The Economic Burden of HIV/AIDS and Myocardial Infarction Treatment in Brazil

Objective. To analyze the expenses of HIV/AIDS and acute myocardial infarction (AMI) treatment in Brazil. Methods. A search in the Brazilian epidemiological database (DATASUS) on AMI and AIDS hospitalizations and their costs was done from January 1998 to December 2011. The number of HIV/AIDS cases and antiretroviral treatment (ART) costs was obtained from public Brazilian databases. Results. In 5 years, HIV/AIDS cases increased 38.5%, mainly in patients aged 25–49. There were 180,640 patients in ART in 2007 at a cost of R$ 3,920 per patient/year. The hospitalizations due to AIDS were stable over the last 13 years; however, the hospitalizations due to AMI have increased 78%. In 2007, the expenses with hospitalizations for HIV/AIDS and AMI (25–49 years) were approximately 0.12 and 1.52% of the Ministry of Health budget allocated to reimburse inpatient costs. The expenses on ART totaled 1.5% of the total budget (all age groups). Conclusion. The prevalence of HIV/AIDS is still increasing in Brazil. There are scientific evidences suggesting an increased incidence of AIM in this population. Considering the high costs for the treatment of both diseases, an economic analysis is important to alert health managers to strengthen the preventive measures to guarantee the financial sustainability of such treatment

Em obesos, a disfunção endotelial correlaciona melhor com a relação cintura-quadril do que com a medida da cintura ou índice de massa corpórea

PURPOSE: Obesity is associated with cardiovascular disease, affecting large arteries and the microcirculation. Waist circumference and body mass index are routinely employed as measures for assessing obesity-related health risk, whereas waist-to-hip ratio is not. We aimed to investigate the association between brachial vascular reactivity and body mass index, waist circumference, and waist-to-hip ratio. METHODS: Eighty-five volunteers (21 men/66 women), aged between 20 and 55 years, underwent determination of waist circumference, body mass index, waist-to-hip ratio, and endothelial function by venous occlusion plethysmography. Forearm blood flow was measured in response to intrabrachial artery infusions of 3 different concentrations of endothelium-dependent (acetylcholine 7.5, 15, and 30 mg/min) and endothelium-independent (sodium nitroprusside 2, 4, and 8 mg/min) vasodilators. RESULTS: There was an inverse correlation of body mass index and waist circumference with forearm blood flow increments after acetylcholine and sodium nitroprusside infusions, while waist-to-hip ratio showed an inverse correlation with forearm blood flow increments only after acetylcholine. When subjects older than 40 years (n = 25) were excluded from the analysis, the inverse correlation of body mass index with forearm blood flow increments after acetylcholine infusion no longer existed, while waist circumference and waist-to-hip ratio showed the same results observed before. CONCLUSION: The waist-to-hip ratio is probably a better estimator of endothelial dysfunction and possibly of cardiovascular risk than body mass index. These findings underscore the importance of routinely collecting hip circumference as an obesity index and risk estimator.OBJETIVO: A obesidade é associada a doenças cardiovasculares e compromete tanto a macro como a microcirculação. As medidas da cintura e do índice de massa corpórea são rotineiramente empregadas para avaliação do risco cardiovascular em obesos, enquanto a relação cintura-quadril é pouco utilizada. O objetivo do trabalho foi determinar que medida antroprométrica, entre as rotineiramente usadas, avalia melhor o risco cardiovascular em obesos. MATERIAL E MÉTODO: Oitenta e quatro voluntários (21 homens/ 66 mulheres), idade entre 20 e 55 anos foram avaliados quanto ao diâmetro da cintura, ao índice de massa corpórea, à relação cintura-quadril e à função endotelial pela técnica de pletismografia com oclusão venosa para medida do fluxo sanguíneo braquial, em resposta a injeção intrabraquial de três doses de acetilcolina (7,5; 15 e 30 mg/min) ou de nitroprussiato de sódio (2; 4 e 8 mg/min), para avaliação da vasodilatação endotélio-dependente e -independente. RESULTADO: Houve correlação inversa entre o índice de massa corpórea, diâmetro da cintura e aumento do fluxo sanguíneo após injeção de acetilcolina e nitroprussiato de sódio, enquanto que a relação cintura-quadril mostrou uma correlação negativa apenas com o aumento no fluxo de sangue no antebraço, após as infusões de acetilcolina. Quando os indivíduos com mais de 40 anos foram retirados da análise, não observamos mais a relação inversa entre índice de massa corpórea e aumento do fluxo sanguíneo após injeção de acetilcolina, enquanto que a cintura e a relação cintura-quadril mantiveram os resultados observados anteriormente. CONCLUSÃO: A relação cintura-quadril é provavelmente um melhor índice para estimar a disfunção endotelial, e consequentemente o risco cardiovascular, que o índice de massa corpórea e esses achados reforçam a importância da aferição da circunferência do quadril como um índice de obesidade e para estimativa do risco cardiovascular

