Introductory concepts of health economics and the social impact of the alcohol misuse

Brazilian society bears high economic costs in view of the problems resulting from the alcohol consumption. There is a lack of economic studies into alcohol misuse or dependence in Brazil due to the limited financial resources, despite the huge health problems the country has been facing. This paper aims to introduce basic concepts of Heath Economics to health care practitioners, such as: Complete and Incomplete Economic Evaluation, Disease Costs, Cost Comparison, Types of Evaluation (cost-minimisation, cost-effectiveness, cost-utility, and cost-benefice), Point of View Analysis (from patient, health institution, Ministry of Health, or society), Types of Costs (direct, indirect and intangible), and other ones. In addition, research data on the impact of the alcohol consumption on the Brazilian society is described. We do not intend to exhaust the subjects addressed in this paper, but emphasise the need for more national researches that link the economic evaluation to the alcohol addiction issue in order to seek maximum efficiency by maximising the health care and minimising the scarce health system resources.A sociedade brasileira arca, atualmente, com um elevado custo econômico frente aos problemas decorrentes do uso abusivo de álcool. No Brasil, estudos econômicos relacionados ao abuso e/ou dependência química são escassos ou inexistentes, embora exista uma grande limitação de recursos e enormes problemas de saúde decorrentes. Este artigo tem como objetivo introduzir aos profissionais da saúde conceitos fundamentais da Economia da Saúde, tais como: avaliação econômica completa e incompleta, custo da doença, comparação de custos, tipos de avaliação (custo-minimização, custo-efetividade, custo-utility e custo-benefício), pontos de vista da análise (do paciente, da Instituição de Saúde, do Ministério da Saúde ou da sociedade), tipos de custos (diretos, indiretos e intangíveis) e outros. Além disso, serão descritos alguns dados de pesquisas sobre o impacto do consumo de álcool na sociedade brasileira. Não pretendemos esgotar os assuntos tratados, mas sim, enfatizar a necessidade de pesquisas nacionais que aliem a avaliação econômica à dependência alcoólica, tendo por finalidade propiciar o maior ganho de saúde possível, com a menor utilização dos escassos recursos destinados ao sistema saúde, na busca de maior eficiência.UNIFESP Departamento de PsiquiatriaUNIFESP UNIADUNIFESPUNIFESP CPESUNIFESP, Depto. de PsiquiatriaUNIFESP, UNIADUNIFESP, CPESSciEL

Brazilian Version of the Foot Health Status Questionnaire (FHSQ-Br): Cross-Cultural Adaptation and Evaluation of Measurement Properties

OBJECTIVE: To conduct a cross-cultural adaptation of the Foot Health Status Questionnaire into Brazilian-Portuguese and to assess its measurement properties. INTRODUCTION: This instrument is an outcome measure with 10 domains with scores ranging from 0-100, worst to best, respectively. The translated instrument will improve the examinations and foot care of rheumatoid arthritis patients. METHODS: The questions were translated, back-translated, evaluated by a multidisciplinary committee and pre-tested (n = 40 rheumatoid arthritis subjects). The new version was submitted to a field test (n = 65) to evaluate measurement properties such as test-retest reliability, internal consistency and construct validity. The Health Assessment Questionnaire, Numeric Rating Scale for foot pain and Sharp/van der Heijde scores for foot X-rays were used to test the construct validity. RESULTS: The cross-cultural adaptation was completed with minor wording adaptations from the original instrument. The evaluation of measurement properties showed high reliability with low variation coefficients between interviews. The a-Cronbach coefficients varied from 0.468 to 0.855, while correlation to the Health Assessment Questionnaire and Numeric Rating Scale was statistically significant for five out of eight domains. DISCUSSION: Intra- and inter-observer correlations showed high reliability. Internal consistency coefficients were high for all domains, revealing higher values for less subjective domains. As for construct validity, each domain revealed correlations with a specific group of parameters according to what the domains intended to measure. CONCLUSION: The FHSQ was cross-culturally adapted, generating a reliable, consistent, and valid instrument that is useful for evaluating foot health in patients with rheumatoid arthritis

