ABSTRACT The research aimed to systematically identify the main drivers to enhance healthcare organizations' competitiveness, specifically for contributory regime (EPS) health insurers in the Colombian context. The study was interpretative, qualitative, and descriptive-exploratory studying documents that showed the possible drivers of competitiveness, and adapting them to the health 'industry', with a specific analysis. Those that, jointly and within a competitive-organizational behavior could be its differential and competitive factors in three dimensions or categories (organizational, strategy and results) and crossed by three levels of analysis (macro, meso, and micro) were identified. This can be useful in contributing to developing the competitive capacity of national Health Maintenance Organizations (HMOs), serving as a discussion platform for public policy and a possible reform regarding the health system, and studying the competitiveness of the health sector and its organizations in the future.

RESUMEN La investigación se propuso establecer sistémicamente los principales impulsores (drivers) que pueden desarrollar la competitividad de las organizaciones de salud, concretamente para las aseguradoras en salud del régimen contributivo (EPS´s) en el contexto colombiano. El estudio fue interpretativo, cualitativo y descriptivo-exploratorio, estudiando documentos que mostraran los posibles impulsores de la competitividad, adaptándolos a la ‘industria’ de la salud, con un análisis específico. Se identificaron aquellos que, conjuntamente y dentro un comportamiento competitivo-organizacional, podrían ser sus factores diferenciales y competitivos en tres dimensiones o categorías (organizacional, estrategia y resultados) y atravesados por tres niveles de análisis (macro, meso y micro). Esto puede ser útil para aportar al desarrollo de la capacidad competitiva de las EPS nacionales, como plataforma de discusión para la política pública y una posible reforma respecto al sistema de salud y para estudiar la competitividad de este sector y sus organizaciones hacia el futuro.

RESUMO A pesquisa se propôs a estabelecer de forma sistêmica os principais fatores que podem desenvolver a competitividade das organizações de saúde, especificamente para as seguradoras de saúde do sistema contributivo (EPS's) no contexto colombiano. O estudo foi interpretativo, qualitativo e descritivo-exploratório, estudando documentos que mostram os possíveis fatores de competitividade, adaptando-os ao "setor" de saúde, com uma análise específica. Foram identificados aqueles que, em conjunto e dentro de um comportamento competitivo-organizacional, poderiam ser seus fatores diferenciadores e competitivos em três dimensões ou categorias (organizacional, estratégia e resultados) e percorridos por três níveis de análise (macro, meso e micro). Isso pode ser útil para contribuir para o desenvolvimento da capacidade competitiva das EPSs nacionais, como uma plataforma de discussão para políticas públicas e uma possível reforma relativas ao sistema de saúde e para estudar a competitividade do setor de saúde e de suas organizações em direção ao futuro.

Abstract In the 19th century, to protect private property, the legislator sometimes had to be wary of dishonest owners. Faced with the resurgence of certain financial crimes, swindles and other frauds, legislative policy oscillated between rigorous repression, intended as a deterrent but deemed excessive, and more flexible sentencing, to make criminal law more effective. The legislator’s main concern was to define the contours of the criminal figures that were developing as a result of the century’s economic and social changes. Among these, two stand out: the insurance swindler, an owner who sets fire to his own property in order to defraud his insurer, and the fraudulent banker, who makes undue profit from mismanagement. In trying to catch them, French law tries, with varying degrees of success, to meet society’s need to identify and punish criminal scams fairly.

Resumo No século XIX, para proteger a propriedade privada, o legislador teve por vezes de se precaver contra os proprietários desonestos. Perante o recrudescimento de certos crimes financeiros, burlas e outras fraudes, a política legislativa oscilou entre uma repressão rigorosa, destinada a dissuadir, mas considerada excessiva, e uma flexibilização das penas, para tornar o direito penal mais eficaz. Acima de tudo, o legislador procurou definir os contornos das figuras criminosas que se desenvolviam com as mudanças económicas e sociais do século. Entre elas, duas chamaram a sua atenção: o estelionatário de seguros, um proprietário que incen-deia a sua propriedade para roubar a sua seguradora, e o banqueiro fraudulento, que obtém um lucro indevido através de uma má gestão. Ao tentar combatê-los, o legislador tentou, com diferentes graus de sucesso, responder à necessidade da sociedade em identificar e punir de forma justa as fraudes criminosas.

