Einstein-Sao Paulo最新文献

{"title":"Cost-benefit analysis of implementing Vendor Neutral Archive (VNA) technology in the Brazilian Public Health System.","authors":"Giulia Osório Santana, Luis Gustavo Nascimento de Paula, Leandro Seiti Anazawa, Pedro Vieira Santana Netto, Aline de Souza Moura, Daniel Tornieri, Joselisa Péres Queiroz de Paiva, Rafael Maffei Loureiro, William Yang Chen Fan, Ligia Bueno Sandes, Lucas Reis Correia","doi":"10.31744/einstein_journal/2025GS1219","DOIUrl":"10.31744/einstein_journal/2025GS1219","url":null,"abstract":"<p><strong>Objective: </strong>To conduct an ex-ante cost-benefit analysis of implementing Vendor Neutral Archive technology in the Brazilian Public Health System.</p><p><strong>Methods: </strong>The cost-benefit analysis involves monetizing the potential costs and benefits of implementing Vendor Neutral Archive in the Brazilian Public Health System, focusing on comparing these values using the return on investment measure.</p><p><strong>Results: </strong>The aggregate analysis at the Brazilian Public Health System level reveals that the estimated return on investment for the first year after Vendor Neutral Archive implementation is 5.63%, rising to 10.12% after three years. The results indicate a positive correlation between the number of imaging exams conducted and the financial gains for the health institution under analysis. A minimum number of approximately 11,500 exams is required to implement Vendor Neutral Archive technology to generate positive returns in the first year after implementation.</p><p><strong>Conclusion: </strong>Despite the importance of interpreting results cautiously owing to assumptions and methodological limitations, the findings highlight the strategic significance of Vendor Neutral Archive in enhancing the efficiency and sustainability of the Brazilian Public Health System. Adopting cloud-based medical image storage requires a significant upfront investment but promises substantial benefits. Within the Brazilian Public Health System, the return on this investment can be realized in less than one year, correlated with the volume of imaging exams performed. This underscores the importance of scalability in the healthcare system, where wider adoption of Vendor Neutral Archive results in higher returns.</p><p><strong>Background: </strong>■ Vendor Neutral Archive implementation has an return on investment of 5.63% in the first year and 10.12% after three years.</p><p><strong>Background: </strong>■ At least 11,500 exams are needed annually for a positive return on investment in the first year after implementation.</p><p><strong>Background: </strong>■ Vendor Neutral Archive enhances interoperability and efficiency by standardizing and centralizing image storage.</p><p><strong>Background: </strong>■ Scalability is key: higher adoption of Vendor Neutral Archive leads to greater financial and operational benefits.</p><p><strong>Background: </strong>Vendor Neutral Archive is a centralized, cloud-based solution that enables interoperable storage and management of medical images. Vendor Neutral Archive enhances data accessibility and long-term cost efficiency, supporting a more scalable and sustainable healthcare infrastructure. This study conducts a cost-benefit analysis of implementing Vendor Neutral Archive technology in the Brazilian Public Health System.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eGS1219"},"PeriodicalIF":0.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myopericytoma of the thoracic spine in a pregnant woman: a case report on the management of a rare neoplasm.","authors":"Adriano Jander Ferreira, Túlio Luiz Marra Négri, Julia Hailer Vieira, Anderson Alves Dias, Mellanie Starck Possa, Giovanni Bessa Pereira Lima","doi":"10.31744/einstein_journal/2025RC1150","DOIUrl":"10.31744/einstein_journal/2025RC1150","url":null,"abstract":"<p><p>Myopericytomas are perivascular myoid neoplasms that rarely exhibit malignant characteristics. They usually arise in the dermis or subcutaneous tissue and exceptionally involve deep soft tissues, with spinal localization being rare. We report the case of a previously healthy 32-year-old pregnant woman who presented with pain in the interscapular region and progressive loss of lower limb strength. Magnetic resonance imaging revealed a solid neoplastic mass at the T3 level, with spinal canal invasion and spinal cord signal abnormalities. The pregnancy was terminated, followed by lesion embolization, decompressive laminectomy, and local radiotherapy. The patient completely recovered from her neurological symptoms. Thoracic spine myopericytomas are rare and have been poorly reported in the literature. No studies have described the aforementioned neoplasm in a pregnant patient. We report this case because of its peculiarity, evolution, and outcome.