Economic burden of colorectal and breast cancers attributable to lack of physical activity in Brazil.

BACKGROUND: The increasing number of cancer patients has an escalating economic impact to public health systems (approximately, International dollars- Int$ 60 billion annually in Brazil). Physical activity is widely recognized as one important modifiable risk factor for cancer. Herein, we estimated the economic costs of colon and post-menopausal breast cancers in the Brazilian Unified Health System (SUS) attributable to lack of physical activity. METHODS: Population attributable fractions were calculated using prevalence data from 57,962 adults who answered a physical activity questionnaire in the Brazilian National Health Survey, and relative risks of colon and breast cancer from a meta-analysis. Annual costs (1 Int$ = 2.1 reais) with hospitalization, chemotherapy and radiotherapy were obtained from the Hospital and Ambulatory Information Systems of the Brazilian SUS. Two counterfactual scenarios were considered: theoretical minimum risk exposure level (≥8000 MET-min/week) and physical activity guidelines (≥600 MET-min/week). RESULTS: Annually, the Brazilian SUS expended Int$ 4.5 billion in direct costs related to cancer treatment, of which Int$ 553 million due to colon and breast cancers. Direct costs related to colon and breast cancers attributable to lack of physical activity were Int$ 23.4 million and Int$ 26.9 million, respectively. Achieving at least the physical activity guidelines would save Int$ 10.3 mi (colon, Int$ 6.4 mi; breast, Int$ 3.9 mi). CONCLUSIONS: Lack of physical activity accounts for Int$ 50.3 million annually in direct costs related to colon and post-menopausal breast cancers. Population-wide interventions aiming to promote physical activity are needed to reduce the economic burden of cancer in Brazil.

The decline in mortality due to acute complications of diabetes mellitus in Brazil, 1991-2010.

BACKGROUND: Mortality from acute complications of diabetes, a predominantly preventable condition, although controlled in high income countries, remains a major challenge for low/middle income countries. The aim of this study is to describe trends in mortality from acute complications of diabetes between 1991 and 2010 in Brazil, a period during which a national health system was implemented offering broad access to diabetes treatment. METHODS: We obtained the number of deaths listed in the Brazilian Mortality Information System between 1991 and 2010 as due to acute complications of diabetes (ICD-9 250.1, .2, or .3 and ICD-10 E10-14.0 or 1), corrected this number for ill-defined causes of death and incompleteness in mortality reporting, and calculated mortality rates standardized to the world's population. We describe mortality trends with Joinpoint regressions. RESULTS: Over this 20 year period, mortality due to the acute complications of diabetes fell 70.9 % (95 % CI 67.2 to 74.5 %), from 8.42 (95 % CI 8.27 to 8.57) deaths per 100000 inhabitants in 1991 to 2.45 (95 % CI 2.38 to 2.52) per 100000 in 2010. The reduction occurred in men and women, in all age groups, and in all regions of Brazil. CONCLUSIONS: Mortality from acute complications of diabetes in Brazil has declined markedly in parallel with the implementation of a national health system providing access to insulin and organization of health care. Further decline is possible and necessary.

Time trend and costs of hospitalizations with diabetes mellitus as main diagnosis in the Brazilian National Health System, 2011 to 2019.

OBJECTIVE: To analyze the diabetes mellitus (DM) temporal trend and hospitalization costs in Brazil, by region, Federative Units (FUs) and population characteristics, from 2011 to 2019. METHODS: This was an ecological study with data from the Hospital Information System, analyzing the annual trend in hospitalization rates for DM according to sex, age, race/skin color and region/FU by Prais-Winsten generalized linear regression. RESULTS: A total of 1,239,574 DM hospitalizations were recorded in the country and the hospitalization rates was 6.77/10,000 inhabitants in the period. The DM hospitalization rates trend was falling for both sexes and in most regions, while it was rising in the younger population and for length of stay (average 6.17 days). Total expenditure was US$ 420,692.23 and it showed a rising trend. CONCLUSION: The temporal trend of hospitalization rates due to DM was falling, with differences according to region/FU and age group. Average length of stay and expenditure showed a rising trend. MAIN RESULTS: From 2011 to 2019, the diabetes mellitus hospitalization rate was 6.77 per 10,000 inhabitants, with a falling trend. Total expenditure was US$420,692.23 and it showed a rising trend. IMPLICATIONS FOR SERVICES: The study warns of the increase in child and adolescent hospitalizations, which indicates the need to invest in preventive actions and early diagnosis. PERSPECTIVES: The increase in length of hospital stay and related costs indicates a worrying scenario for the Brazilian National Health System and emphasizes the need to improve access to and quality of care, with a focus on diabetes education, so as to avoid complications and hospitalizations.

