Daily emotional dynamics and changes in posttraumatic growth and posttraumatic depreciation among people living with HIV.

OBJECTIVE: Posttraumatic growth (PTG), and its negative reflection, posttraumatic depreciation (PTD), are two aspects of response to trauma. This study explores whether daily emotional dynamics (inertia and innovation) can translate into positive versus negative changes among people living with HIV (PLWH) in the form of long-term changes in PTG or PTD. METHODS: The study combined a classical longitudinal approach with two assessments of PTG and PTD within one year and a measurement burst diary design with three weekly electronic diaries. In total, 249 PLWH participated in this study, filling out an expanded version of the Posttraumatic Growth and Depreciation Inventory (PTGDI-X) and a survey of sociodemographic and clinical data. In addition, they assessed their positive affect (PA) and negative affect (NA) at the end of each day in online diaries using a shortened version of the PANAS-X. RESULTS: Although we observed stable significant inertia and innovation of PA and NA across all bursts, these parameters of daily emotional dynamics were unrelated to the longitudinal changes in PTG and PTD. The same null results were also noted for the average levels of NA and PA. CONCLUSIONS: The results indicated the relative stability of emotion regulation in PLWH over the course of one year and contributed to understanding its dynamic mechanisms in terms of trait-like characteristics. The null result of the relationship between the PTG and PTD change might suggest a weak role of emotion regulation in shaping these trajectories as well as a lack of validity of the PTG/PTD measures.

The "long arm" of adverse childhood experiences on adult health depreciation in China.

BACKGROUND: The effects of childhood adversity on health may persist into the middle and old-aged. The assessment of the long-term effect of adverse childhood experiences (ACE) on adult health depreciation promotes a paradigm shift from current factors in health to early causation shaping health life course trajectories. OBJECTIVE: Determine whether the direct and significant dose-response effect between childhood adversity and health depreciation holds true, and to examine whether socioeconomic status (SES) in adulthood can diminish the negative effects of ACE. METHODS: A sample of 6344 nationally representative respondents (48 % were male; Mage = 64.48 years old, SD = 9.6 years old) was obtained. Adverse childhood experiences were collected from a Life History survey in China. Health depreciation was assessed by years lived with disabilities (YLDs) based on the Global Burden of Disease (GBD) disability weights. Ordinary least squares and matching methods (propensity score matching and coarsened exact matching) were used to test the relationship and treatment effect between ACEs and health depreciation. Mediating effect coefficients test and the Karlson-Holm-Breen (KHB) examined the mediating effect of socioeconomic status in adulthood. RESULTS: Compared to respondents without ACE, respondents who experienced 1 ACE increased YLD 15.9 % (p < 0.01); 2 ACEs by 32.8 % (p < 0.01); 3 ACEs by 47.4 % (p < 0.01), and 4+ ACEs by 71.5 % (p < 0.01) higher YLDs. The mediating effect of SES in adulthood was only between 3.9 % and 8.2 %. The interaction effect between ACE and adult socioeconomic status was not significant. CONCLUSION: The "long arm" of ACE on health depreciation exhibited a significant dose-response relationship. Policies and measures aimed at reducing family dysfunction and strengthening early childhood health interventions can facilitate the reduction of health depreciation in middle and old age.

Dynamic effect of exchange rate depreciation on carbon emission in the Mediterranean basin: fresh insights from linear and non-linear ARDL approaches.

The key objective of this study is to explore the relationship between economic growth, renewable and non-renewable energy consumption, exchange rate variation, and environmental pollution by carbon dioxide (CO2) emissions in 19 coastline Mediterranean countries over the period 1995-2020. We suggest the application of two different approaches, namely, the symmetric autoregressive-distributed lag (ARDL) and the non-linear ARDL (NARDL) model. These methods distinguished from traditional ones by the fact that they assess both the long and short run dynamics among variables. More importantly, the NARDL method is the only technique enabling us to test the asymmetric effects of a shock in independent variables on dependent ones. Our results indicate that the long-term pollution is positively correlated with exchange rate for developed countries and negatively correlated for developing ones. Since environmental degradation in developing countries is more vulnerable to any fluctuation in exchange rate, we suggest that policymakers in Mediterranean developing countries must pay more attention to exchange rate variation as well as boosting renewable energy consumption in order to decrease CO2 emissions.