Résumé Au xixe siècle, pour protéger la propriété privée, le législateur doit parfois se méfier du propriétaire, lorsqu’il est malhonnête. Face à la recrudescence de certains crimes financiers, escroqueries et autres fraudes, la politique législative oscille entre une répression rigoureuse, se voulant dissuasive mais jugée excessive, et une détermination des peines plus souples, afin de faire en sorte que le droit pénal soit plus efficace. Le législateur s’emploie surtout à cerner les contours des figures criminelles qui se développent à la faveur des mutations économiques et sociales du siècle. Parmi elles, deux attirent son attention : l’escroc à l’assurance, propriétaire qui incendie son propre bien pour arnaquer son assureur, et le banqueroutier frauduleux, qui fait un profit indu d’une mauvaise gestion. En s’efforçant de les saisir, il essaie, avec plus ou moins de succès, de répondre au besoin de la société d’identifier et de punir avec justesse les arnaques criminelles.

Resumen Introducción. La hemocromatosis hereditaria es un trastorno metabólico hereditario común del metabolismo del hierro con penetrancia variable. La trombosis de la vena porta tiene varias causas bien conocidas que incluyen cirrosis, neoplasia mieloproliferativa, afecciones inflamatorias del abdomen, neoplasia maligna intraabdominal, cirugía intraabdominal y trombofilia. Se desconoce si la hemocromatosis hereditaria está asociada con la trombosis de la vena porta. Material y metodología. Se realizó un análisis retrospectivo de la base de datos de la Muestra Nacional de Pacientes Hospitalizados de 2016 a 2020 utilizando los códigos de la Clasificación Internacional de Enfermedades-10 para identificar hospitalizaciones con trombosis de la vena porta. Utilizamos un análisis de regresión multivariado para calcular el odds ratio ajustado después de controlar por edad, sexo, tipo de seguro, índice de comorbilidad de Charlson, cirrosis, neoplasia mieloproliferativa, afecciones inflamatorias del abdomen, neoplasia maligna intraabdominal, cirugía intraabdominal, antecedentes de trombosis pasada, trombofilia, enfermedad renal terminal, obesidad, tabaquismo e hiperlipidemia. Resultados . Hubo 25.805 hospitalizaciones con diagnóstico primario de trombosis de la vena porta. La regresión logística multivariada mostró que la hemocromatosis hereditaria se asoció de forma independiente con la trombosis de la vena porta (odds ratio = 4.7, IC del 95 % = 1.15 a 19.35, valor de p = 0,03) cuando se controlaron cirrosis, neoplasia mieloproliferativa, afecciones inflamatorias del abdomen, neoplasia maligna intraabdominal, antecedentes de trombosis, antecedentes de cirugía abdominal, antecedentes de trombofilia y enfermedad renal terminal, entre otros factores.

Abstract Introduction. Hereditary hemochromatosis is a common inherited metabolic disorder of iron metabolism with variable penetrance. Portal vein thrombosis has several well-known causes including cirrhosis, myeloproliferative neoplasm, inflammatory conditions of the abdomen, intra-abdominal malignancy, intra-abdominal surgery, and thrombophilia. It is unknown whether hereditary hemochromatosis is associated with portal vein thrombosis. Material and methodology. A retrospective analysis of the National Inpatient Sample database from 2016 to 2020 was conducted using International Classification of Diseases-10 codes to identify hospitalizations with portal vein thrombosis. We used multivariate regression analysis to calculate the adjusted odds ratio after controlling for age, gender, insurance type, Charlson Comorbidity Index, cirrhosis, myeloproliferative neoplasm, inflammatory conditions of the abdomen, intra-abdominal malignancy, intra-abdominal surgery, history of past thrombosis, thrombophilia, end-stage renal disease, obesity, smoking, and hyperlipidemia. Results. There were 25805 hospitalizations with primary diagnosis of portal vein thrombosis. Multivariate logistic regression showed that hereditary hemochromatosis was independently associated with portal vein thrombosis (Odds ratio= 4.7, 95% CI=1.15 to 19.35, p-value=0.03) when cirrhosis, myeloproliferative neoplasm, inflammatory conditions of the abdomen, intra-abdominal malignancy, history of thrombosis, history of abdominal surgery, history of thrombophilia, and end-stage renal disease among other factors were controlled.

Resumen: La investigación, con enfoque epistemológico cuantitativo y el paradigma positivista, tiene como objetivo definir la relación entre el marco regulatorio del sector financiero ecuatoriano y las condiciones de financiamiento a las pymes. Esta fue de tipo descriptivo-correlacional, permitiendo realizar un análisis descriptivo y factorial de variables vinculadas al conocimiento y aplicación de leyes y códigos regulatorios de 54 oficiales de crédito del sector bancario de El Oro, Ecuador. Se identificaron dos dimensiones: una relacionada con el marco regulatorio monetario y otra con códigos orgánicos. Las encuestas señalan que las leyes más aplicadas son: Ley General de Instituciones del Sector Financiero y Ley de Compañías. La primera regula la creación, funcionamiento y cierre de instituciones financieras privadas para proteger a la población y asegurar la estabilidad financiera; su cumplimiento es supervisado por la Superintendencia de Bancos. La segunda simplifica el proceso de constitución de empresas, permitiendo diversos tipos de compañías y flexibilidad en su estructura. Las regulaciones bancarias ecuatorianas han experimentado reformas para fortalecer la solidez y transparencia del sistema, como la Ley de Mercado de Valores y la Ley de Instituciones del Sistema de Seguros Privados, que contribuyen a la estabilidad, regulación, protección al consumidor financiero y promoción de la competencia, generando condiciones de financiamiento favorables, que incluyen confianza, tasas de interés competitivas y amplias opciones financieras.

