195 people participated, 78.5% were women, and 45.1% were aged ≥75 years. Summarized 897 words; 155 different ones. Central nucleus containing cognates: dizziness-vertigo-labyrinthitis and slipper-shoes (behavioral and objective dimension). The word disease integrated the area of contrast. Environmental and personal stressors were identified according to Neuman. Final considerations: Objects and risk behaviors for falls integrated the representations, although environmental and personal stressors indicate the need for preventive interventions in the environment and in the intrapersonal dimension.

OBJECTIVE To analyze the incremental cost-utility ratio for the surgical treatment of hip fracture in older patients.METHODS This was a retrospective cohort study of a systematic sample of patients who underwent surgery for hip fracture at a central hospital of a macro-region in the state of Minas Gerais, Southeastern Brazil between January 1, 2009 and December 31, 2011. A decision tree creation was analyzed considering the direct medical costs. The study followed the healthcare provider’s perspective and had a one-year time horizon. Effectiveness was measured by the time elapsed between trauma and surgery after dividing the patients into early and late surgery groups. The utility was obtained in a cross-sectional and indirect manner using the EuroQOL 5 Dimensions generic questionnaire transformed into cardinal numbers using the national regulations established by the Center for the Development and Regional Planning of the State of Minas Gerais. The sample included 110 patients, 27 of whom were allocated in the early surgery group and 83 in the late surgery group. The groups were stratified by age, gender, type of fracture, type of surgery, and anesthetic risk.RESULTS The direct medical cost presented a statistically significant increase among patients in the late surgery group (p < 0.005), mainly because of ward costs (p < 0.001). In-hospital mortality was higher in the late surgery group (7.4% versus 16.9%). The decision tree demonstrated the dominance of the early surgery strategy over the late surgery strategy: R$9,854.34 (USD4,387.17) versus R$26,754.56 (USD11,911.03) per quality-adjusted life year. The sensitivity test with extreme values proved the robustness of the results.CONCLUSIONS After controlling for confounding variables, the strategy of early surgery for hip fracture in the older adults was proven to be dominant, because it presented a lower cost and better results than late surgery.

ObjectivesTo estimate the cost per quality-adjusted life-year (QALY) focusing on the length of time between trauma and surgery.MethodsA retrospective cohort with systematic sampling was conducted among all the patients who were admitted to the study hospital through the Brazilian National Health System (SUS) over a three-year period. Two treatment strategies were compared: early treatment, if the patient was operated up to the fourth day; and late treatment, if this was done after the fourth day. The cost was the direct medical cost from the point of view of SUS, which was gathered from the management system, from the SUS table of procedures, medications and implant material costs (SIGTAP), to account for the costs associated with the hospital, medical fees and implants used. The outcome of usefulness was measured indirectly by means of EuroQOL-5D, which is an instrument used worldwide, and these measurements were transformed into usefulness by means of the standard rules of the Regional Planning and Development Center of Minas Gerais (CEDEPLAR) of 2013.ResultsThe sample included 110 patients: 27 in the early group and 83 in the late group. The confounding variables of age, gender, anesthetic risk (ASA), fracture type and surgery type were controlled for. The samples were shown to be homogenous with regard to these variables. The cost per QALY of the early strategy was R$ 5,129.42 and the cost of the late strategy was R$ 8,444.50.ConclusionThe early strategy was highly favorable in relation to the late strategy in this study.

We present a unique case of displaced simultaneous bilateral fractures, Garden 3 type, in a 49 year woman treated with non-cemented total hip arthroplasty. The patient showed a Harris hip score of 86 on the right hip and a 81 on the left side on the fourth postoperative year, besides a bilateral Trendelenburg gait, more pronounced on the right side. She needed a cane to walk, and felt pain in the left thigh. The X-ray showed a shortening of 0.9 cm and a left femoral varus. The other arthroplasty components showed good osseointegration and position.We found that the use of the uncemented total hip arthroplasty to treat a simultaneous bilateral fracture in renal osteodystrophy patients has satisfactory results at a four year follow-up.According to the OCEBM Levels of Evidence Working Group, this study is graded as a Level of Evidence IV.

Objetivos: A forma como os sistemas de saúde são financiados é um determinante crítico para alcançar a cobertura universal. Pouco foi publicado caracterizando padrões específicos do aumento preocupante de diagnóstico por imagem durante a última década. Este estudo objetivou verificar quais as variáveis socioeconômicas, estruturais e demográficas possuem associação com os gastos por diagnóstico de imagem ambulatorial de alta complexidade no Brasil. Esse tipo de análise pode permitir que os interessados em contenção de custos compreendam onde ocorre a maioria dos exames de imagens e a maior parte das despesas. Métodos: Os dados foram coletados de 2008 a 2016 do sistema Datasus com o uso do software TabWin versão 1.4.1. Resultados: O presente estudo mostrou que o aumento excessivo dos exames de imagem aumenta os custos e a exposição à radiação. Diversos fatores contribuíram para esse aumento, incluindo maior disponibilidade de tecnologia, aumento da demanda de pacientes e médicos, pagamento por produção e melhorias na tecnologia, resultando em maior facilidade no acesso aos exames de imagem. O estudo mostrou ainda que há concentração dos gastos per capita ambulatoriais com diagnóstico por imagem nas macrorregiões com melhor infraestrutura. Conclusões: É necessário um esforço mais concentrado para reduzir os custos administrativos. Ineficiências são provavelmente o produto de uma série de fatores, incluindo a complexidade administrativa do sistema de saúde do Brasil e a falta de transparência de custos em todo o sistema.