Nativity and Country of Origin Variations in Life Expectancy With Functional Limitations Among Older Hispanics in the United States.

This study examined racial/ethnic, nativity, and country of origin differences in life expectancy with and without functional limitations among older adults in the United States. We used data from the National Health Interview Survey (1999-2015) to estimate Sullivan-based life tables of life expectancies with functional limitations and without functional limitations by sex for U.S.-born Mexicans, foreign-born Mexicans, U.S.-born Puerto Ricans, island-born Puerto Ricans, foreign-born Cubans, and U.S.-born Whites. We find that Latinos exhibit heterogeneous life expectancies with functional limitations. Among females, U.S.-born Mexicans, foreign-born Mexicans, and foreign-born Cubans spend significantly fewer years without functional limitations, whereas island-born Puerto Ricans spend more years with functional limitations. For men, U.S.-born Puerto Ricans were the only Latino subgroup disadvantaged in the number of years lived with functional limitations. Conversely, foreign-born Cubans spend significantly fewer years without functional limitations. To address disparities in functional limitations, we must consider variation in health among Latino subgroups.

Racial density and the socioeconomic, demographic and health context in Brazilian cities in 2000 and 2010. / Densidade racial e a situação socioeconômica, demográfica e de saúde nas cidades brasileiras em 2000 e 2010.

INTRODUCTION: Racial density has not yet been explored in studies of racial inequalities in Brazil. Thisstudy identified categories of racial density in Brazilian cities and described the living and health context in these categories in 2000 and 2010, when demographic censuses were conducted. METHOD: Ecological study which used skin color or race information from the last two censuses to calculate racial density (the ratio of people aggregated to the same racial group) of the Brazilian cities each year. Four categories of racial density (Brown; Mixed-race, predominantly black; White/Caucasian; and Mixed-race, predominantly white). Socioeconomic, demographic and health indicators were described to each category. RESULTS: The categories of racial density captured important inequalities throughout the census and also indicated the continuance of worse living and health conditions in the cities composed by Browns and mixed-race people, predominantly Black; better conditions were indicated in cities where White/Caucasians are predominant. The cities, composed mainly of Browns and mixed-race people, predominantly Black, presented younger age structure, worse human development indexes, greater social vulnerability, income concentration, infant and premature mortality (<65 years) and lower life expectancy in both censuses, as compared to other cities. DISCUSSION: Similarly to other countries, the racial density reflected inequalities in the Brazilian living and health context as well as a time lag among the cities. CONCLUSION: The categories of racial density may contribute to social epidemiology and race relations studies in Brazil.

INTRODUÇÃO: A densidade racial ainda não foi explorada nos estudos sobre desigualdades raciais no Brasil. Este estudo identifica categorias de densidade racial para as cidades brasileiras e descreve a situação de vida e saúde nessas categorias nos anos dos Censos Demográficos de 2000 e 2010. MÉTODO: Estudo ecológico em que a informação de cor/raça nos dois últimos censos foi usada para calcular a densidade racial (proporçãode pessoas do mesmo grupo racial) nas cidades brasileiras em cada ano. Criaram-se quatro categorias de densidade racial (parda; mistos, mas com maioria negra; branca; e mistos, mas com maioria branca).Paraquais foram descritos indicadores socioeconômicos, demográficos e de saúde. RESULTADOS: As categorias de densidade racial captaram desigualdades importantes ao longo dos censos e apontaram a permanência de piores condições de vida e saúde nas cidades formadas por pardos e mistos, mas com maioria negra, e melhores onde predominaram brancos. As cidades predominadas por pardos e mistos, mas com maioria negra, em relação às demais, apresentam, nos dois censos, estrutura etária mais jovem, piores índices de desenvolvimento humano, maior vulnerabilidade social, concentração de renda, mortalidade infantil e prematura (< 65 anos) e menor esperança de vida de seus moradores. DISCUSSÃO: Semelhantemente a outros países, a densidade racial espelhou desigualdades na situação de vida e saúde no Brasil, bem como defasagem temporal entre suas cidades. CONCLUSÃO: As categorias de densidade racial podem contribuir para os estudos sobre a epidemiologia social e sobre as relações raciais no país.

