAQ over three rounds of implementation: round 1 (November, 2011, to March, 2013), round 2 (April, 2013, to September, 2015), and round 3 (October, 2015, to December, 2019). The primary outcome was the percentage of the maximum performance score obtainable by family health teams (the PMAQ score), based on several hundred (ranging from 598 to 914) indicators of health-care delivery. Using census data on household income of local areas, we examined the PMAQ score by income ventile. We used ordinary least squares regressions to examine the association between PMAQ scores and the income of each local area across implementation rounds, and we did an analysis of variance to assess geographical variation in PMAQ score. FINDINGS: Of the 40 361 family health teams that were registered as ever participating in PMAQ, we included 13 934 teams that participated in the three rounds of PMAQ in our analysis. These teams were located in 11 472 census areas and served approximately 48 million people. The mean PMAQ score was 61·0% (median 61·8, IQR 55·3-67·9) in round 1, 55·3% (median 56·0, IQR 47·6-63·4) in round 2, and 61·6% (median 62·7, IQR 54·4-69·9) in round 3. In round 1, we observed a positive socioeconomic gradient, with the mean PMAQ score ranging from 56·6% in the poorest group to 64·1% in the richest group. Between rounds 1 and 3, mean PMAQ performance increased by 7·1 percentage points for the poorest group and decreased by 0·8 percentage points for the richest group (p<0·0001), with the gap between richest and poorest narrowing from 7·5 percentage points (95% CI 6·5 to 8·5) to -0·4 percentage points over the same period (-1·6 to 0·8). INTERPRETATION: Existing income inequalities in the delivery of primary health care were eliminated during the three rounds of PMAQ, plausibly due to a design feature of PMAQ that adjusted financial payments for socioeconomic inequalities. However, there remains an important policy agenda in Brazil to address the large inequities in health. FUNDING: UK Medical Research Council, Newton Fund, and CONFAP (Conselho Nacional das Fundações Estaduais de Amparo à Pesquisa).


Asunto(s)
Salud de la Familia/normas , Atención Primaria de Salud/organización & administración , Calidad de la Atención de Salud/organización & administración , Reembolso de Incentivo/estadística & datos numéricos , Brasil , Disparidades en Atención de Salud/economía , Disparidades en Atención de Salud/normas , Humanos , Estudios Longitudinales , Grupo de Atención al Paciente/organización & administración , Atención Primaria de Salud/economía , Atención Primaria de Salud/normas , Indicadores de Calidad de la Atención de Salud , Calidad de la Atención de Salud/economía , Calidad de la Atención de Salud/normas , Factores Socioeconómicos
11.
Aten. prim. (Barc., Ed. impr.) ; 53(1): 36-42, ene. 2021. tab, graf
Artículo en Español | IBECS-Express | IBECS | ID: ibc-ET6-1866

RESUMEN

OBJETIVO: Analizar si la utilización de códigos Z en la historia clínica electrónica (HCE) se correlaciona con la realidad socioeconómica de la población atendida en Atención Primaria (AP). DISEÑO: Estudio observacional, descriptivo, transversal, de tipo ecológico. Emplazamiento: 90 centros de salud de dos Direcciones Asistenciales de AP, Comunidad de Madrid. PARTICIPANTES: El total de pacientes atendidos durante el año 2016 fue de 1.920.124 (54,33% mujeres, 45,67% hombres). El 7,15% recibió algún código Z (67,29% mujeres, 32,71% hombres). Mediciones principales: Como variable dependiente se estableció la proporción de pacientes con registros de códigos Z en su HCE. Como variables independientes se seleccionaron dos indicadores socioeconómicos que reflejan de forma objetiva las diferencias entre zonas básicas de salud: renta media disponible per cápita y proporción de inmigrantes económicos. Para evaluar la correlación entre variable dependiente e independientes se recurrió a análisis multivariante de correlación-regresión. RESULTADOS: Se observó que a mayor renta disponible, menor proporción de registros de episodios Z en las HCE (coeficiente de correlación de Pearson: -0,56). Sin embargo, existe una gran variabilidad de registro de códigos Z y la codificación no consigue visibilizar las realidades socioeconómicas de las poblaciones atendidas (odds ratio diagnóstica: 0,12 [IC: 0,05-0,32]). CONCLUSIONES: Resulta relevante para una orientación comunitaria de la AP la utilización de distintas herramientas que faciliten visibilizar el impacto en la salud de las desigualdades sociales, así como su evaluación a través de diversas metodologías de investigación. Los códigos Z no visibilizan en la zona estudiada los determinantes sociales de la salud de la población atendida