Posttraumatic growth and posttraumatic depreciation among people living with HIV: the role of resilience and HIV/AIDS stigma in the person-centered approach.

Posttraumatic growth (PTG) among people living with HIV (PLWH) remains an understudied and controversial topic, and several research gaps need to be filled. In our study, we focused on one such gap by implementing parallel assessment of positive (PTG) and negative changes (posttraumatic depreciation [PTD]) following trauma related to HIV diagnosis, along with measurement of resilience and HIV/AIDS stigma and socio-medical data. The study sample comprised 509 PLWH, which completed the standardized psychometric inventories measuring the study variables. The results showed an unexpected positive relationship between PTG and PTD among participants. In addition, following the person-centered approach, we observed specific PTG/PTD clusters in the study sample with different resilience and HIV/AIDS stigma levels. Our study may shed some light on understanding PTG/PTD processes among PLWH and inspire planning for effective psychological help adjusted to patients' specific needs.

Posttraumatic Growth and Posttraumatic Depreciation: Independent Correlates of Well-Being Among People Living with HIV.

BACKGROUND: Although posttraumatic growth (PTG) is intuitively associated with positive adaptation to traumatic life circumstances, studies regarding the link between PTG and well-being present mixed findings. Our study aimed to analyze the link between PTG and well-being indicators (resource gain and loss, positive and negative affect; PA/NA) in a clinical sample of people living with HIV (PLWH), with the additional control of parallel negative changes among participants, i.e., posttraumatic depreciation (PTD). METHODS: The study sample comprised 509 PLWH who completed the standardized psychometric inventories measuring the study variables-PTG/PTD, resource gain and resource loss, and affective well-being. RESULTS: By applying the person-centered perspective to the study results, we observed distinct clusters of participants within resources and PA/NA, which were uniquely associated with PTG/PTD levels, after controlling for sociomedical data among participants. CONCLUSIONS: Including two parallel sides of growth, i.e., PTG and PTD, our study may deepen the understanding of PTG mechanisms and processes among PLWH and inspire planning for more effective psychological interventions designed to meet the specific needs of these patients.

Expanded version of the Posttraumatic Growth and Depreciation Inventory: Scale validation and refinement among Italian adults.

OBJECTIVE: The main aim of this study was to investigate the psychometric properties of the Italian version of the newly-developed Posttraumatic Growth and Depreciation Inventory (PTGDI-X) in a heterogeneous sample of Italian adults who had experienced a traumatic event. METHOD: The instrument was translated following the forward-backward method and completed by 601 participants who met the inclusion criteria. The factorial structure of the PTGDI-X was assessed by means of multiple confirmatory factor analyses (CFA). Convergent and discriminant validity and reliability were also evaluated. RESULTS: The results of the CFA revealed that the original 5-factor model was the best fit for the growth (PTG) dimension of the PTGDI-X, whereas it poorly fit the data with respect to the depreciation (PTD) component. With regard to convergent and divergent validity, positive correlations were found between the PTG scores and the core belief disruption and rumination scores, whereas the PTG factors correlated negatively with depressive and posttraumatic symptom measures. Conversely, positive correlations were identified between the PTD total score and all the other investigated constructs. Finally, the total scales and subscales of the PTG/PTD dimensions revealed good to excellent internal consistency. CONCLUSIONS: The current findings indicate that the Italian version of the PTGDI-X appears to be a valid assessment tool for the multidimensional structure of the PTG component. Future research is needed, on the other hand, to confirm the validity of the PTD dimension in the Italian population. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A short form of the posttraumatic growth and posttraumatic depreciation inventory - expanded (PTGDI-X-SF) among German adults.

