Health insurance and inequalities in catastrophic health spending in cancer patients. A cross-sectional study in China.

OBJECTIVE: To determine the role of social health insurance programs in reducing inequality in the incidence and intensity of catastrophic health expenditure (CHE) of cancer patients in China. METHOD: A convenient sample of 2534 cancer patients treated in nine hospitals in 2015 and 2016 were followed up through face-to-face interviews in March-December 2018. The incidence and intensity (mean positive overshoot) of CHE (≥ 40% household consumption) were calculated. RESULTS: About 72% of cancer patients experienced CHE events after insurance compensation, with the catastrophic mean positive overshoot amounting to 28.27% (SD: 15.83%) of the household consumption. Overall, social insurance contributed to a small percentage of drop in CHE events. Income-related inequality in CHE persisted before and after insurance compensation. Richer patients benefit more than poorer ones. CONCLUSIONS: Cancer treatment is associated with high incidence of CHE events in China. The alleviating effect of social health insurance on CHE events is limited.

[Epidemiological profile of rheumatoid arthritis]. / Perfil epidemiológico de la artritis reumatoide.

Background: Rheumatoid arthritis affects approximately between 0.3 and 1.2% of the world population. In Latin America, different studies have estimated a prevalence between 0.2 and 0.5% in the population over 16 years of age. Objective: To identify the epidemiological profile of rheumatoid arthritis. Material and methods: Descriptive cross-sectional design carried out in an urban population of a social security institution in Mexico. The information of the clinical file of 373 patients was studied. The epidemiological profile included the sociodemographic dimension, family history, health, clinical, therapeutic, biochemical, extra-articular manifestations and complications. Statistical analysis percentages, means, confidence intervals for percentages and confidence intervals for averages were calculated. Results: The wrists were the most affected joints with 44.6% (95% CI: 39.5-49.6%). The extra-articular manifestation with the highest prevalence was asthenia with 9.9% (95% CI: 6.9-12.9%); predominant diagnosis according to ICD-10 was seropositive rheumatoid arthritis with 59.8% (95% CI: 54.8-64.8%), and the rheumatoid factor was highly positive in 78.3% (95% CI: 74.1-82.5%); predominant treatment was with combined therapy at diagnosis in 97.6% (95% CI: 96.0-99.1%). The duration of treatment was > 10 years in 34.1% (95% CI: 29.2-38.8%). Conclusion: This work has described the epidemiological profile of the patient with rheumatoid arthritis in different dimensions.

Introducción: la artritis reumatoide afecta aproximadamente entre 0.3 y 1.2% de la población mundial. En Latinoamérica diferentes estudios han estimado una prevalencia entre 0.2 y 0.5% en población mayor de 16 años de edad. Objetivo: identificar el perfil epidemiológico de la artritis reumatoide. Material y métodos: diseño transversal descriptivo llevado a cabo en población urbana de una institución de seguridad social en México. Se estudió la información del expediente clínico de 373 pacientes. El perfil epidemiológico incluyó la dimensión sociodemográfica, antecedentes heredofamiliares, de salud, clínicos, terapéuticos, bioquímicos, de manifestaciones extraarticulares y de complicaciones. Se calcularon porcentajes, promedios, e intervalos de confianza para porcentajes y promedios. Resultados: las muñecas fueron las articulaciones más afectadas con 44.6% (IC 95%: 39.5-49.6%). La manifestación extraarticular con más alta prevalencia fue la astenia con 9.9% (IC 95%: 6.9-12.9%); el diagnóstico predominante de acuerdo con el CIE-10 fue la artritis reumatoide seropositiva con 59.8% (IC 95%: 54.8-64.8%) y se encontró el factor reumatoide positivo alto en un 78.3% (IC 95%: 74.1%-82.5%); el tratamiento predominante fue con terapia combinada al diagnóstico en un 97.6%, (IC 95%: 96.0-99.1%). La duración del tratamiento fue > 10 años en el 34.1% (IC 95%: 29.2-38.8%). Conclusión: este trabajo ha descrito el perfil epidemiológico del paciente con artritis reumatoide en diferentes dimensiones.

Evaluación de riesgos y mejora de la seguridad biológica y radiológica en la toma de radiografía torácica a pacientes con COVID-19.

INTRODUCTION: Health workers are at high risk of becoming infected with COVID-19. The objective of the study was to evaluate the risks and improve the biological and radiological safety measures for taking chest X-rays in patients with COVID-19 in a Social Security hospital in Utcubamba (Peru). MATERIAL AND METHODS: Quasi-experimental intervention study type before and after without a control group, carried out between May and September 2020. A process map and an analysis of failure modes and effects (FMEA) of radiological care were prepared. The gravity (G), occurrence (O), and detectability (D) values ??were found and the risk priority number (RPN) was calculated for each failure mode (FM). FM with RPN ≥ 100 and G ≥ 7 were prioritized. Improvement actions were implemented based on the recommendations of recognized institutions and the O and D values ??were re-evaluated. RESULTS: The process map consisted of 6 threads and 30 steps. 54 FM were identified, 37 of whom had RPN ≥ 100 and 48 had G ≥ 7. Most of the errors occurred during the examination 50% (27). After entering the recommendations, 23 FM had RPN ≥ 100. CONCLUSIONS: Although none of the measures applied through the FMEA made the failure mode impossible, they made it more detectable and less frequent and reduced the RPN for each failure mode; however, a periodic update of the process is necessary.

Trends (2007-2019) of major atopic diseases throughout the life span in a large Mexican population.

