Resumen: La actividad física en el ocio parece relevante para prevenir el desarrollo de enfermedades crónicas y la obesidad. Sin embargo, poco se sabe sobre el impacto económico de estos comportamientos saludables, especialmente en estudios longitudinales. El objetivo de este estudio fue analizar el impacto de caminar y andar en bicicleta como actividades de ocio sobre la adiposidad y los costos de salud en adultos. Este estudio longitudinal se llevó a cabo en una ciudad brasileña de tamaño mediano e incluyó a 198 participantes sin datos indisponibles atendidos en el Sistema Único de Salud brasileño. Se evaluaron los hábitos de caminar y andar en bicicleta mediante un cuestionario y una entrevista cara a cara en cuatro momentos (inicial, 6 meses, 12 meses y 18 meses). Los costos de atención médica se evaluaron utilizando registros médicos. Los marcadores de adiposidad incluyeron la circunferencia de la cintura y la grasa corporal. Durante el período de seguimiento, los participantes que practicaban más ciclismo presentaron menos grasa corporal (p = 0,028) y costos de salud (p = 0,038). Sin embargo, en el modelo multivariado, el impacto del ciclismo en los costos dejó de ser significativo (p = 0,507) debido al impacto del número de enfermedades crónicas (p = 0,001). El hábito de andar en bicicleta en los momentos de ocio está inversamente relacionado con la adiposidad en los adultos, mientras que su papel en la prevención de enfermedades crónicas parece ser el principal aspecto que lo vincula con la reducción de costos.

Abstract: Leisure-time physical activity seems relevant to prevent the development of chronic diseases and obesity. However, not much is known about the economic burden of these healthy behaviors, mainly in longitudinal designs. This study aimed to analyze the impact of walking and cycling on leisure-time on adiposity and healthcare costs among adults. This longitudinal study was conducted at a medium-size Brazilian city and included 198 participants with no missing data attended in the Brazilian Unified National Health System. Cycling and walking were assessed by a questionnaire with a face-to-face interview at four time-points (baseline, 6-month, 12-month, and 18-month). Healthcare costs were assessed using medical records. Adiposity markers included waist circumference and body fatness. Over the follow-up period, participants who were more engaged in cycling presented lower body fatness (p-value = 0.028) and healthcare costs (p-value = 0.038). However, in the multivariate model, the impact of cycling on costs was not significant (p-value = 0.507) due to the impact of number of chronic diseases (p-value = 0.001). Cycling on leisure-time is inversely related to adiposity in adults, whereas its role on preventing chronic diseases seems the main pathway linking it to cost mitigation.

Resumo: A atividade física no lazer parece relevante para prevenir o desenvolvimento de doenças crônicas e obesidade. No entanto, pouco se sabe sobre o impacto econômico destes comportamentos saudáveis, principalmente em estudos longitudinais. O objetivo deste estudo foi analisar o impacto da caminhada e do ciclismo como atividades de lazer na adiposidade e nos custos de saúde em adultos. Este estudo longitudinal foi realizado em uma cidade brasileira de médio porte e incluiu 198 participantes sem dados indisponíveis atendidos no Sistema Único de Saúde brasileiro. A caminhada e o ciclismo foram avaliados por meio de questionário e entrevista presencial em quatro momentos (linha de base, 6 meses, 12 meses e 18 meses). Os custos de saúde foram avaliados por meio de prontuários médicos. Os marcadores de adiposidade incluíram circunferência da cintura e gordura corporal. Durante o período de acompanhamento, os participantes que praticavam mais ciclismo apresentaram menos gordura corporal (p = 0,028) e custos de saúde (p = 0,038). Porém, no modelo multivariado, o impacto do ciclismo nos custos deixou de ser significativo (p = 0,507) devido ao impacto do número de doenças crônicas (p = 0,001). O ciclismo no momento de lazer está inversamente relacionado à adiposidade em adultos, enquanto o seu papel na prevenção de doenças crônicas parece ser o principal aspecto que o liga à redução de custos.