BACKGROUND: After experiencing trauma, people often report both negative and positive changes, which can be operationally defined as posttraumatic growth (PTG) and posttraumatic depreciation (PTD). However, there is no brief measure for assessing both posttraumatic changes simultaneously. OBJECTIVE: This study describes the short form of the expanded version of the Posttraumatic Growth and Depreciation Inventory (PTGDI-X-SF) among German Adults. METHOD: Using a sample of 253 German adults, the dimensionality of the PTGDI-X-SF was examined by confirmatory factor analyses. Internal consistencies were determined. The relation of PTG and PTD was investigated. Regression analyses explored the relationships to established predictors as previously found for the full-scale version of the PTGDI-X. RESULTS: Findings indicate a 5-factor structure for the PTGDI-X-SF equivalent to the PTGDI-X as well as high reliability for PTG (α = .88) and PTD (α = .88). Participants reported more PTG (M = 2.53, SD = 1.20) than PTD (M = 1.41, SD = 1.16). PTG and PTD were weakly associated (r = -.148, p = .018). PTG was positively related to disruption of core beliefs (ß = .25, p < .001) and deliberate rumination directly after the trauma (ß = .38, p < .001). PTD was positively associated with recent rumination irrespective of whether it was intrusive (ß = .21, p < .05) or deliberate (ß = .33, p < .01). CONCLUSIONS: Overall, results support the applicability of the PTGDI-X-SF as a valid and efficient measure to assess PTG and PTD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Trajectories of posttraumatic growth and posttraumatic depreciation: A one-year prospective study among people living with HIV.

OBJECTIVE: Posttraumatic growth (PTG) and posttraumatic depreciation (PTD) are considered two sides of growth after trauma. Nevertheless, previous studies pointed out that in trauma living with a life-threatening illness, they may be experienced as two independently and share distinct predictors. In our study we aimed to find the different trajectories of PTG and PTD among a sample of people living with HIV (PLWH) and to investigate its predictors out of psychological resilience, and gain and loss of resources from the conservation of resources theory (COR). METHODS: We designed a longitudinal study that consisted of three measurements at 6-month intervals, and we recruited, respectively, 87, 85 and 71 PLWH. Each time participants filled out the following questionnaires: the expanded version of the PTG and PTD Inventory (PTGDI-X), the Brief Resilience Scale (BRS), the Conservation of Resources Evaluation (COR-E), and a survey on sociodemographic and medical data. RESULTS: We observed two separate trajectories of PTG and PTD within participants and found that each of the trajectories were related to different predictors from the studied variables. More specifically, we found a positive relationship between resilience and a descending PTD trajectory that stabilized over time. Gain of resources generally predicted a PTG trajectory, while loss of resources predicted the dynamics of PTD. CONCLUSIONS: Including two parallel constructs, i.e., PTG and PTD, confirmed the independence of their mechanisms in growth processes among PLWH. The initial insight concerning the role of resilience and resources in PTG/PTD processes may inspire more effective planning for psychological help for PLWH, and it may stimulate studies on growth after trauma to further examine the two sides of this phenomenon.

Coping and rumination as predictors of posttraumatic growth and depreciation.

PURPOSE: The present study examined the joint impact of coping and rumination after trauma on posttraumatic growth (PTG) and posttraumatic depreciation (PTD) based on the PTG model. METHODS: A cross-sectional study was conducted between October 2017 and May 2018. A sample of 253 individuals who had experienced a traumatic event in the last two years, was included. Participants completed an online self-reported survey, including demographic variables, trauma characteristics, the German Posttraumatic Growth and Depreciation Inventory - Expanded, the Brief COPE Inventory, and the Event Related Rumination Inventory. An analysis of correlation, a principal component analysis and hierarchical regression analyses were conducted. Statistical analyses were undertaken on SPSS (version 25.0; IBM, New York, USA). RESULTS: After controlling for the effects of personal and trauma characteristics, self-sufficient coping and socially supported coping were found to favor the emergence of PTG. Event-related and recent deliberate rumination were positively related to PTG. Avoidant-focused coping and recent intrusive rumination were positively associated with PTD. Overall, the final models accounted for 46% and 58% of the variance in PTG and PTD. CONCLUSION: Our findings confirm the PTG model and support the central role of deliberate rumination, self-sufficient coping and socially supported coping in the development of PTG. Our results indicate that a similar model of PTD with comparable influencing factors can be assumed: if the individual is stuck in ongoing intrusive rumination and uses more avoidance-focused coping, it might lead to more reports of PTD.