Consensus on relevant psychosocial interventions applied in health institutions to prevent psychological violence at work: Delphi method.

OBJECTIVE: Studies on psychological violence in the workplace (PVW) in Latin America have focused on incidence values. In contrast, studies on preventive interventions (PIs) in the health sector are very limited. Our objective was to determine to what extent there is consensus on the most relevant characteristics of the psychosocial interventions applied in the prevention of PVW in health institutions in Peru. To that end, health professionals with knowledge and experience in PVW at the national level were recruited, and the Delphi consensus technique was applied. RESULTS: The consensus study was developed in four stages that included three phases of Delphi consultation. In the third consultation phase, 428 experts participated in 25 analysis groups from 66 health institutions in the country. A total of 70.3% of the participants were women, and 27.6% of the participants worked in nursing and emergency services. After the Delphi consensus analysis, we obtained a list of 10 hierarchical psychosocial interventions to prevent PVW in the country. Most notable were interventions based on the prior resolution of interprofessional conflicts, on the visibility of incidents to generate an inverse effect and on experiential training to improve assertive and empathic communication skills.

Paid sick leave and nonfatal occupational injuries.

OBJECTIVES: We examined the association between US workers' access to paid sick leave and the incidence of nonfatal occupational injuries from the employer's perspective. We also examined this association in different industries and occupations. METHODS: We developed a theoretical framework to examine the business value of offering paid sick leave. Data from the National Health Interview Survey were used to test the hypothesis that offering paid sick leave is associated with a reduced incidence of occupational injuries. We used data on approximately 38 000 working adults to estimate a multivariate model. RESULTS: With all other variables held constant, workers with access to paid sick leave were 28% (95% confidence interval = 0.52, 0.99) less likely than workers without access to paid sick leave to be injured. The association between the availability of paid sick leave and the incidence of occupational injuries varied across sectors and occupations, with the greatest differences occurring in high-risk sectors and occupations. CONCLUSIONS: Our findings suggest that, similar to other investments in worker safety and health, introducing or expanding paid sick leave programs might help businesses reduce the incidence of nonfatal occupational injuries, particularly in high-risk sectors and occupations.

Sensitivity and specificity of a brief scale to evaluate psychological violence at work in Peruvian health professionals.

OBJECTIVE: Most studies in Latin America that evaluate psychological violence at work (PVW) focus on measuring occurrences of PVW. However, the discriminative validity and randomness of instruments used for evaluating incidents of PVW that are generated by agents internal to the workplace in the Peruvian health sector have not yet been studied. The objective of this study was to determine the sensitivity and specificity of the Scale of Psychological Violence in Health Professionals (SVP-Health) in the Peruvian population. For this purpose, a cross-sectional study based on the two-stage administration of guided surveys and ROC (receiver operating characteristic) curve analysis was performed. RESULTS: The study included 188 professionals from ten care centres in Peru. The professionals were divided into two groups of 94 subjects: those who had experienced PVW and those who had not. The average age of the participants was 36.8 ± 10.5 years; their work experience ranged between one and 35 years; and 59% of the sample were women. According to an analysis based on the ROC curve, (a) there was a significant area under the curve (AUC = 0.899) with adequate randomness; and (b) the SPV-Health adequately distinguished subjects with PVW from those without PVW (89% versus 94%).

