Medicine expenses and obesity in Brazil: an analysis based on the household budget survey.
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ABSTRACT:
SUBMITTER: Canella DS
PROVIDER: S-EPMC4719748 | biostudies-other | 2016
REPOSITORIES: biostudies-other
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Project description:The academic interest in analyzing the correlates of sports participation in several countries has increased recently. Nevertheless, in developing countries, which do not monitor sportive data, this type of investigation is still scarce. This study aims to analyze socioeconomic, motivational, and supportive factors related to sports participation in Brazil. Data from the 2015 National Household Survey-Supplementary Questionnaire of Sports and Physical Activities are examined. In the survey, 71,142 individuals older than 15 years were interviewed (mean age 43.12 years; 53.83% women and 46.17% men). Logistic regression is used for analyzing the data. Results demonstrate a low participation in sports (23.38%). Sports participation declines with increasing age (2% less per year), increases with higher educational level (graduated 5.9 times more), and males prevail in the sporting context (2.3 times more). The main obstacle to women's participation is the lack of sports facilities, and for men the lack of time and health problems. Men practice sports mainly due to socialization, fun, and competition, and women due to medical recommendation. Soccer was the most practiced sport (28.1%), predominating among men. Public policies on sports promotion for fun and socialization may increase male participation, and investments in sports facilities may increase female participation.
| S-EPMC7504227 | biostudies-literature
Project description:BackgroundIn Brazil, investigation and treatment of tuberculosis infection (TBI) in households contacts (HHC) of TB patients is not a priority. We estimated the cost-effectiveness and budget-impact of scaling-up an enhanced HHC management in Brazil.MethodsWe conceptualized a cascade-of-care that captures how HHC of tuberculosis patients are investigated in Brazil (status quo) and two enhanced strategies for management of HHC focusing on: (1) only tuberculosis disease (TBD) detection and, (2) TBD and TBI detection and treatment. Effectiveness was the number of HHC diagnosed with TBD and completing TBI treatment. Proportions in the cascades-of-care were derived from a meta-analysis. Health-system costs (2019 US$) were based on literature and official data from Brazil. The impact of enhanced strategies was extrapolated using reported data from 2019.FindingsWith the status quo, 0 (95% uncertainty interval: 0-1) HHC are diagnosed with TBD and 2 (0-16) complete TBI treatment. With strategy(1), an additional 15 (3-45) HHC would be diagnosed with TBD at a cost of US$346 each. With strategy(2), 81 (19-226) additional HHC would complete TBI treatment at a cost of US$84 each. A combined strategy, implemented nationally to enhance TBD detection and TBI treatment would result in an additional 9,711 (845-28,693) TBD being detected, and 51,277 (12,028-143,495) more HHC completing TBI treatment each year, utilizing 10.9% and 11.6% of the annual national tuberculosis program budget, respectively.InterpretationEnhanced detection and treatment of TBD and TBI among HHC in Brazil can be achieved at a national level using current tools at reasonable cost.FundingNone.
