Efecto de la deuda económica sobre el bienestar psicológico de los residentes de cirugía: Resultados de un estudio nacional en Colombia / Effect of financial debt on the psychological well-being of surgery residents: Results of a national study in Colombia

Introducción. La deuda económica durante la residencia en cirugía general puede afectar el desempeño profesional, las decisiones de vida y el bienestar psicológico. La información disponible en Colombia es limitada. El objetivo de este estudio fue cuantificar la deuda económica del residente de cirugía general, identificar los factores asociados y evaluar su efecto en el bienestar psicológico. Métodos. Estudio de corte transversal analítico. Se invitó a 380 residentes a diligenciar una encuesta sobre los aspectos relacionados con su deuda económica y se utilizó el WHO-index para evaluar su bienestar psicológico. Resultados. Un total de 259 residentes participaron en el estudio (67,6 %). El 56 % posee una deuda económica promedio de COP $88.000.000 ((US$21.826)). Un alto nivel de endeudamiento se relacionó con el año de residencia, el tipo de institución (privada) y la solicitud de préstamos. Se identificó algún trastorno mental en 14,7 % y un bajo nivel de bienestar psicológico en 56,4 % de los participantes. No se identificó ninguna asociación entre una elevada deuda económica y el bajo bienestar psicológico. Conclusiones. La deuda económica tiene un efecto sobre los residentes. El endeudamiento de los residentes de cirugía en Colombia es altamente prevalente, y no se correlaciona con un pobre bienestar psicológico. La autodeterminación favorece el bienestar psicológico en el posgrado en cirugía general. Existe la necesidad de educación financiera en los residentes. Se requieren nuevos estudios que evalúen las causas del pobre bienestar psicológico.

Introduction. Financial debt during surgery residency can affect professional performance, life decisions, and psychological well-being. The information available in Colombia is limited. The objective of this study is to quantify the financial debt of the general surgery resident, identify the associated factors and evaluate their effect on psychological well-being. Methods. A cross-sectional study was carried out. A total of 380 residents were invited to complete a survey on aspects related to their financial debt, and the WHO-index to evaluate their psychological well-being. Results. A total of 259 residents participated in the study (67.6%). 56% have an average economic debt of $88,000,000 COP (US$21,826). High debt was related to level of residence, type of institution (private), and loan application. Some mental disorder was identified in 14.7% and a low level of psychological well-being in 56.4% of the participants. No association was identified between high financial debt and low psychological well-being. Conclusions. Economic debt has an effect on residents. Financial debt among surgical residents in Colombia is highly prevalent; however, it does not correlate with poor psychological well-being. Self-determination favors psychological well-being in the postgraduate course in general surgery. Likewise, the need for financial education in residents is imminent. New studies are required that thoroughly evaluate the causes of poor well-being.

Determinantes de la gestión del riesgo en salud en el Régimen Subsidiado en Colombia: estudio cualitativo

Introducción: El Régimen Subsidiado (RS) del sistema de salud colombiano tiene problemáticas estructurales que no han sido solucionadas y son pocos los estudios que profundizan en la explicación de estas. Objetivo: Explorar la experiencia en la dirección estratégica y gestión operativa y financiera de este régimen, sus aspectos operativos y de gestión del riesgo en esta población, así como las diferencias percibidas frente al Régimen Contributivo. Metodología: Estudio cualitativo. Se utilizó el análisis del discurso desde la perspectiva sociohermenéutica como técnica analítica. Se entrevistaron diez participantes, entre directivos de aseguradoras del RS y gestores del sistema de salud. Las entrevistas fueron grabadas y anonimizadas, previo consentimiento informado. Resultados: Emergen tres patrones discursivos que explican la gestión del riesgo en el RS y su diferenciación con el contributivo. Estos patrones se conectan por medio del rol de los determinantes sociales de la salud como ordenador principal de los procesos de salud-enfermedad y de atención en este régimen. A su vez, estas condiciones de vida son las que determinan de manera importante el perfil epidemiológico, acceso, costo de la atención y en general la forma cómo se consumen los servicios de salud por la población afiliada. Discusión: La literatura del aseguramiento en salud reporta que la gestión del riesgo es una función central y supone un ejercicio estratégico para el adecuado manejo de la siniestralidad para optimizar el uso de la Unidad de Pago por Capitación (UPC) asignada. Los hallazgos muestran que los determinantes sociales de la salud no están siendo tenidos en cuenta como ordenador para la atención, por lo tanto, la gestión del riesgo se centra en la atención de patologías en estados avanzados. Conclusiones: los actores perciben que en general, la situación de salud de los afiliados en este régimen es más grave, más complicada y con mayor carga, lo cual genera una tensión en materia de suficiencia de la unidad per cápita. Existe una ausencia discursiva sobre el rol del modelo de atención y su correlación con las necesidades de esta población.

Introduction: The subsidized regime (SR) of the Colombian health system has structural problems that have not yet been resolved and there is a lack of studies that allow the understanding of most of them. The aim of this study was to explore with stakeholders of the subsidized regime the experience about strategic, financial, and health risk management and the differences perceived with the contributory regime. Methods: A qualitative study was performed; the analytic technique used was the discourse analysis under socio-hermeneutic perspective. 10 participants were interviewed, among them directors of insurance companies of SR and health care system managers. The interviews were recorded, prior informed consent, and analyzed according to the discourse analysis. Finding: Three discursive patterns emerged that explain risk management in SR and its differentiation from contributory regime. These patterns are connected through the role of the social determinants of health as the main axis that explain the health-disease and care processes in this regimen. At the same time, these living conditions are what determine the epidemiological profile, access, cost of care and, in general, the way in which health services are consumed by the affiliated population. Discussion: The health insurance literature reports that risk management is a central function, and it is a strategic exercise for the proper management of claims to optimize the use of resources, however, the findings show that the social determinants of health are not being taken into account as a key element for healthcare organization, therefore, risk management focuses on care for pathologies in advanced stages. Conclusions: The actors perceive that the health situation in this regime is more severe, more complicated and with a greater burden disease, which generates a tension in terms of sufficiency of the Per Capita Unit. There is a discursive absence on the role of the care model and its correlation with the needs of this population.

