RESUMO
BACKGROUND: Equine influenza virus (EIV) is one of the main causes of viral respiratory affections in horses. Little is known about the prevalence of EIV in Saudi Arabia especially the H3N8 serotype. OBJECTIVES: To assess prevalence of equine influenza in horse populations in Eastern and Central Saudi Arabia. STUDY DESIGN: Cross-sectional study. METHODS: We collected 145 sera, 323 nasal and 323 rectal swabs from horses from six major cities in Eastern and Central regions. None of the horses were vaccinated against EIV. Sera were tested in ELISA assays for influenza A type-specific antibodies and by haemagglutination inhibition (HI) tests using equine H3N8. The swabs were tested by RT-qPCR assay targeting a conserved region of the influenza A matrix gene that detects influenza A viruses of all subtypes. RESULTS: None of the swabs had detectable influenza A virus RNA. Of the 145 serasamples tested by ELISA, 81 (55.9%) were positive and 98 (67.6%) of 145 sera tested by HI tests were positive for equine H3. MAIN LIMITATIONS: Our failure to detect and sequence any EIV prevents identification of the lineage of virus that circulates in the Kingdom of Saudi Arabia. CONCLUSIONS: These results confirm that EIV H3N8 is circulating in Saudi Arabia and should be considered as a possible cause when investigating horses with respiratory disease in Saudi Arabia.
Assuntos
Anticorpos Antivirais/sangue , Doenças dos Cavalos/virologia , Vírus da Influenza A Subtipo H3N8 , Infecções por Orthomyxoviridae/veterinária , Animais , Doenças dos Cavalos/epidemiologia , Cavalos , Infecções por Orthomyxoviridae/sangue , Infecções por Orthomyxoviridae/epidemiologia , Infecções por Orthomyxoviridae/virologia , Arábia Saudita/epidemiologia , Estudos SoroepidemiológicosRESUMO
BACKGROUND: The generation of IgE-mediated food allergy in humans is silent and only diagnosed upon manifestation of clinical symptoms. While experimental models have been used to investigate some mechanisms of allergic sensitization, the generation of humoral immunity and memory remains to be elucidated. Here, we defined the evolution of allergen-specific B-cell responses during epicutaneous sensitization to foods. METHODS: Wild-type and genetic knockout animals, and drug or antibody strategies for cell depletion and immunoglobulin signaling blockade were used to investigate epicutaneous sensitization and disease progression; we analyzed allergen-specific germinal centers and IgG1+ memory B cells by flow cytometry, evaluated humoral responses, and determined clinical reactivity (anaphylaxis). RESULTS: Epicutaneous sensitization caused microscopic skin damage, inflammation, and recruitment of activated dendritic cells to the draining lymph nodes. This process generated allergen-specific IgG1+ germinal center B cells, serum IgG1, and anaphylaxis that was mediated by the alternative pathway. Whether we used peanut and/or ovalbumin from the egg white for sensitization, the allergen-specific IgG1+ memory compartment predominantly exhibited an immature, pro-germinal center phenotype (PDL-2- CD80- CD35+ CD73+ ). Subsequent subclinical exposures to the allergen induced IgE+ germinal center B cells, serum IgE, and likely activated the classical pathway of anaphylaxis. CONCLUSIONS: Our data demonstrate that IgG1+ B-cell immunity against food allergens in epicutaneous sensitization precedes the generation of IgE responses. Therefore, the assessment of allergen-specific cellular and humoral IgG1+ immunity may help to identify individuals at risk of developing IgE-mediated food allergy and hence provide a window for therapeutic interventions.
Assuntos
Linfócitos B/imunologia , Hipersensibilidade Alimentar/imunologia , Imunoglobulina E/imunologia , Imunoglobulina G/imunologia , Anafilaxia/imunologia , Animais , Humanos , Imunidade Humoral , Pele/patologia , Fatores de TempoRESUMO
Bats are a unique group of mammals well suited to be hosts for emerging viruses. With current rates of deforestation and urbanization, redistribution of bat habitats to urban and suburban areas may bring bats into closer contact with livestock and humans. Common flying fox, Pteropus medius (previously known as Pteropus giganteus), forms large communal roosts on treetops, often in close proximity to human habitation in Sri Lanka. This report describes the detection of coronavirus RNA in P. medius bat guano collected in Peradeniya, Sri Lanka. These viruses had >97% nucleotide identity with coronaviruses detected in Cynopterus sphinx, Scotophilus heathii and S. kuhlii bats in Thailand. Pteropus medius is widespread in Asia and appears to excrete group D coronaviruses, which are hitherto confined to bats; however, these findings may have public health implications in the future.