| S-EPMC9903685 | biostudies-literature
Project description:BackgroundAccurate national information on dietary intakes, including heterogeneity among individuals, is critical to inform health implications and policy priorities. In low- and middle-income countries, household expenditure surveys constitute the major source of food data, but with uncertain validity for individual-level intakes.ObjectiveTo investigate how individualized dietary consumption estimated from household survey data compared with individual-level 24-hr dietary recalls (24hR); and to assess potential heterogeneity by method for individualizing household intakes, dietary indicator, and individual characteristics (age, sex, education, religion, household income).MethodsWe evaluated data from the 2011-2012 Bangladesh Household Integrated Survey (BIHS), which included household-level consumption data (5,503 households) and individual-level dietary data based on 24hR from these households (22,173 participants). Household and 24hR estimates were standardized and harmonized for 33 dietary indicators, including 9 food groups, total energy, 8 macronutrients, and 15 micronutrients. Individual consumption was estimated from household data using two approaches, the Adult Male Equivalent (AME) and per capita (PC) approach. For each dietary indicator, differences in household vs. individual mean estimates were evaluated overall and by strata of individual characteristics, using Spearman's correlations and univariate and multivariate linear regression models.ResultsIndividualized household estimates overestimated individual intakes from 24hR for all dietary factors using either estimation method (P<0.001 for each), except for starchy vegetables (AME: P = 0.15; PC: P = 0.85). For foods, overestimation ranged from 4% for seafood to about 240% for fruits, and for nutrients from 11% for carbohydrates and poly-unsaturated fats to 55% for vitamin C, with similar overestimation for the AME and the PC method. By strata, overestimation was modestly higher in men vs. women, in children (0-10y) vs. adolescents (11-19y) and adults (20-44y, ?45y), among adults of higher (?6y) vs. lower (<6y) education, in Muslims vs. other religions (Christians, Hindus), and for the lowest vs. all other income groups. This overestimation was notably higher in young children (0-5y) vs. all other age groups and in the lowest vs. all other income groups. Underestimation was rarely observed, for example for milk intake (-56%) in young children (0-5y). The PC approach did not capture heterogeneity in validity of estimation of different dietary factors by age, mainly in children (0-5y, 6-10y). Spearman's correlations between individualized household estimates and 24hR data were higher for the AME (0.30-0.70) than PC (0.20-0.50) approach. Findings were similar with and without multivariate regression, with proportions of variance (R2) in 24hR intakes explained by the AME being generally greater than PC estimates, yet still low to modest.ConclusionsIn this national survey, established methods for estimating individual level intakes from household surveys produce overestimation of intakes of nearly all dietary indicators, with significant variation depending on the dietary factor and modest variation depending on individual characteristics. These findings suggest a need for new methods to estimate individual-level consumption from household survey estimates.
| S-EPMC6110494 | biostudies-literature
Project description:In many countries, statistics from household consumption and expenditure surveys are increasingly being used to inform policies and programs. In household surveys, foods are typically reported as they are acquired (the majority are raw). However, the micronutrient content of some foods diminishes during processing and cooking. Using food consumption data from the 2015/16 Kenya Integrated Household Budget Survey, this study analyzes whether mean consumption estimates of dietary energy, macronutrients, and eight micronutrients are equivalent (applying a two-side paired equivalence test) when matching foods: (1) considering the nutrient content in raw foods (as reported in the survey), and (2) considering the nutrient content in foods as typically consumed, thus applying yield and retention factors as needed. Both food matching approaches rendered statistically equivalent mean consumption estimates, at national and county levels, for dietary energy, protein, fats, available carbohydrates, total fiber, calcium and zinc. Non-equivalent means were found for iron, vitamins A, B1, B2, B12, and C. The higher differences between the means were, in percentage change, for vitamin C (47 %), B1 (34 %) and B12 (26 %).
| S-EPMC8356072 | biostudies-literature
Project description:ObjectiveTo verify the association between sociodemographic factors and the time until the occurrence of new cases of COVID-19 and positive tests for SARS-CoV-2 in Brazil, during the period from May to November 2020, based on a cohort of Brazilians participating in the COVID-19 National Household Sample Survey.MethodsA concurrent and closed cohort was created using monthly data from the PNAD COVID-19, carried out via telephone survey. A new case was defined based on the report of the occurrence of a flu-like syndrome, associated with loss of smell or taste; and positivity was defined based on the report of a positive test, among those who reported having been tested. Cox regression models were applied to verify associations. The analyzes took into account sample weighting, calibrated for age, gender and education distribution.ResultsThe cumulative incidence of cases in the overall fixed cohort was 2.4%, while that of positive tests in the fixed tested cohort was 27.1%. Higher incidences were observed in the North region, in females, in residents of urban areas and in individuals with black skin color. New positive tests occurred more frequently in individuals with less education and healthcare workers.ConclusionThe importance of prospective national surveys is highlighted, contributing to detailed analyzes of social inequalities in reports focused on public health policies.
