Uso de recursos y costos asociados a las fracturas en mujeres españolas / Use of resources and costs associated to fractures in spanish women

El objetivo del estudio fue determinar el uso de recursos y costos debidos a fracturas óseas en mujeres españolas mayores de 50 años en un ámbito poblacional. Se realizó un estudio observacional y retrospectivo, en seis centros de atención primaria y dos hospitales urbanos de España. Se registró datos sociodemográficos, de comorbilidad, uso de recursos (consultas médicas en atención primaria, pruebas complementarias, medicación, atención especializada, hospitalizaciones, visitas, urgencias), costos y pérdida de productividad. Se incluyeron los registros de 19 022 mujeres de los cuales el 7% presentó algún tipo de fractura entre el 2003 y 2007. Las fracturas se asociaron mayoritariamente con osteoporosis (OR: 3,2), fibromialgia (OR: 2,4) y alteraciones tiroideas (OR: 2,2). En el modelo corregido, el costo total para las pacientes que tuvieron fractura fue de USD 3727 mientras que en las que no la tuvieron fue USD 2705,5 (p<0,001). Las pacientes con fractura generan un mayor uso de recursos, costos sanitarios, y pérdidas de productividad laboral.

The objective of the study was to determine the use of resources and costs due to bone fractures in Spanish women above 50 years of age in the population scope. An observational and retrospective study was conducted in six primary care centers and two urban hospitals in Spain. Socio-demographic and co-morbidity data, use of resources (primary care consultations, complementary tests, medications, specialized care, hospitalizations, visits, urgencies), costs and productivity losses were registered. Records of 19 022 women were included, 7% showed some type of fracture between 2003 and 2007. Fractures were mostly associated with osteoporosis (OR: 3.2), fibromyalgia (OR: 2.4) and thyroid changes (OR: 2.2). In the corrected model, the total cost for patients who had a fracture was USD 3727 compared to USD 2705.5 (p<0.001) for those who did not have it. Patients with a fracture generate a greater use of resources, sanitation costs and work productivity losses.

Trauma na infância e adolescência: epidemiologia, tratamento e aspectos econômicos em um hospital público / Epidemiology, treatment and economical aspects of multiple trauma in children and adolescents in a public hospital

INTRODUÇÃO: A realização deste trabalho foi motivada pela escassez de artigos encontrados na literatura que estudam o politrauma na infância e na adolescência.. O objetivo é descrever o perfil epidemiológico das lesões traumáticas na infância tratadas num centro de trauma, avaliar os aspectos econômicos relacionados com o gasto hospitalar e o tempo de internação de acordo com o tratamento realizado. MATERIAIS E MÉTODOS: analisamos todos os prontuários do hospital Geral de Pirajussara no período de dezembro de 2005 a dezembro de 2006. Obtivemos 182 pacientes, sendo 71 por cento do sexo masculino e 29 por cento do feminino; 48 por cento brancos e 52 por cento não brancos. RESULTADOS: houve predominância dos indivíduos do sexo masculino com 71 por cento dos pacientes. O mecanismo de trauma mais freqüente foi a queda (36 por cento). A média de dias de internação foi 4,1 dias, com gasto estimado de R$ 649,50 para cada paciente. A taxa de mortalidade foi de 2,74 por cento, sendo o traumatismo crânio-encefálico responsável por 80 por cento da mortalidade e os maus tratos presentes em 40 por cento dos óbitos. CONCLUSÃO: a população pediátrica tem particularidades que a tornam distinta da população adulta em relação à epidemiologia e manejo das lesões.

INTRODUCTION: the motivation to conduct this study was the reduced number of articles in literature correlating multiple trauma in childhood and infancy. The objective here was to describe the epidemiological profile of traumatic injuries treated in a trauma center, evaluating the economic aspects associated with hospitalized patients' costs and the period of hospital stay according to the treatment provided. MATERIAL AND METHODS: we assessed all Pirajussara Hospital patients' files in the period of December of 2005 to December 2006. We selected 182 patients, 129 (71 percent) males and 53 (29 percent) females; 88 (48 percent) Caucasian and 94 (52 percent) non-Caucasian children. RESULTS: male patients were prevalent, with 129 (71 percent) cases. The most frequent trauma mechanism was fall (36 percent) and the primary diagnose was humeral supracondylar fracture (20,9 percent) and 47 (25,82 percent) associated lesions. The mean hospitalization time was 4.1 days with an estimated cost of R$ 649.50 for each patient. The most expensive and the longest periods of hospital therapy were associated to skull trauma and femoral fracture; the economic impact increased when associated lesions were present. The mortality rate was 2.74 percent with 5 deaths, with skull trauma being accounted for 80 percent of the deaths, while child abuse accounts for 40 percent. CONCLUSION: the pediatric population exhibits particular characteristics that make it unique concerning trauma injuries' epidemiology and handling.

Development and validation of a new clinical risk index for prediction of osteoporosis in Thai women.

The objective of this study was to develop and validate a new simple tool for identifying Thai women who are at high risk of having osteoporosis. A total of 322 women, aged > or = 45 years, were randomly divided into two cohorts: a development (n = 130) and a validation cohort (n = 192). Femoral neck and lumbar spine BMD were measured by LUNAR DPX-IQ densitometer. The prevalence of osteoporosis (defined by BMD T-scores < or = -2.5) was 33 per cent by either femoral neck or lumbar spine BMD. Khon Kaen Osteoporosis Study (KKOS), scoring based on age and weight was calculated and applied to the development cohort. Individuals with KKOS score < or = -1 were defined as "high risk"; otherwise a "low risk" was defined. In the validation cohort, the sensitivity and specificity of KKOS was 70 and 73 per cent, respectively. Furthermore, if the high risk individuals identified by KKOS are to be treated, and if the treatment reduces fracture incidence by 50 per cent and assuming that treatment cost is 10 bahts per day, then the cost to prevent one fracture is estimated to be 466,695 bahts per year. These data suggest that although age and body weight can be used to identify Thai women who are at high risk of having osteoporosis, its application to the general population requires further research to arrive at the optimal cost-benefit for the community.