Abstract: The research, with a quantitative epistemological approach and the positivist paradigm, aims to define the relationship between the regulatory framework of the Ecuadorian financial sector and the financing conditions for SMEs. This was of a descriptive-correlational type, allowing a descriptive and factorial analysis of variables linked to the knowledge and application of laws and regulatory codes of 54 credit officers from the banking sector of El Oro, Ecuador. Two dimensions were identified: one related to the monetary regulatory framework and another with organic codes. Surveys indicate that the most applied laws are: General Law of Financial Sector Institutions and Companies Law. The first regulates the creation, operation and closure of private financial institutions to protect the population and ensure financial stability; Its compliance is supervised by the Superintendency of Banks. The second simplifies the business incorporation process, allowing various types of companies and flexibility in their structure. Ecuadorian banking regulations have undergone reforms to strengthen the soundness and transparency of the system, such as the Securities Market Law and the Law of Institutions of the Private Insurance System, which contribute to stability, regulation, financial consumer protection and promotion of competition, generating favorable financing conditions, which include confidence, competitive interest rates and broad financial options.

On 15 May 2024, the National Health Insurance Act No. 20 of 2023 (the Act) was signed into law, and South Africa (SA) officially adopted a national health insurance (NHI) system as part of its efforts to achieve universal healthcare across the country. While NHI has been controversial and much talked about, plenty of how the scheme will operate remains an unknown, and has not been defined within the Act. However, it is evident that, with SA's limited healthcare budget, the NHI scheme is not going to cover everything for everyone. Some decisions will need to be made about what kinds of healthcare and other benefits South Africans can expect to have covered by the scheme - in other words, decisions about what will be included under NHI and what will be excluded. This paper does not aim to discuss the constitutionality or legality of the NHI Act, but focuses only on the issue of how government ought to consider making decisions about what services the NHI covers.

Abstract Introduction. Proper management of multidrug-resistant tuberculosis is a prioritized strategy for tuberculosis control worldwide. Objective. To evaluate differences concerning demographic and clinical characteristics and programmatic indicators of Buenaventura patient cohort with confirmed diagnosis of multidrug-resistant tuberculosis, compared to those of the other municipalities from Valle del Cauca, Colombia, 2013-2016. Materials and methods. We conducted an analytical cohort study to compare records of patients older than 15 years with multidrug-resistant tuberculosis included in the Programa de Tuberculosis de Buenaventura (with para-aminosalicylic acid) versus the other municipalities of Valle del Cauca (without para-aminosalicylic). Results. Ninety-nine cases were recorded with a median age of 40 years (IQR = 26 - 53); in Buenaventura, 56% of the patients were women, while in the other municipalities, men predominated with 67%; 95% had health insurance. The most common comorbidity was diabetes (14%). Adverse reactions to antituberculosis medications in Buenaventura were 1.3 times more frequent than in the other municipalities (OR = 2.3; 95% CI = 0.993 - 5.568; p = 0.04). In Buenaventura, the mortality rate was 5% compared to the 15% reported in the other municipalities. Treatment failures were not reported in Buenaventura, but 35% did not continue with the follow-up. Treatment success was higher in Buenaventura (56 %). Conclusion. A strengthened program in Buenaventura presented better programmatic results than those from the other municipalities of Valle del Cauca. Access to molecular tests, availability of shortened treatments, and continuous monitoring to identify adverse reactions to antituberculosis medications are routes for all other control programs.