The Chinese version of Posttraumatic Growth and Depreciation Inventory-Expanded version (PTGDI-X) for cancer survivors.

Many patients with cancer report positive changes often referred to as posttraumatic growth (PTG). Some of these self-reported PTG may represent maladaptive illusions created by individuals to cope with the illness. A recently established Posttraumatic Growth and Depreciation Inventory - Expanded version (PTGDI-X) includes both PTG and posttraumatic depreciation (PTD) items. This inventory may provide a more balanced picture of the phenomenological world of cancer survivors. We examined the Chinese version of the PTGDI-X's applicability to cancer patients, and how PTG and PTD were related to posttraumatic stress symptoms. Two hundred sixty-five cancer survivors in Taiwan completed the Chinese version of the PTGDI-X, along with the PTSD Checklist for the DSM-5 to measure posttraumatic stress disorder (PTSD) symptoms. Confirmatory factor analysis showed that the factor structure of the PTGDI-X established in a multi-national study fit our data from cancer patients modestly well. The PTD score had a significant and positive correlation with PTSD symptoms, whereas the PTG and PTSD showed a significant curvilinear relationship in the form of an inverted U-shape. This study's results indicate that PTG and PTD are separated constructs with differential relationships with cancer outcomes. The Chinese version of the PTGDI-X is a viable instrument for psycho-oncological research. The PTD scores can provide useful information to guide cognitive interventions to reduce distorted cognitions. In contrast, the PTG scores can provide further information on the phenomenological world of cancer survivors. In this study, clinical implications and future studies were considered.

Stress-related health depreciation: Using allostatic load to predict self-rated health.

Approximately one quarter of UK adults are currently diagnosed with two or more chronic conditions, often referred to as multimorbidity. Chronic stress has been implicated in the development of many diseases common to multimorbidity. Policymakers and clinicians have acknowledged the need for more preventative approaches to deal with the rise of multimorbidity and "early ageing". However divergence may occur between an individual's self-rated health and objectively measured health that may preclude preventative action. The use of biomarkers which look 'under the skin' provide crucial information on an individual's underlying health to facilitate lifestyle change or healthcare utilisation. The UK's Understanding Society dataset, was used to examine whether baseline variation in biomarkers measuring stress-related "wear and tear" - Allostatic Load (AL) - predict changes in future self-rated health (SRH) while adjusting for baseline SRH, socioeconomic and lifestyle factors, and healthcare inputs. An interaction between baseline AL and baseline SRH was included to test for differential rates of SRH change. We examined SRH using the SF6D instrument, measuring health-related-quality of life (HRQoL), as well as its physical and mental health components separately. We found that HRQoL and physical health decline faster for those with higher baseline AL (indicating greater "wear and tear") however the same pattern was not observed for mental health. These findings provide novel insights for clinicians and policymakers on the usefulness of AL in capturing health trajectories of which individual's may not be aware and its importance in targeting resilience enhancing measures earlier in the lifecourse to delay physical health decline.

Environmental aspects of the depreciation of the culturally significant Wall of Cartagena de Indias - Colombia.

