Research progress on the disease burden of pneumoconiosis in China / 中华劳动卫生职业病杂志

Pneumoconiosis is the largest and most serious disease among the legal occupational diseases in China, which causes long-term heavy disease burden to individuals, enterprises and society. How to scientifically and reasonably measure and reduce the health impact and economic loss caused by pneumoconiosis has become a key and difficult research topic. In recent years, with the development of global burden of disease (GBD) research, some scholars have adopted disease burden index to evaluate the disease burden of pneumoconiosis, but the research results and data are relatively independent, and there is a lack of systematic evaluation system and framework. This paper summarized the application of disease burden assessment index for pneumoconiosis, epidemiological and economic burden of pneumoconiosis, and the cost-effectiveness of reducing the burden. This paper aims to understand the present situation of pneumoconiosis disease burden in our country, discover the problems and challenges of pneumoconiosis disease burden research in our country now. It provides scientific basis for the research and application of pneumoconiosis and other occupational disease burden in China, as well as the formulation of comprehensive intervention measures, optimization of health resources allocation and reduction of disease burden.

Disease burden and prediction of attention deficit hyperactivity disorder in Chinese children and adolescents from 1990 to 2019 / 中国学校卫生

Objective@#To analyze the disease burden and trend of attention deficit hyperactivity disorder (ADHD) in China from 1990 to 2019, so as to provide the basic theoretical basis for the health administrative departments to formulate policies.@*Methods@#Using the 2019 Global Burden of Disease Database, the incidence, prevalence and disability adjusted life year (DALY) rates of ADHD were analyzed for both sex and different age groups, and the trends of ADHD were predicted.@*Results@#In 2019, the incidence, prevalence and DALY rate of ADHD in China were 70.41/100 000, 1 546.15/100 000 and 18.87/100 000 respectively. Compared with 1990, the rates decreased by 27.30%, 25.35% and 55.80% respectively, and these rates of females were lower than those of males. In 2019, the incidence rate of ADHD was the highest in the age group 5-9 years old (837.76/100 000), while the highest prevalence and DALY rates were found in ages groups of 10-14 years old (5 740.47/100 000 and 70.49/100 000). The results of the Joinpoint regression model showed that the incidence, prevalence and DALY rate had a downward trend from 1990 to 2019. The AAPC was -1.35%, -1.16% and -1.16%, respectively, with a statistically significant difference ( P <0.05). The prediction results of grey prediction model GM (1,1) indicated that the incidence and prevalence rate of ADHD in China would decline from 2020 to 2030.@*Conclusion@#The burden of ADHD in China showed a decreasing trend from 1990 to 2019, indicating that the prevention and treatment effect of ADHD in children and adolescents of China was effective. China should take active preventive measures to reduce the burden of ADHD in children and adolescents.

Trends and prediction of the burden of depression among adolescents aged 10 to 24 years in China from 1990 to 2019 / 中国学校卫生

Methods@#To analyze the trend of the burden of depression among adolescents aged 10-24 years from 1990 to 2019 and predict its future trend, so as to provide a theoretical basis for prevention and treatment.@*Methods@#The prevalence and disability adjusted life years (DALYs) were determined using the 2019 Global Burden of Disease Database. The joinpoint regression model was employed to analyze the changing trend of the burden of depression among adolescents aged 10-24 years in China from 1990 to 2019. The ARIMA time series model was established using R software to predict the development trend of depression among adolescents aged 10-24 years in China from 2020 to 2029.@*Results@#From 1990 to 2019, the prevalence and DALYs rate were higher among adolescents aged 10-24 years in comparison to the general population and males. Furthermore, the prevalence and DALYs rate were higher among adolescents aged 20-24 years than among those aged 15-19 and 10-14 years, with statistical significance ( P <0.05). The joinpoint regression analysis revealed that the prevalence of depression among adolescents aged 10-24 years showed an overall decreasing trend with an average annual rate of 1.61% ( t =-10.53, P <0.05), while the prevalence of depression among male and female adolescents in the same age group also showed a decreasing trend, with an average annual decreasing rate of 1.18% ( t =-5.79) and 1.79% ( t =-11.84) ( P <0.05), and the overall decline rate was greater among women than men. There was no significant change in the prevalence of depression among adolescents aged 10-14 years from 1990 to 2019 (AAPC=-0.28, P >0.05), while the prevalence of depression among adolescents aged 15-19 years and 20-24 years also showed a decreasing trend with an average annual rate of 1.43% ( t =-12.05) and 1.90% ( t =-24.92) ( P <0.05). The ARIMA model predicted that the prevalence of depression and the rate of DALYs among adolescents aged 10-24 years would continue to decline from 2020 to 2029.@*Conclusion@#The prevention and treatment of depression among adolescents aged 10-24 years in China should focus on females and those aged 20- 24 years old. We should start from the environment and micro-environment of adolescent growth and take active and effective measures to prevent the occurrence of adolescent depression.

Cost-effectiveness analysis of Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray in treatment of chronic rhinosinusitis / 中国中药杂志

This study aims to evaluate the effectiveness and economic efficiency of Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray in the treatment of chronic rhinosinusitis(CRS). The randomized controlled trial(RCT) of Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray in the treatment of CRS was searched against EMbase, PubMed, Cochrane Library, CNKI, VIP, SinoMed, and Wanfang. The efficacy, nasal mucociliary transport time, and safety of the therapy above in the treatment of CRS were analyzed with single-group rate and Meta-analysis, and the economy and sensitivity were evaluated from the perspective of payer. A total of 9 RCTs were included, including 1 145 patients. Meta-analysis showed that compared with Triamcinolone Acetonide Nasal Spray alone, Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray in the treatment of CRS patients increased the effective rate(RR=1.17, 95%CI[1.11, 1.24], P<0.000 01) and shortened the nasal mucociliary transport time(MD=-3.32, 95%CI[-5.86,-0.78], P=0.01), there was no significant difference in the incidence of adverse reactions between the two groups. The incremental cost-effectiveness analysis showed that the treatment costs of the control group and the observation group were 44.15 yuan and 1 044.96 yuan, respectively. In the Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray treatment group, 75.48 yuan was spent to improve the effective rate of CRS by 1%. The one-way sensitivity analysis indicated the days of treatment, the RR of Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray, the price of unit preparation of Biyuan Tongqiao Granules, and the effective rate of Triamcinolone Acetonide Nasal Spray alone had great influence on the incremental cost-effectiveness ratio. In conclusion, Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray improves the therapeutic effect on CRS. The probabilistic sensitivity analysis showed that when the willingness to pay was greater than 7 920 yuan(less than 0.1 of GDP per capita 8 098 yuan), the combined therapy was economically superior to the control. Due to the limited number of articles published, it is necessary to carry out a real-world clinical trial of Biyuan Tongqiao Gra-nules and Triamcinolone Acetonide Nasal Spray in the treatment of CRS, so as to compare the cost-effectiveness of Biyuan Tongqiao Granules and Triamcinolone Acetonide Nasal Spray.

