Análisis del gasto de bolsillo en medicamentos e insumos en Perú en 2007 y 2016 / Out-of-pocket expenditure on medicines and supplies in Peru in 2007 and 2016

INTRODUCCIÓN: El gasto de bolsillo en medicamentos e insumos puede afectar financieramente los hogares. Objetivo: Determinar el gasto de bolsillo en medicamentos e insumos en Perú y las características de la población con mayor gasto de este tipo en los años 2007 y 2016. MÉTODOS: Estudio transversal analítico de la Encuesta Nacional de Hogares sobre Condiciones de Vida y Pobreza 2007 y 2016. Se determinó la media y mediana del gasto de bolsillo en medicamentos e insumos en dólares americanos para la población general, y según la presencia de factores descritos en la literatura como asociados al gasto de bolsillo en medicamentos e insumos. RESULTADOS: Se incluyeron datos de 92 148 encuestados en 2007 y de 130 296 en 2016. En 2007, se encontró una mediana de 3,19 (rango intercuartílico: 0,96 a 7,99) y una media de 8,14 (intervalo de confianza 95%: 7,80 a 8,49) para el gasto de bolsillo en medicamentos. En 2016, la mediana y media de este gasto fueron de 3,55 (rango intercuartílico: 1,48 a 8,88) y 9,68 (intervalo de confianza 95%: 9,37 a 9,99), respectivamente. Para 2016, se encontró un mayor gasto de bolsillo en medicamentos en mujeres, menores de cinco y mayores de 60 años; personas de mayor nivel educativo; tener seguro privado o de las fuerzas armadas; vivir en la región costa y en zona urbana; tener una enfermedad crónica; y ser de los quintiles de gasto per cápita más altos. Entre 2007 y 2016, se incrementó significativamente (p < 0,05) el gasto de bolsillo en medicamentos e insumos en los menores de cinco años (p < 0,001), personas no aseguradas (p < 0,001), asegurados en el Seguro Integral de Salud (p < 0,001) o a las fuerzas armadas, para el área urbana y rural (p < 0,001, ambos), y en personas sin enfermedades crónicas (p < 0,001). CONCLUSIONES: Se obtuvo el gasto de bolsillo en medicamentos e insumos en población peruana en 2007 y 2016, encontrándose un incremento del mismo entre los años de estudio, existiendo grupos poblacionales con mayor gasto y con aumentos significativos. Se requiere profundizar el estudio de factores asociados al gasto de bolsillo en medicamentos en grupos de mayor vulnerabilidad económico frente al gasto directo en salud en Perú.

BACKGROUND: Out-of-pocket spending on medicines and supplies can lead to a heavy financial burden in households. OBJECTIVE: To determine the out-of-pocket spending on medicines and supplies in Peru and the population groups with the highest out-of-pocket spending on medicines and supplies in 2007 and 2016. METHODS: We conducted an analytical cross-sectional study of the Peruvian National Household Survey on Living and Poverty Conditions for the years 2007 and 2016. Mean and median out-of-pocket spending on medicines and supplies are reported in USD for the general population, and according to the presence or not of factors described in the literature as associated with out-of-pocket spending on medicines and supplies. RESULTS: 92 148 and 130 296 participants from 2007 and 2016 were included. In 2007, a median of 3.19 (interquartile range: 0.96 to 7.99) and an average of 8.14 (95% confidence interval: 7.80 to 8.49) were found for the out-of-pocket spending on medicines and supplies. In 2016, the median and mean out-of-pocket spending on medicines and supplies were 3.55 (interquartile range: 1.48 to 8.88) and 9.68 (95% confidence interval: 9.37 to 9.99), respectively. For 2016, higher out-of-pocket spending on medicines and supplies was found in women, children under five and over 60 years of age, people of higher educational level, having private or armed forces insurance, living in the coastal region, and being in one of the highest per capita quintile of expenditure. Between 2007 and 2016, the out-of-pocket spending on medicines and supplies was significantly increased in children under five (p < 0.001), uninsured persons (p < 0.001), insured to the Seguro Integral de Salud (p < 0.001) or the Armed Forces (p = 0.035), for the urban and rural area (both p < 0.001), and in people without chronic diseases (p < 0.001). CONCLUSIONS: An increase in out-of-pocket spending on medicines and supplies was found in the study period. There were population groups with significant increases in out-of-pocket spending on medicines and supplies. It is necessary to explore further the factors associated with out-of-pocket spending on medicines and supplies in groups of greater economic vulnerability regarding direct health spending in Peru.