Costo-efectividad de la calidad del control prenatal con respecto al bajo peso al nacer en el Cauca / Antenatal control quality cost-effectiveness regarding low birth weight in Cauca

Antecedentes: El departamento del Cauca en Colombia es multiétnico, multicultural y biodiverso, también con grandes diferencias en bajo peso al nacer (BPN), mortalidad perinatal y mortalidad neonatal tardía entre municipios. Objetivo: Determinar la relación de costo-efectividad del control prenatal (CPN) cuando ha tenido buena calidad frente al que ha tenido calidad deficiente con respecto al BPN en el departamento del Cauca entre 2018 y 2020. Método: Evaluación económica con diseño epidemiológico de una cohorte histórica desde la perspectiva de la institución pagadora. Se calculó la razón incremental de costo-efectividad (RICE), análisis de sensibilidad e impacto presupuestal. Resultados: La incidencia de BPN fue del 8,3% (348/4182). La calidad deficiente en el CPN incrementó el riesgo de BPN (OR: 3,38; IC95%: 1,05-8,2) y la buena calidad tuvo una mejor relación de costo-efectividad (RICE: USD 2727,75), con posición dominante frente a la calidad deficiente (6,14 veces el PIB per cápita de ahorro) y con un impacto presupuestal de USD 2.904.392. Conclusiones: La buena calidad del CPN en el departamento del Cauca durante 2018-2020 fue costo-efectiva y dominante por ser de menor costo y mayor efectividad.

Background: The department of Cauca in Colombia is multiethnic, multicultural, and biodiverse, also with large differences in low birth weight (LBW), perinatal mortality, and late neonatal mortality among municipalities. Objective: To determine the cost-effectiveness relationship of antenatal care (ANC) when it has had good quality compared to that which has had poor quality with respect to low birth weight in the department of Cauca between 2018 and 2019. Method: Economic evaluation with epidemiological cohort design historical from the perspective of the payer institution. Incremental cost-effectiveness ratio (RICE), sensitivity analysis, and budgetary impact were calculated. Results: The incidence of LBW was 8.3% (348/4182). Poor quality in ANC increased the risk of LBW (OR: 3.38; CI95%: 1.05-8.2), good quality had a better cost-effectiveness ratio (RICE: USD 2727.75), with dominant position against poor quality (6.14 times the GDP/capita savings) with a budgetary impact of USD 2,904,392. Conclusions: The good quality of the ANC in the department of Cauca during 2018-2020 was cost-effective and dominant because it is lower cost and more effective.

Equidade em saúde para a população em situação de rua: uma revisão crítica / Health equity for homelessness: a critical review

RESUMO A noção de equidade em saúde se manifesta nas sociedades modernas por meio de diferentes ideias e propostas operacionais. No que diz respeito às pessoas em situação de rua, a equidade dialoga com a igualdade e a justiça para mobilizar diversas aplicações na saúde: enquanto a concepção liberal de equidade em saúde busca favorecer as condições de saúde dessa população sem romper com o modo de produção vigente, a concepção crítica almeja ampliar as condições e as necessidades de saúde na luta por uma sociedade emancipada. Com o objetivo de caracterizar as concepções de equidade em saúde expressas na literatura científica sobre essa população, este estudo realizou uma revisão crítica dos artigos disponíveis em portais de busca on-line. 1.716 publicações foram identificadas na amostragem inicial e 35 artigos foram incluídos na revisão após aplicação de procedimentos metodológicos. Os artigos foram caracterizados com relação às ideias e aplicações da equidade em saúde para a população em situação de rua, discutindo-se a respeito de metodologia, justiça e igualdade, distinção entre as concepções, processo saúde-doença, políticas públicas e pandemia da Covid-19. Aponta-se para a dominância da concepção liberal na literatura sobre essa população e a necessidade de investigações a partir da concepção crítica.

ABSTRACT The notion of equity in health manifests itself in modern societies through different ideas and operational proposals. Concerning homeless persons, equity dialogues with equality and justice to mobilize several applications in health: while the liberal conception of equity in health seeks to favor the health conditions of this population without breaking with the current mode of production, the critical conception aims to expand health conditions and needs in the struggle for an emancipated society. With the aim of characterizing the conceptions of equity in health expressed in the scientific literature on this population, this study carried out a critical review of the articles available on online search portals databases. 1,716 publications were identified in the initial sample and 35 articles were included in the review after application of methodological procedures. The articles were characterized in relation to the ideas and applications of equity in health for the homeless population, discussing methodology, justice and equality, distinction between conceptions, health-disease process, public policies and the COVID-19 pandemic. It points to the dominance of the liberal conception in the literature on this population and the need for investigations from the critical conception.

Use of hand-held ultrasound to perform E-FAST by general surgery residents in a trauma reference center: First experience in the Colombian Caribbean region / Uso de ecografía portátil para realizar E-FAST por residentes de cirugía general en un centro de referencia en trauma: primera experiencia en la región del Caribe colombiano

Introduction. Extended focused assessment with sonography for trauma (E-FAST) can be performed with minimal training and achieve ideal results. It allows easy transport and use in austere environments such as the Colombian Caribbean, where many centers do not have 24-hour radiology services. The objective of this study was to determine the performance of the use of E-FAST in the evaluation of trauma by second-year general surgery residents in the emergency department. Methods. Retrospective observational study that evaluated the diagnostic performance of E-FAST with Butterfly IQ, in patients with thoracoabdominal trauma, who attended a referral center in the Colombian Caribbean between November 2021 and July 2022. Sensitivity, specificity, and positive and negative predictive values were evaluated, compared with intraoperative findings or conventional imaging. Results. A total of 46 patients were included, with a mean age of 31.2 ± 13.8 years, 87.4% (n=39) were male. The main mechanism of trauma was penetrating (n=32; 69.5%). It was found that 80.4% (n=37) of the patients had a positive E-FAST result, and of these, 97% (n=35) had a positive intraoperative finding. Sensitivity, specificity, positive predictive value and negative predictive value were 92.1%, 75%, 94.6%, and 66.6%, respectively. The positive likelihood ratio was 3.68, while the negative likelihood ratio was 0.10. Conclusion. General surgery residents have the competence to perform accurate E-FAST scans. The hand-held ultrasound device is an effective diagnostic tool for trauma and acute care surgery patients.

