Abstract Aim: The study aimed to conduct a cost-utility analysis of traditional drug therapy (TDT) provided for hypertensive patients at primary care in comparison to the protocol based on combination with an exercise program (TDT+E) in real-life conditions, adopting a health system perspective. Methods: Longitudinal study based on enrollment of 49 hypertensive adults distributed into two groups, for 12 months. Quality-adjusted life years were estimated using health-related quality of life. Direct health care costs were calculated including inputs and human resources in primary care from medical records. Sensitivity analysis was performed based on multivariate and probabilistic scenarios. Results: Incremental cost-effectiveness ratios of TDT+E in comparison to TDT were +79.69. Sensitivity analysis showed that TDT+E presented advantages considering uncertainties. Conclusion: Our findings show that exercise programs may improve quality of life and life expectancy among hypertensive patients.

RESUMO Pouco se sabe sobre o possível impacto da implementação de programas de exercício físico regular sobre adiposidade corporal e gastos com saúde de pacientes atendidos em Unidades Básicas de Saúde, sendo assim, o objetivo do estudo foi implementar e verificar o efeito de um programa de exercício físico com duração de 12 meses, sobre a obesidade e gastos públicos em saúde desses pacientes. Amostra composta por 25 adultos, com idade ≥50 anos, hipertensos e insuficientemente ativos. Anteriormente ao início do treinamento, aos seis meses e ao final foi realizada avaliação da composição corporal, pressão arterial e análise dos gastos em saúde. O treinamento era realizado três vezes na semana com duração de 60 minutos. Para o fator intervenção houve diferença estatisticamente significativa entre os grupos somente para a variável circunferência de cintura (p=0,019). Para os valores de gordura corporal, o grupo intervenção apresentou reduções ao longo do seguimento, as quais foram significativas quando comparadas ao grupo controle. Os gastos com consultas reduziram ao longo do tempo em ambos os grupos (p=0,026). O programa de exercícios físicos foi capaz de proporcionar benefícios ao percentual de gordura corporal dos pacientes, porém gastos com saúde não foram afetados.

ABSTRACT Little is known about the possible impact of the implementation of regular physical exercise programs on body adiposity and health expenditures of patients attended in Basic Health Units, so the objective of the study was to implement and verify the effect of a physical exercise program with a duration of 12 months, on obesity and the public health expenditure of these patients. The sample was composed of 25 adults, aged ≥50 years, hypertensive and insufficiently active. Prior to beginning the training, at six months, and at the end of training, body composition, blood pressure, and health expenditure analysis were performed. The training was carried out three times a week with a 60-minute duration. For the intervention factor there was a statistically significant difference between the groups only for the waist circumference variable (p-value = 0.019). For body fat values, the intervention group presented reductions throughout the follow-up, which were significant when compared to the control group. Consultation expenditures decreased over time in both groups (p = 0.026). The physical exercise program facilitated a reduction in the percentage of body fat of the patients, but health expenditures were not affected.

Abstract AIMS To compare the profile of adults attended at primary care level of the Brazilian National Health System according to occurrence of T2DM during 18 months of follow-up. METHOD Longitudinal study carried out with 316 adults. T2DM and PA were assessed by questionnaires. Measurements of weight, height and waist circumference (WC) were also performed. Healthcare expenditures were based on the demand of services registered in medical records. Analysis of variance (ANOVA) with Tukey’s post hoc test was used, as well as their similar for non-parametric variables. Spearman’s correlation coefficient analyzed the relationship between variables. All analyzes were performed using the statistical software BioEstat (release 5.0) and the significance level was set at p-value <0.05. RESULTS Patients with T2DM at baseline showed higher values of WC, BMI, nursing appointments, customer services, medication, total cost and lower values of PA when compared to patients T2DM-free. Patients who developed T2DM during the follow-up presented higher values of WC, screening, pharmacy frequency, medications and total cost when compared to individuals without T2DM. Being in the highest quartile of PA did not change the costs of health services among patients T2DM-free. Healthcare expenditures were positively correlated to BMI among participants T2DM-free and with T2DM at baseline. CONCLUSION Participants with T2DM and participants who developed T2DM during the follow-up showed higher values of BMI, WC, healthcare expenditures and were less active when compared to participants T2DM-free. Healthcare expenditures were positively correlated with BMI among participants with T2DM at baseline and T2DM-free.

RESUMO Inúmeros fatores estão associados aos distúrbios do sono ocasionando o aumento nos gastos com saúde. O objetivo do trabalho foi analisar a associação dos distúrbios do sono e doenças crônicas não transmissíveis em pacientes com idade superior a 50 anos atendidos por Unidades Básicas de Saúde de Presidente Prudente. Participaram 363 pacientes. O histórico de doenças foi auto relatada a partir da aplicação de questionário, o nível de atividade física foi verificado através do questionário de Baecke, e a qualidade do sono foi avaliada utilizando o Mini-Sleep questionnaire. Dados antropométricos e de composição corporal foram coletados utilizando estadiômetro e balança, foram considerados obesos os pacientes dentro do percentil 75. A análise estatística foi composta pelos testes t de Student, qui-quadrado, e regressão logística binária. Os resultados mostraram que o distúrbio do sono está associado as doenças osteoporose, artrite/artrose, dor lombar, depressão e obesidade. Adicionalmente obesidade e inatividade física influenciam na ocorrência de doenças crônicas não transmissíveis.