Among the diverse archeological relics of the past, the Cartagena de Indias Wall is one of the greatest representations of European cultural architecture in South America. To assess the implication of contamination on the depreciation of the culturally significant Wall of Cartagena de Indias - Colombia, a detailed, multi-analytical approach was conducted on components of the wall. Accumulated ultra-fine particles (UFPs) and superficial nano-particles (NPs) containing hazardous elements (HEs) on the wall were identified in an attempt to understand whether atmospheric pollution is hastening the depreciation of the structure itself. Mortar which at one point held the stones together is now weak and has fallen away in places. Irreparable damage is being done by salt spray, acid rain and the site's tropical humid climate. Several HEs and organic compounds found within the local environment are also contributing to the gradual deterioration of the construction. In this study, advanced microscopy analyses have been applied to understand the properties of UFPs and NPs deposited onto the wall's weathered external walls through exposure to atmospheric pollution. Several materials identified by X-Ray Diffraction (XRD) can be detected using high-resolution transmission electron microscopy (HR-TEM) and field emission scanning electron microscope (FE-SEM). The presence of anglesite, gypsum, hematite containing HEs, and several organic compounds modified due to moisture and contamination was found. Black crusts located on the structure could potentially serve as a source of HEs pollution and a probable hazard to not only to the ecosystem but also to human health.

Suicídio e depressão na população LGBT: postagens publicadas em blogs pessoais / Suicide, depression and sexual and gender minorities: posts published on personal blogs / Suicidio, depresión en la población LGBT: publicaciones en blogs personales

OBJETIVO: o objetivo do estudo foi analisar postagens sobre suicídio, depressão e população LGBT em blogs da plataforma Tumblr®. MÉTODO: estudo com abordagem qualitativa, que submeteu à análise temática postagens identificadas a partir da busca de palavras chave relacionadas ao comportamento suicida e população LGBT na plataforma TUMBLR. RESULTADOS: foram identificados 14 blogs, com 916 postagens. Os principais temas abordados estiveram relacionados a sofrimento intenso, comportamentos autodestrutivos, vulnerabilidade emocional, rejeição e autodepreciação. CONCLUSÃO: esses temas relevam importantes necessidades a serem investigadas e abordadas em intervenções para a promoção da saúde mental da comunidade LGBT no âmbito individual e coletivo.

OBJECTIVE: the aim of the study was to analyze posts on suicide, depression, and the LGBT population on Tumblr® platform blogs. METHOD: a study with a qualitative approach, which submitted to thematic analysis posts identified from the search for keywords related to suicidal behavior and LGBT population on the TUMBLR platform. RESULTS: 14 blogs were identified, with 916 posts. The main topics addressed were related to intense suffering, self-destructive behaviors, emotional vulnerability, rejection and self-depreciation. CONCLUSION: these themes reveal important needs to be investigated and addressed in interventions to promote mental health in the LGBT community at the individual and collective levels.

OBJETIVO: el objetivo del estudio fue analizar publicaciones sobre suicidio y depresión en la población LGBT en los blogs de la plataforma Tumblr®. MÉTODO: estudio con un enfoque cualitativo, que sometió a análisis temático publicaciones identificadas a partir de la búsqueda de palabras clave relacionadas con el comportamiento suicida y la población LGBT en la plataforma TUMBLR. RESULTADOS: se identificaron 14 blogs, con 916 publicaciones. Los principales temas abordados se relacionaron con el sufrimiento intenso, los comportamientos autodestructivos, la vulnerabilidad emocional, el rechazo y la autoestima. CONCLUSIÓN: estos temas revelan necesidades importantes que deben investigarse y abordarse en intervenciones para promover la salud mental en la comunidad LGBT a nivel individual y colectivo.

Optimisation of medical equipment replacement using stochastic dynamic programming.