Assuntos
Quirópteros/virologia , Infecções por Coronavirus/veterinária , Coronavirus/isolamento & purificação , Fezes/virologia , Animais , Coronavirus/genética , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Genoma Viral/genética , Filogenia , RNA Viral/genética , Sri Lanka/epidemiologia , TailândiaRESUMO
What is the best way to use oxygen therapy for patients with an acute medical illness? A systematic review published in the Lancet in April 2018 found that supplemental oxygen in inpatients with normal oxygen saturation increases mortality.1 Its authors concluded that oxygen should be administered conservatively, but they did not make specific recommendations on how to do it. An international expert panel used that review to inform this guideline. It aims to promptly and transparently translate potentially practice-changing evidence to usable recommendations for clinicians and patients.2 The panel used the GRADE framework and following standards for trustworthy guidelines.3
Assuntos
Humanos , Oxigênio/sangue , Oxigenoterapia/métodos , Oximetria/classificação , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/terapia , Oxigenoterapia , Doença Aguda/terapia , Infarto do MiocárdioRESUMO
Equine coronaviruses (ECoV) are the only coronavirus known to infect horses. So far, data on ECoV infection in horses remain limited to the USA, France and Japan and its geographic distribution is not well understood. We carried out RT-PCR on 306 nasal and 315 rectal swabs and tested 243 sera for antibodies to detect coronavirus infections in apparently healthy horses in Saudi Arabia and Oman. We document evidence of infection with ECoV and HKU23 coronavirus by RT-PCR. There was no conclusive evidence of Middle East respiratory syndrome coronavirus infection in horses. Serological data suggest that lineage A betacoronavirus infections are commonly infecting horses in Saudi Arabia and Oman but antibody cross-reactivities between these viruses do not permit us to use serological data alone to identify which coronaviruses are causing these infections.
Assuntos
Betacoronavirus/imunologia , Infecções por Coronavirus/veterinária , Coronavirus/imunologia , Doenças dos Cavalos/epidemiologia , Coronavírus da Síndrome Respiratória do Oriente Médio/imunologia , Animais , Betacoronavirus/genética , Betacoronavirus/isolamento & purificação , Chlorocebus aethiops , Coronavirus/genética , Coronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Reações Cruzadas , Doenças dos Cavalos/virologia , Cavalos , Coronavírus da Síndrome Respiratória do Oriente Médio/genética , Coronavírus da Síndrome Respiratória do Oriente Médio/isolamento & purificação , Omã/epidemiologia , Arábia Saudita/epidemiologia , Células VeroRESUMO
Middle East respiratory syndrome coronavirus (MERS-CoV) is an existential threat to global public health. The virus has been repeatedly detected in dromedary camels (Camelus dromedarius). Adult animals in many countries in the Middle East as well as in North and East Africa showed high (>90%) seroprevalence to the virus. Middle East respiratory syndrome coronavirus isolated from dromedaries is genetically and phenotypically similar to viruses from humans. We summarize current understanding of the ecology of MERS-CoV in animals and transmission at the animal-human interface. We review aspects of husbandry, animal movements and trade and the use and consumption of camel dairy and meat products in the Middle East that may be relevant to the epidemiology of MERS. We also highlight the gaps in understanding the transmission of this virus in animals and from animals to humans.
