Direct and Indirect Costs of Diabetes in Brazil in 2016.

Background: The global economic burden of Diabetes mellitus (DM) is expected to reach US$ 745 billion in 2030. The growing prevalence of the disease, mainly type 2 diabetes, is the result of population aging, nutritional transition, which include growing rates of obesity and consumption of foods high in sugar and fat. Brazil is the fourth country in the number of patients with diabetes globally and follows the global trends, with a continuous increase in prevalence. Objectives: To estimate the economic burden of DM in Brazil, including all direct and indirect costs. Methods: We used a cost-of-illness approach to calculate the total economic burden of DM. We used official healthcare-related statistics referring to 2016. Findings: We estimated the Brazilian economic burden to reach US$ 2.15 billion in 2016, of which 70.6% are indirect costs related to premature deaths, absenteeism, and early retirement. We estimate that if the rate of growth of diabetes prevalence remains in Brazil, direct and indirect costs of diabetes will more than double by 2030 (an increase of 133.4% or 6.2% per year). Conclusion: Our results are in accordance with the literature that shows that indirect costs are more relevant in low- and middle-income countries due to poorer access to health care, which result in higher mortality rates from non-communicable diseases. However, due to the potentially underestimated prevalence of diabetes in Brazil and the lack of access to nationwide private healthcare costs, we estimate costs of diabetes in Brazil to be higher than the conservative results we found. The onset of the COVID-19 pandemic is likely to result in even greater costs than what we estimated.

HOW DO BOARD-CERTIFIED HAND SURGEONS MANAGE CARPAL TUNNEL SYNDROME? A NATIONAL SURVEY.

OBJECTIVE: To evaluate tendencies in the planning, diagnosis, and treatment of carpal tunnel syndrome (CTS) by Brazilian hand surgery specialists. METHODS: This cross-sectional study was performed at the 36th Brazilian Hand Surgery Congress. We prepared a questionnaire about preferences in the management of CTS, and board-certified hand surgeons that attended the congress were asked to fill out the questionnaires. A total of 174 questionnaires were analyzed. RESULTS: Electromyography examination is used by most surgeons. Night splinting is the most commonly used conservative treatment option. Half of the surgeons utilized prophylactic antibiotics. Most of the interviewees conduct inpatient surgery in the operating room and prefer intravenous regional anesthesia. Most of surgeons use the standard open technique associated with proximal release of the antebrachial fascia and do not perform neurolysis. Compressive dressings are most commonly used for 7 days. CONCLUSION: The approach to CTS among Brazilian hand surgeons with regard to pre-, intra-, and post-operatory conduct is consistent with the international literature. However, there is a need to reflect and conduct new studies on non-surgical treatment involving local corticosteroid injection, use of prophylactic antibiotics, hospital admission, and type of anesthesia in order to provide more cost-effective approach to surgical treatment for CTS. Level of Evidence V; Expert opinion.

OBJETIVO: Avaliar as tendências no planejamento, diagnóstico e tratamento da síndrome do túnel do carpo (STC) dos cirurgiões brasileiros especialistas em mão. MÉTODOS: Este estudo transversal foi realizado no 36o Congresso Brasileiro de Cirurgia da Mão. Preparamos um questionário sobre as preferências no tratamento de STC, e os cirurgiões especialistas em mão que participaram do congresso foram solicitados a responder os questionários. Foram analisados 174 questionários. RESULTADOS: A eletroneuromiografia é usada pela maioria dos cirurgiões. A tala noturna é a modalidade de tratamento conservador mais usada. Metade dos cirurgiões utiliza antibióticos profiláticos de rotina. A maioria dos entrevistados realiza as cirurgias no centro cirúrgico com internação hospitalar e prefere anestesia regional intravenosa. A maior parte dos cirurgiões emprega a técnica aberta padrão associada à abertura da fáscia antebraquial e não realiza neurólise. Curativos compressivos são habitualmente usados por sete dias. CONCLUSÃO: A conduta pré, intra e pós-operatória na STC entre os cirurgiões de mão brasileiros é compatível com a literatura internacional. Entretanto, há necessidade de reflexão e de novos estudos sobre a infiltração local de corticoides, o uso de antibióticos profiláticos, internação hospitalar e tipo de anestesia com o objetivo de proporcionar melhor custo-efetividade ao tratamento cirúrgico da STC. Nível de Evidência V; Opinião do especialista.

How do board-certified hand surgeons manage carpal tunnel syndrome? a national survey / Como o cirurgião especialista em mão aborda a síndrome do túnel do carpo? um levantamento nacional

ABSTRACT Objective: To evaluate tendencies in the planning, diagnosis, and treatment of carpal tunnel syndrome (CTS) by Brazilian hand surgery specialists. Methods: This cross-sectional study was performed at the 36th Brazilian Hand Surgery Congress. We prepared a questionnaire about preferences in the management of CTS, and board-certified hand surgeons that attended the congress were asked to fill out the questionnaires. A total of 174 questionnaires were analyzed. Results: Electromyography examination is used by most surgeons. Night splinting is the most commonly used conservative treatment option. Half of the surgeons utilized prophylactic antibiotics. Most of the interviewees conduct inpatient surgery in the operating room and prefer intravenous regional anesthesia. Most of surgeons use the standard open technique associated with proximal release of the antebrachial fascia and do not perform neurolysis. Compressive dressings are most commonly used for 7 days. Conclusion: The approach to CTS among Brazilian hand surgeons with regard to pre-, intra-, and post-operatory conduct is consistent with the international literature. However, there is a need to reflect and conduct new studies on non-surgical treatment involving local corticosteroid injection, use of prophylactic antibiotics, hospital admission, and type of anesthesia in order to provide more cost-effective approach to surgical treatment for CTS. Level of Evidence V; Expert opinion.

RESUMO Objetivo: Avaliar as tendências no planejamento, diagnóstico e tratamento da síndrome do túnel do carpo (STC) dos cirurgiões brasileiros especialistas em mão. Métodos: Este estudo transversal foi realizado no 36o Congresso Brasileiro de Cirurgia da Mão. Preparamos um questionário sobre as preferências no tratamento de STC, e os cirurgiões especialistas em mão que participaram do congresso foram solicitados a responder os questionários. Foram analisados 174 questionários. Resultados: A eletroneuromiografia é usada pela maioria dos cirurgiões. A tala noturna é a modalidade de tratamento conservador mais usada. Metade dos cirurgiões utiliza antibióticos profiláticos de rotina. A maioria dos entrevistados realiza as cirurgias no centro cirúrgico com internação hospitalar e prefere anestesia regional intravenosa. A maior parte dos cirurgiões emprega a técnica aberta padrão associada à abertura da fáscia antebraquial e não realiza neurólise. Curativos compressivos são habitualmente usados por sete dias. Conclusão: A conduta pré, intra e pós-operatória na STC entre os cirurgiões de mão brasileiros é compatível com a literatura internacional. Entretanto, há necessidade de reflexão e de novos estudos sobre a infiltração local de corticoides, o uso de antibióticos profiláticos, internação hospitalar e tipo de anestesia com o objetivo de proporcionar melhor custo-efetividade ao tratamento cirúrgico da STC. Nível de Evidência V; Opinião do especialista.