Lista de espera para transplante hepático: impacto clínico e econômico / Waiting list for liver transplantation: clinical and economic burden

ABSTRACT Background Burden of disease is an indicator that relates to health status. United States and European epidemiological data have shown that the burden of chronic liver disease has increased significantly in recent decades. There are no studies evaluating the impact of complications of chronic liver disease on the waiting list for deceased donor liver transplantation (LTx). Objective: To determine the clinical and economic burden of complications of liver disease in wait-listed patients from the perspective of a transplant center. Methods The study retrospectively analyzed medical records of 104 patients wait-listed for deceased donor LTx from October 2012 to May 2016 and whose treatment was fully provided at the study transplant center. Clinical data were obtained from electronic medical records, while economic data were collected from a hospital management software. To allocate all direct medical costs, two methods were used: full absorption costing and micro-costing. Results: The most common complication was refractory ascites (20.2%), followed by portosystemic encephalopathy (12.5%). The mean number of admissions per patient was 1.37±3.42. Variceal hemorrhage was the complication with longest median length of stay (18 days), followed by hepatorenal syndrome (13.5 days). Hepatorenal syndrome was the costliest complication (mean cost of $3,565), followed by portosystemic encephalopathy ($2,576) and variceal hemorrhage ($1,530). Conclusion: The burden of chronic liver disease includes a great cost for health systems. In addition, it is likely to be even greater as a result of the insidious course of the disease.

RESUMO Contexto O impacto da doença é um indicador relacionado ao estado de saúde. Dados epidemiológicos norte-americanos e europeus mostraram que, nas últimas décadas, o impacto da doença hepática crônica tem aumentado significativamente. Não há estudos que avaliem o impacto das descompensações da doença hepática crônica na lista de espera para transplante hepático (TxH) com doador falecido. Objetivo: Determinar o impacto clínico e econômico das descompensações da doença hepática nos pacientes em lista de espera sob a perspectiva do centro transplantador. Métodos Foram analisados, retrospectivamente, os prontuários de 104 pacientes incluídos em lista de espera para TxH com doador falecido entre outubro de 2012 e maio de 2016 e acompanhados integralmente no centro transplantador. Dados clínicos foram obtidos do prontuário eletrônico, enquanto dados econômicos foram coletados através de software de gestão hospitalar. A apropriação dos custos médicos diretos foi realizada sob duas metodologias: custeio por absorção pleno e microcusteio. Resultados: A descompensação com maior incidência foi a ascite refratária (20,2%) seguida de encefalopatia portossistêmica (12,5%). A média de internações por paciente foi de 1,37±3,42. A hemorragia digestiva alta varicosa foi a descompensação com maior tempo mediano de internação (18 dias), seguida da síndrome hepatorrenal (13,5 dias). A descompensação mais onerosa foi a síndrome hepatorrenal (custo médio de US$ 3.565), seguida encefalopatia portossistêmica (US$ 2.576) e a hemorragia digestiva alta varicosa (US$ 1.530). Conclusão O impacto da doença hepática crônica inclui um custo importante para os sistemas de saúde. Além disso, é provável que seja ainda maior em decorrência do curso insidioso da doença.

Absenteísmo e custos indiretos por transtornos mentais no serviço público federal brasileiro / Absenteeism and indirect costs for mental disorders in the Brazilian federal public service

Objetivo: Esta pesquisa objetiva estimar os custos econômicos indiretos decorrentes dos transtornos mentais (TMs) entre servidores públicos federais, no período entre janeiro de 2012 e dezembro de 2017. Métodos: Trata-se de um estudo ecológico, de delineamento longitudinal retrospectivo e caráter exploratório. Utilizou-se a Abordagem do Capital Humano para o cálculo do custo indireto. Resultados: Os TMs foram responsáveis por 5.664.800 dias concedidos de licença ao longo de todo o período, resultando em custo indireto estimado em R$ 1.889.554.416,60, dos quais os transtornos do humor e ansiosos representaram os maiores custos. Conclusões: Este estudo demonstrou a relevância dos TMs para essa comunidade de servidores, bem como revelou a dimensão dos impactos econômicos decorrentes do absenteísmo, o que pode possibilitar, às instâncias gestoras e aos profissionais envolvidos com a saúde do servidor público federal, melhor compreensão dos custos dos TMs, direcionando-os ao planejamento de intervenções mais acertadas.

Objective: This research aims to estimate the indirect economic costs resulting from DM among federal civil servants, between January 2012 and December 2017. Methods: This is an ecological study, with a retrospective longitudinal design and exploratory character. The Human Capital Approach was used to calculate the indirect cost. Results: DM were responsible for 5.664.800 days of leave granted throughout the period, resulting in an estimated indirect cost of R$ .889.554.416,60, of which mood and anxiety disorders represented the highest costs. Conclusions: This study demonstrated the relevance of DM for this community of servers, as well as revealed the dimension of the economic impacts resulting from absenteeism, which can enable management bodies and professionals involved in the health of the federal public servant to better understand the costs of DM, directing them to the planning of the most appropriate interventions.

Plan de negocio de intervenciones de enfermería: Programa "Cuidando a los Cuidadores" / A business plan for nursing interventions: "Caring for Caregivers" program

Introducción: En Colombia el 65,51% de las atenciones prestadas fueron por enfermedades crónicas no transmisibles. Estas generan algún grado de discapacidad y dependencia, requiriendo un cuidador. Objetivo: Establecer una propuesta de plan de negocio para el programa "Cuidando a los cuidadores", orientada al análisis de costos, económico y financiero. Materiales y métodos: Estudio de evaluación económica de un programa de enfermería, con análisis de costos el cual se llevó a cabo en 4 pasos: 1) Caracterizar la estructura de costos del programa, 2) Elaborar las proyecciones, 3) Establecer el valor comercial de los niveles del programa, y 4) Evaluar mediante indicadores financieros la información obtenida en los pasos anteriores, para determinar la viabilidad económica del programa. Resultados: Se estima un costo anual de $6,9115 pronosticando a 5 años un costo anual de $8,732 en el nivel básico y de $7,131 en el nivel de seguimiento del programa. Los recursos para la implementación del programa son de $6,101, presentando un incremento patrimonial de $12,177 entre 2019 y 2023. Finalmente, la tasa interna de retorno-TIR es de 326,19%, lo que indica que por cada $1 invertido, retornarán $326, concluyendo que el programa financieramente es rentable. Discusión: Se realizó el análisis únicamente del programa "Cuidando a Cuidadores®", debido a que no existen en Colombia programas con características similares. Conclusión: "Cuidando a los cuidadores", es un programa con un potencial de crecimiento en Colombia, debido al beneficio social que ofrece, y a la escaza competencia que presenta. La evaluación financiera demostró que es rentable.