| S-EPMC10946290 | biostudies-literature
Project description:BACKGROUND:The Ebola virus disease (EVD) epidemic has threatened access to basic health services through facility closures, resource diversion, and decreased demand due to community fear and distrust. While modeling studies have attempted to estimate the impact of these disruptions, no studies have yet utilized population-based survey data. METHODS AND FINDINGS:We conducted a two-stage, cluster-sample household survey in Rivercess County, Liberia, in March-April 2015, which included a maternal and reproductive health module. We constructed a retrospective cohort of births beginning 4 y before the first day of survey administration (beginning March 24, 2011). We then fit logistic regression models to estimate associations between our primary outcome, facility-based delivery (FBD), and time period, defined as the pre-EVD period (March 24, 2011-June 14, 2014) or EVD period (June 15, 2014-April 13, 2015). We fit both univariable and multivariable models, adjusted for known predictors of facility delivery, accounting for clustering using linearized standard errors. To strengthen causal inference, we also conducted stratified analyses to assess changes in FBD by whether respondents believed that health facility attendance was an EVD risk factor. A total of 1,298 women from 941 households completed the survey. Median age at the time of survey was 29 y, and over 80% had a primary education or less. There were 686 births reported in the pre-EVD period and 212 in the EVD period. The unadjusted odds ratio of facility-based delivery in the EVD period was 0.66 (95% confidence interval [CI] 0.48-0.90, p-value = 0.010). Adjustment for potential confounders did not change the observed association, either in the principal model (adjusted odds ratio [AOR] = 0.70, 95%CI 0.50-0.98, p = 0.037) or a fully adjusted model (AOR = 0.69, 95%CI 0.50-0.97, p = 0.033). The association was robust in sensitivity analyses. The reduction in FBD during the EVD period was observed among those reporting a belief that health facilities are or may be a source of Ebola transmission (AOR = 0.59, 95%CI 0.36-0.97, p = 0.038), but not those without such a belief (AOR = 0.90, 95%CI 0.59-1.37, p = 0.612). Limitations include the possibility of FBD secular trends coincident with the EVD period, recall errors, and social desirability bias. CONCLUSIONS:We detected a 30% decreased odds of FBD after the start of EVD in a rural Liberian county with relatively few cases. Because health facilities never closed in Rivercess County, this estimate may under-approximate the effect seen in the most heavily affected areas. These are the first population-based survey data to show collateral disruptions to facility-based delivery caused by the West African EVD epidemic, and they reinforce the need to consider the full spectrum of implications caused by public health emergencies.
| S-EPMC4970816 | biostudies-other
Project description:BackgroundEthnobotanical research has demonstrated that several wild food plants (WFP) are used for medicinal purposes. Therefore, in addition to constituting an important source of nutrients, WFP can be used to help treat and avoid health problems. This study sought to characterize the traditional use of plants considered simultaneously as food and medicine by local specialists in the community of Caeté-Açu, which borders Chapada Diamantina National Park (NE Brazil). We also sought to identify the variables that influence the species' cultural importance.MethodsWe selected local specialists based on a snowball sample and used a free-listing technique to register the wild plants they knew that are both edible and medicinal. Then, we asked the specialists to rank each plant component cited according to the following attributes: (1) ease of acquisition, (2) taste, (3) smell, (4) nutritional value, and (5) medicinal value. We used multiple regression to determine the variables that influence the cultural salience.ResultsThe most culturally salient species was Anredera cordifolia (Ten.) Steenis. The main medicinal effects associated with this species were related to body strengthening, intestinal regulation, and stomach issues. The most salient used species were those that were easiest to acquire and had the highest perceived nutritional values.ConclusionIt is likely that the sociocultural backgrounds of the respondents (elders, former miners, or descendants of miners) and the historical importance of wild food plants to local diets increased the predictive power of the perceived nutritional importance and ease of acquisition of these plants.
