Prevalence and costs of headaches for the public health system in a town in the interior of the state of São Paulo Prevalência e custos das cefaléias para o Sistema Público de Saúde de uma cidade do interior do Estado de São Paulo

Despite the high prevalence, impact and economic importance of headaches, studies on this subject are rare in Brazil. The aim of the present study was to estimate the prevalence of headaches in the public health system of a town in the interior of the State of São Paulo, as well as to estimate the costs resulting from its management. Data refer to the year of 1998 and were obtained according to the following steps: 1) territorial and demographic characterization of the municipality; 2) characterization of the financial indices and social well-being; 3) budget characteristics of the municipality; 4) evaluation of the structuring of the medical service; 5) determination of the prevalence of headaches at different patient care levels; and 6) calculation of the costs of headaches. Headaches represented 7.9% of all visits at basic health units, 9.7% in the emergency room and 1.1% of hospital admissions. The total costs were R$85,131.31 (US$ 70,942.76) corresponding to R$7.59 (US$ 6,32) per inhabitant/year. The present study shows the need for epidemiological and economic impact studies, which would provide the basis for the rational use of health funds.<br>Apesar da grande prevalência, impacto e importância econômica das cefaléias, são incomuns os estudos referentes a esses aspectos em nosso meio. O presente estudo visa estimar a prevalência das cefaléias no sistema público de uma cidade do interior do Estado de São Paulo, bem como estimar os custos decorrentes de seu manejo. Os dados referem-se ao ano de 1998 e obedeceram às seguintes etapas: 1 -- caracterização territorial e demográfica do município; 2 -- caracterização de índices financeiros e de bem estar social; 3 -- características orçamentárias do município; 4 -- avaliação da estruturação do atendimento médico; 5 -- levantamento da prevalência das cefaléias nos diversos níveis de atendimento; 6 -- cálculo dos custos das cefaléias. Cefaléias foram responsáveis por 7,9% dos atendimentos em unidades básicas de saúde, 9,7% em pronto socorro e 1,1% das internações hospitalares. Os custos totais foram de R$85.131,31 (US$ 70,942.76) o que equivale a R$7,59 (US$ 6,32) por habitante/ano. Esse estudo demonstra a necessidade da realização de trabalhos epidemiológicos e de impacto econômico que permitam racionalizar o emprego de verbas para a saúde

A Cost-Utility Analysis Of Alternative Strategies In Screening For Breast Cancer

Screening for early detection is a primary way to control breast cancer. The choice of effective screening policies involves substantial uncertainty and difficult tradeoffs among medical costs and the duration and quality of life. In this paper, we study the choice of the age at which screening should begin and the frequency of screening tests. These have been issues of important debate in the health policy community. We address these questions using the framework of costutility analysis, as we consider it important to evaluate the outcomes of preventive care in terms of morbidity and quality of life, in addition to survival. After a brief review of background information on breast cancer screening, we introduce cost-utility analysis and its relation with Bayesian decision-making. We then discuss modelling and prior specifications, and carry out a cost-utility evaluation of the currently recommended policy. Finally we compare those to the the Bayes-optimal decision for various values o..

Sulfonium Salts as Leaving Groups for Aromatic Labelling of Drug-like Small Molecules with Fluorine-18

Positron emission tomography (PET) is unique in that it allows quantification of biochemical processes in vivo, but difficulties with preparing suitably labelled radiotracers limit its scientific and diagnostic applications. Aromatic [(18)F]fluorination of drug-like small molecules is particularly challenging as their functional group compositions often impair the labelling efficiency. Herein, we report a new strategy for incorporation of (18)F into highly functionalized aromatic compounds using sulfonium salts as leaving groups. The method is compatible with pharmacologically relevant functional groups, including aliphatic amines and basic heterocycles. Activated substrates react with [(18)F]fluoride at room temperature, and with heating the reaction proceeds in the presence of hydrogen bond donors. Furthermore, the use of electron rich spectator ligands allows efficient and regioselective [(18)F]fluorination of non-activated aromatic moieties. The method provides a broadly applicable route for (18)F labelling of biologically active small molecules, and offers immediate practical benefits for drug discovery and imaging with PET