Introducción. La evaluación enfocada extendida con ecografía en trauma (E-FAST, extended focused assessment with sonography for trauma) puede realizarse con entrenamiento mínimo y lograr resultados ideales. Su fácil transporte permite usarla en entornos austeros, como el Caribe colombiano, donde muchos centros no disponen de servicio radiológico las 24 horas. El objetivo de este estudio fue determinar el rendimiento del uso de E-FAST por residentes de cirugía general de segundo año en la evaluación del paciente con trauma en urgencias. Métodos. Estudio observacional retrospectivo que evaluó el rendimiento diagnóstico de E-FAST con Butterfly IQ, en pacientes con trauma toracoabdominal que acudieron a un centro de referencia del Caribe colombiano, entre noviembre de 2021 y julio de 2022. Se evaluaron sensibilidad, especificidad, valores predictivos positivo y negativo, comparando la descripción de la ecografía con los hallazgos intraoperatorios o imagenología convencional. Resultados. Se incluyeron un total de 46 pacientes, con una media de edad de 31,2 ± 13,8 años, siendo el 87,4 % (n=39) hombres. El principal mecanismo de trauma fue penetrante (n=32; 69,5 %). Se encontró que el 80,4 % (n=37) de los pacientes tuvo resultado E-FAST positivo, y que, de estos, el 97 % (n=35) tuvo un hallazgo positivo intraoperatorio. Se calculó una sensibilidad de 92,1 %, especificidad de 75 %, valor predictivo positivo de 94,6 % y negativo de 66,6 %; la razón de verosimilitud positiva fue de 3,68 y la negativa de 0,10. Conclusión. Los residentes de cirugía general están capacitados para realizar exploraciones E-FAST precisas. El ecógrafo portátil es una herramienta de diagnóstico eficaz para pacientes traumatizados.

Impacto econômico da implementação de políticas públicas para distúrbios de sono no Brasil: uma revisão integrativa / Economic impact of the implementation of public policies for sleep disorders in Brazil: an integrative review

Objetivo: Identificar estudos sobre políticas públicas, ações de saúde e análises econômicas relacionados aos distúrbios de sono no Brasil e discutir os seus resultados para o sistema de saúde, gestores de políticas públicas e a sociedade. Métodos: Revisão integrativa da literatura nas bases de dados Lilacs (via BVS), SciELO e PubMed (via Medline), incluindo estudos publicados nos idiomas português, inglês e espanhol, entre os anos de 1960-2023; foram excluídos estudos que não apresentaram a perspectiva brasileira ou aqueles cuja versão integral não estava disponível (seja gratuitamente ou na versão paga). Resultados: A busca retornou 536 resultados, dos quais apenas dois atendiam aos critérios de inclusão e mais cinco trabalhos foram incluídos manualmente, após consulta com especialistas de sono (todos abordaram apneia obstrutiva do sono, sendo: um relato sobre alteração na legislação de trânsito focada em prevenção de acidentes por sonolência excessiva; uma revisão de escopo sobre análises de custo-efetividade do tratamento da doença com uso de CPAP; dois relatos sobre linha de cuidado em um município e outros três em Secretarias Estaduais de Saúde). Conclusões: A revisão integrativa encontrou poucas evidências acerca do tema e aponta para a necessidade de futuros estudos que visem a suprir essa lacuna científica e de que seja necessário o desenvolvimento de futura linha de cuidado que amplie o acesso ao tratamento de doenças do sono no Sistema Único de Saúde.

Objective: To identify studies on public policies, health actions, and economic analyses related to sleep disorders in Brazil and discuss their results for public policy managers and society. Methods: Integrative literature review using Lilacs (via BVS), SciELO, and PubMed (via Medline) databases, including studies published in Portuguese, English, and Spanish languages, between years of 1960-2023; studies that did not present the Brazilian perspective or whose full version was not available were excluded (free or paid version). Results: The search returned 536 results, of which only two met the inclusion criteria, and five more studies were included manually after consulting sleep experts (all addressing obstructive sleep apnea, namely: a report on changes in traffic legislation focused on preventing accidents caused by excessive sleepiness; a scoping review on cost-effectiveness analysis of CPAP for sleep apnea treatment; two reports on care lines in one municipality and another three in State Secretariats). Conclusions: The integrative review found few evidences on the topic and points to the need for future studies aimed at filling this scientific gap and the development of a care line that expands access to sleep disorder treatment in Brazilian Public Health System.

Evolución de la eficiencia y la productividad del sistema de salud público chileno entre 2010 y 2019 / Efficiency and productivity of the Chilean public health system between 2010 and 2019

Introducción Frente al fuerte incremento del gasto en salud, es necesario indagar si ha venido acompañado de aumentos proporcionales en la producción de atenciones de salud dirigidas a los beneficiarios del Fondo Nacional de Salud. Métodos En esta investigación observacional, descriptiva y longitudinal retrospectiva estimamos la eficiencia técnica del Sistema Nacional de Servicios de Salud a través del costo medio de producción y la productividad media del trabajo en el periodo de 2010 a 2019. Resultados Durante la década estudiada, la producción ha aumentado en torno al 6% anual; la dotación de trabajadores aumentó (mayormente en el estamento médico) 61%; el gasto en remuneraciones aumentó 106% real; el gasto en bienes y servicios de consumo ha aumentado 25% real; la eficiencia del gasto ha disminuido 21% y la productividad es el elemento menos dinámico del sistema con 0,6% de crecimiento medio anual. Tras sustraer el componente de exámenes diagnósticos, el escenario empeora. Conclusiones Los resultados muestran que el mayor gasto en salud no ha venido aparejado de aumentos proporcionales en producción, traduciéndose en una caída en la eficiencia del gasto sanitario y aumentos magros o caídas en productividad, según cómo se mida la producción. Esto hace que la estrategia de crecimiento del sector público dependa principalmente de aumentos en la dotación de trabajadores. Esta baja productividad constituye una limitante seria para mejorar el acceso de los beneficiarios del Fondo Nacional de Salud a las atenciones de salud y contribuye a incrementar las listas de espera. Especial atención debiera brindarse a los costos medios de producción y a la productividad media del trabajo en un escenario de menor dinamismo en el crecimiento del gasto público en salud y de reforma del sistema de salud.