Introduction: In Colombia, 65.51% of the care provided was for chronic non-communicable diseases. These generate some degree of disability and dependency, requiring a caregiver. Objective: Establish a business plan proposal for the "Caring for caregivers" program, oriented to cost, economic and financial analysis. Materials and Methods: conomic evaluation study with a cost analysis of a nursing program in which four steps were followed for data analysis: 1) Describe the cost structure of the program, 2) make projections, 3) determine the commercial value of levels offered by the program, and 4) evaluate the information obtained in the previous steps using financial indicators to determine if the proposal makes the program economically viable. Results: An average annual cost of $ 6.9115 is estimated, forecasting a 5-year average annual cost of $ 8732 at the basic level and $ 7131 at the program monitoring level. The resources for the implementation of the program are $ 6.101, presenting an equity increase of $ 12.177 between 2019 and 2023. Finally, the internal rate of return - IRR is 326.19%, this means that for every $ 1 invested in the program, they will return $ 326 concluding that the program from this financial point of view is profitable. Discussion: Only the "Caring for Caregivers" program was analyzed, because there are no programs with similar characteristics in Colombia. Conclusions: "Caring for caregivers®" is a program with growth potential in Colombia, due to the social benefit it offers, and the scarce competition it presents. The financial assessment showed that it is cost-effective.

Introdução: Na Colômbia, 65,51% dos atendimentos foram por doenças crônicas não transmissíveis. Estas geram algum grau de deficiência e dependência, requerendo um cuidador. Objetivo: Estabelecer uma proposta de plano de negócio para o programa "Cuidando dos cuidadores", orientada à análise de custos, econômico e financeiro. Materiais e métodos: Estudo de avaliação econômica com análise de custos de um curso de enfermagem em que foram realizadas quatro etapas para análise de dados: 1) Caracterizar a estrutura de custos do curso, 2) Elaborar projeções, 3) Estabelecer o valor comercial dos níveis oferecidos pelo programa, e 4) Avaliar por meio de indicadores financeiros as informações obtidas nas etapas anteriores, para determinar se a proposta torna o programa economicamente viável. Resultados: Estima-se um custo médio anual de $ 6,9115, prevendo um custo médio anual de 5 anos de $ 8.732 no nível básico e $ 7.131 no nível de acompanhamento do programa. Os recursos necessários para a implementação do programa são de $ 6.101, apresentando um aumento de ativos de $ 12.177 entre 2019 e 2023. Por fim, a taxa interna de retorno - TIR é de 326,19%, isso significa que para cada $ 1 investido no programa, eles serão retornar $326, concluindo que o programa é lucrativo deste ponto de vista financeiro. Discussão: Foi realizada a análise unicamente do programa "Cuidando a Cuidadores®", devido a que não existem na Colômbia programas com características similares. Conclusão: "Cuidar de cuidadores®" é um programa com potencial de crescimento na Colômbia, pelo benefício social que oferece e pela falta de concorrência que apresenta. As despesas operacionais versus as receitas que gera mostraram que é financeiramente rentável.

Contraceptives, chronic illness, pregnancy, and health care costs in one health insurance in Colombia

Objetivo Evaluar el impacto del embarazo en mujeres con una alta carga de enfermedad, especialmente con enfermedades crónicas no transmisibles (ECNT) en los costos de una aseguradora de salud. Materiales y Métodos Estudio de costos retrospectivos realizado en Famisanar EPS entre 2016 y 2018. Utilizamos múltiples modelos de regresión lineal para evaluar; los costos generales se calcularon para cada paciente. La perspectiva de la aseguradora fue considerada para el análisis. Resultados El universo de estudio estuvo conformado por 458 249 mujeres en edad fértil afiliadas a Famisanar EPS entre los 15 y 49 años, de las cuales 24 030 (5,2%) mujeres tienen alguna relación con el ECNT. De ellas, 2454 (10,2%) fueron al parto y cesárea. Habíamos determinado los costos del embarazo en mujeres sanas en USD 200,41 y el embarazo en mujeres con ECNT USD 519,95 (97,5%) en términos de los costos de las complicaciones en la atención de gestación. Mediante la regresión multinomial, comparamos los embarazos de ECNT con los otros grupos de mujeres. No observamos diferencias significativas en zona e ingresos, observamos diferencias significativas en la edad. Conclusión El ECNT preexistente en mujeres embarazadas puede conducir al uso de recursos adicionales en el sistema de salud. El ECNT en la sociedad representa una carga severa para un sistema de salud debido a los altos costos, especialmente cuando se habla de mujeres que tienen un ECNT y están embarazadas.

Objetive Evaluate the impact of pregnancy on women with a high disease burden, especially with Chronic Non-Communicable Diseases (CNCD) in the costs of a health insurer. Materials and Methods Retrospective costing study conducted at Famisanar EPS between 2016 and 2018. We used multiple linear regression models to evaluate; the overall costs were calculated for each patient. The insurer's perspective was taken into account for the analysis. Results The study universe was made up of 458 249 women of childbearing age affiliated to Famisanar EPS between 15 and 49 years, of which 24 030 (5.2%) women have some relationship with the CNCD, of these, 2 454 (10.2%) went to childbirth and caesarean section. We had determined the costs of pregnancy healthy's women in USD 200.41 and pregnancy CNCD's women USD 519.95 (97.5%) in terms of the costs for the complication's gestation care. Using multinomial regression, we compared the pregnancy with CNCD with the other groups of women. We did not observe any significant differences in ingress and zone. However, we observe signicant differences in the age. Conclusion Pre-existing CNCD in pregnant women can lead to the use of additional resources in the health system. CNCD in society represent a severe burden for a health system due to high costs and especially when talking about women who have an CNCD and are in pregnant. The study also indicates that female infertility treatments are important for cost containment in health systems.