ABSTRACT BACKGROUND: Research on the economic burden of sedentary behavior and abdominal obesity on health expenses associated with cardiovascular diseases is scarce. OBJECTIVE: The objective of this study was to verify whether sedentary behavior, isolated and combined with abdominal obesity, influences the medication expenditure among adults with cardiovascular diseases. DESIGN AND SETTING: This cross-sectional study was conducted in the city of President Prudente, State of São Paulo, Brazil in 2018. METHODS: The study included adults with cardiovascular diseases, aged 30-65 years, who were treated by the Brazilian National Health Services. Sedentary behavior was assessed using a questionnaire. Abdominal obesity was defined by waist circumference. Medication expenditures were verified using the medical records of each patient. RESULTS: The study included a total of 307 adults. Individuals classified in the group with risk factor obesity combined (median [IQ] USD$ 29.39 [45.77]) or isolated (median [IQ] USD$ 27.17 [59.76]) to sedentary behavior had higher medication expenditures than those belonging to the non-obese with low sedentary behavior group (median [IQ] USD$ 13.51 [31.42]) (P = 0.01). The group with combined obesity and sedentary behavior was 2.4 (95%CI = 1.00; 5.79) times more likely to be hypertensive. CONCLUSION: Abdominal obesity was a determining factor for medication expenses, regardless of sedentary behavior, among adults with cardiovascular diseases.

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 Este estudo teve como objetivo identificar as doenças crônicas mais prevalentes entre os aposentados da cidade de Rio Claro-SP e possíveis associações de trabalho realizado durante a vida (manual ou intelectual) com inatividade física, índice de massa corporal, doenças e gastos com serviços de saúde. Trata de um estudo transversal realizado em dois momentos (2014 e 2018). Instrumentos utilizados para coleta de dados: Inquérito de Morbidades Referidas; Questionário desenvolvido por Pimenta (2006); Internacional Physical Activity Questionnaire; Índice de massa corporal. Os testes estatísticos aplicados foram o teste Qui-quadrado, de Kruskal-Wallis e Mann Whitney com o ajuste de Bonferroni. A amostra do presente estudo foi composta por 171 aposentados, com maior prevalência de casados (81,3%), com ensino médio incompleto (53,8%), classe econômica "C" (49,1%), trabalho manual realizado ao longo da vida ( 54,4%), obesos (49,1%) e sedentários (33,9%). A análise de associação demonstrou que a maioria da amostra que realizou trabalho manual ao longo da vida associando a hipertensão (valor de p = 0,01) e osteoartrite (valor de p = 0,01). Conclui-se que o trabalho manual parece apresentar maior risco para o desenvolvimento de doenças crônicas.

ABSTRACT This study aimed to identify the most prevalent chronic diseases among retired residents in the city of Rio Claro-SP and possible associations of work performed during their lives (manual or intellectual) with physical inactivity, body mass index, diseases, and expenses with health services. This is a cross-sectional population study with retired individuals, performed at two moments (2014 and 2018). Instruments used for data collection: Survey of Referred Morbidities; Questionnaire developed by Pimenta (2006); International Physical Activity Questionnaire; Body mass index The statistical tests applied were the Chi-square test, by Kruskal-Wallis and Mann Whitney with the Bonferroni adjustment. The sample of the present study was composed of 171 retirees, with the highest prevalence of married individuals (81.3%), with secondary education incomplete (53.8%), economic class "C" (49.1%), manual work performed throughout life (54.4%), obese (49.1%), and sedentary (33.9%). The association analysis demonstrated that the majority of the sample who performed manual work throughout life was associated with hypertension (p= 0.01) and Osteoarthritis (p 0.01). It is concluded that manual labor seems to present a greater risk for the development of chronic diseases.

