Percepción del impacto económico en pacientes con cáncer en un hospital de tercer nivel, La Paz - Bolivia: un estudio exploratorio cualitativo / Perception of the economic impact in patients diagnosed with cancer in a third level hospital, La Paz - Bolivia: a qualitative exploratory study

Los pacientes con cáncer experimentan además del impacto de la enfermedad, el impacto económico, y este es más evidente en los pacientes con escasos recursos económicos, los motivos son multifactoriales. OBJETIVO: describir la percepción sobre el impacto económico en los pacientes bolivianos con cáncer en el Hospital de Clínicas Universitario- La Paz. MÉTODOS: el diseño es cualitativo exploratorio, muestreo por bola de nieve, se realizaron entrevistas a profundidad dirigidas a pacientes con cáncer del hospital de Clínicas Universitario de La Paz- Bolivia entre diciembre de 2018 a febrero de 2019. RESULTADOS: se entrevistaron a 11 pacientes y 9 familiares. Se han identificado el impacto de los gastos en los pacientes con cáncer en las siguientes categorías: Ahorros y deudas, vivienda, trabajo, familia, tratamiento, esfera psicológica, gastos a futuro, y en el cuidado de otros enfermos en la casa. Las percepciones son variables, algunos pacientes muestran mayor preocupación por su economía que por su enfermedad, relatan además el cambio que significó en su económica recibir el diagnóstico de cáncer en distintas áreas. CONCLUSIÓN: se ha encontrado, en el presente trabajo, que la percepción del impacto económico para los pacientes con cáncer es multidimensional. Se ha evidenciado además, que el impacto depende del estadio de la enfermedad y del contexto social que vive el paciente, siendo este variable y dando como resultado necesidades de acompañamiento variable por parte de los equipos oncológicos

Cancer patients experience, is about disease´s and economic impact, and this impact is more evident in patients with limited economic resources in low-income countries, the reasons are multifactorial. OBJECTIVE: describe the perception of the economic impact on Bolivian patients with cancer at the Hospital de Clínicas Universitario-La Paz. METHODS: the design is qualitative and exploratory, sampling was by snowball, in-depth interviews were conducted at cancer patients at the Clínicas Universitario de La Paz hospital - Bolivia between December 2018 and February 2019. RESULTS: 11 patients and 9 family members were interviewed. The impact of expenses on cancer patients has been identified in the following categories: Savings and debts, housing, work, family, treatment, psychological sphere, future expenses, and caring for other patients at home. Perceptions are variable, some patients show more significant concern about their finances than about their illness, and they also report the change that receiving the diagnosis of cancer meant in their finances in different areas. CONCLUSION: in this investigation, the perception of economic impact on cancer patients is multidimensional. It has also been shown that the impact depends on the stage of the disease, and the social context in which the patient lives, this being variable and resulting in variable support needs from the oncology teams

Flebite associada ao cateter venoso periférico em cardiologia: incidência, fatores de risco e custos associados / Phlebitis associated with peripheral venous catheter in cardiology: incidence, risk factors and associated costs

Objetivo: Determinar a incidência de flebite, fatores de risco associados e custos diretos de tratamento. Métodos: Estudo descritivo, correlacional, com análise de custo direto. Utilizaram-se dados da documentação dos enfermeiros entre janeiro 2019 e agosto 2021. Resultados: Incluíram-se 2.374 pessoas com cateter venoso periférico, com internamento na cardiologia. A incidência de flebite foi de 12,38%, das quais 78,23% eram de grau 1 de severidade. Verificou-se associação estatística entre o desenvolvimento de flebite e a administração de amiodarona endovenosa, dias de hospitalização e serviço de internamento. Estimaram-se 1662€ de custos adicionais ao tratamento da flebite, em material clínico e horas de cuidados de enfermagem. Conclusão: Os cuidados de enfermagem são eficazes na identificação precoce e tratamento da flebite, promovendo redução de custos adicionais e garantindo melhores cuidados e ganhos em saúde.

Objective: This study aimed to identify the incidence rate of phlebitis, associated risk factors and treatment direct costs. Methods: Descriptive, correlational study with direct cost analisys. Data from the nurses' clinical records between January 2019 and August 2021 were used. Results: Included 2,374 files of people with peripheral venous catheter who were admitted to Cardiology. The phlebitis incidence rate was 12.38% and regarding severity 78.23% were grade 1. The phlebitits was significantly related with intravenous amiodarone administration, length of stay and physical department. This represents €1662 of additional treatment costs, in clinical supplies and nursing time. Conclusion: Nursing care is effective in the early identification and treatment of phlebitis, reducing costs and improve clinical and economic outcomes.

Understanding of job burnout hazards and active promotion of scientific research based prevention and control strategy / 环境与职业医学

Job burnout is rampant in workplaces and has become an important global public health concern. It is one of the top occupational health problems to be addressed in the workplace in Europe and America. The prevalence rate of job burnout is also at a high level in China, and cannot be ignored for its associated health loss and economic impact of occupational population, so we should deepen the understanding of job burnout hazards, promote relevant scientific research, and develop associated prevention and control programs. This paper introduced the epidemic status of job burnout, health hazards and economic impact, development stage, influencing factors, conceptual models, measurement and evaluation methods, and prevention and control measures, and proposed scientific research directions as well as prevention and control strategies of job burnout in the future.