Análisis de Costos de cuidados en salud para pacientes con cáncer al final de la vida: Hospital versus domicilio con cuidados paliativos, en el tercer nivel de atención / Analysis of health care costs for patients with cancer at the end of life: Hospital versus home with palliative care, at the third level of care

Introducción: La etapa final de pacientes oncológicos genera elevados costos, sobretodo en hospitales. Objetivos: Determinar la diferencia de costos de atención al final de la vida de pacientes oncológicos en el hospital versus el domicilio. Material y métodos: Estudio retrospectivo de análisis de costos en pacientes fallecidos por cáncer en estadio clínico IV de un hospital terciario de la seguridad social, marzo 2018. Se comparó un grupo domiciliario (GD) de un programa paliativo con un grupo hospitalario (GH) admitido por emergencia. Se estimaron costos directos de servicios profesionales, hospitalización, procedimientos, exámenes auxiliares y medicamentos. Para el análisis estadístico se utilizó Chi cuadrado y T de Student, considerando un valor p<0,05 y utilizando SPSS 24.0. Resultados: Se incluyeron 81 pacientes en GD y 22 en GH, edad entre 36 y 96 años, con una mediana de 72 años en GD y 77 en GH (p=0,97), sexo femenino 59 y 73% respectivamente (p=0,25), predominando cáncer de origen digestivo y genitourinario. El costo promedio por paciente en GD fue 497 dólares americanos y en el GH 1908 (p<0,01), con un promedio diario por pacientes de 17 vs 447 respectivamente. En el GH predominaron los costos de hospitalización, exámenes auxiliares (tomografía, resonancia, análisis de gases arteriales, proteína C reactiva) y antibióticos (ertapenem y colistina), mientras que en GD el mayor costo fue en servicio médicos y medicamentos. Conclusión: Los costos médicos en la etapa final de vida de pacientes con cáncer avanzado son 3,8 veces mayor cuando fallece en el hospital que en el domicilio.

Background: The final stage of cancer patients generates high costs, especially in hospitals. To determine the difference in care costs Objectives:at the end of life for cancer patients in the hospital versus at home. Material and methods: Retrospective cost analysis study in patients who died of clinical stage IV cancer in a tertiary social security hospital, March 2018. Ahome group (Home) of a palliative program was compared with a hospital group (Hospital) admitted from the emergency department. Direct costs of professionalservices,hospitalization,procedures,auxiliaryexams,and medications were estimated. Chi square and Student's Twere used for statistical analysis, considering a value of p<0.05 and using SPSS 24.0. Results: 81 patients in Home and 22 in Hospital were included, aged between 36 and 96 years, with a median of 72 years in Home and 77 in Hospital (p=0.97), female sex 59 and 73% respectively (p= 0.25), predominantly cancer of digestive and genitourinary origin. The average cost per patient in Home was 497 US dollars and in Hospital 1908 (p<0.01), with a daily average per patient of 17 vs 447 respectively. In the Hospital, the costs of hospitalization, auxiliary tests (tomography, resonance, arterial gas analysis, C-reactive protein) and antibiotics (ertapenem and colistin) predominated, while in the Home the highest cost was in medical services and medications. Conclusion: The medical costs in the final stage of life of patients with advanced cancer are 3.8 times higher when they die in the hospital than at home.

Survival and disease burden trend analysis of occupational pneumoconiosis from 1963 to 2020 in Shizuishan City / 中华劳动卫生职业病杂志

Objective: To understand the survival status and its influencing factors of occupational pneumoconiosis patients in Shizuishan City, and to analyze the disease burden of occupational pneumoconiosis and its trend, so as to provide scientific basis for formulating comprehensive prevention and treatment measures of occupational pneumoconiosis. Methods: A retrospective survey was conducted during July to December 2020 to explore the survival status of occupational pneumoconiosis patients who had been reported from 1963 to 2020 in Shizuishan City. The Kaplan-Meier method and Life-table method were used for survival analysis, and Cox proportional hazards regression model was used to analyze the influencing factors of survival time. The disability adjusted life years (DALY) was applied to analyze the disease burden of occupational pneumoconiosis and its temporal trend. Results: From 1963 to 2020, a total of 3263 cases of occupational pneumoconiosis were reported in Shizuishan City, of which 1467 died, so that the fatality rate was 44.96%. The median survival time was 26.71 years, average age of death was (70.55±10.92) years old. There were significant differences in the survival rates of occupational pneumoconiosis patients among different types, diagnosis age, exposure time, industry, initial diagnosis stage and whether upgraded (P<0.05) . As the survival time increased, the survival rate of patients decreased gradually. When the survival time was ≥50 years, the cumulative survival rate of patients was 4.20%. Cox regression analysis suggested that the type of pneumoconiosis, industry, diagnosis age, exposure time, initial diagnosis stage and whether upgraded were the influencing factors for the survival time of patients with occupational pneumoconiosis (P<0.05) . The total DALY attributable to occupational pneumoconiosis from 1963 to 2020 in Shizuishan City was 48026.65 person years, of which the years of life lost (YLL) was 15155.39 person years, and the average YLL was 10.33 years/person, and the years lost due to disability (YLD) was 32871.26 person years, and the average YLD was 10.07 years/person. The DALY attributed to coal worker's pneumoconiosis and silicosis were 39408.51 person years and 6565.02 person years, respectively, and they accounted for 82.06% and 13.67% of the total disease burden in Shizuishan City, respectively. The DALY caused by occupational pneumoconiosis in the age group of 40-49 years old and the first diagnosis of stage I occupational pneumoconiosis were higher, which were 20899.71 and 36231.97 person years, respectively. The average YLL and average YLD showed a volatility downtrend over time. Conclusion: The disease burden of occupational pneumoconiosis cannot be ignored in Shizuishan City, and timely targeted measures should be taken for key populations and key industries. It is recommended that life-cycle health management and hierarchical medical should be taken to improve the life quality of patients and prolong their lifes.

Direct costs of prematurity and factors associated with birth and maternal conditions / Custos diretos da prematuridade e fatores associados ao nascimento e condições maternas

ABSTRACT OBJECTIVE To estimate the direct costs due to hospital care for extremely, moderate, and late preterm newborns, from the perspective of a public hospital in 2018. The second objective was to investigate whether factors associated with birth and maternal conditions explain the costs and length of hospital stay. METHODS This is a cost-of-illness study, with data extracted from hospital admission authorization forms and medical records of a large public hospital in the Federal District, Brazil. The association of characteristics of preterm newborns and mothers with costs was estimated by linear regression with gamma distribution. In the analysis, the calculation of the parameters of the estimates (B), with a confidence interval of 95% (95%CI), was adopted. The uncertainty parameters were estimated by the 95% confidence interval and standard error using the Bootstrapping method, with 1,000 samples. Deterministic sensitivity analysis was performed, considering lower and upper limits of 95%CI in the variation of each cost component. RESULTS A total of 147 preterm newborns were included. We verified an average cost of BRL 1,120 for late preterm infants, BRL 6,688 for moderate preterm infants, and BRL 17,395 for extremely preterm infants. We also observed that factors associated with the cost were gestational age (B = -123.00; 95%CI: -241.60 to -4.50); hospitalization in neonatal ICU (B = 6,932.70; 95%CI: 5,309.40-8,556.00), and number of prenatal consultations (B = -227.70; 95%CI: -403.30 to -52.00). CONCLUSIONS We found a considerable direct cost resulting from the care of preterm newborns. Extreme prematurity showed a cost 15.5 times higher than late prematurity. We also verified that a greater number of prenatal consultations and gestational age were associated with a reduction in the costs of prematurity.

