ABSTRACT
This study provides an overview of the literature on the cost-effectiveness of homecare services compared to in-hospital care for adults and older adults. A systematic review was performed using Medline, Embase, Scopus, Web of Science, CINAHL and CENTRAL databases from inception to April 2022. The inclusion criteria were as follows: (i) (older) adults; (ii) homecare as an intervention; (iii) hospital care as a comparison; (iv) a full economic evaluation examining both costs and consequences; and (v) economic evaluations arising from randomized controlled trials (RCTs). Two independent reviewers selected the studies, extracted data and assessed study quality. Of the 14 studies identified, homecare, when compared to hospital care, was cost-saving in seven studies, cost-effective in two and more effective in one. The evidence suggests that homecare interventions are likely to be cost-saving and as effective as hospital. However, the included studies differ regarding the methods used, the types of costs and the patient populations of interest. In addition, methodological limitations were identified in some studies. Definitive conclusions are limited and highlight the need for better standardization of economic evaluations in this area. Further economic evaluations arising from well-designed RCTs would allow healthcare decision-makers to feel more confident in considering homecare interventions.
Subject(s)
Home Care Services , Humans , Aged , Cost-Benefit AnalysisABSTRACT
Fundamento: A obesidade tem sido apontada como um dos principais fatores de risco para doenças cardiovasculares. Objetivo: Avaliar a associação da obesidade central com a incidência de doenças e fatores de risco cardiovascular. Métodos: Estudo transversal, realizado com pacientes atendidos em um ambulatório de síndrome metabólica, que apresentavam índice de massa corporal ≥ 24,9 kg/m2 . Foram analisados o estado nutricional, os exames laboratoriais (perfil lipídico e glicemia) e o uso de anti-hipertensivos. Os participantes foram estratificados em grupos em relação à presença ou à ausência dos seguintes fatores de risco: diabetes, hipertensão e dislipidemia. Resultados: Mulheres (n = 39), com idade média de 44,18 ± 14,42 anos, sendo 70% obesos e 38% hipertensos corresponderam à maioria da amostra estudada. A circunferência abdominal encontrada foi de 110,19 cm ± 15,88 cm; os triglicerídeos de 153,72 mg/dL ± 7,07 mg/dL; a glicemia de jejum de 188,6 mg/dL ± 116 mg/dL. Foi encontrada associação significativa entre a relação cintura/estatura e os achados de hipertensão (p = 0,007); entre o volume de gordura visceral e diabetes (p = 0,01); entre o índice de conicidade e os achados de hipertensão (p = 0,009) e diabetes (p = 0,006). Não foi encontrada associação significativa entre o índice de massa corporal e circunferência abdominal com os achados de hipertensão, diabetes e dislipidemia. Conclusão: A obesidade central esteve associada a uma maior incidência de desenvolvimento de fatores de risco relacionados a doenças cardiovasculares
Background: Obesity has been identified as a major risk factor for cardiovascular disease. Objective: To evaluate the association of central obesity with the incidence of cardiovascular diseases and risk factors. Methods: This was a cross-sectional study, carried out with patients treated at a metabolic syndrome outpatient clinic, with body mass index ≥ 24.9 kg/m2 . Nutritional status, laboratory tests (lipid and glycemic profile) and blood pressure status were analyzed. Participants were stratified into groups regarding the presence or absence of risk factors: diabetes, hypertension, and dyslipidemia. Results: Women (n = 39), mean age of 44.18 ± 14.42 years, of which 70% were obese and 38% were hypertensive, corresponded to most of the studied sample. Abdominal circumference was 110.19 cm ± 15.88 cm; levels of triglycerides were 153.72 mg/dL ± 7.07 mg/dL; and fasting glycemia was 188.6 mg/dL ± 116 mg/dL. A significant association was found between the waist/height ratio and the findings of hypertension (p = 0.007); between visceral fat volume and diabetes (p = 0.01); between the conicity index and the findings of hypertension (p = 0.009) and diabetes (p = 0.006). No significant association was found between body mass index and waist circumference with findings of hypertension, diabetes and dyslipidemia. Conclusion: Central obesity was associated with a higher incidence of development of risk factors related to cardiovascular diseases