Cost-utility analysis of traditional drug therapy with and without exercise program for hypertensive patients in real-life data primary health care

Abstract Aim: The study aimed to conduct a cost-utility analysis of traditional drug therapy (TDT) provided for hypertensive patients at primary care in comparison to the protocol based on combination with an exercise program (TDT+E) in real-life conditions, adopting a health system perspective. Methods: Longitudinal study based on enrollment of 49 hypertensive adults distributed into two groups, for 12 months. Quality-adjusted life years were estimated using health-related quality of life. Direct health care costs were calculated including inputs and human resources in primary care from medical records. Sensitivity analysis was performed based on multivariate and probabilistic scenarios. Results: Incremental cost-effectiveness ratios of TDT+E in comparison to TDT were +79.69. Sensitivity analysis showed that TDT+E presented advantages considering uncertainties. Conclusion: Our findings show that exercise programs may improve quality of life and life expectancy among hypertensive patients.

Associação entre qualidade do sono e doenças cardiometabólicas de pacientes da Atenção Primária à Saúde / Association between sleep quality and cardiometabolic diseases of primary care system patients

A privação do sono está relacionada ao desenvolvimento de doenças cardiometabólicas. O objetivo deste estudo foi analisar a associação entre qualidade do sono e ocorrência de doenças cardiometabólicas em adultos atendidos na Atenção Primária à Saúde. Estudo longitudinal composto por 169 adultos (68,6% do sexo feminino), média de idade 61,80 (desvio padrão = 8,80), acompanhados por 30 meses. A presença das doenças hipertensão arterial, dislipidemia, diabetes mellitus e ocorrência de infarto e a qualidade do sono foram mensuradas por meio de questionários. Os participantes foram divididos em grupos de acordo com a qualidade do sono (adequada/inadequada). Para verificar a diferença de idade, classe econômica, atividade física habitual e circunferência de cintura, entre os grupos a e b, utilizou-se o teste t de Student para amostras independentes. Para comparar a proporção das doenças (hipertensão arterial, infarto, diabetes e dislipidemias) entre os grupos, utilizou-se o teste Qui-quadrado com correção de Yates. A regressão logística binária foi utilizada para testar a magnitude de tais associações, ajustadas por sexo, idade, atividade física, obesidade abdominal, etilismo e tabagismo. As análises estatísticas foram realizadas no software BioEstat (versão 5.0) e o nível de significância adotado foi de p < 0,05. Verificou-se que 83,4% dos adultos reportaram ao menos uma alteração na qualidade do sono e os que apresentaram inadequada qualidade do sono tiveram 3,4 vezes mais chances de reportar diabetes (OR = 3,47; IC95%: 1,06-11,30), comparados aos com o sono adequado. Inadequada qualidade do sono parece contribuir para o aumento da ocorrência de diabetes mellitus, independente do tempo de prática de atividade física e a obesidade abdominal

Sleep deprivation is related to the development of cardiometabolic diseases. The aim of this study was to analyze the association between sleep quality and occurrence of cardiometabolic diseases in adults attending Primary Health Care. Longitudinal study of 169 adults (68.6% female), mean age 61.80 (deviation = 8.80), followed for 30 months. The presence of the diseases hypertension, dyslipidemia, diabetes mellitus and occurrence of infarction and the quality of sleep were measured using questionnaires. Participants were divided into groups according to sleep quality (adequate / inadequate). To verify the difference in age, economic class, habitual physical activity and waist circumference, between groups a and b, the Student's t test for in-dependent samples was used. To compare the proportion of diseases (hypertension, heart attack, diabetes, and dyslipidemia) between the groups, the chi-square test with Yates correction was used. Binary logistic regression was used to test the magnitude of such associations, adjusted for gender, age, physical activity, abdominal obesity, alcoholism and smoking. Statistical analyzes were performed using BioEstat software (version 5.0) and the significance level adopted was p <0.05. 83.4% of adults reported at least one change in sleep quality and those with inadequate sleep quality were 3.4 times more likely to report diabetes (OR = 3.47; 95%CI: 1.06 -11.30) compared to those with adequate sleep. Inadequate sleep quality seems to contribute to the increased occurrence of diabetes mellitus, regardless of the length of physical activity and abdominal obesity

Type 2 diabetes, healthcare expenditures and its correlation with anthropometric factors and physical activity: 18-month follow-up in a Brazilian city