Uso de modelos simuladores como metodología docente para la carrera de medicina / Use of simulator models like educational methodology for the medicine carrer

Introduction: Usefulness of high tech clinical simulators as learning tools, are partially established. Objective: To determine utility of an Emergency Care Simulator (ECS) as a learning tool inmedicine. Methods: Study was conducted in 2007, during the respiratory diseases rotation of third year medical students. Informed consent was required to participants. They were divided in two groups: Study Group (SG) and Control group (CG). Both were submitted to the same regular respiratory diseases learning activities. Only the SG had a session with the ECS. The simulated scenario referred to a young man with severe community pneumonia. At the end of the activities every student from those groups answered a modified essay and a questionnaire about this disease problem (maximum score was 70 points). The SG also responded a list of12 statements to get their opinion on this experience. Results: 63 students participated in the study, 42 in the SG and 21 in the CG. All the SG answered the questionnaire and 31 answeredthe modified essay. All the CG answered the modified essay. The scores in the essay were (mean +/- SD) 44, 3 +/-12,9 and 35,5+/-14,7 for the SG and CG, respectively (p=0,026). 80 percent ofthe SG agreed that the experience was useful to learn; entertaining and allowing the application of previous knowledge. Less than 50 percent felt the simulation real enough. Conclusions: A learning activity about severe community acquired pneumonia with the METI ECS simulator apparently was useful for students learning and well evaluated by them.

Embryonic and larval development of Jundiá (Rhamdia quelen, Quoy & Gaimard, 1824, Pisces, Teleostei), a South American Catfish

The jundiá (Rhamdia quelen, Quoy & Gaimard) is an endemic South American fish species. Because this species supports cold winters and grows faster during warm months, it has begun to be viewed as an ideal species for fish production in southern South America. In the present study, jundiá oocytes used were obtained by extrusion from females after hormone injection. Soon after hydration, the eggs were transferred to 50 L conic glass incubators, with constant and controlled water influx. Samples of fertilized eggs were transferred to Petri dishes and, examined under a stereoscopic microscope, were spherical, demersal, and non-adhesive with defined perivitelline space and resistant chorion. Cleavage stages occurred during the first 3.5 h. After hatching, larvae were transferred to 200 L glass fiber incubators. First signs of embryo movement were observed 21 h after fertilization; larval eclosion occurred 30.5 h after fertilization. Present findings may provide a basis for studies aimed at determining the complete ontogeny of jundiá and may be useful in eco-toxicological studies.

O jundiá (Rhamdia quelen, Quoy & Gaimard) é uma espécie endêmica da América do Sul. Por ser adaptada ao frio do inverno e ter um crescimento rápido durante os meses quentes, o jundiá é uma espécie adequada para aqüicultura no sul da América do Sul. Muitos aspectos da fisiologia reprodutiva, larvicultura, hematologia, fisiologia da resposta ao estresse, têm sido recentemente estudados. Os ovócitos utilizados neste estudo foram obtidos pela extrusão de fêmeas após indução hormonal. Logo após a hidratação, foram transferidos para incubadoras cônicas de vidro com capacidade para 50 L, com fluxo de água constante e controlado. Amostras de ovos fertilizados foram colocadas em placas de Petri e examinadas através de estereomicroscópio. Os ovos eram esféricos, demersais e não-adesivos, com espaço perivitelino definido e córion resistente. Os estágios de clivagem ocorreram durante as 3,5 primeiras horas. Após a eclosão, as larvas foram transferidas para incubadoras de fibra de vidro de 200 l. Os primeiros sinais de movimento embrionário foram observados 21 h após a fertilização, e a eclosão das larvas ocorreu 30,5 h após a fertilização. Estes resultados podem servir como base para muitos estudos, objetivando o conhecimento da ontogenia completa do jundiá, e para aplicação em estudos ecotoxicológicos.

Ambulatorio didatico homeopatico: relato de experiencia / Didactal homeopathic ambulatory: experience report

Atraves do relato do acompanhamento de pacientes durante 4 mses no ambulatorio didatico da segunda turma de mestrado profissionalizante em homeopatia...