RESUMO OBJETIVOS Estimar os custos diretos advindos com a assistência hospitalar a recém-nascidos prematuros extremos, moderados e tardios, sob a perspectiva de um hospital público em 2018. O segundo objetivo foi investigar se fatores associados ao nascimento e às condições maternas explicam os custos e o tempo de permanência hospitalar. MÉTODOS Estudo de custo da doença, com extração de dados a partir das autorizações de internação hospitalares e prontuários de um hospital público de grande porte do Distrito Federal. Estimou-se a associação de características dos recém-nascidos prematuros e das genitoras nos custos por meio de regressão linear com distribuição gamma. Na análise, adotou-se o cálculo dos parâmetros das estimativas (B), com intervalo de confiança de 95% (IC95%). Os parâmetros de incerteza foram estimados pelo intervalo de confiança de 95% e erro padrão por meio do método de Bootstrapping, com 1.000 amostragens. Realizou-se análise de sensibilidade determinística, considerando limites inferiores e superiores do IC95% na variação de cada componente de custo. RESULTADOS Foram incluídos 147 recém-nascidos prematuros. Verificamos um custo médio de R$ 1.120 para prematuros tardios, R$ 6.688 para prematuros moderados e R$ 17.395 para prematuros extremos. Verificamos também que os fatores associados ao custo foram idade gestacional (B = -123,00; IC95% -241,60 a -4,50); internação em UTI neonatal (B = 6.932,70; IC95% 5.309,40-8.556,00) e número de consultas pré-natal (B = -227,70; IC95% -403,30 a -52,00). CONCLUSÕES Verificamos um custo direto considerável advindo da assistência a recém-nascidos prematuros. A prematuridade extrema demonstrou um custo 15,5 vezes maior comparado à tardia. Verificamos ainda que uma maior quantidade de consultas pré-natal e a idade gestacional foram associadas a uma redução dos custos da prematuridade.

Patient treatment cost of oral diseases in Ghana

Objectives: To estimate patient treatment cost of oral diseases in Ghana Design: A cross-sectional study design using cost-of-illness analysis was employed Setting: The study was conducted at the dental unit of the University of Ghana Hospital, Legon Participants: About185 patients attending the dental unit of the hospital were selected Interventions: None Main outcome measures: Direct medical and non-medical costs, indirect costs, and intangible costs of treatment of oral conditions Results: The estimated average cost of treatment for oral diseases was US$ 35.75. The total cost was US$ 6,614.11, with the direct and indirect costs constituting 94.5% and 5.5%, respectively of the total cost. Direct medical costs constituted 86.9%, while direct non-medical costs constituted 13.1% of the total direct cost. The richer socio-economic group had the highest cost per quintile, with a mean of US$ 46.69. The intangible cost described was highest for pain (47.1%), followed by difficulty in eating (40.8%) and sleeping (34.6%) for both men and women. Conclusion: The costs of oral diseases are huge and cannot be overlooked. Oral diseases also pose significant productivity losses to patients

Costos del cáncer ocupacional: una scoping review / Costs of occupational cancer: a scoping review

RESUMEN Introducción: la carga debida al cáncer es alta, y además de su impacto en la salud de las personas tiene efectos económicos. Objetivo: identificar los costos asociados al cáncer como resultado de la exposición ocupacional. Métodos: se realizó una scoping review. Para esta se hizo una búsqueda sistemática de acuerdo con la pregunta PECO en las siguientes bases de datos indexadas: Scopus, Web of Science, Embase, Science Direct, Academic Search Complete (EBSCO), BVS y PubMed. Como criterios de elegibilidad de los escritos estaba que se tratara sobre cáncer de origen ocupacional y que mencionara los costos; se seleccionaron 19 artículos. Resultados: entre los estudios se identificaron los países donde se han hecho investigaciones al respecto, el tipo de estudio, los tipos de cáncer, sus costos y métodos de estimación. En cuanto a los costos, se encontraron principalmente trabajos centrados en los costos directos, es decir, los que representan la atención en salud, dejando de lado el análisis de los que son indirectos, es decir los que están relacionados con la pérdida de la productividad. Conclusión: se concluye que se requiere de un abordaje interdisciplinario para el análisis de los costos, con el fin de mejorar la comprensión de estos y particularmente la de los indirectos.

SUMMARY Background: The burden of disease due to cancer is high and has an impact on people's health and economic cost. Objective: Identify the costs associated with occupational cancer. For this purpose, a scoping review was carried out. Methods: First, a systematic search was performed according to the PECO question, we used the following indexed databases: Scopus, Web of Science, Embase, Science Direct, Academic Search Complete (EBSCO), BVS and PubMed. The eligibility criteria were that the study focus in any type of occupational cancer and mention the cost related. After the selection and screening process, 19 articles were included. Results: The studies identified the countries where research has been carried out, the type of study, the types of cancer, the methods of cost estimations and types of cost. In relation with the costs, we mainly found articles focused on direct costs, that is, what health care represents; but there are few studies that included analysis of indirect costs that are related to lost productivity. Conclusion: It is concluded that an interdisciplinary approach to cost analysis is required to improve understanding of costs, particularly indirect costs.

Trabalhadoras da saúde face à pandemia: por uma análise sociológica do trabalho de cuidado / Female healthcare workers and the Covid-19 pandemic in Brazil: a sociological analysis of healthcare work

Resumo Este texto tem como finalidade discutir o cuidado de trabalhadoras da área da saúde em face da Covid-19, sob a análise sociológica de autoras que o vêm discutindo enquanto um trabalho que é desempenhado, na sua maioria, pelas mulheres das classes populares, é desvalorizado e sofre baixa remuneração. É uma atividade que envolve as construções sociais das emoções e tem utilizado o corpo como um instrumento de trabalho no cuidado com o outro. Além disso, a precarização do trabalho em saúde na sociedade brasileira acirrada nas últimas décadas, como o aumento de contratos temporários, perdas de direitos trabalhistas, a sobrecarga das atividades, condições de trabalho precárias, dentre outros, soma-se com o aumento dos atendimentos médico-hospitalares diante da pandemia da Covid-19. Neste contexto, as trabalhadoras em saúde vivenciam as ausências de equipamentos de proteção individual, medo de contaminação pelo vírus, preocupações com filhos e familiares, vivências diante da morte e do adoecimento de si e de colegas de profissão. Este texto aponta para a necessidade de atenção governamental, bem como para a gestão do trabalho em saúde e dos órgãos de classe profissional, analisando as condições de trabalho que as trabalhadoras em saúde estão vivendo no enfrentamento da pandemia.

