Canasta alimentaria normativa: perspectivas actuales e implicaciones para la salud pública en Venezuela / Normative Food Basket current perspectives and implications for public health in Venezuela

La Canasta Alimentaria Normativa (CAN) es un instrumento estratégico de planificación y seguimiento, que impacta el ámbito económico (fijación del salario mínimo SM y del umbral de la pobreza relativa), la seguridad alimentaria y la salud pública. El objetivo fue describir la evolución histórica de la CAN en Venezuela, contrastando su valoración económica respecto al SM durante el período 1990 ­ 2023. Tipo de estudio: Descriptivo. Se empleó la CAN del Instituto Nacional de Estadísticas/Instituto Nacional de Nutrición (INE/INN) y su comparación con la canasta del Centro de Documentación y Análisis Social de la Federación Venezolana de Maestros(CENDAS ­ FVM). Los valores mensuales de la CAN y del SM se recalcularon a dólares USA, de acuerdo a la tasa de cambio oficial. No se incluyó evaluación de la estructura interna, ni sus expresiones en términos de aporte de energía y nutrientes. Resultados: Desde 1990 hasta el año 2015, se requirieron entre1,0 y 1,8 SM y entre 0,6 y 1,7 Ingresos Mínimos Legales (IML)para acceder a la CAN. Para el año 2023 se requirieron hasta 78,3SM y 51,6 IML. El valor promedio de la canasta del CENDAS-FVM fue superior al valor de la CAN INE/INN, en una proporción de 1,7: 1. Conclusiones: la CAN resultó sensible en identificar los cambios y tendencias de su estimación económica, en el ambiente inflacionario venezolano. El uso de sus resultados está sujeta a cierto grado de discrecionalidad política. El costo de la CAN, expresa una contracción del poder de compra de los hogares venezolanos con potenciales impactos sobre la nutrición y la salud física y mental a corto y largo plazo.

The Normative Food Basket (NFB) represents astrategic planning and monitoring instrument, which impactsthe economic sphere (setting of the minimum wage (MW) andthe relative poverty threshold), food security and public health.The objective was to describe the historical evolution of the NFB in Venezuela, contrasting its economic valuation with respect to the MW during the period 1990 ­ 2023. Type of study: Descriptive. The NFB of the National Institute of Statistics/National Institute of Nutrition (NIS/NIN) was used and itscomparison with the basket of the Center for Documentationand Social Analysis of the Venezuelan Federation of Teachers (CENDAS ­ FVM). The monthly values of the NFB and theMW were recalculated into dollars (US$), according to theofficial exchange rate. No evaluation of the internal structurewas included, nor its expressions in terms of energy and nutrientcontribution. Results: From 1990 to 2015, between 1.0 and1.8 MW and between 0.6 and 1.7 Minimum Legal Income(MLI) were required to access the NFB. By 2023, up to 78.3MW and 51.6 MLI were required. The average value of the CENDAS-FVM basket was higher than the value of the NFBNIS/NIN, in a proportion of 1.7: 1. Conclusions: As a statistical operation, the NFB was sensitive in identifying changes andtrends in its estimate economic, in the Venezuelan inflationaryenvironment. The use of its results is subject to a certain degree ofpolitical discretion. The cost of CAN expresses a contraction inthe purchasing power of Venezuelan households with potentialimpacts on nutrition and physical/mental health in the shortand long term.

Racionamiento, inflación e inequidad sanitaria en Venezuela: caso de las enfermedades cardiovasculares / Rationing, inflation and health inequity in Venezuela: case of cardiovascular diseases

los modelos público-sanitarios de caráctermonopólico como el venezolano, suelen asociarse a tendencias al racionamiento de los bienes y servicios que proveen a sus usuarios, así como a la merma de la calidad de estos. Por otro lado, la provisión de dichos bienes y servicios por la vía de mecanismos de mercado, tiene ante sí, el inconveniente que supone el ambiente inflacionario de su economía, cuyo impacto en los precios limita el acceso del paciente a su consumo. El caso de la enfermedad cardiovascular ofrece algunas claves para la comprensión de este fenómeno en el medio venezolano.

Public-health models of a monopolistic nature, suchas the Venezuelan, bring with them trends in the rationing ofthe goods and services they provide to their users, as well as inthe reduction of their quality. On the other hand, the provisionof these goods and services by means of market mechanisms hasbefore it, in our environment, the enormous impediment posedby the inflationary environment of its economy, whose impacton prices limits the patient's access to consumption. The case of cardiovascular disease offers some keys to understanding thisphenomenon in the Venezuelan environment.

