Characterization of the patterns of care, access, and direct cost of systemic lupus erythematosus in Brazil: findings from the Macunaíma study

Abstract Background A cost of illness (COI) study aims to evaluate the socioeconomic burden that an illness imposes on society as a whole. This study aimed to describe the resources used, patterns of care, direct cost, and loss of productivity due to systemic lupus erythematosus (SLE) in Brazil. Methods This 12-month, cross-sectional, COI study of patients with SLE (ACR 1997 Classification Criteria) collected data using patient interviews (questionnaires) and medical records, covering: SLE profile, resources used, morbidities, quality of life (12-Item Short Form Survey, SF-12), and loss of productivity. Patients were excluded if they were retired or on sick leave for another illness. Direct resources included health-related (consultations, tests, medications, hospitalization) or non-health-related (transportation, home adaptation, expenditure on caregivers) hospital resources. Costs were calculated using the unit value of each resource and the quantity consumed. A gamma regression model explored cost predictors for patients with SLE. Results Overall, 300 patients with SLE were included (92.3% female, mean [standard deviation (SD)] disease duration 11.8 [7.9] years), of which 100 patients (33.3%) were on SLE-related sick leave and 46 patients (15.3%) had stopped schooling. Mean (SD) travel time from home to a care facility was 4.4 (12.6) hours. Antimalarials were the most commonly used drugs (222 [74.0%]). A negative correlation was observed between SF-12 physical component and SLE Disease Activity Index (- 0.117, p = 0.042), Systemic Lupus International CollaboratingClinics/AmericanCollegeofRheumatology Damage Index (- 0.115, p = 0.046), medications/day for multiple co-morbidities (- 0.272, p < 0.001), SLE-specific drugs/day (- 0.113, p = 0.051), and lost productivity (- 0.570, p < 0.001). For the mental component, a negative correlation was observed with medications/day for multiple co-morbidities (- 0.272, p < 0.001), SLE-specific medications/day (- 0.113, p = 0.051), and missed appointments (- 0.232, p < 0.001). Mean total SLE cost was US$3,123.53/patient/year (median [interquartile range (IQR)] US$1,618.51 [$678.66, $4,601.29]). Main expenditure was medication, with a median (IQR) cost of US$910.62 ($460, $4,033.51). Mycophenolate increased costs by 3.664 times (p < 0.001), and inflammatory monitoring (erythrocyte sedimentation rate or C-reactive protein) reduced expenditure by 0.381 times (p < 0.001). Conclusion These results allowed access to care patterns, the median cost for patients with SLE in Brazil, and the differences across regions driven by biological, social, and behavioral factors. The cost of SLE provides an updated setting to support the decision-making process across the country.

Opiniones y conocimientos de estudiantes universitarios sobre el aborto como problema de salud pública / Opinions and knowledge of university students about abortion as a public health problem

El propósito principal del proyecto es contribuir a la promoción de un enfoque integral que atienda el problema el aborto y su incidencia en la mortalidad materna en Argentina. La investigación combina datos cualitativos y cuantitativos, con un diseño no-experimental transversal de tipo exploratorio-descriptivo que se desarrolló en dos fases secuenciales. Los resultados indican que el aborto es considerado una problemática de magnitud para los/as estudiantes de las distintas carreras, y requiere de políticas sanitarias para su tratamiento y resolución. Se observa desconocimiento de los dispositivos de intervención en salud pública para situaciones de embarazo no deseado; así como sobre la normativa que rige el aborto. La información producida servirá como insumo para el desarrollo de acciones que favorezcan el acceso de las mujeres y/o personas con capacidad de gestar a la interrupción legal del embarazo, y contribuya a orientar los procesos de formación de los recursos humanos especializados.

The main purpose of this project is to contribute to the promotion of an integral focus that attends to the problem of abortion and the incidence in maternal mortality in Argentina. The investigation combines qualitative and quantitative information, with a non-experimental transversal design, explorer-descriptive type, which has been developed in two sequential phases. The results indicate that abortion is considerated a huge problem for the students of the difference areas, and it requires of sanitary politics for the treatment and resolution. There is a lack of knowledge about the intervention devices in public health for situations of unwanted pregnancy; as well as on the normative that regulates abortion. The information produced will serve as input for the development of actions that favour the access of women or people with the capacity to gestate to the legal interruption of pregnancy, and contribute to guide the process of formation of specialized human resources.