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eRC1150"},"PeriodicalIF":0.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristic competencies for effective teachers in healthcare education.","authors":"Marina Iahn-Aun, Marcelo Vivolo Aun, Welbert Oliveira Pereira","doi":"10.31744/einstein_journal/2025RW1360","DOIUrl":"10.31744/einstein_journal/2025RW1360","url":null,"abstract":"<p><p>Teachers have the significant potential to facilitate alterations in the teaching-learning process that can positively affect student outcomes. In the healthcare field, exposure to effective teachers is associated with enhanced clinical performance and student knowledge. The literature explores several characteristics that increase the possibility of obtaining better outcomes when developed by teachers. These features are described from the perspectives of students, managers, and teachers. However, when considering teacher development programs, it is necessary to translate these characteristics, skills, and personality traits into competencies for training and enhancement. Therefore, in this review, we propose eight primary competencies that encompass the majority of these previously described characteristics: knowledge, communication skills, empathy, ability to facilitate engagement, preparation, organization, ability to assess learning progress, self-reflection, and continuous enhancement. All of these are trainable. However, teacher training is a complex and continuous process. Understanding these competencies is crucial for designing effective teacher development programs that offer measurable outcomes, reinforce teaching adherence, optimize enhancement timelines, and reduce institutional costs. This review discusses each of the eight competencies, their interrelationships, and their effects on healthcare education, offering a foundation for teachers and managers to facilitate educational excellence.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eRW1360"},"PeriodicalIF":0.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multifocal papillary thyroid microcarcinomas: is the total tumor diameter associated with the tumor behavior? A retrospective cohort study.","authors":"Larissa Ariane de Nardi, Ana Flávia Aguiar Ribeiro Coutinho, Carlos Segundo Paiva Soares, Simone Antunes Terra, Cristiano Claudino de Oliveira, Katia Hiromoto Koga, Sonia Marta Moriguchi, José Vicente Tagliarini, Gláucia Maria Ferreira da Silva Mazeto","doi":"10.31744/einstein_journal/2025AO1724","DOIUrl":"10.31744/einstein_journal/2025AO1724","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether the total tumor diameter (sum of the largest diameters of all foci) predicts tumor aggressiveness at initial presentation and treatment response at 1-year follow-up in patients with multifocal papillary thyroid microcarcinoma.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 475 patients with differentiated thyroid carcinoma. Fifty-two patients with multifocal papillary thyroid microcarcinoma were included. The primary variable was total tumor diameter, and outcomes included initial tumor aggressiveness, evaluated according to the American Joint Committee on Cancer (AJCC; stages I or II), risk of recurrence according to the American Thyroid Association (low or not low), and response to therapy at 1 year (excellent or not).</p><p><strong>Results: </strong>AJCC stage II disease was significantly associated with age ≥55 years, lymph node dissection, angiolymphatic invasion, extrathyroidal extension, lymph node metastasis, number of metastatic lymph nodes, non-low risk of recurrence, first stimulated thyroglobulin, and response to therapy at 1-year. Non-low risk of recurrence were associated with Bethesda V/VI cytology, lymph node dissection, angiolymphatic and tumor capsule invasion, extrathyroidal extension, lymph node metastasis, number of metastatic lymph nodes, first stimulated thyroglobulin, and radioiodine dose. Non-excellent response at 1-year follow-up were associated with preoperative thyroid-stimulating hormone levels, lymph node metastasis, number of metastatic lymph nodes, and first stimulated thyroglobulin. Multivariate analysis revealed that only the number of metastatic lymph nodes independently predicted AJCC stage.