Administrative And Clinical Denials By A Large Dental Insurance Provider

The objective of this study was to assess the prevalence and the type of claim denials (administrative, clinical or both) made by a large dental insurance plan. This was a cross-sectional, observational study, which retrospectively collected data from the claims and denial reports of a dental insurance company. The sample consisted of the payment claims submitted by network dentists, based on their procedure reports, reviewed in the third trimester of 2012. The denials were classified and grouped into 'administrative', 'clinical' or 'both'. The data were tabulated and submitted to uni- and bivariate analyses. The confidence intervals were 95% and the level of significance was set at 5%. The overall frequency of denials was 8.2% of the total number of procedures performed. The frequency of administrative denials was 72.88%, whereas that of technical denials was 25.95% and that of both, 1.17% (p < 0.05). It was concluded that the overall prevalence of denials in the studied sample was low. Administrative denials were the most prevalent. This type of denial could be reduced if all dental insurance providers had unified clinical and administrative protocols, and if dentists submitted all of the required documentation in accordance with these protocols.29

FORMAÇÃO DO PSICÓLOGO PARA ATUAR NO SUS: POSSÍVEIS ENCONTROS E DESENCONTROS ENTRE AS DIRETRIZES CURRICULARES NACIONAIS E AS MATRIZES CURRICULARES DE UM CURSO DE PSICOLOGIA

Desde a sua regulamentação, a Psicologia vem acompanhando os diversos desdobramentos sociais, políticos e econômicos do país, e é nesse embate de conflitos que surge a necessidade de uma transformação na formação em Psicologia, que se aproxime do SUS. Este trabalho tem como objetivos identificar as possíveis relações nas matrizes curriculares de um Curso de Psicologia de Santa Catarina com as competências e habilidades contidas nas Diretrizes Curriculares Nacionais (DCNs), visando aproximar-se de uma formação voltada para o SUS e comparar as disciplinas e as ementas das duas últimas grades curriculares do Curso de Psicologia. A presente pesquisa fez uso da abordagem qualitativa de caráter documental. Os dados foram coletados a partir de documentos que expressam o currículo. Neste estudo optou-se pelas matrizes curriculares do Curso de Psicologia pesquisado, analisando os conteúdos que evidenciaram uma aproximação com as competências e habilidades das DCNs. Quando comparadas as matrizes curriculares, essas evidenciaram diferenças como a influência do relatório Flexner e das Diretrizes Curriculares. Apesar das possíveis aproximações do currículo pesquisado com o SUS, entende-se que os atores sociais são os principais protagonistas para que essa transformação na formação do psicólogo efetivamente aconteça

Administrative and clinical denials by a large dental insurance provider

The objective of this study was to assess the prevalence and the type of claim denials (administrative, clinical or both) made by a large dental insurance plan. This was a cross-sectional, observational study, which retrospectively collected data from the claims and denial reports of a dental insurance company. The sample consisted of the payment claims submitted by network dentists, based on their procedure reports, reviewed in the third trimester of 2012. The denials were classified and grouped into ‘administrative’, ‘clinical’ or ‘both’. The data were tabulated and submitted to uni- and bivariate analyses. The confidence intervals were 95% and the level of significance was set at 5%. The overall frequency of denials was 8.2% of the total number of procedures performed. The frequency of administrative denials was 72.88%, whereas that of technical denials was 25.95% and that of both, 1.17% (p < 0.05). It was concluded that the overall prevalence of denials in the studied sample was low. Administrative denials were the most prevalent. This type of denial could be reduced if all dental insurance providers had unified clinical and administrative protocols, and if dentists submitted all of the required documentation in accordance with these protocols29

A review of flocking behavior by hook-billed kite, chondrohierax uncinatus, in south America

The Hook-billed Kite (Chondrohierax uncinatus) is a diurnal raptor species that is widely distributed across the Neotropics, but some aspects of its social and ecological behavior are poorly understood. Here, we review and report records of flocking behavior of this species at various locations in South America, mainly in Brazil. We report eight new observations of such behavior, mainly in northern Brazil. It is possible that flocking behavior in this species is more common in northern South America than in the southern part of the continent, but it is perhaps overlooked or goes unreported by observers in these places. © 2018, Sociedade Brasileira de Ornitologia. All rights reserved

Screening Of Miners And Millers At Decreasing Levels Of Asbestos Exposure: Comparison Of Chest Radiography And Thin-section Computed Tomography.