OBJECTIVE: Analyze whether the use of Z codes in the Electronic Health Record (EHR) correlates with the socioeconomic reality of the population attended. DESIGN: Observational, descriptive, cross-sectional, ecological study. LOCATION: 90 health centres of two Primary Health Care (PHC) Departments of the Community of Madrid. PARTICIPANTS: The total number of patients treated during 2016: 1,920,124 (54.33% women, 45.67% men). The 7.15% received some Z code (67.29% women, 32.71% men). MAIN MEASUREMENTS: As a dependent variable, the proportion of patients with Z code records in their EHRs was established. As independent variable, two socioeconomic indicators were selected that objectively reflect the differences between Basic Health Areas: Average Income Available per capita and Proportion of Economic Immigrants. To evaluate the correlation between dependent and independent variables, a multivariate correlation-regression analysis was used. RESULTS: It was observed that the higher the disposable income, the lower the proportion of Z code records in the EHRs (Pearson correlation coefficient: -0.56). However, there is a great variability in the registration of Z codes and the coding fails to make visible the socio-economic realities of the populations covered (Diagnostic Odds Ratio: 0.12. CI: 0.05-0.32). CONCLUSIONS: The use of different tools that facilitate the visualization of the health impact of social inequalities, as well as their evaluation through various research methodologies, is relevant for a community orientation of the PHC. The Z codes do not make visible in the studied area the social determinants of health of the population attended

12.
Pharmaceut Med ; 35(1): 21-29, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33464482

RESUMEN

The evolution of healthcare, together with the changing behaviour of healthcare professionals, means that medical affairs functions of pharmaceutical organisations are constantly reinventing themselves. The emergence of digital ways of working, expedited by the COVID-19 pandemic, means that pharmaceutical-healthcare relationships are evolving to operate in an increasingly virtual world. The value of the pharmaceutical medical affairs function is dependent on understanding customers' needs and providing the right knowledge at the right time to physicians. This requires a human-centric artificial intelligence (AI) approach for medical affairs, which allows the function to query internal and external data sets in a conversational format and receive timely, accurate and concise intelligence on their customers.


Asunto(s)
Inteligencia Artificial , Prestación Integrada de Atención de Salud/organización & administración , Gestión de la Información/organización & administración , Comunicación , Prestación Integrada de Atención de Salud/economía , Prestación Integrada de Atención de Salud/normas , Personal de Salud , Humanos , Gestión de la Información/economía , Gestión de la Información/normas , Evaluación de Resultado en la Atención de Salud
13.
Rev. argent. salud publica ; 13(Suplemento COVID-19): 1-10, 2021.
Artículo en Español | LILACS, BINACIS, ARGMSAL | ID: biblio-1152006

RESUMEN

INTRODUCCIÓN: Un contexto de pandemia y aislamiento social puede potenciar la tríada emocional de ansiedad, miedo y angustia, ante la incertidumbre, los problemas económicos, el exceso de información y la escolaridad en línea, entre otros factores. El objetivo de esta investigación fue evaluar la ansiedad en el contexto de la pandemia por COVID-19 en una muestra de la población argentina a los 60 días de confinamiento obligatorio. MÉTODOS: Estudio no experimental transversal. Se seleccionó una muestra de tipo no probabilística de 712 voluntarios, con una amplia cobertura etaria y geográfica, a la que se le aplicó el cuestionario de ansiedad de estado y de rasgo. Este instrumento psicométrico mide ambos tipos de ansiedad y está constituido por 40 ítems distribuidos en dos subescalas. Se analizaron tres subgrupos: profesionales de la salud, personas con otras profesiones de riesgo y personas que desarrollan actividades sin riesgo específico vinculado. RESULTADOS: Se observaron niveles bajos de ansiedad en general, pero las mujeres mostraron valores de ansiedad más altos que los hombres. Se detectaron diferencias significativas del 5% en el caso de las mujeres, resultando los valores medios de AE superiores a los valores medios de AR para todos los subgrupos analizados. DISCUSIÓN: Este estudio abre el interrogante sobre cuál sería el factor de mayor malestar, si la COVID-19 o las medidas de prevención; a la vez que la evidencia de bajos niveles de ansiedad nos lleva a la necesidad de investigar, en un futuro cercano, indicadores de depresión