ABSTRACT BACKGROUND: Physical activity (PA) practices seem to differ between weekdays and weekends and these pattern changes can affect body fat differently. However, previous studies did not assess the mediation effect of weekday and weekend PA on maintenance of body fat using sophisticated statistical models. OBJECTIVE: To analyze the mediation effect of PA during weekdays and weekends on maintenance of fat mass over a 12-month follow-up. DESIGN AND SETTING: Longitudinal cohort study (12 months) conducted at a public university in Presidente Prudente, Brazil. METHODS: A sample of 225 adults (117 females) was used. Body fatness and fat mass were assessed using dual-energy X-ray absorptiometry. PA levels were assessed using a pedometer. The statistical analysis consisted of paired-sample t tests, independent-sample t tests, Pearson correlations and mediation models. RESULTS: After 12 months, weekend PA had decreased while body composition indicators remained stable (without changes). The correlation between fat mass at baseline and follow-up was high for both sexes (men: 0.966; women: 0.941; P-value = 0.001 for both). Moreover, PA indices were inversely but moderately related to fat mass at baseline and follow-up. Lastly, weekend PA mediated the association between fat mass at baseline and follow-up (P-value < 0.05) by around 2% and 4%. CONCLUSION: Weekend PA mediated the association between fat mass at baseline and fat mass after one year of follow-up among these adults. Further studies are required to investigate the association between physical activity, body fat and other variables such as dietary patterns and sleep time.

BACKGROUND: This study was based on filling a gap in our knowledge regarding the issue of what the protective effect of physical exercise on patients within the Brazilian National Health System could be, in relation to low back pain. OBJECTIVES: To determine the prevalence of chronic low back pain (CLBP) and to analyze the protective effect of physical exercise among patients over 50 years old attended at primary healthcare units (PHUs). DESIGN AND SETTING: Analytical cross-sectional study at Universidade Estadual Paulista (UNESP) that was conducted in two PHUs (Parque Cedral and Vila Real), located in different regions of the city of Presidente Prudente, Brazil. METHODS: In total, 327 patients were interviewed and evaluated at which retrospective characteristics covering the previous 12 months. The Nordic questionnaire was used to classify CLBP, and the Baecke questionnaire for physical activity level. The body mass index (kg/m2) was calculated using body mass and height values, both collected at the time of the interview. RESULTS: High prevalence of low back pain was found; 175 patients (53.5%) reported having had at least one episode of low back pain in the previous year. Of these, 71 (21.7%) answered yes to all four questions on the Nordic questionnaire and were classified as CLBP. Physical exercise remained associated with CLBP, independent of other factors (odds ratio = 0.35; 95% confidence interval = 0.15-0.80). CONCLUSION: High prevalence of low back pain was identified among PHU users. Physical exercise was associated as an independent protective factor against this pathological condition.

Resumo O objetivo deste estudo foi analisar a relação entre padrão de sono e despesas de saúde em adultos, bem como identificar se atividade física, marcadores bioquímicos e obesidade afetam esse relacionamento. A amostra foi composta por 168 adultos com idade ≥ 50 anos atendidos por duas unidades básicas de saúde em Presidente Prudente, SP, Brasil. Foram avaliadas as despesas de saúde, padrões do sono, antropometria, atividade física, variáveis metabólicas e cardiovasculares. Foram utilizados Kruskal-Wallis, Mann-Whitney e Spearman. Os distúrbios do sono foram correlacionados positivamente com os custos mais elevados com medicamentos e negativamente com os custos com testes laboratoriais, mesmo após ajuste por fatores de confusão. Além disso, os custos de saúde também foram correlacionados ao escore de atividade física, pressão arterial, obesidade e variáveis metabólicas. Distúrbios graves do sono e alta porcentagem de gordura corporal foram associados ao aumento do uso de medicamentos. O padrão de sono está correlacionado com os custos de cuidados de saúde primários, obesidade e atividade física.