Hospital admissions for treatment of ruptured and unruptured cerebral aneurysms within the Brazilian National Health System, 2009-2018: a descriptive study. / Internações hospitalares para tratamento de aneurismas cerebrais rotos e não rotos no Sistema Único de Saúde do Brasil, 2009-2018: um estudo descritivo.

OBJECTIVE: To analyze hospital admissions for treatment of ruptured and unruptured cerebral aneurysms with embolization and brain microsurgery performed within the Brazilian National Health System (SUS), 2009-2018. METHODS: This was a descriptive study, using data from the SUS's Hospital Information System. Frequency of hospital admissions, procedures, use of intensive care unit (ICU), case fatality ratio and expenditures were described. RESULTS: Of the 43,927 hospital admissions, 22,622 (51.5%) resulted in microsurgery. Embolization and cerebral microsurgery were more frequent among females. Length of hospital stay with embolization procedure was 7.7 days (±9.0), and with microsurgery, 16.2 (±14.2) days, frequency of ICU admission, 58.6% and 85.3%, and case fatality ratio, 5.9% and 10.9% respectively. Of the total expenditure, USD 240 million, 66.3% corresponded to hospitalizations with embolization procedure. CONCLUSION: Hospital admissions with embolization procedure for treatment of cerebral aneurysms within the SUS showed a shorter length of stay, less frequent use of ICU and lower case fatality ratio, but higher expenditure when compared to brain microsurgery.

Costs of cancer attributable to excess body weight in the Brazilian public health system in 2018.

OBJECTIVES: The prevalence of excess body weight (EBW) has increased over the last decades in Brazil, where 55.4% of the adult population was overweight in 2019. EBW is a well-known risk factor for several types of cancer. We estimated the federal cost of EBW-related cancers in adults, considering the medical expenditures in the Brazilian Public Health System. METHODS: We calculated the costs related to 11 types of cancer considering the procedures performed in 2018 by all organizations that provide cancer care in the public health system. We obtained data from the Hospital and Ambulatory Information Systems of the Brazilian Public Health System. We calculated the fractions of cancer attributable to EBW using the relative risks from the literature and prevalence from a nationally representative survey. We converted the monetary values in Reais (R$) to international dollars (Int$), considering the purchasing power parity (PPP) of 2018. RESULTS: In Brazil, the 2018 federal cost for all types of cancers combined was Int$ 1.73 billion, of which nearly Int$ 710 million was spent on EBW-related cancer care and Int$ 30 million was attributable to EBW. Outpatient and inpatient expenditures reached Int$ 20.41 million (of which 80% was for chemotherapy) and Int$ 10.06 million (of which 82% was for surgery), respectively. Approximately 80% of EBW-attributable costs were due to breast, endometrial and colorectal cancers. CONCLUSION: A total of 1.76% of all federal cancer-related costs could be associated with EBW, representing a substantial economic burden for the public health system. We highlight the need for integrated policies for excess body weight control and cancer prevention.

[Manager profile and practices of county health management in the Unified Health System (SUS) according to population size in the municipalities of the Rio Grande do Sul state]. / Perfil do gestor e práticas de gestão municipal no Sistema Único de Saúde (SUS) de acordo com porte populacional nos municípios do estado do Rio Grande do Sul.

This study intended to gather who are the county health managers and the practices performed in management. It is based on a cross-sectional design. The methodology involved the use of electronic questionnaire, which was sent to the health departments of the 497 municipalities of the state of Rio Grande do Sul (RS). Of these, 297 were answered (59.75%). However, only those with more than 50% of valid answers (n = 264) were included in the statistical analysis. The analysis included the calculation of the distribution of variables and chi-square testes, taking population size as an independent variable. Most managers were women; graduated; from different professional backgrounds; average age of 43.76 years-old, and white. The average health expenditure in the municipalities was ≈ 20% of revenues. There was a consensus on the insufficiency of resources. With regards to population size, 79.92% presented with ≤ 20,000 inhabitants. Statistically significant differences were found in the management of municipalities of different sizes, both in terms of priorities and difficulties. The study allowed to partially understanding the reality of municipal management. These results indicate the need to further investigate the feminization of health management, working process assessment, and the impacts of economical austerity policy.