Densidade racial e a situação socioeconômica, demográfica e de saúde nas cidades brasileiras em 2000 e 2010 / Racial density and the socioeconomic, demographic and health context in Brazilian cities in 2000 and 2010

RESUMO: Introdução: A densidade racial ainda não foi explorada nos estudos sobre desigualdades raciais no Brasil. Este estudo identifica categorias de densidade racial para as cidades brasileiras e descreve a situação de vida e saúde nessas categorias nos anos dos Censos Demográficos de 2000 e 2010. Método: Estudo ecológico em que a informação de cor/raça nos dois últimos censos foi usada para calcular a densidade racial (proporçãode pessoas do mesmo grupo racial) nas cidades brasileiras em cada ano. Criaram-se quatro categorias de densidade racial (parda; mistos, mas com maioria negra; branca; e mistos, mas com maioria branca).Paraquais foram descritos indicadores socioeconômicos, demográficos e de saúde. Resultados: As categorias de densidade racial captaram desigualdades importantes ao longo dos censos e apontaram a permanência de piores condições de vida e saúde nas cidades formadas por pardos e mistos, mas com maioria negra, e melhores onde predominaram brancos. As cidades predominadas por pardos e mistos, mas com maioria negra, em relação às demais, apresentam, nos dois censos, estrutura etária mais jovem, piores índices de desenvolvimento humano, maior vulnerabilidade social, concentração de renda, mortalidade infantil e prematura (< 65 anos) e menor esperança de vida de seus moradores. Discussão: Semelhantemente a outros países, a densidade racial espelhou desigualdades na situação de vida e saúde no Brasil, bem como defasagem temporal entre suas cidades. Conclusão: As categorias de densidade racial podem contribuir para os estudos sobre a epidemiologia social e sobre as relações raciais no país.

ABSTRACT: Introduction: Racial density has not yet been explored in studies of racial inequalities in Brazil. Thisstudy identified categories of racial density in Brazilian cities and described the living and health context in these categories in 2000 and 2010, when demographic censuses were conducted. Method: Ecological study which used skin color or race information from the last two censuses to calculate racial density (the ratio of people aggregated to the same racial group) of the Brazilian cities each year. Four categories of racial density (Brown; Mixed-race, predominantly black; White/Caucasian; and Mixed-race, predominantly white). Socioeconomic, demographic and health indicators were described to each category. Results: The categories of racial density captured important inequalities throughout the census and also indicated the continuance of worse living and health conditions in the cities composed by Browns and mixed-race people, predominantly Black; better conditions were indicated in cities where White/Caucasians are predominant. The cities, composed mainly of Browns and mixed-race people, predominantly Black, presented younger age structure, worse human development indexes, greater social vulnerability, income concentration, infant and premature mortality (<65 years) and lower life expectancy in both censuses, as compared to other cities. Discussion: Similarly to other countries, the racial density reflected inequalities in the Brazilian living and health context as well as a time lag among the cities. Conclusion: The categories of racial density may contribute to social epidemiology and race relations studies in Brazil.

Prevalence and Trends in Morbidity and Disability Among Older Mexican Americans in the Southwestern United States, 1993-2013.

This study examines the prevalence of morbidity and disability among older Mexican Americans using 5-year age groups. Twenty-year panel data from the Hispanic Established Populations for the Epidemiological Study of the Elderly are used to make detailed comparisons by nativity and gender. Results show that prevalence rates for most chronic conditions for both males and females do not vary by nativity. For disabilities, nativity is a significant predictor of increased instrumental activity of daily living disability for foreign-born females and reduced activity of daily living disability for U.S.-born males. Additionally, results show significant interactions between nativity and age cohorts, with the gap increasing with age for males and decreasing with age for females. These results have important implications for health services and health policy. Given the rapid aging of the Mexican American population, the prevention and treatment of medical conditions, particularly among the foreign-born, should be a major public health priority to reduce dependence from disabilities.

Age of Migration Life Expectancy with Functional Limitations and Morbidity in Mexican Americans.