Efeitos de um programa multidisciplinar sobre a modulação autonômica de crianças e adolescentes com sobrepeso e obesidade / Effects of a multidisciplinary program on autonomic modulation in overweight or obese children and adolescents

PURPOSE: this study evaluated the effects of a multidisciplinary program on autonomic modulation in overweight or obese children and adolescents. METHODS: fifteen individuals with 10,93 ± 2,28 years were submitted to autonomic evaluation using heart rate variability before and after a program based on physical exercises for three months, three times a week, 60 minutes per session and psychological and nutritional counseling. Data was analyzed using the paired t-test or Wilcoxon test and the level of significance was set at P < 0.05. RESULTS: multidisciplinary program was able to promote benefits in autonomic modulation observed thought temporal (SDNN: 39,96 ± 10,33 x 49,44 ± 12,31; p = 0,019; rMSSD: 28,97 ± 11,50 x 37,26 ± 11,17; p = 0,018), spectral (LFnu: 64,49 ± 12,21 x 56,74 ± 11,18; p = 0,014; HFnu: 35,50 ± 12,21 x 43,25 ± 11,18; p = 0,014) and geometrical (SD1: 20,51 ± 8,13 x 26,36 ± 7,90; p = 0,018 SD2: 52,31 ± 13,04 x 64,58 ± 16,33; p = 0,031) indices in overweigh and obese children and adolescents. Also, after the intervention there was a reduction on resting heart rate (88,53 ± 9,24 x 83,09 ± 7,93; p = 0,023) and there were changes in the classification of overweigh 26,67% x 46,66% and obesity 73,33% x 53,33%, although not significant changes in body mass index. CONCLUSIONS: exercise program together with nutritional and psychological counseling is able to promote benefits in autonomic modulation in children and adolescents who are overweight or obese.

OBJETIVO: avaliar a influência de um programa multidisciplinar na modulação autonômica de crianças e adolescentes com sobrepeso e obesidade. MÉTODO: quinze indivíduos com 10,93 ± 2,28 anos foram submetidos a avaliação da modulação autonômica por meio da variabilidade da frequência cardíaca antes e após um programa de atividades físicas conduzido por três meses, com frequência de três vezes na semana por 60 minutos cada sessão, associado com aconselhamento nutricional e psicológico. Para análise estatística foi utilizado teste T para dados pareados ou teste de Wilcoxon com significância de p < 0,05. RESULTADOS: o programa multidisciplinar foi capaz de influenciar positivamente a modulação autonômica o que pode ser observado por índices temporais (SDNN = 39,96 ± 10,33 vs. 49,44 ± 12,31; p = 0,019; rMSSD = 28,97 ± 11,50 vs. 37,26 ± 11,17; p = 0,018), espectrais (LFnu = 64,49 ± 12,21 vs. 56,74 ± 11,18; p = 0,014; HFnu = 35,50 ± 12,21 vs. 43,25 ± 11,18; p = 0,014) e geométricos (SD1 = 20,51 ± 8,13 vs. 26,36 ± 7,90; p = 0,018; SD2 = 52,31 ± 13,04 vs. 64,58 ± 16,33; p = 0,031) de variabilidade em crianças e adolescentes com sobrepeso e obesidade. Adicionalmente, após a intervenção houve redução da frequência cardíaca de repouso (88,53 ± 9,24 vs. 83,09 ± 7,93; p = 0,023) e mudanças na classificação da obesidade dos indivíduos para sobrepeso 26,67% vs. 46,66% e obesidade 73,33% vs. 53,33%. Apesar disso, não houve diferença significante no índice de massa corporal. CONCLUSÕES: um programa de exercícios associado com aconselhamento nutricional e psicológico foi capaz de promover benefícios na modulação autonômica em crianças e adolescentes com sobrepeso e obesidade.