Assuntos
Camelus/virologia , Infecções por Coronavirus/virologia , Coronavírus da Síndrome Respiratória do Oriente Médio/isolamento & purificação , Adulto , Criação de Animais Domésticos/tendências , Animais , Infecções por Coronavirus/transmissão , Laticínios/virologia , Humanos , Produtos da Carne/virologia , Oriente Médio/epidemiologia , Coronavírus da Síndrome Respiratória do Oriente Médio/genética , Fenótipo , Saúde Pública , Estudos SoroepidemiológicosRESUMO
BACKGROUND: Food allergy, in particular peanut allergy, is a growing concern in Western countries. The prevalence of allergy to peanut, which currently stands at 1.4%, nearly tripled between 1997 and 2008. Allergic sensitization is a particularly difficult process to study as it is clinically silent. We sought to identify key pathways and mediators critically involved in the induction of allergic sensitization to peanut. METHODS: Comprehensive metabolomics analysis with liquid chromatography-mass spectrometry was used to detect metabolite changes in mice (C57BL/6) undergoing sensitization. Loss-of-function and gain-of-function studies were performed in mice subjected to two models of peanut sensitization and anaphylaxis that involved either oral or epicutaneous sensitization. Flow cytometric analyses on dendritic cells (DCs) in vitro and in vivo were used to investigate the mechanisms of immune activation. RESULTS: Elevated levels of uric acid (UA) were detected in mice undergoing sensitization as well as in peanut-allergic children who were not challenged with peanut. In mice, the depletion of UA during sensitization prevented the development of peanut-specific immunoglobulins IgE and IgG1 as well as anaphylaxis while exogenous delivery of UA crystals (monosodium urate, MSU) restored the allergic phenotype. Monosodium urate enhanced CD86 and OX40L expression on DCs, independent of Toll-like receptors 2 and 4, the NLRP3 inflammasome, and IL-1ß, via a PI3K signaling pathway. CONCLUSION: Overproduction of the UA alarmin in the local microenvironment plays a critical role in the induction of peanut-allergic sensitization, likely due to its ability to activate DCs. These finding suggest that cellular damage or tissue injury may be an essential requisite for the development of allergic sensitization to foods.
Assuntos
Alarminas/imunologia , Hipersensibilidade a Amendoim/imunologia , Ácido Úrico/imunologia , Alarminas/metabolismo , Animais , Modelos Animais de Doenças , Ensaio de Imunoadsorção Enzimática , Feminino , Citometria de Fluxo , Humanos , Imunoglobulina E/sangue , Imunoglobulina E/imunologia , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Metabolômica , Camundongos , Camundongos Endogâmicos C57BL , Hipersensibilidade a Amendoim/metabolismo , Ácido Úrico/metabolismoRESUMO
Intestinal T helper type 2 (Th2) immunity in food allergy results in IgG1 and IgE production, and antigen re-exposure elicits responses such as anaphylaxis and eosinophilic inflammation. Although interleukin-4 (IL-4) is critically required for allergic sensitization, the source and control of IL-4 during the initiation of Th2 immunity in vivo remains unclear. Non-intestinal and non-food allergy systems have suggested that natural killer-like T (NKT) or γδ T-cell innate lymphocytes can supply the IL-4 required to induce Th2 polarization. Group 2 innate lymphoid cells (ILCs) are a novel IL-4-competent population, but their contribution to initiating adaptive Th2 immunity is unclear. There are also reports of IL-4-independent Th2 responses. Here, we show that IL-4-dependent peanut allergic Th2 responses are completely intact in NKT-deficient, γδ T-deficient or ILC-deficient mice, including antigen-specific IgG1/IgE production, anaphylaxis, and cytokine production. Instead, IL-4 solely from CD4(+) Th cells induces full Th2 immunity. Further, CD4(+) Th cell production of IL-4 in vivo is dependent on OX40L, a costimulatory molecule on dendritic cells (DCs) required for intestinal allergic priming. However, both Th2 cells and ILCs orchestrated IL-13-dependent eosinophilic inflammation. Thus, intestinal Th2 priming is initiated by an autocrine/paracrine acting CD4(+) Th cell-intrinsic IL-4 program that is controlled by DC OX40L, and not by NKT, γδ T, or ILC cells.