Abstract The aim of this study was to analyze the relationship between sleep pattern and healthcare expenditures in adults, as well as to identify whether physical activity, biochemical markers and obesity affect this relationship. The sample was composed of 168 adults aged ≥ 50 years attended by two Basic Healthcare Units in Presidente Prudente, SP, Brazil. Health expenditure, sleep pattern, anthropometry, adiposity index, physical activity, metabolic and cardiovascular variables were assessed. Statistical analyses were performed using Kruskal-Wallis, Mann-Whitney and Spearman tests. Sleep disorders were positively correlated to higher costs with medicines and negatively correlated to costs with laboratory tests, even after adjusts by confounders. In addition, healthcare costs were also correlated to physical activity score, blood pressure, obesity and metabolic variables. Severe sleep disorders and high percentage of body fat were associated with increased use of medications. Sleep pattern is correlated to primary care healthcare costs, obesity and physical activity level.

Resumo O objetivo deste estudo foi analisar a relação entre padrão de sono e despesas de saúde em adultos, bem como identificar se atividade física, marcadores bioquímicos e obesidade afetam esse relacionamento. A amostra foi composta por 168 adultos com idade ≥ 50 anos atendidos por duas unidades básicas de saúde em Presidente Prudente, SP, Brasil. Foram avaliadas as despesas de saúde, padrões do sono, antropometria, atividade física, variáveis metabólicas e cardiovasculares. Foram utilizados Kruskal-Wallis, Mann-Whitney e Spearman. Os distúrbios do sono foram correlacionados positivamente com os custos mais elevados com medicamentos e negativamente com os custos com testes laboratoriais, mesmo após ajuste por fatores de confusão. Além disso, os custos de saúde também foram correlacionados ao escore de atividade física, pressão arterial, obesidade e variáveis metabólicas. Distúrbios graves do sono e alta porcentagem de gordura corporal foram associados ao aumento do uso de medicamentos. O padrão de sono está correlacionado com os custos de cuidados de saúde primários, obesidade e atividade física.

Abstract The aim of this study was to analyze the relationship between sleep pattern and healthcare expenditures in adults, as well as to identify whether physical activity, biochemical markers and obesity affect this relationship. The sample was composed of 168 adults aged ≥ 50 years attended by two Basic Healthcare Units in Presidente Prudente, SP, Brazil. Health expenditure, sleep pattern, anthropometry, adiposity index, physical activity, metabolic and cardiovascular variables were assessed. Statistical analyses were performed using Kruskal-Wallis, Mann-Whitney and Spearman tests. Sleep disorders were positively correlated to higher costs with medicines and negatively correlated to costs with laboratory tests, even after adjusts by confounders. In addition, healthcare costs were also correlated to physical activity score, blood pressure, obesity and metabolic variables. Severe sleep disorders and high percentage of body fat were associated with increased use of medications. Sleep pattern is correlated to primary care healthcare costs, obesity and physical activity level.