Background: Major atopic diseases such as atopic dermatitis (AD), allergic rhinitis (AR), and asthma share the same atopic background, but they often show differences in their epidemiological behavior. Objective: We aimed to report the profile of these atopic diseases in a large Mexican population, including their age-related incidences, male:female (M:F) ratios, recent time trends, and association with altitude. Methods: Registries from the largest, nationwide health institution in Mexico (more than 34 million insured subjects), were reviewed. New cases of AD, AR, and asthma diagnosed each year by family physicians from 2007 to 2019 were adjusted by the corresponding insured population to estimate incidence rates. Results: Incidences of the 3 atopic diseases were highest in the 0-4 years age-group and progressively decreased thereafter until adolescence. Asthma and AR, but not AD, were more frequent in males during childhood (M:F ratios of 1.5, 1.3, and 0.95, respectively), but predominated in females during adulthood (M:F ratios of 0.52, 0.68, and 0.73, respectively). Time trends showed an initial increasing trend of annual incidences, with a peak around 2009-2011, and a downward trend afterward. This decreasing trend was seen in all age-groups and was more evident for AD (∼50% drop) and asthma (∼40% drop) than for AR (∼20% drop). Geographical distribution suggested that incidences of asthma and AR, but not of AD, had an inverse association with altitude. Conclusion: Annual incidences of the 3 major atopic diseases have declined in recent years in almost all age groups, and their epidemiological profile during the life span showed contrasting differences according to age, sex, and ecological association with altitude, mainly regarding AD.

[Approximation to the cost of occupational diseases treated in seven hospitals in Spain]. / Aproximación al coste de enfermedades profesionales atendidas en siete hospitales en España.

OBJECTIVE: To estimate the hospital cost of a sample of cases treated in seven hospitals of the National Health System in several Spanish cities. METHOD: Study based on 78 cases of occupational disease recognized by the social security, and previously treated in hospitals in Badalona, Barcelona, Ferrol, Gijón, Girona, Madrid and Vigo between 2017 and 2019. RESULTS: The healthcare activity generated by these hospitals to attend these processes involved a total cost of 282,927€. CONCLUSIONS: It is urgent to improve the coordination between the two public health systems, the social security health care system and the National Health System.

Preliminary assessment of antivenom availability and management in the public health system of Costa Rica: An analysis based on a survey to pharmacists in public health facilities.

Availability and accessibility of safe and effective antivenoms are key elements for the successful treatment of snakebite envenoming (SBE). This study provides a preliminary analysis on the way antivenoms are managed by the public health system in Costa Rica and on the role played by pharmacists in the overall management of antivenoms. This was an observational, cross-sectional study based on an online survey sent to pharmacists working at Caja Costarricense de Seguro Social (Costa Rican Social Security System; CCSS) in different locations in Costa Rica. Characteristics and location of health facilities, as well as antivenom availability and management details, were analyzed. Responses from a total of 96 pharmacists, corresponding to 55 different healthcare facilities, were included in this study. Most respondents worked at pharmacies located in urban communities (69.0%) and in the secondary level of care, which includes clinics, and regional and peripheral hospitals (55.2%). Overall, participants reported antivenom availability at all levels of care and in centers having various operating schedules, although they were not available in some facilities in regions where SBE is uncommon or do not attend SBE cases because of the proximity of more complex health centers. On average, the stocks of anticoral and polyvalent antivenoms per health facility were compatible with the dose of antivenom required for treating a SBE case. More than half of participants reported knowing the availability of protocols for the management of SBE and the correct use of antivenom at their healthcare facilities. Of the total respondents, 49% agreed on possessing all the resources needed for the correct management of these medicines at their facilities, and 65.6% indicated that they know the procedures for antivenom storage and management. Our findings provide a first description of the availability of antivenoms in the public health system of Costa Rica, including the primary care level. Results also underscore the perceived role of participating pharmacists in the management of these life-saving drugs and the need to improve their knowledge on this topic.

Contact dermatitis: Clinical practice findings from a single tertiary referral hospital, a 4-Year retrospective study.

BACKGROUND: It is estimated that 20% of the general population is sensitized to some kind of contact allergen. Contact dermatitis is one of the major occupational diseases worldwide. This disease has a higher prevalence in the female gender and is more frequently observed in the third or fourth decade of life. The main objective of this study was to describe the main sociodemographic and clinical characteristics of patients with contact dermatitis treated in the Allergy Unit of the San Juan De Dios Hospital - Caja Costarricense de Seguro Social. METHODS: Clinical records of contact dermatitis outpatients from a single hospital were analyzed, in a 4-year retrospective observational study. RESULTS: At the time of the patch testing, patients showed a mean age of 42.2 years. Disease frequency was higher in the female population (female/male ratio of 4.2:1) and in patients mostly dedicated to household workchores. Most patients presented several years of disease history, and the hands were the highest affected body part. Patch testing revealed that nickel sulfate, Cl+Me-Isothiazolinone (Kathon CG), and thimerosal were allergens regularly associated with contact dermatitis in the analyzed population. CONCLUSIONS: To a great extent, sociodemographic and clinical characteristics identified in these patients resemble what is reported in other regions, including the Americas and worldwide. It is worth highlighting a high female proportion rate probably related to cultural aspects, a smaller percentage of irritant contact dermatitis that may be associated to institutional patient management, and a slight difference in the most common allergens when compared to other published studies.

