Acute Coronary Syndrome Treatment Costs from the Perspective of the Supplementary Health System

AbstractBackground:Acute coronary syndrome (ACS) is defined as a “group of clinical symptoms compatible with acute myocardial ischemia”, representing the leading cause of death worldwide, with a high clinical and financial impact. In this sense, the development of economic studies assessing the costs related to the treatment of ACS should be considered.Objective:To evaluate costs and length of hospital stay between groups of patients treated for ACS undergoing angioplasty with or without stent implantation (stent+ / stent-), coronary artery bypass surgery (CABG) and treated only clinically (Clinical) from the perspective of the Brazilian Supplementary Health System (SHS).Methods:A retrospective analysis of medical claims of beneficiaries of health plans was performed considering hospitalization costs and length of hospital stay for management of patients undergoing different types of treatment for ACS, between Jan/2010 and Jun/2012.Results:The average costs per patient were R$ 18,261.77, R$ 30,611.07, R$ 37,454.94 and R$ 40,883.37 in the following groups: Clinical, stent-, stent+ and CABG, respectively. The average costs per day of hospitalization were R$ 1,987.03, R$ 4,024.72, R$ 6,033.40 and R$ 2,663.82, respectively. The average results for length of stay were 9.19 days, 7.61 days, 6.19 days and 15.20 days in these same groups. The differences were significant between all groups except Clinical and stent- and between stent + and CABG groups for cost analysis.Conclusion:Hospitalization costs of SCA are high in the Brazilian SHS, being significantly higher when interventional procedures are required.

Reproducibility and Reliability of the Quality of Life Questionnaire in Patients With Atrial Fibrillation

Abstract Background: Studies have shown the impact of atrial fibrillation (AF) on the patients' quality of life. Specific questionnaires enable the evaluation of relevant events. We previously developed a questionnaire to assess the quality of life of patients with AF (AFQLQ version 1), which was reviewed in this study, and new domains were added. Objective: To demonstrate the reproducibility of the AFQLQ version 2 (AFQLQ v.2), which included the domains of fatigue, illness perception and well-being. Methods: We applied 160 questionnaires (AFQLQ v.2 and SF-36) to 40 patients, at baseline and 15 days after, to measure inter- and intraobserver reproducibility. The analysis of quality of life stability was determined by test-retest, applying the Bartko intraclass correlation coefficient (ICC). Internal consistency was assessed by Cronbach's alpha test. Results: The total score of the test-retest (n = 40) had an ICC of 0.98 in the AFQLQ v.2, and of 0.94 in the SF36. In assessing the intra- and interobserver reproducibility of the AFQLQ v.2, the ICC reliability was 0.98 and 0.97, respectively. The internal consistency had a Cronbach's alpha coefficient of 0.82, compatible with good agreement of the AFQLQ v.2. Conclusion: The AFQLQ v.2 performed better than its previous version. Similarly, the domains added contributed to make it more comprehensive and robust to assess the quality of life of patients with AF.

Protective Effect of Aortic Stenosis on the Coronary Arteries. Hypothetic Considerations to an Old Enigma

Abstract A literature overview of angiographic studies has shown that the prevalence of significant coronary disease in patients with aortic stenosis (AS) varies from 20 to 60%. Early necropsy studies suggested that patients with AS had a lower than expected incidence of coronary artery disease (CAD), originating the concept of a protective effect of AS on the coronary arteries. The myth of AS protection against CAD would be better explained as endothelium-myocardial interaction (crosstalk) protection triggered by left ventricular overload. Therefore, the cGMP/NO pathway induced by the AS overload pressure would explain the low incidence of CAD, which is compatible with the amazing natural long-term evolution of this cardiac valve disease.

