Inequality in health coverage, empirical analysis with microdata for Argentina 2006

The literature on Health Economics does not usually study health coverage1 in itself but only in an indirect way. Specifically, the approach is often focused in health coverage as an explanatory variable of other variables which are related to the current stock of health. The intertemporal influence of health coverage over the past and future health stock is clear and evidently important beyond its influence over the present health status and its effects over the probability of sickness and recovery. Therefore, it should be clear that the interest of economic agents is to optimally preserve their health status and improve it throughout their entire life. This is an important microeconomic foundation that sustains the interest to study the health coverage as one of the important explanatory factors of the health stock. This work intends to perform a descriptive study on health coverage and explore its relationship with other variables that condition and modify the probability that economic agents receive coverage. Given the dichotomic nature of health coverage, the realization of a descriptive and conditional analysis presents a slightly different agenda than the usual one. This work is organized in the following way: Section I, utilizing microdata from the encuesta permanente de hogares (EPH) for the first semester of 2006 in Argentina, summary statistics are presented and a general description of the health coverage in Argentina for the people who belong to families without salary workers in it. In section II a binary regression model is estimated, and the probability of having coverage is studied. Subsequently, a Concentration Index is calculated on an individual basis. Next, following an adapted methodology than Wagstaff-Doorslaer-Watanabe (2002), a decomposition of the explained part of index which generates the probability of coverage is performed. In Section III, a decomposition of the change in the Concentration Indexes between years 2004 and 2006 takes place, utilizing microdata from the EPH corresponding to the first semester of 2004.Centro de Estudios Distributivos, Laborales y Sociales (CEDLAS

Inequality in health coverage, empirical analysis with microdata for Argentina 2006

The literature on Health Economics does not usually study health coverage1 in itself but only in an indirect way. Specifically, the approach is often focused in health coverage as an explanatory variable of other variables which are related to the current stock of health. The intertemporal influence of health coverage over the past and future health stock is clear and evidently important beyond its influence over the present health status and its effects over the probability of sickness and recovery. Therefore, it should be clear that the interest of economic agents is to optimally preserve their health status and improve it throughout their entire life. This is an important microeconomic foundation that sustains the interest to study the health coverage as one of the important explanatory factors of the health stock. This work intends to perform a descriptive study on health coverage and explore its relationship with other variables that condition and modify the probability that economic agents receive coverage. Given the dichotomic nature of health coverage, the realization of a descriptive and conditional analysis presents a slightly different agenda than the usual one. This work is organized in the following way: Section I, utilizing microdata from the encuesta permanente de hogares (EPH) for the first semester of 2006 in Argentina, summary statistics are presented and a general description of the health coverage in Argentina for the people who belong to families without salary workers in it. In section II a binary regression model is estimated, and the probability of having coverage is studied. Subsequently, a Concentration Index is calculated on an individual basis. Next, following an adapted methodology than Wagstaff-Doorslaer-Watanabe (2002), a decomposition of the explained part of index which generates the probability of coverage is performed. In Section III, a decomposition of the change in the Concentration Indexes between years 2004 and 2006 takes place, utilizing microdata from the EPH corresponding to the first semester of 2004.Centro de Estudios Distributivos, Laborales y Sociales (CEDLAS

The archaeological record from gruta El Manzano and their implicances for Nodpatagonia archaeology

En este trabajo se presentan los resultados de los análisis realizados sobre los materiales del sitio arqueológico Gruta de El Manzano, localizado sobre el río Grande, en el Departamento de Malargüe, al sur de la provincia de Mendoza. Utilizando la información generada, se discuten aspectos de la funcionalidad del sitio, los cambios a través del tiempo y se destaca su importancia para la discusión de los temas de la arqueología del norte de Patagonia. Los recientes fechados radiocarbónicos ubican al inicio de las ocupaciones en más de 8.000 años AP y confirman la existencia del hiatus regional para el Holoceno medio. Los materiales analizados muestran importantes cambios en las tendencias de los mismos, especialmente hacia la segunda mitad del Holoceno tardío, donde los diferentes indicadores sugieren diferencias en relación a la movilidad, el uso de la fauna, los recursos vegetales y la incorporación de tecnología cerámica.In this paper we present the results of the analysis carried out with the materials from Gruta de El Manzano archaeological site, located beside Grande River, in Malargüe, southern Mendoza province. Using the new information, we discuss the site function, changes trough time, and remark his importance for the northern Patagonia discussion. The last radiocarbon data place the beginning of the occupation in more than 8.000 years BP and confirm the existence of the mid Holocene regional hiatus. The analiced materials shows important changes in their tendencies, especially during the second half of the late Holocene, were different lines of evidencies suggest changes in relation to the mobility, the use of animal and plant resources and the incorporation of pottery technology.Facultad de Ciencias Naturales y Muse

Quantification of isomeric equilibria formed by metal ion complexes of 8-[2-(phosphonomethoxy)ethyl]-8-azaadenine (8,8aPMEA) and 9-[2-(phosphonomethoxy)ethyl]-8-azaadenine (9,8aPMEA) : derivatives of the antiviral nucleotide analogue 9-[2-(phosphonomethoxy)ethyl]adenine (PMEA)

