RESUMO
The protocols and published results on hand transplantation show acceptable results of this technology. None of the registered groups, however has a sufficient number of patients to allow continuity of the process. In Colombia the main problems are violence, drug traffic, and guerrillas. Thanks to the profitability of drug traffic, guerrillas, who initially were created based on ideologic differences, have become terrorist groups whose main source of income is drug traffic. From that interest comes the use of landmines to protect illicit crops. Colombia is the most mined country in the world, followed by Cambodia and Afghanistan, and the only country in Latin America where there are still landmines. The mines, violence, and trauma produce a large number of people with disabilities and amputations. From 1990 to 2006, the number of victims rose from 21 to 1,041 per year. In Colombia, amputations are more frequently due to trauma than to disease. The fact that 88% of the victims are children and people of working age, affects the political and economic development. These alarming numbers generate a challenge for government, which has led to the creation of policies and laws aimed at comprehensive action against mines. This program under the Presidency has among its objectives assistance to victims, including integrated treatment, prostheses, and other procedures, financed entirely by the government. The number, type of victims, and their motivation to be transplanted, along with government programs directed to their attention, are key factors that we think will enable the continuity of our hand transplantation program at the Fundación Santa Fe de Bogotá, giving Colombia the unfortunate privilege of having the largest number of potential patients for transplantation.
Assuntos
Traumatismos da Mão/terapia , Transplante de Mão , Transplante/métodos , Colômbia , Estudos de Viabilidade , Cirurgia Geral/economia , Geografia , Programas Governamentais , Traumatismos da Mão/cirurgia , Humanos , Desenvolvimento de Programas , Doadores de Tecidos , Obtenção de Tecidos e Órgãos , Transplante/economia , Transplante Homólogo , ViolênciaRESUMO
OBJECTIVE: To describe the technical aspects of the Exceptional Circumstance Drug Dispensing Program of the Brazilian Ministry of Health, especially with respect to the cost of dispensed medication. METHODS: Technical information was obtained from the ordinances that regulate the Program. Expenditure from 2000 to 2007 was obtained from the Sistema Único de Saúde's (Unified Healthcare System) Outpatient Information System. All drugs dispensed between 1993 and 2009 and the amount and cost of each procedure were evaluated, based on information from the high-complexity procedure authorization of each of the country's states. RESULTS: The Program changed with the increase in the number of pharmacological agents and presentations distributed by, and the number of diseases contemplated in the program. In 1993, the program distributed 15 pharmacological agents in 31 distinct presentations. This number increased to 109 agents in 243 presentations in 2009. Total Ministry of Health expenditure with medications was R$1,410,181,600.74 in 2007, almost twice the amount spent in 2000, R$684,975,404.43. Diseases whose expenditure increased in the period included chronic renal insufficiency, transplantation, and hepatitis C. CONCLUSIONS: The Exceptional Circumstance Drug Dispensing Program is in constant transformation, aimed at building instruments and strategies that can ensure and expand access to medication among the population. Alternatives should be sought to decrease the financial impact of the Program to a level that does not impact other sectors of the health care system, given the high cost associated with novel interventions.
Assuntos
Governo Federal , Gastos em Saúde , Programas Nacionais de Saúde/economia , Preparações Farmacêuticas/economia , Assistência Farmacêutica/economia , Brasil , Custos de Medicamentos , Política de Saúde/economia , Acessibilidade aos Serviços de Saúde , Hepatite C/economia , Humanos , Legislação de Medicamentos , Preparações Farmacêuticas/provisão & distribuição , Insuficiência Renal Crônica/economia , Transplante/economiaRESUMO
An organ donation is based on feelings of human solidarity and altruism. This approach, however, has not improved the organ shortage problem. The following suggestions might help to dismantle the persistent barrier linked to organ donation. (1) Society should be aware that during our lifetime we might be as much potential organ recipients as organ donors. (2) Educational campaigns should integrate the notion that cadaver organs are an irreplaceable source of health for every member of society. (3) Communication campaigns should illustrate that in allowing the use of our organs after death, we are, in fact, sharing a chance to prolong health for everybody, including perhaps ourselves. Furthermore, people need to acknowledge that using body parts is acceptable, and part of a tacit agreement between all members of society. Making a live organ donation to which the donor is emotionally related is a pressure-free decision. On the contrary, the donation of cadaver organs is influenced by negative factors. Conversely, self-interest and resistance to offering the body of a loved one to a stranger may make donation much more difficult if the current message is not modified. In an international survey of 242 transplantation professionals, with a 57% response rate, 70% to 83% agreed with this proposal. An international public survey has recently been finished, showing some results about the public's knowledge about religious opinions concerning transplantation, suggesting that religious institutions should assume a leadership role to give information about their positions. On the other hand, partial results concerning public attitudes regarding economic support to organ donation indicate that final data may be of interest. The creation of a Task Force with representatives from the World Health Organization, UNESCO, churches, and leaders of the global transplantation community may be key to joint efforts as a means to modify negative attitudes, to develop a new philosophy, and to deliver a new message to society.
Assuntos
Atitude Frente a Saúde , Doadores de Tecidos/ética , Transplante/economia , Transplante/ética , Cadáver , Educação em Saúde , Inquéritos Epidemiológicos , Humanos , Fatores Socioeconômicos , Doadores de Tecidos/provisão & distribuição , Transplante/psicologiaRESUMO
The epidemiology profile of developing countries is in transition. While the prevalence of infectious and preventable diseases, malnutrition, and in general the health problems traditionally associated to the poor, is still high, the characteristic health profile of industrialized countries (i.e. chronic and degenerative diseases, accidents, violence, social pathology) is beginning to surface. This paper focuses on the need to consider organ transplantation as a health priority in developing countries, as an important element in the global strategy to cover both aspects of the health care demand.