Resumo Fundamento: O estilo de vida pouco saudável está se expandindo e isso pode ter repercussões no estado de saúde, exigindo ações contra a ocorrência de doenças e levando ao aumento de gastos. Objetivo: Examinar a interrelação entre os custos do uso de medicamentos e comportamentos de estilo de vida. Métodos: Estudo de coorte com 118 participantes com idade de 51,7 ± 7,1 anos. Foram coletados dados pessoais e antropométricos e informações sobre medicamentos de uso contínuo para calcular os custos. As variáveis de estilo de vida incluíram: atividade física (AF) habitual, avaliada por pedômetro; comportamento sedentário, pelo questionário de Baecke; qualidade do sono, através do Mini Questionário do Sono, e autorrelato de tabagismo e consumo de álcool. As análises estatísticas foram realizadas no programa BioEstat (versão 5.2), e o nível de significância estabelecido como p < 0,05. Resultados: Em 12 meses, 62 indivíduos compraram 172 medicamentos, representando um custo total de US$ 3.087,01. Gastos com medicamentos foram negativamente relacionados à AF (r = -0,194, p-valor = 0,035 e r = -0,281, p-valor = 0,002), mas relacionaram-se positivamente com a qualidade do sono (r = 0,299, p-valor=0,001 e r=0,315, p-valor = 0,001) e idade (r = 0,274, p-valor = 0,003). Quatro modelos multivariados foram executados, considerando os comportamentos de estilo de vida em diferentes momentos da coorte e custos dos medicamentos, e todos esses modelos identificam relações importantes entre comportamentos de estilo de vida e gastos com medicamentos. Conclusão: A pior qualidade do sono parece aumentar os custos relacionados ao uso de medicamentos em adultos, enquanto a obesidade e o envelhecimento desempenham um papel relevante nesse fenômeno, e o consumo de álcool parece ser uma variável com impacto econômico significativo.

Abstract Background: The unhealthy lifestyle is growing and this can have repercussions on health status demanding actions on the occurrence of diseases and leads to increased expenses. Objective: To examine the interrelationship between the costs of medicine use and lifestyle behaviors. Methods: A cohort study with 118 participants, age around 51.7 ± 7.1 years old. It was collected personal and anthropometric data and information about medicine of continuous use to calculate the costs. Lifestyle variables included habitual physical activity (PA) assessed by pedometer, sedentary behavior by Baecke questionnaire, sleep quality by mini sleep questionnaire and self-report of smoke and alcohol consumption. Statistical analyses were performed by BioEstat (version 5.2) and the significance level set at p-value < 0.05. Results: In 12 months, 62 subjects bought 172 medicines, representing an overall cost of US$ 3,087.01. Expenditures with drugs were negatively related to PA (r = -0.194, p-value = 0.035 and r = -0.281, p-value = 0.002), but positively related with sleep quality (r = 0.299, p-value=0.001 and r = 0.315, p-value = 0.001) and age (r = 0.274, p-value = 0.003). Four multivariate models were executed considering lifestyle behaviors in different moments of cohort and medicine costs, and all these models identify important relationship between lifestyle behaviors with expenditures with drugs. Conclusion: Worse sleep quality seems to increase the costs related to medicine use in adults, while obesity and ageing play a relevant role in this phenomenon and alcohol consumption seems a variable with relevant economic impact.

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.

Resumo O objetivo deste estudo foi descrever a prevalência da participação esportiva em crianças e adolescentes brasileiros por meio de uma revisão sistemática. Esta revisão segue os itens Preferred Reporting for Systematic reviews e Meta-Analysis (PRISMA) e o protocolo foi previamente cadastrado no PROSPERO (95441), as buscas foram realizadas nas seguintes bases de dados eletrônicas: PubMed, ScIELO, Bireme e EMBASE . A estratégia de busca incluiu uma combinação de palavras-chave: crianças e adolescentes, prevalência e participação esportiva. Quatro artigos incluíram 7104 adolescentes com idades entre 10 e 18 anos, residentes em quatro cidades diferentes localizadas no Sudeste (n = 1) e Sul (n = 3) do Brasil, foram realizadas coletas de dados entre 2004 e 2012. As maiorias dos estudos tiveram desenho transversal e os achados de todas as pesquisas foram publicados em revistas internacionais. A definição de “participação esportiva” não foi a mesma em todos os artigos. A prevalência geral de participação esportiva entre adolescentes foi de 58,1%, maior entre os meninos (65,9%) do que nas meninas (51,5%). A revisão sistemática identificou que a prevalência de participação esportiva entre adolescentes brasileiros é baixa e significativamente afetada por gênero.

