The burden of physical activity on type 2 diabetes public healthcare expenditures among adults: a retrospective study

<p>Abstract</p> <p>Background</p> <p>Determinants of public healthcare expenditures in type 2 diabetics are not well investigated in developing nations and, therefore, it is not clear if higher physical activity decreases healthcare costs. The purpose of this study was to analyze the relationship between physical activity and the expenditures in public healthcare on type 2 diabetes mellitus treatment.</p> <p>Methods</p> <p>Cross-sectional study carried out in Brazil. A total of 121 type 2 diabetics attended to in two Basic Healthcare Units were evaluated. Public healthcare expenditures in the last year were estimated using a specific standard table. Also evaluated were: socio-demographic variables; chronological age; exogenous insulin use; smoking habits; fasting glucose test; diabetic neuropathy and anthropometric measures. Habitual physical activity was assessed by questionnaire.</p> <p>Results</p> <p>Age (r = 0.20; p = 0.023), body mass index (r = 0.33; p = 0.001) and waist-to-hip ratio (r = 0.20; p = 0.025) were positively related to expenditures on medication for the treatment of diseases other than diabetes. Insulin use was associated with increased expenditures. Higher physical activity was associated with lower expenditure, provided medication for treatment of diseases other than diabetes (OR = 0.19; p = 0.007) and medical consultations (OR = 0.26; p = 0.029).</p> <p>Conclusions</p> <p>Type 2 diabetics with higher enrollment in physical activity presented consistently lower healthcare expenditures for the public healthcare system.</p

Individual and social determinants of multiple chronic disease behavioral risk factors among youth

<p>Abstract</p> <p>Background</p> <p>Behavioral risk factors are known to co-occur among youth, and to increase risks of chronic diseases morbidity and mortality later in life. However, little is known about determinants of multiple chronic disease behavioral risk factors, particularly among youth. Previous studies have been cross-sectional and carried out without a sound theoretical framework.</p> <p>Methods</p> <p>Using longitudinal data (n = 1135) from Cycle 4 (2000-2001), Cycle 5 (2002-2003) and Cycle 6 (2004-2005) of the National Longitudinal Survey of Children and Youth, a nationally representative sample of Canadian children who are followed biennially, the present study examines the influence of a set of conceptually-related individual/social distal variables (variables situated at an intermediate distance from behaviors), and individual/social ultimate variables (variables situated at an utmost distance from behaviors) on the rate of occurrence of multiple behavioral risk factors (physical inactivity, sedentary behavior, tobacco smoking, alcohol drinking, and high body mass index) in a sample of children aged 10-11 years at baseline. Multiple behavioral risk factors were assessed using a multiple risk factor score. All statistical analyses were performed using SAS, version 9.1, and SUDAAN, version 9.01.</p> <p>Results</p> <p>Multivariate longitudinal Poisson models showed that social distal variables including parental/peer smoking and peer drinking (Log-likelihood ratio (LLR) = 187.86, degrees of freedom (DF) = 8, <it>p </it>< .001), as well as individual distal variables including low self-esteem (LLR = 76.94, DF = 4, <it>p </it>< .001) increased the rate of occurrence of multiple behavioral risk factors. Individual ultimate variables including age, sex, and anxiety (LLR = 9.34, DF = 3, <it>p </it>< .05), as well as social ultimate variables including family socioeconomic status, and family structure (LLR = 10.93, DF = 5, <it>p </it>= .05) contributed minimally to the rate of co-occurrence of behavioral risk factors.</p> <p>Conclusions</p> <p>The results suggest targeting individual/social distal variables in prevention programs of multiple chronic disease behavioral risk factors among youth.</p

Acceptability and feasibility of a low-cost, theory-based and co-produced intervention to reduce workplace sitting time in desk-based university employees