The U.S. Mexican American population enjoys longer life expectancies relative to other racial/ethnic groups but is disproportionately affected by chronic conditions and functional limitations. Studying the impact of heterogeneity in age, time and other characteristics of migration among older Mexican Americans can inform our understanding of health disparities and healthcare needs in later-life. This research used 20 years of data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to assess the proportion of life spent with functional limitations and one or more morbidity (according to age of migration and sex) in the U.S. Mexican-American population. The results indicate that early-life and late-life migrant women spend more years with Performance-Oriented Mobility Assessment limitations than U.S.-born women. Conversely, midlife migrant women were not statistically different from U.S.-born women in years spent disabled. In men, midlife migrants had longer life expectancies and had more disability-free years than U.S.-born men. For morbidity, late-life migrant women spent a significantly smaller proportion of their elderly years with morbidity than U.S.-born women, but late-life migrant men spent more years with morbidity than U.S.-born men. These findings illustrate that older Mexican Americans in the United States are heterogeneous in nativity and health outcomes. More years spent disabled or unhealthy may result in greater burden on family members and greater dependence on public resources. These findings have implications for the development of social and health policies to appropriately target the medical conditions and disabilities of older Mexican Americans entering late life.

Self-Reported Health and Functional Characteristics of Mexican and Mexican American Adults Aged 80 and Over.

OBJECTIVE: To examine the health and functional characteristics of Mexican and Mexican American adults aged ≥80. METHOD: Data came from Wave I (2001) and Wave III (2012) of the Mexican Health and Aging Study (MHAS), and Wave IV (2000-2001) and Wave VII (2010-2011) of the Hispanic Established Populations for Epidemiologic Studies of the Elderly (HEPESE). RESULTS: In 2000-2001, diabetes, arthritis, hypertension, and stroke were higher in the HEPESE than in the MHAS. In the HEPESE, activities of daily living (ADL) difficulties and all health conditions, except heart attack, were greater in 2010-2011 than in 2000-2001. In the MHAS, hypertension and ADL difficulties were greater, and arthritis was lower in 2012 compared with 2001. In 2010-2011, all self-reported health conditions were higher in the HEPESE compared with the 2012 observation of the MHAS. DISCUSSION: The observed differences may reflect worse health for Mexican Americans, health care access, reporting bias, and more selective survival to very old age in Mexico.

Acculturation, Gender, and Active Life Expectancy in the Mexican-Origin Population.

OBJECTIVE: This study examines the potential effects of nativity and acculturation on active life expectancy (ALE) among Mexican-origin elders. METHOD: We employ 17 years of data from the Hispanic Established Population for the Epidemiologic Study of the Elderly to calculate ALE at age 65 with and without disabilities. RESULTS: Native-born males and foreign-born females spend a larger fraction of their elderly years with activities of daily living (ADL) disability. Conversely, both foreign-born males and females spend a larger fraction of their remaining years with instrumental activities of daily life (IADL) disability than the native-born. In descriptive analysis, women with low acculturation report higher ADL and IADL disability. Men manifest similar patterns for IADLs. DISCUSSION: Although foreign-born elders live slightly longer lives, they do so with more years spent in a disabled state. Given the rapid aging of the Mexican-origin population, the prevention and treatment of disabilities, particularly among the foreign born, should be a major public health priority.

Longer lives, sicker lives? Increased longevity and extended disability among Mexican-origin elders.

OBJECTIVES: (a) To identify factors associated with different patterns of functional decline in a longitudinal sample of older Mexican-origin individuals, and (b) to determine the proportions of life after age 65 characterized by serious functional impairment. METHODOLOGY: We use the Hispanic Established Populations for Epidemiologic Studies of the Elderly to examine changes in objective Performance Oriented Mobility Assessments in a cohort of 3,050 Mexican-origin elders initially interviewed in 1993/1994 and recontacted 6 times over 17 years. This sample combined with an additional cohort of 902 individuals 75 and older added at wave 4 in 2004/2005 (combined sample = 3,952) is used in life table analyses to estimate the number of years after 65 characterized by serious functional impairment. RESULTS: Three distinct patterns of functional decline emerge: (a) high initial functioning followed by decline, but not to the level of disability (48%); (b) moderate initial functioning followed by decline to the level of disability (37.5%); and (c) initial disability followed by continued poor functioning (14.5%). Life table analyses reveal that subjects spent over half of the period after 65 with serious functional limitations. Significant gender and nativity differentials emerge. DISCUSSION: Protracted morbidity that accompanies increases in life expectancy has serious implications for the physical, social, and economic well-being of older individuals and their families, as well as for health and long-term care policy.