</p><p><strong>Conclusion: </strong>Total tumor diameter was not associated with initial tumor aggressiveness or treatment response at 1-year follow-up in patients with multifocal papillary thyroid microcarcinoma.</p><p><strong>Background: </strong>■ In multifocal papillary thyroid microcarcinomas.</p><p><strong>Background: </strong>■ The total tumor diameter was not associated with aggressiveness or initial evolution.</p><p><strong>Background: </strong>■ Other factors are associated with disease outcomes.</p><p><strong>Background: </strong>■ The number of metastatic lymph nodes is an independent predictor of American Joint Committee on Cancer stage.</p><p><strong>Background: </strong>This study demonstrated that in multifocal papillary thyroid microcarcinomas, the sum of the largest diameters of all tumor foci was not associated with tumor aggressiveness or response to therapy at 1-year follow-up. Conversely, the total number of metastatic lymph nodes was an independent predictor of American Joint Committee on Cancer staging.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO1724"},"PeriodicalIF":0.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term effects of remote ischemic conditioning on vascular function in patients with cardiovascular diseases: a systematic review with meta-analysis.","authors":"Samuel Amorim, Gilberto Laurentino, Victor Sabino de Queiros, Yujia Liu, Per Aagaard, Charlotte Suetta, Naufal Zagidullin, Kenneth J Gollob","doi":"10.31744/einstein_journal/2025RW1937","DOIUrl":"10.31744/einstein_journal/2025RW1937","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this systematic review with meta-analysis was to compare the short-term (≤1 month) effects of remote ischemic conditioning versus sham remote ischemic conditioning on vascular function in patients with cardiovascular diseases.</p><p><strong>Methods: </strong>A systematic review was conducted to identify relevant studies through six healthcare science databases up to March 2025. Arterial stiffness and endothelial function were defined as the primary outcome. Meta-analyses were performed using a random-effect model. Also, GRADE Pro software was used to evaluate the quality of evidence.</p><p><strong>Results: </strong>A total of 7 randomized clinical trials with 603 patients with cardiovascular diseases were included in the systematic review. Also, we included 5 studies in the meta-analysis. Compared with sham remote ischemic conditioning or control, short-term remote ischemic conditioning resulted in enhanced endothelial function (MD=4.22% [95%CI=1.75; 6.69]; p=0.0008; I2=0%) without any changes in arterial stiffness, (MD=-0.05 m/s [95%CI =-0.77, 0.67]; p=0.89; I2=89%).</p><p><strong>Conclusion: </strong>This systematic review and meta-analysis found that short-term remote ischemic conditioning was associated with improvements in endothelial function compared with sham remote ischemic conditioning or control in cardiovascular patients, without any impact on arterial stiffness.</p><p><strong>Prospero database registration: </strong>ID CRD42021234702.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eRW1937"},"PeriodicalIF":0.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interconnected study of molecular pathways: miR-137 as a central element at the intersection of lipid metabolism and prostate carcinogenesis.","authors":"Karina Serafim da Silva, Vanessa Ribeiro Guimarães, Feres Camargo Maluf, Gabriel Arantes Dos Santos, Juliana Alves de Camargo, Iran Amorim da Silva, Katia Ramos Moreira Leite, Sabrina Thalita Dos Reis, Nayara Izabel Viana, Miguel Srougi, Ruan Pimenta","doi":"10.31744/einstein_journal/2025AO1601","DOIUrl":"10.31744/einstein_journal/2025AO1601","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the roles of miR-137 and its target genes in lipid metabolism and prostate tumorigenesis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We used a series of bioinformatic approaches to establish the relationship between miR-137 and its target genes. We mapped the metabolic pathways of interest in the Reactome database and identified the central target genes of miR-137 in this pathway using four platforms: Reactome, miRDB, miRmap, and TargetScan. To assess the expression and association with clinical parameters, we obtained information from the UALCAN, OncoDB, and GEPIA2 databases using a dataset of patients with prostate cancer from The Cancer Genome Atlas. For functional enrichment analysis and construction of the protein-protein interaction network, we used the Kyoto Encyclopedia of Genes and Genomes, Gene Ontology, and STRING.