RESUMO
BACKGROUND: The aim of this study was to investigate the costs and the health outcomes of primary care treatments for chronic diseases and to analyze the association between domains of quality of life (QoL), physical activity and healthcare costs. METHODS: The sample encompassed 292 patients aged 50 years or more in Brazilian primary care facilities, categorized in three groups: no drug treatment or only regular physical activity, only drug treatment, and drug treatment with regular physical activity. Patients were assessed in relation to quality of life, healthcare costs, regular physical activity, and use of medications. RESULTS: Results indicate higher cost-utility ratio among primary care patients adopting only drug treatment (3.92), followed by drug treatment with regular physical activity (3.21), and no drug treatment or only regular physical activity (0.12). CONCLUSIONS: QoL was significantly associated with risk factors for chronic diseases, especially obesity, and limitations in mobility showed important increases in healthcare costs. The dominant strategy in terms of cost-utility ratio was identified among primary care patients without drug treatment or physically active, followed by patients in drug treatment combined with regular physical activity. Drug treatment without regular physical activity showed worst results in relation to other primary care strategies.
Assuntos
Doença Crônica/tratamento farmacológico , Doença Crônica/economia , Exercício Físico , Custos de Cuidados de Saúde , Atenção Primária à Saúde/economia , Qualidade de Vida , Idoso , Brasil , Doença Crônica/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Sit-to-walk (STW) is a sequential task and a merge of sit-to-stand (STS) and gait initiation that are impaired in people with Parkinson's disease (PD). Performing sequential task under time constraint (e.g., stand up and walk to answer an urgent call) might influence people with PD due to their deficits on internal regulation of continuous, rhythmic and fast movements. It is known the PD behavior during STS and gait initiation tasks are impaired, however, little is known regarding PD behavior on STW. Thus, the aim of this study was to assess the motor behavior of people with PD and healthy older adults during the STW task under time constraint. METHODS: Fourteen people with idiopathic PD and 14 healthy older adults (OA) participated in this study. They performed the STW task under a time constraint. STW performance (STW total duration, duration of each of the 4 phases of the STW, and the drop in the center of mass (COM) momentum, identified as Fluidity Index - FI), kinematics and kinetics outcomes were assessed throughout the task. RESULTS: The PD group showed increased STW total time and lower FI, longer seat-off (Phase 1) time and first step (Phase 4) when compared to the OA group. Furthermore, the PD group showed more motor impairments (kinematics and kinetics) than the OA group throughout the task from seat-off until heel-off. Also, people with PD exhibited larger mediolateral COM displacement in the standing phase (Phase 2) and greater ground reaction force (GRF) in Phases 1 and 3. CONCLUSIONS: We observed that people with PD exhibited more restrictions when compared with healthy older adults on their STW performance, COM and GRF parameters during the STW under time constraint. Some clinical impairments usually observed in people with PD might explain their STW performance such as, motor planning deficits, less automatic motor control and mediolateral balance impairments.
Assuntos
Análise da Marcha , Movimento , Doença de Parkinson/fisiopatologia , Equilíbrio Postural , Caminhada/fisiologia , Idoso , Fenômenos Biomecânicos , Estudos de Casos e Controles , Feminino , Humanos , Cinética , Masculino , Pessoa de Meia-Idade , Postura , Índice de Gravidade de Doença , TempoRESUMO
BACKGROUND: Metabolic syndrome (MetS) is a combination of risk factors for cardiovascular disease and type 2 diabetes mellitus. The prevalence of MetS worldwide is increasing. There is no study investigating the economic burden of MetS, especially in developing countries, on medication-related expenditure. The aim of this study was to investigate the association of medication-related expenditures with MetS and to explore how physical activity (PA) may influence this association. METHODS: A total of 620 participants, 50 years or older, randomly selected in the city of Bauru, Brazil. Participants were followed from 2010 to 2014, and data on health care expenditure were collected annually. PA questionnaire was applied at baseline, 2 (2012), and 4 (2014) years later. RESULTS: Mean age was 64.7 (95% confidence interval, 64.1-65.3). MetS was associated with higher medication expenditure related to diseases of the circulatory (P <.01) and endocrine (P <.01) systems. MetS explained 17.2% of medication-related expenditures, whereas PA slightly attenuated this association, explaining 1.1% of all health care costs. CONCLUSION: This study demonstrates that MetS has a significant burden on health care expenditures among adults, whereas PA seems to affect this phenomenon significantly, but in low magnitude.