Revisiting the Hispanic mortality advantage in the United States: the role of smoking.

More than three decades of health disparities research in the United States has consistently found lower adult mortality risks among Hispanics than their non-Hispanic white counterparts, despite lower socioeconomic status among Hispanics. Explanations for the "Hispanic Paradox" include selective migration and cultural factors, though neither has received convincing support. This paper uses a large nationally representative survey of health and smoking behavior to examine whether smoking can explain life expectancy advantage of Hispanics over US-born non-Hispanics whites, with special attention to individuals of Mexican origin. It tests the selective migration hypothesis using data on smoking among Mexico-to-US migrants in Mexico and the United States. Both US-born and foreign-born Mexican-Americans exhibit a life expectancy advantage vis-à-vis whites. All other Hispanics only show a longevity advantage among the foreign-born, while those born in the United States are disadvantaged relative to whites. Smoking-attributable mortality explains the majority of the advantage for Mexican-Americans, with more than 60% of the gap deriving from lower rates of smoking among Mexican-Americans. There is no evidence of selective migration with respect to smoking; Mexicans who migrate to the US smoke at similar rates to Mexicans who remain in Mexico, with both groups smoking substantially less than non-Hispanic whites in the US. The results suggest that more research is needed to effectively explain the low burden of smoking among Mexican-Americans in the United States.

Policy initiatives, culture and the prevention and control of chronic non-communicable diseases (NCDs) in the Caribbean.

OBJECTIVE: To explore interactions between disease burden, culture and the policy response to non-communicable diseases (NCDs) within the Caribbean, a region with some of the highest prevalence rates, morbidity and mortality from NCDs in the Americas. METHODS: We undertook a wide ranging narrative review, drawing on a variety of peer reviewed, government and intergovernmental literature. RESULTS: Although the Caribbean is highly diverse, linguistically and ethnically, it is possible to show how 'culture' at the macro-level has been shaped by shared historic, economic and political experiences and ties. We suggest four broad groupings of countries: the English-speaking Caribbean Community (CARICOM); the small island states that are still colonies or departments of colonial powers; three large-Spanish speaking countries; and Haiti, which although part of CARICOM is culturally distinct. We explore how NCD health policies in the region stem from and are influenced by the broad characteristics of these groupings, albeit played out in varied ways in individual countries. For example, the Port of Spain declaration (2007) on NCDs can be understood as the product of the co-operative and collaborative relationships with CARICOM, which are based on a shared broad culture. We note, however, that studies investigating the relationships between the formation of NCD policy and culture (at any level) are scarce. CONCLUSION: Within the Caribbean region it is possible to discern relationships between culture at the macro-level and the formation of NCD policy. However, there is little work that directly assesses the interactions between culture and NCD policy formation. The Caribbean with its cultural diversity and high burden of NCDs provides an ideal environment within which to undertake further studies to better understand the interactions between culture and health policy formation.

The quest for equity in Latin America: a comparative analysis of the health care reforms in Brazil and Colombia.

INTRODUCTION: Brazil and Colombia have pursued extensive reforms of their health care systems in the last couple of decades. The purported goals of such reforms were to improve access, increase efficiency and reduce health inequities. Notwithstanding their common goals, each country sought a very different pathway to achieve them. While Brazil attempted to reestablish a greater level of State control through a public national health system, Colombia embraced market competition under an employer-based social insurance scheme. This work thus aims to shed some light onto why they pursued divergent strategies and what that has meant in terms of health outcomes. METHODS: A critical review of the literature concerning equity frameworks, as well as the health care reforms in Brazil and Colombia was conducted. Then, the shortfall inequality values of crude mortality rate, infant mortality rate, under-five mortality rate, and life expectancy for the period 1960-2005 were calculated for both countries. Subsequently, bivariate and multivariate linear regression analyses were performed and controlled for possibly confounding factors. RESULTS: When controlling for the underlying historical time trend, both countries appear to have experienced a deceleration of the pace of improvements in the years following the reforms, for all the variables analyzed. In the case of Colombia, some of the previous gains in under-five mortality rate and crude mortality rate were, in fact, reversed. CONCLUSIONS: Neither reform seems to have had a decisive positive impact on the health outcomes analyzed for the defined time period of this research. This, in turn, may be a consequence of both internal characteristics of the respective reforms and external factors beyond the direct control of health reformers. Among the internal characteristics: underfunding, unbridled decentralization and inequitable access to care seem to have been the main constraints. Conversely, international economic adversities, high levels of rural and urban violence, along with entrenched income inequalities seem to have accounted for the highest burden among external factors.