Resumen Introducción. El manejo adecuado de la tuberculosis multirresistente es una estrategia priorizada para el control de la tuberculosis en el mundo. Objetivo. Evaluar las diferencias entre las características demográficas y clínicas, y los indicadores programáticos de los pacientes con diagnóstico confirmado de tuberculosis pulmonar resistente a rifampicina o multirresistente en Buenaventura, frente a la cohorte de los demás municipios del Valle del Cauca entre 2013 y 2016. Materiales y métodos. Se desarrolló un estudio analítico de cohortes para comparar los registros de pacientes mayores de 15 años con tuberculosis multirresistente, del Programa de Tuberculosis de Buenaventura (con ácido paraaminosalicílico), frente a los demás municipios del Valle del Cauca (sin ácido paraaminosalicílico). Resultados. Se registraron 99 casos con una mediana de edad de 40 años (RIC = 26 - 53); en Buenaventura, el 56 % eran mujeres; en los demás municipios, predominaron los hombres (67 %); el 95 % de los evaluados tenía aseguramiento en salud. La comorbilidad más frecuente fue diabetes (14 %). Las reacciones adversas a medicamentos antituberculosos en Buenaventura fueron 1,3 veces más frecuentes que en los demás municipios (OR = 2,3; IC95 %: 0,993 - 5,568; p = 0,04). En Buenaventura falleció el 5 % de los casos frente al 15 % reportado en los demás municipios. No hubo fracasos con el tratamiento en Buenaventura, pero se reportó un 35 % de pérdida del seguimiento. El éxito del tratamiento fue mayor en Buenaventura en el 56 %. Conclusión. El programa fortalecido de Buenaventura presentó mejores resultados programáticos que los demás municipios del Valle del Cauca. El acceso a pruebas moleculares, la disponibilidad de tratamientos acortados y el seguimiento continuo para identificar reacciones adversas a medicamentos antituberculosos son un derrotero para todos los programas de control.

Resumen. La cantidad de muertes violentas en México ha venido creciendo durante los últimos años, lo que ha ocasionado enormes retos en las políticas públicas, específicamente en las relacionadas con la seguridad pública, los servicios de salud y las aseguradoras. En general, una muerte violenta es una tragedia que, con frecuencia, puede ser evitada. Además, dicha pérdida no sólo afecta a la víctima y a sus familiares, ya que repercute en toda la sociedad. En efecto, al considerar esta problemática, y utilizando las ecuaciones de ingreso de Mincer, observamos que se han perdido cuantiosas vidas de trabajadores (potenciales o en activo), por lo que la sociedad ha perdido el ingreso y el consumo potenciales de las personas fallecidas. Por tal razón, en este artículo estimamos las pérdidas económicas causadas por las muertes violentas, esperando coadyuvar a aumentar la conciencia sobre la urgencia de delinear e instrumentar políticas públicas que disminuyan este tipo de fallecimientos que, insistimos, son evitables.

Abstract. The number of violent deaths in Mexico has been increasing in recent years. This has brought a great challenge to public policies, specifically those related to public safety, health services, Tand insurance. A violent death is a senseless tragedy that could be avoided, and it is incorrect to think that this death exclusively affects the victim and their family members. In reality, it affects the whole of society. When considering this problem using Mincer’s income equations, we observe that the lives of workers (potential or active) have been lost and that society has lost the income and potential consumption of the deceased. For this reason, in this article we intend to assess the economic losses caused by violent demises, hoping to help increase awareness that public policies are urgently needed to reduce these types of preventable deaths.

Resumen Se analiza el efecto de cambios no esperados del ingreso, tanto permanentes como transitorios, al consumo de los hogares mexicanos durante el periodo 2000 - 2016 siguiendo la metodología desarrollada por Blundell et al. (2008). En específico, se estima qué hipótesis es más acorde con la evidencia empírica en México: ingreso permanente, mercados completos, o aseguramiento parcial. Los resultados sugieren la presencia de aseguramiento parcial en el consumo ante choques permanentes en el ingreso a nivel nacional, aunque los resultados también son consistentes con la hipótesis de ingreso permanente. A nivel regional, los coeficientes del efecto del choque permanente en el ingreso sobre el consumo son similares al estimado a nivel nacional en las regiones norte, centro norte y centro, y de mayor magnitud en el sur, si bien con significancia estadística solo en las regiones centro norte y sur. En referencia a los choques temporales, el coeficiente del efecto del choque al ingreso sobre el consumo no resulta estadísticamente significativo a nivel nacional ni regional, lo que sugiere un suavizamiento del consumo por parte de los hogares ante cambios temporales en su ingreso.

Abstract The effect of unexpected changes in income, both permanent and transitory, on the consumption of Mexican households during the period 2000 - 2016 is analyzed following the methodology developed by Blundell et al. (2008). Specifically, it is estimated which hypothesis is more consistent with the empirical evidence in Mexico: permanent income, complete markets, or partial insurance. The results suggest the presence of partial insurance on consumption in the face of permanent income shocks at the national level, although results are also consistent with the permanent income hypothesis. At the regional level, the coefficients that measure the effect of an income permanent shock on consumption are similar to those estimated at the national level for the north, north central and central regions, and of greater magnitude in the south, although with statistical significance only in the central north and south regions. Regarding temporary shocks, the coefficient of the effect of income shocks on consumption is not statistically significant at the national or regional level, which suggests a consumption smoothing by households in the face of temporary changes in their income.

