Background The aim of this study was to assess the risk of readmission in patients with severe mental disorders, compare it between patients using different types of antipsychotics and determine risk factors for psychiatric readmission. Methods Medical records of a non-concurrent cohort of 625 patients with severe mental disorders (such as psychoses and severe mood disorders) who were first discharged from January to December 2012 (entry into the cohort), with longitudinal follow-up until December 2017 constitute the sample. Descriptive statistical analysis of characteristics of study sample was performed. The risk factors for readmission were assessed using Cox regression. Results Males represented 51.5% of the cohort, and 75.6% of the patients had no partner. Most patients (89.9%) lived with relatives, and 64.7% did not complete elementary school. Only 17.1% used more than one antipsychotic, 34.2% did not adhere to the treatment, and 13.9% discontinued the medication due to unavailability in public pharmacies. There was a need to change the antipsychotic due to the lack of therapeutic response (11.2% of the patients) and adverse reactions to the antipsychotic (5.3% of the patients). Cox regression showed that the risk of readmission was increased by 25.0% (RR, 1.25; 95% CI, 1.03–1.52) when used typical antipsychotics, compared to those who used atypical ones, and by 92.0% (RR, 1.92; 95% CI, 1.63–2.27) when patients did not adhere to maintenance treatment compared to those who adhered. Conclusions Use of atypical antipsychotics and adherence to treatment were associated with a lower risk of psychiatric readmissions.

O objetivo é avaliar a efetividade clínica das diferentes coberturas tópicas empregadas no tratamento de pacientes com lesão por pressão internados em um hospital público, no período de fevereiro de 2015 a fevereiro de 2017. Trata-se de uma coorte não concorrente com dados de um hospital de médio porte. O teste de Mann-Whitney foi adotado para comparar o tempo de cicatrização entre os antimicrobianos empregados. Foram acompanhados 107 pacientes que apresentaram 820 lesões por pressão. O tempo médio de cicatrização das LP foi de 73±86 dias. Das coberturas empregadas no tratamento, a convencional (39,9%) e o hidrocoloide (21,9%) foram as mais utilizadas. Não foi encontrada diferença significativa de efetividade entre as coberturas antimicrobianas. É necessária a formulação de um protocolo de tratamento que considere a qualidade de vida do paciente, a relação de custoefetividade e o impacto orçamentário das alternativas, pois não houve diferença na efetividade clínica. Descritores: Lesão por Pressão, Efetividade, Avaliação de Resultado de Intervenções Terapêuticas.   Effectiveness of dressings to treat patients with pressure injuries Abstract: The objective is to evaluate the clinical effectiveness of the different topical bandages used in the treatment of patients with pressure injuries admitted to a public hospital, from February 2015 to February 2017. This is a non-concurrent cohort with data from a hospital medium-sized. The Mann-Whitney test was used to compare the healing time between the antimicrobials used. We followed 107 patients who presented 820 pressure. The mean healing time for pressure injury was 73 ± 86 days. Of the dressings used in the treatment, conventional (39.9%) and hydrocolloid (21.9%) were the most used. There was no significant difference in effectiveness between the antimicrobial dressings. It is necessary to formulate a treatment protocol that considers the patient's quality of life, the cost-effectiveness and the budgetary impact of the alternatives, as there was no difference in clinical effectiveness. Descriptors: Pressure Injury, Effectiveness, Result Evaluation of Therapeutic Interventions.   Efectividad de los apósitos para el tratamiento de pacientes con lesiones por presión Resumen: El objetivo es evaluar la efectividad clínica de diferentes apósitos tópicos utilizados en el tratamiento de pacientes con lesiones por presión ingresados en un hospital público, desde febrero de 2015 a febrero de 2017. Se trata de una cohorte no concurrente con datos de un hospital de tamaño medio. Se utilizó la prueba de Mann-Whitney para comparar el tiempo de curación entre los antimicrobianos utilizados. Se siguió a 107 pacientes que presentaban 820 lesiones por presión. El tiempo medio de curación de PL fue de 73 ± 86 días. De los apósitos utilizados en el tratamiento, los más utilizados fueron los convencionales (39,9%) y los hidrocoloides (21,9%). No hubo diferencias significativas en la efectividad entre los apósitos antimicrobianos. Es necesario formular un protocolo de tratamiento que considere la calidad de vida del paciente, la rentabilidad y el impacto presupuestario de las alternativas, ya que no hubo diferencia en la efectividad clínica. Descriptores: Lesión por Presión, Eficacia, Evaluación de Resultados de Intervenciones Terapéuticas.