[Years of potential life lost by female homicide victims in Recife, Pernambuco State, Brazil]. / Anos potenciais de vida perdidos por mulheres vítimas de homicídio na cidade do Recife, Pernambuco, Brasil.

This cross-sectional epidemiological study aimed to calculate the potential years of life lost by female homicide victims in Recife, Pernambuco State, Brazil, in 2003-2007. A database was used from the Operational Division for Information on Births and Deaths under the Recife Municipal Health Department. All death certificates for childbearing-age women were reviewed for the five-year period. The results showed a total of 12,120 potential years of life lost by these women, mostly young, black (88%), with unknown levels of schooling (78.2%), single (80%), in District III of the city, and murdered with firearms in their own homes. The specific mortality rate was 10.8 homicides per 100,000 childbearing-age women. The 43.3 years of life lost per woman express the city's characteristics, poverty levels, unemployment, population density, residential instability, and social inequality, exposing residents to social strife, crime, and violence.

Anos potenciais de vida perdidos por mulheres vítimas de homicídio na cidade do Recife, Pernambuco, Brasil / Years of potential life lost by female homicide victims in Recife, Pernambuco State, Brazil

This cross-sectional epidemiological study aimed to calculate the potential years of life lost by female homicide victims in Recife, Pernambuco State, Brazil, in 2003-2007. A database was used from the Operational Division for Information on Births and Deaths under the Recife Municipal Health Department. All death certificates for childbearing-age women were reviewed for the five-year period. The results showed a total of 12,120 potential years of life lost by these women, mostly young, black (88 percent), with unknown levels of schooling (78.2 percent), single (80 percent), in District III of the city, and murdered with firearms in their own homes. The specific mortality rate was 10.8 homicides per 100,000 childbearing-age women. The 43.3 years of life lost per woman express the city's characteristics, poverty levels, unemployment, population density, residential instability, and social inequality, exposing residents to social strife, crime, and violence.

Estudo epidemiológico, transversal, objetivando calcular os anos potenciais de vida perdidos por mulheres vítimas de homicídio na cidade do Recife, Pernambuco, Brasil, no quinquênio 2003-2007. Utilizou-se de um banco de dados da Gerência Operacional de Informação de Mortalidade e Natalidade da Secretaria de Saúde do Recife, e foram revisadas todas as declarações de óbitos das vítimas de homicídio, com idade fértil no quinquênio analisado. Os resultados revelaram que houve 12.120 anos potenciais de vida perdidos, no período, por mulheres jovens, negras (88 por cento), de escolaridade desconhecida (78,2 por cento), solteiras (80 por cento), mortas na Região Político-administrativa III, que foram assassinadas com uso de arma de fogo, no próprio domicílio. A taxa de mortalidade específica, no período, correspondeu a 10,8 por 100 mil mulheres em idade fértil. Os 43,3 anos de vida perdidos por cada vítima refletem, entre outros aspectos, as características do município, relativas ao nível de pobreza, desemprego, densidade populacional, instabilidade residencial, desigualdade social, que expõem seus habitantes a crises sociais, crimes e violência.

Inflammatory gene variants in the Tsimane, an indigenous Bolivian population with a high infectious load.

