ABSTRACT BACKGROUND: It is well known that early start of drug use can lead users to psychosocial problems in adulthood, but its relationship with users’ direct healthcare costs has not been well established OBJECTIVES: To estimate the direct healthcare costs of drug dependency treated at a community mental health service, and to ascertain whether early start of drug use and current drug use pattern may exert influences on these costs. DESIGN AND SETTING: Retrospective cross-sectional study conducted at a community mental health service in a municipality in the state of São Paulo, Brazil. METHODS: The relationships between direct healthcare costs from the perspective of the public healthcare system, age at start of drug use and drug use pattern were investigated in a sample of 105 individuals. A gamma-distribution generalized linear model was used to identify the cost drivers of direct costs. RESULTS: The mean monthly direct healthcare costs per capita for early-start drug users in 2020 were 1,181.31 Brazilian reais (BRL) (274.72 United State dollars (USD) according to purchasing power parity (PPP)) and 1,355.78 BRL (315.29 USD PPP) for late-start users. Early start of drug use predicted greater severity of cannabis use and use of multiple drugs. The highest direct costs were due to drug dependence combined with alcohol abuse, and due to late start of drug use. CONCLUSIONS: Preventive measures should be prioritized in public policies, in terms of strengthening protective factors before an early start of drug use.

ABSTRACT BACKGROUND: Psychosocial care centers for alcohol and drug users (CAPS-ad) are reference services for treatment of drug users within the Brazilian National Health System. Knowledge of their total costs within the evidence-based decision-making process for public-resource allocation is essential. The aims here were to estimate the total costs of a CAPS-ad and the costs of packages of care (according to intensity of care); to ascertain the ratio between total CAPS-ad costs and the federal funding allocated; and to describe the methods for estimating unit costs for each CAPS-ad cost component. DESIGN AND SETTING: Retrospective study conducted in a public community mental health service. METHODS: This was a retrospective cost description study on a CAPS-ad located in a city in the state of São Paulo, using a public healthcare provider perspective and a top-down approach, conducted over a 180-day period from March 1 to August 30, 2015. RESULTS: The total mean monthly costs of the CAPS-ad were BRL 64,017.54. Healthcare staff accounted for 56.5% of total costs. The mean costs per capita and per month for intensive and non-intensive care packages were, respectively, BRL 668.34 and BRL 37.12. CONCLUSIONS: The federal budget allocation covered 62.1% of the CAPS-ad costs and the remaining 37.9% end up funded by the municipal government. The cost of the intensive package of care was 18 times greater than the non-intensive package. Developing criteria for using services and different packages of care based on patients’ needs, and optimizing human resources according to specific actions, may improve people’s mental health and avoid wasted resources.

Objetivo: Identificar níveis de autopercepção de desempenho ocupacional e qualidade de vida de indivíduos com deficiência visual e posterior análise de inter-relação entre os índices encontrados. Métodos: Estudo descritivo de corte transversal junto a pessoas com deficiência visual inscritas em programa de reabilitação visual. Foram utilizados os questionários COPM para mensuração da autopercepção de desempenho ocupacional, SF-36 para mensuração de níveis de qualidade de vida e questionário de investigação sociodemográfico e perfil dos sujeitos. Resultados: Vinte três sujeitos compuseram a amostra, sendo 74% com baixa visão, 52,2% do gênero feminino e média de idade de 46,7 anos. A autopercepção de desempenho e aspectos emocionais dos participantes com baixa visão foram melhores do que os com cegueira. Quanto maior era o tempo de deficiência visual, pior era a avaliação da dor. O domínio vitalidade apresentou relação estatisticamente significativa com os domínios estado geral de saúde, desempenho e satisfação, assim como o domínio saúde mental apresentou relação com estado geral de saúde, dor, desempenho e vitalidade. Conclusão: Quanto melhores foram os índices de saúde mental, melhores foram as avaliações dos domínios físicos, funcionais e sociais, fato que indica a importância de considerar a saúde mental em programas de reabilitação. A COPM e a SF-36 abordam a questão da funcionalidade de maneiras distintas e seus resultados não são compatíveis.

ABSTRACT Objective: Identify levels of self-perception of occupational performance and quality of life of individuals with visual impairment and subsequent analysis of the interrelationship between the indices found. Methods: Descriptive cross-sectional survey with people with visual disabilities enrolled in visual rehabilitation program. COPM was applied to measure the self-perception of occupational performance, the SF-36 for quality of life measurement and a socio-demographic questionnaire to describe personal characteristics. Results. Twentythree subjects were included in the sample: 74% with low vision, 52.2% were female and mean age of 46.7 years. The self-perception of performance and emotional aspects domains of participants with low vision were better than those with blindness. The greater the time of visual impairment, worse was the self-perception of pain. The vitality domain showed statistical significant relationship with the domains general health, performance and satisfaction as well as the mental health domain were related to general health, pain, performance and vitality. Conclusion: The best were the mental health index, the better were the evaluations of physical, functional and social areas, a fact that indicates the importance of considering mental health in visual rehabilitation programs. The COPM and the SF-36 address the issue of functionality in different ways and their results are not compatible.

Este trabalho tem como objetivo apresentar um novo modelo experimental de reconstrução em falha mandibular em coelhos. Foram utilizados 14 animais, nos quais, em uma primeira etapa, extraiu-se cirurgicamente o dente incisivo inferior esquerdo permanente. Após um período de 50 dias para o preenchimento ósseo do alvéolo dentário, foi realizada a cirurgia. Inicialmente, coletou-se 10x5x5mm de enxerto ósseo autógeno da crista ilíaca e, em seguida, foi procedida uma falha mandibular parcial de mesmo tamanho, que foi preenchida com o enxerto e fixada com microplaca de titânio. Os coelhos foram submetidos a avaliações clínicas e radiográficas, sendo sete submetidos a eutanásia aos 15 dias e os demais aos 30 dias para análise macro e microscópica. A ingestão de água e ração não foi comprometida, e os animais não apresentaram algia, dificuldade de mastigação e de apreensão. Somente um animal apresentou rejeição a um parafuso, sem ocorrer o deslocamento da placa nem do enxerto. Esse método mostrou-se eficaz como modelo experimental de reconstrução em falha mandibular de coelhos, demonstrando a evolução cicatricial óssea do enxerto por meio dos exames radiográficos, macroscópicos e microscópicos aos 15 e 30 dias.

This paper aims to present a new experimental model of mandibular defect reconstruction in rabbits. It was used 14 animals, in which, in a first stage the left permanent inferior incisive tooth was extracted surgically. After a 50 days period for the bone to fulfill the dentary alveolus, surgery was performed. At first, a 10x5x5mm autograft was removed form the iliac crest, following a partial mandibular failure in the bone with the same auto graft size which was filled with the graft and fixed using titanium microplate. The rabbits were submitted to clinical and radiographic evaluation and 7 of them were euthanasiated at 15 days and the other 7 at 30 days to macro and microscopic analysis. The water and commercial food ingestion was not compromised, and the animals did not showed any chewing or apprehension difficulties, neither pain. Only one animal presented rejection to one screw, without occurring micro plate nor auto graft dislocation. This method showed to be efficient for an experimental model of reconstruction in mandibular defects of rabbits, demonstrating a healing evolution of the graft through radiographic, macroscopic and microscopic exams in 15th and 30th days.