IntroductionThe Zika virus is a newly emerging infection associated with increasingly large outbreaks especially in countries such as Brazil where an estimated 326,224 cases were confirmed between 2015 and 2018. Common symptoms associated with Zika include headache, conjunctivitis, fever, erythema, myalgia, vomiting, diarrhea, and abdominal pain. However, the symptoms are usually self-limiting and last on average for 4 to 7 days, with patients typically not accessing the public healthcare system (SUS). In severe cases, symptoms include neurological disorders and neonatal malformations. A future Zika vaccine can contribute to decreasing the number of cases and associated complications. However, this has to be balanced against continuing costs to control this and other vector borne diseases. Consequently, information about consumers’ willingness to pay (WTP) for a hypothetical Zika vaccine can help with price setting discussions in Brazil starting with the private market before being considered within SUS.MethodsA cross-sectional study was conducted among residents in one of the main provinces of Brazil (Minas Gerais) regarding their WTP for a hypothetical Zika vaccine with agreed characteristics. This included a mean effective protection of 80 percent, with the possibility of some local and systemic side-effects. The discussed price was USD 56.41 (BRL 180.00) per vaccination as this figure was utilized in a previous WTP study for a dengue vaccine.ResultsFive hundred and seventeen people were interviewed. However, thirty would not be vaccinated even if the vaccine was free. Most of the resultant interviewees (489) were female (58.2 percent), were employed (71.2 percent), had private health insurance (52.7 percent), had household incomes above twice the minimum wage (69.8 percent) and did not have Zika (96.9 percent). The median individual maximum WTP for this hypothetical Zika vaccine was USD 31.34 (BRL 100.00).ConclusionsWTP research can contribute to decision-making about possible prices alongside other economic criteria once a Zika vaccine becomes available in Brazil alongside other programmes to control the virus.

No abstract

Introduction:Schizophrenia is a chronic debilitating condition characterized by disorders in thought, affect and behavior. The worldwide prevalence is around 0.3 to 1 percent. The pharmacological treatment is based on antipsychotic drugs, but their efficacy is limited, culminating in discontinuation of treatment, relapses, and readmissions to health services. Quetiapine was initially approved for use in the United States of America in 1997. The drug has moderate affinity for D2 and 5-HT2A receptors and high affinity for H1 receptors. This study aimed to conduct an assessment of the cost-utility of quetiapine for schizophrenia around the world.Methods:Cost-utility studies of head-to-head comparisons of quetiapine against other antipsychotic drugs for the treatment of patients with schizophrenia and related disorders were included, irrespective of the diagnostic criteria used. An electronic search on Medline, Lilacs, Center for Reviews and Dissemination, The Cochrane Library and PsycINFO was conducted and complemented by references of included studies, Google Scholar and conference abstracts. Monetary values were converted to PPP-USD for the same base-year of the study.Results:Six economic evaluations were included, representing four countries and a multicentric analysis. Comparisons between quetiapine and twelve other antipsychotic drugs were identified. Three studies found quetiapine to be dominated by risperidone and the remaining three found it to be more expensive and more effective with incremental cost-effectiveness ratio (ICER) values of USD 36,535, 8,786 and USD 127,600 per quality-adjusted life-year (QALY). Three studies found quetiapine, in comparison to olanzapine, to be inferior, one found it to be superior and two studies found it to be more expensive and more effective with ICER values of USD 139,699 and USD 224,000 per QALY. The reports were considered to be of reasonable quality. Yet the mixture of contexts might influence the results.Conclusions:In general, there seems to be a trend favoring olanzapine and risperidone over quetiapine. None of the studies favored quetiapine over all the other drugs.