Cost-benefit of hospitalization compared with outpatient care for pregnant women with pregestational and gestational diabetes or with mild hyperglycemia, in Brazil

CONTEXTO E OBJETIVO: Gestações complicadas pelo diabetes estão associadas com aumento de complicações maternas e neonatais. Os custos hospitalares aumentam de acordo com a assistência prestada. O objetivo foi calcular o custo-benefício e a taxa de rentabilidade social da hospitalização comparada ao atendimento ambulatorial em gestantes com diabetes ou com hiperglicemia leve. DESENHO do ESTUDO: Estudo prospectivo, observacional, quantitativo, realizado em hospital universitário, sendo incluídas todas as gestantes com diabetes pregestacional e gestacional ou com hiperglicemia leve que não desenvolveram intercorrências clínicas na gestação e que tiveram parto no Hospital das Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (HC-FMB-Unesp). MÉTODOS: Trinta gestantes tratadas com dieta foram acompanhadas em ambulatório e 20 tratadas com dieta e insulina foram abordadas com hospitalizações curtas e frequentes. Foram obtidos custos diretos (pessoal, material e exames) e indiretos (despesas gerais) a partir de dados contidos no prontuário e no sistema de custo por absorção do hospital e posteriormente calculado o custo-benefício. RESULTADOS: O sucesso do tratamento das gestantes diabéticas evitou o gasto de US$ 1.517,97 e US$ 1.127,43 para pacientes hospitalizadas e ambulatoriais, respectivamente. O custo-benefício da atenção hospitalizada foi US$ 143.719,16 e ambulatorial, US$ 253.267,22, com rentabilidade social 1,87 e 5,35 respectivamente. CONCLUSÃO: A análise árvore de decisão confirma que o sucesso dos tratamentos elimina custos no hospital. A relação custo-benefício indicou que o tratamento ambulatorial é economicamente mais vantajoso do que a hospitalização. A rentabilidade social de ambos os tratamentos foi maior que 1, indicando que ambos os tipos de atendimento à gestante diabética têm benefício positivo.

Subclinical mastitis caused by staphylococcus aureus: Analysis cost benefit of antibiotic therapy in lactating cows

The cost benefit analysis of treatment of bovine subclinical mastitis caused by S. aureus was evaluated. Two hundred and seventy udder quarters with subclinical mastitis and healthy were selected in four groups, in conformity to lactational stage and with the treatment or not. Group 1 included treated animals 10 to 60 days in milk; group 2 included treated animals 61 days in milk until two months before the end of lactation; group 3 included animals not treated 10 to 60 days in milk; group 4 included animals not treated from 61 days in milk until two months before the end of lactation. Treatment with gentamicin (150 mg) was accomplished by intramammary doses, once a day, after sensitivity tests. The mammary quarters were evaluated after 30 days again. The costs with the treatment were calculated considering a S. aureus prevalence of 5%, expenses with antibiotic, loss in milk, tests of sensitivity and workload. There was loss of income of 2% and 14% in the groups 1 and 2, respectively, when compared with the incomes before treatment. In such case, the treatment of bovine subclinical mastitis by S. aureus in the lactation was economically not practicable.

Financing for sustainable development: visions and proposals for action from a Latin American and Caribbean perspective

