Direct costs for outpatient excess body weight treatment in Brazilian children and adolescents attending a public children's hospital

Abstract Objective: To estimate the direct costs of treating excess body weight in children and adolescents attending a public children's hospital. Methods: This study analyzed the costs of the disease within the Brazilian Unified Health System (SUS) for 2,221 patients with excess body weight using a microcosting approach. The costs included operational expenses, consultations, and laboratory and imaging tests obtained from medical records for the period from 2009 to 2019. Healthcare expenses were obtained from the Table of Procedures, Medications, Orthoses/Prostheses, and Special Materials of SUS and from the hospital's finance department. Results: Medical consultations accounted for 50.6% (R$703,503.00) of the total cost (R $1,388,449.40) of treatment over the period investigated. The cost of treating excess body weight was 11.8 times higher for children aged 5-18 years compared to children aged 2-5 years over the same period. Additionally, the cost of treating obesity was approximately 4.0 and 6.3 times higher than the cost of treating overweight children aged 2-5 and 5-18 years, respectively. Conclusion: The average annual cost of treating excess body weight was R$138,845.00. Weight status and age influenced the cost of treating this disease, with higher costs being observed for individuals with obesity and children over 5 years of age. Additionally, the important deficit in reimbursement by SUS and the small number of other health professionals highlight the need for restructuring this treatment model to ensure its effectiveness, including a substantial increase in government investment.

Direct costs for outpatient excess body weight treatment in Brazilian children and adolescents attending a public children's hospital.

OBJECTIVE: To estimate the direct costs of treating excess body weight in children and adolescents attending a public children's hospital. METHODS: This study analyzed the costs of the disease within the Brazilian Unified Health System (SUS) for 2,221 patients with excess body weight using a microcosting approach. The costs included operational expenses, consultations, and laboratory and imaging tests obtained from medical records for the period from 2009 to 2019. Healthcare expenses were obtained from the Table of Procedures, Medications, Orthoses/Prostheses, and Special Materials of SUS and from the hospital's finance department. RESULTS: Medical consultations accounted for 50.6% (R$703,503.00) of the total cost (R$1,388,449.40) of treatment over the period investigated. The cost of treating excess body weight was 11.8 times higher for children aged 5-18 years compared to children aged 2-5 years over the same period. Additionally, the cost of treating obesity was approximately 4.0 and 6.3 times higher than the cost of treating overweight children aged 2-5 and 5-18 years, respectively. CONCLUSION: The average annual cost of treating excess body weight was R$138,845.00. Weight status and age influenced the cost of treating this disease, with higher costs being observed for individuals with obesity and children over 5 years of age. Additionally, the important deficit in reimbursement by SUS and the small number of other health professionals highlight the need for restructuring this treatment model to ensure its effectiveness, including a substantial increase in government investment.

Avaliação da qualidade de vida dos portadores de doença pulmonar obstrutiva crônica (DPOC) associada ao desempenho físico funcional / Assessment of quality of life of patients with chronic obstructive pulmonary disease (COPD) associated with a physical functional performance

Avaliar o desempenho físico funcional (DFF) de membros inferiores e sua associação com o grau de dispneia, estado funcional para atividades de vida diária (AVD) e qualidade de vida em portadores de DPOC. Participaram do estudo 52 portadores de DPOC, com média de idade de 65,9 ± 9,25 anos. Como instrumentos foram utilizados o SPPB para avaliar o DFF de membros inferiores; a espirometria para estadiamento da DPOC; as escalas Medical Research Council (MRC) e London Chest Activity of Daily Living (LCADL) para avaliar a gravidade da dispneia e o estado funcional para AVD, respectivamente; e o questionário Airways Questionnaire–20 (AQ-20) para avaliar a qualidade de vida. Dos 52 avaliados, 26 apresentaram um bom DFF, 24 moderado desempenho e apenas 2 indivíduos alcançaram um baixo e ruim desempenho. O escore total do SPPB correlacionou-se negativamente com a escala LCADL (r = -0,336; p<0,05), com a idade (r = -0,435; p<0,01), e com a presença de queixas osteomusculares (r = -0,280; p<0,05). Não foram evidenciadas correlações significativas do SPPB com o AQ-20 ou com a escala MRC. As categorias "bom" e "moderado" da variável DFF de membros inferiores foram significativamente correlacionadas às variáveis presença de co-morbidades osteomusculares, idade e auto-relato de limitação funcional para as AVD, segundo a escala LCADL.

To evaluate of the physical functional performance (PFP) of the lower limbs and their association with the degree of dyspnea, functional status for activities of daily living (ADLs) and quality of life in patients with COPD. The study enrolled 52 patients with COPD with a mean age of 65.9 ± 9.25 years. The SPPB were used to assess the PFP of lower limbs; spirometry for staging of COPD; the Medical Research Council scale (MRC) and the London Chest Activity of Daily Living (LCADL) to assess the severity of dyspnea and functional status for ADL , respectively, and the Airways Questionnaire-20 (AQ-20) to assess the quality of life. Of 52 evaluated, 26 showed a good PFP, 24 moderate performance and only two subjects achieved a low and poor performance. The total score SPPB correlated negatively with LCADL (r = -0.336, p <0.05) with age (r = -0.435, p <0.01), and the presence of musculoskeletal complaints (r = -0.280, p <0.05). There were no significant correlations SPPB with AQ-20 or MRC scale. The categories "good" and "moderate" variable PFP of lower limbs were significantly correlated with variables presence of musculoskeletal co-morbidities, age and self-reported functional limitation on ADLs, according to LCADL scale.

Estado nutricional e consumo de macronutrientes de idosos da cidade de Joinville, SC / Nutritionalstatus and food intake of elderly from Joinville city. 2002

O envelhecimento populacional é um fenômeno universal e em Joinville, entre 1980-2000, houve aumento de 151 por cento das pessoas com mais de 60 anos, caracterizando rápido crescimento deste grupo etário nessa cidade. Este estudo teve como objetivo avaliar o estado nutricional e o consumo de macronutrientes de idosos da cidade de Joinville. Na primeira etapa, 660 idosos foram entrevistados em domicílio, utilizando-se amostragem aleatória e sistemática em múltiplos estágios nos setores censitários urbanos de Joinville. Na segunda etapa, 221 idosos que compareceram aos postos de saúde, foram examinados quanto a características bioquímicas, antropométricas e dietéticas. A média de idade dos indivíduos examinados foi 68.4 anos, sendo a maioria (59,3 por cento) mulheres. Estas apresentaram valores médios de IMC, perímetro do braço e prega cutânea tricipital significativamente (p<0,05) maiores que os homens. A s concentrações médias de glicose, colesterol total. LDL-c triglicerídios no sangue, foram consideradas limítrofes segundo valores de referência. O valor total calórico para homens (1.515,1 kcal) e mulheres (1,339,6 kcal) foi considerado abaixo do recomendado pelo National Research Council. A contribuição percentual média de macronutrientes, para ambos os sexos, enquadrou-se dentro dos valores aceitáveis, havendo maior consumo de carboidratos e proteínas pelas mulheres. O estado nutricional do grupo investigado foi considerado adequado quanto às variáveis antropométrica e dietética. Os valores limítrofes do perfil bioquímico revelaramSituação preocupante para o desenvolvimento de doenças crônicas não transmissíveis, as quais podem ser prevenidas através de intervenções educacionais abordando temas como dieta e estilo de vida saudáveis.