Asunto(s)
Ansiedad , Cuarentena , Miedo , Betacoronavirus
14.
Med Care ; 59(1): 6-12, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32925454

RESUMEN

BACKGROUND: US hospitals are penalized for excess 30-day readmissions and mortality for select conditions. Under the Centers for Medicare and Medicaid Services policy, readmission prevention is incentivized to a greater extent than mortality reduction. A strategy to potentially improve hospital performance on either measure is by improving nursing care, as nurses provide the largest amount of direct patient care. However, little is known as to whether achieving nursing excellence, such as Magnet status, is associated with improved hospital performance on readmissions and mortality. OBJECTIVE: The purpose of this study was to examine the relationship between hospitals' Magnet status and performance on readmission and mortality rates for Medicare beneficiaries. RESEARCH DESIGN: This is a cross-sectional analysis of Medicare readmissions and mortality reduction programs from 2013 to 2016. A propensity score-matching approach was used to take into account differences in baseline characteristics when comparing Magnet and non-Magnet hospitals. SUBJECTS: The sample was comprised of 3877 hospitals. MEASURES: The outcome measures were 30-day risk-standardized readmission and mortality rates. RESULTS: Following propensity score matching on hospital characteristics, we found that Magnet hospitals outperformed non-Magnet hospitals in reducing mortality; however, Magnet hospitals performed worse in reducing readmissions for acute myocardial infarction, coronary artery bypass grafting, and stroke. CONCLUSIONS: Magnet hospitals performed better on the Hospital Value-Based Purchasing Mortality Program than the Hospital Readmissions Reduction Program. The results of this study suggest the need for The Magnet Recognition Program to examine the role of nurses in postdischarge activities as a component of its evaluation criteria.


Asunto(s)
Hospitales/normas , Medicare , Mortalidad/tendencias , Infarto del Miocardio/epidemiología , Readmisión del Paciente/estadística & datos numéricos , Indicadores de Calidad de la Atención de Salud/normas , Accidente Cerebrovascular/epidemiología , Estudios Transversales , Hospitales/estadística & datos numéricos , Humanos , Medicare/economía , Medicare/estadística & datos numéricos , Infarto del Miocardio/mortalidad , Alta del Paciente , Readmisión del Paciente/tendencias , Accidente Cerebrovascular/mortalidad , Estados Unidos/epidemiología , Compra Basada en Calidad/organización & administración , Compra Basada en Calidad/normas
15.
Saúde debate ; 44(127): 1066-1078, Out.-Dez. 2020. tab, graf
Artículo en Portugués | LILACS-Express | LILACS | ID: biblio-1156928

