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Rodrigues PHDA, Mattos ALC, Monteiro NSDS, Silva RDFDC, Baldo VSS. [State and capital accumulation in Brazilian health from the perspective of the Marxist Dependency Theory]. CAD SAUDE PUBLICA 2024; 39:e00082923. [PMID: 38198364 PMCID: PMC10775961 DOI: 10.1590/0102-311xpt082923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/05/2023] [Accepted: 09/12/2023] [Indexed: 01/12/2024] Open
Abstract
The health sector is one of the major fields of economic, social, scientific, and technological development in Brazil, and has been the arena of dispute between capitalist interests that regard health as a commodity and advocates of universal access who regard health as an essential good. The Brazilian Federal Constitution of 1988 determined that health is a fundamental right and the State's responsibility, and since then the country has made progress with public policy, but has suffered setbacks and blockages due to its status as a peripheric country, historically subordinated to the interests of core countries, which see Brazil as a broad consumer market. These external interests associated with the internal bourgeoisie have been taking advantage of the Brazilian State since the 1960s, when the foundation of business groups expanded, dominating various health segments, especially since the neoliberal policies of the 1990s. These aspects are much explored in publications in Public Health, but this text seeks a new approach, using the Marxist Theory of Dependency as a reference to analyze, albeit in a preliminary way, the situation of political, economic, and technological dependence that has distanced health policy from the ideals of a public and universal system, defended in the Brazilian Health Reform.
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Affiliation(s)
| | - Arthur Lobo Costa Mattos
- Instituto de Medicina Social Hésio Cordeiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
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Pinheiro LCHT, Rossi M, dos Santos CAF, Oliveira LVF, Vencio S, de Paula Vieira R, Juliano Y, Armond J, Silva CHM, Fonseca AL, França CN, Bachi ALL. Prevalence of associations among sarcopenia, obesity, and metabolic syndrome in Brazilian older adults. Front Med (Lausanne) 2023; 10:1206545. [PMID: 37746072 PMCID: PMC10514480 DOI: 10.3389/fmed.2023.1206545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Background Although aging is a process associated with the development of obesity, metabolic syndrome (MetS), and sarcopenia, the prevalence of these conditions in older adults from São Paulo, Brazil, is unclear. Methods Therefore, the current study aimed to investigate the prevalence of obesity, sarcopenia, and MetS, both separately and together, in a community-based sample of older adults from São Paulo, Brazil. Data from the medical records of 418 older adults of both genders, aged 60 years or older (mean age 69.3 ± 6.5 years), who were not physically active, were used to conduct this retrospective cross-sectional study. Anthropometric variables were used to determine both body mass index (BMI) and Conicity index (C index). Sarcopenia and MetS were defined according to the criteria of the European Working Group on Sarcopenia in Older People and by the Brazilian Society of Endocrinology and Metabolism, respectively. Results Based on BMI, the group of older men (n = 91) showed a predominance of adequate weight (n = 49) and the group of older women (n = 327) showed a predominance of obesity (n = 181). In association with obesity, while only the group of older women presented with sarcopenia (n = 5), 52 older women and 9 older men presented with MetS, and two older women presented with sarcopenia + MetS [prevalence ratio = 0.0385, 95% CI (0.007;0.1924)]. Based on the C index, 58 older women and 11 older men presented with MetS, while the occurrence of sarcopenia or MetS + sarcopenia was found in 32 and 5 older women, respectively [prevalence ratio = 0.0910, 95% CI (0.037;0.2241)]. Discussion Our results suggest that obesity, as measured by BMI or the C Index, was more closely associated with the occurrence of MetS than sarcopenia, regardless of gender, and also that sarcopenic obesity was only found in the group of older women. Additionally, the prevalence ratio of obesity, sarcopenia, and MetS evidenced using the C index was 2.3 times higher than the values found using the BMI classification.