Antioxidant intake among Brazilian adults - The Brazilian Osteoporosis Study (BRAZOS): a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Antioxidant nutrient intake and the lesser formation of free radicals seem to contribute to chronic diseases. The aim of the present study was to evaluate the intake profile of the main dietary antioxidants in a representative sample of the adult Brazilian population and discuss the main consequences of a low intake of these micronutrients on overall health.</p> <p>Methods</p> <p>The sample comprised 2344 individuals aged 40 years or older from 150 cities and was based on a probabilistic sample from official data. The research was conducted through in-home interviews administered by a team trained for this purpose. Dietary intake information was obtained through 24-h recall. The Nutrition Data System for Research software program was used to analyze data on the intake of vitamins A, C and E, selenium and zinc, which was compared to Dietary Reference Intakes (DRIs). Differences in intake according to sex, anthropometrics, socioeconomic status and region were also evaluated. The SPSS statistical package (version 13) was used for the statistical analysis. P-values < 0.05 were considered significant.</p> <p>Results</p> <p>Higher proportions of low intake in relation to recommended values were found for vitamin E (99.7%), vitamin A (92.4%) and vitamin C (85.1%) in both genders. Intake variations were found between different regions, which may reflect cultural habits.</p> <p>Conclusion</p> <p>These results should lead to the development of public health policies that encourage educational strategies for improving the intake of micronutrients, which are essential to overall health and prevention of non-communicable diseases.</p

A global research priority agenda to advance public health responses to fatty liver disease

Background & aims An estimated 38% of adults worldwide have non-alcoholic fatty liver disease (NAFLD). From individual impacts to widespread public health and economic consequences, the implications of this disease are profound. This study aimed to develop an aligned, prioritised fatty liver disease research agenda for the global health community. Methods Nine co-chairs drafted initial research priorities, subsequently reviewed by 40 core authors and debated during a three-day in-person meeting. Following a Delphi methodology, over two rounds, a large panel (R1 n = 344, R2 n = 288) reviewed the priorities, via Qualtrics XM, indicating agreement using a four-point Likert-scale and providing written feedback. The core group revised the draft priorities between rounds. In R2, panellists also ranked the priorities within six domains: epidemiology, models of care, treatment and care, education and awareness, patient and community perspectives, and leadership and public health policy. Results The consensus-built fatty liver disease research agenda encompasses 28 priorities. The mean percentage of ‘agree’ responses increased from 78.3 in R1 to 81.1 in R2. Five priorities received unanimous combined agreement (‘agree’ + ‘somewhat agree’); the remaining 23 priorities had >90% combined agreement. While all but one of the priorities exhibited at least a super-majority of agreement (>66.7% ‘agree’), 13 priorities had 90% combined agreement. Conclusions Adopting this multidisciplinary consensus-built research priorities agenda can deliver a step-change in addressing fatty liver disease, mitigating against its individual and societal harms and proactively altering its natural history through prevention, identification, treatment, and care. This agenda should catalyse the global health community’s efforts to advance and accelerate responses to this widespread and fast-growing public health threat. Impact and implications An estimated 38% of adults and 13% of children and adolescents worldwide have fatty liver disease, making it the most prevalent liver disease in history. Despite substantial scientific progress in the past three decades, the burden continues to grow, with an urgent need to advance understanding of how to prevent, manage, and treat the disease. Through a global consensus process, a multidisciplinary group agreed on 28 research priorities covering a broad range of themes, from disease burden, treatment, and health system responses to awareness and policy. The findings have relevance for clinical and non-clinical researchers as well as funders working on fatty liver disease and non-communicable diseases more broadly, setting out a prioritised, ranked research agenda for turning the tide on this fast-growing public health threat