Isolamento de Aeromonas hydrophila EM Bettas plendens – alterações histopatológicas nas brânquias / Isolation of Aeromonas hydrophila in Bettas plendens - histopathologic changes in gills / Aislamiento de Aeromonas hydrophila EN Bettas plendens - alteraciones histopatológicas en las branquias

O objetivo deste estudo foi isolar e caracterizar Aeromonas hydrophila, causadora de mortalidade em peixes descrever as alterações histopatológicas provocadas nas brânquias de machos de beta Bettas plendens. Foram utilizados dez peixes que apresentavam característica de alteração de comportamento como anorexia, letalidade e apatia. Amostras de água, muco e brânquias foram inoculadas em meio de cultura Agar sangue a 25ºC por 48 horas. Foi caracterizado A. hidrófila como principal causa do surto de mortalidade. Foram observadas alterações histopatológicas nas brânquias desde fusão lamelar secundária e necrose do tecido. A. hidrophila prejudica o órgão respiratório de forma irreversível, comprometendo as trocas gasosas levando o peixe ao óbito...

The objective of this study was to isolate and characterize Aeromonas hydrophila, a cause of mortality, and to describe the histopathological changes caused in the gills of Bettas plendens. Ten fish presenting change behavior such as anorexia, lethality and apathy were used in this study. Water, mucus and gill samples were inoculated in blood agar culture medium at 25°C for 48 hours. Aeromonas hidrophila was characterized as the main cause of mortality outbreak. Histopathological changes were observed in the gills, from secondary lamellar fusion to tissue necrosis. A. hidrophila irreversibly harms the respiratory organ, compromising the gaseous exchanges, which leads to the death of the fish...

El objetivo de este estudio fue aislar y caracterizar Aeromonas hydrophila, causante de mortalidad en peces, y describir las alteraciones histopatológicas causadas en las branquias de machos de beta Bettas plendens. Se utilizó 10 peces que presentaban características de cambio de comportamiento como anorexia, mortalidad y apatía. Las muestras de agua, moco y branquias fueron inoculadas en medio de cultivo Agar sangre a 25° C durante 48 horas. Fue caracterizado A. hidró- fila como principal causa del surto de mortalidad. Se ha observado cambios histopatológicos en las branquias, desde fusión lamelar secundaria y necrosis de los tejidos. A. hidrophila compromete el órgano respiratorio de forma irreversible, comprometiendo los cambios gaseosos y llevando los peces a la muerte...

Factores de riesgo para la salud de los adolescentes: investigación y promoción de la salud en establecimientos secundarios de enseñanza / Risk factors for adolescent health: research and promotion of health in secondary education establishments

Se exponen los resultados obtenidos de la aplicación de una encuesta orientada a relevar los factores de riesgo asociados a la salud de los adolescentes, y cuyos principales resultados son los siguientes: a) La iniciación temprana al consumo de tabaco y alcohol; b) Un bajo grado de adopción de hábitos alimentarios saludables; c) Ocupación del tiempo libre mediante actividades que denotan elevados niveles de sedentarismo; d) Frecuentes episodios de violencia interpersonal; e) Elevado porcentaje de accidentes reportados en y fuera de la escuela. Se espera que el presente estudio genere insumos pertinentes para continuar el trabajo de extensión en dos establecimientos educativos del nivel secundario, sirviendo como línea de base que permita a la vez evaluar el resultado de posteriores intervenciones. Se establece seguidamente una discusión respecto de la importancia que presentan los datos relevados y un examen acerca de los supuestos teóricos y metodológicos que sustentan el presente enfoque.

It will be presented the results of the implementation of a survey aimed to lighten the risk factors associated with the health of adolescents, and the main results are the following: to) the early initiation to the consumption of tobacco and alcohol; (b) a low degree of adoption of healthy eating habits; (c) occupation of leisure time activities that denote high levels of physical inactivity; (d) frequent episodes of interpersonal violence; (e) high percentage of accidents reported in and out of school. It is expected that this study allow us to continue the work of extension in two educational establishments of the secondary level, serving as a baseline that allows at the same time evaluate the results of subsequent interventions. A discussion then establishes respect for the importance that they have forbidden data and a review on the theoretical and methodological assumptions underpinning the present approach.