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Affiliation(s)
| | - Marcelo Rossi
- Post-graduation Program in Health Science, Santo Amaro University (UNISA), São Paulo, Brazil
| | - Carlos André Freitas dos Santos
- Discipline of Geriatrics and Gerontology, Department of Medicine, Paulista School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Postgraduate Program in Translational Medicine, Department of Medicine, Paulista School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Luis Vicente Franco Oliveira
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis, Brazil
| | - Sergio Vencio
- Institute of Pharmaceutical Sciences, Goiania, Brazil
| | - Rodolfo de Paula Vieira
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis, Brazil
- Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), São José dos Campos, Brazil
- Post-graduation Program in Science of Human and Rehabilitation, Federal University of São Paulo (UNIFESP), Santos, Brazil
| | - Yara Juliano
- Post-graduation Program in Health Science, Santo Amaro University (UNISA), São Paulo, Brazil
| | - Jane Armond
- Post-graduation Program in Health Science, Santo Amaro University (UNISA), São Paulo, Brazil
| | - Carlos Hassel Mendes Silva
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis, Brazil
| | - Adriano Luís Fonseca
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis, Brazil
| | - Carolina Nunes França
- Post-graduation Program in Health Science, Santo Amaro University (UNISA), São Paulo, Brazil
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Barreto-Santos L, Vasconcelos-Rocha S, Souza-Lessa R, Alves-Vilela AB. [Multimorbity in elderly municipal of northeast Brazil: prevalence and associated factors]. Rev Salud Publica (Bogota) 2023; 21:519-525. [PMID: 36753203 DOI: 10.15446/rsap.v21n5.77775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 07/29/2019] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To estimate the prevalence and the factors associated with the presence of multimorbidity in the elderly population of the municipality of Ibicuí - BA. METHODS This study was carried out with 310 elderly individuals, aged > 60 years old, of both sexes, living in the municipality of Ibicuí - BA. Sociodemographic information and personal information, living conditions, life habits, body mass, stature and presence of multimorbidity were collected. The descriptive analysis was used and multimorbidity prevalence ratios were estimated according to variables of interest. As a measure of statistical significance, the qui-quadrado de Pearson test was used, adopting p≤0.05. The multivariate analysis hierarchized by Poisson regression was employed after bivariate analysis to select the independent variables (p<0.20). RESULTS The general prevalence of multimorbidity was 80.3%. The hierarchical multi-varied analysis showed the variables of gender and monthly income (p<1.5) were significantly related to the problem. The results reveal also a high prevalence of multimorbidity in the studied population. Mainly women and the poorest suffer from it. CONCLUSIONS It is necessary to redirect the planning of health actions in the municipality, with changes in the health care policy of the elderly, and especially in the social support networks that support these individuals, considering that in this locality the presence of multimorbidity was related to socio-economic grounds.
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Affiliation(s)
- Loiamara Barreto-Santos
- LB: Fisioterapeuta. M. Sc. Enfermagem e Saúde. Universidade Estadual do Sudoeste da Bahia. Jequié, Brasil.
| | - Saulo Vasconcelos-Rocha
- SV: Educador Físico. Ph.D. Educação Física. Universidade Estadual do Sudoeste da Bahia. Vitória da Conquista, Brasil.
| | - Rosângela Souza-Lessa
- RS: Fisioterapeuta. M. Sc. Saúde, Ambiente e Trabalho Universidade Estadual do Sudoeste da Bahia. Jequié, Brasil.
| | - Alba B Alves-Vilela
- AB: Enfermeira. Ph.D. Enfermagem. Universidade Estadual do Sudoeste da Bahia. Jequié, Brasil.