O estudo buscou conhecer quem são os gestores municipais de saúde e práticas realizadas no âmbito de gestão. Possuiu delineamento transversal. A metodologia contou com o envio de um questionário eletrônico às secretarias de saúde dos 497 municípios do estado do Rio Grande do Sul (RS). Destes, 297 retornaram (59,75%). Contudo, foram considerados na análise estatística apenas os questionários com mais de 50% de respostas válidas (n = 264). A análise contou com o cálculo da distribuição das variáveis e com testes de qui-quadrado, onde o porte populacional foi considerado variável independente. A maioria foi composta por mulheres, com escolaridade alta e distintas formações, média de idade de 43,76 anos, cor branca. A média de gastos com saúde foi de ≈20% das receitas. Houve consenso quanto na insuficiência dos recursos. Quanto ao porte populacional, 79,92% possuíam ≤ 20.000 habitantes. Diferenças significativas foram observadas na gestão de municípios de distintos portes, tanto nas prioridades, quanto nas dificuldades. O estudo permitiu conhecer parcialmente a realidade da gestão municipal. Além disso, os resultados sugeriram a necessidade de novas pesquisas sobre a feminilização da gestão, avaliação de processos de trabalho e impactos da política de austeridade.

Vaccine dose usage and wastage in the Metropolitan Region of Porto Alegre, Rio Grande do Sul, Brazil: a descriptive study, 2015-2017. / Utilização e perda de doses de vacinas na Região Metropolitana de Porto Alegre, Rio Grande do Sul: um estudo descritivo de 2015-2017.

OBJECTIVE: to estimate usage and wastage of multi-dose and single-dose vaccine vials in the Metropolitan Region of Porto Alegre, Rio Grande do Sul, Brazil, from 2015 to 2017. METHODS: a descriptive study was carried out based on secondary data from the National Immunization Program Information System (SIPNI) and the Strategic Health Supplies Information System (SIES). RESULTS: a total of 12,342 records were examined; mean wastage rate was 45.8% (95%CI 39.5;51.7), while usage rate was 54.2% (95%CI 48.3;60.5); vaccines with the highest mean annual wastage rate were MMR (68.8% - 95%CI 66.5;71.1), BCG (68.1% - 95%CI 65.4;70.7), Hepatitis B (56.4% - 95%CI 53.0-59.7) and Yellow Fever (55.9% - 95%CI 51.4;60.4). CONCLUSION: the highest rates of vaccine wastage were for multi-dose vials; although single-dose vaccines also exceeded the acceptable limit defined by the World Health Organization.

Bariatric surgeries performed by the Brazilian National Health System in the period 2010-2016: a descriptive study of hospitalizations. / Cirurgias bariátricas realizadas pelo Sistema Único de Saúde no período 2010-2016: estudo descritivo das hospitalizações no Brasil.

OBJECTIVE: to characterize Brazilian National Health System (SUS) hospitalizations for bariatric surgeries in Brazil, in the period 2010-2016. METHODS: this was a descriptive study of time series using data from the SUS Hospital Information System (SIH/SUS); the target population consisted of patients aged 16 years and older. RESULTS: there were 46,035 hospitalizations (6,576/year; 4.3/100,000 inhabitants/year); average age was 39.0 years old (SD:10.4); female sex predominated (85.4%), and the 35-39 age group accounted for 18.0% of cases; 16,923 patients (36.8%) needed to be admitted to the intensive care unit (ICU); there were 99 (0.2%) in-hospital deaths; the median hospital stay was 3 days, and the interquartile range was 2 days; average annual expense was R$ 39,410,919.37 and the average cost of hospitalization was R$ 5,992.75 (R$ 1,464.15/day). CONCLUSION: bariatric surgeries were characterized as procedures involving young female adults, frequent ICU use and low lethality.

Working Time Society consensus statements: Regulatory approaches to reduce risks associated with shift work-a global comparison.