The acidity constants of the two-fold protonated acyclic 9-[2-(phosphonomethoxy)ethyl]-8-azaadenine, H2(9,8aPMEA)(+)(-), and its 8-isomer, 8-[2-(phosphonomethoxy)ethyl]-8-azaadenine, H2(8,8aPMEA)(+)(-), both abbreviated as H2(PA)(+)(-), as well as the stability constants of their M(H;PA)+ and M(PA) complexes with the metal ions M2+=Mg2+, Ca2+, Sr2+, Ba2+, Mn2+, Co2+, Ni2+, Cu2+, Zn2+ or Cd2+, have been determined by potentiometric pH titrations in aqueous solution at I=0.1 M (NaNO3) and 25 degrees C. Application of previously determined straight-line plots of log K(M)M(R-PO3) versus pK(H)H(R-PO3)for simple phosph(on)ate ligands, R-PO3(2-), where R represents a residue without an affinity for metal ions, proves that for all M(PA) complexes a larger stability is observed than is expected for a sole phosphonate coordination of the metal ion. This increased stability is attributed to the formation of five-membered chelates involving the ether oxygen present in the aliphatic residue (-CH2-O-CH2-PO3(2-)) of the ligands. The formation degrees of these chelates were calculated; they vary between about 13% for Ca(8,8aPMEA) and 71% for Cu(8,8aPMEA). The adenine residue has no influence on complex stability except in the Cu(9,8aPMEA) and Zn(9,8aPMEA) systems, where an additional stability increase attributable to the adenine residue is observed and equilibria between four different isomers exist. This means (1) an open isomer with a sole phosphonate coordination, M(PA)op, where PA(2-)=9,8aPMEA2-, (2) an isomer with a five-membered chelate involving the ether oxygen, M(PA)cl/O, (3) an isomer which contains five- and seven-membered chelates formed by coordination of the phosphonate group, the ether oxygen and the N3 site of the adenine residue, M(PA)cl/O/N3, and finally (4) a macrochelated isomer involving N7, M(PA)cl/N7. For Cu(9,8aPMEA) the formation degrees are 15, 30, 48 and 7% for Cu(PA)op, Cu(PA)cl/O, Cu(PA)cl/O/N3 and Cu(PA)cl/N7, respectively; this proves that the macrochelate involving N7 is a minority species. The situation for the Cu(PMEA) system, where PMEA2- represents the parent compound, i.e. the dianion of 9-[2-(phosphonomethoxy)ethyl]adenine, is quite similar. The relationship between the antiviral activity of acyclic nucleoside phosphonates and the structures of the various complexes is discussed and an explanation is offered why 9,8aPMEA is biologically active but 8,8aPMEA is not

Ticagrelor in patients with diabetes and stable coronary artery disease with a history of previous percutaneous coronary intervention (THEMIS-PCI) : a phase 3, placebo-controlled, randomised trial

Background: Patients with stable coronary artery disease and diabetes with previous percutaneous coronary intervention (PCI), particularly those with previous stenting, are at high risk of ischaemic events. These patients are generally treated with aspirin. In this trial, we aimed to investigate if these patients would benefit from treatment with aspirin plus ticagrelor. Methods: The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS) was a phase 3 randomised, double-blinded, placebo-controlled trial, done in 1315 sites in 42 countries. Patients were eligible if 50 years or older, with type 2 diabetes, receiving anti-hyperglycaemic drugs for at least 6 months, with stable coronary artery disease, and one of three other mutually non-exclusive criteria: a history of previous PCI or of coronary artery bypass grafting, or documentation of angiographic stenosis of 50% or more in at least one coronary artery. Eligible patients were randomly assigned (1:1) to either ticagrelor or placebo, by use of an interactive voice-response or web-response system. The THEMIS-PCI trial comprised a prespecified subgroup of patients with previous PCI. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, or stroke (measured in the intention-to-treat population). Findings: Between Feb 17, 2014, and May 24, 2016, 11 154 patients (58% of the overall THEMIS trial) with a history of previous PCI were enrolled in the THEMIS-PCI trial. Median follow-up was 3·3 years (IQR 2·8–3·8). In the previous PCI group, fewer patients receiving ticagrelor had a primary efficacy outcome event than in the placebo group (404 [7·3%] of 5558 vs 480 [8·6%] of 5596; HR 0·85 [95% CI 0·74–0·97], p=0·013). The same effect was not observed in patients without PCI (p=0·76, p interaction=0·16). The proportion of patients with cardiovascular death was similar in both treatment groups (174 [3·1%] with ticagrelor vs 183 (3·3%) with placebo; HR 0·96 [95% CI 0·78–1·18], p=0·68), as well as all-cause death (282 [5·1%] vs 323 [5·8%]; 0·88 [0·75–1·03], p=0·11). TIMI major bleeding occurred in 111 (2·0%) of 5536 patients receiving ticagrelor and 62 (1·1%) of 5564 patients receiving placebo (HR 2·03 [95% CI 1·48–2·76], p<0·0001), and fatal bleeding in 6 (0·1%) of 5536 patients with ticagrelor and 6 (0·1%) of 5564 with placebo (1·13 [0·36–3·50], p=0·83). Intracranial haemorrhage occurred in 33 (0·6%) and 31 (0·6%) patients (1·21 [0·74–1·97], p=0·45). Ticagrelor improved net clinical benefit: 519/5558 (9·3%) versus 617/5596 (11·0%), HR=0·85, 95% CI 0·75–0·95, p=0·005, in contrast to patients without PCI where it did not, p interaction=0·012. Benefit was present irrespective of time from most recent PCI. Interpretation: In patients with diabetes, stable coronary artery disease, and previous PCI, ticagrelor added to aspirin reduced cardiovascular death, myocardial infarction, and stroke, although with increased major bleeding. In that large, easily identified population, ticagrelor provided a favourable net clinical benefit (more than in patients without history of PCI). This effect shows that long-term therapy with ticagrelor in addition to aspirin should be considered in patients with diabetes and a history of PCI who have tolerated antiplatelet therapy, have high ischaemic risk, and low bleeding risk