| S-EPMC8157413 | biostudies-literature
Project description:BackgroundIn an obesity epidemic, physicians are unprepared to treat patients with obesity. The objective of this study was to understand how obesity is currently addressed in United States (U.S.) Internal Medicine (IM) residency programs and benchmark the degree to which curricula incorporate topics pertaining to the recently developed Obesity Medicine Education Collaborative (OMEC) competencies.MethodsInvitations to complete an online survey were sent via postal mail to U.S IM residency programs in 2018. Descriptive analyzes were performed.ResultsDirectors/associate directors from 81 IM residencies completed the online survey out of 501 programs (16.2%). Although obesity was an intentional educational objective for most programs (66.7%), only 2.5% of respondents believed their residents are "very prepared" to manage obesity. Formal rotation opportunities in obesity are limited, and at best, only one-third (34.6%) of programs reported any one of the core obesity competencies are covered to "a great extent." Many programs reported psychosocial components of obesity (40.7%), weight stigma (44.4%), etiological aspects of obesity (64.2%) and pharmacological treatment of obesity (43.2%) were covered to "very little extent" or "not at all." Lack of room in the curriculum and lack of faculty expertise are the greatest barriers to integrating obesity education; only 39.5% of residency programs have discussed incorporating or expanding formal obesity education.ConclusionsOur study found the current obesity curricula within U.S. IM residency programs do not adequately cover important aspects that address the growing obesity epidemic, suggesting that obesity education is not enough of a priority for IM residency programs to formalize and implement within their curricula.
| S-EPMC7691912 | biostudies-literature
Project description:Rural family differentiation is an important perspective to analyze farmers' behavior and poverty. Based on the data of 1673 farm households from rural field survey in 2019 in Hubei Province of China, this paper examines the main influencing factors of farm household differentiation on farm household poverty vulnerability from the perspective of the sustainable livelihoods of farm households. On this basis, the contribution of each influencing factor to farm household poverty vulnerability is analysed using the regression decomposition method. The results of the study show that the variables of farm household differentiation have a significant impact on poverty vulnerability, and the net household income per capita, which reflect the vertical differentiation of farm households, and the proportion of non-farm labor, which reflects the horizontal differentiation of farm households. Both have a significant negative impact on the poverty vulnerability of farm households. The regression decomposition method shows that the proportion of non-farm labor force, which reflects the horizontal differentiation of farm households, has the highest contribution to the poverty vulnerability of farm households. Human capital, natural capital, social capital, and physical capital also influence the poverty vulnerability of farm households to a certain extent.
| S-EPMC9031628 | biostudies-literature
Project description:BackgroundAcromegaly is a rare, chronic and debilitating disease whose treatment places a high burden on health systems. In the reality of the Brazilian public health network, many patients are kept on drug treatment because of barriers to access to surgery.ObjectiveThe aim of this study was to estimate the costs and budget impact of routine transsphenoidal endoscopic surgery in relation to those of long-term drug treatment with octreotide long-acting release (LAR) from a cohort of patients followed at the referral medical centre for acromegaly treatment in the Federal District, Brazil.MethodsBased on micro-costing data collected using mixed methods from a local perspective of the public health system, we performed a budget impact analysis (BIA) on a 3-year time horizon. Uncertainty was handled with deterministic (tornado and scenario) and probabilistic (Monte Carlo simulations) sensitivity analyses.ResultsCompared with the continued use of octreotide LAR at a dose of 30 mg every 28 days, the incremental budget impact of conducting two surgeries per month, considering a cure rate of 55%, could bring savings of approximately US$879,362.18 (95% CI 860,176.29-898,548.08) over 3 years. Depending on the key variable values, the savings amplitude ranged from US$431,836.39 to US$1,519,132.04.ConclusionsImproving access to surgery could result in significant cost reductions in acromegaly treatment. The present study stands out for being the first to estimate the costs of transsphenoidal surgery in the context of the public health system in Brazil.
| S-EPMC6533371 | biostudies-literature