scholarly journals A Cost Evaluation of Peritoneal Dialysis and Hemodialysis in the Treatment of End-Stage Renal Disease in São Paulo, Brazil

2013 ◽  
Vol 33 (3) ◽  
pp. 304-315 ◽  
Author(s):  
Mirhelen Mendes de Abreu ◽  
David R. Walker ◽  
Ricardo C. Sesso ◽  
Marcos B. Ferraz
Keyword(s):  
Peritoneal Dialysis ◽  
Health Care Systems ◽  
Hospital Costs ◽  
Indirect Costs ◽  
Social Consequences ◽  
Cost Evaluation ◽  
Average Total Cost ◽  
Total Cost ◽  
Care Systems ◽  
The Impact

ObjectiveConventional hemodialysis (HD) predominates over peritoneal dialysis (PD) around the world. Prospective and comparative studies comparing the costs of these modalities are scarce. In the present prospective assessment, we describe the resources used and total patient costs for both HD and PD.MethodologyWe assessed 249 patients on HD and 228 on PD. All patients were 18 years of age or older and on stable dialysis. The information was collected at three points over 1 year, using standard questionnaires. The sources for costs were the Brazilian public and private health care systems. Societal perspective was considered.Statistical AnalysisCore trends and dispersions were measured. Regression models assessed the impact of modality on the average total cost per patient per year.ResultsOf the 249 HD patients and 228 PD dialysis patients, 189 (74%) and 160 (70%) respectively completed follow-up. The mean age for women was 55.8 years; for men, it was 59.8 years ( p = 0.001). The average total cost per patient–year was US$28 570 for HD and US$27158 for PD. By category, the costs consisted of direct medical–hospital costs (82.3% for HD, 86.5% for PD), direct nonmedical costs (5.3% for HD, 3.7% for PD), and indirect costs (12.4% for HD, 9.8% for PD). Overall costs were less for PD patients than for their HD counterparts ( p = 0.025).ConclusionsMaintenance dialysis represented the most important source of costs for both modalities; loss of productivity incurred significant costs. Future studies should contemplate the social consequences arising from each modality.

scholarly journals Aging, diversity, and health: the Brazilian and the Canadian context

2011 ◽  
Vol 24 (6) ◽  
pp. 851-856 ◽  
Author(s):  
Lisiane Manganelli Girardi Paskulin ◽  
Marinês Aires ◽  
Ana Valéria Goncalves ◽  
Carla Cristiane Becker Kottwitz ◽  
Eliane Pinheiro de Morais ◽  
...  
Keyword(s):  
Living Arrangements ◽  
Health Care Systems ◽  
Age Groups ◽  
Social Consequences ◽  
Health Policies ◽  
Local Health ◽  
Canadian Context ◽  
Aging Populations ◽  
Care Systems ◽  
The Impact

Aging is a universal and yet diverse phenomenon. This paper presents a review on the topic of diversity in the context of the aging populations in Brazil and Canada. The diversity of the aging population in both countries is discussed in terms of gender, ethnicity, age groups and living conditions while considering the impact on the health care systems. Understanding and reflecting on the Brazilian and Canadian realities reinforces the need for respecting these diversities when developing and implementing local health policies and interventions. There are some similarities regarding gender, but marked differences in immigration patterns, education and living arrangements. The heterogeneity in the aging process within each country and between them carries different expectations and generates social consequences that manifest themselves in differences in health situations, resulting in new challenges to health services and the formulation of public policies for this age group in both countries.

scholarly journals The Impact and Implications of The COVID-19 Pandemic on Organ Procurement Outside of an Epicenter

2021 ◽  
pp. 152692482110028
Author(s):  
Janice Jene Hudgins ◽  
Allison Jo Boyer ◽  
Kristen Danielle Orr ◽  
Clint Allen Hostetler ◽  
Jeffrey Paul Orlowski ◽  
...  
Keyword(s):  
Health Care ◽  
Initial Phase ◽  
Organ Procurement ◽  
Health Care Systems ◽  
Health Data ◽  
Organ Procurement Organization ◽  
Care Systems ◽  
The Impact ◽  
Variable Impact ◽  
Single Organ