The Tsimane of lowland Bolivia are an indigenous forager-farmer population living under conditions resembling pre-industrial European populations, with high infectious morbidity, high infection and inflammation, and shortened life expectancy. Analysis of 917 persons ages 5 to 60+ showed that allele frequencies of 9 SNPs examined in the apolipoprotein E (apoE), C-reactive protein (CRP), and interleukin-6 (IL-6) genes differed from some European, African, and north Asian-derived populations. The apoE2 allele was absent, whereas four SNPs related to CRP and IL-6 were monomorphic: CRP (rs1800947, rs3093061, and rs3093062) and IL-6 (rs1800795). No significant differences in apoE, CRP, and IL-6 variants across age were found CRP levels were higher in carriers of two CRP proinflammatory SNPs, whereas they were lower in carriers of apoE4. Taken together the evidence for (1) different allele frequencies between the Tsimane and other populations and (2) the correlations of CRP and apoE alleles with blood CRP may suggest that these variants are under selection in response to a high infection environment.

The color of child mortality in Brazil, 1950-2000: social progress and persistent racial inequality.

Now that racism has been officially recognized in Brazil, and some universities have adopted affirmative-action admission policies, measures of the magnitude of racial inequality and analyses that identify the factors associated with changes in racial disparities over time assume particular relevance to the conduct of public debate. This study uses census data from 1950 to 2000 to estimate the probability of death in the early years of life, a robust indicator of the standard of living among the white and Afro-Brazilian populations. Associated estimates of the average number of years of life expectancy at birth show that the 6.6-year advantage that the white population enjoyed in the 1950s remained virtually unchanged throughout the second half of the twentieth century, despite the significant improvements that accrued to both racial groups. The application of multivariate techniques to samples selected from the 1960, 1980, and 2000 census enumerations further shows that, controlling for key determinants of child survival, the white mortality advantage persisted and even increased somewhat in 2000. The article discusses evidence of continued racial inequality during an era of deep transformation in social structure, with reference to the challenges of skin color classification in a multiracial society and the evolution of debates about color, class, and discrimination in Brazil.

Measuring the impact of diabetes on life expectancy and disability-free life expectancy among older adults in Mexico.

UNLABELLED: OBJECTIVES. The aim of the present study is to investigate differences in total life expectancy (TLE), disability-free life expectancy (DFLE), disabled life expectancy (DLE), and personal care assistance between individuals with and without diabetes in Mexico. METHODS: The sample was drawn from the nationally representative Mexican Health and Aging Study. Disability was assessed through a basic Activities of Daily Living (ADL) measure, the Instrumental Activities of Daily Living (IADL) scale, and the Nagi physical performance measure. The Interpolation of Markov Chains method was used to estimate the impact of diabetes on TLE and DFLE. RESULTS: Results indicate that diabetes reduces TLE at ages 50 and 80 by about 10 and 4 years, respectively. Diabetes is also associated with fewer years in good health. DFLE (based on ADL measures) at age 50 is 20.8 years (95% confidence interval [CI]: 19.2-22.3) for those with diabetes, compared with 29.9 years (95% CI: 28.8-30.9) for those without diabetes. Regardless of diabetes status, Mexican women live longer but face a higher disability burden than men. CONCLUSION: Among older adults in Mexico, diabetes is associated with shorter TLE and DFLE. The negative effect of diabetes on the number of years lived, particularly in good health, creates significant economic, social, and individual costs for elderly Mexicans.

Análise de custo-efetividade de procedimentos para o adiamento dafase terminal da doença renal crônica associada ao diabetes mellitus e à hipertensão arterial sob a perspectiva do Sistema Único de Saúde / Cost-effectiveness of procedures for the postponement of the terminal stage of chronic kidney disease associated with diabetes mellitus and hypertension from the perspective of the Unified Health System