Chest radiography (CXR) is inferior to Thin-section computed tomography in the detection of asbestos related interstitial and pleural abnormalities. It remains unclear, however, whether these limitations are large enough to impair CXR´s ability in detecting the expected reduction in the frequency of these asbestos-related abnormalities (ARA) as exposure decreases. Clinical evaluation, CXR, Thin-section CT and spirometry were obtained in 1418 miners and millers who were exposed to progressively lower airborne concentrations of asbestos. They were separated into four groups according to the type, period and measurements of exposure and/or procedures for controlling exposure: Group I (1940-1966/tremolite and chrysotile, without measurements of exposure and procedures for controlling exposure); Group II (1967-1976/chrysotile only, without measurements of exposure and procedures for controlling exposure); Group III (1977-1980/chrysotile only, initiated measurements of exposure and procedures for controlling exposure) and Group IV (after 1981/chrysotile only, implemented measurements of exposure and a comprehensive procedures for controlling exposure). In all groups, CXR suggested more frequently interstitial abnormalities and less frequently pleural plaques than observed on Thin-section CT (p<0.050). The odds for asbestosis in groups of decreasing exposure diminished to greater extent at Thin-section CT than on CXR. Lung function was reduced in subjects who had pleural plaques evident only on Thin-section CT (p<0.050). In a longitudinal evaluation of 301 subjects without interstitial and pleural abnormalities on CXR and Thin-section CT in a previous evaluation, only Thin-section CT indicated that these ARA reduced as exposure decreased. CXR compared to Thin-section CT was associated with false-positives for interstitial abnormalities and false-negatives for pleural plaques, regardless of the intensity of asbestos exposure. Also, CXR led to a substantial misinformation of the effects of the progressively lower asbestos concentrations in the occurrence of asbestos-related diseases in miners and millers.10e011858

Cardiac implications after myocardial infarction in rats previously undergoing physical exercise

BACKGROUND: Few studies have analyzed the cardiac effects of exercise prior to coronary occlusion. OBJECTIVE: To evaluate the effects of myocardial infarction in rats undergoing physical exercise. METHODS: Female rats underwent swimming exercise or were kept sedentary for eight weeks and were randomized to coronary occlusion or sham surgery, in one of the following four groups: Sedentary (S), exercise (E), Sedentary myocardial infarction (SMI) and Exercise myocardial infarction (EMI). After six weeks, their biometrics, Doppler echocardiography, hemodynamics and myocardial mechanics were analyzed. RESULTS: No cardioprotection was observed in EMI animals and there was no difference in infarct size (%LV) between EMI (38.50 ± 4.60%) and SMI (36.58 ± 4.11%). Water content of the lung (%) of SMI (80 ± 0.59) and EMI (80 ± 0.57) was higher than that of S (78 ± 0.15) and E (78 ± 0.57) groups. Left ventricular systolic pressure (mmHg) (S: 130 ± 5, E: 118 ± 8; SMI: 91 ± 3; EMI: 98 ± 3) and the first positive time derivative (mmHg) positive pressure (S: 8216 ± 385; E: 8437 ± 572; SMI: 4674 ± 455; EMI: 5080 ± 412) of S and E were higher than those of SMI and EMI. The transverse fractional shortening (%) of SMI (27 ± 2) and EMI (25 ± 2) were similar and lower than that of E (65 ± 2) and S (69 ± 2). The E/A ratio was higher in SMI (5.14 ± 0.61) and EMI (4.73 ± 0.57) compared to S (2.96 ± 0.24) and E (2.83 ± 0 21). In studies of isolated papillary muscle, depression of the contractile capacity observed was similar to that of SMI and EMI, and there was no change in myocardial stiffness. CONCLUSION: Previous training by swimming did not attenuate cardiac implications due to myocardial infarction.FUNDAMENTO: Poucos estudos analisaram os efeitos cardíacos do exercício físico prévio à oclusão coronariana. OBJETIVO: Avaliar, em ratas submetidas a exercício físico, as repercussões do infarto do miocárdio. MÉTODOS: Ratas foram submetidas à natação ou permaneceram sedentárias por oito semanas e foram randomizadas para oclusão coronariana ou cirurgia simulada, compondo quatro grupos: Sedentário (S), Exercício (E), Sedentário infarto (SIM) e Exercício infarto (EIM). Após seis semanas, foram analisados biometria, ecodopplercardiograma, hemodinâmica e mecânica miocárdica. RESULTADOS: Não foram observados cardioproteção nos animais EIM e diferença no tamanho do infarto (%VE) entre EIM (38,50 ± 4,60%) e SIM (36,58 ± 4,11%). Os teores de água pulmonar (%) de SIM (80 ± 0,59) e EIM (80 ± 0,57) foram maiores do que em S (78 ± 0,15) e E (78 ± 0,57). A pressão sistólica (mmHg) do ventrículo esquerdo (S: 130 ± 5; E: 118 ± 8; SIM: 91 ± 3; EIM: 98 ± 3) e a primeira derivada temporal (mmHg/s) positiva da pressão (S: 8.216 ± 385; E: 8.437 ± 572; SIM: 4.674 ± 455; EIM: 5.080 ± 412) de S e E foram maiores do que em SIM e EIM. As frações de encurtamento da área transversa (%) de SIM (27 ± 2) e EIM (25 ± 2) foram similares e menores do que E (65 ± 2) e S (69 ± 2). A relação E/A foi maior em SIM (5,14 ± 0,61) e EIM (4,73 ± 0,57) em relação a S (2,96 ± 0,24) e E (2,83 ± 0,21). Em estudos de músculos papilares isolados foi verificada depressão da capacidade contrátil semelhante em SIM e EIM, e não houve alteração da rigidez miocárdica. CONCLUSÃO: O treinamento prévio por natação não atenuou as repercussões cardíacas em virtude do infarto do miocárdio.UNIFESP Departamento de MedicinaCentro Universitário Adventista de São PauloUNIFESP Departamento de FisiologiaInCor Departamento de PatologiaUniversidade Nove de Julho Departamento de Educação FísicaUNIFESP, Depto. de MedicinaUNIFESP, Depto. de FisiologiaSciEL