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Saes MO, Machado KP, Facchini LA, Thumé E. Rheumatic diseases and associated factors in older adults: a Brazilian population-based study. ABCS HEALTH SCIENCES 2021. [DOI: 10.7322/abcshs.2020049.1498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Introduction: Rheumatic diseases have high occurrence in older adults, which may lead to a reduction in independence and quality of life. Objective: To calculate prevalence and to identify factors associated with rheumatic diseases in older adults of the urban area of a municipality in Southern Brazil. Methods: Cross-sectional population-based study, conducted in 2008 in the city of Bagé-RS, Brazil with older adults aged 60 years or over. The outcome was defined from the question "Has any doctor told you that you have rheumatism, arthritis or arthrosis?" Poisson regression was used for the crude and adjusted analysis. Results: A total of 1,593 participants were interviewed. 27.3% (95% CI 25.0-29.5) reported having medical diagnosis of at least one of the rheumatic diseases studied. In the adjusted analysis, it was found that female sex (RP=2.86; 95% CI 2.28-3.59; p≤0.001), without schooling (RP=1.24; 95% CI 1.0-1.58; p=0.047), not living alone (RP=1.29; 95% CI 1.03-1.61; p=0.024), poor self-perception of health (PR=1.54; 95% CI 1.63-2.02; p=0.001), spinal problems (PR=1,96; 95% CI 1.67-2.31; p≤0.001), fall in the last year (PR=1.22; 95% CI 1.04-1.43; p=0.013), incapacity for instrumental activities of daily living (PR=1.20; 95% CI 1.02-1.41; p=0.028) and healthcare appointment in the last 3 months (PR=1.20; 95% CI 1.01-1.42; p=0.035) were associated with the presence of rheumatic diseases (rheumatism, arthritis and arthrosis). Conclusion: It is suggested that care of musculoskeletal problems of the spine should be increased, in order to reduce falls and functional disability in older adults, based on actions focused on the prevention of these problems.
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Oliveira TL, Santos CM, Miranda LDP, Nery MLF, Caldeira AP. [Factors associated with the cost of hospitalization for diseases sensitive to Primary Care in the Unified Health System]. CIENCIA & SAUDE COLETIVA 2021; 26:4541-4552. [PMID: 34730642 DOI: 10.1590/1413-812320212610.10862021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 05/20/2021] [Indexed: 11/21/2022] Open
Abstract
The scope of this article is to identify the factors associated with the costs of hospital admissions for Conditions Sensitive to Primary Care (CSPC) in the Unified Health System (SUS). It involved a cross-sectional, analytical study with random samples of hospitalizations in the SUS over the period of two years. The distribution of costs and the duration of 414 hospitalizations were evaluated according to sex, age group and CSPC. The high cost had a prevalence of 37.8% and was associated with being over 40 years of age and unmarried, with an income below 1.5 minimum wages, hospitalization longer than 7 days and admission to the ICU. The average period of hospitalizations was 9.35 days, and the average cost was R$3,606.09. The hospitalization of youths had a cost/day of R$207.08, while for the elderly the cost/day was R$399.53. Men had a higher prevalence of hospitalizations and were responsible for the elevated average cost of hospitalization. Cardiac, pulmonary, and cerebrovascular diseases were prevalent, and cardiac diseases were responsible for the highest cost of hospitalization. These results point to the urgent need to bolster Primary Health Care, with constant monitoring of these diseases, thereby ensuring that available resources are sufficient to treat them, without the need for hospitalization and unnecessary expenses.
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Affiliation(s)
- Thatiane Lopes Oliveira
- Instituto Federal do Norte de Minas Gerais. R. Prof. Monteiro Fonseca 216, Vila Brasilia. 39400-149 Montes Claros MG Brasil.
| | | | | | | | - Antônio Prates Caldeira
- Departamento de Saúde da Mulher e da Criança, Universidade Estadual de Montes Claros. Montes Claros MG Brasil
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Castro M, Mattos E, Patriota F. The effects of health spending on the propagation of infectious diseases. HEALTH ECONOMICS 2021; 30:2323-2344. [PMID: 34247434 DOI: 10.1002/hec.4388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 06/13/2023]
Abstract
We explore the discontinuity in the allocation of the main federal grant to Brazilian municipalities to identify the local effects of health spending and the spillovers into the bordering jurisdictions. Fiscal reactions are asymmetric: small neighbors reduce health spending, while we do not find a significant budgetary response in the largest neighbor. Our results suggest a reduction in the spread of infectious diseases in the neighbors, with fewer residents hospitalized with gastrointestinal infections. In addition, the elderly demand less hospitalization in the largest bordering jurisdictions due to respiratory infectious diseases. Finally, we find a direct and significant reduction in infant mortality, consistent with the observed pediatricians' increase, while the spillover effects on neighbors' mortality rates are not conclusive.
