RESUMEN
PIP: This essay introduces a series of articles in which authors from Brazil, China, the Netherlands, and New Zealand describe their health care system. The juxtaposition of these four case studies reveals how different systems confront common problems. The four systems use widely differing combinations of the same financing tactics, and all are engaged in limiting inefficient increases in health services expenditures. Thus, they face the common problem of obtaining sufficient knowledge to convince health care professionals and the public that they have the ability to eliminate less cost-effective procedures and control the pace of medical innovation. This series also illustrates how the economic differences between countries result in different resource allocations for health care expenditures. The case studies underscore the fact that health systems must mount a country-specific response to common health challenges. Thus, health care providers must provide the most cost-effective, equitable, and acceptable health care possible within the parameters of their society.^ieng
Asunto(s)
Atención a la Salud/organización & administración , Planificación en Salud/organización & administración , Política de Salud , Adolescente , Adulto , Anciano , Brasil , Niño , Preescolar , China , Economía , Femenino , Infecciones por VIH/prevención & control , Humanos , Lactante , Recién Nacido , Masculino , Países Bajos , Nueva Zelanda , Valores SocialesRESUMEN
The aim of the study was to describe survival patterns of Southern Brazilian AIDS patients: 224 predominantly working class AIDS patients were treated in an AIDS referral centre in Porto Alegre between October 1986 and September 1991. The caseload increased progressively, as did the number of female AIDS cases treated at the Hospital during the study period. Self-referred patients were more likely to present with an AIDS defining condition (P < 0.03) and they (n = 106) had significantly worse survival patterns compared with patients referred by other health care professionals (n = 112; P < 0.04). Median survival from the time of AIDS diagnosis was 5 months which did not change significantly during the study period (P = 0.38). Patients (n = 42) presenting with opportunistic infections other than mycobacterial disease (n = 42), Pneumocystis carinii pneumonia (n = 37) or candidiasis (n = 18), had significantly worse survival patterns (P = 0.001). Patients treated with zidovudine (n = 33) survived significantly longer from time of AIDS diagnosis than those not on zidovudine (n = 185; P = 0.0002). No significant survival differences were observed from time of AIDS diagnosis between those who commenced on zidovudine before developing AIDS (n = 17) and those who were treated with zidovudine since diagnosed with AIDS (n = 16; P = 0.80). During the study period zidovudine was only available through private prescriptions. Survival of Southern Brazilian AIDS patients has not improved: earlier access to HIV-related services and the provision of effective and affordable therapeutic interventions are two measures which could improve future survival patterns.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/mortalidad , Infecciones Oportunistas Relacionadas con el SIDA/terapia , Síndrome de Inmunodeficiencia Adquirida/mortalidad , Síndrome de Inmunodeficiencia Adquirida/terapia , Vigilancia de la Población , Pautas de la Práctica en Medicina , Adulto , Brasil/epidemiología , Causas de Muerte , Prescripciones de Medicamentos , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Estudios Prospectivos , Derivación y Consulta , Factores de Riesgo , Tasa de Supervivencia , Factores de Tiempo , Resultado del Tratamiento , Carga de Trabajo , Zidovudina/provisión & distribución , Zidovudina/uso terapéuticoRESUMEN
In order to describe the changing patterns of risk factors for HIV-1 transmission of patients using hospital services at an AIDS referral centre in Porto Alegre, southern Brazil, data on demographic characteristics, referral patterns and risk factors at time of first presentation were collected prospectively on 405 patients between October 1985 and September 1991. Overall HIV-related patient workload increased during the study period, as did the proportion of infected female patients seen (P < 0.05). Of all patients, 147 (36%) presented with symptomatic HIV disease and 77 (19%) presented with an AIDS defining condition; men were more likely to present with symptomatic disease than women. Approximately 156 (44%) of men were self-referred compared with 4 (8%) of the women (P < 0.0001). Of the 357 infected men, 82 (23%) were bisexuals; of the 26 heterosexually infected women, 7 (24%) had bisexual male partners. These data suggest the increasing importance of heterosexual HIV transmission in this hitherto 'low' prevalence area, with male bisexuals constituting an important route through which heterosexual females are being infected in this area. The data also suggest that heterosexual women in Southern Brazil do not perceive themselves to be at risk for HIV-1 infection.
PIP: Unprotected homosexual intercourse and IV drug use were originally described as the predominant routes of HIV transmission in South America. Recent data, however, indicate that heterosexual transmission is becoming increasingly important in the region. With the goal of describing the changing patterns of risk factors for HIV-1 transmission, the authors collected prospectively data on demographic characteristics, referral patterns, and risk factors of patients at the time of first presentation to hospital services at an AIDS referral center in Porto Alegre, southern Brazil. The 357 male and 48 female patients presented over the period October 1985-September 1991. The overall HIV-related patient workload increased during the study period, as did the proportion of infected female patients. 44% of the men and 8% of women were self-referred. 36% of patients presented with symptomatic HIV disease and 19% with an AIDS-defining condition, with the men more likely than women to present with symptomatic disease. 23% of the infected men were bisexual; 24% of the heterosexually infected women had bisexual male partners. These findings suggest the importance of heterosexual HIV transmission in this area, with male bisexuals serving as an important route through which heterosexual females are being infected in the area. The data also suggest that heterosexual women in southern Brazil do not perceive themselves as being at risk for HIV-1 infection.
Asunto(s)
Infecciones por VIH/transmisión , VIH-1 , Adulto , Actitud Frente a la Salud , Brasil/epidemiología , Distribución de Chi-Cuadrado , Demografía , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/psicología , Humanos , Masculino , Percepción , Estudios Prospectivos , Derivación y Consulta , Análisis de Regresión , Factores de Riesgo , Conducta SexualRESUMEN
In this multicenter study 191 practitioners treated 532 patients with coronary artery disease and chronic stable angina pectoris by isosorbide-5-mononitrate (IS-5-MN), 20 mg 2-3 times daily. At the end of this period the frequency of anginal attacks was reduced by 83% and nitroglycerin consumption by 85.7% (p less than 0.0001). 40.1% of the patients categorized this treatment as very good, 28.6% as excellent and 23% as good. Serious adverse effects were observed in 2% of the patients and 6.4% of the patients discontinued treatment during the study because of inefficacy, infarction, death, or adverse effects. At the end of the study 90.2% of the patients were still on IS-5-MN. In conclusion, IS-5-MN is an effective treatment for patients with chronic stable angina pectoris. It is well tolerated, with minimal side effects.