1
|
Alves FLMT, Laporta GZ. Prevalence and factors associated with lower limb amputation in individuals with type II diabetes mellitus in a referral hospital in Fortaleza, Ceará, Brazil: A hospital-based cross-sectional study. Heliyon 2020; 6:e04469. [PMID: 32715137 PMCID: PMC7372145 DOI: 10.1016/j.heliyon.2020.e04469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 07/07/2020] [Accepted: 07/13/2020] [Indexed: 12/03/2022] Open
Abstract
AIMS To analyze the association between demographic, socioeconomic, clinical, epidemiological, and primary healthcare factors with the severity of lower limb amputations (LLAs) in individuals with type II diabetes mellitus (DM-II) at a reference hospital in Fortaleza, Ceará, in Northeast Brazil. METHODS A cross-sectional study was performed with a representative sample of individuals hospitalized with DM-II and the degree of LLA severity: (1) toes; (2) transmetatarsal or infrapatellar; (3) suprapatellar; (4) disarticulation or bilateral. Potentially associated factors with the outcome degree of amputation severity were identified in a semi-structured evaluation during hospitalization. The prevalence ratios of the degree of amputation severity as a function of associated factors were calculated with robust variance Poisson regression models. RESULTS The prevalence of high degree of severity in amputations (suprapatellar, with disarticulation or bilateral) was high in the total sample of 385 patients, revealing to be 49% (187/385). Prevalence ratios (PR) indicated a higher prevalence of DM-II amputation severity in patients who lacked of specific guidance on DM-II amputation in primary care (PR = 1.52, 95% CI: 1.05-2.21). CONCLUSIONS LLAs in DM-II were associated with age above 67 years, male gender, cardiovascular disease, and low support for guidance at the primary healthcare level.
Collapse
Affiliation(s)
- Francisca Lesse Mary Teixeira Alves
- Setor de Pós-graduação, Pesquisa e Inovação, Centro Universitário Saúde ABC (FMABC), Fundação ABC, Santo André, São Paulo, Brazil
- Hospital Geral de Fortaleza (HGF), Secretaria de Estado da Saúde State, Fortaleza, Ceará, Brazil
| | - Gabriel Zorello Laporta
- Setor de Pós-graduação, Pesquisa e Inovação, Centro Universitário Saúde ABC (FMABC), Fundação ABC, Santo André, São Paulo, Brazil
| |
Collapse
|
2
|
Toscano CM, Sugita TH, Rosa MQM, Pedrosa HC, Rosa RDS, Bahia LR. Annual Direct Medical Costs of Diabetic Foot Disease in Brazil: A Cost of Illness Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15010089. [PMID: 29316689 PMCID: PMC5800188 DOI: 10.3390/ijerph15010089] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 12/31/2017] [Accepted: 01/01/2018] [Indexed: 12/30/2022]
Abstract
The aim of this study was to estimate the annual costs for the treatment of diabetic foot disease (DFD) in Brazil. We conducted a cost-of-illness study of DFD in 2014, while considering the Brazilian Public Healthcare System (SUS) perspective. Direct medical costs of outpatient management and inpatient care were considered. For outpatient costs, a panel of experts was convened from which utilization of healthcare services for the management of DFD was obtained. When considering the range of syndromes included in the DFD spectrum, we developed four well-defined hypothetical DFD cases: (1) peripheral neuropathy without ulcer, (2) non-infected foot ulcer, (3) infected foot ulcer, and (4) clinical management of amputated patients. Quantities of each healthcare service was then multiplied by their respective unit costs obtained from national price listings. We then developed a decision analytic tree to estimate nationwide costs of DFD in Brazil, while taking into the account the estimated cost per case and considering epidemiologic parameters obtained from a national survey, secondary data, and the literature. For inpatient care, ICD10 codes related to DFD were identified and costs of hospitalizations due to osteomyelitis, amputations, and other selected DFD related conditions were obtained from a nationwide hospitalization database. Direct medical costs of DFD in Brazil was estimated considering the 2014 purchasing power parity (PPP) (1 Int$ = 1.748 BRL). We estimated that the annual direct medical costs of DFD in 2014 was Int$ 361 million, which denotes 0.31% of public health expenses for this period. Of the total, Int$ 27.7 million (13%) was for inpatient, and Int$ 333.5 million (87%) for outpatient care. Despite using different methodologies to estimate outpatient and inpatient costs related to DFD, this is the first study to assess the overall economic burden of DFD in Brazil, while considering all of its syndromes and both outpatients and inpatients. Although we have various reasons to believe that the hospital costs are underestimated, the estimated DFD burden is significant. As such, public health preventive strategies to reduce DFD related morbidity and mortality and costs are of utmost importance.