Macroecologia de carnívoros do Novo Mundo (Mammalia): envelopes de restrição e análise de padrões filogenéticos

The relationship between body size and geographic range was analyzed for 70 species of terrestrial Carnivora ("fissipeds") of the New World, after the control of phylogenetic patterns in the data using phylogenetic eigenvector regression. The analysis from EcoSim software showed that the variables are related as a triangular envelope. Phylogenetic patterns in data were detected by means of phylogenetic correlograms, and 200 simulations of the phenotypic evolution were also performed over the phylogeny. For body size, the simulations suggested a non-linear relationship for the evolution of this character along the phylogeny. For geographic range size, the correlogram showed no phylogenetic patterns. A phylogenetic eigenvector regression was performed on original data and on data simulated under Ornstein-Uhlenbeck process. Since both characters did not evolve under a simple Brownian motion process, the Type I errors should be around 10%, compatible with other methods to analyze correlated evolution. The significant correlation of the original data (r = 0.38; P < 0.05), as well as the triangular envelope, then indicate ecological and adaptive processes connecting the two variables, such as those proposed in minimum viable population models.

Helminths of introduced house sparrows (Passer domesticus) in Brazil: does population age affect parasite richness?

Species introductions have altered host and parasite diversity throughout the world. In the case of introduced hosts, population age appears to be a good predictor of parasite richness. Habitat alteration is another variable that may impact host-parasite interactions by affecting the availability of intermediate hosts. The house sparrow (Passer domesticus (Linnaeus, 1758)) is a good model to test these predictions. It was introduced in several parts of the world and can be found across rural-urban gradients. A total of 160 house sparrows from Porto Alegre, state of Rio Grande do Sul, Brazil, were necropsied. Thirty house sparrows (19 %) were parasitized with at least one out of five helminth species (Digenea: Tamerlania inopina Freitas, 1951 and Eumegacetes sp.; Eucestoda: Choanotaenia passerina (Fuhrmann, 1907) Fuhrmann, 1932; Nematoda: Dispharynx nasuta (Rudolphi, 1819) Stiles & Hassall, 1920 and Cardiofilaria pavlovskyi Strom, 1937). Overall, there was no difference in prevalence and intensity of infection of any parasite species, parasite richness and community diversity between adult males and females and adults and juveniles. The number of infected sparrows among seasons, the richness of helminths and the abundance of species were also similar between rural and urban landscapes. Only the prevalence of C. passerina varied seasonally (p=0.0007). A decrease in the number of parasite species from the original range of P. domesticus (13) to its port of entrance in Brazil, the city of Rio de Janeiro (nine), to Porto Alegre (five) is compatible with the hypothesis that host population age is a good predictor of parasite richness.

Cytogenetic study in natural hybrids of Callithrix (Callitrichidae: Primates) in the Atlantic forest of the state of Rio de Janeiro, Brazil

In the Atlantic forest of Rio de Janeiro, Callithrix aurita (É. Geoffroy in Humboldt, 1812) is a native species vulnerable to extinction and C. jacchus (Linnaeus, 1758) and C. penicillata (É. Geoffroy, 1812) are invasive species. The major threats to the native species are habitat degradation and hybridization, although there are currently no genetic data about natural hybrids available. Previous studies have revealed that species of the Callithrix genus are extremely homogeneous in their karyotypes with the exceptions of the morphology and size of the Y chromosome and its nucleolar organizer region (NOR) banding pattern. Three male marmosets captured in the wild in Guapimirim municipality, Rio de Janeiro, Brazil, considered as possible hybrids between C. aurita and C. jacchus or C. penicillata on the basis of pelage pattern, were cytogenetically studied. Metaphase chromosomes were obtained by using short-term lymphocyte cultures and Ag-NOR staining was performed. The hybrids karyotypes were 2n=46, 14 uni- and 30 bi-armed autosomes, a median size submetacentric X and NOR bearing autosomes, being compatible with that observed for the genus. In the three individuals studied, Y chromosomes were similar to those found for C. aurita, without NORs. The data obtained suggest the involvement of C. aurita in natural hybridization with one of the invasive species. We discuss the possible consequences of this hybridization.