Introduction In view of the strong increase in health expenditure, it is necessary to investigate whether proportional increases in healthcare production for the beneficiaries of the National Health Fund have corresponded to this increase. Methods In this observational, descriptive, and retrospective longitudinal research, we estimate the technical efficiency of the National Health Services System through the average cost of production and average labor productivity in the period from 2010 to 2019. Results During the studied decade, production has increased by approximately 6% annually; the number of workers increased (mostly physicians) by 61%; spending on salaries increased by 106% in real terms; spending on consumer goods and services has increased by 25% in real terms; the efficiency of spending has decreased by 21%, and productivity is the least dynamic element of the system with an average annual growth rate of 0.6%. After subtracting the diagnostic tests component, this scenario worsens. Conclusions The results show that higher health expenditure has not been matched by commensurate increases in output, translating into a fall in the efficiency of healthcare expenditure and meager increases or falls in productivity, depending on how the output is measured. This means that the public sector's growth strategy depends mainly on increases in the number of workers. This low productivity is a serious constraint to improving healthcare access for National Health Fund beneficiaries and contributes to increasing waiting lists. Special attention should be paid to average production costs and average labor productivity in a scenario of less dynamic growth in public health spending and health system reform.

La economía feminista. Camino hacia la construcción de un paradigma alternativo. Ideas para seguir debatiendo / The feminist economy. Path towards the construction of an alternative paradigm. Ideas for further discussion

El abordaje onto epistémico de este ensayo se desarrolla en tres grandes miradas: un desarrollo gnoseológico orientado a precisar diferentes posicionamientos de la economía feminista como un movimiento político, herramienta de lucha y resistencia para enfrentar un modelo económico misógino, patriarcal, excluyente y a espaldas de la vida. Seguidamente, se precisan aspectos relevantes de su historicidad, partiendo de las figuras más resaltantes de la economía neoclásica. El hombre dentro de esta perspectiva (Homus Economicus), es el motor de la producción de riqueza, el agente económico por excelencia. Modelo donde no aparecen las relaciones sociales, las mujeres, la vida… Solo producir y consumir. Finalmente, se destaca toda una serie de avances y desafíos. Dentro de estas nuevas perspectivas, se pone especial atención a las relaciones de cuidado y afecto que se producen en los hogares como trabajo no remunerado. El cuidado de la vida humana toma el escenario, exigiendo nuevas perspectivas de análisis y la ampliación de fronteras a fin de destacar su relevancia social y económica; a partir de la utilización de estrategias para la valoración de la producción doméstica incorporando nuevas propuestas sobre el manejo de las estadísticas con lentes de género. El presupuesto gubernamental, se debe presentar desagregado y analizado el efecto de políticas de gastos e ingresos de manera diferenciada y situada(AU)

The ontologic epistemic approach in this essay is developed in three main perspectives: a gnoseological development aimed at specifying different positions of feminist economics as a political movement, a tool of struggle and resistance to face a misogynistic, patriarchal, exclusionary economic model behind the back of life. Next, relevant aspects of its historicity are specified, starting from the most outstanding figures of neoclassical economics. Man within this perspective (Homus Economicus), is the engine of the production of wealth, the economic agent par excellence. Model where social relationships, women, life do, not appear... Just produce and consume. Finally, a whole series of advances and challenges are highlighted. Within these new perspectives, special attention is paid to the relationships of care and affection that occur in households as unpaid work. The care of human life takes the stage, demanding new perspectives of analysis and the expansion of borders in order to highlight its social and economic relevance; from the use of strategies for the valuation of domestic production, incorporating new proposals on the management of statistics with gender lenses. The government Budget, should be presented disaggregated, and the effect of expenditure and revenue policies should be analyzed in a differentiated and situated manner(AU)

Perioperative costs of local or regional anesthesia versus general anesthesia in the outpatient setting: a systematic review of recent literature

Abstract Background and objectives: In this systematic review, we carried out an assessment of perioperative costs of local or regional anesthesia versus general anesthesia in the ambulatory setting. Methods: A systematic literature search was conducted to find relevant data on costs and cost-effectiveness analyses of anesthesia regimens in outpatients, regardless of the medical procedure they underwent. The hypothesis was that local or regional anesthesia has a lower economic impact on hospital costs in the outpatient setting. The primary outcome was the average total cost of anesthesia calculated on perioperative costs (drugs, staff, resources used). Results: One-thousand-six-hundred-ninety-eight records were retrieved, and 28 articles including 27,581 patients were selected after reviewing the articles. Data on the average total costs of anesthesia and other secondary outcomes (anesthesia time, recovery time, time to home readiness, hospital stay time, complications) were retrieved. Taken together, these findings indicated that local or regional anesthesia is associated with lower average total hospital costs than general anesthesia when performed in the ambulatory setting. Reductions in operating room time and postanesthesia recovery time and a lower hospital stay time may account for this result. Conclusions: Despite the limitations of this systematic review, mainly the heterogeneity of the studies and the lack of cost-effectiveness analysis, the economic impact of the anesthesia regimes on healthcare costs appears to be relevant and should be further evaluated.

HR Must Study Personal Economics - A Behavioral Economics Approach

Organizations in both the public and private sectors are increasingly using behavioural economics techniques to address a range of problems, including mechanism design and incentive architecture. Yet, there hasn't been much attention paid to how behavioural economics' experimental techniques might assist businesses in learning more about their (current or potential) workforce, and particularly about the preferences and tendencies of their employees. This has significant ramifications for overall organisational performance because certain designs or incentives may only influence people who share a certain disposition (such as those who are risk-averse or fairness-oriented), but not others, or they may even have the opposite effect on people who have different sets of preferences. In this post, we highlight a variety of intriguing directions for using a behavioural economics lens to comprehend and control employees. Also, a thorough case study is given.