Foreword Throughout the preparatory process for the World Summit on Sustainable Development and at the Summit itself, which was held in Johannesburg, South Africa, from 26 August to 4 September 2002, discussions were dominated by one central concern: the need to define and reach consensus on concrete, quantitative goals, with fixed deadlines for implementation, which were to supplement the Millennium Development Goals and facilitate progress towards an effective transition to sustainable development. Participants at the Summit explicitly affirmed the need, as a matter of urgency, to identify the financial and technical resources whereby sustainable development would become a reality and benefit directly and particularly rural and urban communities in the developing countries. The document we are now presenting is the outcome of extensive discussions held at a high-level forum during the Johannesburg Summit. Led by representatives of the Government of Mexico, the Economic Commission for Latin America and the Caribbean (ECLAC), the United Nations Development Programme (UNDP) and the Andean Development Corporation, those discussions were based on the ECLAC/UNDP study entitled Financing for sustainable development in Latin America and the Caribbean: from Monterrey to Johannesburg, which considers the opportunities and challenges for improving prospects for investment and financing for sustainable development and underscores the need to establish a new balance between the market economy and public interest through joint public/private initiatives that combine market innovation, social responsibility and appropriate regulations. Other eminent persons attending the event included heads of State, such as Gustavo Noboa, then President of Ecuador; Enrique V. Iglesias, President of the Inter-American Development Bank (IDB); José María Figueres, Managing Director of the Global Agenda of the World Economic Forum and former President of Costa Rica; and Gro Harlem Brundtland, the legendary figure who pioneered sustainable development. Valuable contributions to the discussions were made by Yolanda Kakabadse, President of the World Conservation Union; Xóchitl Gálvez Ruiz, head of the Unit for the Development of Indigenous Peoples of the Office of the President of Mexico; Cecilia López, former Minister for the Environment of Colombia; and Juan Carlos Maqueda, then Vice President of Argentina. The views emerging from the forum as set forth in this document are designed to facilitate and promote application of the Plan of Implementation of the World Summit on Sustainable Development within the framework of the Millennium Development Goals and the commitments assumed at the International Conference on Financing for Development, which was held in Monterrey, Mexico. We also aspire to continue moving forward with the adoption of measures and policies to increase investment and financing for sustainable development as well as to foster partnerships between the public and private sectors and nongovernmental organizations. We recognize, in this context, the importance of strengthening and improving public and private institutions in order to meet the operational needs associated with the effort to achieve the Millennium Development Goals and pursue the Plan of Implementation formulated in Johannesburg. We trust that this document will contribute to in-depth discussions on the application of the Plan of Implementation in the relevant forums, in particular the United Nations Commission on Sustainable Development. The Plan of Implementation of the World Summit on Sustainable Development opens up new opportunities for Latin America and the Caribbean to renew and revive their own regional agenda -with emphasis on global and especially regional public goods- and to interweave it more cohesively with the global agenda in order to promote the common interests of Latin America and the Caribbean more forcefully in international development forums. The regional agenda and the global agenda cannot be separated in a contrived manner; indeed, to an increasing degree, what we are witnessing are global environmental processes which call for action at the local level. The achievement of sustainable development in Latin America and the Caribbean, where the necessary economic, social, environmental and geopolitical conditions are combined, requires a subtle balance between the market economy, the State and the citizen. Such a balance will result in the consolidation of democratic governance in the service of human development. VICENTE FOX President of Mexico JOSÉ ANTONIO OCAMPO Executive Secretary, Economic Commission for Latin America and the Caribbean (ECLAC) ELENA MARTÍNEZ Assistant Aministrator and Regional Director for Latin America and the Caribbean of the United Nations Development Programme (UNDP) ENRIQUE GARCÍA Executive President, Andean Development Corporation (ADC)""

Macroeconomic stability and investment allocation of domestic pension funds in emerging economies: the case of Chile

Includes bibliography

Environmental protection measures, their evaluation (cost-benefit analysis) and their incorporation in development planning

Includes bibliography

Public policy for pensions, health and sickness insurance

Includes bibliography

Municipal solid waste management in the Caribbean: a benefit-cost analysis

Includes bibliography

Pension funds and the financing productive investment: an analysis based on Brazil's recent experience

Includes bibliography

Public policy for pensions, health and sickness insurance: potential lessons from Sweden for Latin America

Includes bibliography

The Latin American experience in pension system reform: coverage, fiscal issues and possible implications for China

Includes bibliography

Pension reform in Central and Eastern Europe: necessity, approaches and open questions

Includes bibliography

Sistemas de pensiones de América Latina, diagnóstico y alternativas de reforma. Estudios de caso de América Latina y el Caribe: conclusiones y recomendaciones, Santiago 3-5 diciembre 1990 y 22-23 agosto 1991 = Pension systems in Latin America: diagnosis and reform alternatives. Case studies in Latin America and the Caribbean: conclusions and recommendations, Santiago, 3-5 December 1990 and 22-23 August 1991

Documentos presentados a dos seminarios realizados en la Sede de CEPAL en Santiago entre el 3 y 5 de diciembre de 1990 y el 22 y 23 de agosto de 1991