BACKGROUND: Maintaining or promoting employment in the presence of disability or reducing the impact of disability on employability should be the adopted focus to decrease the negative impact that disability has on the economy and just as important on the livelihood and well-being of exposed insured individuals. Group risk disability insurance protects an employee's income when illness or injury result in work disability. To achieve this, factors that promote the success of rehabilitation and support for return-to-work of employees following illness and injury need to be understood from an insurance perspective. OBJECTIVES: To explore principles of disability claims management during the rehabilitation and work reintegration stage using a multi-stakeholder approach for the purpose of successful return to work. METHODS: An exploratory qualitative design was used to collect data via semi-structured interviews with 26 purposively selected participants. Interviews were audio-recorded, data were transcribed and analysed thematically. Qualitative research was used to understand the necessary role players in the work reintegration process, factors that hinder and promote work reintegration and best practice principles for Disability Claims Management (DCM). RESULTS: Three themes emerged from the study; (i) role players and their functions with collaboration is integral to disability claims management, (ii) various factors promote and restrict return-to-work planning, and (iii) best practice principles in the DCM pathway that promote return-to-work. These principles include behavioural economics as the central principle, with resource identification and competency, governance, role engagement and education and awareness as supporting principles. CONCLUSION: Collaborative and integrated approaches by role players within a workers' family unit, health system, employer structure and insurance compensation are required for positive return-to-work outcomes. The various role players are responsible for creating policies, structures, intervention strategies, and environments that foster return-to-work. IMPLICATIONS FOR PRACTICE • An integrated approach is required for optimal RTW outcomes as employers' policies restrict work integration. • A collaborative approach by all role players involved in DCM, focusing on positive RTW outcomes is required in the RTW process • Occupational therapists can influence employer incapacity and disability policies in order to keep people employed and productive in the presence of medical conditions with the application of reasonable accommodations where necessary. • Occupational therapists are suitably positioned to outline workplace environment and other supports required to guide and support employees through rehabilitation and RTW and in ensuring that employees who can remain at work while on a partial or fully insured benefit, can engage optimally in aspects of work function.

Abstract: Migration is a phenomenon with an impact on the health of adolescents. Barriers to accessing health services expose them to risks such as sexual violence, unwanted pregnancies, and sexually transmitted infections/HIV. Objective: To analyze variables of sexual and reproductive health in migrant and Chilean adolescents. Patients and Method: Cross-sectional and analytical study with a sample of 3 375 adolescents aged 19 or younger, both Chilean and foreign, from the 10th National Youth Survey. Sociodemographic and sexual and reproductive health variables were analyzed. Descriptive analysis, Rao-Scott statistical test, and adjusted Odds Ratio calculation were performed using STATA v 12 software. Results: 6.4% of the adolescents were foreigners, mainly from Venezuela (36.98%). Differences were found in health insurance coverage, sexual behaviors, contraceptive use, and children between Chilean and foreign adolescents. Conclusions: It is concerning that one-third of migrant adolescents are not registered in the health insurance system. Differences in sexual behaviors and reproductive variables may reflect cultural and social influences, as well as inequities in access to healthcare.

Resumen: La migración es un fenómeno con impacto en la salud de adolescentes. Las barreras para acceder a servicios de salud los expone a riesgos como violencia sexual, embarazos no deseados e infecciones de transmisión sexual/VIH. Objetivo: Analizar variables de Salud Sexual y Reproductiva en adolescentes migrantes y chilenos. Pacientes Método: Estudio transversal y analítico con muestra de 3 375 adolescentes de 19 años o menos, chilenos y extranjeros de la 10° Encuesta Nacional de la Juventud. Se analizaron variables sociodemográficas y de Salud sexual y reproductiva. Se realizó un análisis descriptivo, prueba estadística de Rao-Scott, cálculo de Odds Ratio ajustado, utilizando el software STATA v12. Resultados: El 6,4% de los adolescentes eran extranjeros, principalmente de nacionalidad venezolana (36,98%). Se encontraron diferencias en la previsión de salud, comportamientos sexuales, uso de anticonceptivos e hijos entre adolescentes chilenos y extranjeros. Conclusiones: Es preocupante que un tercio de los adolescentes migrantes no esté afiliado al sistema de seguro de salud. Las diferencias en los comportamientos sexuales y variables reproductivas pueden reflejar influencias culturales y sociales, pero también inequidades en el acceso a atención en salud.