Modelos neuroeconómicos explicativos de la relación entre aversión al riesgo, impulsividad y cardiocepción en estudiantes universitarios: revisión de alcance

Introducción: los modelos neuroeconómicos explican la toma de decisiones a partir de procesos neurofisiológicos, cognitivos y emocionales. La toma de decisiones se estudia a partir de otros subprocesos como la aversión al riesgo. La relación entre aversión al riesgo, impulsividad y/o interocepción es importante para determinar el rol de la conducta y cognición humanas en el mantenimiento de problemas de salud. Esto se ha estudiado en población universitaria, en la que se presentan factores de riesgo para la salud. Objetivo: sintetizar los modelos neuroeconómicos descritos en la literatura para establecer la relación entre la aversión al riesgo, impulsividad y/o la cardiocepción en estudiantes universitarios. Metodología: revisión tipo alcance realizada del 01 de junio al 30 de septiembre de 2021 en los recursos; PubMed, PsyInfo, Google Scholar, Sciencedirect, Scopus, Open dissertations y OpenGrey. Como criterio de inclusión se estableció que se tratara de investigaciones experimentales y observacionales en inglés o español en estudiantes universitarios que evaluaran la relación entre toma de decisiones, impulsividad y/o interocepción. No se filtró por fecha ni por tipo de acceso. Resultados: se rastrearon 1035 documentos, 14 cumplieron con los criterios de inclusión. Se identificaron cuatro modelos: neuroeconómico conductual, paradigma de descuento temporal, teoría biopsicológica de Gray y diferencias individuales. Se hallaron correlaciones positivas y negativas entre impulsividad, aversión al riesgo e interocepción. Conclusiones: según los estudios existe una relación entre impulsividad y aversión al riesgo, que dependiendo del modelo implementado será positiva o negativa. Las asociaciones con interocepción son poco concluyentes y requieren mayor investigación.

Introduction: neuroeconomic models explain decision making based on neurophysiological, cognitive, and emotional processes. Decision making is studied from other threads such as risk aversion. The relationship between risk aversion, impulsivity and/or interoception is important to determine the role of human behavior and cognition in the maintenance of health problems. This has been studied in the university population, in which health risk factors are present. Objective: to synthesize the neuroeconomic models described in the literature to establish the relationship between risk aversion, impulsivity and/or cardioception in university students. Methodology: scoping review carried out from June 1 to September 30, 2021, in the resources; PubMed, PsyInfo, Google Scholar, Sciencedirect, Scopus, Open dissertations, and OpenGrey. As inclusion criteria, it was established that they were experimental and observational investigations in English or Spanish in university students that evaluated the relationship between decision-making, impulsivity and/or interoception. It was not filtered by date or by type of access. Results: 1035 documents were searched, 14 met the inclusion criteria. Four models were identified: behavioral neuroeconomic, delaying discount paradigm, Gray's biopsychological theory, and individual differences. Positive and negative correlations were found between impulsivity, risk aversion, and interoception. Conclusions: according to the studies, there is a relationship between impulsivity and risk aversion, which depending on the model implemented will be positive or negative. Associations with interoception are inconclusive and require further investigation.

Impacto económico de medicamentos de alto precio/costo en la seguridad social de Argentina. El caso del instituto de obra social para las Fuerzas Armadas y de Seguridad / Economic impact of high-price/cost medicines on social security in Argentina. The case of the Institute for the Armed and Security Forces

Resumen Introducción: En Argentina, los medicamentos de alto costo (MAC) generan una carga económica elevada que deben afrontar las instituciones sanitarias. Sin embargo, no existe a la fecha un estu dio en Argentina que indique la magnitud del real problema de los MAC para la Seguridad Social. El presente trabajo, explora cuál es su impacto económico para una de las principales Obras Sociales del país. Métodos: Se realizó un estudio descriptivo con etapa analítica a partir de datos obtenidos en gerencia de prestaciones, área farmacia y área contable de la institución. Cada medicamento fue clasificado según recomendación de OMS (clasificación Anatómica-Terapéutica- Química-ATC). Los precios fueron consignados en tres valores: nominal al momento de adquisición, actualizado a pesos fin de 2021 utilizando el CER (coeficiente de estabilización de referencia), y en dólares (USD). Se evaluaron 105 324 dispensas de MAC, correspondientes a 258 011 unidades para 10 450 afiliados. Resultados: El gasto total anualizado fue 57 millones de dólares (USD), y por usuario 6220 USD. Solo 1.9% de los afiliados requirieron MAC, aunque el gasto fue del 21.9% de los ingresos (aportes + contribuciones). Los primeros 5 medicamentos que generaron el mayor gasto fueron enzalutamida, bevacizu mab, nivolumab, palbociclib, pembrolizumab. Las enfermedades oncológicas y reumatológicas representaron el 62.8% del gasto. Conclusión: A la luz de los resultados, se deduce que los MAC constituyen un riesgo potencial de desfinanciación del sistema de salud si son abordados de manera atomizada por cada subsector. Los MAC requieren de políticas globales de carácter nacional y/o regional.

Abstract Introduction: In Argentina, high-cost drugs (HCD) induce a high economic burden for all the health system sec tors. However, it does not exist in Argentina any data that indicates the real problem of HCD for Social Security. That is why, the present study explores the economic impact of the HCD for one of the main Institutions of the country. Methods: A descriptive study with an analytical stage was carried out based on data obtained from management, pharmacy and accounting area. Each drug was classified according to WHO recommendation (Anatomical-Therapeutic-Chemical-ATC classification). The prices were expressed in three ways: nominal value at the time of acquisition in local currency, updated using the CER (reference stabilization coefficient), and in US dollars. A total of 105 324 HCD dispensed were evaluated, which corresponded to 258 011 units destined to 10 450 patients. Results: Total annualized spend was US$57 million (US$6220 per patient). Only 1.9% of affiliates required HCD, although those expenses represented 21.9% of the institutions´ total income. The first 5 drugs associated to the highest expenditure were enzalutamide, bevacizumab, nivolumab, palbociclib, pembrolizumab. Oncological and rheumatological diseases represented 62.8% of the HCD costs. Conclusion: Considering the results obtained, it can be deduced that if the HCD problem is approached in a scattered way by each subsec tor, it will become a potential risk for health system defund. The HCD topic requires of global policies at national or even regional level.