Abstract The article aims to discuss the care provided by female healthcare workers in Brazil during the Covid-19 pandemic, based on a sociological analysis by authors who discuss such care as devalued and poorly paid work performed to a large extent by low-income women. The work involves social constructions of emotions and has used the body as a work instrument in care for others. In addition, the increasingly precarious nature of health work in Brazilian society, aggravated in recent decades, with an increase in temporary contracts, loss of labor rights, overload of tasks, and adverse work conditions, among others, adds to the increase in medical and hospital care in the Covid-19 pandemic. In this context, female healthcare workers experience lack of personal protective equipment, fear of coronavirus infection, concerns with their children and other family members, and illness and death of coworkers and themselves. The article highlights the need for government attention and management of healthcare work and professional societies, analyzing the work conditions female healthcare workers are experiencing in confronting the pandemic.

Tradução, adaptação transcultural e validação do questionário Comprehensive Score for Financial Toxicity (COST) para a cultura brasileira / Translation, cross-cultural adaptation and validation of the Comprehensive Score for Financial Toxicity (COST) questionnaire for Brazilian culture

Este estudo está inserido na linha de pesquisa o Processo de Cuidar em Saúde e Enfermagem, e integra o Grupo de Pesquisa Multiprofissional em Saúde do Adulto da Universidade Federal do Paraná. Introdução: a toxicidade financeira é um efeito colateral do tratamento oncológico, que descreve o ônus financeiro experimentado pelo paciente com câncer, o qual tem dificuldade para custear o tratamento e os custos decorrentes da doença. O questionário COmprehensive Score for Financial Toxicity foi desenvolvido e validado para mensurar a toxicidade financeira dos pacientes com câncer. Objetivo: traduzir, adaptar transculturalmente e validar o questionário COmprehensive Score for Financial Toxicity para a cultura brasileira. Método: pesquisa metodológica dividida em duas etapas: a primeira, denominada tradução e adaptação transcultural, utilizou o referencial metodológico do grupo Functional Assessment of Chronic Illness Therapy, e a segunda, validação das propriedades psicométricas, foi realizada de acordo com o referencial de Pasquali. A primeira etapa foi concluída em julho de 2018, e a segunda foi realizada entre setembro de 2018 e janeiro de 2020. Participaram da primeira etapa, quatro tradutores, dois profissionais de saúde e 15 pacientes com diagnóstico de câncer no pré-teste, e da segunda etapa, 126 pacientes com câncer. Quarenta e três (43) pacientes realizaram tratamento em instituição privada e 83 em instituição pública no sul do Brasil. Para a etapa de validação, foi realizada o coeficiente Alfa de Cronbach para verificação da consistência interna, a análise fatorial exploratória, análise fatorial confirmatória. Resultados: a participação dos tradutores, desenvolvedores e especialistas conferiu a validade de conteúdo do questionário. O coeficiente alfa de Cronbach, encontrado no pré-teste, foi de 0,83. As Análises fatorial exploratória e confirmatória revelaram que o questionário COmprehensive Score for Financial Toxicity, versão brasileira, mede um único construto, ou seja, a toxicidade financeira com valor de - ??2/????= 179,78, CFI=0,00, PGFI= 0,302, RMSEA=1,196 e Pclose=0,000. O alfa de Cronbach da segunda etapa foi de 0,815. Ao realizar a comparação do escore entre as amostras, foi possível constatar que a amostra da instituição privada possui escore 24,02 e a amostra da instituição pública, escore 16,33, indicando que aqueles que possuem plano privado de saúde, tem menor toxicidade financeira (p=0,001). Conclusão: o questionário COmprehensive Score for Financial Toxicity é válido e confiável para mensurar a toxicidade financeira dos pacientes com câncer no Brasil.

This study is included in the research line the Process of Caring for Health and Nursing and is part of the Multiprofessional Research Group on Adult Health at the Federal University of Paraná. Introduction: financial toxicity is a side effect of cancer treatment, which describes the financial burden experienced by cancer patients, who have trouble affording the treatment and the costs resulting from the disease. The COmprehensive Score for Financial Toxicity questionnaire was developed and validated to measure the financial toxicity of cancer patients. Objective: to translate, cross-culturally adapt and validate the COmprehensive Score for Financial Toxicity questionnaire for the Brazilian culture. Method: this is a methodological research divided into two stages: the first, named translation and cross-cultural adaptation, which used the methodological framework of the Functional Assessment of Chronic Illness Therapy group, and the second, psychometric properties validation, which was carried out according to Pasquali's framework. The first stage was accomplished in July 2018, and the second from September 2018 and January 2020. Four translators, two health professionals and 15 patients diagnosed with cancer in the pre-test participated in the first stage, and 126 cancer patients in the second stage. Forty-three (43) patients underwent treatment in a private institution and 83 in a public institution in southern Brazil. For the validation stage, Cronbach's alpha coefficient was calculated to check internal consistency and exploratory factorial analysis, confirmatory factorial analysis was performed. Results: the participation of translators, developers and specialists checked the questionnaire content validity. Cronbach's alpha coefficient, found in the pre-test, was 0.83. The exploratory and confirmatory factorial analyzes showed that the questionnaire COmprehensive Score for Financial Toxicity, Brazilian version, measures a single construct, that is, the financial toxicity with a value of - ??2/???? = 179.78, CFI=0.00, PGFI = 0.302, RMSEA = 1.196 and Pclose=0.000. Cronbach's alpha for the second stage was 0.815. When comparing the score between the samples, it was possible to verify that the private institution sample has a score of 24.02 and the sample of the public institution, a score of 16.33, indicating that those who have a private health plan have less financial toxicity (p=0.001). Conclusion: the COmprehensive Score for Financial Toxicity questionnaire is valid and reliable for measuring the financial toxicity of cancer patients in Brazil.

Custos catastróficos em pacientes com tuberculose no Brasil: estudo em cinco capitais / Costos catastróficos en pacientes con tuberculosis en Brasil: un estudio en cinco capitales / Catastrophic costs in tuberculosis patients in Brazil: a study in five capitals

Resumo Objetivo avaliar o impacto econômico domiciliar do adoecimento pela tuberculose no Brasil. Método pesquisa transversal multicêntrica de 2016 a 2018, em cinco capitais do Brasil, em pacientes diagnosticados com tuberculose. Os custos totais foram a soma dos custos diretos e indiretos incorridos antes e durante o diagnóstico e tratamento. A regressão logística foi utilizada para estudar determinantes de custos catastróficos. A pobreza foi medida como renda familiar per capita diária < U$ 5,5. Resultados trezentos e sessenta e um pacientes foram inscritos no estudo. O custo extrapolação foi de R$3.664,47 (DP: R$ 2.667,67) e o custo total de extrapolação foi de R$22.291,82 (DP: R$ 16.259,50). No geral, 29% dos participantes do estudo foram caracterizados como pobres antes da tuberculose, e 39% depois. Em média, a renda diminuiu em 11% dos participantes e 41% tiveram custos catastróficos. Os determinantes estatisticamente significativos de experimentar custos catastróficos foram: participante ser o chefe da família, vivendo na pobreza antes da tuberculose, desemprego e interrupção do trabalho durante o tratamento (p < 0,05). Conclusão e implicações para a prática embora o tratamento seja financiado pelo governo, a tuberculose continua resultando em custos catastróficos e diminuição da renda para muitas famílias no Brasil.

