Quality of Life analysis of patients in chronic use of oral anticoagulant: an observational study

<p>Abstract</p> <p>Background</p> <p>Treatment with oral anticoagulant may influence the quality of life perception as it promotes changes in the patient's life, not offering an evident symptomatic relief and presenting well defined risks, such as bleeding. In this trial, the influence of chronic use of anticoagulants on the quality of life perception has been analyzed in patients assisted at the anticoagulation outpatient unit.</p> <p>Methods</p> <p>The health related quality of life was evaluated through a cross-section study with a sample composed of 72 patients seen from July 23, 2009 to September 2, 2010 at the Anticoagulation Outpatient Unit of the Federal University of Bahia's University Hospital. The study's population was composed by patients with atrial fibrillation and mechanical heart valve. The patients were submitted to two quality of life evaluation questionnaires: a generic questionnaire - the Medical Outcomes Study SF-36 Health Survey (SF36) - and a specific questionnaire - the Duke Anticoagulation Satisfaction Scale (DASS).</p> <p>Results</p> <p>The quality of life perception of the patients studied, based on both the DASS and the SF36, was positive regarding the treatment with oral anticoagulant. The SF36 presented an average score of 62.2 (± 20.0). Among the SF36 evaluated domains, the physical-emotional aspect was the most compromised one regarding life quality perception. The DASS presented an average score of 67.1 (± 18.2) and the domain presenting a greater compromise was the one related to the treatment inconveniences (annoyances, burdens and obligations). Previous hemorrhagic event, comorbidities, drug interactions with medicines that increase the anticoagulant effect, lower education level in the SF36 and younger age group influence a more negative perception of the quality of life, whereas lower education level in the DASS and the duration of treatment for more than 1 year offer a more positive perception.</p> <p>Conclusion</p> <p>Patients seen at the anticoagulation outpatient unit of the University Hospital of Federal University of Bahia/Brazil had a positive perception of the treatment. Factors such as hemorrhagic event, comorbidities, drug interactions, education level, age group and duration of treatment have an influence on the quality of life perception.</p

Concorrência e pirataria na indústria fonográfica a partir dos anos 90

This work aims to determine the impact of independent recorders and fake products as a menace on the oligopoly power stability of transnational recorders (known as majors ). In the first part it s presented the characteristics and specific features of the phonographic industry, which will differentiate it from the other markets and contribute to the knowledge of the segment competitiveness. Following, one aims to identify, through the use of the ECD model of industrial organization, the main barriers to the entrance of independent recorders in a market dominated by the majors . At last, the access to advertisement and distribution media due to the Internet, like free music distribution programs, offers new competitiveness perspectives for the independent recorders and intensifies the fakeness in the segment, which provoked an unsatisfactory performance of the majors in the years 1990 and 2000.Esta dissertação propõe-se a determinar em que medida a concorrência das gravadoras independentes e a pirataria representam uma ameaça à estabilidade do poder de oligopólio das gravadoras transnacionais (as denominadas majors). Na primeira parte são apresentadas as características e especificidades da indústria fonográfica, que vão diferenciá-la dos outros mercados e contribuir para a compreensão da concorrência no setor. Em seguida procura-se identificar, a partir do modelo ECD da organização industrial, as principais barreiras à entrada das gravadoras independentes em um mercado dominado pelas majors. Por fim, o acesso aos meios de divulgação e distribuição possibilitados pela Internet, como os programas de distribuição gratuita de músicas, oferece novas perspectivas de concorrência para as gravadoras independentes e intensificam a pirataria no setor, provocando um desempenho insatisfatório das majors nos anos 90 e 2000

Economic evaluation of human albumin use in patients with nephrotic syndrome in four Brazilian public hospitals: pharmacoeconomic study

ABSTRACT CONTEXT AND OBJECTIVE: In 2004, the Brazilian National Health Surveillance Agency (Agência Nacional de Vigilância Sanitária, ANVISA) published a resolution establishing guidelines for albumin use. Although the published data do not indicate any definitive conclusions about the benefits of albumin use in patients with nephrotic syndrome (NS), the guidelines recommend this procedure only in cases of edema that is refractory to use of diuretics. The aim here was to analyze albumin use among patients with nephrotic syndrome. DESIGN AND SETTING: Pharmacoeconomic study conducted in four large public referral hospitals for nephrology services in northeastern Brazil. METHOD: Cost-effectiveness and cost-utility economic evaluations were performed on a concurrent cohort of patients with nephrotic syndrome, who were divided into two groups according to compliance or noncompliance with the guidelines. Quality-of-life data were obtained from the SF36 and CHQ-PF50 questionnaires. RESULTS: This study enrolled 109 patients (60% adults and 56% women); 41.3% were using albumin in accordance with the guidelines. The weight, diuresis and fluid balance parameters were more cost-effective for patients who adhered to the guidelines. Regarding days of hospitalization avoided, the incremental ratio showed a daily cost of R$55.33, and guideline-compliant patients were hospitalized for five days or fewer. The quality of life improved by 8$ 3,458.13/QALY (quality-adjusted life year) for the healthcare system were generated through guideline compliance. CONCLUSION: The economic analyses of this study demonstrated that there were greater cost benefits for patients whose treatment followed the guidelines