RESUMEN

RESUMO Os inquéritos de saúde conduzidos em comunidades geograficamente isoladas auxiliam na caracterização do comportamento reprodutivo e seus condicionantes. O objetivo deste estudo foi conhecer o perfil da saúde sexual, reprodutiva e aspectos socioculturais e econômicos de mulheres ribeirinhas do Médio Solimões, Amazonas, Brasil. Estudo retrospectivo e descritivo feito com mulheres da comunidade da Vila Sião, Alvarães (AM). No total, 28 mulheres, com idades entre 18 e 57 anos, foram individualmente entrevistadas, utilizando formulário para a obtenção de dados socioculturais, históricos de vida sexual e reprodutiva. Os resultados das análises descritivas indicaram que as entrevistadas eram mestiças, com ensino fundamental, casadas e atuavam na agricultura familiar. Em relação à história de vida sexual das entrevistadas, notou-se que os relacionamentos eram duradouros, com os mesmos parceiros, e as primeiras gestações ocorreram ainda na adolescência. Os indicadores gestacionais mostraram predomínio de parto domiciliar. Essas mulheres apresentaram elevado coeficiente de fecundidade. No entanto, os históricos de perdas gestacionais atribuídos à eclâmpsia, a acidentes domésticos e a doenças enfatizam a importância do acompanhamento pré-natal para a promoção da saúde da gestante e do bebê. A partir desses resultados, conclui-se que a interiorização dos serviços de saúde é essencial para que uma assistência médica especializada chegue até as comunidades ribeirinhas e isoladas do Amazonas, Brasil.


ABSTRACT Health surveys conducted in geographically isolated communities help to characterize reproductive behavior and its conditioning factors. The aim of this study was to know the sexual and reproductive health profile and the socio-cultural and economic aspects related to riverside women from Middle Solimões, Amazonas, Brazil. This is a retrospective and descriptive study carried out with women from Vila Sião community, Alvarães (AM). Twenty-eight women, 18-57 years old, were individually interviewed using a survey form to obtain socio-cultural data, sexual and reproductive life histories. The results of the descriptive analyses indicated that the respondents were of mixed race, with elementary education, married and worked in family-based agriculture. Regarding the respondents' sexual life history, it was noted that the relationships are long-lasting, with the same partner, and that the first pregnancy occurred during adolescence. Gestational indicators showed a predominance of home birth. These women had a high fertility coefficient. However, the history of gestational loss attributed to eclampsia, home accidents, and illnesses emphasizes the importance of prenatal care for the promotion of the pregnant woman and the baby. From these results it is concluded that the internalization of health services is essential for specialized medical assistance to reach the riverside and isolated communities of Amazonas, Brazil.

16.
Arq. bras. med. vet. zootec. (Online) ; 72(6): 2288-2296, Nov.-Dec. 2020. tab
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1142283

RESUMEN

ABSTRACT The objective of this study was to analyze applications of real options theory for increasing the productivity of Mantiqueira ecotype dairy cows kept in guinea grass pastures with different sources of bulky supplementation (black oats, fodder cane, or sorghum silage), because the traditional methodologies do not consider the uncertainties related to this activity. Real options theory, an investment evaluation method, fills this gap as its most significant feature is its flexibility to act on uncertain events. Based on the results obtained for two economic indicators, the net present value and internal rate of return, and considering the production items identified in the sensitivity analysis, this study evaluated the expansion flexibility of each system using the real options theory methodology in discrete time as proposed by Copeland and Antikarov (2001). The analysis of the expansion options showed that the values of the production systems increased by 6.73%, 1.21%, and 19.49% for the systems supplemented with sorghum silage, black oats, and fodder cane, respectively. The expanded net present values were R$ 141,642.39, R$ 64,211.08, and R$ 58,013.07 for the systems that adopted bulky supplementation with black oats, fodder cane, and sorghum silage, respectively.


RESUMO Objetivou-se analisar a aplicação da Teoria das Opções Reais para expansão da produtividade de vacas leiteiras do ecótipo Mantiqueira, mantidas em pastagem de capim-Mombaça com fornecimento de diferentes fontes de suplementação volumosa (aveia-preta, cana-forrageira ou silagem de sorgo), uma vez que as metodologias tradicionais não consideram as incertezas presentes na atividade. A Teoria de Opções Reais é um método de avaliação de investimento que possui como maior característica a valoração da flexibilidade de agir a eventos incertos, preenchendo, assim, a lacuna deixada pelo método tradicional. A partir dos resultados obtidos pelos indicadores econômicos valor presente líquido e taxa interna de retorno, em conjunto com os itens de produção identificados na análise de sensibilidade, foi possível avaliar o valor da flexibilidade de expansão que cada sistema apresentou. A flexibilidade de expansão foi avaliada utilizando-se a metodologia Teoria das Opções Reais, proposta por Copeland e Antikarov (2001), em tempo discreto. O resultado da análise da opção de expansão apresentou aumento nos valores dos sistemas de produção, na ordem de 6,73%, 1,21% e 19,49%, para os sistemas suplementados com silagem de sorgo, aveia-preta e cana-forrageira, respectivamente. Os resultados obtidos para os valores presentes líquidos expandidos foram de R$ 141.642,39, R$ 64.211,08 e R$ 58.013,07, para os sistemas que adotaram a suplementação volumosa com aveia-preta, cana-forrageira e silagem de sorgo, respectivamente.