BACKGROUND: Prolonged sedentary time is linked with poor health, independent of physical activity levels. Workplace sitting significantly contributes to sedentary time, but there is limited research evaluating low-cost interventions targeting reductions in workplace sitting. Current evidence supports the use of multi-modal interventions developed using participative approaches. This study aimed to explore the acceptability and feasibility of a low-cost, co-produced, multi-modal intervention to reduce workplace sitting. METHODS: The intervention was developed with eleven volunteers from a large university department in the UK using participative approaches and “brainstorming” techniques. Main components of the intervention included: emails suggesting ways to “sit less” e.g. walking and standing meetings; free reminder software to install onto computers; social media to increase awareness; workplace champions; management support; and point-of-decision prompts e.g. by lifts encouraging stair use. All staff (n = 317) were invited to take part. Seventeen participated in all aspects of the evaluation, completing pre- and post-intervention sitting logs and questionnaires. The intervention was delivered over four weeks from 7th July to 3rd August 2014. Pre- and post-intervention difference in daily workplace sitting time was presented as a mean ± standard deviation. Questionnaires were used to establish awareness of the intervention and its various elements, and to collect qualitative data regarding intervention acceptability and feasibility. RESULTS: Mean baseline sitting time of 440 min/workday was reported with a mean reduction of 26 ± 54 min/workday post-intervention (n = 17, 95 % CI = −2 to 53). All participants were aware of the intervention as a whole, although there was a range of awareness for individual elements of the intervention. The intervention was generally felt to be both acceptable and feasible. Management support was perceived to be a strength, whilst specific strategies that were encouraged, including walking and standing meetings, received mixed feedback. CONCLUSIONS: This small-scale pilot provides encouragement for the acceptability and feasibility of low-cost, multi-modal interventions to reduce workplace sitting in UK settings. Evaluation of this intervention provides useful information to support participatory approaches during intervention development and the potential for more sustainable low-cost interventions. Findings may be limited in terms of generalisability as this pilot was carried out within a health-related academic setting

Clustering of risk factors for non-communicable disease and healthcare expenditure in employees with private health insurance presenting for health risk appraisal: a cross-sectional study

Background: The global increase in the prevalence of NCD's is accompanied by an increase in risk factors for these diseases such as insufficient physical activity and poor nutritional habits. The main aims of this research study were to determine the extent to which insufficient physical activity (PA) clustered with other risk factors for non-communicable disease (NCD) in employed persons undergoing health risk assessment, and whether these risk factors were associated with higher healthcare costs. Methods. Employees from 68 companies voluntarily participated in worksite wellness days, that included an assessment of self-reported health behaviors and clinical measures, such as: blood pressure (BP), Body Mass Index (BMI), as well as total cholesterol concentrations from capillary blood samples. A risk-related age, 'Vitality Risk Age' was calculated for each participant using an algorithm that incorporated multiplicative pooled relative risks for all cause mortality associated with smoking, PA, fruit and vegetable intake, BMI, BP and cholesterol concentration. Healthcare cost data were obtained for employees (n = 2 789). Results: Participants were 36 ± 10 years old and the most prevalent risk factors were insufficient PA (67%) and BMI ≥ 25 (62%). Employees who were insufficiently active also had a greater number of other NCD risk factors, compared to those meeting PA recommendations (chi§ssup§2§esup§ = 43.55; p < 0.0001). Moreover, employees meeting PA guidelines had significantly fewer visits to their family doctor (GP) (2.5 versus 3.11; p < 0.001) than those who were insufficiently PA, which was associated with an average cost saving of ZAR100 per year (p < 0.01). Furthermore, for every additional year that the 'Vitality Risk Age' was greater than chronological age, there was a 3% increased likelihood of at least one additional visit to the doctor (OR = 1.03; 95% CI = 1.01 - 1.05). Conclusion: Physical inactivity was associated with clustering of risk factors for NCD in SA employees. Employees with lower BMI, better self-reported health status and readiness to change were more likely to meet the PA guidelines. These employees might therefore benefit from physical activity intervention programs that could result in improved risk profile and reduced healthcare expenditure