The Medical Economic Effects of Two Pharmacists Checking Patient Medications Brought to Hospitals by Part of Inpatient Pharmaceutical Services / 医薬品情報学

Objective: Pharmacists in inpatient pharmaceutical services are required to evaluate the medications that patients bring with them to the hospital when admitted and to make recommendations to physicians about these medications' proper use. Many hospitals perform such inpatient pharmaceutical services. Studies have found that pharmacists with insufficient years of experience are often put in charge of this practice. This has resulted in patients continuing to take inappropriate medications. We hypothesized that the involvement of another pharmacist in checking outpatient medications brought to the hospital might lower the rate of inappropriate use. We initiated the rechecking of medications brought to the hospital by the drug information (DI) pharmacist, based on the need for cooperation between the DI pharmacist and ward pharmacists.Methods: We initiated rechecks by DI pharmacists of medications brought to the hospital and first checked by ward pharmacists, and estimated the medical economic impact of pharmaceutical intervention between 1 May 2019 and 30 April 2020.Results: Within one year, the DI pharmacist suggested 15 interventions, including four interventions related to digitalis products and three related to direct oral anticoagulants. The medical economic impact was estimated to be 10,175,000 yen.Conclusion: Our findings suggest that checking by another pharmacist of outpatient medications brought to the hospital is a useful addition to the check by ward pharmacists.

A review of the epidemiology, diagnosis, treatment, vaccines and economic impact of human monkeypox (Mpox) outbreaks

The current monkeypox outbreak is a public health emergency of international concern and is coming in the wake of the SARS-CoV-2 pandemic. Human monkeypox is a viral zoonotic infection caused by monkeypox virus, an enveloped double-stranded DNA virus of the genus Orthopoxvirus and family Poxviridae that also contain smallpox, cowpox, Orf, and vaccinia viruses. Online databases including PubMed, Google Scholar and Web of Science were searched to obtain relevant publications on the epidemiology, treatment, vaccines and the economic impacts of the current monkeypox (Mpox) outbreak.

The impact of COVID-19 on HIV treatment of adolescents in sub-Saharan Africa: A scoping review

Background: Adolescents living with HIV are a key population who are susceptible to poor health. The global coronavirus disease 2019 pandemic and widespread national COVID-19 restrictions has disrupted health service delivery and HIV support services, affecting treatment adherence among adolescents with HIV. Aim: This study aimed to review the available literature on the impact of the COVID-19 pandemic on the HIV treatment of adolescents in sub-Saharan Africa. Method: Seven online databases were searched for articles published between 2020 and 2022 that focused on the impact of COVID-19 on adolescents living with HIV on antiretroviral therapy. A data charting extraction form and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA) flowchart were used for screening and reporting the articles in this review. A narrative synthesis was conducted. Results: Five overarching themes emerged from the articles in this review, which highlighted the mental, social, and economic impacts of the COVID-19 pandemic, as well as the impact of the reallocation of healthcare services and challenges to accessing HIV care services on the antiretroviral therapy (ART) adherence of adolescents living with HIV. Conclusion: The global COVID-19 pandemic affected adolescents living with HIV in sub-Saharan Africa in many ways, but very little research has been done to describe the various ways in which the physical and mental well-being of adolescents were impacted.

Impacto económico de la COVID-19 en el sector de la salud en Santiago de Cuba / Economic impact of COVID-19 in the health sector of Santiago de Cuba

Introducción: El enfrentamiento a la epidemia de la COVID-19 tuvo un impacto económico negativo en el mundo, lo que generó un incremento de los gastos y costos en el sector de la salud en la provincia de Santiago de Cuba. Objetivo: Describir el impacto económico de la COVID-19 en el sector sanitario en Santiago de Cuba durante un año. Métodos: Se realizó un estudio descriptivo y prospectivo en la provincia de Santiago de Cuba en el año 2021, para lo cual se analizaron las variables días-pacientes, gastos presupuestarios, salario promedio del personal, costos totales de un día-paciente y costos unitarios de un día-paciente. Resultados: La investigación reveló un incremento en los gastos y su efecto en la economía del sector sanitario en el 2021. Al analizar los gastos por partidas, se determinó una mayor significación en los de medicamentos, con 59,0 % del total, lo que representó un crecimiento de los costos unitarios en comparación con los estándares publicados. Conclusiones: Los gastos del sector sanitario en esta provincia contribuyeron a controlar la propagación de la COVID-19, a evitar el sobregasto por la introducción de las vacunas, y permitieron la disminución de los índices de infección. Además, se evidenció el incremento de los costos en los diferentes niveles de actividad entre 3 y 29 veces más que los costos estandarizados del país.

Introduction: The confrontation to the epidemic of COVID-19 had a negative economic impact in the world, what generated an increment of the expenses and costs in the health sector of Santiago de Cuba province. Objective: To describe the economic impact of the COVID-19 in the sanitary sector of Santiago de Cuba during a year. Methods: A descriptive and prospective study was carried out in Santiago de Cuba province in the year 2021, for which the day-patient, budgetary expenses, average salary, total costs of a day-patient and unitary costs of a day-patient variables were analyzed. Results: The investigation revealed an increment in the expenses and its effect in the economy of the sanitary sector in 2021. When analyzing the expenses for departures, a higher significance was determined in those of medications, with 59.0 % of the total, what represented a growth of the unitary costs in comparison with the published standards. Conclusions: The expenses of the sanitary sector in this province contributed to control the propagation of COVID-19, to avoid the over expense for the introduction of vaccines, and allowed the decrease of the infection indexes. Also, the increment of the costs was evidenced in the different activity levels between 3 and 29 times more than the standardized costs of the country.