The COVID-19 pandemic has been well-documented to have a variable impact on individual communities and health care systems. We describe the experience of a single organ procurement organization (OPO), located in an area without a large cluster of cases during the initial phase of the COVID-19 pandemic. A review of community health data describing the impact of COVID-19 nationally and in Oklahoma was conducted. Additionally, a retrospective review of available OPO data from March 2019-May 2020 was performed. While the amount of donor referrals received and organs recovered by the OPO remained stable in the initial months of the pandemic, the observed organs transplanted vs. expected organs transplanted (O:E) decreased to the lowest number in the 15-month period and organs transplanted decreased as well. Fewer organs from Oklahoma donors were accepted for transplant despite staff spending more time allocating organs.

scholarly journals SARS-CoV-2 and Cytomegalovirus Co-Infections—A Case Series of Critically Ill Patients

2021 ◽  
Vol 10 (13) ◽  
pp. 2792
Author(s):  
Patrícia Moniz ◽  
Sérgio Brito ◽  
Pedro Póvoa
Keyword(s):  
Intensive Care Unit ◽  
Critically Ill ◽  
Immune Suppression ◽  
Clinical Course ◽  
Health Care Systems ◽  
Case Series ◽  
Confounding Factors ◽  
Care Systems ◽  
The Impact ◽  
Cmv Reactivation

The SARS-CoV-2 pandemic has placed great strain on the most developed of health care systems, especially in the context of critical care. Although co-infections with cytomegalovirus (CMV) are frequent in the critically ill due to underlying immune suppression of multiple causes, the impact on COVID-19 patients remains unclear. Furthermore, severe COVID-19 has recently been associated with significant immune suppression, and this may in turn impact CMV reactivation, possibly contributing to clinical course. Nevertheless, multiple confounding factors in these patients will certainly challenge upcoming research. The authors present a case series of five patients admitted to the intensive care unit (ICU) in the context of respiratory failure due to severe COVID-19. All patients evolved with CMV reactivation during ICU stay.

scholarly journals Sustainability of Biosimilars in Europe: A Delphi Panel Consensus with Systematic Literature Review

2020 ◽  
Vol 13 (11) ◽  
pp. 400
Author(s):  
Arnold G. Vulto ◽  
Jackie Vanderpuye-Orgle ◽  
Martin van der Graaff ◽  
Steven R. A. Simoens ◽  
Lorenzo Dagna ◽  
...  
Keyword(s):  
Health Care ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Health Care Systems ◽  
Delphi Panel ◽  
The European Union ◽  
Modified Delphi ◽  
Care Systems ◽  
Supply Risks ◽  
The Impact

Introduction: Biosimilars have the potential to enhance the sustainability of evolving health care systems. A sustainable biosimilars market requires all stakeholders to balance competition and supply chain security. However, there is significant variation in the policies for pricing, procurement, and use of biosimilars in the European Union. A modified Delphi process was conducted to achieve expert consensus on biosimilar market sustainability in Europe. Methods: The priorities of 11 stakeholders were explored in three stages: a brainstorming stage supported by a systematic literature review (SLR) and key materials identified by the participants; development and review of statements derived during brainstorming; and a facilitated roundtable discussion. Results: Participants argued that a sustainable biosimilar market must deliver tangible and transparent benefits to the health care system, while meeting the needs of all stakeholders. Key drivers of biosimilar market sustainability included: (i) competition is more effective than regulation; (ii) there should be incentives to ensure industry investment in biosimilar development and innovation; (iii) procurement processes must avoid monopolies and minimize market disruption; and (iv) principles for procurement should be defined by all stakeholders. However, findings from the SLR were limited, with significant gaps on the impact of different tender models on supply risks, savings, and sustainability. Conclusions: A sustainable biosimilar market means that all stakeholders benefit from appropriate and reliable access to biological therapies. Failure to care for biosimilar market sustainability may impoverish biosimilar development and offerings, eventually leading to increased cost for health care systems and patients, with fewer resources for innovation.

