Cost of diseases in Brazil: breast cancer, enteritis, cardiac valve disease and bronchopneumonia

The results from the need to develop methodologies for performing cost analysis in developing countries, principally in the region of Latin America, were studied. It, furthermore, serves to generate knowledge from an economic evaluation in order to support decision-making related to the organization of health systems, particularly in the efficient use of resources which are allocated for the provision of medical services. Two chronic diseases (breast cancer and cardiac valve disease) and two infections (enteritis and bronchopneumonia) were selected for the study. The results recommend the use of a valid methodology for economic cost analysis of any disease to be studied and the use of this information in the decision-making process.

CITRICULTURE ECONOMIC AND FINANCIAL EVALUATION UNDER CONDITIONS OF UNCERTAINTY

ABSTRACT The citriculture consists in several environmental risks, as weather changes and pests, and also consists in considerable financial risk, mainly due to the period ofreturn on the initial investment. This study was motivated by the need to assess the risks of a business activity such as citriculture. Our objective was to build a stochastic simulation model to achieve the economic and financial analysis of an orange producer in the Midwest region of the state of Sao Paulo, under conditions of uncertainty. The parameters used were the Net Present Value (NPV), the Modified Internal Rate of Return(MIRR), and the Discounted Payback. To evaluate the risk conditions we built a probabilistic model of pseudorandom numbers generated with Monte Carlo method. The results showed that the activity analyzed provides a risk of 42.8% to reach a NPV negative; however, the yield assessed by MIRR was 7.7%, higher than the yield from the reapplication of the positive cash flows. The financial investment pays itself after the fourteenth year of activity.

On the economic analysis of response to preventive measures

There are many circumstances in which the effectiveness of preventive measures depends to a large extent on the compliance of the patient in changing his or her behavior or lifestyle. It is shown how economic techniques can be used (i) to describe the rationale of individuals and predict their behavior (Section 2); and (ii) to assess preventive measures that, by requiring a change of conduct, imply "costs" to the individual due to a decline in the quality of life (Appendix). Cigarette smoking and coronary heart disease are used as an illustration. While the analysis of Section 2 uses graphical techniques, a simple textbook-type of lifetime utility model with a mathematical emphasis is used in the Appendix. It is also shown that techniques often used to assess health care programs such as the QALYs (Quality-Adjusted Life Years) are inappropriate to the evaluation of preventive programs aiming at behavioral changes. Finally, topics that call for further research are indicated.

BASS 4: a software system for ergonomic design and evaluation of working hours

OBJECTIVE: To extend an existing computer programme for the evaluation and design of shift schedules (BASS 3) by integrating workload as well as economic aspects. METHODS: The redesigned prototype BASS 4 includes a new module with a suitable and easily applicable screening method (EBA) for the assessment of the intensity of physical, emotional and cognitive workload components and their temporal patterns. Specified criterion functions based on these ratings allow for an adjustment of shift and rest duration according to the intensity of physical and mental workload. Furthermore, with regard to interactive effects both workload and temporal conditions, e.g. time of day, are taken into account. In a second new module, important economic aspects and criteria have been implemented. Different ergonomic solutions for scheduling problems can now also be evaluated with regard to their economic costs. RESULTS: The new version of the computer programme (BASS 4) can now simultaneously take into account numerous ergonomic, legal, agreed and economic criteria for the design and evaluation of working hours. CONCLUSIONS: BASS 4 can now be used as an instrument for the design and the evaluation of working hours with regard to legal, ergonomic and economic aspects at the shop floor as well as in administrative (e.g. health and safety inspection) and research problems.

Economic analysis of surgical treatment of hip fracture in older adults

OBJECTIVE To analyze the incremental cost-utility ratio for the surgical treatment of hip fracture in older patients.METHODS This was a retrospective cohort study of a systematic sample of patients who underwent surgery for hip fracture at a central hospital of a macro-region in the state of Minas Gerais, Southeastern Brazil between January 1, 2009 and December 31, 2011. A decision tree creation was analyzed considering the direct medical costs. The study followed the healthcare provider’s perspective and had a one-year time horizon. Effectiveness was measured by the time elapsed between trauma and surgery after dividing the patients into early and late surgery groups. The utility was obtained in a cross-sectional and indirect manner using the EuroQOL 5 Dimensions generic questionnaire transformed into cardinal numbers using the national regulations established by the Center for the Development and Regional Planning of the State of Minas Gerais. The sample included 110 patients, 27 of whom were allocated in the early surgery group and 83 in the late surgery group. The groups were stratified by age, gender, type of fracture, type of surgery, and anesthetic risk.RESULTS The direct medical cost presented a statistically significant increase among patients in the late surgery group (p < 0.005), mainly because of ward costs (p < 0.001). In-hospital mortality was higher in the late surgery group (7.4% versus 16.9%). The decision tree demonstrated the dominance of the early surgery strategy over the late surgery strategy: R$9,854.34 (USD4,387.17) versus R$26,754.56 (USD11,911.03) per quality-adjusted life year. The sensitivity test with extreme values proved the robustness of the results.CONCLUSIONS After controlling for confounding variables, the strategy of early surgery for hip fracture in the older adults was proven to be dominant, because it presented a lower cost and better results than late surgery.