Impacto económico de la falla cardíaca en el cuidador informal / Economic impact of heart failure in the informal caregiver

Resumen Introducción: La insuficiencia cardíaca (IC) es una patología estructural o funcional del corazón que deteriora la capacidad de llenado, generando síntomas que afectan la calidad de vida y la funcionalidad. Es conocido el impacto de esta enfermedad sobre los sujetos que la padecen, pero ha sido poco explorado su impacto económico sobre los cuidadores. Objetivo: Estimar el impacto económico de la IC desde la perspectiva de los cuidadores informales. Resultados: Estudio cuantitativo, tipo evaluación económica parcial. Fueron incluidos 54 sujetos diagnosticados con IC y un cuidador informal por sujeto. La edad promedio de los sujetos con IC fue 70.61 años, la mayoría hombres (64.8%), con un tiempo de diagnóstico de 84 meses y un puntaje de Barthel de 81.94, que representa una dependencia leve. Respecto a los cuidadores, el 48.1% reportaban un vínculo laboral activo; el ingreso mediano fue de $1260.000 COP/mes. El número de horas de cuidado fue de 4.93 h/día. El impacto económico se reflejó en los ingresos mensuales, causando una pérdida de $644,017.50 por actividades de cuidado y en el tiempo laboral una reducción del 30%. El 29% de los ingresos fueron destinados a labores del cuidado; por lo tanto, generaron gastos que redujeron el 71% de los ingresos. De acuerdo con lo anterior, por cada 10 horas de trabajo se destinan 7 horas al cuidado. Conclusiones: La IC impacta de manera negativa la economía de los cuidadores informales de sujetos con esta patología.

Abstract Introduction: Heart failure (HF) is a structural or functional pathology of the heart that impairs filling capacity of this organ, generating symptoms that affect quality of life and functionality in subjects who suffer this disease. This impact on economic life in caregivers of patients with HF has been poorly studied, therefore, there is a lack of information about this topic. Objective: To estimate the economic impact of HF from the perspective of informal caregivers. Type of study: quantitative study, partial economic evaluation type. Population and sample: 54 subjects diagnosed with HF and one informal caregiver per subject were included. Results: The average age of the subjects with HF is 70.61 years, most of them men (64.8%), with a diagnosis time of 84 months and a Barthel score of 81.94 points, which represents a mild dependency. Regarding caregivers, 48.1% reported an active employment relationship, the median income was $1,260,000 COP/month. The number of hours of care is 4.93 hours/day. The economic impact was reflected in monthly income, causing a loss of $644,017.50 due to care activities and a 30% reduction in working time. 29% of income was allocated to care work, therefore, they generated expenses that reduced 71% of income. According to the above, for every 10 hours of work, 7 hours are spent on care. Conclusions: HF negatively impacts the economy of the informal caregiver of subjects with this pathology.

Perception and Practices of COVID-19 in Rural Areas of Southeastern Nigeria: A Community-based Cross-sectional Survey

Aims: Despite all efforts made globally by governments of various nations and all concerned agencies through preventative measures, quick testing, isolation, shutting down of societies and economy, the virus still succeeded in spreading through communities perhaps due to the wrong perspective, in addition to surveillance, prevention and management challenges. This study evaluated the perception and practices of covid-19 in rural areas of southeastern Nigeria. Study Design: The study adopted a community-based cross-sectional survey design that investigated awareness, perspective, surveillance challenges, prevention, management and economic impact in rural settlement areas of south-east, Nigeria. Place and duration of study: This study was be conducted in rural settlement areas of south-east Nigeria (Abia, Anambra, Ebonyi, Enugu, and Imo states). February � April, 2021. Methodology: Data was collected by the use of the questionnaire. Five hundred copies were administered per state. Results: Most participants (2464, 98.6%) heard first of COVID-19 through radio/television (1409, 56.3%), social media (539, 21.5%) and their friends/relatives (418, 16.7%); 1896 (75.8%) believed in the existence of COVID-19 infection. However, the majority in Ebonyi state (309, 61.8%) had their disbelief on the existence of COVID-19. Participants confirmed having knowledge of COVID-19 testing (2319, 92.8%) and isolation centers (2299, 92.0%), however, a major challenge was lack of (1698, 67.9%) or no awareness (550, 22.0%) of masses testing centre in their areas. A few individuals (392, 15.7%) reported having experienced one or two COVID-19 symptoms about 3 months ago. Knowledge on how to prevent contracting COVID-19 is relatively high (66.7%) among the respondents. COVID-19 induced economic burden amongst residents were mainly as a result of the imposition of lockdown to movements and businesses (1098, 43.9%), disruption of studies (959, 38.4%), increased hunger (950, 38.0%), high expenditure (894, 35.8%) and loss of job/income (816, 32.6%). Conclusion: It is concluded that the majority of the people in southeast Nigeria are aware of the possible existence of Covid-19 in their area.