Temporal trend and magnitude of previdenciary benefits for workplace accidents in Brazil / Tendência temporal e magnitude dos benefícios previdenciários de natureza acidentária no Brasil

ABSTRACT Objective: To analyze the temporal trend and magnitude of national indicators of previdenciary benefits for workplace accidents issued and granted by the Social Security of Brazil. Methods: Secondary data from Social Security from 2008 to 2019 were used. The trend and percentage variation of the indicators were estimated through Prais-Winsten generalized linear regression. Results: A total of 9,220,372 previdenciary benefits for workplace accidents were issued by the Social Security of Brazil in the period, costing approximately R$ 8.4 billion and representing about 2.0% of the net value of all benefits paid. None of the categories of previdenciary benefits for workplace accidents showed an increasing trend. The highest variation in the benefits granted and issued for workplace accidents occurred in temporary disability benefit (B91), with an annual percentage variation of -54.00% and -29.29%, respectively. Conclusion: A reduction in magnitude and an overall decreasing trend were observed in the historical series of national indicators of benefits granted and benefits issued related to workplace accidents in Brazil from 2008 to 2019.

RESUMO Objetivo: Analisar a tendência temporal e a magnitude dos indicadores nacionais de benefícios previdenciários emitidos e concedidos por acidentes do trabalho pela Previdência Social do Brasil. Métodos: Foram utilizados dados secundários da Previdência Social de 2008 a 2019. A tendência e variação percentual dos indicadores foram estimadas por meio de regressão linear generalizada de Prais-Winsten. Resultados: Um total de 9.220.372 benefícios previdenciários por acidentes do trabalho foi emitido pela Previdência Social do Brasil no período, custando aproximadamente R$ 8,4 bilhões e representando cerca de 2,0% do valor líquido de todos os benefícios pagos. Nenhuma das categorias de incapacidades relacionadas a acidentes do trabalho apresentou tendência de aumento. A maior variação nos benefícios concedidos e emitidos por acidentes do trabalho ocorreu no auxílio por incapacidade temporária (B91), com variação percentual anual de -29,29% e -54,00%, nessa ordem. Conclusão: Verificou-se redução na magnitude e tendência global decrescente em relação as séries históricas dos indicadores nacionais de benefícios concedidos e emitidos de natureza acidentária no Brasil, de 2008 a 2019.

Factores asociados a mortalidad por COVID-19 en el Seguro Social Universitario de la ciudad de La Paz, 2021 ­ 2022 / Factors associated with COVID-19 mortality in the University Social Security system of the city of La Paz, 2021 - 2022

Objetivo: determinar los factores asociados a mortalidad por COVID-19 en pacientes del Seguro Social Universitario de la ciudad de La Paz (S.S.U.) durante las gestiones 2021 y 2022. Material y Métodos: estudio transversal analítico, realizado en el S.S.U. con pacientes mayores a 18 años que acudieron a consulta con resultado positivo de COVID-19 en las gestiones 2021 y 2022 (marzo), llegando a un total de 1381 casos. Los datos fueron recolectados a partir de datos administrativos. Se determinó el número de fallecimientos mediante frecuencias y se procedió a relacionar la ocurrencia de muerte con los factores de estudio, utilizando la prueba Chi-cuadrado (X2) y la medición de riesgo mediante Razón de Posibilidades (RP). Resultados: 53 personas fallecieron entre las gestiones 2021 y 2022 (marzo), lo que representa una mortalidad del 3,8% respecto a los casos confirmados (1 381). Están asociados a la mortalidad por COVID-19 el ser mayor de 60 años, ser hombre, tener un diagnóstico grave, el ingreso a UTI, asimismo es factor protector el hecho de estar vacunado. Conclusiones: la vacuna es un protector efectivo contra la muerte por COVID-19

Objective: to determine the factors associated with mortality due to COVID-19 in patients of the Seguro Social Universitario of the city of La Paz (S.S.U.) during the 2021 and 2022. Material and methods: analytical cross-sectional study, carried out in the S.S.U. with patients over 18 years of age who came for consultation with a positive result of COVID-19 in 2021 and 2022 (march), reaching a total of 1381 cases. The data were collected from administrative information. The number of deaths was determined by frequencies and the occurrence of death was related to the study factors, using the Chi-square test (X2) and the risk measurement by Odds Ratio (OR). Results: 53 persons died between 2021 and 2022 (march), representing a mortality rate of 3.8% of confirmed cases (1 381). Mortality due to COVID-19 is associated with being older than 60 years, being male, having a serious diagnosis, being admitted to the ICU, and being vaccinated is also a protective factor. Conclusions: the vaccine is an effective protector against death from COVID-19

Alineamiento de la producción científica a las prioridades de investigación en el Seguro Social de Salud del Perú: Propuesta de fortalecimiento y descentralización de la investigación / Alignment of scientific production to research priorities in the Peruvian Health Social Health Insurance: Purpose to strengthening and decentralization of research

Introducción: Uno de los indicadores del impacto del establecimiento de prioridades en investigación en salud es la producción científica. EsSalud planteó nueve temas de investigación prioritarios (TIP) y 20 preguntas de investigación prioritarias (PIP) 2017-2019. Evaluamos el alineamiento a estas prioridades de investigación en los artículos científicos publicados con filiación de EsSalud durante 2017-2020, y caracterizamos aquellos financiados por esta institución. Material y Métodos: Análisis de los artículos científicos registrados en la base de datos de producción científica de EsSalud 2017-2020. Empleamos una metodología estandarizada y por duplicado para evaluar el alineamiento a los TIP y PIP 2017-2019 de EsSalud. La evaluación del alineamiento a las PIP sólo lo realizamos en artículos originales y resúmenes de congreso. Reportamos frecuencias de alineamiento a cada TIP y PIP, y frecuencia de alineamiento a por lo menos un TIP según características de los artículos. Además, se reportó las características de los artículos financiados por EsSalud. Resultados: Un total de 170 de 1283 artículos se alinearon a al menos un TIP. Ocho de las veinte PIP no fueron respondidas. Los artículos con autores que pertenecen o recibieron financiamiento del IETSI-EsSalud tuvieron la mayor tasa de alineación. Finalmente, los artículos financiados por EsSalud fueron principalmente estudios observacionales, guías de práctica clínica y revisiones sistemáticas. Conclusión: Los artículos científicos publicados con filiación de EsSalud durante el 2017 al 2020 tienen baja alineación con las prioridades de investigación de la institución. Por lo tanto, es necesario generar un proceso de gestión de implementación, seguimiento y evaluación de las prioridades de investigación en la institución.