Sequencing lifeline repairs after an earthquake: an economic approach

Recoveries after recent earthquakes in the U.S. and Japan have shown that large welfare gains can be achieved by reshaping current emergency plans as incentive-compatible contracts. We apply tools from the mechanisms design literature to show ways to integrate economic incentives into the management of natural disasters and discuss issues related to the application to seismic event recovery. The focus is on restoring lifeline services such as the water, gas, transportation, and electric power networks. We put forward decisional procedures that an uninformed planner could employ to set repair priorities and help to coordinate lifeline firms in the post-earthquake reconstruction.

Rational sabotage in cooperative production

In this paper we consider a model of cooperative production in which rational agents have the possibility to engage in sabotage activities that decrease output. It is shown that sabotage depends on the interplay between the degree of congestion, the technology of sabotage, the number of agents the degree of meritocracy and the form of the sharing rule. In particular it is shown that, ceteries paribus, meritocratic systems give more incentives to sabotage than egalitarian systems. We address two questions: The degree of meritocracy that is compatible with absence of sabotage and the existence of a Nash equilibrium with and without sabotage.

Stable condorcet rules

We consider the following allocation problem: A fixed number of public facilities must be located on a line. Society is composed of $N$ agents, who must be allocated to one and only one of these facilities. Agents have single peaked preferences over the possible location of the facilities they are assigned to, and do not care about the location of the rest of facilities. There is no congestion. In this context, we observe that if a public decision is a Condorcet winner, then it satisfies nice properties of internal and external stability. Though in many contexts and for some preference profiles there may be no Condorcet winners, we study the extent to which stability can be made compatible with the requirement of choosing Condorcet winners whenever they exist.

Economic growth and atmospheric pollution in Spain: discussing the environmental Kuznets curve by hypothesis

The environmental Kuznets curve (EKC) hypothesis posits an inverted U relationship between environmental pressure and per capita income. Recent research has examined this hypothesis for different pollutants in different countries. Despite certain empirical evidence shows that some environmental pressures have diminished in developed countries, the hypothesis could not be generalized to the global relationship between economy and environment at all. In this article we contribute to this debate analyzing the trends of annual emission flux of six atmospheric pollutants in Spain. The study presents evidence that there is not any correlation between higher income level and smaller emissions, except for SO2 whose evolution might be compatible with the EKC hypothesis. The authors argue that the relationship between income level and diverse types of emissions depends on many factors. Thus it cannot be thought that economic growth, by itself, will solve environmental problems.

L' Ensenyament per tasques: programació d'una assignatura de traducció de l'alemany a l'espanyol

In this work we present a proposal for a course in translation from German into Spanish following the task based approach as known in second language acquisition. The aim is to improve the translation competence of translation students. We depart from the hypothesis that some students select inapropiate translation strategies when faced with certain translation problems leading them to translation errors. In order to avoid these translation errors originated by wrong application of such strategies we propose a didactic method which helps to prevent them by a) raising awareness of the different subcompetences required while translating, b) improving the ability to identify translation problems and relate them to the different subcompetences and c) enhancing the use of the most adequate strategy according to the characteristics of each problem. With regard to translation and how translation competence is acquired our work follows the communicative approach to translation theory as defended among others by Hatim & Mason (1990), Lörscher (1992) and Kiraly (1995), where translation is seen as a communicative activity which can be analized from a psycholinguistic perspective. In this sense we give operative definitions for what we understand by “translation problem”, “translation strategy”, “translation error”, “translation competence” and “translation”. Our approach to didactics adapts recent developments in Second Language Teaching within the communicative paradigm as is the task based approach by Nunan (1989) acquisition to translation. Fitting the recquirements of this pedagogic approach we present a planning for a translation course which is compatible with present translation studies.