Consumo de embutidos en mujeres costarricenses: efecto del nivel socioeconómico / Intake of processed meats by Costa Rican women: effect of socioeconomic status

Resumen Introducción: El consumo de embutidos se ha asociado con serios problemas de salud que son comunes entre la población femenina. En el 2015 la Agencia Internacional para la Investigación en Cáncer clasificó los embutidos, como carcinógenos para los seres humanos ya que su ingesta está relacionada con el cáncer colorrectal. El aumento en el consumo de embutidos, los cuales son un alimento fuente de proteína de bajo costo, es diferencial según nivel socioeconómico y puede tener un impacto en la incidencia de enfermedades crónicas en la población. Objetivo: Examinar la asociación entre el consumo de embutidos y (a) la ingesta total de proteína, (b) la ingesta inadecuada de proteína, según NSE. Métodos: Se seleccionó una muestra (N = 135) de mujeres de 25 a 45 años, con 1 a 4 hijos, pertenecientes a tres diferentes niveles socioeconómicos, residentes de dos cantones del Gran Área Metropolitana de San José, Costa Rica, entre junio 2014 y marzo 2015. Mediante el uso de fotografías se indagó la percepción de las mujeres en cuanto al costo y su preferencia de consumo de 12 distintos alimentos, entre los cuales se incluyó los embutidos. Por medio de recordatorios alimentarios de 24 horas recolectados en tres visitas diferentes, y el uso de la base de datos de composición de alimentos ValorNut, se midió el consumo de proteína total en gramos y se determinó la cantidad promedio de veces por día que las mujeres consumen embutidos. A partir del peso de cada participante se determinó su requerimiento de proteína. La ingesta inadecuada de proteína se estimó como la diferencia entre el requerimiento y la ingesta observada. Mediante un modelo de regresión lineal se determinó la asociación entre el consumo total de proteína medido en gramos y la cantidad de veces por día que se ingiere embutidos. Mediante un modelo de regresión logística se estimó la asociación entre la ingesta inadecuada de proteína y la cantidad de veces por día que se ingiere embutidos. Resultados: Los embutidos son percibidos como la fuente de proteína menos apetecible, sin embargo, fue la tercera fuente de proteína más consumida. El consumo de embutidos difiere según NSE (P < 0.01), en el alto NSE es donde se consumen con menor frecuencia. Los embutidos más comúnmente consumidos fueron mortadela (bajo NSE), salchichón (NSE medio), y jamón de pavo (alto NSE). El consumo de embutidos se asocia significativamente con un incremento en la ingesta de proteína. Se encontró una asociación inversa entre el NSE y la ingesta inadecuada de proteína. Conclusiones: El consumo de embutidos está asociado con el nivel socioeconómico. Es probable que las mujeres consuman embutidos porque los perciben como un alimento fuente de proteína de bajo costo. Se requiere establecer estrategias educativas que ayuden a las mujeres a identificar sus necesidades alimentarias de proteína y a conciliar estas necesidades con la adquisición de alimentos saludables a un costo aceptable.

Abstract Introduction: Intake of processed meats has been associated with serious health problems that are common among women. In 2015, the International Agency for Research on Cancer classified processed meats as human carcinogens, associated specifically with colon cancer. The increase in intake of processed meats, which are a low-cost source of dietary protein, varies by socioeconomic status (SES) and can impact chronic disease incidence. Objective: Examine the association between processed meats intake and (a) total protein intake, (b) inadequate protein intake, by SES. Methods: This study included a representative sample (N = 135) of women age 25 to 45 years, with one to four children, from three different socioeconomic groups who were residents of two counties from the Greater Metropolitan Area of San José, Costa Rica between June 2014 and March 2015. Using photographs, we examined women's perceptions of the cost and perceived desirability of 12 different foods, including processed meats. Using 24-hour dietary recalls collected on three different days, and the ValorNut food composition database, we estimated total protein intake, in grams, and determined the intake frequency (times/day) of processed meat. Each women's dietary protein requirement was estimated based on her bodyweight. Inadequate protein intake was calculated as the difference between protein requirement and actual intake. A linear regression model was used to determine the association between total protein intake in grams and intake frequency (times/day) of processed meat. A logistic regression model was used to estimate the association between low protein intake and intake frequency (times/day) of processed meat. Results: Processed meats were perceived as the least preferred protein source but were the third most commonly consumed protein source. Consumption of processed meats differed by SES and was lower in the higher SES group (P < 0.01). The most commonly consumed processed meats by SES were "mortadella" (low-SES), sausages (middle-SES), and sliced turkey/ham (high-SES). Processed meat intake was significantly associated with an increase in protein intake. There was an inverse association between SES and inadequate protein intake. Conclusions: Processed meat intake is associated with SES. Women may consume processed meats because they are perceived to be a low-cost protein source. Educational strategies are needed to help women identify their protein needs and meet those needs with healthier and affordable dietary alternatives.