Background: One of the impact indicators of priorities in health research-setting is the scientific production that refers to these priorities. EsSalud raised nine priority research topics (PRT) and 20 priority research questions (PRQ) for the 2017-2019 period. We assess the alignment to these research priorities in the scientific articles published during the 2017-2020 period by EsSalud, and we characterize those financed by this institution. Material and Methods: Analysis of the scientific articles registered in the EsSalud scientific production database for the period 2017-2020. We used a standardized methodology and in duplicate to evaluate the alignment of a scientific article to the PRTand PRQ 2017-2019 of EsSalud. The evaluation of the alignment to the PRQs is only carried out in original articles and congress summaries. We report alignment frequencies to each PRTand PRQ, and we report the frequency of alignment to at least one PRT according to the articles' characteristics. In addition, the characteristics of the articles financed by EsSalud were reported. Results: 170 out of 1283 articles were aligned to at least one PRT. Eight of the twenty PRQs went unanswered. Articles with authors who belong to or received funding from IETSI-EsSalud had the highest alignment rate. Finally, the highly cited articles financed by EsSalud were mainly observational studies, clinical practice guidelines and systematic reviews. Conclusion: The articles published by EsSalud during 2017 to 2020 have low alignment with institutional research priorities. Furthermore, it is necessary a process of implementation, monitoring, and evaluation of research priorities in the institution.

As transformações recentes no programa de reabilitação profissional do INSS / Recent changes in the Brazilian Social Security Institute's professional rehabilitation program / Las recientes transformaciones en el programa de rehabilitación profesional del Instituto Brasileño de Seguridad Social

Resumo Neste artigo, analisam-se as transformações ocorridas no Programa de Reabilitação Profissional do Instituto Nacional do Seguro Social desde 2009. Considera-se que o referido serviço foi concebido e operacionalizado com base no chamado campo da Saúde do Trabalhador, mas sofreu, a partir de 2018, um processo de desestruturação. As características desse processo são reveladas por meio da análise dos manuais técnicos de procedimentos (2011, 2016 e 2018), pois neles se encontram concepções teóricas, regras de organização e objetivos do serviço. O artigo é desenvolvido em três partes que evidenciam, sequencialmente, a construção do campo da Saúde do Trabalhador, sua inserção na política pública de Previdência Social e, enfim, sua operacionalização e suas transformações por meio dos manuais de procedimentos. Os resultados revelam um processo de desestruturação do programa, que se afasta de uma concepção multidimensional da saúde do trabalhador, ao mesmo tempo que a dimensão biológica se torna central.

Abstract This article analyses the transformations that have taken place in the Professional Rehabilitation Program of the Brazilian Institute of Social Security since 2009. It is considered that the aforementioned service was conceived and operated based on the so-called field of Workers' Health, but since 2018 suffered a process of disruption. The characteristics of this process are revealed through the analysis of technical manuals of procedures (2011, 2016 and 2018), as they contain theoretical concepts, organization rules and service objectives. The article is developed in three parts that sequentially show the construction of the Workers' Health field, its insertion in the Social Security public policy and, finally, its operationalization and its transformations through manuals of procedures. The results reveal a process of de-structuring of the program, which moves away from a multidimensional conception of worker's health, while the biological dimension becomes central.

Resumen En el presente artículo, se analizan las transformaciones que se han producido en el Programa de Rehabilitación Profesional del Instituto Brasileño de Seguridad Social desde 2009. Se considera que el dicho servicio fue concebido y operado en función del llamado campo de la Salud del Trabajador, pero sufrió, desde 2018, un proceso de desestructuración. Las características de este proceso son reveladas en el análisis de los manuales técnicos de procedimientos (2011, 2016 e 2018), pues en ellos se encuentran concepciones teóricas, reglas de organización y objetivos de servicio. El artículo se desarrolla en tres partes que evidencian, en secuencia, la construcción del campo de la Salud del Trabajador, su inserción en la política pública de Seguridad Social y, al fin, su puesta en marcha y sus transformaciones a través de los manuales de procedimientos. Los resultados revelan un proceso de desestructuración del programa, que se distancia de una concepción multidimensional de la salud del trabajador, mientras que la dimensión biológica se vuelve central.