Prodromal Parkinson's disease and its socio-demographic characteristics among people aged 55 and above in four provinces of China / 环境与职业医学

Background China is witnessing an accelerated aging process and an increasingly serious situation of Parkinson's disease. Research on the pre-disease stage and its related influencing factors has gained more and more attention. Objective To analyze the current situation of prodromal Parkinson's disease (pPD) of people aged 55 years and above in four provinces of China, and to explore its influencing demographic and socio-economic characteristics. Methods Using the data of Community-based Cohort Study on Nervous System Disease in 2020, a total of 10724 participants with complete data on demographic and socio-economic factors and risk factors on Parkinson's disease were selected. Based on the criteria recommended by the International Parkinson and Movement Disorder Society (MDS), we evaluated risk level (i.e., post-test probability) of pPd, prevalence of possible or probable pPD, and number of pPD-related risk/prodromal markers in the participants. Multiple linear regression and multiple logistic regression models were used to analyze the influencing socio-demographic factors of risk level of pPd and prevalence of possible or probable pPD, and Poisson regression and multinomial logit regression models were used to analyze the influencing socio-demographic factors of the number of pPD-related risk/prodromal markers in the total sample, men, and women, respectively. Results The median (P25, P75) of post-test probability of pPD in 2020 was 0.78% (0.42%, 1.66%), the prevalence rate of possible or probable pPD was 0.34%, and 69.03% of the participants reported 3-5 pPD-related risk/prodromal markers. The post-test probabilities of men, those with older age, lower education level, per capita monthly household income < 1000 yuan, urban residency, or without active employment were higher (P<0.05). Men and being aged ≥ 75 years had a higher prevalence of possible or probable pPD (P<0.05). The OR of possible or probable pPD was 8.404 (95%CI: 2.839−24.879) in subjects aged ≥ 75 years versus those aged 55−64 years. Males, those without active employment, being less educated, with older age, and urban residents were more likely to report pPD-related risk/prodromal markers than those of the opposite groups (P<0.05). Conclusion Men, subjects aged ≥75 years, those with lower education level, urban residents, and those without active employment have higher risk levels of pPD and are more likely to report pPD-related risk/prodromal markers among people aged 55 years and above in the four provinces of China, poor economic situation is also associated with higher risk levels of pPD.

Better timing for HoLEP: a retrospective analysis of patients treated with HoLEP over a 10-year period with a 1-year follow-up / 亚洲男科学杂志(英文版)

The aim of this study was to explore the optimal timing of holmium laser enucleation of the prostate (HoLEP) in patients presenting benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS). A retrospective analysis was conducted based on the perioperative and postoperative outcome data of 1212 patients who underwent HoLEP in Shanghai Ninth People's Hospital (Shanghai, China) between January 2009 and December 2018. According to the preoperative International Prostate Symptom Score (IPSS), all patients whom we analyzed were divided into Group A (IPSS of 8-18) and Group B (IPSS of 19-35). Peri- and postoperative outcome data were obtained during the 1-year follow-up. IPSS changes were the main postoperative outcomes. The postoperative IPSS, quality of life, peak urinary flow rate, postvoid residual, and overactive bladder symptom score (OABSS) improved significantly. The IPSS improved further in the group with severe LUTS symptoms, but the postoperative IPSS was still higher than that in the moderate LUTS group. OABSSs showing moderate and severe cases after follow-up were more frequent in Group B (9.1%) than in Group A (5.2%) (P < 0.05). There were no significant intergroup differences in the intraoperative American Society of Anesthesiologists or hospitalization expense scores, and the medication costs, as well as the total costs, were significantly higher in Group B. In this retrospective study, HoLEP was an effective treatment for symptomatic BPH. For patients with LUTS, earlier surgery in patients with moderate severity may result in a marginally better 12-month IPSS than that in men with severe symptoms.

Capital estrangeiro e mudança estrutural no mercado privado de serviços de saúde brasileiro / Foreign capital and structural change in the Brazilian private health services market / Capital extranjero y cambio estructural en el mercado privado de servicios de salud brasileño

Resumo: Este artigo analisa o processo de transformação estrutural no mercado privado de serviços de saúde brasileiro a partir dos anos 2000, com ênfase na crescente participação de fundos financeiros e do capital estrangeiro no processo de expansão e consolidação do setor. A análise do movimento de ingresso do capital estrangeiro nos serviços e planos de saúde no Brasil foi desenvolvida a partir da construção de uma base dados com um total de 297 operações patrimoniais envolvendo empresas com atividades em serviços de saúde, inclusive operadoras de planos e seguros de saúde e administradoras de benefícios em saúde. A análise dessas operações evidencia que o afluxo de capital estrangeiro foi fundamental para viabilizar a centralização de capital em determinadas empresas e catalisar o processo de concentração e transformação estrutural do setor de serviços de saúde ao longo das últimas duas décadas. Conclui-se que o acirramento da disputa intercapitalista no mercado de serviços de saúde levou à emergência de grandes corporações no mercado e a novos modelos de negócio, com destaque especial para o surgimento de redes verticalizadas de atendimento (operação de planos, serviços hospitalares, ambulatoriais, de diagnóstico e tratamento e de atenção básica).

Abstract: This article analyzes the process of structural transformation within the Brazilian private health services market since the 2000s, with emphasis on the growing participation of financial funds and foreign capital in the process of expansion and consolidation of the sector. The analysis of the movement of foreign capital into health services and plans in Brazil was developed from the construction of a database with a total of 297 equity operations involving companies with activities in health services, including companies operating health plans and insurance and companies administering health benefits. The analysis of these operations shows that the influx of foreign capital was fundamental to enable the centralization of capital in certain companies and catalyze the process of concentration and structural transformation of the health services sector over the last two decades. We concluded that the intensification of the intercapitalist dispute within the health services market led to the emergence of large corporations and new business models, with special emphasis on the emergence of verticalized care networks (operation of plans, hospital services, outpatient services, diagnosis and treatment, and primary care).

Resumen: Este artículo analiza el proceso de transformación estructural en el mercado privado de servicios de salud brasileño, a partir de los años 2000, con énfasis en la creciente participación de fondos financieros y del capital extranjero en el proceso de expansión y consolidación del sector. El análisis del movimiento de ingreso del capital extranjero en los servicios y planes de salud en Brasil fue desarrollado a partir de la construcción de una base datos con un total de 297 operaciones de capital de empresas con actividades en servicios de salud; inclusive las empresas operadoras de planes y seguros de salud y las empresas administradoras de beneficios en salud. El análisis de esas operaciones muestra que la entrada de capital extranjero fue fundamental para viabilizar la centralización de capital en determinadas empresas y catalizar el proceso de concentración y transformación estructural del sector de servicios de salud a lo largo de las últimas dos décadas. La conclusión que el recrudecimiento de la disputa intercapitalista dentro del mercado de servicios de salud llevó a la emergencia de grandes corporaciones en el mercado y nuevos modelos de negocio, con destaque especial para surgimiento de redes verticalizadas de atención (operación de planes, servicios hospitalarios, ambulatorios, de diagnóstico y tratamiento y de atención básica).