Assuntos
Alérgenos/imunologia , Arachis/química , Interleucina-4/imunologia , Intestinos/imunologia , Glicoproteínas de Membrana/imunologia , Hipersensibilidade a Amendoim/imunologia , Células Th2/imunologia , Fatores de Necrose Tumoral/imunologia , Alérgenos/química , Animais , Eosinófilos/imunologia , Eosinófilos/patologia , Imunidade Inata , Imunoglobulina E/imunologia , Imunoglobulina G/imunologia , Interleucina-13/genética , Interleucina-13/imunologia , Interleucina-4/genética , Intestinos/patologia , Glicoproteínas de Membrana/genética , Camundongos , Camundongos Knockout , Ligante OX40 , Hipersensibilidade a Amendoim/patologia , Receptores de Antígenos de Linfócitos T gama-delta/genética , Receptores de Antígenos de Linfócitos T gama-delta/imunologia , Células Th2/patologia , Fatores de Necrose Tumoral/genéticaRESUMO
The origins of allergic asthma, particularly in infancy, remain obscure. Respiratory viral infections and allergen sensitization in early life have been associated with asthma in young children. However, a causal link has not been established. We investigated whether an influenza A infection in early life alters immune responses to house dust mite (HDM) and promotes an asthmatic phenotype later in life. Neonatal (8-day-old) mice were infected with influenza virus and 7 days later, exposed to HDM for 3 weeks. Unlike adults, neonatal mice exposed to HDM exhibited negligible immune responsiveness to HDM, but not to influenza A. HDM responsiveness in adults was associated with distinct Ly6c+ CD11b+ inflammatory dendritic cell and CD8α+ plasmacytoid (pDC) populations that were absent in HDM-exposed infant mice, suggesting an important role in HDM-mediated inflammation. Remarkably, HDM hyporesponsiveness was overcome when exposure occurred concurrently with an acute influenza infection; young mice now displayed robust allergen-specific immunity, allergic inflammation, and lung remodeling. Remodeling persisted into early adulthood, even after prolonged discontinuation of allergen exposure and was associated with marked impairment of lung function. Our data demonstrate that allergen exposure coincident with acute viral infection in early life subverts constitutive allergen hyporesponsiveness and imprints an asthmatic phenotype in adulthood.
Assuntos
Asma/imunologia , Coinfecção/imunologia , Células Dendríticas/metabolismo , Vírus da Influenza A/imunologia , Infecções por Orthomyxoviridae/imunologia , Remodelação das Vias Aéreas , Animais , Animais Recém-Nascidos , Antígenos CD/metabolismo , Antígenos de Dermatophagoides/imunologia , Asma/patologia , Asma/fisiopatologia , Asma/virologia , Diferenciação Celular , Coinfecção/patologia , Coinfecção/fisiopatologia , Coinfecção/virologia , Células Dendríticas/imunologia , Células Dendríticas/patologia , Células Dendríticas/virologia , Progressão da Doença , Humanos , Imunização , Vírus da Influenza A/patogenicidade , Camundongos , Camundongos Endogâmicos BALB C , Infecções por Orthomyxoviridae/patologia , Infecções por Orthomyxoviridae/fisiopatologia , Infecções por Orthomyxoviridae/virologia , Pyroglyphidae , Testes de Função RespiratóriaRESUMO
Bats are increasingly recognized to harbor a wide range of viruses, and in most instances these viruses appear to establish long-term persistence in these animals. They are the reservoir of a number of human zoonotic diseases including Nipah, Ebola, and severe acute respiratory syndrome. We report the identification of novel groups of astroviruses in apparently healthy insectivorous bats found in Hong Kong, in particular, bats belonging to the genera Miniopterus and Myotis. Astroviruses are important causes of diarrhea in many animal species, including humans. Many of the bat astroviruses form distinct phylogenetic clusters in the genus Mamastrovirus within the family Astroviridae. Virus detection rates of 36% to 100% and 50% to 70% were found in Miniopterus magnater and Miniopterus pusillus bats, respectively, captured within a single bat habitat during four consecutive visits spanning 1 year. There was high genetic diversity of viruses in bats found within this single habitat. Some bat astroviruses may be phylogenetically related to human astroviruses, and further studies with a wider range of bat species in different geographic locations are warranted. These findings are likely to provide new insights into the ecology and evolution of astroviruses and reinforce the role of bats as a reservoir of viruses with potential to pose a zoonotic threat to human health.