Producción científica y redes de colaboración en la Seguridad Social del Perú (EsSalud): Análisis bibliométrico 2008-2020 / Scientific production and collaborative networks in Peruvian Social Security (EsSalud): Bibliometric analysis 2008-2020

Introducción: La producción científica de EsSalud ha aumentado progresivamente. Sin embargo, no se ha descrito su producción científica e identificado sus redes de colaboración en las principales bases de datos bibliográficas a nivel internacional. Objetivos: Describir la producción científica de EsSalud en revistas científicas indizadas durante el periodo 2008-2020. Material y Métodos: Estudio bibliométrico que evaluó artículos científicos y resúmenes de congresos, con al menos una filiación institucional relacionada a EsSalud entre sus autores, que se encuentren indizadas en las bases de datos bibliográficas de Scopus, Web of Science, Ovid-Medline o Scielo Citation Index durante el periodo 2008-2020. Se reporta la producción científica anual total y por separado, según base. Se identificaron las redes de colaboración intra y extrainstitucionales. Resultados: Se obtuvieron 4159 registros y, tras aplicar los criterios de selección, quedaron 2333 artículos. Se observó un incremento de publicaciones en todas las bases de datos, excepto en Scielo Citation Index. La mayoría de los artículos fueron originales, observacionales y autofinanciados. Dos hospitales nacionales de EsSalud aportaron casi dos tercios de toda la producción científica evaluada. Se identifico poca colaboración entre instituciones de EsSalud de Lima con las de otras regiones y entre regiones, pero sí con las universidades locales. El área médica que más fue abordada por las publicaciones científicas fue la relacionada con las especialidades de medicina clínica. Conclusiones: La producción científica de EsSalud ha aumentado y ha mejorado en calidad, con una importante colaboración con universidades locales. Es importante impulsar iniciativas que promuevan la investigación y colaboración dentro de EsSalud, en el marco de las prioridades de investigación y de las principales causas de mayor carga de enfermedad en la institución y el país.

Background: Scientific production of Social Security in Perú (EsSalud) has progressively increased. However, there is no description of its scientific production and collaboration networks in relevant international databases. Objectives: Describe the scientific production of EsSalud in indexed journals during the 2008-2020 period. Material and Methods: Bibliometric study that evaluated scientific articles and meeting abstracts,with at least one institutional affiliation related to EsSalud among its authors, indexed in the Scopus, Web of Science, Ovid-Medline, or Scielo Citation Index databases published during the period 2008-2020. The total annual scientific production is reported and separately according to base. Intra and extra-institutional collaboration networks were evaluated. 4159 records were Results: obtained and, after applying the selection criteria, 2333 articles remained. Scientific production from all data bases, except for the Scielo Citation Index, had a progressive increase. Most of articles were original, observational, and self-funded. Two national hospitals from EsSalud accounted for almost two-thirds of all analyzed scientific production. Institutions from Lima had little collaboration with other institutions from other regions, leading to little interregional collaboration. On the other side, there was a noticeable collaboration with local universities. The medical area that was most addressed by scientific publications was that related to clinical medicine specialties. EsSalud's Conclusions:scientific production number and quality had increased during last years in collaboration with local universities.It is important to promote initiatives thar boost the research and collaboration within EsSalud's institutions,emphasizing research priorities and the leading causes of national morbidity and mortality.

O programa de reabilitação profissional do INSS e a reinserção do trabalhador no mercado de trabalho / The INSS professional rehabilitation program and the reinsertion of workers into the job market

Resumo Introdução No Brasil, a assistência pública voltada aos trabalhadores acometidos por doenças ou acidentes, incapazes de exercerem sua profissão, mas com potencial laborativo residual, é prestada pelo Instituto Nacional do Seguro Social (INSS), por meio do Programa de Reabilitação Profissional (PRP). Objetivo Compreender a contribuição do PRP na reinserção do trabalhador no mercado de trabalho. Método Trata-se de um estudo de caso, documental, transversal e descritivo, que teve como fonte de dados 592 prontuários de trabalhadores encaminhados ao PRP de uma Agência do INSS da região Sudeste do Brasil, no período de 2007 a 2012, dos quais foram extraídos dados sociodemográficos, acadêmicos e profissionais, além de entrevistas com oito usuários reabilitados. Resultados Os resultados apontaram que, dentre os segurados encaminhados ao Programa, 48,5% foram elegíveis, 34% considerados reabilitados e, destes, 49,02% estavam empregados. Os entrevistados não apontaram relação direta entre o PRP e sua reinserção no mercado, mas afirmaram que os recursos utilizados foram importantes para conquistarem, senão um emprego, ao menos reconhecimento pessoal e profissional. Apesar da taxa de empregabilidade dos trabalhadores reabilitados ser satisfatória em comparação com aqueles encontrados em estudos de países desenvolvidos e com sociedades menos desiguais, esse aparato ainda não se tornou um aliado efetivo do trabalhador brasileiro. Conclusão É essencial que os profissionais do INSS e reabilitados tenham uma postura mais ativa no processo reabilitatório. Deve-se considerar a promoção de ações intersetoriais que busquem articular as políticas públicas relativas à área e que abarquem a complexidade do processo de retorno ao trabalho.

Abstract Introduction In Brazil, public assistance to workers affected by diseases or accidents, unable to practice their profession, but with residual work potential, is provided by the National Social Security Institute (INSS), through the Professional Rehabilitation Program (PRP). Objective The general purpose of this research was to understand the PRP's contribution to the reinsertion of the worker into the labor market. Method It is a case study, documentary, cross-sectional and descriptive, which had as a data source 592 medical records of workers referred to the PRP of an INSS Agency of the Southeast region of Brazil, from 2007 to 2012, from which they were extracted sociodemographic, academic and professional data, as well as interviews with eight rehabilitated users. Results The results showed that 48.5% of the insured persons were eligible, 34% considered rehabilitated and 49.02% were employed. The respondents did not point out a direct relationship between the PRP and their reinsertion in the market, but stated that the resources used were important to achieve, if not a job, at least personal and professional recognition. Although the employability rate of the rehabilitated workers is satisfactory compared to those found in studies of developed countries and with less unequal societies, this apparatus has not yet become an effective ally of the Brazilian worker. Conclusion It is essential that the INSS and rehabilitated professionals have a more active stance in the rehabilitation process. The promotion of intersectoral actions that seek to articulate the public policies related to the area and that encompass the complexity of the process of return to work should be considered.