Outbreak of human toxoplasmosis in a rural area. A three year serologic follow-up study

Thirty-six persons living on a farm located in the state of Minas Gerais (Brazil) were studied. Nine of them had the glandular form of toxoplasmosis, between May and August, 1976. These nine cases of toxoplasmosis were confirmed serologically by immunefluorescence-IF-, presenting IgG antibody titres between 1:4096 and 1:32000 and IgM antibody titres between 1:16 and 1:8000. Twelve out of thirty-six persons studied were considered to be "dubious cases". They were defined either by presenting a clinical picture compatible with acquired toxoplasmosis, yet having low serologic titres, or inversely they did not have a clear clinical picture but had serologic evidence of recent Toxoplasma infection. Fifteen out of thirty-six persons studied showed neither serologic nor clinical evidence of recent Toxoplasma infection. The epidemiologic information suggests two possible modes of transmission: a) poorly cooked pork at a barbecue party; b) farm vegetables and soil contaminated with Toxoplasma gondii oocysts (rat-cat cycle). Serologic follow-up nine months later in the human farm population demonstrated still high IgG titres, yet they tended to decline and IgM titres became negative. Three years later most of the IgG titres continued to decline and were almost compatible with the titres obtained in Brazilian population surveys.

Further experiments on susceptibility of Biomphalaria amazonica to Schistosoma mansoni

A sample of Biomphalaria amazonica from Porto Velho, Rondônia state, was exposed to miracidia of Schistosoma mansoni (SJ2 strain) from São José dos Campos, São Paulo state (five miracidia per snail). Water freshly taken from the snails' breeding place was used to make sure that its quality was compatible with hatching of miracidia and their penetration into the snails. The resulting infection rate was 3.5%, as against 45% in B. tenagophila controls. In comparison with the controls, B. amazonica, besides a lower infection rate, showed a longer prepatent period and a lower cercarial production. These characteristics seem to indicate that it is a poor host of S. mansoni, like B. straminea, but it should be considered that, this notwithstanding, the latter is admittedly a good vector of the parasite in hyperendemic areas of northeastern Brazil. These results point to the possibility of introduction of schistosomiasis mansoni into the western Amazonian region, where B. amazonica is widespread.

Incentives for interdisciplinary research

This paper is a positive analysis of the driving forces in interdisciplinary research. I take the perspective of a research institution that has to decide how to apply its resources among the production of two types of knowledge: specialized or interdisciplinary. Using a prize mechanism of compensation, I show that the choice of interdisciplinarity is compatible with profit maximization when the requirement for the production is sufficiently demanding, and when the new interdisciplinary field is not too neutral. Productive gains due to complementarities of efforts is the main advantage of interdisciplinary organization.

Análisis y diseño de filtros apilados basados en resonadores acústicos

Durant els últims anys la demanda de filtres pas banda de ràdio freqüència, de reduïdes dimensions, lleugers i d'elevades prestacions destinats a sistemes de comunicacions inalàmbriques s'ha incrementat de forma significativa. Aquests sistemes principalment són els sistemes de telefonia mòbil de tercera generació UMTS y el sistema de navegació GPS. Els filtres actuals, basats en ressonadors SAW (Surface Acoustic Wave), tenen unes dimensions reduïdes però estan limitats en freqüència (3 GHz) i la seva tecnologia no és compatible amb les tecnologies estàndards de circuits integrats. Per aquestes raons s'espera que els filtres basats en ressonadors BAW (Bulk Acoustic Wave) substitueixin als SAW. Els dos tenen dimensions similars, però els filtres BAW poden funcionar a freqüències superiors a 3 GHz, poden treballar amb nivells de potència majors, i és important destacar el fet que la seva tecnologia és compatible amb les tecnologies estàndards de circuits integrats. La investigació en l'àmbit dels filtres BAW s'ha centrat en millorar els processos tecnològics i la qualitat dels materials, però s'ha treballat poc en l'adaptació de les tècniques sistemàtiques de disseny de filtres a les particularitats d'aquesta tecnologia, per tant el principal objectiu d'aquest treball és presentar mètodes sistemàtics per al disseny de filtres BAW, centrant-se en l'estudi d’estructures apilades.