Assuntos
Infecções por Astroviridae/veterinária , Astroviridae/classificação , Quirópteros/virologia , Variação Genética , Animais , Astroviridae/genética , Astroviridae/isolamento & purificação , Infecções por Astroviridae/virologia , Quirópteros/classificação , Clonagem Molecular , Hong Kong , Humanos , Mamastrovirus/classificação , Mamastrovirus/genética , Mamastrovirus/isolamento & purificação , Dados de Sequência Molecular , Filogenia , Análise de Sequência de DNA , Zoonoses/transmissão , Zoonoses/virologiaRESUMO
We previously reported the detection of bat coronaviruses (bat CoVs 1A, 1B, HKU7, HKU8 and bat-severe acute respiratory syndrome coronavirus) in Miniopterus spp. that cohabit a cave in Hong Kong. Here, we report the full genomic sequences of bat CoVs 1A, 1B and HKU8. Bat CoVs 1A and 1B, which are commonly found in the Miniopterus, are phylogenetically closely related. Using species-specific RT-PCR assays, bat CoVs 1A and 1B were confirmed to have distinct host specificities to Miniopterus magnater and Miniopterus pusillus, respectively. Interestingly, co-infections of bat CoVs 1B and HKU8 in M. pusillus are detected in seven of 38 virus-positive specimens collected from 2004 to 2006. These findings highlight that co-infections of some coronaviruses might be common events in nature. The biological basis for the host restriction of bat coronaviruses, however, is yet to be determined.
Assuntos
Quirópteros/virologia , Infecções por Coronavirus/veterinária , Coronavirus/genética , Genoma Viral , Animais , Coronavirus/isolamento & purificação , Infecções por Coronavirus/virologia , Hong Kong , Dados de Sequência Molecular , Filogenia , Análise de Sequência de DNA , Homologia de SequênciaRESUMO
A novel group 1 coronavirus was previously identified in bent-winged bats (Miniopterus spp.). Here, results are described from our ongoing surveillance of these bats for coronaviruses. These findings show that group 1 coronaviruses are endemic in these bat populations in Hong Kong. Genetic analysis of these viruses indicates that there are at least four different, but closely related, group 1 coronaviruses (bat-CoV 1A, 1B, HKU7 and HKU8) circulating in bent-winged bats. Phylogenetic analysis revealed that these group 1 bat coronaviruses have descended from a common ancestor and that these viruses have been established in these bats for a long period of time. These data provide a better understanding of the emergence and evolution of coronaviruses. Bat-CoV 1A and 1B were detected in apparently healthy Miniopterus magnater and Miniopterus pusillus, respectively, on repeated sampling occasions at a single habitat, suggesting that these viruses have established a persistent infection in these populations.
Assuntos
Quirópteros/virologia , Coronavirus/isolamento & purificação , Sequência de Aminoácidos , Animais , Sequência de Bases , Coronavirus/classificação , Coronavirus/genética , DNA Viral/genética , Evolução Molecular , Hong Kong , Dados de Sequência Molecular , Proteínas do Nucleocapsídeo/genética , Filogenia , Homologia de Sequência de Aminoácidos , Especificidade da EspécieRESUMO
Exotic wildlife can act as reservoirs of diseases that are endemic in the area or can be the source of new emerging diseases through interspecies transmission. The recent emergence of severe acute respiratory syndrome-associated coronavirus (SARS-CoV) highlights the importance of virus surveillance in wild animals. Here, we report the identification of a novel bat coronavirus through surveillance of coronaviruses in wildlife. Analyses of the RNA sequence from the ORF1b and S-gene regions indicated that the virus is a group 1 coronavirus. The virus was detected in fecal and respiratory samples from three bat species (Miniopterus spp.). In particular, 63% (12 of 19) of fecal samples from Miniopterus pusillus were positive for the virus. These findings suggest that this virus might be commonly circulating in M. pusillus in Hong Kong.