Parameters, strategies and techniques of game analysis

The development of a game with educational purposes, similar to a game focusing on fun, requires an analysis process, which must evaluate positive and negative points, to support a plan of product improvement. The game A mansão de Quelícera, supported by the CNPq project “Diálogos entre Arte e Design” (Dialogues between Art and Design), was reviewed by a group of researchers from different institutions of higher education in Brazil. Different parts of the game were the subject of evaluation and redesign, as presented in two articles presented in SBGames 2012. In this article, the research explores parameters, strategies and analysis’ techniques of digital games, pointing out existing approaches and the ones organized by researchers of the group, whose action part of the gameplayer interaction. The theoretical foundation for this research considered the parameters of quality for computer games and the parameters defined by the MEC (Ministry of Education-Brazil) to evaluate educational technologies, as well as made use of strategies and techniques for data collection.O desenvolvimento de um jogo com fins educacionais, similarmente a um jogo com foco na diversão, requer um processo de análise, o qual deve avaliar pontos positivos e negativos, para embasar um plano de aperfeiçoamento do produto. O jogo A Mansão de Quelícera, contemplado pelo projeto CNPq “Diálogos entre Arte e Design”, esteve em processo de análise por um grupo de pesquisadores de diferentes instituições de ensino superior brasileiras. Diferentes partes do jogo foram objeto de avaliação e de remodelagem, como apresentado em dois artigos no SBGames 2012. Neste artigo, a pesquisa explora parâmetros, estratégias e técnicas de análise de jogos digitais, pontuando abordagens existentes e as organizadas por pesquisadores do grupo, cuja ação parte da interação jogador-jogo. O embasamento teórico para esta pesquisa considerou os parâmetros de qualidade para jogos de computadores e os parâmetros definidos pelo MEC para avaliar tecnologias educacionais, bem como utilizou-se de estratégias e técnicas para a coleta de dados.info:eu-repo/semantics/publishedVersio

Higher adiponectin concentrations are associated with reduced metabolic syndrome risk independently of weight status in Brazilian adolescents

Objective: To evaluate the association between adiponectin concentrations and metabolic syndrome (MetS) risk and to investigate if this association is independent of weight status in adolescents. Methods: Adiponectin concentrations and MetS risk were assessed in 4546 Brazilian adolescents (12–17 years old) enrolled in The Study of Cardiovascular Risks in Adolescents (“ERICA”), a cross-sectional multicenter study in Brazil. For analyses, adiponectin was categorized in sex and age-specific quartiles and MetS risk was expressed as a continuous score, calculated as the average of the standardized values (z-score) of the five MetS components. Multiple linear regression models were used to investigate the association between the quartiles of adiponectin and MetS risk. Results: Adiponectin was inversely associated with waist circumference and log-transformed triglycerides, and positively associated with HDL-c. We also observed an inverse association between adiponectin concentrations and MetS risk. After adjustment for sociodemographic variables, physical activity, skipping breakfast and body mass index (BMI), higher quartiles of adiponectin remained inversely associated with waist circumference and MetS risk. A direct association between adiponectin and HDL-c was also observed. In further analysis, the sample was stratified by weight status and an inverse association between quartiles of adiponectin and MetS risk was observed in both normal weight and overweight/obese adolescents. Conclusion: Higher adiponectin concentrations were independently and inverse associated with MetS risk in Brazilian adolescents, even after adjusting for BMI. These results were similar in normal weight and overweight/obese adolescents, suggesting that adiponectin may play a role in early development of MetS

