Concorrência e as participações minoritárias entre firmas rivais

The objective of this paper is to analyze the impacts of minority shareholdings among rival firms on competition. The application of MHHI (Modified Herfindahl Hirschman Index), a measure of market concentration recently proposed in the literature, shows that these structural links may cause adverse effects on competition. Such losses are intensified with increasing market-shares and the controlling power that the acquiring firm has on the acquired one. However when these links are ignored or taken as full mergers, such losses are underestimated or overestimated, respectively. Therefore we conclude that the MHHI would be the most adequate measure of market concentration in the presence of minority shareholdings among rival firms.O objetivo deste trabalho é analisar quais os impactos sobre a concorrência de participações minoritárias entre firmas rivais. A aplicação do MHHI, índice de concentração recentemente proposto na literatura, indica que essas ligações estruturais podem causar efeitos adversos sobre a concorrência. Tais prejuízos se intensificam quanto maiores os market-shares e o poder de controle que a firma adquirente tem sobre a adquirida. Porém, quando essas ligações são ignoradas ou consideradas como fusões completas, tais prejuízos são subestimados ou superestimados, respectivamente. Assim, conclui-se que o MHHI é um indicador de concentração mais adequado na presença de participações minoritárias entre firmas rivais

Spatial clustering of onchocerciasis in Bioko Island, Equatorial Guinea

INTRODUCTION: Onchocerciasis is a chronic neglected tropical disease caused by the filarial nematode Onchocerca volvulus, which is endemic in Equatorial Guinea. The aim was to estimate the current spatial distribution of onchocerciasis, and its related factors, in Bioko Island after several years of mass drug administration and vector control activities, by using GIS technics. METHODOLOGY: The survey was carried out within the framework of a wider research project entitled "Strengthening the National Programme for Control of Onchocerciasis and other Filariasis in Equatorial Guinea". A structured questionnaire was designed to cover basic socio-demographic information and risk factors for onchocerciasis and the coordinates of household. the hydrographic network data to calculate the positive onchocerciasis rate was used. Poisson generalized linear model was used to explore the association between onchocerciasis and the following covariates: distance to the river, preventive practices, water source and household´s main source of income. Two different cluster analysis methods were used: Getis-Ord Gi statistic and SaTScan™ purely spatial statistic estimator. RESULTS: The risk of onchocerciasis was higher for those who drank water from external sources (RR 25.3) than for those who drank home tap water (RR 8.0). The clusters with z-score higher were located at the east of the island. For 5 km and 1 km distances, one significant cluster in the east was detected (RR 5.91 and RR 7.15). CONCLUSION: No environmental factors related with onchocerciasis were found, including proximity to rivers. This could be partially explained by the fact that the vector was eliminated in 2005.S

Failures in the case management of children with uncomplicated malaria in Bata district of Equatorial Guinea and associated factors

BACKGROUND: In Equatorial Guinea, malaria continues to be one of the main causes of morbidity and mortality among children. The National Therapeutic Guide established artesunate-amodiaquine (ASAQ) as first-line treatment for uncomplicated malaria, but compliance with this treatment is low. The aim of this study was to assess, for the first time, the performance of public healthcare workers in the diagnosis and treatment of uncomplicated malaria, their compliance with first-line Malaria National Therapeutic Guide and the associated factors. METHODS: A cross-sectional survey was conducted at the nine public health facilities in the Bata District of Equatorial Guinea to assess the management of uncomplicated malaria in children < 15 years of age. Bivariate and multivariate statistical analyses were used to determine the recommended treatment compliance and related factors. RESULTS: A total of 227 children with uncomplicated malaria were recorded from 9 public health facilities. Most of the treatments prescribed (83.3%) did not follow the first-line treatment recommended for uncomplicated malaria. The diagnosis was established with parasite confirmation in 182 cases (80.2%). After adjustment for other variables, children under 2 months of age, the use of parasite confirmation to the diagnosis of malaria and being familiar with the national therapeutic guide were significantly associated with the prescription of the first-line recommended treatment. Cases attended at the hospital or in a health facility with ASAQ in the pharmacy at the time of the study were also more likely to be prescribed with the recommended treatment, but with non-significant association after adjustment for other variables. CONCLUSIONS: This study identified the factors associated with the low compliance with the first-line treatment by the public healthcare facilities of Bata District of Equatorial Guinea. It seems necessary to improve case management of children with uncomplicated malaria; to reinforce the use of Malaria National Therapeutic Guide and to inform about the danger of using artemisinin monotherapy. Furthermore, it is crucial to provide recommended first-line treatment to the pharmacies of all public health facilities to ensure access to this treatment.This study was funded by the by the Agencia Española de Cooperación Internacional AECID2017/CTR/0900237 (http://www.aecid.es/ES) and the Tropical Diseases Research Network RD16CIII/003/001RICET (https://www.ricet.es/).The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.S