The effects of COVID-19 on food insecurity, financial vulnerability and housing insecurity among women and girls living with or at risk of HIV in Nigeria

Aim: Women and girls living with or at high risk of acquiring HIV (WGL&RHIV) in Africa are economically vulnerable. This study aims to advance understanding of the economic impact of COVID-19 on WGL&RHIV and to identify the factors associated with this insecurity.Methods: Data were collected from a cross-sectional survey conducted among a convenience sample of WGL&RHIV in Nigeria between May and September 2021. Logistic regressions enabled the study of the role of HIV status, mental health and macrosocial characteristics (people with disability, transgender women, sex workers, persons engaged in transactional sex, substance users, and people on the move) on economic vulnerability, measured by food, financial and housing insecurity, since the COVID-19 pandemic began. The model accounted for the possible interactions between the macrosocial characteristics and controlled for confounders.Results: There were 3 313 (76.1%) of 4 355 respondents facing food insecurity, 3 664 (83.6%) of 4 385 with financial vulnerability and 1 282 (36.2%) of 3 544 with housing insecurity. Being a member of the key and vulnerable groups was strongly associated with food insecurity, financial vulnerability and housing insecurity, regardless of HIV serostatus. For example, WGL&RHIV engaging in transactional sex were more than four times more likely (aOR 4.42; 95% CI 2.57­7.59) to face housing insecurity and more than twice more likely to face food insecurity (aOR 2.47, 95% CI 1.35­4.52) and financial vulnerability (aOR 2.87, 95% CI 1.39­5.93). This economic vulnerability may reduce their negotiating power for safer sex or the use of HIV prevention methods, exposing them to increased risks of HIV infection. Poor mental health was also associated with the three forms of economic vulnerability.Conclusions: As the long-term impact of the COVID-19 crisis on African economies unfolds, HIV programmes at the country level must include economic vulnerability and mental unwellness mitigation activities for WGL&RHIV

Economic impact of pharmaceutical interventions in a medium complexity Brazilian university hospital

Abstract Clinical pharmacists have been increasing their participation mainly through actions aimed at patient care, with international studies demonstrating favorable cost-benefit ratio from pharmacists interventions. However, there are few studies carried out in Brazil about the subject. This study aims to assess the economic impact of pharmaceutical interventions (PIs) in a hospital setting performed in October 2018. Each performed PI was registered and associated with the direct cost of drugs for economic impact analysis. A total of 185 PIs were evaluated, comprising 106 patients. The most intervened drugs were antibiotics, presenting the greatest economic impact, R$2,370. The total economic impact was R$2,578, mainly in the Pediatric Intensive Care Unit that represented R$1,701. Regarding the economic impact by PI as the "Suspension of drug without indication" saved R$1,360 while the "Inclusion of required drugs" cost R$807. It was estimated that the savings would be R$30,936 and, if PIs were performed at day zero, the savings would be R$79,728 per year. An average of 1.75 PI per patient was performed with an economic impact of R$14 per PI. Our results showed that clinical pharmacist's role in the evaluation of pharmacotherapy is important for patients' health and represents a positive economic impact.

Overview of human and animal brucellosis in Nigeria and its economic impacts on production

Brucellosis is a wide spread zoonotic bacterial disease of humans and animals. In humans the disease is recognized commonly as undulant fever, characterized by headache malaise, and arthritis. Brucellosis can occur in any age group, but mainly found in young men between the ages of 20 and 40 years because of occupational hazards. Domestic animals (cattle, sheep and goat, pigs, dogs etc) are highly susceptible to brucellosis. Generally, brucellosis manifest in female animals as abortion, retained placenta, stillbirth and death of young ones soon after birth. In males, the main features are vesiculitis, orchitis, and epididymitis, which may render infected male infertile for life. The endemicity of brucellosis has remained a threat in low- income countries of sub-Saharan Africa and South Asia and has multiple economic implications across agriculture and public health sectors, and broader implications on economic and social development sectors. Google and Google Scholar were used to retrieve articles used for this review, which included published research articles and local, national and international reports on brucellosis. In this review, we summarised human and animal brucellosis, prevalence of infections in Nigeria, and economic impacts on production. It is believed that this review will guide researchers on the state of brucellosis in developing countries where the disease is still endemic, using Nigeria as a case study.

Vacunas antineumocócicas conjugadas: una revisión de las consideraciones éticas e impacto socio-económico / Pneumococcal conjugate vaccines: a review of ethical considerations and socio-economic impact