Evaluation of statistical and geostatistical models of digital soil properties mapping in tropical mountain regions

Soil properties have an enormous impact on economic and environmental aspects of agricultural production. Quantitative relationships between soil properties and the factors that influence their variability are the basis of digital soil mapping. The predictive models of soil properties evaluated in this work are statistical (multiple linear regression-MLR) and geostatistical (ordinary kriging and co-kriging). The study was conducted in the municipality of Bom Jardim, RJ, using a soil database with 208 sampling points. Predictive models were evaluated for sand, silt and clay fractions, pH in water and organic carbon at six depths according to the specifications of the consortium of digital soil mapping at the global level (GlobalSoilMap). Continuous covariates and categorical predictors were used and their contributions to the model assessed. Only the environmental covariates elevation, aspect, stream power index (SPI), soil wetness index (SWI), normalized difference vegetation index (NDVI), and b3/b2 band ratio were significantly correlated with soil properties. The predictive models had a mean coefficient of determination of 0.21. Best results were obtained with the geostatistical predictive models, where the highest coefficient of determination 0.43 was associated with sand properties between 60 to 100 cm deep. The use of a sparse data set of soil properties for digital mapping can explain only part of the spatial variation of these properties. The results may be related to the sampling density and the quantity and quality of the environmental covariates and predictive models used.

Economic analysis of an agrosilvipastoral system for a mountainous area in Zona da Mata Mineira, Brazil

The objective of this work was to evaluate the economic viability of an agrosilvipastoral system developed for Zona da Mata mountainous areas in Minas Gerais state, Brazil, as well as to compare different options for wood (Eucalyptus grandis and Acacia mangium) commercialization of the second thinning. The data were obtained from a 10 year-old agrosilvipastoral system established in four hectares at Embrapa Gado de Leite station in Coronel Pacheco, MG, Brazil. As evaluation criteria for the economic viability analysis, the adopted methods were the net present value (NPV) and the internal rate of return (IRR), both calculated at 6% interest rate. Despite the small difference, adding value to forest products increased the attractiveness of the proposed system. Considered separately, the agricultural activity was impracticable, whereas the forestry and livestock activities were independently viable. The studied system seems to be equally tolerant to price variations for forest and livestock products, as well as strongly tolerant to variations in production costs.

Evaluation of Xylella fastidiosa genetic diversity by fAFPL markers

The first phytopathogenic bacterium with its DNA entirely sequenced is being detected and isolated from different host plants in several geographic regions. Although it causes diseases in cultures of economic importance, such as citrus, coffee, and grapevine little is known about the genetic relationships among different strains. Actually, all strains are grouped as a single species, Xylella fastidiosa, despite colonizing different hosts, developing symptoms, and different physiological and microbiological observed conditions. The existence of genetic diversity among X. fastidiosa strains was detected by different methodological techniques, since cultural to molecular methods. However, little is know about the phylogenetic relationships developed by Brazilian strains obtained from coffee and citrus plants. In order to evaluate it, fAFLP markers were used to verify genetic diversity and phylogenetic relationships developed by Brazilian and strange strains. fAFLP is an efficient technique, with high reproducibility that is currently used for bacterial typing and classification. The obtained results showed that Brazilian strains present genetic diversity and that the strains from this study were grouped distinctly according host and geographical origin like citrus-coffee, temecula-grapevine-mulberry and plum-elm.

EVALUATION OF TECHNOLOGICAL INTENSITY OF EXPORTS IN THE FORESTRY SECTOR

ABSTRACT One of the fastest growing sectors in the domestic industry is the forestry, which has contributed significantly to economic development, job creation, income taxes, putting Brazil in a prominent position in the world market. This paper analyzes the evolution of the technological intensity of 12 main products exported by the sector, from 2000 to 2011. For that, utilizes an indicator called PRODY, which allows classifying different products according to their technological intensity or income content and considers the GDP per capita of exporting countries of each product, weighted by its revealed comparative advantage. It can be seen by the results, a continuous growth in all products' technology indicators and their decomposition into income effects, comparative advantage and joint effects, allowed to verify the main causes of this growth. Products with lower PRODY values are those that presented a higher evolution during the period studied. Products of higher processing, and those from pulp and paper industry, had greater technological advances, thanks to a joint effect, while the ones of lower processing, had a technological improvement due to the increase in GDP per capita in exporting countries. Sawn wood was the standout product, being the only one who proved to be dependent of comparative advantage effect, confirming that this industry has been reinventing itself and incorporating, in fact, more technology. This study revealed the importance of technological intensification to generate comparative advantage and be able to stand against international competition.