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Affiliation(s)
- Marcelo Castro
- Federal University of Uberlândia (UFU), Campus UFU Santa Mônica, Uberlândia, Minas Gerais, Brazil
| | - Enlinson Mattos
- São Paulo School of Economics, Fundação Getúlio Vargas, São Paulo, São Paulo, Brazil
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Abstract
Objetivos: verificar o número e as causas de hospitalizações por quedas em idosos brasileiros, além dos gastos federais do Sistema Único de Saúde (SUS), no período de 2000 a 2018.Métodos: trata-se de um estudo ecológico, utilizando informações disponíveis na base de dados do Departamento de Informática do SUS. Foram coletados dados de idosos (≥60 anos) que internaram no SUS devido às quedas no período de 2000 a 2018 no Brasil. Extraíram-se o número de hospitalizações no País e nas regiões (Norte, Nordeste, Sul, Sudeste e Centro-Oeste), as causas das quedas (Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde – 10) e o valor de gastos federais. Para fins estatísticos, utilizou-se análise descritiva.Resultados: totalizaram-se 1,48 milhões de hospitalizações por quedas em idosos no Brasil, com uma taxa de 38,6 a cada 10 mil. As principais causas desses registros no DATASUS foram as “quedas sem especificações”, as “outras quedas no mesmo nível” e as “quedas no mesmo nível por escorregão, tropeção ou passos em falsos”. Em relação às localidades, os idosos pertencentes às regiões Sudeste (47,1), Sul (44,1) e Centro-Oeste (40,4) foram aqueles que apresentaram maiores medianas das taxas de hospitalizações por quedas no período analisado. Entretanto, o Nordeste (variação%=0,4), o Sul (variação%=0,2) e o Centro-Oeste (variação%=0,2) demonstraram maiores elevações desse indicador ao longo dos 18 anos, enquanto apenas a região Norte apresentou redução (variação%=-0,5). A mediana de gastos hospitalares federais (milhões) foi de R$135,58, variando de R$112,89 até R$194,98.Conclusões: houve aumento das taxas de hospitalizações por quedas em idosos no SUS em quase todas as unidades federativas. As causas mais frequentes foram as “quedas sem especificações”, as “outras quedas no mesmo nível” e as “quedas no mesmo nível por escorregão, tropeção ou passos em falsos”. Além disso, ocorreu elevação dos gastos hospitalares federais ao longo do período no País.
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Lozano-Ortega G, Ng DB, Szabo SM, Deighton AM, Riveros B, Guttschow A, Gooch KL, Gomes CM. Management of Patients with Overactive Bladder in Brazil: A Retrospective Observational Study Using Data From the Brazilian Public Health System. Adv Ther 2020; 37:2344-2355. [PMID: 32297282 PMCID: PMC7467463 DOI: 10.1007/s12325-020-01318-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION In Brazil, current data on the use of healthcare resources to manage individuals with overactive bladder (OAB) are lacking. This study aimed to characterize contemporary treatment and the economic burden among patients with OAB managed under the Brazilian public health system (Sistema Único de Saúde [SUS]). METHODS Population-based data from January to December of 2015 were acquired from Brazil's public health database. Adults at least 18 years of age with an ICD-10 diagnostic code for OAB within the period were included. Records of outpatient visits, hospitalizations, and onabotulinumtoxinA injections were used to calculate estimates of resource use and costs (in Brazilian reals [R$]) among those with OAB (frequency [%] and mean (standard deviation [SD]) as appropriate). Patient identifiers were not available, so a record linkage methodology was used to match medical encounters to individuals. Pharmacologic management of OAB was informed by government medication purchases available from the official Brazilian government databases. RESULTS During 2015, 26,640 patients with OAB were identified. All cohort members had at least one outpatient visit and 15,349 (57.6%) were hospitalized. Of the study cohort, 10.0% visited a general practitioner (GP), 41.3% visited a specialist, and 52.0% visited other non-medical healthcare practitioners within the year. Mean (SD) healthcare costs among the study cohort totaled R$355 (R$866) per patient per year; and were R$291 (R$654), R$27 (R$130), R$27 (R$30), and R$11 (R$17) for hospitalizations, GP, specialist, and non-medical healthcare practitioner visits per patient per year, respectively. Regional analysis of reported government medication purchases suggested that access to OAB treatments is highly limited. CONCLUSIONS High resource use and costs were estimated among patients with OAB managed within the SUS. These data provide a snapshot of the management of patients with OAB in Brazil, with the patients seeking treatment under SUS likely representing a more burdened subpopulation.