Introducción: Desde hace más de 15 años, las vacunas antineumocócicas conjugadas (PCVs) están disponibles en muchas partes del mundo, y son efectivas en la prevención de las enfermedades neumocócicas en niños. La OMS recomienda la inclusión de las PCVs en los programas de inmunización infantil en todo el mundo. Objetivo: Valorar el abordaje ético y el impacto socioeconómico de las vacunas antineumocócicas conjugadas para la decisión de uso en diferentes contextos. Material y Métodos: Se realizó una búsqueda bibliográfica en las bases de datos PubMed y SciELO, considerando informes de la web de la OMS. Desarrollo: Está globalmente considerado que para la reglamentación, el desarrollo y el uso de las PCVs，se deben tener en cuenta aspectos regulatorios, resultados de investigaciones y el consentimiento informado (CI) de los sujetos. En el contexto de países como China，la PCV13 de la empresa Pfizer es de la Clase II debido a su alto precio de importación, en otros contextos como Cuba no se ha introducido la vacunación contra neumococo por limitaciones financieras. Los equipos de investigación trabajan en el desarrollo de las PCVs para reducir el coste de la importación de estas vacunas, haciendo realidad la inclusión de las PCVs en el programa nacional de inmunización. A pesar de complejidad cada vez mayor de la investigación vacunológica, los investigadores seguirán obligados a adherirse a los principios éticos. Conclusiones: Es necesario una vacuna antineumocócica conjugada más económica para tener un impacto socio-económico más alto. Los profesionales sanitarios tienen la obligación de ser éticos y rigurosos en las investigaciones vacunológicas. Además, estas investigaciones requieren de la revisión por parte de un consejo de revisión ética a escala nacional y su seguimiento debe ser sistemático. Cabe señalar que los estudios en población infantil deben ser fuertemente regulados y controlados(AU)

Introduction: Pneumococcal conjugate vaccines (PCVs) have been available in many parts of the world for more than 15 years and are effective in preventing pneumococcal diseases in children. The WHO recommends the inclusion of PCVs in childhood immunization programmes worldwide. Objective: To value the approach to ethics and the socioeconomic impact of the conjugate pneumococcal vaccines. Material and Methods: A bibliographic review was carried out in databases such as PubMed and SciELO, considering reports from the WHO website. Development: It is globally considered that regulatory aspects, research results and informed consent (IC) of the subjects should be taken into account for the regulation, development and use of PCVs. In the context of countries such as China，the PCV13 of the Pfizer company is Class II due to its high import price. In other contexts, such as Cuba, pneumococcal vaccination has not been introduced due to financial limitations. Research teams are working on the development of PCVs to reduce the cost of importing these vaccines, making the inclusion of PCVs in the national immunization program a reality. Despite the increasing complexity of vaccinology research, researchers will continue to be obliged to adhere to ethical principles. Conclusions: A cheaper pneumococcal conjugate vaccine would be needed to have a higher socioeconomic impact. Healthcare professionals have the obligation to be ethical and rigorous in vaccinology research. In addition, such research requires review by a national ethical review board and should be systematically monitored. It should be noted that studies in the pediatric population should be strongly regulated and controlled(AU)

Impacto psicosocial y económico de la uveítis en México / Psychosocial and economic impact of uveitis in Mexico

Resumen Objetivo: Conocer el impacto psicosocial y económico quede la uveítis en México. Métodos: Encuesta en pacientes diagnosticados con uveítis. Se registraron datos demográficos y nivel socioeconómico. Se identificaron síntomas, tiempo al diagnóstico, tratamiento, comportamiento, actitudes y sentimientos ante la enfermedad. Resultados: Se realizaron 100 encuestas a pacientes con uveítis, con edad media de 45 ± 17.08 años, nivel socioeconómico ≤ D; 54 eran mujeres. El diagnóstico se realizó al 1.87 ± 2.73 años. Acuden anualmente a cita 2.1 ± 2.14 mes, más de 1 a urgencias y son hospitalizados 3.7 días. Utilizan tratamiento sistémico con antiinflamatorios esteroideos (53 %), inmunosupresor (31 %), terapia biológica (7 %), tratamiento tópico con lubricantes (44 %), esteroides (26 %) y cirugías (39 %). Comorbilidades observadas: hipertensión arterial, diabetes mellitus, artritis reumatoide (18 %), síndrome de Sjögren, lupus y colitis ulcerativa crónica inespecífica. Complicaciones: deterioro visual, cataratas y ceguera. La uveítis afecta su vida en el 83 % de los casos, en el 41 % a diario y el 49 % necesitan cuidados de otra persona. El 79 % reciben atención privada, el 43 % cuenta con seguridad social, gastando mensualmente $3,590 ± $2,730.65 pesos en medicamentos, transporte, consulta médicas y estudios. Anualmente con ausentismo laboral de 8.5 ± 14.56 días, más 7.0 días de incapacidad u hospitalización. El 51 % refieren falta de apoyo para conocer la enfermedad. Conclusiones: Se trata del primer estudio nacional que escenifica la condición de los pacientes con uveítis y las insuficiencias por las que atraviesan, incluyendo el ámbito económico y biopsicosocial.

Abstract Objective: Determine the psychosocial and economic impact suffered by patients diagnosed with uveitis in Mexico. Methods: Survey in uveitis-diagnosed patients. Demographic data and socioeconomic level were recorded. Symptoms, time to diagnosis, type of treatment, behavior, attitudes and feelings towards the disease were identified. Results: One hundred surveys were conducted in patients with uveitis, who had a mean age of 45 ± 17.08 years, and socioeconomic level ≤ D; 54 were females. Diagnostic delay was 1.87 ± 2.73 years. Annually, patients attend 2.1 ± 2.14 appointments per month, and are admitted once to the emergency department and remain hospitalized for 3.7 days. Patients use systemic treatment with steroidal anti-inflammatory drugs (53 %), immunosuppressant agents (31 %), biological therapy (7 %), topical treatment with lubricants (44 %) or steroids (26 %) and undergo surgery (39 %). Observed comorbidities include hypertension, diabetes mellitus, rheumatoid arthritis (18 %), Sjögren’s syndrome, systemic lupus erythematosus, and nonspecific chronic ulcerative colitis. Complications: visual impairment, cataracts and blindness. Uveitis affects their life in 83 % of cases, in 41 % does it daily, and 49 % need care from another person. Seventy-nine percent receive private care and 43 % have social security, with $ 3,590 ± $ 2,730.65 pesos being spent monthly on medicines, transportation, medical appointments and studies. Annually, work absenteeism is 8.5 ± 14.56 days, plus 7.0 days of disability or hospitalization; 51% refer lack of support to learn about the disease. Conclusions: This is the first national study to portray the condition of patients with uveitis and the shortcomings they go through, including the economic and biopsychosocial fields.

