Association between quality of life, physical activity, use of medication and costs of treatment for chronic diseases in Primary Care.

BACKGROUND: The aim of this study was to investigate the costs and the health outcomes of primary care treatments for chronic diseases and to analyze the association between domains of quality of life (QoL), physical activity and healthcare costs. METHODS: The sample encompassed 292 patients aged 50 years or more in Brazilian primary care facilities, categorized in three groups: no drug treatment or only regular physical activity, only drug treatment, and drug treatment with regular physical activity. Patients were assessed in relation to quality of life, healthcare costs, regular physical activity, and use of medications. RESULTS: Results indicate higher cost-utility ratio among primary care patients adopting only drug treatment (3.92), followed by drug treatment with regular physical activity (3.21), and no drug treatment or only regular physical activity (0.12). CONCLUSIONS: QoL was significantly associated with risk factors for chronic diseases, especially obesity, and limitations in mobility showed important increases in healthcare costs. The dominant strategy in terms of cost-utility ratio was identified among primary care patients without drug treatment or physically active, followed by patients in drug treatment combined with regular physical activity. Drug treatment without regular physical activity showed worst results in relation to other primary care strategies.

Association of Different Physical Activity Domains on All-Cause Mortality in Adults Participating in Primary Care in the Brazilian National Health System: 4-Year Follow-up.

BACKGROUND: Evidence has shown that physical activity (PA) is associated with low mortality risk. However, data about reduced mortality due to PA are scarce in developing countries and the dose-response relationship between PA from different domains and all-cause mortality remains unclear. Thus, the aim of this study is to investigate the association of PA from different domains on all-cause mortality among Brazilian adults. METHODS: 679 males and females composed the study sample. Participants were divided into quartile groups according to PA from different domains (occupational, sports, and leisure-time). Medical records were used to identify the cause of the death. Cox regression analysis was performed to determine the independent associations of PA from different domains and all-cause mortality. RESULTS: During the follow-up period, 59 participants died. The most prevalent cause of death was circulatory system diseases (n = 20; 33.9% [21.8%-45.9%]). Higher scores of occupational (HR= 0.45 [95% CI: 0.20-0.97]), sports (HR= 0.44 [95% CI: 0.20-0.95]) and overall PA (HR= 0.40 [95% CI: 0.17-0.90]) were associated with lower mortality, even after adjustment for confounders. CONCLUSIONS: The findings in this study showed the importance of being active in different domains to reduce mortality risk.

Associação entre doenças cardiocirculatórias e internações hospitalares entre pacientes atendidos no Sistema Único de Saúde / Association between cardiovascular diseases and hospitalization among patients users of the Brazilian National Health System

Modelo do estudo: Transversal. Objetivo de estudo: Verificar a associação entre doenças cardiocirculatórias e internações hospitalares em pacientes atendidos pelo Sistema Único de Saúde da cidade de Presidente Prudente, SP, Brasil. Metodologia: A amostra foi composta por pacientes de duas Unidades Básicas de Saúde da cidade de Presidente Prudente/SP. Internações hospitalares, presença de doenças,prática habitual de atividades físicas, índice de massa corporal e medidas pressão arterial foram as variáveis analisadas. Correlação de Spearman indicou relacionamento entre as variáveis e significância estatística foi fixada em p-valor < 5%. Resultados: Foram entrevistados 514 adultos de ambos os sexos. A ocorrência de internação hospitalar no último ano foi de 14,9%. Houve relacionamento entre atividade física habitual, diagnóstico de HA, arritmia e infarto com número de dias internados. Após o ajuste por fatores de confusão, pacientes com dois e três/quatro diagnósticos para doenças cardiocirculatórias apresentaram maior ocorrência de internações hospitalares quando comparados aos sem diagnóstico de doenças. Conclusão: Foi encontrado relacionamento entre internações hospitalares e diagnóstico de hipertensão arterial, arritmia, infarto e menores níveis de prática de atividade física habitual entre pacientes atendidos pelo Sistema Público de Saúde de Presidente Prudente, SP, Brasil.