17.
PLoS One ; 15(12): e0242962, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33382746

RESUMEN

OBJECTIVE: The Da Qing Diabetes Prevention program (DQDP) was a randomized lifestyle modification intervention conducted in 1986 for the prevention and control of type 2 diabetes in individuals with impaired glucose tolerance. The current study estimated long-term cost-effectiveness of the program based on the health utilities from the Chinese population. METHODS: A Markov Monte Carlo model was developed to estimate the impact of the intervention from the healthcare system perspective. The analysis was run over 30-year and lifetime periods and costs were estimated respectively as health management service costs. Baseline characteristics and intervention effects were assessed from the DQDP. Utilities and costs were generated from relevant literature. The outcome measures were program cost per quality-adjusted life-years (QALYs) gained and incremental cost-effectiveness ratio (ICER) of the intervention. Sensitivity analyses and threshold analyses were performed. RESULTS: Using a 30-year horizon, the intervention strategy was cost-saving and was associated with better health outcomes (increase of 0.74 QALYs per intervention participant). Using a lifetime horizon, the intervention strategy was cost-saving and was associated with additional 1.44 QALYs. Sensitivity analyses showed that the overall ICER was most strongly influenced by the hazard ratio of cardiovascular disease event. CONCLUSIONS: The Da Qing lifestyle intervention in a Chinese population with impaired glucose tolerance is likely to translate into substantial economic value. It is cost-saving over a 30-year time and lifetime frame.


Asunto(s)
Análisis Costo-Beneficio , Diabetes Mellitus Tipo 2/prevención & control , Estilo de Vida , Cadenas de Markov , Método de Montecarlo , Prevención Primaria/economía , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud
18.
JAMA Netw Open ; 3(12): e2028312, 2020 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-33315111

