Comorbidities do not mitigate the effect of habitual physical activity on the reduction of healthcare costs among adults with cardiovascular diseases: A mediation analysis.

BACKGROUND: Habitual Physical activity (HPA) is a non-pharmacological strategy to prevent and control chronic diseases, and it plays an important role in minimizing healthcare costs. OBJECTIVES: This study aimed to investigate the relationship between HPA and healthcare costs from the perspective of the Brazilian National Healthcare System, and to establish the mediating role of comorbidities in this relationship among patients with cardiovascular diseases (CVD). DESIGN AND SETTING: This longitudinal study was conducted in a medium-sized Brazilian city and included 278 participants assisted by the Brazilian National Healthcare System. METHODS: Information on healthcare costs were obtained from medical records and included primary, secondary, and tertiary levels. Comorbidities (diabetes, dyslipidemia, and arterial hypertension) were self-reported, and obesity was confirmed with the percentage of body fat. HPA was measured using a questionnaire (Baecke questionnaire). Face-to-face interviews provided information on sex, age, and education level. Statistical analysis included linear regression and Structural Equation Modeling, significance was set at 5 % and the Stata software (version 16.0) was used to perform the analysis. RESULTS: The sample included 278 adults with a mean age of 54.49 (8.32) years. For each score of HPA, there was a reduction in healthcare costs of US$ 83.99/24 months (95 % CI: - 159.15; - 8.84), and the sum of comorbidities did not mediate this relationship. CONCLUSION: It is concluded that healthcare costs seem to be affected by HPA among patients with CVD, while this phenomenon seems not to be mediated by the sum of comorbidities.

Impacts of bariatric surgery in health outcomes and health care costs in Brazil: Interrupted time series analysis of multi-panel data.

BACKGROUND: The increasing burden of obesity generates significant socioeconomic impacts for individuals, populations, and national health systems worldwide. The literature on impacts and cost-effectiveness of obesity-related interventions for prevention and treatment of moderate to severe obesity indicate that bariatric surgery presents high costs associated with high effectiveness in improving health status referring to certain outcomes; however, there is a lack of robust evidence at an individual-level estimation of its impacts on multiple health outcomes related to obesity comorbidities. METHODS: The study encompasses a single-centre retrospective longitudinal analysis of patient-level data using micro-costing technique to estimate direct health care costs with cost-effectiveness for multiple health outcomes pre-and post-bariatric surgery. Data from 114 patients who had bariatric surgery at the Hospital of Clinics of the University of Sao Paulo during 2018 were investigated through interrupted time-series analysis with generalised estimating equations and marginal effects, including information on patients' characteristics, lifestyle, anthropometric measures, hemodynamic measures, biochemical exams, and utilisation of health care resources during screening (180 days before) and follow-up (180 days after) of bariatric surgery. RESULTS: The preliminary statistical analysis showed that health outcomes presented improvement, except cholesterol and VLDL, and overall direct health care costs increased after the intervention. However, interrupted time series analysis showed that the rise in health care costs is attributable to the high cost of bariatric surgery, followed by a statistically significant decrease in post-intervention health care costs. Changes in health outcomes were also statistically significant in general, except in cholesterol and LDL, leading to significant improvements in patients' health status after the intervention. CONCLUSIONS: Trends multiple health outcomes showed statistically significant improvements in patients' health status post-intervention compared to trends pre-intervention, resulting in reduced direct health care costs and the burden of obesity.

Association between bone mass and functional capacity among elderly people aged 80 years and over.

OBJECTIVE: Analyzed the association of bone mass with the functional capacity of elderly aged 80 or more. METHODS: The sample consisted of 93 elderly aged 80 and 91 years (83.2±2.5 years) being 61 women (83.3±2.7 years) and 32 men (83.1±2.2 years) living in the city of Presidente Prudente - São Paulo/Brazil. The assessment of bone mass was realized by absorptiometry dual-energy X-ray (DXA), where have been measured values bone mineral content (BMC) and bone mineral density (BMD) of the femur and spine (L1-L4). The functional capacity was evaluated by means of walking speed tests, static equilibrium and strength of lower limbs contained in the questionnaire Wellness Health and Aging (SABE). The variables of bone mass and functional capacity were categorized according to the median values and score tests, respectively. For statistical analysis we carried out the chi-square test, the software used was SPSS (13.0) and the significance level was set at 5%. RESULTS: Elderly male with higher performance in the functional tests showed higher femur BMC compared to lower performance, result not found when evaluated women. CONCLUSION: Thus, the bone of the femur for the oldest old male is associated with functional capacity. The constant assessment of the bone mineral mass and practive of physical activity throughout life would be measures to prevent falls in the elderly.

OBJETIVO: Analisar a associação entre a massa óssea e capacidade funcional de idosos com 80 anos ou mais. MÉTODOS: A amostra foi composta por 93 idosos entre 80 e 91 anos (83,2±2,5 anos), 61 mulheres (83,3±2,7 anos) e 32 homens (83,1±2,2 anos) da cidade de Presidente Prudente. A avaliação da massa óssea foi feita pela absorptiometria de dupla energia de raios X (DXA), na qual foram mensurados os valores de conteúdo mineral ósseo (BMC) e densidade mineral óssea (BMD) do fêmur e da coluna (L1­L4). A capacidade funcional foi avaliada por meio dos testes de velocidade para caminhar, equilíbrio estático e força de membros inferiores contidos no questionário Saúde, Bem-Estar e Envelhecimento (Sabe). As variáveis da massa óssea e capacidade funcional foram categorizadas de acordo com os valores de mediana e a pontuação obtida nos testes, respectivamente. Para tratamento estatístico fez-se o teste qui-quadrado, o software usado foi SPSS (13.0) e o nível de significância estabelecido foi de 5%. RESULTADOS: Os idosos do sexo masculino com maior desempenho nos testes funcionais apresentaram maiores valores de BMC de fêmur comparados com os de menor desempenho, resultado não encontrado quando avaliadas as mulheres. CONCLUSÃO: Dessa forma, a massa óssea do fêmur para idosos longevos do sexo masculino está associada à capacidade funcional. A avaliação constante da massa mineral óssea e a prática de atividade física ao longo da vida seriam medidas para prevenção das quedas em idosos.