Collapse
Affiliation(s)
- Cristiana M Toscano
- Collective Health Department, Federal University of Goiás, Goiânia, Goiás 74605-050, Brazil.
| | - Tatiana H Sugita
- Collective Health Department, Federal University of Goiás, Goiânia, Goiás 74605-050, Brazil.
| | - Michelle Q M Rosa
- Internal Medicine Department, State University of Rio de Janeiro, Rio de Janeiro 20551-030, Brazil.
| | | | - Roger Dos S Rosa
- Social Medicine Department, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre 90035-003, Brazil.
| | - Luciana R Bahia
- Internal Medicine Department, State University of Rio de Janeiro, Rio de Janeiro 20551-030, Brazil.
| |
Collapse
|
3
|
Peixoto AM, Zimpel SA, Oliveira ACAD, Monteiro RLS, Carneiro TKG. Prevalência de amputações de membros superiores e inferiores no estado de Alagoas atendidos pelo SUS entre 2008 e 2015. FISIOTERAPIA E PESQUISA 2017. [DOI: 10.1590/1809-2950/17029524042017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO A amputação é um recurso terapêutico utilizado para realizar a remoção de um membro, outro apêndice ou saliência do corpo, na ocorrência de lesões graves de nervos, artérias, partes moles e ossos. O objetivo desta pesquisa foi verificar a prevalência de amputações de membros no estado de Alagoas. Tratou-se de um estudo de dados secundários, com abordagem epidemiológica e observacional, no período de 2008 a 2015. As informações foram coletadas do banco de dados do SIHSUS. Foram registrados 361.585 procedimentos de amputações de membros no Brasil, com predominância nas regiões Sudeste, Nordeste e Sul, responsáveis por 88,13% desse total. Alagoas ocupou o 21º lugar em número de amputações entre os estados brasileiros: seus procedimentos ocorreram em seis microrregiões, destas, 3 foram responsáveis por 95% dos casos. A prevalência de amputação em Alagoas foi de 19,05 amputações/100 mil habitantes. Três tipos de procedimentos apresentam maior predominância: amputação de membros inferiores, dedos, pé e tarso, o que representa 95% das amputações.
Collapse
|
4
|
Umebayashi Zanoti MD, Megumi Sonobe H, Lima Ribeiro SJ, Minarelli Gaspar AM. Development of coverage and its evaluation in the treatment of chronic wounds. INVESTIGACION Y EDUCACION EN ENFERMERIA 2017; 35:330-339. [PMID: 29767913 DOI: 10.17533/udea.iee.v35n3a09] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/30/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To describe the development of the bacterial cellulose coating with anti-inflammatory Ibuprofen (BC/Ibu) and to evaluate the cicatrization process with its use in patients with chronic wounds of venous and diabetic etiology. METHODS Longitudinal descriptive study. The cellulose membrane, cultivated with bacteria Gluconacetobacter xylinus and with incorporation of Ibuprofen, was used in the treatment of patients with chronic wounds in public health services in a Brazilian municipality. The ideal coverage characteristics were evaluated through physical, chemical and cell proliferation tests. RESULTS The sample consisted of 14 patients (10 women and 4 men), 8 with venous ulcer, 5 with diabetic foot and one with mixed wound. There was reduction of area and pain in 9 lesions; total healing of 3 wounds; and debridement of the devitalized tissue in 5 wounds with increased area. The use of the membrane was important in the reduction of pain, exudation and ease in the accomplishment of the curative. CONCLUSIONS BC/Ibu favored the cicatrization process of patients with chronic vasculogenic wounds.
Collapse
|
5
|
Abstract
Trata-se de estudo descritivo, em coorte transversal incluindo 59 indivíduos com DM, que apresentavam pé diabético como complicação, atendidos no ambulatório de Pé Diabético do Centro Hiperdia, no município de Juiz de Fora – MG, no período de julho de 2013 a julho de 2014. Resultados: As condições predisponentes mais prevalentes foram HAS (96,6%), neuropatia (85,4%) e dislipidemia (69,5%). Foi observada ainda presença de sobrepeso/obesidade (28,8%/50,8%), tabagismo (42,4%), sedentarismo (28,8%) e mau controle glicêmico (HbA1c: 8,8% ±2,24 ). Em relação ao cuidado com os pés, 86,4% dos participantes se diziam conscientes. É fundamental a instituição da educação em diabetes em todos os níveis de cuidado, para que a prevenção se dê de forma realmente eficaz, visto que a maioria dos fatores de risco são modificáveis. A orientação desses pacientes sobre cuidado com os pés é um importante instrumento na redução do risco de ulceração e amputação em membros inferiores.