Challenges and potentialities of business entrepreneurship in nursing: analogies to brazilian entrepreneurial activity / Desafíos y potencialidades del emprendimiento empresarial en enfermería: analogías con la actividad empresarial brasileña / Desafios e potencialidades do empreendedorismo de negócios na enfermagem: analogias à atividade empreendedora brasileira

ABSTRACT Objective: to reflect on the potentialities and challenges of entrepreneurial activity in the early-stage stage of nurses, considering the analogies between the profile of Brazilian nursing and business entrepreneurs in the country. Method: this is a theoretical reflection articulated around the concept of phases of entrepreneurial activity. From this starting point, common variables from the Nursing Profile survey and the Global Entrepreneurship Monitor Brazil Report were selected, such as sex, age group, education level, family income and occupation. Taking into account a parallel between variables, reflection on the challenges and potential of entrepreneurial nurses in the nascent and new entrepreneurial activity phases was ordered. Results: it is possible that nascent and new entrepreneurial nurses are predominantly women, specialized with the possibility of income compatible with traditional jobs. Specialization, professional experience and professional legislation are strengths, while sex is a challenge. Conclusion: there are both potentialities and challenges. For nascent and new entrepreneurs to emerge, entrepreneurial education, promotion of gender equality, work and income policies are particularly relevant.

RESUMEN Objetivo: reflexionar sobre las potencialidades y desafíos de la actividad empresarial en la etapa inicial de los enfermeros frente a las analogías entre el perfil de la enfermería brasileña y los empresarios del país. Método: reflexión teórica articulada en torno al concepto de fases de la actividad emprendedora. A partir de ese punto de partida, fueron seleccionadas variables comunes de la Encuesta Perfil de Enfermería y del Informe Global Entrepreneurship Monitor Brasil, entre las que se encuentran género, grupo etario, nivel educativo, renta familiar y ocupación. Teniendo en cuenta un paralelismo entre las variables, se ordenó la reflexión sobre los desafíos y potencialidades de los enfermeros emprendedores en las fases de actividad emprendedora naciente y nueva. Resultados: es posible que las enfermeras nacientes y nuevas emprendedoras sean predominantemente mujeres, especializadas, con posibilidad de ingresos compatibles con los trabajos tradicionales. La especialización, la experiencia profesional y la legislación profesional son potencialidades, mientras que el género es un desafío. Conclusión: hay potencialidades y desafíos. Para el surgimiento de emprendedores emergentes y nuevos, la educación emprendedora, la promoción de la igualdad de género, las políticas de trabajo e ingresos son particularmente relevantes.

RESUMO Objetivo: refletir sobre potencialidades e desafios da atividade empreendedora em estágio inicial de enfermeiros face à analogias entre o perfil da enfermagem brasileira e de empreendedores de negócios no país. Método: reflexão teórica articulada em torno do conceito de fases de atividade empreendedora. Deste ponto de partida foram selecionadas variáveis comuns da pesquisa Perfil da Enfermagem e do Relatório do Global Entrepreneurship Monitor Brasil, sendo sexo, faixa etária, nível de escolaridade, renda familiar e ocupação. Levando em conta um paralelo entre as variáveis, ordenou-se a reflexão sobre os desafios e potencialidade de enfermeiros empreendedores nas fases de atividade empreendedora nascente e nova. Resultados: é possível que enfermeiros empreendedores nascentes e novos sejam predominantemente mulheres, especializadas, com possibilidade de renda compatível com postos tradicionais de trabalho. A especialização, a experiência profissional e a legislação profissional são potencialidades; enquanto que o sexo, um desafio. Conclusão: há tanto potencialidades quanto desafios. Para que empreendedores nascentes e novos surjam são relevantes, sobretudo, a educação empreendedora, promoção da igualdade de gênero, políticas de trabalho e renda.

Análise das solicitações de medicamentos não padronizados de um hospital universitário terciário / Analysis of requests for non-standard medicines from a tertiary university hospital

Introdução: O uso extensivo de medicamentos não padronizados causa aumento de custos em saúde, além de potencial redução de segurança e uso racional de medicamentos. A Comissão de Farmácia e Terapêutica orienta a prescrição de medicamentos, por meio da avaliação e seleção de medicamentos a serem incluídos no formulário de medicamentos padronizados, com base nas melhores evidências científicas disponíveis e no perfil dos pacientes locais, promovendo o uso racional de medicamentos. O objetivo deste trabalho foi analisar as solicitações de fornecimento de medicamentos não padronizados na instituição. Métodos: Trata-se de um estudo observacional e descritivo onde foram analisadas as solicitações de medicamentos não padronizados realizadas entre fevereiro de 2016 e dezembro de 2021, identificando os medicamentos envolvidos e seus respectivos custos. Resultados: Foram realizadas 203 solicitações no período, sendo 174 incluídas no estudo. Os medicamentos que tiveram mais solicitações foram o rituximabe (41), a imunoglobulina humana (31), o sucralfato (23), a nitazoxanida (12) e o eltrombopague (7). As solicitações com maior custo foram as de imunoglobulina humana (US$ 799,702.38), rituximabe (US$ 717,320.26), eltrombopague (US$ 281,062.50), ruxolitinibe (US$ 167,867.46) e bortezomibe (US$ 149,033.52). As principais clínicas que solicitaram medicamentos não padronizado foram a neurologia (47), a hematologia (30), as moléstias infecciosas e parasitárias (17), e a anestesiologia (12). As solicitações de maior custo foram realizadas pela neurologia (US$ 145,519.08), hematologia (US$ 120,980.25), transplante de medula óssea (US$ 51,635.11) e dermatologia (US$ 44,813.40). Conclusão: O estudo demonstrou que há um fluxo estruturado de solicitação de medicamentos não padronizados na instituição, sendo uma importante ferramenta de gerenciamento dessas solicitações, evitando a aquisição desnecessária de itens que não compõem o elenco terapêutico do hospital.