Study Design: Cross-sectional. Objective of the study: To investigate the relationship between cardiovascular disease and hospitalizations among users of the Brazilian Public Health care System of Presidente Prudente, SP, Brazil. Methods: The sample was composed by patients from two Basic Health care Units of Presidente Prudente / SP. Hospitalizations, presence of disease, habitual physical activity, body mass index and blood pressure measures were the variables analyzed. Spearman correlation indicated relationship between variables and statistical significance was set at p-value < 5%. Results: 514 adults of both sexes were interviewed. The occurrence of hospitalization in the previous year was 14.9%. There was relationship between habitual physical activity, diagnosis of hypertension, arrhythmia and stroke with number of days hospitalized. After adjustment for confounders, patients with two and three/four diagnostic for cardiovascular diseases were more frequent hospitalized compared to patients without diagnoses. Conclusion: It was found relationship between hospitalizations and diagnosis of hypertension, arrhythmia, stroke and lower levels of habitual physical activity among patients users of the public health care system in Presidente Prudente, SP, Brazil.

The burden of abdominal obesity with physical inactivity on health expenditure in Brazil

The purpose of this study was to analyze the association between the clustering of physical inactivity with abdominal obesity and public health care expenditure in Brazilian adults. The sample was composed of 963 patients of both genders, randomly selected in the Brazilian Public Health care System during 2010. Entire health care expenditures during the last year were computed and stratified into: medical consultations, medication dispensing, laboratory tests and overall expenditure. Waist circumference was used to diagnose abdominal obesity and physical activity was assessed by previously validated questionnaire. Sedentary and abdominally obese patients (OR= 3.01 [OR95%CI= 1.81-4.99]) had higher likelihood be inserted in the group of higher expenditures than only abdominally obese patients (OR= 1.66 [OR95%CI= 1.07-2.59]). There is a synergic effect between abdominal obesity and physical inactivity on overall health care expenditures.

O objetivo deste estudo foi analisar a associação entre a agregação de inatividade física com a obesidade abdominal e despesas de saúde pública em adultos brasileiros. A amostra foi composta de 963 pacientes de ambos os sexos, selecionados aleatoriamente no Sistema Único de Saúde em 2010. Gastos com saúde durante o último ano foram computados e estratificados em: consultas médicas, distribuição de medicamentos, exames laboratoriais e gasto total. A circunferência da cintura foi usada para diagnosticar a obesidade abdominal e atividade física foi avaliada através de um questionário previamente validado. Pacientes sedentários e com obesidade abdominal (OR = 3.01 [IC95% = 1.81-4.99]) apresentaram maior probabilidade de ser inserido no grupo de despesas mais elevadas do que apenas os pacientes com obesidade abdominal (OR= 1.66 [IC95%= 1.07-2.59]). Existe um efeito sinérgico entre a obesidade abdominal e sedentarismo em despesas totais de saúde.

El objetivo de este estudio fue analizar la asociación entre la agregación de la inactividad física con la obesidad abdominal y el gasto público en salud en adultos brasileños. La muestra consistió en 963 pacientes de ambos sexos, seleccionados al azar en el Sistema de la Salud en 2010. El gasto en salud en el último año se calcula y se estratificó en: consultas médicas, medicamentos, exámenes de laboratorio y el gasto total. Circunferencia de la cintura se utiliza para diagnosticar la obesidad abdominal y la actividad física se evaluó mediante un cuestionario previamente validado. Pacientes sedentarios y con obesidad abdominal (OR= 3,01 [IC95%= 1,81-4,99]) tenían más probabilidades de ser incluido en el grupo de los mayores gastos que sólo los pacientes con obesidad abdominal (OR= 1,66 [IC95%= 1,07-2,59]). Existe un efecto sinérgico entre la obesidad abdominal y la inactividad física en el gasto total en salud.