scholarly journals The impact of chronic disease and disability on the elderly

1999 ◽  
Vol 55 (3) ◽  
pp. 9-14
Author(s):  
C. J. Eales
Keyword(s):  
Health Care ◽  
Chronic Disease ◽  
Chronic Diseases ◽  
Health Care Systems ◽  
The Elderly ◽  
Therapeutic Interventions ◽  
Elderly Persons ◽  
Care Systems ◽  
And Function ◽  
The Impact

Health care systems for elderly people should aim to delay the onset of illness, reducing the final period of infirmity and illness to the shortest possible time. The most effective way to achieve this is by health education and preventative medicine to maintain mobility and function. Changes in life style even in late life may result in improved health, effectively decreasing the incidence of chronic diseases associated with advancing age. This paper presents the problems experienced by elderly persons with chronic diseases and disabilities with indications for meaningful therapeutic interventions.

‘Untying the Knot’: Achieving Integrative and Collaborative Care within Trauma and Fear Saturated Systems – A Practice-Focused Discussion Paper

2017 ◽  
Vol 42 (2) ◽  
pp. 104-107 ◽  
Author(s):  
Dilip Balu
Keyword(s):  
Child Protection ◽  
Health Care Systems ◽  
Traumatic Experience ◽  
Ripple Effect ◽  
Discussion Paper ◽  
Care Systems ◽  
Trauma Informed ◽  
The Impact ◽  
The Brain ◽  
Mental Health Care Systems

The author's clinical experience with the Child Protection and Mental Health Care systems informs this brief practice-focused paper. The author posits that Secondary Traumatic Stress and Vicarious Trauma are central to understanding the impact of relationally traumatic material and the experience of individuals, families, team and the wider ecology of care systems. In particular, the author hypothesises that the tendency of systems to become fragmented in operation, with silos of sub-parts working parallel to each other, may be a natural adaptation to the ways in which traumatic experience ripples across system boundaries. This ‘ripple effect’ may lead to increasing emotional and relational reactivity, and survival-oriented inward focus of energies and efforts. The metaphor of the brain and nervous system is used to explore ideas of connection and integration in care systems. Trauma-informed leadership by individuals and teams is also touched upon in relation to reducing fear-driven clinical practice.

scholarly journals The impact of the recession on health care expenditure — How does the Czech Republic, Hungary, Poland and Slovakia compare to other OECD countries?

2015 ◽  
Vol 37 (1) ◽  
pp. 73-88
Author(s):  
Petra Baji ◽  
Márta Péntek ◽  
Imre Boncz ◽  
Valentin Brodszky ◽  
Olga Loblova ◽  
...  
Keyword(s):  
Health Care ◽  
Czech Republic ◽  
Economic Crisis ◽  
Growth Rates ◽  
Health Care Systems ◽  
Oecd Countries ◽  
The Czech Republic ◽  
Relative Growth ◽  
Care Systems ◽  
The Impact

In the past few years, several papers have been published in the international literature on the impact of the economic crisis on health and health care. However, there is limited knowledge on this topic regarding the Central and Eastern European (CEE) countries. The main aims of this study are to examine the effect of the financial crisis on health care spending in four CEE countries (the Czech Republic, Hungary, Poland and Slovakia) in comparison with the OECD countries. In this paper we also revised the literature for economic crisis related impact on health and health care system in these countries. OECD data released in 2012 were used to examine the differences in growth rates before and after the financial crisis. We examined the ratio of the average yearly growth rates of health expenditure expressed in USD (PPP) between 2008–2010 and 2000–2008. The classification of the OECD countries regarding “development” and “relative growth” resulted in four clusters. A large diversity of “relative growth” was observed across the countries in austerity conditions, however the changes significantly correlate with the average drop of GDP from 2008 to 2010. To conclude, it is difficult to capture visible evidence regarding the impact of the recession on the health and health care systems in the CEE countries due to the absence of the necessary data. For the same reason, governments in this region might have a limited capability to minimize the possible negative effects of the recession on health and health care systems.