Parameters, strategies and techniques of game analysis

The development of a game with educational purposes, similar to a game focusing on fun, requires an analysis process, which must evaluate positive and negative points, to support a plan of product improvement. The game A mansão de Quelícera, supported by the CNPq project “Diálogos entre Arte e Design” (Dialogues between Art and Design), was reviewed by a group of researchers from different institutions of higher education in Brazil. Different parts of the game were the subject of evaluation and redesign, as presented in two articles presented in SBGames 2012. In this article, the research explores parameters, strategies and analysis’ techniques of digital games, pointing out existing approaches and the ones organized by researchers of the group, whose action part of the gameplayer interaction. The theoretical foundation for this research considered the parameters of quality for computer games and the parameters defined by the MEC (Ministry of Education-Brazil) to evaluate educational technologies, as well as made use of strategies and techniques for data collection.O desenvolvimento de um jogo com fins educacionais, similarmente a um jogo com foco na diversão, requer um processo de análise, o qual deve avaliar pontos positivos e negativos, para embasar um plano de aperfeiçoamento do produto. O jogo A Mansão de Quelícera, contemplado pelo projeto CNPq “Diálogos entre Arte e Design”, esteve em processo de análise por um grupo de pesquisadores de diferentes instituições de ensino superior brasileiras. Diferentes partes do jogo foram objeto de avaliação e de remodelagem, como apresentado em dois artigos no SBGames 2012. Neste artigo, a pesquisa explora parâmetros, estratégias e técnicas de análise de jogos digitais, pontuando abordagens existentes e as organizadas por pesquisadores do grupo, cuja ação parte da interação jogador-jogo. O embasamento teórico para esta pesquisa considerou os parâmetros de qualidade para jogos de computadores e os parâmetros definidos pelo MEC para avaliar tecnologias educacionais, bem como utilizou-se de estratégias e técnicas para a coleta de dados.info:eu-repo/semantics/publishedVersio

Relação entre as adipocinas, inflamação e reatividade vascular em controles magros e pacientes obesos com síndrome metabólica

PURPOSE: Metabolic syndrome is an important risk factor for cardiovascular disease. Adipokines interfere with insulin action and endothelial cell function. We investigated the relationship among adipokines, metabolic factors, inflammatory markers, and vascular reactivity in obese subjects with metabolic syndrome and lean controls. METHODS: Cross-sectional study of 19 obese subjects with metabolic syndrome and 8 lean volunteers evaluated as controls. Vascular reactivity was assessed by venous occlusion pletysmography measuring braquial forearm blood flow (FBF) and vascular resistance (VR) responses to intra-arterial infusions of endothelium-dependent (acetylcholine-Ach) and independent (sodium nitroprusside-SNP) vasodilators. Blood samples were obtained to evaluate C reactive protein (CRP), plasminogen activator inhibitor 1 (PAI-1), fibrinogen, adiponectin, resistin, and lipid profile. Patients were classified with regard to insulin resistance through the HOMA-IR index. RESULTS: PAI-1, CRP and fibrinogen were higher and adiponectin was lower in metabolic syndrome subjects compared to controls. Metabolic syndrome subjects had impaired vascular reactivity. Adiponectin and PAI-1 were associated with insulin, HOMA-IR, triglycerides, and HDLc; and resistin with CRP. Adiponectin was associated with VR after Ach in the pooled group and resistin with D FBF after Ach in the metabolic syndrome group. CONCLUSION: Metabolic syndrome subjects exhibited low levels of adiponectin and high levels of CRP, fibrinogen, and PAI-1. Adiponectin and PAI-1 correlated with insulin resistance markers. Adiponectin and resistin correlated with vascular reactivity parameters. An adipocyte-endothelium interaction might be an important mechanism of inflammation and vascular dysfunction.A Síndrome Metabólica é um importante fator de risco para doenças cardiovasculares. As adipocinas interferem com a ação da insulina e com a função endotelial. OBJETIVO: Investigar a relação entre adipocinas, fatores metabólicos, marcadores inflamatórios e reatividade vascular para inferência da função endotelial em pacientes obesos e controles magros. MATERIAL E MÉTODO: Estudo transversal de 19 pacientes obesos com Síndrome Metabólica e 8 controles magros. A reatividade vascular foi avaliada pela pletismografia de oclusão venosa medindo o fluxo sangüíneo da artéria braquial e sua resistência vascular a partir de infusões intra-arteriais de vasodilatadores endotélio-dependente (acetilcolina) e endotélio-independente (nitroprussiato de sódio). Foram também avaliados no sangue a proteína C reativa (PCR), o inibidor do ativador do plasminogênio 1 (PAI-1), fibrinogênio, adiponectina, resistina e o perfil lipídico. Os pacientes foram classificados quanto à resistência insulínica pelo índice HOMA-IR. RESULTADO: PAI-1, PCR e fibrinogênio apresentaram valores mais altos e a adiponectina mais baixos para os pacientes com Síndrome Metabólica do que com os controles. Pacientes com Síndrome Metabólica apresentaram prejuízo da reatividade vascular. A adiponectina e PAI-1 estiveram associadas à insulina, HOMA-IR, triglicerídeos e HDLc; e resistina com o PCR. Adiponectina esteve associada com a resistência vascular e a resistina com o fluxo sangüíneo depois da acetilcolina em pacientes com Síndrome Metabólica. CONCLUSÃO: Pacientes com Síndrome Metabólica exibiram baixas concentrações sangüíneas de adiponectina e altos níveis de PCR, fibrinogênio e PAI-1. Adiponectina e PAI-1 correlacionaram com os marcadores da resistência insulínica. Adiponectina e resistina correlacionaram com a reatividade vascular. A interação adipócito-endotélio vascular pode ser um importante mecanismo de inflamação e disfunção vascular