Temporal evolution of the resistance genotypes of Plasmodium falciparum in isolates from Equatorial Guinea during 20 years (1999 to 2019)

Background: Malaria is one of the deadliest diseases in the world, particularly in Africa. As such, resistance to anti-malarial drugs is one of the most important problems in terms of global malaria control. This study assesses the evolution of the different resistance markers over time and the possible influence of interventions and treatment changes that have been made in Equatorial Guinea. Methods: A total of 1223 biological samples obtained in the period 1999 to 2019 were included in the study. Screening for mutations in the pfdhfr, pfdhps, pfmdr1, and pfcrt genes was carried out by nested PCR and restriction-fragment length polymorphisms (RFLPs), and the study of pfk13 genes was carried out by nested PCR, followed by sequencing to determine the presence of mutations. Results: The partially and fully resistant haplotypes (pfdhfr + pfdhps) were found to increase over time. Moreover, in 2019, the fully resistant haplotype was found to be increasing, although its super-resistant counterpart remains much less prevalent. A continued decline in pfmdr1 and pfcrt gene mutations over time was also found. The number of mutations detected in pfk13 has increased since 2008, when artemisinin-based combination therapy (ACT) were first introduced, with more mutations being observed in 2019, with two synonymous and five non-synonymous mutations being detected, although these are not related to resistance to ACT. In addition, the non-synonymous A578S mutation, which is the most frequent on the African continent, was detected in 2013, although not in the following years. Conclusions: Withdrawal of the use of chloroquine (CQ) as a treatment in Equatorial Guinea has been shown to be effective over time, as wild-type parasite populations outnumber mutant populations. The upward trend observed in sulfadoxine-pyrimethamine (SP) resistance markers suggest its misuse, either alone or in combination with artesunate (AS) or amodiaquine (AQ), in some areas of the country, as was found in a previous study conducted by this group, which allows selective pressure from SP to continue. Single nucleotide polymorphisms (SNPs) 540E and 581G do not exceed the limit of 50 and 10%, respectively, thus meaning that SP is still effective as an intermittent preventive treatment (IPT) in this country. As for the pfk13 gene, no mutations have been detected in relation to resistance to ACT. However, in 2019 there is a greater accumulation of non-synonymous mutations compared to years prior to 2008.The projects where the samples were taken were funded by Spanish Agency for International Cooperation and Development (AECID), ISCIII, Cooperative Research Network on Tropical Diseases (RICET) and by the Strategic Action in Health (Acción Estratégica en Salud) of the Institute of Health Carlos III (Madrid, Spain), project No. TRPY111/2018 (PI17CIII/0016).S

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Impacto no cotidiano de mulheres com incontinência urinária atendidas em um centro especializado em urologia, no Sul de Santa Catarina

Trabalho de Conclusão de Curso, apresentado para obtenção do grau de Bacharel, no Curso de Enfermagem, da Universidade do Extremo Sul Catarinense, UNESC.O objetivo deste estudo foi conhecer o impacto no cotidiano das mulheres com incontinência urinária (IU) e a percepção deste impacto pelas mesmas. A IU é uma patologia que ocorre perda involuntária de urina. A presente pesquisa foi de cunho qualitativo e descritivo, desenvolvida em um centro especializado em urologia no sul de Santa Catarina, com quinze mulheres com diagnóstico de IU com comprovação através do estudo urodinâmico. Utilizou-se para coletar os dados a entrevista semi estruturada. Os dados foram analisados com a técnica de análise simples de conteúdo proposta por Minayo (2008). Respeitaram-se em todos os momentos da pesquisa os aspectos éticos da Resolução CNS 466/12. Os resultados encontrados vêm ao encontro com outros estudos: mulheres incontinentes com qualidade de vida afetada em seu cotidiano nas questões de atividade profissional, doméstica, sexual, física e psicológica. Constatou-se também o desconhecimento das causas que levaram a desenvolver a IU, já que foram atribuídas a fatores que não tem nenhum embasamento científico. Observou-se ainda uma relação importante entre a IU e processos psicológicos de tristeza, ansiedade bem como isolamento social. Em conclusão, o estudo evidencia a influência da IU nos mais variados aspectos do dia a dia da mulher, requerendo dela uma atitude pró-ativa como protagonista principal para a produção e resgate de sua saúde