Seguridad social y medicamentos Mecanismos de cobertura de dos obras sociales en contexto de inflación 2011-2019 / Social security and medicines: coverage mechanisms of two health insurance organizations in the context of inflation, 2011-2019

INTRODUCCIÓN: La elevada inflación argentina puede comprometer el acceso a los medicamentos, incluso con cobertura de la seguridad social. El objetivo de este estudio fue describir la evolución entre 2011 y 2019 de la cobertura del Instituto Nacional de Servicios Sociales para Jubilados y Pensionados (INSSJyP, también conocido como PAMI) y del Instituto de Obra Médico Asistencial (IOMA) para una selección de medicamentos de uso ambulatorio, fuera de patente, de consumo frecuente en patologías prevalentes, y evaluar si la evolución del ingreso de los beneficiarios acompañó el aumento del gasto de bolsillo para estos fármacos. MÉTODOS: Se registró la evolución del precio de venta al público (PVP) y de la cobertura por INSSJyP y por IOMA en los cuatrienios 2011-2015 y 2015-2019 para una selección de 10 fármacos utilizados en enfermedades crónicas de alta prevalencia. Se calculó la evolución del gasto de bolsillo para las presentaciones promedio, más barata y más cara de cada fármaco, y se comparó con la evolución de los ingresos de los beneficiarios. RESULTADOS: La cobertura promedio del INSSJyP para los fármacos estudiados subió de 63% en 2011 a 73% en 2019. La cobertura del PVP promedio por el IOMA fue de 55% en 2011 y descendió a 36% en 2019, debido a la demora en la actualización de los montos fijos. Para los beneficiarios de ambas instituciones el gasto de bolsillo creció menos que el ingreso en 2011-2015 pero lo superó ampliamente en 2015-2019. DISCUSIÓN: El sistema de cobertura por monto fijo tiene ventajas conceptuales, pero requiere una actualización oportuna de los valores con la inflación

The Impact of Inflation on the Medical and Hospital Money Transfers of the Neurosurgical Procedures of the Brazilian Unified Healthcare System from 2008 to 2017

Introduction There are more than 1,500 hospital procedures included in the Brazilian Unified Healthcare System's (SUS, in the Portuguese acronym) table, which is the reference for service payment provided by establishments serving the public health network, and they are stagnant. The underfinancing of procedures is so dramatic that in some cases the amounts paid by the SUS are even lower than the taxes generated by the costs of the same procedures in Brazilian private hospitals. This article aims to compare the evolution of the compensation of neurosurgical procedures by calculating the percentile of the lag in the values transferred to both neurosurgeons and hospitals, according to the SUS table, establishing the ideal and real values according to the current inflation, in a retrospective 9-year comparison. Methodology This is an observational, comparative, retrospective study, based on the values of medical and hospital money transfers of 25 neurosurgical procedures in 2008, which were corrected according to the 2017 National Consumer Price Index (IPCA, in the Portuguese acronym). Results Through this study, from 2008 to 2017, the transfers of medical fees regarding neurosurgical techniques are almost completely outdated. As examples, we can mention: the external/subgaleal ventricular shunt, with a deficit of 43.6%; the electrode implant for brain stimulation, with - 41.67%; and decompressive craniotomy, with - 32.21% in relation to the corrected value. Only 4 of the 25 neurosurgeries present a value above that predicted by the IPCA, one of them being cerebral aneurysm embolization larger than 1.5 cm with a narrow neck (þ 8.0%). Regarding the money transfers to hospitals, all procedures are 43.6% lower than expected, since there was no readjustment in the amounts paid to the institutions in the analyzed period. For example, in 2008, for the transposition of the cubital nerve, R$ 267.30 were transferred, and the same amount was maintained in 2017; and, for the surgical treatment of compressive syndrome in osteofibrous tunnel at carpal level (R$ 145.18), the amount also remained fixed throughout these 9 years. Conclusion Because they did not follow the evolution of the economy, in 80% of the surgeries, the neurosurgeons did not have their economic demands met regarding the procedures performed through SUS. And the data became even more alarming when the money transfers to hospitals were evaluated, since there was no evolution in the money transfers for any of the neurosurgeries evaluated.