Proceso de definición de prioridades institucionales de investigación en el Seguro Social de Salud del Perú, 2020-2022 / Process of defining institutional priorities for research in the Peruvian Social Health Insurance, 2020-2022

Introducción: La definición de prioridades de investigación en salud dirige los esfuerzos de investigación para promover ciencia, tecnología e innovación en salud. Material y Métodos: La definición de estas en el Seguro Social de Salud peruano para el periodo 2020-2022 se realizó en cuatro etapas y de forma sistemática, estructurada, participativa y secuencial. Resultados: Primero, se evaluó el avance de investigación en las prioridades del periodo 2017-2019. En la segunda etapa, se consultó diversas fuentes y se identificó necesidades de investigación orientadas a enfermedades y se estableció el marco para prioridades orientadas a sistemas de salud e intervenciones sanitarias. La tercera etapa consistió en una consulta ampliada para seleccionar los temas prioritarios orientados a enfermedades. Finalmente, se desarrolló un taller participativo y multidisciplinario para seleccionar temas, subtemas y áreas prioritarias de investigación. Conclusión: El producto final fue la definición de 11 temas prioritarios, siete para enfermedades y cuatro para sistemas de salud e intervenciones sanitarias.

Introduction: Health research priorities definition address research efforts to the promotion of health science, technology, and innovation. Material and Methods: Health research priorities in the Peruvian Social Security for the period 2020-2022 was carried out in four stages using a systematic, structured, participatory and sequential process. Results: First, the progress of the research in the priorities of the period 2017-2019 was evaluated. In the second stage, various sources were consulted to identify disease-oriented research needs and the framework for priorities oriented to health systems and health interventions. The third stage consisted of an expanded consultation to select priority disease-oriented topics. Finally, a participatory and multidisciplinary workshop was developed to select themes, subtopics, and priority areas for research. Conclusion: The final product was the definition of 11 priority themes, seven for diseases and four for health systems and health interventions

Use of local anesthetic for the resolution of benign anorectal pathology in the Social Security Institute of Guatemala (IGSS) / Uso de anestésico local para resolução de patologia anorretal benigna no Instituto Guatemalteco de Seguridade Social

Abstract Introduction The use of regional anesthetic block has increased, along with the reduction of the use of spine anesthetic in this particular field of surgical activity. In the last decade ambulatory surgery and local anesthetic have lower surgical time, complications of the anesthetic itself, and hospital stay. Objective Presenting the results obteained with the use of local anesthesic and analgesic in the resolution of benign anorectal pathology. Methods A prospective, longitudinal, study, from January 2017 to December 2017, patients were classified according to surgical procedures performed using analogical visual scale to determine the pain tolerance, during the procedure, 24 h later and in the 5th post operative day. Results 253 procedures were performed with 116 local analgesia, 116 were male (45.86%) years 137 female (54%), Milligan-Morgan hemorroidectomy with Ligasure and fistulotomy were the most frequently performed procedures 32% each, followed by biopsy 16%, left lateral esfinterotomy 13% and cutaneous appendix 12%. Females presented better pain tolerance than males patients (92 vs. 81), 68% referred good tolerance through the procedure. Conclusions 68% of all the patients obtained good pain tolerance through anal anesthetic block, females manifested better pain tolerance than males, in non-complicated anorectal pathology local block ha shown to be safe and reproductible for the treatment of benign anorectal pathology in the Guatemalan Institute for Social Security.

Resumo Introdução O uso de bloqueio anestésico regional aumentou ao mesmo tempo em que diminuiu o uso do anestésico espinhal nesse campo específico da atividade cirúrgica. Na última década, a cirurgia ambulatorial e o anestésico local apresentaram um tempo cirúrgico menor, menos complicações associadas ao próprio anestésico e redução da permanência hospitalar. Objetivo Apresentar os resultados obtidos com o uso de anestésico local e analgésico na resolução da patologia anorretal benigna. Métodos Estudo prospectivo, longitudinal, realizado no período de janeiro a dezembro de 2017. Com o uso de uma escala visual analógica, os pacientes foram classificados para determinar a tolerância à dor durante o procedimento, 24 horas após a cirurgia e no quinto dia de pós-operatório. Resultados No total, 253 procedimentos foram realizados com 116 analgesias locais; 116 pacientes eram do sexo masculino (4586%) e 137 do sexo feminino (54%). A técnica de Milligan-Morgan para hemorroidectomia com ligadura e a fistulotomia foram os procedimentos realizados com mais frequência (32% cada), seguidos de biópsia (16%), esfincterotomia lateral esquerda (13%) e apêndice cutâneo (12%). As mulheres apresentaram melhor tolerância à dor que os homens (92 vs. 81), e 68% apresentaram boa tolerância durante o procedimento. Conclusões De todos os pacientes, 68% apresentaram boa tolerância à dor com o uso de bloqueio anestésico por via retal; as mulheres manifestaram melhor tolerância à dor que os homens. Na patologia anorretal não complicada, o bloqueio local mostrou ser seguro e reprodutível para o tratamento da patologia anorretal benigna no Instituto Guatemalteco de Seguridade Social.