Assuntos
Coronavirus/isolamento & purificação , Genoma Viral , RNA Viral/análise , Sequência de Aminoácidos , Animais , Quirópteros , Coronavirus/classificação , Coronavirus/genética , Dados de Sequência Molecular , Filogenia , RNA Viral/genética , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
OBJECTIVE: To calculate the financial break-even point and illustrate how changes in third-party reimbursement and eligibility could affect a program's fiscal standing. METHODS: Demographic, clinical, and financial data were collected retrospectively for 446 patients treated in a fast-track program during June 1993. The fast-track program is located within the confines of the emergency medicine and trauma center at a 1,050-bed tertiary care Midwestern teaching hospital and provides urgent treatment to minimally ill patients. A financial break-even analysis was performed to determine the point where the program generated enough revenue to cover its total variable and fixed costs, both direct and indirect. RESULTS: Given the relatively low average collection rate (62%) and high percentage of uninsured patients (31%), the analysis showed that the program's revenues covered its direct costs but not all of the indirect costs. CONCLUSIONS: Examining collection rates or payer class mix without examining both costs and revenues may lead to an erroneous conclusion about a program's fiscal viability. Sensitivity analysis also shows that relatively small changes in third-party coverage or eligibility (income) requirements can have a large impact on the program's financial solvency and break-even volumes.
Assuntos
Serviço Hospitalar de Emergência/economia , Administração Financeira de Hospitais/métodos , Triagem/economia , Análise Custo-Benefício , Custos Diretos de Serviços , Reforma dos Serviços de Saúde/economia , Hospitais de Ensino/economia , Humanos , Reembolso de Seguro de Saúde/economia , Medicaid/economia , Meio-Oeste dos Estados Unidos , National Health Insurance, United States/economia , Estudos Retrospectivos , Sensibilidade e Especificidade , Estados UnidosRESUMO
We report the determination of digoxin concentration in serum with Microgenics Cedia digoxin reagents on the Technicon CHEM 1. The Technicon CHEM 1 clinical chemistry analyzer has a throughput of 720 tests per hour and uses only 7 microliters each of two reagents. A 100 test kit can perform 2,640 tests. The within-run coefficient of variation (CV) range is 2.3-0.9% and the total CV is 6.3-2.9% at concentrations tested ranging from 1.10 to 2.94 ng/ml. The results of the Technicon CHEM 1 (y) assay correlated well with those by the Technicon RA 1000 system (x) with 31 clinical serum samples (y = -0.03 + 1.11x, r = 0.96). We concluded that the Cedia digoxin assay on the Technicon CHEM 1 provides a very cost-effective, precise, rapid, and accurate means to determine digoxin concentration in serum.
Assuntos
Digoxina/sangue , Técnicas Imunoenzimáticas , Kit de Reagentes para Diagnóstico , Calibragem , Química Clínica/economia , Química Clínica/métodos , Monitoramento de Medicamentos/economia , Monitoramento de Medicamentos/métodos , Humanos , Microquímica/economia , Microquímica/métodos , Kit de Reagentes para Diagnóstico/economia , Sensibilidade e EspecificidadeRESUMO
This article describes parallel developments of the Hong Kong economy and its health care system. The purpose is to illustrate how the Hong Kong health system evolved in response to external and internal pressures generated by economic prosperity. The Hong Kong system illustrates the importance of clear policy making in the face of these pressures. In particular, issues of investment, financing and distribution of health services are examined in relation to hospital cost control and service accessibility. In the past, health care costs in Hong Kong have been controlled at the expense of limited accessibility of health services. At present, Hong Kong policy-makers are faced with the challenge of maintaining a sharp focus on cost control as they face pressure to expand and improve health care coverage for the citizens. So far they have responded by emphasizing management efficiency through reorganization. It remains to be seen whether this strategy can be successful without passing increased health care costs to the consumers.
Assuntos
Atenção à Saúde/economia , Política de Saúde/economia , Hospitais Privados/economia , Hospitais Públicos/economia , Controle de Custos , Coleta de Dados , Tomada de Decisões Gerenciais , Atenção à Saúde/tendências , Financiamento Governamental/tendências , Custos de Cuidados de Saúde , Política de Saúde/tendências , Acessibilidade aos Serviços de Saúde/tendências , Hong Kong , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Indústrias , Mudança SocialRESUMO
The effectiveness of tangential fluoroscopic guidance of the anesthetizing needle to avoid transgression of the pleura and therefore lower pneumothorax and chest tube insertion rates after transthoracic needle lung biopsy (TNB) was investigated. Tangential guidance was used in 41 patients (group A) and was not used in 51 (group B). The pneumothorax rate was 39% (16 of 41) for group A and 31% (16 of 51) for group B. The chest tube insertion rate was 12% (five of 41) for group A and 4% (two of 51) for group B. None of the differences in rates were significant. Use of this technique does not lower pneumothorax or chest tube insertion rates in patients undergoing TNB.