Crises econômicas, mortalidade de crianças e o papel protetor do gasto público em saúde / Economic crises, child mortality and the protective role of public health expenditure

Resumo O objetivo do estudo foi analisar como as crises econômicas afetam a saúde infantil a nível global e entre subgrupos de países com diferentes níveis de renda. Foram utilizados dados do Banco Mundial e da OMS para 127 países entre os anos de 1995 e 2014. Foi utilizado um modelo de efeitos fixos, avaliando o efeito da mudança em indicadores macroeconômicos (PIB per capita, taxa de desemprego e de inflação, e taxa de desconforto) na taxa de mortalidade neonatal, infantil, e de menores de cinco anos. Adicionalmente, avaliou-se a modificação do efeito da associação de acordo com a renda dos países e também a influência do gasto público em saúde nessa relação. As evidências mostraram que piores indicadores econômicos (menor PIB per capita e maiores inflação, taxa de desemprego e taxa de desconforto) estão associados com maiores taxas de mortalidade infantil. Nas subamostras por estrato de renda, observa-se a mesma relação, porém com efeitos de maior magnitude entre os países de renda baixa e média. Verificou-se ainda que um maior percentual nos gastos públicos em saúde ameniza os efeitos dos indicadores econômicos nas taxas de mortalidade infantil. Desta forma, é necessário aumentar a atenção aos efeitos nocivos das crises macroeconômicas para garantir melhorias na saúde infantil.

Abstract The aim of the study was to analyze how economic crises affect child health globally and between subgroups of countries with different levels of income. Data from the World Bank and the World Health Organization were used for 127 countries between 1995 and 2014. A fixed effects model was used, evaluating the effect of the change on macroeconomic indicators (GDP per capita, unemployment and inflation rates and misery index) in neonatal, infant and under-five mortality rates. Moreover, we evaluated whether there was a change in the association effect according to the income of the countries and also analyzed the role of public health expenditure in this association. Evidence has shown that worse economic indicators (lower GDP per capita, higher inflation, unemployment rates and misery index) are associated with higher child mortality rates. In the subsamples by income strata, the same association is observed, but with effects of greater magnitude for low- and middle-income countries. We also verified that a higher percentage in public health expenditures alleviates the effects of economic indicators on child mortality rates. Thus, more attention needs to be paid to the harmful effects of the macroeconomic crises to ensure improvements in child health.

Inflação dos planos de saúde - 2000-2018

Esta Nota Técnica tem por objetivo examinar a evolução dos preços dos planos de saúde no período compreendido entre 2000 e 2018. Constatou-se que a taxa de inflação acumulada dos planos foi superior à taxa de inflação da economia e da saúde. Isso explica, em parte, o fato de a Agência Nacional de Saúde Suplementar (ANS) ter aprovado recentemente a nova metodologia de cálculo do reajuste dos planos individuais e familiares em dezembro de 2018.

Impact of Cytomegalovirus Disease on New-Onset Type 2 Diabetes Mellitus: Population-Based Matched Case-Control Cohort Study

BACKGROUND: A latent cytomegalovirus (CMV) cause chronic inflammation through undesirable inflation of cell-mediated immune response. CMV immunoglobulin G has been associated with cardiovascular disease and type 1 diabetes mellitus. We evaluated impact of CMV diseases on new-onset type 2 diabetes mellitus (T2DM).METHODS: From the Korean Health Insurance Review and Assessment Service claim database of entire population with 50 million, we retrieved 576 adult case group with CMV diseases diagnosed with International Statistical Classification of Diseases and Related-Health Problems 10th Revision (ICD-10) B25 code between 2010 and 2014 after exclusion of patients with T2DM to 2006. The 2,880 control patients without T2DM from 2006 to cohort entry point were selected between 2010 and 2014 by age, sex matching with case group. The subjects without new-onset T2DM were followed until 2015. T2DM, hypertension (HTN), dyslipidemia (DYS), and end-stage renal disease (ESRD) were coded as ICD-10.RESULTS: The frequency of new-onset T2DM in case group was significantly higher than that in control (5.6% vs. 2.2%, P<0.001). The group with T2DM (n=95) had higher incidence of CMV diseases than the group without T2DM (n=3,361) (33.7% vs. 16.2%, P<0.001). In multivariate regression model adjusted by age, sex, lower income, HTN, and DYS, the incidence rate (IR) of T2DM in case group was significantly higher than that in the control group (IR per 1,000, 19.0 vs. 7.3; odds ratio, 2.1; 95% confidence interval, 1.3 to 3.2). The co-existence of HTN, DYS, and ESRD with CMV diseases did not influence the IR of T2DM.CONCLUSION: CMV diseases increase the patients' risk of developing T2DM.