In this paper, the medical equipment replacement strategy is optimised using a multistage stochastic dynamic programming (SDP) approach. The outcome is an optimal path which shows whether to keep an existing piece of medical equipment (defender) or replace it with a more economical alternative (challenger). We assume that each decision can result in a number of different possible outcomes, each with a known probability. Contrary to deterministic dynamic programming, the state at the next stage is not completely determined by the state and policy decision at the current stage. Instead, the next stage depends on the operation and maintenance cost which is modelled as a stochastic variable. A Keep-Replace sequence of the highest returns (lowest costs) is the result of solving the problem using forward decision making. The benefit of the SDP solution versus that of keeping medical equipment until the end of its expected life is investigated for three scenarios: (1) no revenue for the defender and the challenger, (2) equal revenues for both, and (3) higher revenue for the challenger. The percentage of benefits relative to the current acquisition cost for the three scenarios are 616.9%, 728.2%, and 789.29%, respectively. Each percentage represents the relative difference between the equipment life cycle cost of the optimal sequence and that of the conventional sequence.

Perceived posttraumatic growth and depreciation after spinal cord injury: Actual or illusory?

OBJECTIVE: This study examined whether retrospective reports of posttraumatic growth (PTG) and depreciation (PTD) of individuals recently diagnosed with a spinal cord injury (SCI) coincide with prospectively measured changes in the conceptually close domains of general self-efficacy (SE) and purpose in life (PIL). The study also tested whether PTG/D and changes in SE and PIL independently predict psychological adjustment to the injury (depressive symptoms, anxiety, life satisfaction). METHOD: Adopting a longitudinal design, a sample of 206 newly injured patients admitted to one of the four Swiss SCI rehabilitation centers was analyzed. SE and PIL were assessed one month after injury diagnosis and at rehabilitation discharge, PTG/D and the adjustment indicators only at discharge. Structural equation modeling was used to calculate latent change scores for SE and PIL, to correlate these scores to PTG/D scores, and to regress the adjustment indicators on both of them. RESULTS: PTG/D scores were weakly (rmax = .20, p = .033) correlated to changes in SE and PIL. In the multivariate analyses, positive changes in SE and PIL and PTG scores were all associated with better adjustment (e.g., fewer depressive symptoms). In contrast, PTD scores were related to lower adjustment. CONCLUSIONS: These results suggest that PTG/D in the initial time after a potentially traumatic medical event seem to be illusory to some degree, as indicated by their weak association with "actual" (i.e., longitudinally measured) changes. Nevertheless, both, PTG/D and actual changes, need to be considered by researchers and clinicians, as they seem to be independently related to psychological adjustment. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Dental implant bottom-up cost analysis / 대한치과보철학회지

PURPOSE: The purpose of this study was to estimate the cost of dental implant using the bottom-up approach with the current data from dental clinics. MATERIALS AND METHODS: In this study, direct and indirect costs required for each treatment were calculated using the bottom-up approach. In the bottom-up costing, the average monthly total cost of dental clinic includes labor and material costs, administrative expenses, medical malpractice costs, and opportunity costs of invested capital. For the dental implant cost components, those include direct costs (labor costs, laboratory costs, material costs, depreciation or other operating costs), indirect costs (administrative costs), and the opportunity costs of investment for dental clinic. RESULTS: Dental implant costs of metal crown, porcelain crown and over-denture were 1,449,000 won, 1,583,000 won, and 2,471,000 won respectively. The proportion of cost components was as follows. The labor cost were 50%, and material, administrative and other cost were 33%, 15% and 2%, respectively. For direct, indirect and investment cost, the ratio were 83%, 15% and 2%, respectively. CONCLUSION: The labor costs were evaluated to comprise largest proportion (about 50%, 730,000 won). Dental implant cost using Bottom-up costing was 1,450,000 won for metal crown and 1,580,000 won for porcelain crown.