Resumen Objetivo evaluar el impacto económico domiciliario de enfermarse por tuberculosis en Brasil. Método Investigación multicéntrica transversal de 2016 a 2018, en cinco capitales de Brasil, en pacientes diagnosticados con tuberculosis. Los costos totales fueron la suma de los costos directos e indirectos incurridos antes y durante el diagnóstico y el tratamiento. Se utilizó la regresión logística para estudiar los determinantes de los costos catastróficos. La pobreza se midió como un ingreso familiar diario per cápita < U$ 5,5. Resultados se inscribieron 361 pacientes en el estudio. El costo de extrapolación fue de R$ 3.664,47 (DE: R$ 2.667,67) y el costo total de extrapolación fue R$ 22.291,82 (DE: R$ 16.259,50). En general, el 29% de los participantes se caracterizaron como pobres antes de la tuberculosis y el 39%, después. En promedio, los ingresos disminuyeron en 11% de los participantes y el 41% tuvo costos catastróficos. Determinantes estadísticos de costos catastróficos: participante ser cabeza de familia; vivir en pobreza antes de la tuberculosis; desempleo; interrupción del trabajo durante el tratamiento (p<0.05). Conclusión e implicaciones para la práctica aunque el tratamiento es financiado por el gobierno, la tuberculosis sigue teniendo costos catastróficos y una disminución de los ingresos para muchas familias en Brasil.

Abstract Objective to assess the home economics impact of illness from Tuberculosis in Brazil. Method multicenter cross-sectional research from 2016 to 2018, in five capitals of Brazil, in patients diagnosed with tuberculosis. The total costs were the sum of the direct and indirect costs incurred before and during diagnosis and treatment. Logistic regression was used to study determinants of catastrophic costs. Poverty was measured as daily household income per capita < U$ 5.5. Results 361 patients were enrolled in the study. The extrapolation cost was R$ 3,664.47 (SD: R$ 2,667.67) and the total extrapolation cost was R$ 22,291.82 (SD: R$ 16,259.50). Overall, 29% of study participants were characterized as poor before tuberculosis, and 39% afterwards. On average, income declined by 11% among participants and 41% had catastrophic costs. The statistically significant determinants of experiencing catastrophic costs were: participant being the head of the family; living in poverty before tuberculosis; unemployment and interruption of work during treatment (p <0.05). Conclusion and implications for practice although treatment is financed by the government, tuberculosis continues to cause catastrophic costs and decreased of income for many families in Brazil.

Economic burden of chronic urticaria in Brazil: a 1 year real life study / Carga econômica da urticária crônica no Brasil: um estudo de vida real no período de 1 ano

Background: The costs of chronic urticaria (CU) are unknown in Brazil. The objective of this study was to describe the costs associated with the treatment of CU. Methods: This longitudinal, descriptive study recruited patients with chronic spontaneous urticaria and/or chronic inducible urticaria, who attended at least 4 visits to a specialized outpatient clinic within a 12-month period. Patients with other skin diseases and those who discontinued treatment were excluded. Patients underwent a provocation test and an objective evaluation, before receiving treatment according to the most recent guidelines. Data on direct and indirect costs of treatment were collected at each visit, and analyzed using Chisquare tests, the Mann-Whitney test, analysis of variance (ANOVA), paired t-tests, Tukey post-hoc tests and Wilcoxon tests. A p-value of 5% was considered significant. Results: From November 2016 to December 2018, 55 out of 68 enrolled patients completed the protocol. The cost of absenteeism was US$ 21,125.84 and that of transportation was US$ 3,755.69. The total indirect cost of CU was US$ 24,881.53 (US$ 452.39 per patient-year; SD, 461.11). The cost of medical appointments was US$ 3,838.17, and that of laboratory tests, US$ 6,607.39. The total cost of medications was US$ 174,697.58, of which US$ 141,582.91 was associated with the use of omalizumab in 12 patients. The total direct cost of CU was US$ 185,143.14 (US$ 3,366.23 per patient-year; SD, 6,446.58), resulting in an overall annual cost of US$ 210,024.67 (US$ 3,818.63 per patient-year). The higher the household income, the higher the costs of CU treatment. Conclusion: CU had a significant cost to the study population. The total estimated mean cost of illness was US$ 3,818.63 patient-year. The cost of medication was significantly increased by the use of omalizumab, an effective option for patients with CU refractory to high-dose antihistamine therapy, but a major contributor to the economic burden of patients with CU.

Introdução: Os custos da urticária crônica (UC) são desconhecidos no Brasil. O objetivo deste estudo é descrever os custos relacionados ao seu tratamento. Métodos: Estudo longitudinal descritivo de pacientes com urticária crônica espontânea e/ou urticária crônica induzível, que compareceram a pelo menos quatro consultas em um ambulatório especializado em um período de 12 meses. Foram excluídos aqueles com outras doenças de pele e que interromperam o tratamento. Os pacientes foram submetidos a testes de provocação, avaliação objetiva e tratamento de acordo com as diretrizes mais recentes. Dados sobre custos diretos e indiretos do tratamento foram coletados em cada visita. Foram utilizados os testes qui-quadrado, Mann-Whitney, Anova, t-pareado, post-hoc Tukey, e Wilcoxon's. Foi considerado significativo p < 0,05. Resultados: De novembro de 2016 a dezembro de 2018, 55 pacientes dos 68 inscritos completaram o protocolo. O custo do absenteísmo foi de US$ 21.125,84, e o transporte, de US$ 3.755,69. O custo indireto total foi de US$ 24.881,53 (US$ 452,39 paciente-ano; DP ± 61,11). As despesas com consultas foram de US$ 3.838,17, e o custo total de exames laboratoriais foi de US$ 6.607,39. O custo total com medicamentos foi de US$ 174.697,58, dos quais US$ 141.582,91 relacionados ao uso de omalizumabe em 12 pacientes. O custo direto total foi de US$ 185.143,12 (US$ 3.366,23 por paciente-ano, DP ± 6.446,58), resultando em um custo anual global relacionado à doença de US$ 210.024,67 (US$ 3.818,63 paciente-ano). Quanto maior a renda familiar, maiores os custos com a urticária crônica. Conclusão: A UC tem um custo significativo para a população do estudo. O custo médio total estimado foi de US$ 3.818,63 paciente-ano. Os altos custos com medicamentos, aumentados pelo uso do omalizumabe, que é uma opção eficaz em pacientes com altas doses de anti-histamínicos, resultam na maior carga econômica entre os pacientes com UC.