Dimensional changes in reconstructed nipples: autologous versus prosthetic breast reconstruction

PURPOSE: The creation of the nipple-areola complex is the final stage in breast reconstruction and highly affects patient satisfaction. The neo-nipple is well known to shrink over time, particularly in the nipple projection. Currently, no reconstruction technique is clearly superior in terms of nipple size maintenance. We evaluated nipple size changes among several methods of breast mound reconstruction. METHODS: Seventy-eight patients received nipple-areola complex reconstruction secondarily after breast reconstruction. C-V flap nipple reconstructions were performed using a free transverse rectus abdominis myocutaneous (TRAM) flap in 25 cases (TRAM group), a latissimus dorsi (LD) myocutaneous flap in 27 cases (LD group), and an implant in 26 cases (implant group). The circumference and projection of the neo-nipple were measured using a flexible ruler, immediately after reconstruction and average 10 months after surgery. RESULTS: The overall circumference and projection at the final measurement were 91.43% ± 7.11% and 62.16% ± 21.55%, respectively, of immediate postoperative values. The change in circumference did not significantly differ among the 3 groups. In contrast, the change in projection was significantly worse in implant group compared to that in TRAM and LD groups. In addition, among the patients in implant group, greater inflation was significantly associated with greater decrease in the nipple projection. CONCLUSION: Breast mound reconstruction with autologous musculocutaneous flap techniques achieves better long-term maintenance of the neo-nipple projection compared to that achieved with expanded tissue and implantation. Considering the prospective loss of long-term nipple dimension, the preoperative design should be oversized in accordance with its origin in mound reconstruction.

Multicollinearity and misleading statistical results / 대한마취과학회지

Multicollinearity represents a high degree of linear intercorrelation between explanatory variables in a multiple regression model and leads to incorrect results of regression analyses. Diagnostic tools of multicollinearity include the variance inflation factor (VIF), condition index and condition number, and variance decomposition proportion (VDP). The multicollinearity can be expressed by the coefficient of determination (R(h)²) of a multiple regression model with one explanatory variable (X(h)) as the model’s response variable and the others (X(i) [i≠h] as its explanatory variables. The variance (σ(h)²) of the regression coefficients constituting the final regression model are proportional to the VIF(1/1−R(h)²). Hence, an increase in R(h)² (strong multicollinearity) increases σ(h)². The larger σ(h)² produces unreliable probability values and confidence intervals of the regression coefficients. The square root of the ratio of the maximum eigenvalue to each eigenvalue from the correlation matrix of standardized explanatory variables is referred to as the condition index. The condition number is the maximum condition index. Multicollinearity is present when the VIF is higher than 5 to 10 or the condition indices are higher than 10 to 30. However, they cannot indicate multicollinear explanatory variables. VDPs obtained from the eigenvectors can identify the multicollinear variables by showing the extent of the inflation of σ(h)² according to each condition index. When two or more VDPs, which correspond to a common condition index higher than 10 to 30, are higher than 0.8 to 0.9, their associated explanatory variables are multicollinear. Excluding multicollinear explanatory variables leads to statistically stable multiple regression models.

Aging and the Immune System: the Impact of Immunosenescence on Viral Infection, Immunity and Vaccine Immunogenicity

Immunosenescence is characterized by a progressive deterioration of the immune system associated with aging. Multiple components of both innate and adaptive immune systems experience aging-related changes, such as alterations in the number of circulating monocytic and dendritic cells, reduced phagocytic activities of neutrophils, limited diversity in B/T cell repertoire, T cell exhaustion or inflation, and chronic production of inflammatory cytokines known as inflammaging. The elderly are less likely to benefit from vaccinations as preventative measures against infectious diseases due to the inability of the immune system to mount a successful defense. Therefore, aging is thought to decrease the efficacy and effectiveness of vaccines, suggesting aging-associated decline in the immunogenicity induced by vaccination. In this review, we discuss aging-associated changes in the innate and adaptive immunity and the impact of immunosenescence on viral infection and immunity. We further explore recent advances in strategies to enhance the immunogenicity of vaccines in the elderly. Better understanding of the molecular mechanisms underlying immunosenescence-related immune dysfunction will provide a crucial insight into the development of effective elderly-targeted vaccines and immunotherapies.

Efficiency of Air Bubble Removal in Preparation of Low-Profile Angioplasty Balloon Catheter: Bench-Top Comparison of Six Methods / 신경중재치료의학

PURPOSE: Complete removal of air bubbles from balloons for neurovascular angioplasty is cumbersome. We compared the preparation difficulty, air removal efficiency, and air collection pattern of six different balloon catheter preparation methods to propose a better preparation method for both initial and second balloon uses, especially for small-profile angioplasty balloon catheters. MATERIALS AND METHODS: A total of 18 neurovascular angioplasty balloon catheters with nominal diameters of 2 mm were prepared to test six different preparation methods: the instruction for use method (method A), simplified method using a syringe (method B) and four newly devised preparation methods using inflating devices (methods C–F). Serial radiographs were obtained while the balloons were gradually inflated. We measured the time for each preparation and the bubble number, analyzed their distribution in the balloon, and calculated the contrast filling ratio (contrast filling area/total balloon area) for initial and second ballooning. The whole process was repeated three times. RESULTS: The preparation time varied widely (11.5 seconds [method D] to 73.3 seconds [method A]). On initial inflation, the contrast filling ratio at 8 atm was the highest (100%) with methods A and F. On second inflation, the ratio was again highest with method A (99.5%), followed by method F (99.2%). Initial ballooning tended to show a uniform pattern of single bubble in the distal segment of the balloon; in contrast, second ballooning showed varying patterns in which the bubbles were multiple and randomly distributed. CONCLUSION: None of the six methods were able to completely exclude air bubbles from the balloon catheters including the second ballooning; however, the method of repeating aspiration with high-volume inflating device (method F) could be a practical option considering the simplicity and efficiency of preparation.