Assuntos
Anestesia Local , Biópsia por Agulha , Fluoroscopia , Pulmão/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesia Local/efeitos adversos , Biópsia por Agulha/efeitos adversos , Tubos Torácicos , Feminino , Humanos , Injeções/efeitos adversos , Masculino , Pessoa de Meia-Idade , Agulhas , Pneumotórax/etiologia , Pneumotórax/prevenção & controle , Pneumotórax/terapia , Estudos Prospectivos , Radiografia IntervencionistaRESUMO
Policy-makers in industrialized countries face the dilemma of having to contain soaring hospital costs while resisting any reduction in the quality and quantity of hospital services. Among the many hospital financing systems, centralized control via global budgeting is advocated by some to be the most effective in containing hospital costs. Containing hospital costs, however, is but one aspect of the trade-off between cost containment and quality of care. The hospital financing system of Hong Kong provides some insights into the extent to which cost control can be achieved through global budgeting; and its impact on the accessibility of hospital care. The case of Hong Kong highlights three necessary conditions for effective cost control: (1) the payer must have a clear policy stance on overall public spending; (2) the payer must have a clear policy stance on the importance of hospital care relative to other goods and services; and (3) the payer must also have the will and ability to limit hospital spending within finalized global budgets. However, successful cost containment in Hong Kong affects the accessibility of hospital care. In a time of population growth and economic prosperity, new community needs seem to have preceded government plans and actions to build hospital facilities.
Assuntos
Orçamentos/legislação & jurisprudência , Países em Desenvolvimento , Economia Hospitalar/legislação & jurisprudência , Política de Saúde/legislação & jurisprudência , Controle de Custos/legislação & jurisprudência , Comparação Transcultural , Financiamento Governamental/economia , Financiamento Governamental/legislação & jurisprudência , Gastos em Saúde/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Hong Kong , Humanos , PolíticaRESUMO
BACKGROUND: The large number of medically indigent patients in the United States is a major concern to policymakers and may be due to recent increases in the number of uninsured people. The purpose of this study was to identify the factors that affect the amount of unpaid hospital charges for services provided to pregnant women. METHODS: Individual and hospital data were collected on a representative set of 235 pregnancy and childbirth patients with unpaid hospital charges from 28 hospitals in the state of Indiana. RESULTS: Most of these patients did not have insurance coverage (63.8%), yet the majority were employed in the public or private sector (72.3%). Over half (55.5%) of the total uncompensated care amount for this group was from the $1000 to 2499 debt category. The median charge for these patients was $1468, of which the typical hospital was able to collect only 25.5%. CONCLUSIONS: The findings support the belief that any national effort to expand the availability of health insurance coverage to women through increased employment will not totally eliminate the uncompensated care problem. The findings also indicate that rural hospitals face the uncompensated care problem mainly because a significant portion of rural patients are without adequate health insurance coverage.
Assuntos
Parto Obstétrico/economia , Administração Financeira de Hospitais/economia , Indigência Médica/economia , Cuidado Pré-Natal/economia , Adolescente , Adulto , Feminino , Humanos , Seguro Saúde , Crédito e Cobrança de Pacientes , GravidezRESUMO
For this study, a sample of 985 patients classified as "charity" and "bad debt" cases in 1986 were identified from 28 Indiana hospitals. In a multiple regression model, insurance coverage, total hospital charge, pregnancy-related diagnoses, marital status, employment status, discharge status, urban location, and total hospital revenue were significant factors in predicting unpaid hospital bills, when controlling other demographic characteristics. Sixty percent had some form of insurance and were responsible for 40 percent of the uncompensated amount, justifying the need to examine the adequacy of patient insurance coverage. However, providing insurance coverage will not entirely eliminate the problem of uncompensated care; hospitals also need to increase collection efforts for all unpaid bills.