Indirect costs of migraine in a public Brazilian hospital.

OBJECTIVES: To evaluate the indirect costs of migraine affecting employees of a public Brazilian hospital. BACKGROUND: Migraine is a common primary headache which has a negative influence on the well-being and quality of life, as well as the professional life, of affected individuals. METHODS: Our series consisted of 846 employees with migraine. The Lost Hours Equivalence Index, which considers both the hours lost due to the absence from work and reduction in productivity, was used to estimate the number of working hours lost due to migraine. RESULTS: Of the employees with migraine studied, 91% presented a mean 56.9% loss of productivity. The mean number of total lost working hours per month due to migraine was 6.5. The estimated total indirect cost of migraine was R $986 903.77 (US $815 622.54), implicating costs of R $241.30 (US $199.42) per employee per year. CONCLUSIONS: Based on its impact on life and the resulting costs, migraine should be considered a public health problem and thus measures should be adopted to reduce its impact on the individual and on society.

[Migraine prevalence and impact in employees of the clinical hospital of the medical school of Ribeirão Preto-USP]. / Prevalência e impacto da migrânea em funcionários do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP.

Headache is a common symptom in the population, with a life prevalence around 90%. It results in an important impact in the life quality of sufferers. The aim of this study is to evaluate the prevalence of migraine among employees of an university hospital (HC), as well as to measure the headache intensity, interference and impact in the daily activities. A total of 1890 employees had answered to a questionnaire which made possible to carry out diagnosis of migraine. Life prevalence of this headache type was 30. 4%. Pain was considered intense, most of the time, by 86% of the migraneurs. It was verified an important impact in the daily life aspects as much during as between the headache attacks. It can be concluded that migraine represents a public health problem among the HC employees. Because migraine brings about an important impact in the life quality of those workers, it is possible that a reduction of working capacity with considerable economic burden exists. This problem deserves, thus, special attention, through a better diagnostic and treatment.

Structural features and bleeding activity of commercial low molecular weight heparins: neutralization by ATP and protamine.

Differences in the structure of three low molecular weight heparins (LMWHs) have been observed by applying physico-chemical methods as well as enzymatic degradation with bacterial heparinase and heparitinase II. The production of enoxaparin maintains the internal structure of the parent heparin with the exception of the unsaturated nonreducing end. In contrast, the production of dalteparin and nadroparin removes part of their nonsulfated uronic acid residues and, unlike enoxaparin and unfractionated heparin (UFH), these LMWHs also contain regions that remain resistant to the action of heparitinase II. Enoxaparin has a lower molecular weight distribution than dalteparin and nadroparin and is composed of at least four discrete molecular weight populations. A rat-tail model demonstrated that LMWHs applied topically or injected intravenously had a lower bleeding potency when compared with UFH treatment. The bleeding potencies of the different LMWHs were similar. Furthermore, adenosine triphosphate (ATP) completely neutralized bleeding caused by LMWHs and UFH in the animal model when applied topically and significantly reduced bleeding in heparinized surgical patients undergoing cardiopulmonary bypass surgery.