Índice interno de variação de preços de materiais de consumo e de medicamentos em um hospital de ensino de alta complexidade / Internal rate of varying prices of consumable and medicines in a high complexity university hospital

Modelo do estudo: Trata-se de um estudo de caso, no qual foram analisados dados dentro de um contexto real que é o do HCFMRP-USP Objetivos: Apresentar os índices de variação de preços do HCFMRP-USP (IVPH), ano 2013, geral para materiais de consumo e medicamentos; específico para materiais de consumo e específico para medicamentos. Materiais e Método: Para o IVPH foi definido o Índice de Paasche como o mais adequado para o perfil de consumo do Hospital. Para o cálculo, foi definida uma cesta de consumo considerando 40% do gasto financeiro em 2012 o que representou 13% dos itens e também pelos itens que tiveram consumo regular, ou seja, em todos os meses de janeiro a dezembro de 2013. Resultados: os IVPH gerais foram 6,74% para materiais e medicamentos; 6,97% para materiais de consumo e 6,73% para medicamentos. Conclusões: Comprar a preços praticados no mercado e utilizar ferramentas para analisar o poder de compra da instituição contribui para a aplicação correta e racional dos parcos recursos disponíveis. A proposta de criar o índice interno de variação de preços vem contribuir como ferramenta para gestão dos recursos e para a análise da evolução do poder de compra do HCFMRP-USP, assim como os índices padronizados de variação de preço são utilizados para análise do poder de compra da moeda. (AU)

Methods: For the IVPH, the Paasche Index was defined as the most adequate for the hospital consumption. For the calculation, a consumption set was defined as 40% of the financial expense in 2012, which represented 13% of the items and also the items that had regular consumption, that is, in all the months of January to December 2013. Results: The general IVPH were 6.74% for materials and medicines; 6.97% for consumer materials and 6.73% for medicines. Conclusions: Buying at prices practiced in the market and using tools to analyze the purchasing power of institution contributes to the correct and rational application of the meager resources available. The proposal to create the internal price variation index is to contribute as a resource management tool and to analyze the evolution of purchasing power of the HCFMRP-USP, as well as the standardized index of price variation is used to analyze the power of purchase of the currency. (AU)

Radiological Results of the Double-Balloon Inflation Technique during Kyphoplasty / 대한척추외과학회지

STUDY DESIGN: Retrospective case-control study. OBJECTIVES: We analyzed the radiological results of the double-balloon inflation technique in terms of its ability to reduce cement leakage, to increase bone cement bonding, and to promote anterior column height recovery. SUMMARY OF LITERATURE REVIEW: Various methods, such as the egg-shell technique, have been proposed to prevent leakage of cement during kyphoplasty in cases of osteoporotic compression fracture. MATERIALS AND METHODS: This study analyzed 18 patients diagnosed with osteoporotic compression fracture of the lumbar spine who underwent the double-balloon inflation technique after April 2015, and 30 consecutive patients with the same diagnosis who were treated using the conventional method prior to April 2015. We analyzed the radiological results on immediate postoperative simple X-rays in the anteroposterior and lateral views, 6-week postoperative lateral X-rays, and 6-month postoperative lateral X-rays to detect changes in anterior vertebral height and the cement leakage rate. RESULTS: The average anterior vertebral height increased by 7.58 mm in the double-balloon inflation group, and by 5.8 mm in the conventional group on the immediate postoperative radiographs (p=0.044). On average, a decrease of 3.08 mm was observed at 6 weeks postoperatively in the double-balloon inflation group, in contrast to a decrease of 4.68 mm in the conventional group (p=0.149). At the 6-month postoperative follow-up, an average decrease of 1.45 mm was found in the double-balloon inflation technique group, while a decrease of 1.40 mm was found in the conventional group (p=0.9110). The cement leakage rate was 22% in the double-balloon inflation group and 27% in the conventional group (p=0.730). CONCLUSIONS: Compared to the conventional method, the double-balloon inflation technique can be done more safely, and also promotes a greater recovery of anterior vertebral height.