O objetivo deste estudo foi realizar uma análise de custo-efetividade de propostas para o adiamento da fase terminal da doença renal crônica (ADRC) associada à hipertensão arterial e ao diabetes mellitus no contexto nacional, sob a perspectiva do Sistema Único de Saúde. Dentre as possibilidades de manejo da doença analisadas constam a experiência do ambulatório de DRC da Universidade do Estado do Rio de Janeiro e a abordagem clínica tradicional, representada pela atenção fornecida hoje pelo SUS. As alternativas estudadas foram: Tratamento Tradicional do SUS com o uso de Inibidor da enzima conversora de angiotensina (IECA) para o controle da pressão arterial; ADRC 1, representado pelo Programa de ADRC da UERJ; ADRC 2, como uma proposta de programa de ADRC de acordo com as diretrizes clínicas incluindo o uso do ARA II; ADRC 3, como uma proposta de programa de ADRC de acordo com as diretrizes clínicas incluindo com o uso de estatina; ADRC 4 como uma proposta de ADRC completa incluindo o uso de ARA II e estatina . O ADRC UERJ foi uma alternativa avaliada como um referencial para o SUS de um programa que oferece cuidado integral ao paciente portador de DRC com abordagem multidisciplinar. Os resultados mostraram que pacientes com nefropatia diabética no SUS, teriam uma expectativa de vida aproximada de 6,66 anos, enquanto que na UERJ a expectativa de vida seria de 11,56 anos. As alternativas ADRC 3 e ADRC 4 proporcionariam uma expectativa de vida de cerca de 16 anos, e 10 QALYS extras com relação ao SUS. Ao relacionar as dimensões custo e efetividade aplicando-se uma taxa de desconto de 5 % ao ano, verificou-se que a alternativa mais vantajosa foi o ADRC 3, apresentando economia da ordem de R$ 10.525,27 com relação ao SUS para cada ano adicional sobre a expectativa de vida, isto porque os pacientes prescindiriam de hemodiálise...

The objective of this study was to estimate the cost-effectiveness for some alternatives of Conservative Management of Chronic Kidney Disease (CKD) related to hypertensionand diabetes mellitus under Brazilian Public Health System (SUS) perspective. These options include an experience of a conservative management based on a multidisciplinary approach performed by the University of Rio de Janeiro (UERJ) and the current practice that have been carried out in SUS. The point was to evaluate both, benefits and incremental costs that would result from a full coverage of technologies that are not still largely available in brazilian primary care, like Angiotensin II-Receptor Antagonists (ARA II) and Statins. The alternatives assessed were: Current practice in SUS including Angiotensin-converting enzyme (ACE) inhibitors to treat hypertension; ADRC 1 represented by UERJ Program; ADRC 2 as a hypothetical program based oncurrent guidelines, including the prescription of statins; ADRC 3 as a hypothetical program based on current guidelines, including the prescription of ARA II; and ADRC 4 as a hypothetical program based on current guidelines, including the prescription of ARA II and statins. The UERJ program was an alternative evaluated as a reference toSUS and as an example of a clinical management that offers a whole care to their CKD patients with a multidisciplinary team support. Results showed that SUS patients with diabetic nephropahy have a life expectancy of 6,66 years while UERJ patients have11,56 years. Both alternatives ADRC 3 and 4, increase the SUS quality-adjusted life expectancy in about 10 years. The results of cost-effectiveness ratios discounted at 5% a.a. showed that the dominant strategy was ADRC 3 indicating costs savings of R$10.525,27 for each year of life added compared to SUS. This occurs because in this alternative patients would not need hemodialysis during their lifetime...

Cilostazol e aterosclerose / Cilostazol and atherosclerosis

Embora o cilostazol seja conhecido no Japão há mais de 30 anos, somente na última década foi adotado no tratamento da aterosclerose em países ocidentais. Após 40 anos de tratamento empírico da doença arterial periférica (DAP), o cilostazol demonstrou, à luz da medicina baseada em evidências, aumentar a capacidade funcional e melhorar a claudicação intermitente e a qualidade de vida de pacientes com DAP sintomática, tornando-se o agente de primeira escolha para esse fim, de acordo com as melhores diretrizes atuais. Na doença cerebrovascular o cilostazol diminui o risco de AVC recorrente e de progressão da aterosclerose em artérias cerebrovasculares de pacientes com DAP ou em uso isolado de ácido acetilsalicílico após AVC/AIT. Após angioplastia coronária e implante de stent o cilostazol tem se mostrado uma arma promissora em reduzir o risco de reestenose, a necessidade de revascularização do vaso-alvo e a ocorrência de ECAM (evento coronário agudo maior).Este agente apresenta propriedades vasodilatadoras, antiproliferativas e antiplaquetárias e emerge como uma nova e eficiente opção no combate às graves consequências potenciais da aterosclerose.