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Pharmacoeconomics ; 39(7): 809-822, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-33970445


BACKGROUND: Alcohol-attributable costs to society are captured by cost-of-illness studies, however estimates are often not comparable, e.g. due to the omission of relevant cost components. In this contribution we (1) summarize the societal costs attributable to alcohol use, and (2) estimate the total costs under the assumption that all cost components are considered. METHODS: A systematic review and meta-analyses were conducted for studies reporting costs from alcohol consumption for the years 2000 and later, using the EMBASE and MEDLINE databases. Cost estimates were converted into 2019 international dollars (Int$) per adult and into percentage of gross domestic product (GDP). For each study, weights were calculated to correct for the exclusion of cost indicators. RESULTS: Of 1708 studies identified, 29 were included, and the mean costs of alcohol use amounted to 817.6 Int$ per adult (95% confidence interval [CI] 601.8-1033.4), equivalent to 1.5% of the GDP (95% CI 1.2-1.7%). Adjusting for omission of cost components, the economic costs of alcohol consumption were estimated to amount to 1306 Int$ per adult (95% CI 873-1738), or 2.6% (95% CI 2.0-3.1%) of the GDP. About one-third of costs (38.8%) were incurred through direct costs, while the majority of costs were due to losses in productivity (61.2%). DISCUSSION: The identified cost studies were mainly conducted in high-income settings, with high heterogeneity in the employed methodology. Accounting for some methodological variations, our findings demonstrate that alcohol use continues to incur a high level of cost to many societies. REGISTRATION: PROSPERO #CRD42020139594.

Consumo de Bebidas Alcohólicas , Costo de Enfermedad , Adulto , Costos de la Atención en Salud , Humanos
Expert Rev Pharmacoecon Outcomes Res ; 21(5): 869-876, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33899647


INTRODUCTION: This contribution gives an overview on estimating the economic impact of substance use (SU) and substance use disorders (SUDs) from a societal perspective. AREAS COVERED: In this Expert Review, we first discuss the scope of the economic costs of SU to society and the methods used to estimate them. In general, cost studies should not be limited to SUDs, but should also include costs related to the consequences of any type of SU to achieve a comprehensive picture of the societal burden. Further, estimating potentially avoidable costs will increase the value of cost studies. Importantly, methodologically sound cost studies shed light on the magnitude of societal problems related to SU and can be used as a reference point to evaluate regulatory policies and other preventive measures. The area of estimating potential economic benefits of SU is understudied and lacks a theoretical and methodological framework. EXPERT OPINION: Overall, economic studies on the impact of SU and SUDs can strongly contribute to better-informed decision-making in the creation of regulatory and control policies. The least developed area of research refers to a consensus methodology that could be used in studies which compare economic costs to potential economic benefits.

Costo de Enfermedad , Costos de la Atención en Salud , Trastornos Relacionados con Sustancias/economía , Política de Salud , Humanos
Eval Health Prof ; 43(1): 23-32, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-30033748


The main objective of this study was to evaluate the effects of interactive video games on functional balance and mobility in poststroke individuals. The Health Science databases accessed included Medline via PubMed, LILACS, SciELO, and PEDro. The inclusion criteria were as follows: clinical studies evaluating the use of interactive video games as a treatment to improve functional balance and mobility in individuals poststroke and studies published in the Brazilian Portuguese, English, or Spanish language between 2005 and April 2016. PEDro Scale was used to analyze the methodological quality of the studies. The Berg Balance Scale and Timed Up and Go Test (TUGT) data were evaluated using a meta-analysis, the publication bias was assessed by funnel plots, and the heterogeneity of the studies by I 2 statistic. Eleven studies were included in the final analysis. Functional balance improved in individuals treated using interactive video games (mean difference = 2.24, 95% confidence interval [0.45, 4.04], p = .01), but no improvement was observed in mobility as measured by TUGT. The studies presented low heterogeneity (24%). The mean score on the PEDro Scale was 6.2 ± 1.9. Interactive video games were effective in improving functional balance but did not influence the mobility of individuals poststroke.

Equilibrio Postural/fisiología , Rehabilitación de Accidente Cerebrovascular/métodos , Juegos de Video , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto
Exp Brain Res ; 237(12): 3123-3132, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31559447


To evaluate the effect of dual tasking that combines walking with a mental tracking task on spatiotemporal gait parameters in younger and older adults. After completing the International Physical Activity Questionnaire (IPAQ), participants performed single tasks: preferred paced walk (PPW); fast paced walk (FPW); single-leg stance (SLS); spelling backwards cognitive task (CT). Thereafter, dual tasks: PPW + CT; FPW + CT; SLS + CT. Spatiotemporal gait parameters and the durations of SLS and SLS + CT were measured. Twenty younger and 20 older adults participated. The IPAQ scores were similar in both groups. Compared to the single task, stride length was shorter, stride time was longer, and stride length and time variability were higher during the PPW and FPW dual tasks in both groups. Older age was associated with shorter stride length during PPW and FPW, and longer stride time during FPW dual compared to single tasks. The older group exhibited shorter times during SLS and SLS + CT compared to younger group. Despite similar self-reported fitness, older age is associated with shorter stride length and longer stride time during FPW dual tasks as well as short times during SLS + CT, which may indicate diminished balance and posture stability.

Envejecimiento/fisiología , Función Ejecutiva/fisiología , Marcha/fisiología , Desempeño Psicomotor/fisiología , Adulto , Anciano , Fenómenos Biomecánicos/fisiología , Femenino , Humanos , Masculino , Memoria a Corto Plazo/fisiología , Persona de Mediana Edad , Análisis Espacio-Temporal , Adulto Joven
Clin Anat ; 32(4): 515-523, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30701597


Vastus medialis (VM) has two partitions, longus (VML), and obliquus (VMO), which have been implicated in knee pathologies. However, muscle architecture of VMO and VML has not been documented volumetrically. The aims of this study were to determine and compare the muscle architecture of VMO and VML in three-dimensional (3D) space, and to elucidate their relative functional capabilities. Twelve embalmed specimens were used in this study. Each specimen was serially dissected, digitized (Microscribe™ MX), and modeled in 3D (Autodesk Maya®). Architectural parameters: fiber bundle length (FBL), proximal (PPA)/distal (DPA) pennation angle, and physiological cross-sectional area (PCSA) were compared using descriptive statistics/t-tests. Sarcomere lengths (SLs) were measured and compared from six biopsy sites of VM. VMO and VML were found to have superficial and deep parts based on fiber bundle attachments to aponeuroses, medial patellar retinaculum, and adductor magnus tendon. The superficial part of VMO was further subdivided into superior and inferior partitions. Architecturally, VMO was found to have significantly shorter mean FBL, greater mean PPA and DPA, and smaller mean PCSA than VML. VML was found to be connected to the fascia lata by thin fascial bands, not present in VMO. SLs of VMO and VML were comparable. VMO and VML are architecturally and functionally distinct, as evidenced by marked differences in their musculoaponeurotic geometry, attachment sites, and architectural parameters. VMO likely contributes greater to medial patellar stabilization, whereas VML, with a larger relative excursion and force-generating capability, to the extension of the knee. Clin. Anat. 32:515-523, 2019. © 2019 Wiley Periodicals, Inc.

Músculo Cuádriceps/anatomía & histología , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Imagenología Tridimensional , Masculino , Músculo Cuádriceps/diagnóstico por imagen , Músculo Cuádriceps/fisiología