Caesarean sections (CSs) have increased globally, with concerns being raised involving overutilisation and inequalities in access. In Zimbabwe, where healthcare access varies greatly, we aimed to analyse factors associated with ever having a CS using the 2019 National Multiple Indicator Cluster Survey. The weighted national CS rate was 10.3%, and CS happened more commonly among women in urban than rural areas (15.7% v. 7.4%; odds ratio (OR) 2.34; (95% confidence interval (CI)) 1.71 - 3.20; p=0.001). Percentages of those having a CS significantly increased with education: overall χ² for a trend of p=0.001 and wealth quintile, and overall χ² for a trend of p=0.001. Women with insurance coverage were more likely to have had a CS than those without: 26.7% v. 8.7%; OR 3.82; 95% CI 2.51 - 5.83; p=0.001. The same was the case for women with access to the internet: 15.4% v. 7.0%, OR 2.42; 95%CI 1.71 - 3.41; p=0.001). These findings show an association that could indicate this being overutilised by insured women in urban settings, rather than being accessible based on clinical needs. Further research should explore reasons for these disparities and inform interventions to ensure equitable access to optimum childbirth in Zimbabwe.

ABSTRACT Introduction: Overactive bladder is characterized by overactivity of the detrusor and causes urge urinary incontinence. Accidents at work have a negative impact on the health of workers and consequently on the productivity of companies and the global economy. The worker and his/her family members are entitled to compensation for damage resulting from it. The responsibility for the repair and other charges arising from accidents at work lies with the employer, who is obliged to transfer it to entities legally authorized for this purpose (insurance companies). Case Report: In this clinical case, an accident at work is described in a 57-year-old woman, an operational assistant at a public health institution. The victim suffered a fall on a wet floor, which resulted in a rupture of the adductor muscles of the thighs, with aggravation of a pre-existing pathology (surgically corrected stress urinary incontinence). A few years after the accident, the victim underwent a new urogynecological surgical intervention at the insurance company, with worsening of existing stress incontinence and emergence of urge urinary incontinence, having developed, in this context, overactive bladder. Discussion/Conclusion: In this case report, the insurance company recognized the causal link between the accident at work and the injuries that developed. The consequences of this accident go beyond the work sphere, with an impact on the quality of life, leisure and sexual dimension of the worker. The reparation of damage by work accidents in Portugal focuses essentially on the loss of earning capacity. Occupational health services play a key role both in the prevention of accidents at work and in the follow-up of victims after returning to work. Occupational physicians and insurance companies play a key role in professional reintegration, so their communication and bonding should be strengthened.

RESUMO Introdução: A bexiga hiperativa caracteriza-se por hiperatividade do detrusor e ocasiona incontinência urinária de urgência. Os acidentes de trabalho têm um impacto negativo na saúde dos trabalhadores e consequentemente na produtividade das empresas e economia global. O trabalhador e os seus familiares têm direito à reparação dos danos emergentes. A responsabilidade pela reparação e demais encargos decorrentes cabe ao empregador, que é obrigado a transferi-la para entidades legalmente autorizadas para o efeito (seguradoras). Caso Clínico: Neste caso clínico descreve-se um acidente laboral numa trabalhadora de 57 anos, assistente operacional de uma instituição pública de saúde. A sinistrada sofreu queda em piso molhado, que resultou em rotura dos músculos adutores das coxas, com agravamento de patologia pré-existente (incontinência urinária de esforço corrigida cirurgicamente). Alguns anos após o acidente, a sinistrada foi submetida a nova intervenção cirúrgica uro-ginecológica na seguradora, com agravamento da incontinência de esforço já existente e surgimento de incontinência urinária de urgência, tendo desenvolvido, nesse contexto, bexiga hiperativa. Discussão/Conclusão: No caso clínico em questão, foi reconhecido pela companhia de seguros o nexo de causalidade entre o sinistro ocorrido e as lesões desenvolvidas. As consequências ultrapassam a esfera laboral, com impacto na qualidade de vida, lazer e dimensão sexual da trabalhadora. A reparação por acidentes de trabalho em Portugal incide essencialmente na perda da capacidade de ganho. Os serviços de saúde ocupacional têm um papel fundamental tanto na prevenção dos acidentes, como no acompanhamento dos sinistrados após regresso ao trabalho. O médico do trabalho e as companhias de seguro têm um papel fundamental na reintegração profissional, pelo que a sua comunicação e vínculo devem ser reforçados.