Scientizing Everyday Life, Rationalizing Eating Habits: The Rise of Nutrition Science in 1910s-1920s Japan / 의사학

Historians of science have noted that modern nation-states and capitalism necessitated the systematic creation and implementation of a wide array of knowledge and technologies to produce a more productive and robust population. Commonly labeled as biopolitical practices in Foucauldian sense, such endeavors have often been discussed in the realms of public hygiene, housing, birth control, and child mortality, among others. This article is an attempt to extend the scope of the discussion by exploring a relatively understudied domain of nutrition science as a critical case of social engineering and intervention, specifically during and after World War I in the case of Japan. Research and dissemination of knowledge on food and health in Japan, like other industrializing nation-states, centered on new public hygiene initiatives since the late nineteenth-century. However, in the aftermath of WWI, or more precisely, after the Rice Riots of 1918, a new trend began to dominate the discourse of nutrition and health. In the face of wartime inflation and the resultant nation-wide riots, physicians and social scientists alike began to view the food choice and budget issue as a solution to the middle class crisis. This new perception drew on the conceptual framework to understand food, metabolism, and cost in the language of quantifiable nutrition vis-à-vis monetary values. By analyzing how specific nutritional knowledge was translated into the tenets for public campaigns to reform everyday life, this paper ultimately sheds light on the institutionalization of a new area of research, nutrition (eiyō) in Japan.

What is the proper way to apply the multiple comparison test? / 대한마취과학회지

Multiple comparisons tests (MCTs) are performed several times on the mean of experimental conditions. When the null hypothesis is rejected in a validation, MCTs are performed when certain experimental conditions have a statistically significant mean difference or there is a specific aspect between the group means. A problem occurs if the error rate increases while multiple hypothesis tests are performed simultaneously. Consequently, in an MCT, it is necessary to control the error rate to an appropriate level. In this paper, we discuss how to test multiple hypotheses simultaneously while limiting type I error rate, which is caused by α inflation. To choose the appropriate test, we must maintain the balance between statistical power and type I error rate. If the test is too conservative, a type I error is not likely to occur. However, concurrently, the test may have insufficient power resulted in increased probability of type II error occurrence. Most researchers may hope to find the best way of adjusting the type I error rate to discriminate the real differences between observed data without wasting too much statistical power. It is expected that this paper will help researchers understand the differences between MCTs and apply them appropriately.

Effects of Iranian Economic Reforms on Equity in Social and Healthcare Financing: A Segmented Regression Analysis / 예방의학회지

OBJECTIVES: One of the main objectives of the Targeted Subsidies Law (TSL) in Iran was to improve equity in healthcare financing. This study aimed at measuring the effects of the TSL, which was implemented in Iran in 2010, on equity in healthcare financing. METHODS: Segmented regression analysis was applied to assess the effects of TSL implementation on the Gini and Kakwani indices of outcome variables in Iranian households. Data for the years 1977-2014 were retrieved from formal databases. Changes in the levels and trends of the outcome variables before and after TSL implementation were assessed using Stata version 13. RESULTS: In the 33 years before the implementation of the TSL, the Gini index decreased from 0.401 to 0.381. The Gini index and its intercept significantly decreased to 0.362 (p < 0.001) 5 years after the implementation of the TSL. There was no statistically significant change in the gross domestic product or inflation rate after TSL implementation. The Kakwani index significantly increased from -0.020 to 0.007 (p < 0.001) before the implementation of the TSL, while we observed no statistically significant change (p=0.81) in the Kakwani index after TSL implementation. CONCLUSIONS: The TSL reform, which was introduced as part of an economic development plan in Iran in 2010, led to a significant reduction in households’ income inequality. However, the TSL did not significantly affect equity in healthcare financing. Hence, while measuring the long-term impact of TSL is paramount, healthcare decision-makers need to consider the efficacy of the TSL in order to develop plans for achieving the desired equity in healthcare financing.

New economical and simple device for intraoperative expansion on small and medium sized soft tissue defects

Intraoperative expansion has been used to cover small to large defects without disadvantages of the conventional tissue expanders. Various materials, for example, expanders and Foley catheters are being used. We introduce a new, convenient and economical device immediately available in the operating room, according to the defect size for intraoperative expansion, with latex gloves or balloons. The retrospective study was done with 20 patients who presented with skin and soft tissue defects. During the operation, expansion was done with latex gloves or balloons inflated with saline through an intravenous line and a three-way stopcock. After the inflation, the glove was removed and skin was covered with expanded tissue. A careful decision was made regarding the inflation volume and placement of the expander according to the defect size. There were no postoperative complications. The skin contracture and tension was minimal with a texture similar to the adjacent tissue. The new intraoperative expansion devices with latex gloves and balloons were cheap and made easily right in the operation room. The reconstruction of small to large sized skin defects can be done successfully, functionally and aesthetically without using expensive commercial materials.