RESUMEN

Importance: Both noninvasive anatomic and functional testing strategies are now routinely used as initial workup in patients with low-risk stable chest pain (SCP). Objective: To determine whether anatomic approaches (ie, coronary computed tomography angiography [CTA] and coronary CTA supplemented with noninvasive fractional flow reserve [FFRCT], performed in patients with 30% to 69% stenosis) are cost-effective compared with functional testing for the assessment of low-risk SCP. Design, Setting, and Participants: This cost-effectiveness analysis used an individual-based Markov microsimulation model for low-risk SCP. The model was developed using patient data from the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) trial. The model was validated by comparing model outcomes with outcomes observed in the PROMISE trial for anatomic (coronary CTA) and functional (stress testing) strategies, including diagnostic test results, referral to invasive coronary angiography (ICA), coronary revascularization, incident major adverse cardiovascular event (MACE), and costs during 60 days and 2 years. The validated model was used to determine whether anatomic approaches are cost-effective over a lifetime compared with functional testing. Exposure: Choice of index test for evaluation of low-risk SCP. Main Outcomes and Measures: Downstream ICA and coronary revascularization, MACE (death, nonfatal myocardial infarction), cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) of competing strategies. Results: The model cohort included 10 003 individual patients (median [interquartile range] age, 60.0 [54.4-65.9] years; 5270 [52.7%] women; 7693 [77.4%] White individuals), who entered the model 100 times. The Markov model accurately estimated the test assignment, results of anatomic and functional index testing, referral to ICA, revascularization, MACE, and costs at 60 days and 2 years compared with observed data in PROMISE (eg, coronary CTA: ICA, 12.2% [95% CI, 10.9%-13.5%] vs 12.3% [95% CI, 12.2%-12.4%]; revascularization, 6.2% [95% CI, 5.5%-6.9%] vs 6.4% [95% CI, 6.3%-6.5%]; functional strategy: ICA, 8.1% [95% CI, 7.4%-8.9%] vs 8.2% [95% CI, 8.1%-8.3%]; revascularization, 3.2% [95% CI, 2.7%-3.7%] vs 3.3% [95% CI, 3.2%-3.4%]; 2-year MACE rates: coronary CTA, 2.1% [95% CI, 1.7%-2.5%] vs 2.3% [95% CI, 2.2%-2.4%]; functional strategy, 2.2% [95% CI, 1.8%-2.6%] vs 2.4% [95% CI, 2.3%-2.4%]). Anatomic approaches led to higher ICA and revascularization rates at 60 days, 2 years, and 5 years compared with functional testing but were more effective in patient selection for ICA (eg, 60-day revascularization-to-ICA ratio, CTA: 53.7% [95% CI, 53.3%-54.0%]; CTA with FFRCT: 59.5% [95% CI, 59.2%-59.8%]; functional testing: 40.7% [95% CI, 40.4%-50.0%]). Over a lifetime, anatomic approaches gained an additional 6 months in perfect health compared with functional testing (CTA, 25.16 [95% CI, 25.14-25.19] QALYs; CTA with FFRCT, 25.14 [95% CI, 25.12-25.17] QALYs; functional testing, 24.68 [95% CI, 24.66-24.70] QALYs). Anatomic strategies were less costly and more effective; thus, CTA with FFRCT dominated and CTA alone was cost-effective (ICERs ranged from $1912/QALY for women and $3,559/QALY for men) compared with functional testing. In probabilistic sensitivity analyses, anatomic approaches were cost-effective in more than 65% of scenarios, assuming a willingness-to-pay threshold of $100 000/QALY. Conclusions and Relevance: The results of this study suggest that anatomic strategies may present a more favorable initial diagnostic option in the evaluation of low-risk SCP compared with functional testing.


Asunto(s)
Dolor en el Pecho/diagnóstico , Angiografía por Tomografía Computarizada , Estenosis Coronaria/diagnóstico , Vasos Coronarios/diagnóstico por imagen , Prueba de Esfuerzo , Reserva del Flujo Fraccional Miocárdico , Revascularización Miocárdica , Angiografía por Tomografía Computarizada/economía , Angiografía por Tomografía Computarizada/métodos , Estenosis Coronaria/fisiopatología , Análisis Costo-Beneficio/métodos , Prueba de Esfuerzo/economía , Prueba de Esfuerzo/métodos , Femenino , Humanos , Masculino , Cadenas de Markov , Persona de Mediana Edad , Modelos Teóricos , Revascularización Miocárdica/métodos , Revascularización Miocárdica/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud , Pronóstico , Medición de Riesgo/economía , Medición de Riesgo/métodos
19.
Gac. sanit. (Barc., Ed. impr.) ; 34(6): 553-560, nov.-dic. 2020. tab, graf
Artículo en Español | IBECS-Express | IBECS | ID: ibc-ET1-6787

RESUMEN

OBJETIVO: El objetivo de este estudio fue cuantificar los beneficios económicos conseguidos antes y después de la implantación del permiso de conducción por puntos en las vías interurbanas en España. MÉTODO: Estudio descriptivo a través de la construcción de tres indicadores que expresaron el ahorro de costes por el número de víctimas evitadas. Se definieron dos periodos respecto al objetivo y se recopilaron datos de muertos, heridos graves y heridos leves en vías interurbanas entre 1999 y 2014 para cada provincia española. Se utilizaron para cada provincia datos de su población, producto interior bruto o número de vehículos-kilómetros recorridos en sus vías (MVKR). La cuantificación del ahorro se obtuvo utilizando las cifras oficiales de los costes para cada tipo de víctima en precios de 2014. RESULTADOS: El ahorro por habitante en muertos en el periodo de vigencia del permiso de conducción por puntos se situó entre 3,89 euros y 19,65 euros anuales. El ahorro en heridos graves por MVKR se redujo un 15%-66% entre 2006 y 2014, lo que supone anualmente desde 449,15 euros a 1707,88 euros. CONCLUSIONES: Durante el periodo de vigencia del permiso de conducción por puntos las provincias españolas han conseguido importantes ahorros de costes