Perfil clínico-epidemiológico de los derechohabientes con tuberculosis del IHSS, Teguciglpa; período 2011-2016 / Clinical and epidemiological profile of rightholders with tuberculosis of IHSS, Tegucigalpa; period 2011-2016

Antecedentes: Las condiciones laborales de ciertas personas pueden favorecer la aparición de tuberculosis. Objetivo. Determinar la existencia de patrones ocupacionales entre derechohabientes con tuberculosis (TB), del Instituto Hondureño de Seguri-dad Social (IHSS) en Tegucigalpa y resultado del abordaje diagnóstico y tratamiento. Metodología. Estudio descriptivo, retrospectivo, en los derechohabientes del IHSS Tegucigalpa, con universo de 460,150; la muestra fueron todos los expedientes de personas con Tuberculosis del periodo 2011-2016 mayores de 18 años. Se obtuvo información de la base de datos, fichas de notificación, expediente clínico y libro de seguimiento, determinando ocupación, variables sociodemográficas y programáticas. Se analizaron frecuencias e intervalos de confianza utilizando Epi Info Versión 7.2. Se solicitó permiso al IHSS y se respetó la confidencialidad de datos. Resultados. Se encontró expedientes de 214 pacientes con tuberculosis siendo mujeres (113) 52.6% y hombres (101) 47.4%; (137) 64% presentaron tuberculosis pulmonar y (77) 36% con tuberculosis extrapulmonar. La situación laboral predominante fue la de los asalariados de ocupación no especificada (73/214) 34%, seguido de Jubilados (16/214) 7%, empleados de salud (12/214) 6%, vigilantes (5/214) 2% y empleados de maquila (5/214) 2%. El método diagnóstico más frecuente fue baciloscopia (127) 59%, tuvieron éxito de tratamiento (171) 80%, fallecieron (13) 6%, perdida de seguimiento (13) 6%. ConclusiónEs necesario diseñar estrategias de prevención y capacitación para diagnóstico y tratamiento oportuno en lugares de trabajo como compañías de vigilancia, maquila, escuelas y universidades, hospitales e investigar razones de excedo de fallecimientos y perdida de seguimiento de pacientes...(AU)

[Financial expenses incurred by herniated disk in health professionals]. / Costo del subsidio por diagnóstico de hernia de disco en trabajadores del Instituto Mexicano del Seguro Social.

BACKGROUND: Long-term sick leave by illeness is cause of financial expences and worker's loss of productivity. OBJECTIVE: To evaluate the financial expense incurred by spinal disk herniation in health professionals. METHODS: 3000 health professionals of the Instituto Mexicano del Seguro Social work in Tecate, Tijuana and Rosarito, cities of Baja California, Mexico. During 2009-2011, 1070 health professionals had long sick leave certificates and 48 had a cervical or lumbar disk herniation. We evaluated the total days of absenteeism in comparison with the absenteeism days suggested by the Medical Disability Advisor. RESULTS: Of the 48 spinal herniated disks, 54% were cervical and 65% had surgical management. The mean (± SD) days of absence was 125 ± 84 and 24 (50%) of the spinal herniated disks exceeded the Medical Disability Advisor disability duration parameters, in 6 (26%), 12 (52%), and 5 (22%) patients due to no diagnostic concordance, diagnosis delay and residual pain, respectively. The total cost of the spinal herniated disks that extended outside of the Medical Disability Advisor disability duration parameters was 683,026 pesos versus 367,081 pesos of the spinal herniated disks that did not exceed the Medical Disability Advisor disability duration parameters. After 12 months of follow-up, 9 (18.8%) continue with sick leave and 2 (4%) had permanent disability. CONCLUSIONS: In patients with a spinal herniated disk, the costs of subsidies were two-fold more due principally to a not diagnostic agreement.

Antecedentes: las incapacidades prolongadas no sólo tienen un alto costo económico sino también repercusiones en la productividad debido a la ausencia del trabajador. Objetivo: evaluar el costo del subsidio pagado por el Instituto Mexicano Seguro Social (IMSS) a los trabajadores que incapacita por hernia de disco. Material y métodos: estudio observacional, descriptivo, transversal y retrospectivo efectuado con trabajadores del IMSS a quienes se incapacita para no laborar por más de 14 días. El estudio se efectuó mediante la revisión de los registros asentados entre 2009-2011 de 1,070 trabajadores con incapacidad prolongada de los que 48 tuvieron diagnóstico de hernia de disco. Se cuantificaron los días totales de incapacidad, días subsidiados por incapacidad versus los días sugeridos por el consejero médico de incapacidades. Resultados: de los 48 pacientes con hernias de disco, 54% fueron cervicales y 65% recibieron tratamiento uirúrgico. Los días totales promedio de incapacidad por hernias de disco fueron 125 ± 84 y 24 (50%), respectivamente. De las que rebasaron las recomendadas por el consejero médico, 6 (26%) fueron por concordancia diagnóstica, 12 (52%) por diferimiento en el diagnóstico y 5 (22%) por dolor residual. El costo de las incapacidades laborales originadas por hernias de disco que rebasaron las sugeridas por el consejero médico fue de 683,026 pesos en comparación con 367,081 pesos que no rebasaron la recomendación de éste. Después de 12 meses de seguimiento, 9 casos (18.8%) seguían con incapacidad y 2 (4%) tuvieron pensión por invalidez. Conclusiones: el costo en subsidio por incapacidades a pacientes con hernia de disco se duplicó principalmente por diferimiento en el diagnóstico.

[Implementation Plan for Two Clinical Practice Guides (CPGs) Contained in the Integral Care Guides (ICGs) of the General System of Social Health Care in Colombia: A) "Early Detection of Depressive Episode and Recurrent Depressive Disorder in Adults. Integral Attention of Adults with Diagnosis of Depressive Episode or Recurrent Depressive Disorder (CPG-Depression)". B) "Early Detection, Diagnosis and Treatment of the Acute Intoxication Phase In 18-Years-Old Patients with Alcohol Abuse or Dependence (CPG-Alcohol)"]. / Plan de implementación de dos Guías de Práctica Clínica (GPC) contenidas en las Guías de Atención Integral (GAI) en el Sistema General de Seguridad Social en Salud de Colombia: A) "Detección temprana del episodio depresivo y trastorno depresivo recurrente en adultos. Atención integral de los adultos con diagnóstico de episodio depresivo o trastorno depresivo recurrente (GPC-depresión)". B) "Detección temprana, diagnóstico y tratamiento de la fase aguda de intoxicación de pacientes mayores de 18 años con abuso o dependencia del alcohol (GPC-alcohol)".