Abstract The objective of this study was to describe the prevalence of sports participation in Brazilian children and adolescents using a systematic review approach. This review follows the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement and the protocol was previously registered on PROSPERO (95441), the searches were performed in the following electronic databases: PubMed, ScIELO, Bireme, and EMBASE. The search strategy included a combination of keywords: Children and adolescents, prevalence and sports participation. Four papers included 7104 adolescents aged from 10 to 18 years old, living in four different cities located at Southeast (n= 1) and South (n= 3) of Brazil data collections were carried out between 2004 and 2012. Most of the studies had cross-sectional design and the findings of all surveys were published in international journals. The definition of “sports participation” was not the same in all papers. The overall prevalence of sports participation among adolescents was 58.1%, higher among boys (65.9%) than in girls (51.5%). The systematic review identified that the prevalence of sports participation among Brazilian adolescents is low and significantly affected by gender.

Resumo Dada a importância da atividade física para promoção da saúde, assim como para a prevenção de doenças crônicas não transmissíveis, o Sistema Único de Saúde (SUS) mudou a estratégia de atuação nas últimas décadas, procurando adotar atividades preventivas, buscando melhorar a qualidade de vida da população brasileira e diminuir gastos com tratamento de doenças. Objetivou-se investigar as mudanças na prática de atividade física e tempo de televisão em usuários do SUS durante um período de 18 meses e o impacto do sexo e tempo nessas variáveis. Foram avaliados 198 participantes (58 homens e 140 mulheres). Nível de atividade física foi mensurado através do questionário de Baecke. Homens apresentaram maiores escores em todas as variáveis de atividade física: caminhada (p-valor 0,013), ciclismo (p-valor 0,001) e locomoção (p-valor 0,007) do que mulheres, mas não para assistir televisão (p-valor= 0,362). Após 18 meses, em toda a amostra, o escore de caminhada aumentou 25,9% (IC95%= 10,6 - 41,1), mas não ciclismo (1,5% [95%CI= -2,7 – 5,7]), locomoção (14,4% [95%CI= -0,4 – 29,3]) e televisão (1,6% [95%CI= -5,7 – 9,1]). Entre usuários do SUS, homens foram usualmente mais ativos que mulheres em comportamentos ativos, mas não ao assistir televisão. Porém, diferenças ao longo do tempo foram similares entre os sexos.

Abstract Given the importance of physical activity for health promotion and for the prevention of chronic non-communicable diseases, the Unified Health System (SUS) has changed its strategy of action in the last decades, trying to adopt preventive activities, seeking better quality of life of the Brazilian population and reduce costs with treatment of diseases. The aim of this study was to investigate changes in physical activity and sedentary behavior patterns in users of the Brazilian National Unified Health System during 18 months and the impact of sex and time on such variables. One hundred and ninety-eight participants (58 men and 140 women) were evaluated. Physical activity level was assessed using the Baecke questionnaire. Men had higher scores in all physical activity variables compared to women: walking (p-value= 0.013), cycling (p-value= 0.001) and commuting (p-value= 0.007), but not for TV watching (p-value= 0.362). After 18 months, in the overall sample, walking score increased 25.9% (95%CI= 10.6 to 41.1), but not cycling (1.5% [95%CI= -2.7 to 5.7]), commuting (14.4% [95%CI= -0.4 to 29.3]) and TV watching (1.6% [95%CI= -5.7 to 9.1]). Men were usually more active than women in active behaviors, but not in TV watching. However, differences over time were similar between sexes.