Impacto económico en el medio odontológico durante la pandemia del COVID-19: revisión integradora / Economic impact in the dental field during COVID-19 pandemic: integrative review

La pandemia por COVID-19 no sólo ha generado un impacto negativo en la salud, sino que la economía global también se ha visto mermada, afectando más a los países subdesarrollados. Con relación a estos daños en las finanzas de los profesionales de la salud, existen algunos efectos que derivan de la pandemia COVID-19, los cuales tienen una fuerte repercusión en la economía de todos los trabajadores a nivel mundial y el ámbito odontológico no es la excepción. Esta revisión se obtuvo mediante la búsqueda de la información en una exploración electrónica en las bases de datos PubMed, Cochrane Library, LILACS, SciELO y Latindex. El impacto económico derivado de esta pandemia, sin lugar a dudas, ha afectado la economía de los odontólogos de práctica pública y privada, por lo que la toma de decisiones en la odontología debe contemplar un uso equilibrado de los recursos financieros (AU)

The COVID-19 pandemic has not only generated a negative impact on health, but the global economy has also been reduced, being the underdeveloped countries the most affected ones. In relation to these damages in the finances of health professionals, there are some effects that derive from the COVID-19 pandemic, having a strong impact on the economy of all workers worldwide and the dental field is no exception. This review was obtained by searching the information through an electronic examination in databases like PubMed, Cochrane Library, LILACS, SciELO and Latindex databases. The economic impact derived from this pandemic has undoubtedly affected the economy of dentists in public and private practice, so that decision-making in dentistry must consider a balanced use of financial resources (AU)

O Programa de Aquisição de Alimentos (PAA) como estratégia de enfrentamento aos desafios da COVID-19 / El Programa de Adquisición de Alimentos (PAA) como estrategia para enfrentar los desafíos de la COVID-19 / The Food Acquisition Program (PAA) as a strategy to face the challenges of COVID-19

Resumo Este artigo analisou o Programa de Aquisição de Alimentos (PAA) como ferramenta para mitigar os impactos econômicos e sociais da COVID-19 no Brasil. Para isso, foram realizadas projeções de investimentos e analisadas as condições de operacionalização do programa no momento atual. Foi adotada uma metodologia quanti-quali de análise. Na abordagem quantitativa, foram construídos cenários com projeções de investimentos na política pública; na qualitativa, realizaram-se entrevistas não estruturadas com atores-chave na execução do programa. Os resultados revelaram que o aumento de recursos investidos no programa em um cenário otimizado pode proporcionar ampla capilarização dos benefícios. Identificou-se que o PAA é estratégico para o enfrentamento aos efeitos negativos da COVID-19 porque escoa os produtos da agricultura familiar, o que promove estruturação de cadeias produtivas, acesso a novos mercados e indução ao dinamismo econômico, além de atuar no combate à fome e à miséria de famílias que vivem em situação de vulnerabilidade. O programa não só apresenta condições de operacionalização durante a pandemia da COVID-19, como tem se adaptado à realidade atual, seguindo protocolos estabelecidos pelas autoridades de saúde. Concluiu-se que o PAA pode minimizar as crises sanitária e econômica, principalmente para a população mais vulnerável, apresentando ações que vão ao encontro das demandas da sociedade civil organizada e de recomendações de organismos nacionais e internacionais especializados, visando à redução dos impactos econômicos e sociais da pandemia causada pelo novo coronavírus.

Resumen Este artículo analizó el Programa de Adquisición de Alimentos (PAA) como una herramienta para mitigar los impactos económicos y sociales de la COVID-19 en Brasil. Con este fin, se hicieron proyecciones de inversión y se analizaron las condiciones para operativizar el programa en el momento actual. Se adoptó una metodología de análisis cuanti-cualitativo. En el enfoque cuantitativo, los escenarios se construyeron con proyecciones de inversión en políticas públicas; en el cualitativo, se realizaron entrevistas no estructuradas con actores clave en la ejecución del programa. Los resultados revelaron que el aumento de recursos invertidos en el programa en un escenario optimizado puede proporcionar una amplia capilarización de los beneficios. Se identificó que el PAA es estratégico para enfrentar los efectos negativos de la COVID-19 porque incentiva la venta de los productos de la agricultura familiar, lo que promueve la estructuración de las cadenas de producción, el acceso a nuevos mercados e induce al dinamismo económico, además de actuar en la lucha contra el hambre y la miseria de las familias que viven en situación de vulnerabilidad. El programa no solo presenta condiciones operativas durante la pandemia de COVID-19, sino que también se ha adaptado a la realidad actual, siguiendo los protocolos establecidos por las autoridades sanitarias. Se concluyó que el PAA puede minimizar las crisis sanitaria y económica, especialmente para la población más vulnerable, presentando acciones que satisfagan las demandas de la sociedad civil organizada y las recomendaciones de organizaciones nacionales e internacionales especializadas destinadas a reducir los impactos económicos y sociales de la pandemia causada por el nuevo coronavirus.