Evaluation of an indicator for water yield in a watershed of Alto Rio Grande Region, State of Minas Gerais , Brazil

The Brazilian Law stipulates that water is a limited natural resource doted of economic value, thus it is necessary to develop mechanisms for its adequate management. Actions that encourage the farmers to apply soil conservation practices with the purpose of increase water yield from springs and to promote improvement of its quality, reducing production of sediment transportation, is being encouraged by governments, even with financial compensation for owners. From these assertions, this study aims to quantify the benefits of the conservation actions of the management units and to characterize a Water Yield Indicator (WYI) to support sustainable actions in the watershed of Alto Rio Grande region, in the state of Minas Gerais (MG). To assess the impact of actions it were identified four scenarios of land use and occupation of the watershed from Marcela stream which is located in Alto Rio Grande Region. After analyzing the results, it can be stated that the scenarios simulation has demonstrated important changes in water yield and that the definition of the Water Yield Index from the junction of the erosion potential with the water storage potential, has proved effective, as it integrate quantity and quality of water.

Evaluation of the heating of broilers in shed by means of gas hoods and underfloor heating

This study was conducted to evaluate and compare the behavior of the heating inside poultry shed through gas hood and underfloor heating. The experiment was conducted in poultry shed belonging to the Federal Institute of Education, Science and Technology of Triângulo Mineiro Region, Uberlândia city – state of Minas Gerais (MG), Brazil. The dimensions of the shed are 24 meters long and 9.6 meters wide and with a ceiling height of 3.2 meters. The temperature was measured with an optical thermometer of Minipa brand, MT 350 model. It was used, to the analysis of temperature behavior, the public domain software FEMM 4.2, which uses finite elements techniques, with data collected from two lots. Underfloor heating is made using hot water flowing through a serpentine type system, which is installed below the bed; this hot water is from solar heaters. An energetic and economic assessment of the warming shed for raising chickens was realized. From the results obtained with the simulations, it may observe that the heating through the floor provides a more homogeneous distribution of temperature when compared with the hood heating. The flow of heat is upwards supplying, thus, the greatest need of heating of the bird, which is the pectoral part.

Development and evaluation of a recombinant DNA vaccine candidate expressing porcine circovirus 2 structural protein

Porcine circovirus 2 (PCV2) is generally associated with the porcine circovirosis syndrome, which is considered an important disease of swine and has potentially serious economic impact on the swine industry worldwide. This article describes the construction of a recombinant plasmid expressing the PCV2 structural protein and the evaluation of cellular and humoral immune responses produced by this recombinant vaccine in BALB/c mice. The vaccine candidate was obtained and analyzed in vivo, in an effort to determine the ability to induce a specific immune response in mice. DNA was extracted from a Brazilian PCV2 isolate and the gene coding for Cap protein was amplified by PCR and inserted into an expression plasmid. Groups of BALB/c mice were inoculated intra-muscularly and intradermally in a 15-day interval, with 100 µg and 50 µg of the vaccine construct, respectively. Another group was inoculated intramuscularly with 100 µg of empty plasmid, corresponding to the control group. Seroconversion and cellular response in BALB/c mice were compared and used for vaccine evaluation. Seroconversion was analyzed by ELISA. After a series of 3 immunizations the spleen cells of the immunized animals were used to perform lymphocyte proliferation assays. Seroconversion to PCV2 was detected by ELISA in the animals inoculated with the vaccine construct when compared with control groups. Lymphocyte proliferation assays showed a stronger cell proliferation in the inoculated animals compared with the control group. Thus, the vaccine candidate construct demonstrated to be able to induce both humoral and cellular responses in inoculated mice.

Molecular characterization and evaluation of antimicrobial susceptibility of enteropathogenic E. coli (EPEC) isolated from minas soft cheese

Foodborne disease caused by microorganisms is a problem of public health. Minas soft cheese is a national product manufactured using simple technology; it has high level of acceptance in the country making its production an important economic activity. Many microorganisms may be present in foods including the bacterium Escherichia coli (E. coli). Overall, E. coli is a harmless commensal bacterium; however, some strains may have a pathogenic potential. Several outbreaks of foodborne diseases associated with consumption of contaminated cheese have been reported, and the presence of pathogenic strains of E. coli has increased. The objective of this study was to isolate, evaluate the antimicrobial susceptibility, and characterize, by Multiplex PCR, the pathogenic E. coli strains isolated from Minas cheese commercialized in Rio de Janeiro. Thirty samples were analyzed and five strains of E. coli (EPEC) were identified. The assessment of antimicrobial susceptibility revealed 40% of the isolates resistant to ampicillin and 40% with intermediate resistance to ampicillin-sulbactam combination. These findings are a warning signal to health authorities since Minas cheese is a ready to eat food product, and therefore should not pose health risks to the population.