Comparison of Effectiveness between Blood Bank Automation System and Manual Method for ABO-RhD Blood Typing and Antibody Screening Test in a Single Center / 대한수혈학회지

BACKGROUND: The automation system for blood typing and antibody screening has been developed and is now used widely. In this study, we evaluated the economic effectiveness between automation system QWALYS-3 (DIAGAST, Loos Cedex, France) and manual testing. METHODS: Clinical samples from March 2012 were used for comparison of the costs and TAT for ABO-RhD blood typing and antibody screening. The costs included those of materials (reagents and consumables), labor, and equipment depreciation. TAT was analyzed for either blood typing only for one, 16, and 32 samples or blood typing and antibody screening for the same number of samples. RESULTS: The blood typing TAT for one, 16, and 32 samples was 4.5, 35.1, and 70.1 minutes by manual and 24.0, 36.0, and 38.1 minutes by automated system. Both blood typing and antibody screening TAT for one, 16, and 32 samples was 27.5, 75.0, and 129.9 minutes by manual and 45.0, 52.0, and 54.0 minutes by automation. CONCLUSION: The blood automation system reduced TAT only for the batch test, therefore, when using the automation system, blood bank test size and emergency situation should be considered.

Mobile dental units: leasing or buying? A dollar-cost analysis.

INTRODUCTION: The decision to acquire a mobile dental unit is based on a standard capital budgeting analysis. The next step is to determine whether to obtain the use of the mobile dental unit by borrowing and purchasing or by leasing. As a financing mechanism, leases are simply another way of borrowing money to pay for the asset. OBJECTIVE: To compare lease vs. debt as financial vehicles to acquiring a mobile dental unit. METHODS: An estimate for a new mobile unit was obtained. Lease and loan proposals from financial lenders were collected. A cost of capital rate was chosen for comparison. Cash flows associated with borrowing and leasing vs. buying were determined fortwo different scenarios: for profit (FP) vs. not-for-profit (NFP), at 5 years. A dollar-cost analysis was utilized to determine the option with the lowest capitalized value. RESULTS: There was a net advantage to buying vs. leasing for both for FP and NFP organizations. Due to tax advantages, owning and leasing were substantially less expensive for FP than for NFP. Slight decreases in the monthly lease payments would make leasing competitive to the buying approach. CONCLUSION: Exploring alternative financing vehicles may allow dental programs to expand their services through the acquisition of a mobile unit. Though programs generally own assets, it is the use of the asset which is important rather than the ownership. Dental programs can find leasing an attractive alternative by offering access to capital with cash-flow advantages.

Non-cardiac surgery in developing countries: epidemiological aspects and economical opportunities--the case of Brazil.

BACKGROUND: Worldwide distribution of surgical interventions is unequal. Developed countries account for the majority of surgeries and information about non-cardiac operations in developing countries is scarce. The purpose of our study was to describe the epidemiological data of non-cardiac surgeries performed in Brazil in the last years. METHODS AND FINDINGS: This is a retrospective cohort study that investigated the time window from 1995 to 2007. We collected information from DATASUS, a national public health system database. The following variables were studied: number of surgeries, in-hospital expenses, blood transfusion related costs, length of stay and case fatality rates. The results were presented as sum, average and percentage. The trend analysis was performed by linear regression model. There were 32,659,513 non-cardiac surgeries performed in Brazil in thirteen years. An increment of 20.42% was observed in the number of surgeries in this period and nowadays nearly 3 million operations are performed annually. The cost of these procedures has increased tremendously in the last years. The increment of surgical cost was almost 200%. The total expenses related to surgical hospitalizations were more than $10 billion in all these years. The yearly cost of surgical procedures to public health system was more than $1.27 billion for all surgical hospitalizations, and in average, U$445.24 per surgical procedure. The total cost of blood transfusion was near $98 million in all years and annually approximately $10 million were spent in perioperative transfusion. The surgical mortality had an increment of 31.11% in the period. Actually, in 2007, the surgical mortality in Brazil was 1.77%. All the variables had a significant increment along the studied period: r square (r(2)) = 0.447 for the number of surgeries (P = 0.012), r(2) = 0.439 for in-hospital expenses (P = 0.014) and r(2) = 0.907 for surgical mortality (P = 0.0055). CONCLUSION: The volume of surgical procedures has increased substantially in Brazil through the past years. The expenditure related to these procedures and its mortality has also increased as the number of operations. Better planning of public health resource and strategies of investment are needed to supply the crescent demand of surgery in Brazil.