RESUMO
Introducción: Ante el COVID-19 se reorganizaron hospitales en el sistema de salud de Paraguay donde el financiamiento predominante es el gasto de bolsillo. Objetivos: Analizar el gasto de bolsillo en el hospital respiratorio integrado de Encarnación. Materiales y métodos: Estudio cuantitativo, observacional, descriptivo entre agosto 2020 y febrero 2021. Incluyó una muestra no aleatoria de 95 casos. Se aplicó una encuesta telefónica a un informante clave. Las variables dependientes fueron: gasto de bolsillo, razón gasto/ingreso y razón gasto/días de internación. Las independientes fueron: sexo, adulto mayor, ingreso a UTI, seguro médico y diagnóstico de COVID-19. El gasto excesivo se definió como mayor a 0,1 del ingreso y el catastrófico como mayor a 0,25 del ingreso. La asociación significativa se determinó mediante pruebas de Chi2 y Mann-Whitney (p<0,05). Resultados: El 97,8% tuvo gasto de bolsillo principalmente por medicamentos y descartables. El gasto total promedio fue 1,98 millones Gs, el gasto diario promedio 215,4 mil Gs y la razón gasto/ingreso 1,13. En cuidados intensivos el gasto total promedio fue 7,18 millones Gs (el máximo fue 18,41 millones Gs), el gasto diario promedio 666,8 mil Gs (el máximo fue 2,85 millones Gs diarios) y la razón gasto/ingreso 3,83. El gasto fue excesivo en el 87% de los casos y catastrófico en el 52% de los casos. El gasto se asoció significativamente con la edad mayor a 60 años, el haber ingresado a UTI y el diagnóstico de COVID-19, no así con el sexo ni con la tenencia de seguro. Conclusión: Los mecanismos de protección financiera fueron insuficientes para evitar gastos excesivos y catastróficos durante la hospitalización.
Introduction: Faced with COVID-19, hospitals were reorganized in the Paraguayan health system where the predominant financing is out-of-pocket expenses. Objectives: To analyze the out-of-pocket expenditure in the Encarnacion integrated respiratory hospital. Materials and methods: Quantitative, observational, descriptive study between August 2020 and February 2021. It included a non-random sample of 95 cases. A telephone survey was applied to a key informant. The dependent variables were: out-of-pocket expense, expense / income ratio, and expense / hospital days ratio. The independent ones were: sex, elderly, admission to ICU, medical insurance and diagnosis of COVID-19. Excessive spending was defined as greater than 0.1 of income and catastrophic as greater than 0.25 of income. The significant association was determined by Chi2 and Mann-Whitney tests (p <0.05). Results: 97.8% had out-of-pocket expenses mainly for medications and disposables. The average total expense was Gs 1.98 million, the average daily expense was Gs 215.4 thousand and the expense / income ratio was 1.13. In intensive care, the average total expenditure was 7.18 million Gs (the maximum was 18.41 million Gs), the average daily expenditure was 666.8 thousand Gs (the maximum was 2.85 million Gs per day) and the expense / income ratio 3.83. The expense was excessive in 87% of the cases and catastrophic in 52% of the cases. The expense was significantly associated with age over 60 years, having been admitted to the ICU and the diagnosis of COVID-19, not with sex or with insurance. Conclusion: The financial protection mechanisms were insufficient to avoid excessive and catastrophic expenses during hospitalization.
Assuntos
COVID-19 , Gastos em Saúde , Hospitais , PessoasRESUMO
BACKGROUND: Imported strongyloidiasis is increasingly being diagnosed in non-endemic areas. The aim of this study was to describe the epidemiological, clinical and microbiological characteristics of patients with imported strongyloidiasis in Spain. METHODOLOGY: This is an observational retrospective study that included all patients diagnosed of strongyloidiasis registered in the +REDIVI Collaborative Network from 2009 to 2017. Demographic, epidemiological and clinical information was collected from the +REDIVI database, and extra information regarding microbiological techniques, treatment and follow-up was requested to participant centers. FINDINGS: Overall, 1245 cases were included. Most of them were immigrants (66.9%), and South America was the most frequent area of origin. Detection of larvae in stool samples was observed in 21.9% of the patients, and serological tests allowed making the diagnosis in the rest of the cases. Eosinophilia was present in 82.2% of cases. Treatment with ivermectin (compared with albendazole) was the most strongly associated factor to achieve the cure (OR 2.34). CONCLUSIONS: Given the long latency of the infection and the risk of developing a severe presentation, screening of S. stercoralis infection should be mandatory in patients coming from or had traveling to endemic areas, especially in those with immunosuppressant conditions.
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Anti-Helmínticos/uso terapêutico , Estrongiloidíase/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Albendazol/uso terapêutico , Animais , Criança , Pré-Escolar , Emigrantes e Imigrantes/estatística & dados numéricos , Eosinofilia/etiologia , Feminino , Humanos , Lactente , Ivermectina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , América do Sul , Espanha/epidemiologia , Strongyloides stercoralis/efeitos dos fármacos , Strongyloides stercoralis/isolamento & purificação , Strongyloides stercoralis/fisiologia , Estrongiloidíase/complicações , Estrongiloidíase/diagnóstico , Estrongiloidíase/parasitologia , Viagem , Adulto JovemRESUMO
OBJECTIVES: Imported Chagas disease (CD) is an emerging health problem in Europe due to immigration from endemic countries. Although WHO currently recommends two different serological methods to establish diagnosis, new tools like the ARCHITECT Chagas assay have potential for use as a single diagnostic test. Our objective was to determine an optimal signal-to-cut-off (S/CO) value for the ARCHITECT Chagas assay to diagnose CD with a single test. METHODS: A retrospective study conducted at the 12 de Octubre University Hospital (Madrid, Spain). All patients with requests for Chagas screening between January 2014 and August 2017 were consecutively included. All samples were routinely tested with the ARCHITECT assay. Negative samples (S/CO < 0.8) required no further testing. Immunochromatographic testing (ICT) and/or indirect immunofluorescence (IFI) was used to confirm samples with S/CO ≥ 0.8. Receiver operator characteristic (ROC) curve analysis determined the ARCHITECT S/CO value that yielded 100% specificity and positive predictive value. SPSS software, version 22.0 was used for data analysis. RESULTS: A total of 4153 samples were analysed; 361 (8.69%) gave a reactive ARCHITECT Chagas result. 261/361 (72.3%) were women; median age was 38 years old (2-79). 92.8% were Bolivian. A total of 307 (85.0%) were confirmed as cases of Chagas; 52 (14.4%) were not infected; two (0.6%) were not evaluable. Seroprevalence was 7.39%. An S/CO ≥ 3.80 yielded 100% specificity (95% confidence interval [CI], 0.93-1.00) and 100% positive predictive value (95% CI, 0.99-1.00). CONCLUSIONS: Using S/CO ≥ 3.80, the ARCHITECT Chagas could be used as a single test for diagnosis of chronic CD in Bolivian immigrants. Patients with S/CO between 0.80 and 3.80 would require additional testing.