A large number of workers worldwide engage in shift work that can have significant influences upon the quality of working life. For most jurisdictions, setting and enforcing appropriate policies, regulations, and rules around shift work is considered essential to (a) prevent potentially negative consequences of shift work and (b) to improve worker health and well-being. However, the best ways to do this are often highly contested theoretical spaces and often culturally and historically bound. In this paper, we examine the regulatory approaches to regulating shift work in four different regions: Europe, North America, Australasia, and East Asia (Japan, China, and Korea). Despite the fact that social and cultural factors vary considerably across the regions, comparing regulatory frameworks and initiatives in one region can be instructive. Different approaches can minimally provide a contrast to stimulate discussion about custom and practice and, potentially, help us to develop new and innovative models to improve worker well-being and organizational productivity simultaneously. In this paper, our goal is not to develop or even advocate a "perfect" sets of regulations. Rather, it is to compare and contrast the diversity and changing landscape of current regulatory practices and to help organizations and regulators understand the costs and benefits of different approaches. For example, in recent years, many western countries have seen a shift away from prescriptive regulation toward more risk-based approaches. Advocates and critics vary considerably in what drove these changes and the benefit-cost analyses associated with their introduction. By understanding the different ways in which shift work can be regulated, it may be possible to learn from others and to better promote healthier and safer environments for shift-working individuals and workplaces.

Economic burden of diabetes in Brazil in 2014.

BACKGROUND: Diabetes and its complications produce significant clinical, economic and social impact. The knowledge of the costs of diabetes generates subsidies to maintain the financial sustainability of public health and social security systems, guiding research and health care priorities. AIMS: The aim of this study was to estimate the economic burden of diabetes in Brazilian adults in 2014, considering the perspectives of the public health care system and the society. METHODS: A prevalence-based approach was used to estimate the annual health resource utilization and costs attributable to diabetes and related conditions. The healthcare system perspective considered direct medical costs related to outpatient and hospitalization costs. The societal perspective considered non-medical (transportation and dietary products) and indirect costs (productivity loss, disability, and premature retirement). Outpatient costs included medicines, health professional visits, exams, home glucose monitoring, ophthalmic procedures, and costs related to end stage renal disease. The costs of hospitalization attributed to diabetes related conditions were estimated using attributable risk methodology. Costs were estimated in Brazilian currency, and then converted to international dollars (2014). RESULTS: Based on a national self-reported prevalence of 6.2%, the total cost of diabetes in 2014 was Int$ 15.67 billion, including Int$ 6.89 billion in direct medical costs (44%), Int$ 3.69 billion in non-medical costs (23.6%) and Int$ 5.07 billion in indirect costs (32.4%). Outpatient costs summed Int$ 6.62 billion and the costs of 314,334 hospitalizations attributed to diabetes and related conditions was Int$ 264.9 million. Most hospitalizations were due to cardiovascular diseases (47.9%), followed by diabetes itself (18%), and renal diseases (13.6%). Diet and transportation costs were estimated at Int$ 3.2 billion and Int$ 462.3 million, respectively. CONCLUSIONS: Our results showed a substantial economic burden of diabetes in Brazil, and most likely are underrated as they are based on an underestimated prevalence of diabetes. Healthcare policies aiming at diabetes prevention and control are urgently sought.

Normal delivery and cesarean section: cost per brazilian regions, 2015.

OBJECTIVE: To describe the number of funds made by the Brazilian National Health System to normal delivery and cesarean procedures, according to the Brazilian regions in 2015, and estimate the cost cutting if the recommendation concerning the prevalence of cesarean deliveries by the World Health Organization (10 to 15%) were respected. METHODS: Secondary analysis of data from the Hospital Information System of the Brazilian National Health System. The variables considered were the type of delivery (cesarean section and normal), geographic region of admission, length of stay and amount paid for admission in 2015. RESULTS: In the year 2015, there were 984,307 admissions to perform labor in the five Brazilian regions, of which 36.2% were cesarean section. The Northeast and Southeast regions were the two regions that had the highest number of normal deliveries and cesarean sections. The overall average hospital stay for delivery was 3.2 days. About R$ 650 million (US$ 208,5 million) were paid, 45% of the total in cesarean deliveries. If the maximum prevalence proposed by the World Health Organization (WHO) were considered, there would be a potential reduction in spending in the order of R$ 57.7 million (US$ 18,5 million). CONCLUSIONS: Cesarean sections are above the parameter recommended by the WHO in all Brazilian regions. The Northeast and Southeast had the highest total number of normal and cesarean deliveries and thus the greatest potential reduction in estimated costs (69.6% of all considered reduction).