scholarly journals The Super-Wicked Problem of Antimicrobial Resistance

2020 ◽  
pp. 421-443
Author(s):  
Jasper Littmann ◽  
A. M. Viens ◽  
Diego S. Silva
Keyword(s):  
Antimicrobial Resistance ◽  
Global Economy ◽  
Bacterial Infections ◽  
Health Care Systems ◽  
Modern Medicine ◽  
Social Consequences ◽  
Wicked Problem ◽  
Lost Productivity ◽  
Care Systems ◽  
To Come

Abstract Antimicrobial resistance (AMR) – the progressive process by which microbes, such as bacteria, through evolutionary, environmental and social factors develop the ability to become resistant to drugs that were once effective at treating them – is a threat from which no one can escape. It is one of the largest threats to clinical and global health in the twenty-first century – inflicting monumental health, economic and social consequences. All persons locally and globally, and even all future persons yet to come into existence, all suffer the shared, interdependent vulnerability to this threat that will have a substantial impact on all aspects of our lives. For example, while reliable data are hard to find, the European Centre for Disease Prevention and Control (ECDC) has conservatively estimated that, in Europe alone, AMR causes additional annual cost to health care systems of at least €1.5 billion, and is responsible for around 25,000 deaths per year. Furthermore, AMR significantly increases the cost of treating bacterial infections with an increase in length of hospital stays and average number of re-consultations, as well as the resultant lost productivity from increased morbidity. With a combined cost of up to $100 trillion to the global economy – pushing a further 28 million people into extreme poverty – this is one of the most pressing challenges facing the world. Most troublingly, if we do not succeed in diminishing the progression of AMR, there is the very real potential for it to threaten common procedures and treatments of modern medicine, including the safety and efficacy of surgical procedures and immunosuppressing chemotherapy. Some experts are warning that we may soon be ushering in a post-antibiotic area.

Feminine? Masculine? Androgynous leadership as a necessity in COVID-19

2020 ◽  
Vol 35 (7/8) ◽  
pp. 607-617
Author(s):  
Stacy Blake-Beard ◽  
Mary Shapiro ◽  
Cynthia Ingols
Keyword(s):  
Leadership Style ◽  
Health Care Systems ◽  
Leadership Skills ◽  
Leadership Traits ◽  
Political Leaders ◽  
Content Type ◽  
Care Systems ◽  
The Impact ◽  
The Relationship ◽  
Practical Implications

Purpose The purpose of this paper is to explore the relationship between leaders’ expressed traits and their impact on their country’s COVID-19 outcomes. Some leaders are over relying on masculine traits and dismissing feminine traits. An alternative – androgynous leadership – supports leaders in drawing from the full portfolio of behaviors. Design/methodology/approach This paper has a theoretical approach using an extensive review of the literature. Findings Leaders can take a number of actions to fully embrace androgynous leadership. These actions include building a diverse “tempered” team, communicating with respect, recognizing the impact of framing and moving from autopilot to realizing their best androgynous self. Research limitations/implications Research limitations include a critique of Bem’s framework as outdated and dichotomous; a categorization of feminine, masculine and neutral behaviors that is determined by the authors; and a focus on leadership style that does not take other dimensions, such as health-care systems, into account. Practical implications The authors propose that an “androgynous” leadership style has been used effectively by some political leaders around the globe in the COVID-19 crisis. The COVID-19 context has provided a laboratory for developing and building competence as androgynous leaders. Social implications The mental capacity to look at a situation, pause and explicitly select effective behavior is necessary, but oftentimes, it is not put into practice. By not drawing from a larger portfolio of androgynous behaviors, the opportunity for leaders to their best work is missed. Originality/value There is an acknowledgement of the benefits of the combination of masculine and feminine leadership traits. There are also clear recommendations supporting leaders in developing their androgynous leadership skills.

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