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Affiliation(s)
| | - Daniel B Ng
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA.
| | - Shelagh M Szabo
- Broadstreet Health Economics and Outcomes Research, Vancouver, BC, Canada
| | - Alison M Deighton
- Broadstreet Health Economics and Outcomes Research, Vancouver, BC, Canada
| | | | - Anne Guttschow
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA
| | | | - Cristiano M Gomes
- Division of Urology, Department of Surgery, University of Sao Paulo-Sao Paulo/SP School of Medicine, Sao Paulo, Brazil
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Bonfada D, Barbosa ICR, Lima KCD, Garcia-Altés A. Gasto de internação de idosos em unidades de terapia intensiva nos hospitais privados de uma capital do nordeste brasileiro. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2020. [DOI: 10.1590/1981-22562020023.200020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo: Analisar a associação entre variáveis demográficas, de morbidade e relativas às condições da hospitalização com os gastos decorrentes da internação de idosos em unidades de terapia intensiva (UTI) de hospitais privados em uma capital do nordeste brasileiro. Método: Trata-se de um estudo epidemiológico, analítico e do tipo seccional, com abordagem quantitativa, no qual foram coletados dados referentes a 312 internações de idosos em UTI de todos os hospitais privados de Natal (RN), Brasil. A variável dependente foi o custo de internação e as variáveis independentes relacionadas à caracterização dos indivíduos quanto ao perfil sociodemográfico, ao quadro mórbido e às características da internação. Os dados foram analisados por meio de estatística descritiva, teste qui-quadrado, teste t e regressão logística múltipla com as razões de prevalência (RP). Resultados: O custo médio por internação foi de R$ 4.266,05±3.322,50 para o grupo de baixo custo e R$ 39.753,162 ± 4.929,12 para o grupo alto custo. Constatou-se que a hospitalização decorrente de agravos clínicos (RP=1,81; IC95%=1,06-3,09) e respiratórios (RP=2,48; IC95%=1,48-5,24), a necessidade de ventilação mecânica (RP=2,33; IC95%=1,43-3,78) e a desorientação completa ou parcial no momento da admissão (RP=1,81; IC95%=1,15-2,84) estiveram associadas ao maior gasto nas internações no modelo estatístico múltiplo. Conclusão: Esses achados trazem evidências de que a implantação de ações capazes de promover melhores condições de saúde para os idosos, por meio da criação de protocolos e linhas de cuidado, especificamente criados para esse público, podem ser relevantes na redução dos gastos decorrentes da internação de idosos em terapia intensiva. Analyze the association between demographic variables, morbidity and relative to the conditions of hospitalization with the expenses resulting from the admission of elderly people in intensive care units (ICU) of private hospitals in a capital of northeastern Brazil. Method: This is an epidemiological, analytical and sectional study, with a quantitative approach, in which data were collected regarding 312 hospitalizations of elderly people in the ICU of all private hospitals in Natal (RN), Brazil. The dependent variable was the cost of hospitalization and the independent variables related to the characterization of individuals in terms of socio-demographic profile, morbid condition and characteristics of hospitalization. Data were analyzed using descriptive statistics, Chi-square test, t test and multiple logistic regression with prevalence ratios (PR). Results: The average cost per hospitalization was R$ 4.266,05±3.322,50 for the low cost group and R$ 39.753,162±4.929,12 for the high cost group. It was found that hospitalization due to clinical (PR=1,81; 95%CI=1,06-3,09) and respiratory conditions (PR=2,48; 95CI%=1,48-5,24), the need for mechanical ventilation (PR=2,33; 95%CI=1,43-3,78) and complete or partial disorientation at the time of admission (PR=1,81; 95%CI=1,15-2,84) were associated with higher expenditure on hospitalizations in the multiple statistical model. Conclusion: The knowledge produced by the study may serve as a subsidy for the implementation of actions capable of promoting better health conditions for the elderly, reducing expenses related to their hospitalization in highly specialized sectors. In addition, the research raises evidence that the construction of protocols and lines of care guiding the work process in the intensive care sector, specifically created for the elderly, may be relevant in reducing the expenses resulting from hospitalization of the elderly.