Visão geral das meta-análises sobre prevenção e tratamento da obesidade infantil

Objectives: This study aimed to assess the quality of systematic reviews on prevention and non-pharmacological treatment of overweight and obesity in children and adolescents. Data source: A search was done in electronic databases (Medline via PubMed, Web of Science, Scopus, LILACS, the Cochrane Library, and Clinical Trials), including only systematic reviews with meta-analysis. Reviews were selected by two researchers, and a third one solved the divergences. PRISMA statement and checklist were followed. Summary of data: A total of 4574 records were retrieved, including 24 after selection. Six reviews were on obesity prevention, 17 on obesity treatment, and one on mixed interventions for prevention and treatment of obesity. The interventions were very heterogeneous and showed little or no effects on weight or body mass index. Mixed interventions that included dieting, exercise, actions to reduce sedentary behavior, and programs involving the school or families showed some short-term positive effects. Reviews that analyzed cardiovascular risk factors demonstrated significant improvements in the short-term. Conclusion: The systematic reviews of interventions to prevent or reduce obesity in children and adolescents generally showed little or no effects on weight or body mass index, although cardiovascular profile can be improved. Mixed interventions demonstrated better effects, but the long-term impact of obesity treatments of children and adolescents remains unclear.Objetivos: Este estudo teve como objetivo avaliar a qualidade das revisões sistemáticas sobre prevenção e tratamento não farmacológico do sobrepeso e da obesidade em crianças e adolescentes. Fontes de dados: Foi realizada uma busca em bases de dados eletrônicas (Medline via Pubmed, Web of Science, Scopus, LILACS, The Cochrane Library e Ensaios Clínicos), incluindo apenas revisões sistemáticas com meta-análise. As revisões foram selecionadas por dois pesquisadores e um terceiro resolveu as divergências. A lista de recomendações do PRISMA foi seguida. Síntese dos dados: Foram identificados 4.574 publicações, e 24 foram incluídas após a seleção. Seis publicações eram sobre prevenção da obesidade, 17 sobre tratamento da obesidade e 1 sobre intervenções mistas para prevenção e tratamento da obesidade. As intervenções eram muito heterogêneas e mostraram pouco ou nenhum efeito sobre o peso ou índice de massa corporal. Intervenções mistas que incluíam dieta, exercícios, ações para reduzir o comportamento sedentário e programas que envolviam a escola ou as famílias mostraram alguns efeitos positivos de curto prazo. Revisões que analisaram fatores de risco cardiovascular demonstraram melhoras significativas em curto prazo. Conclusão: As revisões sistemáticas de intervenções para prevenir ou reduzir a obesidade em crianças e adolescentes geralmente mostraram pouco ou nenhum efeito sobre o peso ou índice de massa corporal, embora o perfil cardiovascular possa ter melhorado. Intervenções mistas demonstraram melhores efeitos, mas o impacto em longo prazo dos tratamentos da obesidade de crianças e adolescentes ainda não está claro