INTRODUCTION: Clinical practice guides (CPGs) are systematically recommended, with the best clinical evidence available, to help physicians and patients in decision-making concerning the most adequate sanitary care as well as the selection of the best diagnostic and therapeutic options when facing a health problem or a clinical condition. After obtaining these recommendations, it is crucial to adopt them in daily clinical practice; the process through which this change is sought is known as implementation. This document contains recommendations for implementing CPGs in two psychiatric pathologies: 1) depressive episode and recurrent depressive disorder in adults, and 2) acute intoxication phase in cases of alcohol abuse or dependence. METHODOLOGY: The recommended implementation process is described; besides, barriers and facilitators found in the two guides, together with the list of management indicators and clinical outcomes, are identified for their monitoring within the General Health Social Security System of Colombia. CONCLUSION: CPGs contain recommendations with the best clinical evidence available. The challenge is achieving the adoption of such tool by users, being therefore necessary to follow the diffusion, dissemination and implementation plan, overcoming barriers and resorting to intrinsic and extrinsic facilitators for CPGs as well as performing monitoring with indicators described for measuring the implementation process (management indicators) and the effect of CPGs in clinical practice (indicators of clinical outcome.).

O BPC: dos avanços na seguridade aos riscos da reforma da previdência / BPC: from security advances to the risk of social security reform

Resumo Este artigo analisa as propostas de alteração no Benefício de Prestação Continuada (BPC) discutidas no âmbito da reforma previdenciária, tanto na original do governo de 2016 quanto no substitutivo apresentado pelo relator do projeto no Congresso em 2017. As mudanças aventadas incidem sobre dois aspectos: aumento na idade mínima de acesso e desvinculação do valor do benefício do salário mínimo. São discutidas no texto, as justificativas para a reforma do BPC, referentes tanto aos desestímulos à contribuição previdenciária como às mudanças demográficas, assim como são estimados possíveis impactos das alterações propostas. O estudo conclui que as medidas, se aprovadas, tendem a reduzir a cobertura e a ampliar a vulnerabilidade de renda de idosos e de pessoas com deficiência no país.

Abstract This paper analyzes the proposed changes in the Continuous Cash Benefit (BPC) discussed within the Social Security Reform, both with regard to the Federal Government's original proposal in 2016 and the proposal by the rapporteur's project submitted to Congress in 2017. The proposed changes focus on two aspects: increased minimum age of access and unlinking the BPC amount from the minimum wage amount. The document discusses the justifications for the BPC reform, regarding both disincentives to social security contributions and demographic changes, as well as estimated possible impacts of proposed changes. The study concludes that measures, if approved, tend to reduce coverage and increase income vulnerability of the elderly and the disabled in the country.

A reabilitação profissional no INSS: caminhos da terapia ocupacional / Vocational rehabilitation at the National Social Security Institute: paths of occupational therapy

Este texto traz dados de uma pesquisa que objetivou identificar e compreender práticas e concepções delineadas pela terapia ocupacional no Serviço de Reabilitação Profissional no Instituto Nacional do Seguro Social (INSS), no estado de São Paulo. Compreende-se que a reabilitação profissional, que visa a proporcionar aos segurados os meios para reingresso no mercado de trabalho e que é atribuída oficialmente ao Ministério da Previdência Social, dialoga com a saúde, com a educação e com as políticas e ações de trabalho e emprego. Os dados foram coletados por meio de um questionário encaminhado às terapeutas ocupacionais do INSS no referido estado, bem como por entrevistas realizadas com parte delas, abordando temáticas que foram categorizadas para a análise do que relatam acerca de suas práticas e concepções, enfatizando pontos reflexivos sobre limites, possibilidades e desafios nessa atuação e ampliando a discussão para a estrutura do Serviço. É apontada uma série de fatores que implicariam uma avaliação mais negativa que positiva de sua atuação no Instituto, os quais estariam mais vinculados a questões estruturais do Serviço. Creem, todavia, na melhoria dessa estrutura, indicando a necessidade do incremento das possibilidades oferecidas, de uma maior participação e responsabilização por parte das empresas, da construção de um trabalho articulado com os demais setores governamentais e da sociedade civil, além da ampliação e da reformulação da legislação que trata da reabilitação profissional no Brasil.

This article presents data from a research that aimed to identify and understand the practices and concepts of occupational therapy in the Vocational Rehabilitation Program of the National Social Security Institute (INSS), in the state of São Paulo. Vocational rehabilitation aspires to provide means for workers to reenter the job market, being associated with health, education, and labor and employment. Data were collected through a questionnaire sent to occupational therapists, as well as through interviews with some of them. We discussed themes that were categorized to analyze their practices and concepts and highlighted topics that allowed us to reflect on the limits, possibilities and challenges faced by these workers, examining the structure of the program as well. A number of factors imply that their performance at the INSS is more negative than positive, which could be related to structural issues of the program. However, the therapists believe in improving its structure and point out the need to increase the possibilities offered, allowing for a greater participation and responsibility of companies, for more combined efforts with other government sectors and the civil society and for the expansion and reformulation of the Brazilian legislation on vocational rehabilitation.