Bariatric surgeries performed by the Brazilian National Health System in residents of the Metropolitan Region of Porto Alegre, Rio Grande do Sul, Brazil, 2010-2016. / Cirurgias bariátricas realizadas pelo Sistema Único de Saúde em residentes da Região Metropolitana de Porto Alegre, Rio Grande do Sul, 2010-2016.

OBJECTIVE: to characterize caracterize by Brazilian National Health System (SUS) hospitalizations for bariatric surgeries in residents of the Metropolitan Region of Porto Alegre, RS, Brazil, from 2010 to 2016. METHODS: data analysis of the National Hospital Information System (SIH/SUS); calculation of indicators by sex, age groups, use of Intensive Care Unit and hospitalization expenses; the target population were patients aged 15 years and older. RESULTS: there were 1,249 hospitalizations (178.4/year; 5.4/100 thousand inhab./year), and the average age was 41.3±10.3 years old (average±standard deviation); the female sex was more prevalent (85.0%) and the age group 35-39 years accounted for 234 cases (18.7%); 227 patients (18.2%) needed ICU; there were 2 (0.2%) deaths; the mean for hospital stay was 5.1±3.2 days; the average annual expense was BRL1,073.830.29±223,791.48; and the average cost for hospitalization was BRL6,018.26±851,34 (BRL1,171.03/day). CONCLUSION: bariatric surgeries were characterized as procedures undergone by young female adults, with relatively frequent use of ICU and low fatality.

Estimated costs of hospitalization due to coronary artery disease attributable to familial hypercholesterolemia in the Brazilian public health system.

OBJECTIVE: Cardiovascular diseases are the leading cause of death in Brazil, imposing substantial economic burden on the health care system. Familial hypercholesterolemia (FH) is known to greatly increase the risk of premature coronary artery disease (CAD). This study aimed to estimate the economic impact of hospitalizations due to CAD attributable to FH in the Brazilian Unified Health Care System (SUS). SUBJECTS AND METHODS: Retrospective, cross-sectional study of data obtained from the Hospital Information System of the SUS (SIHSUS). We selected all adults (≥ 20 years of age) hospitalized from 2012--2014 with primary diagnoses related to CAD (ICD-10 I20 to I25). Attributable risk methodology estimated the contribution of FH in the outcomes of interest, using international data for prevalence (0.4% and 0.73%) and relative risk for events (RR = 8.56). RESULTS: Assuming an international prevalence of FH of 0.4% and 0.73%, of the 245,981 CAD admissions/year in Brazil, approximately 7,249 and 12,915, respectively, would be attributable to an underlying diagnosis --of FH. The total cost due to CAD per year, considering both sexes and all adults, was R$ 985,919,064, of which R$ 29,053,500 and R$ 51,764,175, respectively, were estimated to be attributable to FH. The average cost per FH-related CAD event was R$ 4,008. CONCLUSION: Based on estimated costs of hospitalization for CAD, we estimated that 2.9-5.3% are directed to FH patients. FH can require early specific therapies to lower risk in families. It is mandatory to determine the prevalence of FH and institute appropriate treatment to minimize the clinical and economic impact of this disease in Brazil.