AIMS: To compare the profile of adults attended at primary care level of the Brazilian National Health System according to occurrence of T2DM during 18 months of follow-up. METHOD: Longitudinal study carried out with 316 adults. T2DM and PA were assessed by questionnaires. Measurements of weight, height and waist circumference (WC) were also performed. Healthcare expenditures were based on the demand of services registered in medical records. Analysis of variance (ANOVA) with Tukey's post hoc test was used, as well as their similar for non-parametric variables. Spearman's correlation coefficient analyzed the relationship between variables. All analyzes were performed using the statistical software BioEstat (release 5.0) and the significance level was set at p-value <0.05. RESULTS: Patients with T2DM at baseline showed higher values of WC, BMI, nursing appointments, customer services, medication, total cost and lower values of PA when compared to patients T2DM-free. Patients who developed T2DM during the follow-up presented higher values of WC, screening, pharmacy frequency, medications and total cost when compared to individuals without T2DM. Being in the highest quartile of PA did not change the costs of health services among patients T2DM-free. Healthcare expenditures were positively correlated to BMI among participants T2DM-free and with T2DM at baseline. CONCLUSION: Participants with T2DM and participants who developed T2DM during the follow-up showed higher values of BMI, WC, healthcare expenditures and were less active when compared to participants T2DM-free. Healthcare expenditures were positively correlated with BMI among participants with T2DM at baseline and T2DM-free.(AU)

Can participation in sports during childhood influence physical activity in adulthood?

Abstract Aims: The promotion of sports participation during the early years of life is important not only because it promotes health during childhood and adolescence, but also because it has benefits in adulthood. This study was developed to identify the association between sports participation during the early years of life and adulthood, to analyze the non-participation in sports throughout life and to identify the correlates of non-participation in sports. DESIGN: Cross-sectional study. Methods: The sample was composed of 743 adults randomly selected in a medium-size Brazilian city. Non-participation in sports during childhood and adolescence was assessed through specific questions, and non-participation in sports in adulthood was assessed using the second section of Baecke questionnaire. Answering "no" in the three periods assessed (childhood, adolescence and adulthood) was characterized as non-participation in sports throughout life. Chronological age, sex, formal education, BMI, current job and ethnicity were considered covariates. Categorical data were expressed as rates and compared using chi-square test and binary logistic regression. Results: The prevalence of adults not engaged in sports throughout life was 58.5% (95% CI= 55.1 - 62.1). Females (OR = 2.41 [1.71 - 3.38]), those more advanced in age (OR = 3.29 [1.82-5.94]) and/or possessing a lower level of education (OR = 4.47 [2.45 - 8.17]) were associated with the non-engagement in sports. Conclusion: Non-participation in sports during childhood can influence non-participation in sports during adulthood, which is significantly affected by sex, age and education level.

Association between sleep disorders and chronic diseases in patients of the brazilian national health system / Associação entre distúrbios do sono e doenças crônicas em pacientes do sistema único de saúde

ABSTRACT Many factors are associated with sleep disorders, causing an increase in health spending. The objective of this study was to analyze the association of sleep disorders and non-communicablechronic diseases in patients over 50 years of age, attended by Basic Health Care Units of Presidente Prudente. In total, 363 patients participated. The history of diseases was self-reported through the use of a questionnaire, the level of physical activity was evaluated by the Baecke questionnaire, and sleep quality was assessed using the Mini-Sleep Questionnaire. Anthropometric and body composition data were collected using a stadiometer and scale; patients in the highest (75th) percentile were considered obese. Statistical analysis was performed using the Student t test, chi-square test, and binary logistic regression. The results showed that sleep disorders are associated with osteoporosis, arthritis/osteoarthritis, low back pain, depression, and obesity. Additionally, obesity and physical inactivity influence the occurrence of non-communicable chronic diseases.

RESUMO Inúmeros fatores estão associados aos distúrbios do sono ocasionando o aumento nos gastos com saúde. O objetivo do trabalho foi analisar a associação dos distúrbios do sono e doenças crônicas não transmissíveis em pacientes com idade superior a 50 anos atendidos por Unidades Básicas de Saúde de Presidente Prudente. Participaram 363 pacientes. O histórico de doenças foi auto relatada a partir da aplicação de questionário, o nível de atividade física foi verificado através do questionário de Baecke, e a qualidade do sono foi avaliada utilizando o Mini-Sleep questionnaire. Dados antropométricos e de composição corporal foram coletados utilizando estadiômetro e balança, foram considerados obesos os pacientes dentro do percentil 75. A análise estatística foi composta pelos testes t de Student, qui-quadrado, e regressão logística binária. Os resultados mostraram que o distúrbio do sono está associado as doenças osteoporose, artrite/artrose, dor lombar, depressão e obesidade. Adicionalmente obesidade e inatividade física influenciam na ocorrência de doenças crônicas não transmissíveis.