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Our in silico study of The Cancer Genome Atlas database revealed that miR-137 is underexpressed in tumor tissues, and its reduction is associated with poor prognosis. An intriguing set of eight genes within the PPARα pathway: PPARGC1A, PPARGC1B, NCOA1, NCOA2, NCOA3, MED1, MED27, and ESRRA displayed synergy, positive correlations, and synchronized expression patterns in adipose, hepatic, and prostatic tissues, all linked to the enigmatic processes of metabolic regulation. Among the highlighted genes, ESRRA was overexpressed in the malignant environment, whereas its counterparts remained underexpressed. The plot was thickened with associations between the expression of NCOA1, NCOA3, and MED27, lymph node involvement, and the overexpression of several genes linked to advanced prostate cancer stages. An intriguing pattern emerged, with patients exhibiting reduced disease-free survival overexpressing NCOA2, NCOA3, MED27, and ESRRA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study elucidates the possibility that miR-137 subtly modulates metabolic genes in prostate cancer, suggesting its latent therapeutic potential as a biomarker for disease progression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;■ The reduction of miR-137 in tumor tissues is associated with a worse prognosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;■ miR-137 has eight oncogenically relevant target genes acting in the PPARα lipid pathway.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;■ NCOA1, NCOA3, MED27, and ESRRA are associated with advanced prostate cancer.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;■ miR-137 exhibits significant clinical potential by repressing the activation of pathways that influence prostate tumorigenesis in hyperstimulated metabolic environments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Prostate cancer progression is sustained by the simultaneous activation of pathways involving lipid uptake and de novo synthesis. In this context, miR-137 inhibits adipogenic differentiation and may reduce lipid uptake by tumor cells by modulating the PPAR/ p160/ESRRA axis, considerably attenuating metabolic effects and suppressing p","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO1601"},"PeriodicalIF":0.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of outcomes and reasons for refusing organs offered by the National Transplant Center.","authors":"Patricia Freire, Carmelia Matos Santiago Reis, Maria Rita Carvalho Garbi Novaes","doi":"10.31744/einstein_journal/2025AO1598","DOIUrl":"https://doi.org/10.31744/einstein_journal/2025AO1598","url":null,"abstract":"<p><strong>Background: </strong>This study analyzed 22,824 organ offers made to Brazil's National Transplant Center. Of these, 37% were accepted and 63% were refused. Among the accepted organs, 76% were transplanted. Understanding reasons for refusal may help improve national organ use and guide the developmentof effective strategies.</p><p><strong>Background: </strong>Logistical factors were not responsible for most organ rejections in the single national waiting list.</p><p><strong>Background: </strong>Refusal information was operator dependent, as the reason for refusal was generic in most cases.</p><p><strong>Background: </strong>It is possible to increase the use of organs offered to the National Transplant Center by converting more offers into transplants performed through a more detailed study of the reasons for refusal.</p><p><strong>Objective: </strong>To investigate the outcomes and reasons for the refusal of organs offered on a single national list managed by the National Transplant Center.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted with a quantitative approach, using data from offers of organs not used in the states and the Federal District, but offered to the National Transplant Center for national distribution.</p><p><strong>Results: </strong>Of the 22,824 offers of unused organs in the states to the National Transplant Center, 8,483 (37%) were accepted and 14,341 (63%) refused. Of the accepted organs, 6,433 (76%) were implanted and 2,050 (24%) were not used.