Tendência temporal e gastos das internações com diagnóstico principal por diabetes mellitus no Sistema Único de Saúde do Brasil, 2011 a 2019 / Time trend and costs of hospitalizations with diabetes mellitus as main diagnosis in the Brazilian National Health System, 2011 to 2019 / Tendencia temporal y costos de las hospitalizaciones con el diagnóstico principal de diabetes mellitus en el Sistema Único de Salud de Brasil, de 2011 a 2019

Objective To analyze the diabetes mellitus (DM) temporal trend and hospitalization costs in Brazil, by region, Federative Units (FUs) and population characteristics, from 2011 to 2019. Methods This was an ecological study with data from the Hospital Information System, analyzing the annual trend in hospitalization rates for DM according to sex, age, race/skin color and region/FU by Prais-Winsten generalized linear regression. Results A total of 1,239,574 DM hospitalizations were recorded in the country and the hospitalization rates was 6.77/10,000 inhabitants in the period. The DM hospitalization rates trend was falling for both sexes and in most regions, while it was rising in the younger population and for length of stay (average 6.17 days). Total expenditure was US$ 420,692.23 and it showed a rising trend. Conclusion The temporal trend of hospitalization rates due to DM was falling, with differences according to region/FU and age group. Average length of stay and expenditure showed a rising trend.

Objetivo Analizar la tendencia temporal y los costos de las internaciones por diabetes mellitus (DM) en Brasil, por región, Unidades Federativas (UF) y características poblacionales, de 2011 a 2019. Métodos Estudio ecológico con datos del Sistema de Información Hospitalaria, analizando la tendencia anual de las tasas de hospitalización (TH) por DM según sexo, edad, raza/color y región/UF mediante regresión de Prais-Winsten. Resultados Se registraron 1.239.574 hospitalizaciones por DM en el país y la TH fue de 6,77/10 mil habitantes en el período. La tendencia de TH por DM fue decreciente en ambos sexos y en la mayoría de las regiones y creciente en la población más joven y en la duración de la estancia. El gasto total fue de 420.692.238 dólares y fue creciente. Conclusión La tendencia temporal de TH por DM fue decreciente, con diferencias según región/UF y grupo de edad. La duración media de la estancia y los gastos mostraron una tendencia creciente.

Objetivo Analisar a tendência temporal e gastos das internações por diabetes mellitus (DM) no Brasil, por região, Unidades da Federação (UFs) e características populacionais, de 2011 a 2019. Métodos Estudo ecológico com dados do Sistema de Informações Hospitalares, analisando a tendência anual das taxas de internação (TIs) por DM segundo sexo, idade, raça/cor e região/UF pela regressão linear generalizada de Prais-Winsten. Resultados Foram registradas 1.239.574 internações por DM no país e a TI foi de 6,77/10 mil habitantes, no período. A tendência das TIs por DM foi decrescente nos dois sexos e na maioria das regiões, e crescente na população mais jovem e no tempo de internação (média de 6,17 dias). O gasto total foi de US$ 420.692,23 e apresentou tendência crescente. Conclusão A tendência temporal da TI por DM foi decrescente, com diferenças segundo região/UF e grupo etário. O tempo médio de internação e os gastos apresentaram tendência de aumento.

Annual Direct Medical Costs of Diabetic Foot Disease in Brazil: A Cost of Illness Study.

The aim of this study was to estimate the annual costs for the treatment of diabetic foot disease (DFD) in Brazil. We conducted a cost-of-illness study of DFD in 2014, while considering the Brazilian Public Healthcare System (SUS) perspective. Direct medical costs of outpatient management and inpatient care were considered. For outpatient costs, a panel of experts was convened from which utilization of healthcare services for the management of DFD was obtained. When considering the range of syndromes included in the DFD spectrum, we developed four well-defined hypothetical DFD cases: (1) peripheral neuropathy without ulcer, (2) non-infected foot ulcer, (3) infected foot ulcer, and (4) clinical management of amputated patients. Quantities of each healthcare service was then multiplied by their respective unit costs obtained from national price listings. We then developed a decision analytic tree to estimate nationwide costs of DFD in Brazil, while taking into the account the estimated cost per case and considering epidemiologic parameters obtained from a national survey, secondary data, and the literature. For inpatient care, ICD10 codes related to DFD were identified and costs of hospitalizations due to osteomyelitis, amputations, and other selected DFD related conditions were obtained from a nationwide hospitalization database. Direct medical costs of DFD in Brazil was estimated considering the 2014 purchasing power parity (PPP) (1 Int$ = 1.748 BRL). We estimated that the annual direct medical costs of DFD in 2014 was Int$ 361 million, which denotes 0.31% of public health expenses for this period. Of the total, Int$ 27.7 million (13%) was for inpatient, and Int$ 333.5 million (87%) for outpatient care. Despite using different methodologies to estimate outpatient and inpatient costs related to DFD, this is the first study to assess the overall economic burden of DFD in Brazil, while considering all of its syndromes and both outpatients and inpatients. Although we have various reasons to believe that the hospital costs are underestimated, the estimated DFD burden is significant. As such, public health preventive strategies to reduce DFD related morbidity and mortality and costs are of utmost importance.