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Affiliation(s)
- Diego Bonfada
- Universidade Federal do Rio Grande do Norte (UFRN), Brasil
| | | | | | - Anna Garcia-Altés
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Espanha
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Rodrigues MM, Alvarez AM, Rauch KC. Tendência das internações e da mortalidade de idosos por condições sensíveis à atenção primária. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2019; 22:e190010. [DOI: 10.1590/1980-549720190010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 01/31/2018] [Indexed: 11/22/2022] Open
Abstract
RESUMO: Objetivo: Analisar a tendência das taxas de internação e de mortalidade de idosos por condições sensíveis à atenção primária (CSAP) no estado de Santa Catarina, Brasil, no período de 2008 a 2015. Método: Estudo ecológico de série temporal, com dados do Sistema de Informações Hospitalares (SIH) do Sistema Único de Saúde (SUS), utilizando as autorizações de internações hospitalares como fonte de dados, no período de 2008 a 2015, em Santa Catarina. Os dados foram analisados por sexo e idade, estratificada em duas faixas etárias: 60a 79 anos e 80 anos ou mais. Foram realizadas a padronização das taxas por idade através do método direto e a análise estatística por meio de regressão linear segmentada (joinpoint regression). Resultados: Asinternações por condições sensíveis representaram 41% do total de internações de idosos em 2008 e 32% em 2015. Avariação anual da taxa comportou-se de maneira decrescente [-4,6^ IC (-5,7; -3,6)]. As causas mais prevalentes foram: insuficiência cardíaca, doença pulmonar obstrutiva crônica e doenças cerebrovasculares. As taxas de mortalidade das internações apresentaram redução, independentemente do sexo e na faixa etária até 80 anos, representando variação anual de menos 2,4%, 2,1% para os idosos e 2,7% para as idosas. Conclusão: Por meio da análise do indicador CSAP, que avalia a qualidade da assistência e a efetividade dos cuidados prestados na atenção primária, os resultados desta pesquisa evidenciaram queda nas taxas de internação de idosos, independentemente do sexo e das faixas etárias estabelecidas no estudo.
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Dantas RCDO, da Silva JPT, Dantas DCDO, Roncalli ÂG. Factors associated with hospital admissions due to hypertension. EINSTEIN-SAO PAULO 2018; 16:eAO4283. [PMID: 30281763 PMCID: PMC6178859 DOI: 10.1590/s1679-45082018ao4283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 04/11/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To study the temporality of hospital admissions due to arterial hypertension and its associated factors. METHODS An ecological study with secondary data on hospital admissions due to essential arterial hypertension - ICD 10, from the Hospital Information System, the Mortality Information System and and the Primary Care Information System, between 2010 and 2015. Descriptive analysis using means, proportions and linear regression. RESULTS We recorded 493,299 hospitalizations due to arterial hypertension from 2010 to 2015, with an average annual progressive cost decrease of -7.76% and -24.21%. Of the patients admitted, 59.2% were women, 60.2% were non-white and 54.7% were older than 60 years. The mean length of stay was 4.2 days, and the hospitalization cost was R$307.60. The multiple linear regression variables that remained significant were the percentage of admissions due to primary care-sensitive conditions, the per capita income and the City Human Development Index. CONCLUSION Hospital admissions due to arterial hypertension have an impact on the percentage of admissions due to primary care- sensitive conditions. Intensifying primary care activities, raising-awareness among professionals to the importance of integrated care, and investing in social development are crucial to change the reality of hypertension in terms of its control and complications.