Abstract This article analyzed the Food Acquisition Program (PAA) as a tool to mitigate the economic and social impacts of COVID-19 in Brazil. The study conducted investment projections and analyzed the conditions to operate the program during the pandemic, adopting quantitative-qualitative analysis. As for the quantitative approach, the study worked with projections of public policy investments; the qualitative policy was carried out with unstructured interviews with key actors. The results showed that, in an optimal scenario, the rise of investment could provide a wide capillarization of the benefits of the program. The results point out that the PAA is strategic to face the negative effects of COVID-19 because it helps family farming products reach the consumers, structuring production chains, facilitating access to new markets, and inducing economic dynamics, in addition to combating hunger and extreme poverty of families living in vulnerability. Also, the research found that the program is in operational conditions and adapted to the reality of the pandemic, following protocols established by health authorities. Therefore, the PAA can minimize health and economic crises for the most vulnerable population. It addresses the demands of the organized civil society and recommendations from national and international organizations specialized in reducing the economic and social impacts of the COVID-19 pandemic.

Impacto econômico da adoção de denosumabe em pacientes com metástases ósseas ou mieloma múltiplo sob a perspectiva do sistema de saúde privado brasileiro / Economic impact of denosumab adoption in cancer patients with bone metastases or multiple myeloma from the Brazilian private healthcare system's perspective

Objetivo: Estimar o custo por evento relacionado ao esqueleto (ERE) e o impacto econômico anual da adoção de denosumabe em pacientes com metástases ósseas secundárias ao câncer de mama, próstata e outros tumores sólidos ou mieloma múltiplo sob a perspectiva do sistema de saúde privado brasileiro. Métodos: Um modelo econômico foi desenvolvido para comparar os custos relacionados com denosumabe versus ácido zoledrônico na prevenção de EREs. O modelo incluiu os seguintes custos: medicamento, administração, monitoramento e manejo de ERE. O custo anual foi apresentado em reais (BRL) para 100 pacientes. Os custos do manejo de ERE [fratura vertebral (FV), fratura não vertebral (FNV), radiação óssea (RO), cirurgia óssea (CO) e compressão da medula espinhal (CME)] foram estimados a partir dos recursos e procedimentos coletados da revisão de literatura, bases de dados e painel Delphi. Dados coletados dos estudos clínicos randomizados relacionados com cada tipo de tumor na análise e de um estudo prospectivo observacional foram utilizados para estimar a eficácia clínica de denosumabe versus ácido zoledrônico. Resultados: O custo por cada tipo de ERE variou de BRL 27.246 a BRL 28.035 para FV, BRL 18.023 a BRL 18.811 para FNV, BRL 42.750 a BRL 43.538 para RO, BRL 18.023 a BRL 18.811 para CO e BRL 12.472 a BRL 13.260 para CME. A introdução de denosumabe foi estimada em economia anual por 100 pacientes de até BRL 1.072.043,14 para câncer de mama, BRL 1.212.822,79 para outros tumores sólidos, BRL 1.929.660,67 para câncer de próstata e BRL 77.965,07 para mieloma múltiplo. Conclusão: Esta análise sugere que EREs adicionam custos substanciais no manejo de pacientes com metástases ósseas. Dessa forma, o uso de denosumabe pode prevenir e retardar EREs em pacientes com câncer e pode possivelmente levar à redução do impacto econômico associado aos EREs sob a perspectiva dos pagadores de saúde privada brasileira.

Objective: To estimate the cost per SRE and annual economic impact of denosumab adoption in patients with bone metastases (BM) secondary to breast cancer, prostate cancer, other solid tumors or multiple myeloma from the Brazilian private healthcare system's perspective. Methods: An economic model was developed to compare the cost outcomes associated with denosumab instead of zoledronic acid for SRE prevention. The model included the following costs: drug, administration, monitoring and SRE management. Annual costs per 100 patients were reported in 2019 Brazilian currency (BRL). The SRE management costs (vertebral fracture (VF), non-vertebral fracture (NVF), radiation to bone (RB), surgery to bone (SB) and spinal cord compression (SCC)) were estimated from the resources and procedures collected from literature review, official database, and a Delphi panel. Data collected from randomized clinical trials related to each tumor type in the analysis and from a prospective observational study was used to estimate the clinical efficacy of denosumab vs zoledronic acid. Results: The cost per each type of SREs across all tumors ranged BRL 27,246 ­ BRL 28,035 for VF, BRL 18,023 ­ BRL 18,811 for NVF, BRL 42,750 ­ BRL 43,538 for RB, BRL 18,023 ­ BRL 18,811 for SB and BRL 12,472 ­ BRL 13,260 for SCC. The introduction of denosumab was estimated to result in annual savings per 100 patients of up to BRL 1,072,043.14 for breast cancer, BRL 1,212,822.79 for other solid tumors, BRL 1,929,660.67 for prostate cancer and BRL 77,965.07 for multiple myeloma. Conclusion: This analysis suggests that SREs add substantial costs to the management of patients with bone metastases. In this way, the use of denosumab would prevent and delay SREs in cancer patients and might possibly lead to reduce the economic burden associated with SREs, borne by Brazilian private healthcare payers.