Disease and Economic Burden of Hospitalizations Attributable to Diabetes Mellitus and Its Complications: A Nationwide Study in Brazil.

Diabetes is associated with a significant burden globally. The costs of diabetes-related hospitalizations are unknown in most developing countries. The aim of this study was to estimate the total number and economic burden of hospitalizations attributable to diabetes mellitus (DM) and its complications in adults from the perspective of the Brazilian Public Health System in 2014. Data sources included the National Health Survey (NHS) and National database of Hospitalizations (SIH). We considered diabetes, its microvascular (retinopathy, nephropathy, and neuropathy) and macrovascular complications (coronary heart disease, cerebrovascular disease, and peripheral arterial disease), respiratory and urinary tract infections, as well as selected cancers. Assuming that DM patients are hospitalized for these conditions more frequently that non-DM individuals, we estimated the etiological fraction of each condition related to DM, using the attributable risk methodology. We present number, average cost per case, and overall costs of hospitalizations attributable to DM in Brazil in 2014, stratified by condition, state of the country, gender and age group. In 2014, a total of 313,273 hospitalizations due to diabetes in adults were reported in Brazil (4.6% of total adult hospitalization), totaling (international dollar) Int$264.9 million. The average cost of an adult hospitalization due to diabetes was Int$845, 19% higher than hospitalization without DM. Hospitalizations due to cardiovascular diseases related to diabetes accounted for the higher proportion of costs (47.9%), followed by microvascular complications (25.4%) and DM per se (18.1%). Understanding the costs of diabetes and its major complications is crucial to raise awareness and to support the decision-making process on policy implementation, also allowing the assessment of prevention and control strategies.

American time use survey: sleep time and its relationship to waking activities.

STUDY OBJECTIVES: To gain some insight into how various behavioral (lifestyle) factors influence sleep duration, by investigation of the relationship of sleep time to waking activities using the American Time Use Survey (ATUS). DESIGN: Cross-sectional data from ATUS, an annual telephone survey of a population sample of US citizens who are interviewed regarding how they spent their time during a 24-hour period between 04:00 on the previous day and 04:00 on the interview day. PARTICIPANTS: Data were pooled from the 2003, 2004, and 2005 ATUS databases involving N=47,731 respondents older than 14 years of age. INTERVENTIONS: N/A. RESULTS: Adjusted multiple linear regression models showed that the largest reciprocal relationship to sleep was found for work time, followed by travel time, which included commute time. Only shorter than average sleepers (<7.5 h) spent more time socializing, relaxing, and engaging in leisure activities, while both short (<5.5 h) and long sleepers (> or =8.5 h) watched more TV than the average sleeper. The extent to which sleep time was exchanged for waking activities was also shown to depend on age and gender. Sleep time was minimal while work time was maximal in the age group 45-54 yr, and sleep time increased both with lower and higher age. CONCLUSIONS: Work time, travel time, and time for socializing, relaxing, and leisure are the primary activities reciprocally related to sleep time among Americans. These activities may be confounding the frequently observed association between short and long sleep on one hand and morbidity and mortality on the other hand and should be controlled for in future studies.