ABSTRACT Online hemodiafiltration (HDF) is a rapidly growing dialysis modality worldwide. In Brazil, the number of patients with private health insurance undergoing HDF has exceeded the number of patients on peritoneal dialysis. The achievement of a high convection volume was associated with better clinical imprand patient – reported outcomes confirming the benefits of HDF. The HDFit trial provided relevant practical information on the implementation of online HDF in dialysis centers in Brazil. This article aims to disseminate technical information to improve the quality and safety of this new dialysis modality. (HDF worldwide Brazil

RESUMO A hemodiafiltração (HDF) on-line é uma modalidade dialítica em rápido crescimento no mundo. No Brasil, o número de pacientes com planos de saúde privados tratados por HDF já ultrapassa aquele de pacientes em diálise peritoneal. O alcance de um alto volume convectivo associado à redução de desfechos clínicos e do risco de morte confirmam os benefícios da HDF. Dados nacionais do estudo HDFit forneceram informações práticas relevantes sobre a implementação da HDF on-line em clínicas de diálise no Brasil. O objetivo desta publicação é a disseminação de informações técnicas que possam auxiliar na utilização, com qualidade e segurança, dessa nova modalidade dialítica. (HDF online on line mundo Brasil peritoneal utilização segurança

Abstract This study analyzed the prevalence of complete neonatal screening (CNS) of children aged under 2 years in Brazil and associated factors using data from the 2013 (n=4,442) and 2019 (n=5,643) national health surveys. We conducted a cross-sectional study to compare prevalence of CNS (eye, ear and heel prick tests) adopting 95% confidence intervals (95%CI) and a 5% significance level. Crude and adjusted Poisson regression was performed to estimate prevalence ratios (PR) and 95%CI to assess the association between socioeconomic, demographic and health variables and CNS. There was a statistically significant increase in CNS prevalence, from 49.2% (95%CI: 47.1-51.3) in 2013 to 67.4% (95%CI: 65.5-69.3) in 2019. However, large disparities persist across states and between sociodemographic groups. In both years, CNS prevalence was lowest among brown and black children, those from families in the three lowest income quintiles, children without health insurance, those from families registered in the Family Health Strategy and children living in the North, cities outside the state capital/metropolitan regions and rural areas. Despite the increase in prevalence of CNS, deep individual and contextual inequalities persist, posing challenges for health policies. (CNS 201 n=4,442 n4442 n 4 442 (n=4,442 n=5,643 n5643 5 643 (n=5,643 surveys crosssectional cross sectional eye, eye (eye tests 95 95CI CI (95%CI level PR (PR socioeconomic 492 49 49.2 47.151.3 471513 47.1 51.3 47 1 51 3 47.1-51.3 674 67 67.4 65.569.3 655693 65.5 69.3 65 69 65.5-69.3 However groups quintiles insurance North capitalmetropolitan capital metropolitan areas policies 20 n=4,44 n444 44 (n=4,44 n=5,64 n564 64 (n=5,64 9 49. 151 47.151. 47151 471 47. 513 51. 47.1-51. 6 67. 569 65.569. 65569 655 65. 693 69. 65.5-69. n=4,4 n44 (n=4,4 n=5,6 n56 (n=5,6 15 47.151 4715 47.1-51 56 65.569 6556 65.5-69 n=4, n4 (n=4, n=5, n5 (n=5, 47.15 47.1-5 65.56 65.5-6 n=4 (n=4 n=5 (n=5 47.1- 65.5- n= (n= (n

Resumo Analisou-se a prevalência e fatores associados à realização da Triagem Neonatal Completa (TNC) entre crianças (<2 anos de idade) no Brasil incluídas na Pesquisa Nacional Saúde 2013 (n=4.442) e 2019 (n=5.643). Estudo transversal comparou as estimativas de prevalência e intervalos de confiança de 95% (IC95%) da TNC (testes do olhinho, orelhinha e pezinho). Diferenças foram consideradas estatisticamente significante ao nível de 5%. Regressões de Poisson bruta e ajustada foram realizadas para estimar Razões de Prevalência (RP) e IC95% para a associação das variáveis socioeconômicas, demográficas e de saúde com a TNC. Verificou-se aumento estatisticamente significante da TNC: 67,4% (IC95%: 65,5-69,3) em 2019, ante 49,2% (IC95%: 47,1-51,3) em 2013. Porém, ainda existem desigualdades e defasagens entre os estados da federação e variáveis sociodemográficas. Entre os anos, a TNC foi menor nas crianças de cor/raça parda e preta, dos três piores quintis de renda, sem plano de saúde, cadastradas na Estratégia de Saúde da Família, da região norte, de cidades do interior e da zona rural do Brasil. Apesar de o aumento da prevalência de TNC, desigualdades e defasagens individuais e contextuais permaneceram, indicando os desafios das políticas de saúde. Analisouse Analisou se (TNC <2 2 (< idade 201 n=4.442 n4442 n 4 442 (n=4.442 n=5.643. n5643 n=5.643 . 5 643 (n=5.643) 95 IC95 IC (IC95% testes olhinho pezinho. pezinho pezinho) 5% RP (RP socioeconômicas Verificouse Verificou 674 67 67,4 65,569,3 655693 65,5 69,3 65 69 3 65,5-69,3 492 49 49,2 47,151,3 471513 47,1 51,3 47 1 51 47,1-51,3 Porém sociodemográficas corraça cor raça preta renda Família norte permaneceram < ( 20 n=4.44 n444 44 (n=4.44 n564 n=5.64 64 (n=5.643 9 IC9 (IC95 6 67, 569 65,569, 65569 655 65, 693 69, 65,5-69, 49, 151 47,151, 47151 471 47, 513 51, 47,1-51, n=4.4 n44 (n=4.4 n56 n=5.6 (n=5.64 (IC9 56 65,569 6556 65,5-69 15 47,151 4715 47,1-51 n=4. n4 (n=4. n5 n=5. (n=5.6 (IC 65,56 65,5-6 47,15 47,1-5 n=4 (n=4 n=5 (n=5. 65,5- 47,1- n= (n= (n=5 (n