Collapse
|
6
|
Del Brutto OH, Mera RM, King NR, Zambrano M, Sullivan LJ. The burden of diabetes-related foot disorders in community-dwellers living in rural Ecuador: Results of the Atahualpa Project. Foot (Edinb) 2016; 28:26-29. [PMID: 27718386 DOI: 10.1016/j.foot.2016.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/13/2016] [Accepted: 05/25/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND/OBJECTIVES Prevalence of diabetes-related foot disorders (DRFD) in rural areas of developing countries is unknown. The burden of these conditions in Atahualpa, a rural Ecuadorian village, were assessed. METHODS Using a population-based design, Atahualpa residents aged ≥40 years with diabetes mellitus were identified. Ankle brachial index determinations were used to assess presence of peripheral arterial disease, and the Michigan Neuropathy Screening Instrument was used to estimate peripheral neuropathy. Ulcers in the foot/ankle as well as history of amputations were considered as evidence of active diabetic foot disease. Using a linear model of risk, factors that independently correlated with DRFD, were assessed. RESULTS Mean age of 110 participants was 64±12years (59% women). Peripheral arterial disease was diagnosed in 24% of cases and peripheral neuropathy in 59% (15% had both conditions). In the adjusted model, increasing age and being men increased the risk for DRFD. Active diabetic foot disease was noted in 7% of participants, and another 60% were at moderate-to-high risk for developing this complication (according to NHS Borders Foot Classification System). CONCLUSIONS The prevalence of DRFD is high in rural Ecuador, and most of the affected individuals are at risk for developing active diabetic foot disease.
Collapse
Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo-Ecuador, Guayaquil, Ecuador.
| | - Robertino M Mera
- Vanderbilt University Medical Center, Nashville, TN, United States
| | - Nathan R King
- School of Medicine, New York University, Langone Medical Center, New York, NY, United States
| | | | - Lauren J Sullivan
- School of Medicine, New York University, Langone Medical Center, New York, NY, United States
| |
Collapse
|
7
|
Santos ICRV, Carvalho EFD, Souza WVD, Albuquerque ECD. Factors associated with diabetic foot amputations. J Vasc Bras 2015. [DOI: 10.1590/1677-5449.20140049] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND: Diabetes and the problem of the diabetic foot specifically are a severe burden on the public healthcare system. Amputations caused by this condition are still common in our setting (Brazil), although the true magnitude of the problem is not known with certainty. Lower limb amputation rates have come to be seen as an indicator of the quality of preventative care of the diabetic foot. OBJECTIVE: To identify associations between amputations and factors related to people, to morbidities and to primary care received. METHODS: This was a cross-sectional study of a sample of 137 patients with diabetic feet admitted to a large hospital in the city of Recife, Pernambuco, Brazil. Logistic regression analysis was conducted. RESULTS: Associations with amputation were detected for the following variables: age over 60; resident of the Metro zone; income of three minimum salaries or less; presence of gangrene on admission; glycemia ≥ 126 mg/dL; smoking; not receiving information about results of glycemia testing; not having feet examined, and not being given guidance on caring for feet at consultations during the previous year. CONCLUSIONS: Factors related to Primary Care, such as time since onset of ulcers, information about results of glycemia testing and lack of guidance on how to care for their feet, were associated with occurrence of lower limb amputations.