Impacto económico del dengue en Paraguay / Dengue economic impact in Paraguay

Resumen Introducción: Desde fines del siglo XX el dengue ha asolado periódicamente al Paraguay. Su elevada morbilidad y mortalidad se traducen en un elevado impacto socio-económico global y una elevada carga en los sistemas de atención médica. Objetivo: Determinar el costo económico y la carga del dengue en el Paraguay. Metodología: Se estimaron los costos directos e indirectos del dengue tanto de casos ambulatorios como hospitalizados. Igualmente fueron calculados los años de vida ajustados por discapacidad (DALY) a partir de la suma de los años de vida perdidos (AVPP) debido a la mortalidad prematura en la población y los años perdidos debido a la discapacidad (DVSP). Resultados: El costo unitario por caso ambulatorio fue de US dólares 52,5 y para pacientes hospitalizados de US dólares 300 con un costo total para los 4 años de US dólares 276.804,864 y US dólares 23.236,45, respectivamente. Los AVPP fueron 18.469,7 por millón de habitantes; los DVSP de 185.835 y los DALYs 32.676 años por millón de habitantes. Conclusiones: El dengue impone considerables costos tanto para el sector de la salud como para la economía en general en el Paraguay.

Abstract Background: Since the end of the 20th century, dengue has periodically devastated Paraguay. Its high morbidity and mortality translate into a high global socio-economic impact and a high burden on health care systems. Aim: To determine the economic cost and burden of dengue in Paraguay. Methods: The direct and indirect costs of dengue were estimated in both outpatient and hospitalized cases. Likewise, the years of life adjusted for disability (DALY) were calculated from the sum of the years of life lost (YPLL) due to premature mortality in the population and years lost due to disability (DVSP). Results: The unit cost per ambulatory case was US dollars 52.5 and for hospitalized patients US dollars 300 with a total cost for the 4 years of US dollars 276,804.864 and US dollars 23,236.45, respectively. The AVPP were 18,469.7 per million inhabitants; the DVSP of 185,835 and the DALYs 32,676 years per million inhabitants. Conclusions: Dengue imposes considerable costs for both the health sector and the economy in general in Paraguay.

Custos de produtividade entre pessoas envolvidas em acidentes de trânsito / Productivity costs among people involved in traffic accidents

Resumo Este artigo objetivou caracterizar os custos de produtividade de pessoas envolvidas em acidente de trânsito (AT) em um município de médio porte. Um estudo longitudinal de base domiciliar foi realizado entre 2013 e 2015. Neste período, foram entrevistados e acompanhados indivíduos com AT e calculados os custos de produtividade. Os valores mensurados e estimados foram considerados para cálculo dos valores brutos e per capita e ajudaram a constituir os custos de perda de produtividade (dias sem trabalhar) e custos de retorno à produtividade (profissionais de saúde, medicamentos, transporte, dispositivos auxiliares e reparo de veículos). Demonstrou-se que os custos de perda foram maiores em relação aos custos de retorno. Entre os itens que compõem os de retorno à produtividade, observaram-se maiores custos em homens, adultos jovens, condutores, usuários de veículos de duas rodas, pessoas com vínculo público, em faixas etárias intermediárias e lesões do tipo fratura. São necessárias a avaliação e o direcionamento nos estágios de recuperação dos envolvidos a fim de minimizar o ônus social gerado por estes eventos.

Abstract This paper aimed to characterize the productivity costs of people involved in traffic accidents (TA) in a medium-sized municipality. A longitudinal household-based study was conducted from 2013 to 2015. During this period, individuals with TA were interviewed, and followed-up and costs of productivity were calculated. The measured and estimated values were considered for the calculation of the gross and per capita values and facilitated the establishment of costs of lost productivity (days off work) and costs of return to productivity (health professionals, medication, transportation, auxiliary devices and vehicle repair). It was shown that the costs of loss were more significant against the costs of return. Among the items that underpin the return to productivity, higher costs were observed in men, young adults, drivers, users of two-wheeled vehicles, people with public employment relationships, intermediate age groups and fracture-type injuries. It is necessary to evaluate and target the stages of recovery of those involved to minimize the social burden generated by these events.

Social determinants of health and catastrophic costs associated with the diagnosis and treatment of tuberculosis / Determinantes sociais da saúde e custos catastróficos associados ao diagnóstico e tratamento da tuberculose

ABSTRACT The epidemiological relevance of tuberculosis is directly related to the socioeconomic profile of a given country. Vulnerability to tuberculosis is influenced by biological factors (e.g., malnutrition, HIV infection, and age) and social factors (e.g., unhealthy housing, high population density, inappropriate working conditions, and lack of access to health services). In many cases, multiple vulnerabilities occur in conjunction. We propose here a reflection on tuberculosis from the point of view of the social determinants of health, as well as the costs associated with its diagnosis and treatment in Brazil, based not only on data in the international literature but also on evidence related to the national context. Given the magnitude of tuberculosis as a socially mediated disease, there is an evident need for greater involvement of health professionals and of the scientific community to implement relevant operational and research measures to understand the social conditions influencing the health-illness continuum for tuberculosis patients. Although the recent economic crisis in Brazil has contributed to increased mortality from all causes, including tuberculosis, health and social protection expenditures have mitigated detrimental health effects. The evidence presented here underscores the importance of public social protection policies for minimizing the effects of tuberculosis indicators, with the aim of eliminating tuberculosis in Brazil.

RESUMO A relevância epidemiológica da tuberculose está diretamente relacionada ao perfil socioeconômico dos países. A vulnerabilidade à tuberculose é influenciada por fatores biológicos, como desnutrição, infecção por HIV ou faixa etária, e fatores sociais, como habitações insalubres, alta densidade demográfica, condições de trabalho inadequadas e inacessibilidade aos serviços de saúde; porém, muitas vezes essas vulnerabilidades se somam. Propomos aqui uma reflexão sobre a tuberculose sob o ponto de vista dos determinantes sociais de saúde e dos custos associados ao seu diagnóstico e tratamento, baseando-nos não somente em dados publicados na literatura internacional, mas também nas evidências já presentes no panorama nacional. Considerando a magnitude da tuberculose como doença socialmente produzida, fica evidente a necessidade de maior envolvimento de profissionais de saúde e da comunidade científica no sentido de implementar medidas operacionais e de investigação relevantes para a compreensão dos condicionantes sociais do processo saúde-doença na tuberculose. A recente crise econômica pela qual passa o Brasil contribuiu para o aumento da mortalidade por todas as causas, incluindo por tuberculose; porém, investimentos em saúde e proteção social reduziram os danos à saúde. Essas evidências reforçam a importância de políticas públicas de proteção social para a redução dos indicadores da tuberculose visando sua eliminação no Brasil.