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BACKGROUND: Novel and highly effective drugs for non-melanoma skin cancer (NMSC) improve patient outcomes, but their high cost strains healthcare systems. Spain's decentralized public health system, managed by 17 autonomous communities (AaCc), raises concerns about equitable access. METHODS: A cross-sectional survey (July-September 2023) was sent to Spanish Multidisciplinary Melanoma Group (GEM Group) members to assess access to new drugs. FINDINGS: Fifty physicians from 15 Spanish AaCc responded to the survey. Access for drug with approved public reimbursement, Hedgehog inhibitors in basal-cell carcinoma and anti PD-L1 antibody in Merkel carcinoma, was observed in 84% and 86% of centers, respectively. For other EMA-approved treatments, but without reimbursement in Spain access decreased to 78% of centers. Heterogeneity in access was mainly observed intra regions. CONCLUSION: Unequal financial support for drugs for NMSC with creates a patchwork of access across Spanish hospitals, with variations even within the same AaCc.
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BACKGROUND: The development of highly active drugs has improved the survival of melanoma patients, but elevated drug prices place a significant burden on health care systems. In Spain, the public health care system is transferred to the 17 autonomous communities (AACC). The objective of this study is to describe the situation of drug access for melanoma patients in Spain and how this decentralized system is affecting equity. METHODS: From July to September 2023, a cross-sectional survey was sent to members of the Spanish Multidisciplinary Melanoma Group (GEM Group). The questionnaire consulted about the real access to new drugs in each hospital. The responses were collected anonymously and analyzed according to several variables, including the AACC. RESULTS: The survey was answered by 50 physicians in 15 AACC. No major differences on access between AACC were observed for indications that are reimbursed by the Spanish Health Care System (adjuvant immunotherapy for stage IIIC-IIID and resected stage IV melanoma). Important differences in drug access were observed among AACC and among centers within the same AACC, for most of the EMA indications that are not reimbursed (adjuvant immunotherapy for stages IIB-IIC-IIIA-IIIB) or that are not fully reimbursed (ipilimumab plus nivolumab in advanced stage). Homogeneously, access to adjuvant targeted drugs, TIL therapy and T-VEC, is extremely low or non-existing in all AACC. CONCLUSIONS: For most indications that reimbursement is restricted out of the EMA indication, a great diversity on access was found throughout the different hospitals in Spain, including heterogeneity intra-AACC.
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Accesibilidad a los Servicios de Salud , Melanoma , Humanos , Melanoma/tratamiento farmacológico , Estudios Transversales , España , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Encuestas y Cuestionarios , Neoplasias Cutáneas/tratamiento farmacológico , Antineoplásicos/uso terapéutico , Antineoplásicos/economía , Ipilimumab/uso terapéutico , Nivolumab/uso terapéutico , Nivolumab/economía , InmunoterapiaRESUMEN
OBJECTIVE: Studies on psychological violence in the workplace (PVW) in Latin America have focused on incidence values. In contrast, studies on preventive interventions (PIs) in the health sector are very limited. Our objective was to determine to what extent there is consensus on the most relevant characteristics of the psychosocial interventions applied in the prevention of PVW in health institutions in Peru. To that end, health professionals with knowledge and experience in PVW at the national level were recruited, and the Delphi consensus technique was applied. RESULTS: The consensus study was developed in four stages that included three phases of Delphi consultation. In the third consultation phase, 428 experts participated in 25 analysis groups from 66 health institutions in the country. A total of 70.3% of the participants were women, and 27.6% of the participants worked in nursing and emergency services. After the Delphi consensus analysis, we obtained a list of 10 hierarchical psychosocial interventions to prevent PVW in the country. Most notable were interventions based on the prior resolution of interprofessional conflicts, on the visibility of incidents to generate an inverse effect and on experiential training to improve assertive and empathic communication skills.
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Intervención Psicosocial , Lugar de Trabajo , Humanos , Femenino , Masculino , Técnica Delphi , Consenso , ViolenciaRESUMEN
Objetivo: Identificar las características de la alimentación de niños y adolescentes desnutridos con acidosis. Métodos: Estudio observacional, transversal controlado en 20 pacientes con diagnóstico de desnutrición, menores de 15 años de edad. Se dividieron en dos grupos: A. 12 pacientes con acidosis metabólica y B: 8 pacientes sin acidosis metabólica. Se evaluó la alimentación por recordatorio de 24 horas durante 7 días consecutivos y frecuencia de consumo. Se realizaron evaluación clínica y antropométrica, gases venosos, electrolitos y química sanguínea, uroanálisis y hematología completa. Resultados: En relación al consumo de macronutrientes no se encontraron diferencias estadísticamente significativas entre ambos grupos. La talla presentó un z-score negativo mayor en los desnutridos con acidosis metabólica: -1,15±0,73 vs -0,21±1,18. (p=0,04). Los desnutridos con acidosis metabólica presentaron mayor consumo de queso, leche completa, carnes rojas y un menor consumo de frutas, vegetales y leguminosas. Los pacientes desnutridos sin acidosis metabólica presentaron un consumo mayor de frutas, vegetales, verduras y leguminosas y menor consumo de huevo, carnes rojas y leche completa. Los desnutridos con acidosis metabólica consumieron mayor cantidad de aminoácidos no volátiles con mayor potencial de carga acida como la metionina y cisteína; esta diferencia entre ambos grupos fue significativa: p=0,000 para metionina y p=0,030 para cisteína. Conclusiones: La alimentación de los pacientes desnutridos con acidosis metabólica fue diferente, con mayor consumo de aminoácidos no volátiles que la de los desnutridos sin acidosis metabólica. Esta mayor ingesta de aminoácidos no volátiles podría explicar la generación de acidosis metabólica en algunos pacientes desnutridos.
Objective: To identify the feeding characteristics of malnourished children with metabolic acidosis. Methods: Observational, crosssectional study in 20 patients under 15 years of age with diagnosis of malnutrition. The patients were divided into two groups: A: 12 children with metabolic acidosis and B: 8 children with no metabolic acidosis. Food intake was evaluated by a 24 hours reminder during 7 consecutive days and frequency of consumption. Anthropometric data, venous gases, serum electrolytes, blood chemistry, urine analysis and complete blood count were analyzed. Results: Nutrient intake showed statistical difference between the two groups. Height was significantly lower in malnourished children with metabolic acidosis than in children with no metabolic acidosis: z score -1,15±0,73 vs -0,21±1,18 (p=0,04). Children with metabolic acidosis had increased intake of cheese, milk, red meat and low consumption of fruits, vegetables and legumes. Children with no metabolic acidosis had a high intake of fruits, vegetables and legumes and low consumption of eggs, red meat and milk. Although energy, protein, fat and carbohydrate intake was higher in children with metabolic acidosis, the difference was not significant. Malnourished children with metabolic acidosis consumed higher amount of non-volatile amino acids with greater potential acid load such as methionine and cysteine. This difference in both amino acids intake between the two groups was significant (p=0.000 for methionine and p=0,030 for cysteine). Conclusions: Intake of non volatile aminoacids was higher in malnourished children with metabolic acidosis. This difference may explain the generation of metabolic acidosis in some malnourished patients.