RESUMO
This paper presented a new approach to the calculation of quality-adjusted life years (QALY) based on multi-criteria decision-making (MCDM) methods and using the EQ-5D-5L questionnaire. The health status utility values were calculated through a hybrid methodology. We combined the analytic hierarchy process (AHP), the AHP with a D-number extended fuzzy preference relation (D-AHP), the fuzzy analytic hierarchy process (F-AHP), and the technique for order preference by similarity to the ideal solution (TOPSIS) to obtain individual and aggregated utility values. The preference data were elicited using a sample of individuals from a Colombian university. In all tested methods, the ordinal preferences were consistent, and the weights were compared using the Euclidean distance criterion (EDC). We identified F-AHP-TOPSIS as the optimal method; its benefits were associated with modeling the response options of the EQ-5D in linguistic terms, it gave the best approximation to the initial preferences according to EDC, and it could be used as an alternative to the known prioritization method. This hybrid methodology was particularly useful in certain medical decisions concerned with understanding how a specific person values his or her current health or possible health outcomes from different interventions in small population samples and studies carried out in low- and middle-low-income countries.
Assuntos
Tomada de Decisões Assistida por Computador , Nível de Saúde , Modelos Teóricos , Anos de Vida Ajustados por Qualidade de Vida , Feminino , Humanos , Masculino , Qualidade de Vida , Inquéritos e QuestionáriosRESUMO
Resumen En este artículo de investigación se analizó el proceso de adquisición tecnológica en las instituciones prestadoras de servicios de salud (IPS) en Colombia. Para este propósito se aplicó una metodología de diagnóstico empresarial denominada benchmarking en seis IPS del departamento de Antioquia (tanto del sector público como del sector privado), lo que permitió identificar las principales formas de adquirir tecnología biomédica, la priorización de las necesidades tecnológicas, los métodos empleados por las instituciones hospitalarias para la evaluación del equipamiento médico, las fuentes de identificación de necesidades, los requisitos legales y técnicos exigidos en el momento de la compra, así como la proporción de búsqueda de alertas nacionales e internacionales en bases de datos relacionadas con los dispositivos. De esta manera, se desarrolló un ejercicio de referenciación comparativa y competitiva como herramienta de gestión que promueve la caracterización e incorporación de las posibles mejores prácticas ejercidas por las clínicas y hospitales del país.
Abstract We analyzed in this research article the process of technology acquisition in Colombian health service provider institutions (IPS). For this purpose we applied a business assessment methodology called benchmarking in six different IPS of the Antioquia department (both in the public and private sectors). This allowed us to identify the main ways to acquire biomedical technology; the prioritization of technological needs; the methods used by hospitals to assess medical equipment; the sources for the identification of needs; the legal and technical requirements requested at the moment of purchase; and also the amount of searches performed regarding national and international alerts in databases related to the devices. In this way, we developed a comparative and competitive referencing work as a management tool promoting characterization and the inclusion of the possible practical improvements carried out by clinics and hospitals across the country.
Resumo Neste artigo de pesquisa foi analisado o processo de aquisição de tecnologia nas instituições que prestam serviços de saúde (IPS, pelas suas siglas em espanhol) na Colômbia. Para o efeito, foi aplicada uma metodologia de diagnóstico empresarial chamada de benchmarking em seis IPS do departamento de Antioquia (tanto do sector público como do privado), o que permitiu identificar as principais maneiras de adquirir tecnologia biomédica, a priorização das necessidades de tecnologia, métodos empregados pelos hospitais para avaliação de equipamentos médicos, fontes de identificação das necessidades, requerimentos legais e técnicos necessários no momento da compra, assim como a proporção de procura de alarmes nacionais e internacionais em bases de dados relacionadas com dispositivos. Assim, um exercício de avaliação comparativa e competitiva foi desenvolvido como ferramenta de gestão que promove a caracterização e incorporação da possível melhor prática exercida por clínicas e hospitais do pais.