Crescimento econômico e taxa de inflação: implicações na receita municipal e na despesa com saúde dos municípios de Pernambuco, Brasil / Economic growth and inflation rate: implications for municipal revenue and health expenditure of the municipalities of Pernambuco, Brazil

Resumo O artigo analisa implicações do crescimento da receita orçamentária municipal e da política monetária de metas da inflação na disponibilidade de recursos públicos para a saúde do ente municipal. A pesquisa é descritiva, exploratória, de natureza quantitativa e de corte longitudinal retrospectivo, abrangendo os anos de 2002 a 2011. Analisaram-se variáveis de Financiamento e Gasto em Saúde dos municípios do estado de Pernambuco, descrevendo a evolução e a relação entre elas. Os dados demonstraram crescimento das variáveis e tendência à homogeneidade. A exceção foi a participação das Transferências Intergovernamentais na Despesa Total do Município com Saúde. Constatou-se correlação significativa entre Receita Orçamentária per capita e Despesa com Saúde per capita e correlação negativa significante forte entre Taxa de Inflação, Receita Orçamentária per capita e Despesa com Saúde per capita. Concluiu-se que o incremento da despesa com saúde deve-se mais ao crescimento da arrecadação municipal que ao das transferências. Estas, em termos relativos, não se elevaram. A forte relação inversa entre Taxa de Inflação e variáveis de Financiamento e Gasto comprovam que a política monetária de metas da inflação tem restringido o financiamento da saúde no ente municipal.

Abstract This paper analyzes the implications of municipal budget revenue growth and the monetary policy’s inflation rates goals in the availability of public health resources of municipalities. This is a descriptive, exploratory, quantitative, retrospective and longitudinal cross-sectional study covering the period 2002-2011. We analyzed health financing and expenditure variables in the municipalities of the state of Pernambuco, Brazil, describing the trend and the relationship between them. Data showed the growth of the variables and trend towards homogeneity. The exception was for the participation of Intergovernmental Transfers in the Total Health Expenditure of the Municipality. We found a significant correlation between Budget Revenue per capita and Health Expenditure per capita and a strong significant negative correlation between Inflation Rate, Budget Revenue per capita and Health Expenditure per capita. We concluded that increased health expenditure is due more to higher municipal tax revenue than to increased transfers that, in relative terms, did not increase. The strong inverse relationship between inflation rate and the Financing and Expenditure variables show that the monetary policy’s inflation goals have restricted health financing to municipalities.

The Study on the Lives and Health Conditions of Internees in Santo Thomas Camp of Philippines: Based on McAnlis's The War in Manila (1941–1945) / 의사학

When Japan invaded the Philippines, two missionary dentists (Dr. McAnlis and Dr. Boots) who were forced to leave Korea were captured and interned in the Santo Thomas camp in Manila. Japan continued to bombard and plunder the Philippines in the wake of the Pacific War following the Great East Asia policy, leading to serious inflation and material deficiency. More than 4,000 Allied citizens held in Santo Thomas camp without basic food and shelter. Santo Thomas Camp was equipped with the systems of the Japanese military medical officers and Western doctors of captivity based on the Geneva Conventions(1929). However, it was an unsanitary environment in a dense space, so it could not prevent endemic diseases such as dysentery and dengue fever. With the expansion of the war in Japan, prisoners in the Shanghai and Philippine prisons were not provided with medicines, cures and food for healing diseases. In May 1944, the Japanese military ordered the prisoners to reduce their ration. The war starting in September 1944, internees received 1000 kcal of food per day, and since January 1945, they received less than 800 kcal of food. This was the lowest level of food rationing in Japan's civilian prison camps. They suffered beriberi from malnutrition, and other endemic diseases. An averaged 24 kg was lost by adult men due to food shortages, and 10 percent of the 390 deaths were directly attributable to starvation. The doctors demanded food increases. The Japanese Military forced the prisoner to worship the emperor and doctors not to record malnourishment as the cause of death. During the period, the prisoners suffered from psychosomatic symptoms such as headache, diarrhea, acute inflammation, excessive smoking, and alcoholism also occurred. Thus, the San Thomas camp had many difficulties in terms of nutrition, hygiene and medical care. The Japanese military had unethical and careless medical practices in the absence of medicines. Dr. McAnlis and missionary doctors handled a lot of patients focusing mainly on examination, emergency treatment and provided the medical services needed by Philippines and foreigners as well as prisoners. Through out the war in the Great East Asia, the prisoners of Santo Thomas camp died of disease and starvation due to inhumane Japanese Policy. Appropriate dietary prescriptions and nutritional supplements are areas of medical care that treat patients' malnutrition and disease. It is also necessary to continue research because it is a responsibility related to the professionalism and ethics of medical professionals to urge them to observe the Geneva Convention.