ABSTRACT Many factors are associated with sleep disorders, causing an increase in health spending. The objective of this study was to analyze the association of sleep disorders and non-communicablechronic diseases in patients over 50 years of age, attended by Basic Health Care Units of Presidente Prudente. In total, 363 patients participated. The history of diseases was self-reported through the use of a questionnaire, the level of physical activity was evaluated by the Baecke questionnaire, and sleep quality was assessed using the Mini-Sleep Questionnaire. Anthropometric and body composition data were collected using a stadiometer and scale; patients in the highest (75th) percentile were considered obese. Statistical analysis was performed using the Student t test, chi-square test, and binary logistic regression. The results showed that sleep disorders are associated with osteoporosis, arthritis/osteoarthritis, low back pain, depression, and obesity. Additionally, obesity and physical inactivity influence the occurrence of non-communicable chronic diseases.

Abstract Aims: The promotion of sports participation during the early years of life is important not only because it promotes health during childhood and adolescence, but also because it has benefits in adulthood. This study was developed to identify the association between sports participation during the early years of life and adulthood, to analyze the non-participation in sports throughout life and to identify the correlates of non-participation in sports. DESIGN: Cross-sectional study. Methods: The sample was composed of 743 adults randomly selected in a medium-size Brazilian city. Non-participation in sports during childhood and adolescence was assessed through specific questions, and non-participation in sports in adulthood was assessed using the second section of Baecke questionnaire. Answering “no” in the three periods assessed (childhood, adolescence and adulthood) was characterized as non-participation in sports throughout life. Chronological age, sex, formal education, BMI, current job and ethnicity were considered covariates. Categorical data were expressed as rates and compared using chi-square test and binary logistic regression. Results: The prevalence of adults not engaged in sports throughout life was 58.5% (95% CI= 55.1 - 62.1). Females (OR = 2.41 [1.71 - 3.38]), those more advanced in age (OR = 3.29 [1.82-5.94]) and/or possessing a lower level of education (OR = 4.47 [2.45 - 8.17]) were associated with the non-engagement in sports. Conclusion: Non-participation in sports during childhood can influence non-participation in sports during adulthood, which is significantly affected by sex, age and education level.

RESUMO Analisar a ocorrência de aposentadorias por invalidez e sua associação com inatividade física e estado nutricional, de maneira isolada e agregada, em pacientes do Sistema Único de Saúde com idade ≥ 50 anos. 542 adultos de ambos os sexos, com idade média de 61,9 anos (IC95%= 61,2; 62,7) foram avaliados em duas Unidades Básicas de Saúde, no ano de 2013. O índice de Massa Corporal (em Kg/m²) foi mensurado e a aposentadoria por invalidez, bem como a prática habitual de atividade física, e a presença de doenças foram auto-referidas. Variável cluster de inatividade física e obesidade foi criada com o objetivo de analisar, em conjunto, a atividade física e o estado nutricional. A ocorrência de aposentadorias por invalidez foi de 25,6% (IC95%= 21,9% - 29,3%). A agregação entre obesidade e inatividade física foi associada à maior ocorrência de aposentadoria por invalidez (OR= 2.26 [IC95%: 1.14; 4.47]) quando modelo foi ajustado por infarto, osteoporose, artrite/artrose, hérnia de disco e lombalgia. Conclui-se que a aposentadoria por invalidez nesta amostra foi superior a 25%, a qual foi significativamente influenciada pela agregação deobesidade e inatividade física.

ABSTRACT To analyze the occurrence of disability pension and its association with physical inactivity and nutritional condition, isolated and aggregated way, in Brazilian National Health System patients aged ≥50 years-old, in 2013. 542 adults of both sexes, with a mean age of 61.9 years (95% CI = 61.2, 62.7) were evaluated in two Basic Health Units. Body mass index (kg/m²) was calculated and disability pensions, habitual physical activity and presence of diseases were self-reported. Variable cluster of physical inactivity and obesity was created with the aim to analyze together physical activity and nutritional status. In overall sample, the occurrence of disability pension was 25.6% (95%CI= 21.9% - 29.3%), which it was associated with cluster of obesity and physical inactivity (OR= 2.26 [95%CI: 1.14; 4.47]) when model was adjusted for heart attack, osteoporosis, arthritis / arthrosis, disc herniation and low back pain. It is concluded that the occurrence of disability pension was higher than 25% and significantly related to cluster of obesity and physical inactivity.