</p><p><strong>Conclusion: </strong>The use of organs at the interstate (national) level could be improved, and ascertaining the reasons for refusal could contribute to intervention strategies.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO1598"},"PeriodicalIF":0.9,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Membrane transporter genes predict chemoradiotherapy response in patients with cervical cancer.","authors":"Natália Gregório Custódio, Fábio Ribeiro Queiroz, Angelo Borges de Melo Neto, Brenda Martins Cavalcante, Laurence Rodrigues do Amaral, Telma Maria Rossi de Figueiredo Franco, Matheus de Souza Gomes, Vasco Ariston de Carvalho Azevedo, Letícia da Conceição Braga, Paulo Guilherme de Oliveira Salles, Wander de Jesus Jeremias","doi":"10.31744/einstein_journal/2025AO1154","DOIUrl":"https://doi.org/10.31744/einstein_journal/2025AO1154","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to explore membrane transporter gene expression as a predictive biomarker of chemoradiotherapy response in cervical cancer. The differential expression of ATP1B3 and SLCO1B3 accurately classified patients as responders or non-responders with 90% accuracy, highlighting their potential for personalized treatment strategies.</p><p><strong>Background: </strong>Two gene groups with contrasting expression profiles were identified.</p><p><strong>Background: </strong>The ATP1B3 and SLCOB3 gene profiles classified patients with 90% accuracy.</p><p><strong>Background: </strong>The ATP1B3 and SLCOB3 gene signature is a potential predictor of treatment response.</p><p><strong>Introduction: </strong>Cervical cancer is the fourth most common cancer in women worldwide. Resistance to chemoradiotherapy in cervical cancer has been widely associated with membrane transport-related genes, particularly those encoding efflux transport proteins, such as the ATP-binding cassette family members (including P-glycoprotein), which act by expelling chemotherapeutic agents from tumor cells, as well as solute carrier proteins, whose expression impairs the uptake of antineoplastic drugs by cancer cells.</p><p><strong>Objective: </strong>This study aimed to identify specific membrane transport-related gene expression profiles as potential biomarkers for predicting chemoradiotherapy response in cervical cancer.</p><p><strong>Methods: </strong>Cervical biopsies were collected from 31 patients (21 responders and 10 non-responders) at Hospital Luxemburgo - Instituto Mário Penna. Fluorescence-activated cell sorting was used to separate non-stem cancer cells from cervical cancer biopsies. cDNA libraries from the 21 responders and 10 non-responders were sequenced using the Illumina platform. Expression analysis was performed using R and the DESeq2 package, with differentially expressed genes identified based on log fold change >1 or <-1 and padj ≤0.05. WEKA software and decision tree methods were used to analyze membrane transporters.</p><p><strong>Results: </strong>The results revealed two major gene groups with contrasting differentially expressed genes profiles. The first group, comprising SLC35 and ATP13, was overexpressed in non-responders, while the second group, consisting of SLC25 and ATP6, was overexpressed in responders. Decision tree analysis revealed that ATP1B3 and SLCOB3 expression profiles accurately classified patients into responder and non-responder groups with 90% accuracy, indicating that ATP1B3 and SLCOB3 are potential predictors of chemoradiotherapy response.</p><p><strong>Conclusion: </strong>Our results strongly suggest the presence of a candidate gene signature comprising ATP1B3 and SLCO1B3 that holds predictive value for chemoradiotherapy response in cervical cancer.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO1154"},"PeriodicalIF":0.9,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital costs of maternal near miss: a micro-costing analysis.","authors":"Moara Maria Silva Cardozo, Suely Arruda Vidal, Arthur Lima Xavier de Azevedo","doi":"10.31744/einstein_journal/2025GS0933","DOIUrl":"https://doi.org/10.31744/einstein_journal/2025GS0933","url":null,"abstract":"<p><strong>Background: </strong>This micro-costing study assessed hospital admissions for maternal near miss in a high-complexity maternity referral center in Brazil. The findings revealed an average cost of US$ 1,427.70 per admission, with personnel costs being the main driver. The estimated national economic burden reached US$ 86 million in 2019. As most cases are preventable, this underscores the systemic gaps in maternal healthcare delivery and reinforces the need for targeted policy interventions to improve quality and prevent avoidable complications.