RESUMO
The taxonomic history of the genus Lagothrix is complex, with molecular and morphological assessments giving conflicting results for the separation between its taxa. Phylogeographic studies of the most widely distributed species, Lagothrix lagotricha, have only been attempted recently and are limited to few individuals per collection site, many of which were captive making their geographical origin dubious. There is debate regarding the possibility of raising subspecies of Lagothrix lagotricha to the species level, therefore the geographical origin of samples is particularly relevant. In the present work we revisit the intraspecific phylogeography of L. lagotricha from northwestern South America, including the subspecies L. l. poeppiggi, L. l. lagotricha and L. l. lugens (sensu Fooden, 1963), using DNA sequence data from hypervariable region I of the mitochondrial control region (D-loop HVI). Our results suggest a complex picture in which there are well delimited evolutionary units that, nonetheless, do not correlate well with the morphological variation used to support the current delimitation of taxa. Additionally, we corroborate previous results showing a lack of reciprocal monophyly between the putative subspecies of Lagothrix lagotricha, and we propose that this may be due to ancestral polymorphism that has been maintained following the recent spread of woolly monkeys throughout the western Amazonian lowlands and into the inter-Andean region of Colombia.
Assuntos
Atelinae/classificação , Evolução Biológica , Filogenia , Animais , Atelinae/genética , Colômbia , DNA Mitocondrial/genética , Haplótipos , Filogeografia , Análise de Sequência de DNA , América do SulRESUMO
Objetivo. Describir las características del consumo de tabaco en los estudiantes de enfermería de la Universidad de Antioquia. Metodología. Estudio descriptivo de 435 estudiantes de enfermería. Se utilizó un formulario autoaplicado para reporte de información de las variables de estudio. Resultados. La prevalencia de vida de consumo de tabaco fue 39.5%, (14.4% actual y 25.1% exfumadores), el 15.4% de los fumadores tiene alto riesgo de adicción a la nicotina. Uno de cada cuatro fumadores inició el hábito en la universidad. Durante los últimos 12 meses cuatro de cada cinco fumadores han intentado dejar el consumo de tabaco y tres de cada cinco tiene la firme intención de dejar de fumar. La tasa de cesación del hábito fue 63.8%. El 98.2% de los estudiantes no está de acuerdo con que el enfermero fume. Conclusión. El consumo de tabaco en estudiantes de enfermería, aunque no es de gran magnitud, es un problema que merece atención de los organismos encargados de los programas de bienestar universitario.
Objective. To describe the tobacco consumption characteristics in nursing students of the University of Antioquia. Methodology. 435 nursing students descriptive study. A self applied form was used to report the information of the study variables. Results. The life prevalence of cigarette consumption was 39.5%, (14.4% current and 25.1% former smokers), 15.4% of smokers are at high risk of nicotine addiction. One out of four smokers started the habit at university. During the last 12 months four out of five smokers have tried to quit smoking and three out of five have the intention to quit smoking. The smoking cessation rate was 63.8%. 98.2% of the students disagree with the fact that nurses smoke. Conclusion. Cigarette consumption among nursing students although is Invest Educ Enferm 2010;28(3) / 371 not of great magnitude, it is a problem that require special attention from the agencies responsible for the universitys welfare programs.
Objetivo. Descrever as características do consumo de fumo nos estudantes de enfermagem da Universidade de Antioquia. Metodologia. Estudo descritivo de 435 estudantes de enfermagem. Utilizou-se um formulario auto-aplicado pára reporte de informação das variáveis de estudo. Resultados. A prevalência de vida de consumo de fumo foi 39.5%, (14.4% atual e 25.1% ex-fumadores), o 15.4% dos fumantes tem alto risco de vício à nicotina. Um de cada quatro fumantes iniciou o hábito na universidade. Durante os últimos 12 meses quatro de cada cinco fumantes tentaram deixar o consumo de fumo e três de cada cinco tem a firme intenção de deixar de fumar. A taxa de cessação do hábito foi 63.8%. O 98.2% dos estudantes não está de acordo com que o enfermeiro fume. Conclusão. O consumo de fumo em estudantes de enfermagem, ainda que não é de grande magnitude, é um problema que merece atendimento dos organismos encarregados dos programas de bem-estar universitário.
Assuntos
Humanos , Estudantes de Enfermagem , Prevalência , TabagismoRESUMO
There is a controversy regarding how many species the genus Lagothrix contains, since the Lagothrix lagothricha subspecies have been recently proposed to be actual species. Clarification of species status is of particular importance in the case of L. l. lugens, because it is the most endangered and its distribution is restricted to the Colombian Andes, a highly deforested region. Using cytogenetic and molecular markers, we obtained evidence indicating that the subspecies status is appropriate for the two taxa occurring in this country. We also report high levels of intraspecific variability in the karyotype. We find evidence for a late Pleistocene separation of the subspecies, and we propose it is the limited area of contact between the taxa that allowed for them to partially differentiate.