RESUMO
OBJECTIVES: To conduct an economic evaluation of intracranial pressure (ICP) monitoring on the basis of current evidence from pediatric patients with severe traumatic brain injury, through a statistical model. METHODS: The statistical model is a decision tree, whose branches take into account the severity of the lesion, the hospitalization costs, and the quality-adjusted life-year for the first 6 months post-trauma. The inputs consist of probability distributions calculated from a sample of 33 surviving children with severe traumatic brain injury, divided into two groups: with ICP monitoring (monitoring group) and without ICP monitoring (control group). The uncertainty of the parameters from the sample was quantified through a probabilistic sensitivity analysis using the Monte-Carlo simulation method. The model overcomes the drawbacks of small sample sizes, unequal groups, and the ethical difficulty in randomly assigning patients to a control group (without monitoring). RESULTS: The incremental cost in the monitoring group was Mex$3,934 (Mexican pesos), with an increase in quality-adjusted life-year of 0.05. The incremental cost-effectiveness ratio was Mex$81,062. The cost-effectiveness acceptability curve had a maximum at 54% of the cost effective iterations. The incremental net health benefit for a willingness to pay equal to 1 time the per capita gross domestic product for Mexico was 0.03, and the incremental net monetary benefit was Mex$5,358. CONCLUSIONS: The results of the model suggest that ICP monitoring is cost effective because there was a monetary gain in terms of the incremental net monetary benefit.
Assuntos
Lesões Encefálicas Traumáticas , Análise Custo-Benefício , Pressão Intracraniana/fisiologia , Modelos Estatísticos , Monitorização Fisiológica , Lesões Encefálicas Traumáticas/terapia , Criança , Técnicas de Apoio para a Decisão , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Masculino , México , Monitorização Fisiológica/métodos , Monitorização Fisiológica/normas , Pediatria , Anos de Vida Ajustados por Qualidade de VidaRESUMO
OBJECTIVE: Biomarkers of pesticide toxicity and paraoxonase 1 (PON1) phenotype and genotypes were evaluated in indigenous Mexican farmworkers exposed mainly to organophosphate (OP) pesticides. METHODS: Acetylcholinesterase, butyrylcholinesterase, and PON1 activities--arylesterase and CMPAase activities--were evaluated spectrophotometrically. PON1 55 and 192 polymorphisms were determined by real-time polymerase chain reaction. Hematological parameters were evaluated using a cytometer. RESULTS: Butyrylcholinesterase and arylesterase activities were lower in farmworkers, who also showed lower levels of leukocytes but higher percentages of lymphocytes when compared with the nonexposed group. Our results showed a high frequency of OP, high hydrolysis-related PON1 alleles (LL/QR and LL/RR) in the study population. An association was observed between CMPAase activity and PON1Q192R polymorphism. CONCLUSIONS: Our results suggest that pesticide exposure modifies biochemical and hematological biomarkers in the study population, and that the phenotype of PON1 (CMPAase) is a sensible susceptibility biomarker of OP pesticide toxicity.
Assuntos
Agricultura , Arildialquilfosfatase/sangue , Arildialquilfosfatase/genética , Hidrolases de Éster Carboxílico/sangue , Inseticidas/toxicidade , Exposição Ocupacional/efeitos adversos , Organofosfatos/toxicidade , Acetilcolinesterase/sangue , Adolescente , Adulto , Biomarcadores/sangue , Contagem de Células Sanguíneas , Butirilcolinesterase/sangue , Estudos Transversais , Feminino , Genótipo , Hematócrito , Hemoglobinas/metabolismo , Humanos , Masculino , México , Pessoa de Meia-Idade , Resíduos de Praguicidas/toxicidade , Fenótipo , Polimorfismo de Nucleotídeo Único , Adulto JovemRESUMO
OBJECTIVE: This study evaluates the effects of exposure to pesticides on the health of pesticide retailers. METHODS: The study population comprised 83-male pesticide retailers and 98 controls. Serum butyrylcholinesterase levels and complete blood analysis were performed in a certified laboratory and each subject completed a structured questionnaire. RESULTS: Butyrylcholinesterase activity and hematological parameters such as hemoglobin and hematocrit were significantly lower in pesticide retailers than in control subjects. In contrast, platelet count as well as hepatic parameters such as glutamic-pyruvate transaminase and gamma-glutamyl transpeptidase activities was higher in pesticide retailers. Furthermore, pesticide retailers experienced burning sensations in the skin more frequently than controls. CONCLUSIONS: These preliminary results suggest the importance of evaluating further toxicological biomarkers in these populations.