</p><p><strong>Background: </strong>Micro-costing showed high per-admission costs (US$ 1,427.70) for maternal near miss.</p><p><strong>Background: </strong>Reimbursement values (US$ 973) underestimate true hospital costs.</p><p><strong>Background: </strong>Brazil's economic burden estimated at US$ 86 million (2019).</p><p><strong>Background: </strong>Most maternal near miss events stem from preventable causes.</p><p><strong>Objective: </strong>This study aimed to estimate the hospital costs of maternal near miss cases from both the institutional and Brazilian Public Health System perspectives in a reference maternitiy hospital.</p><p><strong>Methods: </strong>This cost-of-illness study used primary data collected from 128 patients admitted to the obstetric intensive care unit of a reference hospital in 2019 who met the maternal near-miss criteria. Two costing methods were used: micro-costing assessment through reviewing medical records and micro-costing assessment derived from reimbursement data of the Brazilian Public Health System. The resources used were assigned costs in reais (R$) that were converted into US dollars (US$) based on 2019 values.</p><p><strong>Results: </strong>The average cost of a hospital stay for patients treated for maternal near miss was US$ 1,427.70 per medical record review and US$ 973.00 per Brazilian Public Health System reimbursement. The costs estimated by reimbursement were significantly lower than those estimated by reviewing medical records (p<0.0001). Considering the estimated incidence of maternal near miss among women treated in the Brazilian Public Health System, the projected national economic burden was US$ 86,055,130.50 in 2019.</p><p><strong>Conclusion: </strong>Through using a micro-costing methodology, this study established that, for the Brazilian Public Health System, hospital admissions due to maternal near misses had resulted in high costs, although this condition is considered to involve a large number of preventable cases. The cost estimates derived from the institution's medical records were significantly higher than the estimated reimbursement costs.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eGS0933"},"PeriodicalIF":0.9,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of oral health productivity in the Brazilian prison system from 2017 to 2022: a retrospective ecological study.","authors":"Artur Freitas Riccioppo, Naessa Santos Borges Zure, Lucas Gonçalves de Sousa, Pedro Henrique Mota Rodrigues, Thallys Rodrigues Félix, Álex Moreira Herval","doi":"10.31744/einstein_journal/2025AO1476","DOIUrl":"10.31744/einstein_journal/2025AO1476","url":null,"abstract":"<p><strong>Objective: </strong>This study compared the productivity of prison oral health teams during the COVID-19 crisis (2020-2022) with the previous three-year period (2017-2019) to identify the number and type of dental procedures performed.</p><p><strong>Methods: </strong>We employed an ecological and retrospective study using Primary Care Health Information System data. We analyzed data from all municipalities that reported the productivity of Prison Primary Care Teams from 2017 to 2022, totaling 418 municipalities distributed across all five Brazilian regions. Data pertaining to 15 oral health procedures were collected and subsequently grouped into five categories: preventive, urgent, extraction, periodontics, and restorative. The data revealed a non-normal distribution and were evaluated using the Wilcoxon test.</p><p><strong>Results: </strong>The findings revealed inequality between regions, with the productivity of several municipalities being close to or equal to zero. Although the number of restorative procedures reduced in both periods (2017-2019 and 2020-2022), it was not statistically significant. However, statistically significant increases were observed, with the exception of restorative and periodontal procedures. Urgent and extraction procedures prevailed over restorative and periodontal treatments.</p><p><strong>Conclusion: </strong>Access to Brazilian oral health procedures for inmates is low and remained unaffected by the pandemic, maintaining similar characteristics with increased productivity during that period.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO1476"},"PeriodicalIF":0.9,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}