Medicamentos de dispensação excepcional: histórico e gastos do Ministério da Saúde do Brasil

OBJECTIVE: To describe the technical aspects of the Exceptional Circumstance Drug Dispensing Program of the Brazilian Ministry of Health, especially with respect to the cost of dispensed medication. METHODS: Technical information was obtained from the ordinances that regulate the Program. Expenditure from 2000 to 2007 was obtained from the Sistema Único de Saúde's (Unified Healthcare System) Outpatient Information System. All drugs dispensed between 1993 and 2009 and the amount and cost of each procedure were evaluated, based on information from the high-complexity procedure authorization of each of the country's states. RESULTS: The Program changed with the increase in the number of pharmacological agents and presentations distributed by, and the number of diseases contemplated in the program. In 1993, the program distributed 15 pharmacological agents in 31 distinct presentations. This number increased to 109 agents in 243 presentations in 2009. Total Ministry of Health expenditure with medications was R$1,410,181,600.74 in 2007, almost twice the amount spent in 2000, R$684,975,404.43. Diseases whose expenditure increased in the period included chronic renal insufficiency, transplantation, and hepatitis C. CONCLUSIONS: The Exceptional Circumstance Drug Dispensing Program is in constant transformation, aimed at building instruments and strategies that can ensure and expand access to medication among the population. Alternatives should be sought to decrease the financial impact of the Program to a level that does not impact other sectors of the health care system, given the high cost associated with novel interventions.OBJETIVO: Describir aspectos técnicos del Programa de Medicamentos de Dispensación en Carácter Excepcional del Ministerio de Salud de Brasil, especialmente con relación a los gastos con los medicamentos distribuidos. MÉTODOS: Los aspectos técnicos fueron obtenidos por medio de consulta a todas los reglamentos que rigen el Programa. Gastos en el período de 2000 a 2007 fueron obtenidos del Sistema de Informaciones Ambulatorias del Sistema Único de Salud. Se analizaron los medicamentos dispensados de 1993 a 2009, cantidades y valor de cada procedimiento, informado en las autorizaciones de procedimientos de alta complejidad para cada estado. RESULTADOS: El Programa cambió, con aumento del número de fármacos y presentaciones farmacéuticas distribuidas y de enfermedades contempladas. Eran distribuidos 15 fármacos en 31 diferentes presentaciones farmacéuticas en 1993, pasando para 109 fármacos en 243 presentaciones en 2009. Los gastos totales del Ministerio de Salud con medicamentos sumaron, en 2007, R$1.410.181.600,74, casi el doble del valor gastado en el año 2000: R$ 684.975.404,43. Algunas enfermedades que representaron mayor gastos en ese período fueron: insuficiencia renal crónica, trasplante y hepatitis C. CONCLUSIONES: El Programa de Medicamentos de Dispensación en Carácter Excepcional está en constante transformación, buscando mejorar los instrumentos y estrategias que aseguren y amplíen el acceso de la población a los medicamentos. Se deben buscar alternativas para reducir el impacto financiero del Programa para que no exista prejuicio hacia las otras áreas del sistema de salud, dado el costo elevado de las nuevas tecnologías.OBJETIVO: Descrever aspectos técnicos do Programa de Medicamentos de Dispensação em Caráter Excepcional do Ministério de Saúde do Brasil, especialmente em relação aos gastos com os medicamentos distribuídos. MÉTODOS: Os aspectos técnicos foram obtidos por meio de consulta a todas as portarias que regulamentaram o Programa. Gastos no período de 2000 a 2007 foram obtidos do Sistema de Informações Ambulatoriais do Sistema Único de Saúde. Foram analisados os medicamentos dispensados de 1993 a 2009, quantidades e valor de cada procedimento informados nas autorizações de procedimentos de alta complexidade para cada estado. RESULTADOS: O Programa mudou, com aumento do número de fármacos e apresentações farmacêuticas distribuídas e de doenças contempladas. Eram distribuídos 15 fármacos em 31 diferentes apresentações farmacêuticas em 1993, passando para 109 fármacos em 243 apresentações em 2009. Os gastos totais do Ministério da Saúde com medicamentos somaram, em 2007, R$1.410.181.600,74, quase o dobro do valor gasto em 2000: R$ 684.975.404,43. Algumas das doenças que representaram maiores gastos nesse período foram: insuficiência renal crônica, transplante e hepatite C. CONCLUSÕES: O Programa de Medicamentos de Dispensação em Caráter Excepcional está em constante transformação, visando aprimorar os instrumentos e estratégias que assegurem e ampliem o acesso da população aos medicamentos. Devem-se buscar alternativas para reduzir o impacto financeiro do Programa para que não haja prejuízos às outras áreas do sistema de saúde, dado o custo elevado das novas tecnologias.Universidade Federal de São Paulo (UNIFESP) Centro Paulista de Economia da SaúdeMinistério da SaúdeUNIFESP, Centro Paulista de Economia da SaúdeSciEL