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Freitas FASD, Santos ESDS, Pereira LSM, Lustosa LP. Vulnerabilidade física de idosos na alta hospitalar. FISIOTERAPIA E PESQUISA 2017. [DOI: 10.1590/1809-2950/16205224032017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Vulnerabilidade é a capacidade de um indivíduo sofrer dano em resposta a um estímulo. Identificou-se a vulnerabilidade física de idosos na alta hospitalar e a associação dessa condição com fatores clínicos e sociodemográficos, e foram comparados idosos vulneráveis com os não vulneráveis e aqueles acompanhados ou não pela fisioterapia durante a internação. Este foi um estudo exploratório, com amostra de 122 idosos hospitalizados. Os dados foram obtidos por meio de questionário clínico e sociodemográfico, Mini Exame do Estado Mental, Escala de Depressão Geriátrica e Vunerable Elders Survey-13. Utilizou-se para tanto o teste de correlação de Spearman para identificar a correlação entre vulnerabilidade e dados clínicos e sociodemográficos e o teste de Mann-Whitney. O nível de significância foi de 5%. A vulnerabilidade foi identificada em 75,4% dos idosos. Houve correlação significativa entre vulnerabilidade e idade (r=0,52 p=0,01), tempo de internação (r=0,25 p=0,01) e número de comorbidades (r=0,25 p=0,01), e negativa entre vulnerabilidade e escolaridade (r=-0,20 p=0,02). Houve diferença estatística entre idosos vulneráveis e não vulneráveis para idade (p=0,01), comorbidades (p=0,01), tempo de internação (p=0,01), MEEM (p=0,01) e GDS (p=0,01), e entre idosos acompanhados ou não pela fisioterapia para vulnerabilidade (p=0,04) e tempo de internação (p=0,01). A maioria dos idosos era fisicamente vulnerável na alta hospitalar, sendo eles mais velhos, com mais comorbidades, maior tempo de internação, presença de declínio cognitivo e sintomas depressivos. Aqueles que receberam acompanhamento fisioterapêutico apresentaram maior vulnerabilidade e tempo de internação.
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Affiliation(s)
| | | | | | - Lygia Paccini Lustosa
- Universidade Federal de Minas Gerais, Brazil; Universidade Federal de Minas Gerais, Brazil
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BUENO DR, MARUCCI MDFN, GOUVEIA LA, DUARTE YADO, LEBRÃO ML. Abdominal obesity and healthcare costs related to hypertension and diabetes in older adults. REV NUTR 2017. [DOI: 10.1590/1678-98652017000200006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective: To analyze the association between excess abdominal fat and healthcare costs related to hypertension and diabetes Mellitus in older adults. Methods: These cross-sectional analyses are part of the Health, Wellbeing and Aging Study conducted in São Paulo, Brazil, with 806 older adults with self-reported hypertension and diabetes Mellitus. The study included the annual costs with medicines, hospital admissions, and outpatient services for hypertension and diabetes Mellitus control. Excess abdominal fat was diagnosed based on waist circumference. Level of physical activity, age, and gender were considered covariates. The sample was divided into two groups according to waist circumference. Multiple logistic regression analyzed the associations between annual costs and waist circumference. Results: The cost of services and hospitalizations (R$551.05; 95%CI=418.27-683.83) and total costs (R$817.77; 95%CI=669.21-966.33) were higher in the excess abdominal fat group. Older adults with high waist circumference had higher odds of increasing annual costs due to medicines (OR=2.6; 95%CI=1.13-3.77), regardless of gender, age, and level of physical activity. Conclusion: Healthcare costs for treating hypertension and diabetes Mellitus in older adults are higher in the presence of excess abdominal fat.