Introduction: Widespread use of non-formulary drugs (NFD) increases cost and may reduce safety and rational use of medicines. The Pharmacy and Therapeutics Committee provides guidance on drug prescription by evaluating and selecting medications to be included in a hospital's formulary based on best scientific evidence available and local patients' profile, promoting rational use of medicines. The objective of this study was to assess non-formulary drugs prescriptions at a tertiary hospital. Methods: This was a retrospective study. NFD prescribed and its associated costs were assessed through NFD request forms received from February 2016 to December 2021. Results: A total of 203 NFD request forms were received, from which 174 were included in this study. The most frequently prescribed NFD included rituximab (n = 41), immunoglobulin (31), sucralfate (23), nitazoxanide (12), and eltrombopag (7), with the highest costs being with immunoglobulin (US$ 799,702.38), rituximab (US$ 717,320.26), eltrombopag (US$ 281,062.50), ruxolitinib (US$ 167,867.46), and bortezomib (US$ 149,033.52). The most frequent requesting specialties were neurology (n = 47), hematology (30), infectious disease (17) and anesthesiology (12), and highest costs requests were from neurology (US$ 145,519.08), hematology (US$ 120,980.25), bone marrow transplant unit (US$ 51,635.11), and dermatology (US$ 44,813.40). Conclusion: This study showed that a structured request flow for NFD prescription is a critical procedure in order to better manage drug prescription within the hospital, promoting rational use of medicines and preventing unnecessary spending with drugs for which the clinical indication may be covered by a drug already in the hospital's formulary.

Economic Impact of the COVID-19 Pandemic among Dentists in One of the Poorest Brazilian States: A Cross-Sectional Study

ABSTRACT Objective: To analyze the impact of the COVID-19 pandemic on dentists' income and to identify associated factors in one of the poorest Brazilian states. Material and Methods: A cross-sectional study including dentists who volunteered to answer an electronic questionnaire in Maranhão. Hierarchical multinomial logistic regression analyses were performed, estimating crude and adjusted odds ratios (OR) and respective 95% confidence intervals (95%CI) (alpha=5%). Results: The COVID-19 pandemic impacted the professionals´ income negatively [55.44% (50.26-60.52%)] and also positively [6.9% (4.55-9.94%)]. The negative impact on income was greater among male dentists (OR=2.54; 95%CI: 1.16-5.53), over 30 years of age (OR=3.03; 95%CI: 1.34-6.87), with family income below two minimum wages (OR=4.63; 95%CI: 1.50-14.30), who worked in the continent instead of in the capital island (OR=2.21; 95%CI: 1.14-4.29) and in the private sector (OR=31.43; 95%CI: 11.59-85.22). Moreover, those who had been tested for COVID-19, with a negative result, had a 21.3-fold greater chance of having an increased household income when compared to those who had not been tested. Conclusion: The COVID-19 pandemic negatively impacted the dentists' income in Maranhão, especially the older, males, with lower incomes, and who worked in the private sector, living far from the capital. The SUS played an important role in the social protection of dentists during the COVID-19 pandemic, mitigating the economic impacts on the public sector working class.

Estado e acumulação de capital na saúde brasileira sob a ótica da Teoria Marxista da Dependência / State and capital accumulation in Brazilian health from the perspective of the Marxist Dependency Theory / Estado y acumulación de capital en la salud brasileña desde la perspectiva de la Teoría Marxista de la Dependencia

Resumo: O setor de saúde constitui um dos maiores campos de desenvolvimento econômico, social, científico e tecnológico do Brasil e tem sido arena de disputa entre os interesses capitalistas, que entendem a saúde como bem de mercado, e os defensores do acesso universal, que a entendem como bem essencial. No Brasil, a Constituição Federal de 1988 determinou que a saúde é direito de todos e dever do Estado, e, desde então, o país avança com a política pública, mas sofre recuos e bloqueios pela condição de país de economia periférica, historicamente subordinado aos interesses dos países centrais, que o veem como um amplo mercado consumidor. Esses interesses externos, associados à burguesia interna, têm obtido vantagens do Estado brasileiro desde a década de 1960, quando a formação de grupos empresariais se expandiu, dominando diversos segmentos da saúde, sobretudo a partir de políticas neoliberais dos anos de 1990. Esses aspectos são muito explorados nas publicações do campo da Saúde Coletiva, mas este texto busca uma nova abordagem, utilizando a Teoria Marxista da Dependência como referência para analisar, ainda que de forma preliminar, a situação de dependência política, econômica e tecnológica que tem distanciado a política de saúde dos ideais de um sistema público e universal, defendido na Reforma Sanitária brasileira.

Abstract: The health sector is one of the major fields of economic, social, scientific, and technological development in Brazil, and has been the arena of dispute between capitalist interests that regard health as a commodity and advocates of universal access who regard health as an essential good. The Brazilian Federal Constitution of 1988 determined that health is a fundamental right and the State's responsibility, and since then the country has made progress with public policy, but has suffered setbacks and blockages due to its status as a peripheric country, historically subordinated to the interests of core countries, which see Brazil as a broad consumer market. These external interests associated with the internal bourgeoisie have been taking advantage of the Brazilian State since the 1960s, when the foundation of business groups expanded, dominating various health segments, especially since the neoliberal policies of the 1990s. These aspects are much explored in publications in Public Health, but this text seeks a new approach, using the Marxist Theory of Dependency as a reference to analyze, albeit in a preliminary way, the situation of political, economic, and technological dependence that has distanced health policy from the ideals of a public and universal system, defended in the Brazilian Health Reform.

Resumen: El sector de la salud es uno de los mayores campos de desarrollo económico, social, científico y tecnológico de Brasil y ha sido un escenario de disputa entre los intereses capitalistas, que entienden la salud como un bien de mercado, y los defensores del acceso universal, que entienden la salud como un bien esencial. En Brasil, la Constitución Federal de 1988 estableció que la salud es un derecho de todos y un deber del Estado, y desde entonces el país ha avanzado con políticas públicas, no exentas de retrocesos y bloqueos debido a la condición de país de periferia económica, históricamente subordinado a los intereses de los países centrales, que ven a Brasil como un amplio mercado consumidor. Estos intereses externos, asociados a la burguesía interna, han obtenido ventajas del Estado brasileño desde la década de 1960, cuando se expandió la formación de grupos empresariales, dominando varios segmentos de la salud, sobre todo a partir de políticas neoliberales de la década de 1990. Estos aspectos son ampliamente explorados en publicaciones del campo de la Salud Colectiva, pero este texto busca un nuevo enfoque, utilizando la Teoría Marxista de la Dependencia como referencia para analizar, aunque de forma preliminar, la situación de dependencia política, económica y tecnológica que ha alejado la política de salud de los ideales de un sistema público y universal, defendido en la Reforma Sanitaria brasileña.