Disease and economic burden of hospitalizations attributable to diabetes mellitus and its complications : a nationwide study in Brazil

Diabetes is associated with a significant burden globally. The costs of diabetes-related hospitalizations are unknown in most developing countries. The aim of this study was to estimate the total number and economic burden of hospitalizations attributable to diabetes mellitus (DM) and its complications in adults from the perspective of the Brazilian Public Health System in 2014. Data sources included the National Health Survey (NHS) and National database of Hospitalizations (SIH). We considered diabetes, its microvascular (retinopathy, nephropathy, and neuropathy) and macrovascular complications (coronary heart disease, cerebrovascular disease, and peripheral arterial disease), respiratory and urinary tract infections, as well as selected cancers. Assuming that DM patients are hospitalized for these conditions more frequently that non-DM individuals, we estimated the etiological fraction of each condition related to DM, using the attributable risk methodology. We present number, average cost per case, and overall costs of hospitalizations attributable to DM in Brazil in 2014, stratified by condition, state of the country, gender and age group. In 2014, a total of 313,273 hospitalizations due to diabetes in adults were reported in Brazil (4.6% of total adult hospitalization), totaling (international dollar) Int$264.9 million. The average cost of an adult hospitalization due to diabetes was Int$845, 19% higher than hospitalization without DM. Hospitalizations due to cardiovascular diseases related to diabetes accounted for the higher proportion of costs (47.9%), followed by microvascular complications (25.4%) and DM per se (18.1%). Understanding the costs of diabetes and its major complications is crucial to raise awareness and to support the decision-making process on policy implementation, also allowing the assessment of prevention and control strategies

Economic burden of diabetes in Brazil in 2014

Background : Diabetes and its complications produce significant clinical, economic and social impact. The knowledge of the costs of diabetes generates subsidies to maintain the financial sustainability of public health and social security systems, guiding research and health care priorities. Aims: The aim of this study was to estimate the economic burden of diabetes in Brazilian adults in 2014, considering the perspectives of the public health care system and the society. Methods: A prevalence-based approach was used to estimate the annual health resource utilization and costs attributable to diabetes and related conditions. The healthcare system perspective considered direct medical costs related to outpatient and hospitalization costs. The societal perspective considered non-medical (transportation and dietary products) and indirect costs (productivity loss, disability, and premature retirement). Outpatient costs included medicines, health professional visits, exams, home glucose monitoring, ophthalmic procedures, and costs related to end stage renal disease. The costs of hospitalization attributed to diabetes related conditions were estimated using attributable risk methodology. Costs were estimated in Brazilian currency, and then converted to international dollars (2014). Results: Based on a national self-reported prevalence of 6.2%, the total cost of diabetes in 2014 was Int$15.67 billion, including Int$ 6.89 billion in direct medical costs (44%), Int$3.69 billion in non-medical costs (23.6$ 5.07 billion in indirect costs (32.4%). Outpatient costs summed Int$6.62 billion and the costs of 314,334 hospitalizations attributed to diabetes and related conditions was Int$ 264.9 million. Most hospitalizations were due to cardiovascular diseases (47.9%), followed by diabetes itself (18%), and renal diseases (13.6%). Diet and transportation costs were estimated at Int$3.2 billion and Int$ 462.3 million, respectively. Conclusions: Our results showed a substantial economic burden of diabetes in Brazil, and most likely are underrated as they are based on an underestimated prevalence of diabetes. Healthcare policies aiming at diabetes prevention and control are urgently sought