Photoaging skin therapy with PRP and ADSC: a comparative study

Background: Stem cells from adipose tissue (ADSCs) and platelet-rich plasma (PRP) are innovative modalities that arise due to their regenerative potential. Objective: The aim of this study was to characterize possible histological changes induced by PRP and ADSC therapies in photoaged skin. Methods: A prospective randomized study involving 20 healthy individuals, showing skin aging. They underwent two therapeutic protocols (protocol 1: PRP; protocol 2: ADSCs). Biopsies were obtained before and after treatment (4 months). Results: PRP protocol showed unwanted changes in the reticular dermis, mainly due to the deposition of a horizontal layer of collagen (fibrosis) and elastic fibers tightly linked. Structural analyses revealed infiltration of mononuclear cells and depot of fibrotic material in the reticular dermis. The ADSC protocol leads to neoelastogenesis with increase of tropoelastin and fibrillin. There was an improvement of solar elastosis inducing an increment of macrophage polarization and matrix proteinases. These last effects are probably related to the increase of elastinolysis and the remodeling of the dermis. Conclusions: The PRP promoted an inflammatory process with an increase of reticular dermis thickness with a fibrotic aspect. On the other hand, ADSC therapy is a promising modality with an important antiaging effect on photoaged human skin

Effects Of Length, Complexity, And Grammatical Correctness On Stuttering In Spanish-Speaking Preschool Children

Purpose: To explore the effects of utterance length, syntactic complexity, and grammatical correctness on stuttering in the spontaneous speech of young, monolingual Spanish-speaking children. Method: Spontaneous speech samples of 11 monolingual Spanish-speaking children who stuttered, ages 35 to 70 months, were examined. Mean number of syllables, total number of clauses, utterance complexity (i.e., containing no clauses, simple clauses, or subordinate and/or conjoined clauses), and grammatical correctness (i.e., the presence or absence of morphological and syntactical errors) in stuttered and fluent utterances were compared. Results: Findings revealed that stuttered utterances in Spanish tended to be longer and more often grammatically incorrect, and contain more clauses, including more subordinate and/or conjoined clauses. However, when controlling for the interrelatedness of syllable number and clause number and complexity, only utterance length and grammatical incorrectness were significant predictors of stuttering in the spontaneous speech of these Spanish-speaking children. Use of complex utterances did not appear to contribute to the prediction of stuttering when controlling for utterance length. Conclusions: Results from the present study were consistent with many earlier reports of English-speaking children. Both length and grammatical factors appear to affect stuttering in Spanish-speaking children. Grammatical errors, however, served as the greatest predictor of stuttering.Communication Sciences and Disorder

Avaliação da resistência de genótipos de Pennisetum purpureum às cigarrinhas-das-pastagens.

Resumo: Objetivou-se avaliar a resistência (antibiose e tolerância) de genótipos de Pennisetum purpureum à cigarrinha das pastagens, Mahanarva spectabilis. Foram avaliados seis genótipos de capim elefante (1815-AV, 1810-AV, 1817-AR, 1813-AV, 1829-AV e 1834-IV) provenientes do programa de melhoramento genético da Embrapa. No teste de antibiose, adotou-se o delineamento experimental em blocos casualizados com 30 repetições. Após 40 dias, a porcentagem de sobrevivência ninfal foi avaliada. Para a avaliação da tolerância, adotou-se o delineamento em blocos casualizados em esquema fatorial (genótipo x inseto) com 20 repetições. Utilizou-se 10 adultos por planta atacada. Avaliou-se o teor de clorofila, nota de dano, porcentagem de materia seca, capacidade de rebrota e perda funcional. Os dados foram submetidos à analise de variância (ANOVA). Todos os genótipos foram suscetíveis ao ataque de M. spectabilis, tanto pelo mecanimos de antibiose, quanto pelo de tolerância.Editor Técnico: Leônidas Paixão Passos, Embrapa Gado de Leite

Antiviral treatment for outpatient use during an influenza pandemic: a decision tree model of outcomes averted and cost-effectiveness

Background: Many countries have acquired antiviral stockpiles for pandemic influenza mitigation and a significant part of the stockpile may be focussed towards community-based treatment. Methods: We developed a spreadsheet-based, decision tree model to assess outcomes averted and cost-effectiveness of antiviral treatment for outpatient use from the perspective of the healthcare payer in the UK. We defined five pandemic scenarios– one based on the 2009 A(H1N1) pandemic and four hypothetical scenarios varying in measures of transmissibility and severity. Results: Community-based antiviral treatment was estimated to avert 14% to 23% of hospitalizations in an overall population of 62.28 million. Higher proportions of averted outcomes were seen in patients with high-risk conditions, when compared to non-high-risk patients. We found that antiviral treatment was cost-saving across pandemic scenarios for high-risk population groups, and cost-saving for the overall population in higher severity influenza pandemics. Antiviral effectiveness had the greatest influence on both the number of hospitalizations averted and on cost-effectiveness. Conclusions: This analysis shows that across pandemic scenarios, antiviral treatment can be cost-saving for population groups at high risk of influenza-related complications

Estimativa de parâmetros genéticos visando o melhoramento cafeeiro.

Os programas de melhoramento de Coffea canephora, var. conilon, buscam a seleção de genótipos promissores, de forma sustentável e ecologicamente equilibrada. No entanto, para alcançar o sucesso, há necessidade de quantificar a variabilidade genética e a estimação de parâmetros. As plantas de C. canephora são diplóides, de fecundação cruzada, com tendência a originar lavouras com ampla variabilidade genética em relação à arquitetura da parte aérea, ao formato e tamanho dos grãos, à época e uniformidade de maturação dos frutos, suscetibilidade a pragas e doenças, tolerância à seca, ao vigor vegetativo e à capacidade produtiva