Abstract: Objective: To evaluate the implementation effect of serious illness medical insurance in Guang Xi Zhuang Autonomous Region of western China. Study design: Through the collection of 2017-2021 Guang Xi serious illness medical insurance specific policy making such as fund usage, serious illness compensation, medical expenses data, and data analysis of a serious illness medical insurance effect. Method: Literature research, Policy text analysis, quantitative data collection method, using Excel and SPSS 19.0 data descriptive statistical analysis and comparative analysis. Results: Serious illness medical insurance has had some effect, e.g., from 2017 to 2021, the utilization rate of serious illness medical insurance fund in Guang Xi was 109.49% and 103.87% respectively, the fund balance rate was -9.45% and -8.54% respectively, and the accumulated balance was -2.3871 million CNY and -70.7955 million CNY. Conclusion: The serious illness medical insurance has reduced the burden of large medical expenses of patients to a certain extent, but the fund is under too much pressure, and there is a payment deficit. The coverage and security of serious illness medical insurance need to be expanded and strengthened, and the cooperation mechanism with commercial insurance institutions should be gradually explored to improve the serious illness medical insurance.

Resumo: Objetivo: Avaliar o efeito da implementação de seguro médico para doenças graves na Região Autônoma de Guang Xi Zhuang da China Ocidental. Desenho do Estudo: Através da coleta de políticas específicas de seguro médico para doenças graves de Guang Xi 2017-2021, uso de fundos, compensação por doenças graves, dados de despesas médicas e análise de dados de um efeito de seguro médico para doenças graves. Método: Pesquisa na literatura, análise do texto da política, método de coleta de dados quantitativos usando Excel e SPSS 19.0, análise estatística descritiva de dados e análise comparativa. Resultados: Seguro médico de doenças graves teve um certo efeito. Em 2017 e 2021, a taxa de utilização do fundo de seguro médico para doenças graves em Guang Xi foi 109,49% e 103,87% respectivamente, a taxa de saldo do fundo foi -9,45% e -8,54% respectivamente e o saldo acumulado foi -2,3871 milhões de yuans e -70,7955 milhões de yuans. Conclusão: O seguro médico para doenças graves reduziu o ônus de grandes despesas médicas dos pacientes até certo ponto mas o fundo está sob demasiada pressão e há um déficit de pagamentos. A cobertura e segurança do seguro médico de doenças graves necessitam ser expandidas e fortalecidas, e o mecanismo de cooperação com instituições de seguros comerciais deve ser gradualmente explorado para melhorar o seguro médico para doenças graves.

Resumen: Objetivo: evaluar el efecto de la implementación de seguros médicos para enfermedades graves en la Región Autónoma Guang Xi Zhuang, al oeste de China. Diseño del estudio: a través de la recopilación de pólizas de seguro médico específicas para enfermedades graves de la región de Guang Xi entre 2017-2021, como por ejemplo: uso de fondos, compensación por enfermedades graves, datos de gastos médicos y análisis de datos del efecto de seguros médicos para enfermedades graves. Método: investigación de literatura, análisis de textos de políticas públicas, metodología de recolección de datos cuantitativos utilizando Excel y SPSS 19.0, análisis estadístico descriptivo de datos y análisis comparativo. Resultados: el seguro médico para enfermedades graves ha demostrado tener efectos, tales como: entre 2017 y 2021, la tasa de utilización de fondos de seguros médicos para enfermedades graves en Guang Xi fue de 109,49 % y 103,87 % respectivamente, las tasas de saldo del fondo fue de -9,45 % y -8,54 % respectivamente y el saldo acumulado fue de -2,3871 millones de CNY y -70,7955 millones de CNY. Conclusión: El seguro médico para enfermedades graves ha reducido en cierta medida la carga de los grandes gastos médicos de los pacientes, pero al existir un déficit de pagos está bajo demasiada presión. Por ello, es necesario ampliar y fortalecer la cobertura y seguridad del seguro médico para enfermedades graves, y explorar gradualmente mecanismos de cooperación con instituciones de seguros comerciales.