Children who use mental health services: characterization of the population in a city in southern brazil

Estudos têm indicado que a população infantil constitui grande demanda para os serviços de saúde mental. Neste trabalho, objetivou-se caracterizar o perfil da população infantil que procurou o atendimento nos serviços de saúde mental, na cidade de Itajaí entre os anos de 2002 a 2007. Os dados desta pesquisa foram levantados junto aos prontuários da população atendida em dois serviços públicos de saúde mental existentes na cidade, caracterizando este estudo como documental, exploratório e descritivo. Os resultados encontrados indicam que os transtornos mentais mais relatados como queixa são o Transtorno de Déficit de Atenção e Comportamento Disruptivo totalizando 28,7%, Transtornos de Ansiedade 9,6% e os Transtornos de Aprendizagem 7,8% desta população que procura atendimento nos serviços de saúde mental. Em relação aos Problemas de Comportamento encontram-se os Problemas nas Relações 13,3%, Condições Adicionais que Podem ser Foco de Atenção Clínica 2,7% e Agressividade 2,1%. Com base nestes dados, deve-se repensar o planejamento de políticas públicas para que haja a promoção e, sobretudo, a prevenção dos transtornos mentais que acometem a população infantil.The literature has indicated that the children population represents the majority of people who use mental health services. In this study, the objective is to characterize the profile of the children population who has looked for a mental health service in the town of Itajaí from 2002 to 2007. Data were collected from the documents of this population who attended the two mental health services.This study is a documentary, exploratory and descriptive one. The most frequent mental problens (28, 7%) of the cases were. Déficit of Attention and the Disruptive Behaviour, in this category the Deficit of Attention/hyperactivity, was the most frequent. The problem about behaviour, (13,3%) of data, are the relationship problems. Based on these data, it is extremely urgent to analyse and rethink Public Social Policies in the prevention of mental problems which affect the children population

Fatores de Risco para Câncer de Mama em Juiz de Fora (MG): um estudo caso-controle

O principal fator de risco (FR) para a ocorrência do câncer de mama (CM) é a idade avançada, porém fatores hormonais endógenos e exógenos, hereditariedade, fatores dietéticos e sociodemográficos se interagem na etiologia do CM. Nosso objetivo foi analisar os fatores de risco para câncer de mama em mulheres de nossa região. Foram entrevistados 80 casos e 76 controles, pareados por idade, consecutivos, de setembro de 2000 a maio de 2001. Os dados obtidos foram analisados pelo teste do qui-quadrado e posteriormente pelo modelo de regressão logística. Morar em zona rural foi a variável de risco mais significativa (p=0,0016) e ter tido quatro ou mais filhos mostrou-se como um fator de proteção (p=0,0094). Concluímos que entre as mulheres de nossa região, o fato de morar em zona rural está associado a maior risco de desenvolvimento de CM. Ter tido quatro ou mais filhos, por outro lado, é um fator de proteção

Recruitment characteristics and non-adherence associated factors of fibromyalgia patients in a randomized clinical trial : a retrospective survival analysis

Introduction: Fibromyalgia is a complex pain condition that affects mostly women. Given the disease's lack of understanding, patients report poor adherence to medication and mistrust of medical services. This study aims to describe the recruitment characteristics and non-adherence associated factors of fibromyalgia patients to an RCT. Methods: We performed a retrospective longitudinal analysis with data from our ongoing RCT. We investigated characteristics of subjects recruited, consented, and randomized. Adherence was studied using survival analysis techniques, and its associated factors were identified using Cox proportional hazards regression model. Results: 524 subjects were contacted, 269 were eligible, 61 consented and 40 subjects were randomized. Thirtyeight percent were non-adherent to the protocol with a median of visits of five. The recruitment survey reported that 90% would likely participate in RCTs, 52% had previous participation, and 19% were aware of RCTs by their physicians. Some barriers were investigator-related (staff's friendliness and receiving the results of their trial participation) and center-related (privacy-confidentiality issues and the institution's reputation), without difference between adherent and non-adherent participants. We report significant factors for non-adherence as VAS anxiety score of 5 or more (5.3 HR, p = 0.01), Body Mass Index (BMI) (0.91 HR, p = 0.041) and Quality of Life (QoL) – Personal development subdomain (0.89 HR, p = 0.046). Conclusion: Recruitment and adherence of fibromyalgia patients is a challenge; however, they seem eager to participate in RCTs. We recommend creating a comfortable, friendly and trusting environment to increase the recruitment rate. Higher anxiety, lower BMI and lower quality of life were associated with a higher attrition rate