An evaluation of the economic viability of environmental offsets in the saltworks industry / Uma avaliação da viabilidade econômica de compensações ambientais na indústria salineira

ABSTRACT: The extraction of sea salt depends on the occupation of large areas at the estuary banks, many of them inserted in Permanent Preservation Areas (PPAs). Thus, the objective was to evaluate the economic viability of Environmental Offsets (EO) as an alternative to the unoccupied PPAs in the saltworks. In order to do so, 27 solar saltworks installed in the region of the Brazilian White Coast were evaluated for the occupation of PPAs - measured using images from satellite, georeferenced, vectored with corresponding PPA bands generated - and estimated to EO (Impact Degree x Sum of the investments necessary to implement the project) and Economic Impact (Net Present Value, with long-term interest rate of 7%) of vacating PPAs. It was considered that EO was feasible whenever the costs resulting from it were lower than the economic impact caused by the vacancy of the PPAs. The PPAs were tthe productive area of ​​the saltworksthat occupied 13.70% of PPAs. For all the evaluated enterprises the value corresponding to EO was lower than the Economic Impact resulting from the vacancy of the PPAs. Thus, EO is an economically viable and more attractive alternative to the eviction of PPAs by the saltworks industry and may also provide environmental gains due to the financing of conservation units in the areas of influence of the enterprises. However, there is a need to improve the methodology used to estimate the EO, since a maximum limit is set, the environmental impacts caused by the projects are underestimated.

RESUMO: A extração de sal marinho depende da ocupação de grandes áreas às margens de estuários, muitas delas inseridas em Áreas de Preservação Permanente (APPs). Assim, objetivou-se avaliar a viabilidade econômica da Compensação Ambiental (CA) como alternativa à desocupação de APP pelas salinas. Para tanto, 27 salinas instaladas na região da Costa Branca brasileira foram avaliadas quanto à ocupação de APPs - mensuradas por meio de imagens de satélites, georreferenciadas, vetorizadas com a geração de bandas de APP - e estimados a CA (Grau de Impacto x Somatório dos investimentos necessários para implantação do empreendimento) e o Impacto Econômico (Valor Presente Líquido, com taxa de juros de longo prazo de 7%) da desocupação das APPs. A CA foi considerada viável quando seus custos resultantes foram menor do que o impacto econômico causado pela desocupação das APPs. A área produtiva média das salinas ocupa 13,70% de APP. Para todos os empreendimentos avaliados, o valor correspondente a CA foi menor que o Impacto Econômico resultante da desocupação das APP. Assim, a CA é uma alternativa economicamente viável e mais atrativa frente à desocupação das APP pela indústria salineira, podendo ainda propiciar ganhos ambientais em decorrência do financiamento de Unidades de Conservação nas áreas de influência dos empreendimentos. Evidencia-se, contudo, a necessidade do aprimoramento da metodologia usada para estimar a CA, já que fixado um limite máximo, os impactos ambientais provocados pelos empreendimentos são subestimados.

Economic Impact of a Vaccine Preventable Disease: A Scoping Review on Tuberculosis

@#Using pulmonary tuberculosis (pTB) as an example of a vaccine-preventable disease (VPD), we aimed to gather evidence on the economic impact of treating a case or managing an outbreak of a VPD. A scoping review was conducted. Online databases (MEDLINE and Google Scholar) were used to collate published studies from the year 2015 to 2019 on the management cost of one case or an outbreak of pTB. Keywords used were cost, treatment, outbreak, pulmonary tuberculosis, tuberculosis, economic, economic evaluation. A total of 29 studies were analysed. The costs of pTB treatment for individual patient were higher in high-income countries compared to middle-income and low-income countries. A case of pTB can result in household catastrophic health expenditure; while an outbreak can overwhelm the health system’s capacity, and disrupts the economy of a country. Therefore, accessibility of vaccines especially in low-income countries must be ensured. Also, vaccine-hesitant individuals must reconsider their stance on vaccination.

35 años de ARCAL y 500 de La Habana / 35 years of ARCAL and 500 of Havan

RESUMEN En 2019 Cuba asumió la presidencia del Acuerdo Regional de Cooperación para la Promoción de la Ciencia y la Tecnología Nucleares en América Latina y el Caribe (ARCAL). Este acontecimiento coincide con el aniversario 35 del Acuerdo y los 500 años de La Habana. El artículo presenta los principales impactos de ARCAL en Cuba y una panorámica de las actividades que se realizan para celebrar el aniversario de ARCAL en el marco de las festividades por el medio milenio de la capital.

ABSTRACT In 2019, Cuba assumed the presidency of the Regional Cooperative Agreement for the Promotion of Nuclear Science and Technology in Latin America and the Caribbean (ARCAL). This event coincides with the 35th anniversary of the Agreement and the 500 years of Havana. The article presents the main impacts of ARCAL in Cuba and an overview of the activities carried out to celebrate the anniversary of ARCAL in the framework of the festivities for the half millennium of the capital.