Concorrência e as participações minoritárias entre firmas rivais

O objetivo deste trabalho é analisar quais os impactos sobre a concorrência de participações minoritárias entre firmas rivais. A aplicação do MHHI, índice de concentração recentemente proposto na literatura, indica que essas ligações estruturais podem causar efeitos adversos sobre a concorrência. Tais prejuízos se intensificam quanto maiores os market-shares e o poder de controle que a firma adquirente tem sobre a adquirida. Porém, quando essas ligações são ignoradas ou consideradas como fusões completas, tais prejuízos são subestimados ou superestimados, respectivamente. Assim, conclui-se que o MHHI é um indicador de concentração mais adequado na presença de participações minoritárias entre firmas rivais.The objective of this paper is to analyze the impacts of minority shareholdings among rival firms on competition. The application of MHHI (Modified Herfindahl Hirschman Index), a measure of market concentration recently proposed in the literature, shows that these structural links may cause adverse effects on competition. Such losses are intensified with increasing market-shares and the controlling power that the acquiring firm has on the acquired one. However when these links are ignored or taken as full mergers, such losses are underestimated or overestimated, respectively. Therefore we conclude that the MHHI would be the most adequate measure of market concentration in the presence of minority shareholdings among rival firms

Knowledge and practices regarding malaria and the National Treatment Guidelines among public health workers in Equatorial Guinea.

In 2018, an estimated 228 million cases of malaria occurred worldwide. Countries are far from having achieved reasonable levels of national protocol compliance among health workers. Lack of awareness of treatment protocols and treatment resistance by prescribers threatens to undermine progress when it comes to reducing the prevalence of this disease. This study sought to evaluate the degree of knowledge and practices regarding malaria diagnosis and treatment amongst prescribers working at the public health facilities of Bata, Equatorial Guinea. A cross-sectional survey was conducted in October-December 2017 amongst all public health professionals who attended patients under the age of 15 years, with suspected malaria in the Bata District of Equatorial Guinea. Practitioners were asked about their practices and knowledge of malaria and the National Malaria Treatment Guidelines. A bivariate analysis and a logistic regression model were used to determine factors associated with their knowledge. Among the 44 practitioners interviewed, 59.1% worked at a Health Centre and 40.9% at the District Hospital of Bata. Important differences in knowledge and practices between hospital and health centre workers were found. Clinical diagnosis was more frequently by practitioners at the health centres (p = 0.059), while microscopy confirmation was more frequent at regional hospital (100%). Intramuscular artemether was the anti-malarial most administrated at the health centres (50.0%), while artemether-lumefantrine was the treatment most used at the regional hospital (66.7%). Most practitioners working at public health facilities (63.6%) have a low level of knowledge regarding the National Malaria Treatment Guidelines. While knowledge regarding malaria, the National Malaria Treatment Guidelines and treatment resistances is low, it was higher amongst hospital workers than amongst practitioners at health centres. It is essential to reinforce practitioners' knowledge, treatment and diagnosis practices and use of the National Malaria Treatment Guidelines in order to improve malaria case management and disease control in the region. A specific malaria training programme ensuring ongoing updates training is necessary in order to ensure that greater experience does not entail obsolete knowledge and, consequently, inadequate diagnosis and treatment practices.This study was funded by the by the Agencia Española de Cooperación Internacional.AECID2017/CTR/0900237 (https ://www.aecid .es/ES), the Spanish State Foundation for Health, Childcare and Social Welfare (FCESAI) and the Tropical Diseases Research Network RD16CIII/003/001RICET (https ://www.ricet .es). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.S