Eficácia E Custo-Utilidade De Intervenções Para O Tratamento Da Enurese Em Crianças E Adolescentes Sob A Perspectiva Do Sistema Único De Saúde Brasileiro: Effectiveness and Cost-Utility of Interventions for Enuresis Treatment in Children and Adolescents From the Brazilian Single Health System Perspective.

OBJECTIVES: This study aimed to estimate the cost-utility of effective interventions for enuresis treatment in children and adolescents and to calculate the incremental cost-utility ratio from the perspective of the Brazilian Unified Health System in a 1-year time horizon. METHODS: The economic analysis is in 7 stages: (1) survey of evidence of treatments for enuresis, (2) performing the network meta-analysis, (3) estimation of the probability of cure, (4) cost-utility analysis, (5) model sensitivity analysis, (6) analysis of acceptability of interventions by acceptability curve, and (7) monitoring the technological horizon. RESULTS: The association between desmopressin and oxybutynin is the therapeutic strategy with the highest probability of success in the treatment of enuresis in children and adolescents compared with placebo (relative risk [RR] 2.88; 95% confidence interval [CI] 1.65-5.04), followed by the combination therapy between desmopressin and tolterodine (RR 2.13; 95% CI 1.13-4.02), alarm (RR 1.59; 95% CI 1.14-2.23), and neurostimulation (RR 1.43; 95% CI 1.04-1.96). Combination therapy between desmopressin and tolterodine was the only 1 considered not to be cost-effective. Neurostimulation, alarm therapy, and therapy had the respective incremental cost-utility ratio values: R$5931.68, R$7982.92, and R$29 050.56/quality-adjusted life-years. CONCLUSION: Among the therapies that are on the borderline of efficiency, the combined therapy between desmopressin and oxybutynin presents the greatest incremental benefit at an incremental cost that is still feasible, given that it does not exceed the reference value of the cost-effectiveness threshold established in Brazil.

Sleep Quality, Excessive Daytime Sleepiness, and Physical Activity Level in Health Professionals with and Without COVID-19: a Cross-Sectional Study.

Objective To compare the sleep quality, excessive daytime sleepiness, and physical activity level in health professionals infected and not infected with COVID-19. Methods Cross-sectional study based on online forms (Google Forms) filled out by health professionals who cared for COVID- 19 patients in hospitals in the Recife metropolitan area, Brazil, between October 2020 and May 2021. Anthropometric, sociodemographic, and occupational data were collected, along with the assessment of excessive daytime sleepiness (with Epworth Sleepiness Scale [ESE]), sleep quality (with Pittsburgh Sleep Quality Index [PSQI]), and physical activity level (with International Physical Activity Questionnaire [IPAQ] - short version). Results A total of 96 participants were assessed (37 with COVID-19, 59 without COVID-19). There were no differences between the groups regarding physical activity levels classified as sedentary, moderately active, or highly active (p = 0.850), or the weekly energy expenditure (p = 0.522). Infected professionals had a greater workload than non-infected ones, besides poorer sleep quality (10.46 ± 3.75 vs. 7.88 ± 3.75; p = 0.001) and excessive daytime sleepiness (10.19 ± 3.05 vs. 8.44 ± 3.85; p = 0.016). Conclusion Based on the results, this study shows that professionals infected with COVID-19 have poorer sleep quality, associated with excessive daytime sleepiness, in contrast with non-infected professionals.