Collapse
|
8
|
Bertoldi AD, Kanavos P, França GVA, Carraro A, Tejada CAO, Hallal PC, Ferrario A, Schmidt MI. Epidemiology, management, complications and costs associated with type 2 diabetes in Brazil: a comprehensive literature review. Global Health 2013; 9:62. [PMID: 24299125 PMCID: PMC4220809 DOI: 10.1186/1744-8603-9-62] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 11/11/2013] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND With an estimated 74% of all deaths attributable to non-communicable diseases (NCDs) in 2010, NCDs have become a major health priority in Brazil. The objective of the study was to conduct a comprehensive literature review on diabetes in Brazil; specifically: the epidemiology of type 2 diabetes, the availability of national and regional sources of data (particularly in terms of direct and indirect costs) and health policies for the management of diabetes and its complications. METHODS A literature search was conducted using PubMed to identify articles containing information on diabetes in Brazil. Official documents from the Brazilian government and the World Health Organization, as well as other grey literature and official government websites were also reviewed. RESULTS From 2006 to 2010, an approximate 20% increase in the prevalence of self-reported diabetes was observed. In 2010, it was estimated that 6.3% of Brazilians aged 18 years or over had diabetes. Diabetes was estimated to be responsible for 278,778 years of potential life lost for every 100,000 people. In 2013, it is estimated that about 7% of patients with diabetes has had one or more of the following complications: diabetic foot ulcers, amputation, kidney disease, and fundus changes. The estimated annual direct cost of diabetes was USD $3.952 billion in 2000; the estimated annual indirect cost was USD $18.6 billion. The two main sources of data on diabetes are the information systems of the Ministry of Health and surveys. In the last few years, the Brazilian Ministry of Health has invested considerably in improving surveillance systems for NCDs as well as implementing specific programmes to improve diagnosis and access to treatment. CONCLUSIONS Brazil has the capacity to address and respond to NCDs due to the leadership of the Ministry of Health in NCD prevention activities, including an integrated programme currently in place for diabetes. Strengthening the surveillance of NCDs is a national priority along with recognising the urgent need to invest in improving the coverage and quality of mortality data. It is also essential to conduct regular surveys of risk factors on a national scale in order to design effective preventive strategies.
Collapse
Affiliation(s)
- Andréa D Bertoldi
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 3° piso, Pelotas, RS, Brazil, 96.020-220
| | - Panos Kanavos
- LSE Health, London School of Economics and Political Science, London, UK
- Department of Social Policy, London School of Economics and Political Science, London, UK
| | - Giovanny V A França
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 3° piso, Pelotas, RS, Brazil, 96.020-220
- MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge, UK
| | - André Carraro
- Programa de Pós-Graduação em Organizações e Mercados, Universidade Federal de Pelotas, RS, Brazil
| | | | - Pedro C Hallal
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 3° piso, Pelotas, RS, Brazil, 96.020-220
| | - Alessandra Ferrario
- LSE Health, London School of Economics and Political Science, London, UK
- Department of Social Policy, London School of Economics and Political Science, London, UK
| | - Maria Inês Schmidt
- Programa de Pós-graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| |
Collapse
|
9
|
Mendonça SDS, Morais JDS, Moura MCGGD. Proposta de um protocolo de avaliação fisioterapêutica para os pés de diabéticos. FISIOTERAPIA EM MOVIMENTO 2011. [DOI: 10.1590/s0103-51502011000200010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUÇÃO: Em virtude dos altos custos sociais e econômicos decorrentes das complicações do diabetes mellitus (DM) e sabendo-se que uma avaliação clínica minuciosa pode prevenir ou reduzir os impactos desse distúrbio, têm-se cada vez mais a necessidade do desenvolvimento de avaliações específicas. OBJETIVO: O presente trabalho tem como objetivo propor um protocolo de avaliação fisioterapêutica para os pés de diabéticos. Materiais e método: A composição do presente artigo resultou de uma revisão de literatura, que foi realizada a partir dos trabalhos indexados nos periódicos das bases de dados LILACS, SciELO, PubMed e MEDLINE. Os descritores utilizados foram: "diabetes mellitus", "fatores de risco", "pé diabético" e "avaliação". RESULTADOS: O protocolo proposto compõe-se de três etapas: a primeira para avaliação dos aspectos sociodemográficos, estilo de vida, histórico da doença, antecedentes de problemas nos pés; a segunda para as condições dermatológicas, circulatórias, neurológicas, funcionais e estruturais; e por último, a avaliação de autocuidado com o pé. CONCLUSÃO: A avaliação sugerida pode ser útil para a caracterização minuciosa dos diabéticos, e assim identificar aqueles que apresentam maiores riscos de desenvolverem complicações, bem como pode facilitar a determinação de medidas preventivas e o tratamento adequado.
Collapse
|
10
|
Parisi MCR, Giannella D, Fernandes TD, Rezende KF, Nery M. Diabetic foot screening: study of a 3000 times cheaper instrument. Clinics (Sao Paulo) 2011; 66:1105-7. [PMID: 21808884 PMCID: PMC3129973 DOI: 10.1590/s1807-59322011000600032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
|