OBJECTIVE: To quantify cost savings obtained before and after the implementation of the penalty-points driving licence on the interurban roads in Spain. METHOD: Descriptive study through the construction of three indicators that expressed the cost savings by the number of victims avoided. We defined two periods according to the objective and collected data on fatalities, serious injuries and slight injuries on interurban roads in 1999-2014 for each Spanish province. Thus, data for its population, GDP or number of vehicles-kilometres travelled on its roads (MVKT) were used for each province. The quantification of savings was obtained using official figures of costs for each type of victim in 2014 prices. RESULTS: The cost savings per inhabitant on fatalities in the period of validity of the penalty-points driving licence was between € 3.89 and € 19.65 per year. Savings on serious injuries by MVKT were reduced by 15%-66% between 2006 and 2014, being from € 449.15 to 1707.88 € annually. CONCLUSIONS: During the period of validity of the penalty-points driving licence, the Spanish provinces have achieved significant cost savings

20.
Rev. Hosp. Ital. B. Aires (2004) ; 40(4): 185-190, dic. 2020.
Artículo en Español | LILACS | ID: biblio-1145464

RESUMEN

Esta revisión narrativa describe el daño colateral de la pandemia de COVID-19, tanto en aspectos de la salud, como también sociales, educativos o económicos. Comunicamos el impacto mundial y local. Consideramos que varias de estas consecuencias eran inevitables, especialmente las sucedidas durante los primeros meses de una pandemia que se difundió a gran velocidad y con graves consecuencias directas en la morbimortalidad de la población. Sin embargo, luego de seis meses de su llegada a la Argentina, es oportuno revaluar la situación y replantearse si no se debería cambiar el enfoque para balancear la minimización del impacto directo de COVID-19 junto con la del daño colateral que las medidas para paliarlo produjeron. Es un desafío que no debe limitarse al sistema de salud. Debe encararse con un abordaje intersectorial amplio y con participación activa de la sociedad. Así como aplanamos la curva de COVID-19, cuanto más nos demoremos en aplanar las otras curvas de problemas sanitarios y sociales que se están generando, mayor será su impacto, tanto en el corto como en el largo plazo. (AU)


This narrative review shows the collateral damage of the COVID-19 pandemic, whether in health, social, educational or economic aspects. We report on the impact at the global and local levels. Many of these consequences were inevitable, especially in the first months of a pandemic that spread at great speed and with serious direct consequences on the morbidity and mortality of the population. However, six months after the arrival in our country, it is an opportunity to reassess the situation and rethink whether the approach should not be changed to balance the minimization of the direct impact of COVID-19 with that of the collateral damage that mitigation measures produced. This is a challenge that should not be limited to the health system. It must be addressed with a broad intersectoral approach and active participation of society. Just as we flatten the COVID-19 curve, the longer we delay in flattening the other curves of health and social problems that are being generated, the greater the impact, both in the short and long term. (AU)


Asunto(s)
Humanos , Neumonía Viral/economía , Infecciones por Coronavirus/economía , Determinantes Sociales de la Salud/estadística & datos numéricos , Argentina , Neumonía Viral/mortalidad , Neumonía Viral/psicología , Calidad de Vida , Aislamiento Social , Problemas Sociales/prevención & control , Problemas Sociales/estadística & datos numéricos , Estrategias Nacionales , Sistemas de Salud/tendencias , Indicadores de Morbimortalidad , Mortalidad , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/psicología , Impactos en la Salud/estadística & datos numéricos , Equidad en el Acceso a los Servicios de Salud , Análisis de las Consecuencias , Comunicación en Salud/métodos , Pandemias/estadística & datos numéricos
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...