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Sagiv D, Migirov L, Lipschitz N, Dagan E, Glikson E, Wolf M, Alon EE. The admission patterns of octogenerians nonagenerians and centenarians to the Department of Otoloaryngology. Eur Arch Otorhinolaryngol 2016; 273:4615-4621. [PMID: 27356556 DOI: 10.1007/s00405-016-4165-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 06/22/2016] [Indexed: 11/30/2022]
Abstract
Life expectancy in Israel has risen by almost 6 years during the last 25 years, and the proportion of people 65 years of age or older is expected to reach 12 % of the total population by 2020. A substantial increase in the workload for Otolaryngologists and Head and Neck surgeons is anticipated. Our goal was to characterize the admissions of patients 80 years of age and older to the Department of Otolaryngology, Head and Neck Surgery in a tertiary medical center. The study group included all patients 80 years of age and older who were admitted to the Department of OTOHNS in our institute between 2009 and 2013. There were two control groups for comparison divided by age; one group 40-59 years old and the other group 60-79 years old. There were 385 admissions of 317 patients aged 80-103 years (4.2 % of overall admissions). Over the study period, admissions of patients over 80 years increased on average by 3 % per annum (p = 0.4), and those patients over 90 years old by 52 % per annum (p < 0.001). The most common indication was HN malignancy (28.8 %) followed by otologic disorders (22.0 %). Of the overall 158 operations conducted, 131 patients (82.9 %) underwent elective procedures (mainly oncology) and 27 patients (17.1 %) underwent emergent procedures. The distribution of the reasons for admission of the patients older than 80 years is surprisingly different from that of the "younger" patients. With life expectancy rising, our study predicts a workload increase mainly in the HN oncologic and otologic services.
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Affiliation(s)
- Doron Sagiv
- Department of Otolaryngology and Head & Neck Surgery, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel.
| | - Lela Migirov
- Department of Otolaryngology and Head & Neck Surgery, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noga Lipschitz
- Department of Otolaryngology and Head & Neck Surgery, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
| | - Elad Dagan
- Department of Otolaryngology and Head & Neck Surgery, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
| | - Eran Glikson
- Department of Otolaryngology and Head & Neck Surgery, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
| | - Michael Wolf
- Department of Otolaryngology and Head & Neck Surgery, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran E Alon
- Department of Otolaryngology and Head & Neck Surgery, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kernkamp CDL, Costa CKF, Massuda EM, Silva ES, Yamaguchi MU, Bernuci MP. Perfil de morbidade e gastos hospitalares com idosos no Paraná, Brasil, entre 2008 e 2012. CAD SAUDE PUBLICA 2016; 32:S0102-311X2016000705005. [DOI: 10.1590/0102-311x00044115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 02/22/2016] [Indexed: 11/22/2022] Open
Abstract
Resumo: O aumento da população idosa leva a uma crescente demanda por serviços de saúde e expansão dos gastos, com consequências relevantes sobre a estabilidade econômica. Nesse contexto, o objetivo do estudo foi analisar o perfil das morbidades e gastos hospitalares com idosos em relação às condições socioeconômicas e demográficas do Paraná, Brasil, no período de 2008 a 2012, aplicando-se a análise fatorial em componentes principais e de agrupamentos. As regiões com maior e menor desenvolvimento econômico e humano apresentaram alta prevalência das internações e dos custos relativos às doenças do aparelho circulatório, respiratório e do coração para os sexos masculino e feminino. Já nas regiões com nível de desenvolvimento intermediário, as doenças do sistema nervoso em homens e do aparelho circulatório em mulheres se destacaram com relação às morbidades e gastos hospitalares. Assim, ações de prevenção e promoção de saúde a essa população idosa podem ser direcionadas para investigações regionais.
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