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 CONTEXTO E OBJETIVO: Neste estudo longitudinal, o objetivo foi descrever as tendências temporais de atividade física (AF) em diferentes domínios de 2010 a 2014 entre usuários do Sistema Único de Saúde, levando em conta o efeito do sexo, idade e condição econômica (CE). TIPO DE ESTUDO E LOCAL: Estudo longitudinal realizado em cinco Unidades Básicas de Saúde em Bauru (SP), Brasil. MÉTODOS: A amostra foi composta de 620 homens e mulheres que foram entrevistados em 2010, 2012 e 2014. O mesmo grupo de pesquisadores realizou as entrevistas utilizando o questionário desenvolvido por Baecke et al. Escores da AF ocupacional, exercícios/esportes, lazer/transporte e AF global foram considerados neste estudo longitudinal. Tendências temporais de AF nos quatro anos de seguimento foram avaliados de acordo com sexo, idade e CE. RESULTADOS: Verificou-se que, após quatro anos de seguimento, a redução da AF total (-13,6%; intervalo de confiança, IC 95% = -11,9 a -15,3) foi estatisticamente significativa. Além disso, o declínio no domínio ocupacional e no exercício/participação esportiva foram afetados pela idade, enquanto a redução na AF total foi afetada pelo sexo, idade e CE. CONCLUSÕES: A AF total diminuiu significativamente de 2010 para 2014 em pacientes ambulatoriais do Sistema Único de Saúde, e idade e sexo masculino foram importantes determinantes de AF em seus diferentes domínios.

ABSTRACT CONTEXT AND OBJECTIVE: In this longitudinal study, we aimed to describe time trends of physical activity (PA) in different domains from 2010 to 2014 among users of the Brazilian National Health System, taking into account the effects of sex, age and economic status (ES). DESIGN AND SETTING: Longitudinal study conducted in five primary care units in Bauru (SP), Brazil. METHODS: The sample was composed of 620 men and women who were interviewed in 2010, 2012 and 2014. The same group of researchers conducted the interviews, using the questionnaire developed by Baecke et al. Scores for occupational, exercise/sport, leisure-time/transportation and overall PA were considered in this longitudinal survey. Time trends of PA over the four years of follow-up were assessed according to sex, age and ES. RESULTS: We found that after four years of follow-up, the reduction in overall PA (-13.6%; 95% confidence interval, CI = -11.9 to -15.3) was statistically significant. Additionally, declines in the occupational domain and exercise/sports participation were affected by age, while the reduction in overall PA was affected by sex, age and ES. CONCLUSIONS: Overall PA decreased significantly from 2010 to 2014 among these outpatients of the Brazilian National Health System, and age and male sex were important determinants of PA in its different domains.

RESUMO CONTEXTO E OBJETIVO: Um dos grandes desafios dos governos em todo o mundo é o financiamento de sistemas de saúde e, por isso, é necessário compreender fatores e componentes-chave associados a despesas em saúde. O objetivo foi identificar fatores demográficos, socioeconômicos, de estilo de vida e clínicos associados aos gastos diretos com saúde na atenção primária entre adultos do Sistema Único de Saúde da cidade de Bauru. TIPO DE ESTUDO E LOCAL: Estudo transversal realizado em cinco Unidades Básicas de Saúde em Bauru (SP), Brasil. MÉTODO: Gastos com saúde nos últimos 12 meses foram avaliados através de prontuários médicos de adultos de 50 anos ou mais. Gastos anuais com saúde foram avaliados com: medicamentos, exames laboratoriais, consultas médicas e total. Índice de massa corporal, circunferência da cintura, hipertensão, idade, sexo, atividade física e tabagismo foram avaliados por meio de entrevista face a face. RESULTADOS: O gasto total com serviços de saúde para os 963 participantes deste inquérito foi de US$ 112.849.74 (46,9% consultas, 35,2% medicamentos e 17,9% exames). Gastos com medicamentos foram associados com sobrepeso (odds ratio, OR = 1,80 [intervalo de confiança, IC 95%: 1,07-3,01]), hipertensão (OR = 3,04 [IC 95%: 1,91-4,82]) e atividade física moderada (OR = 0,56 [95% IC: 0,38-0,81]). Gastos com consultas foram associados com hipertensão (OR = 1,67 [IC 95%: 1,12-2,47]) e sexo feminino (OR = 1,70 [IC 95%: 1,14-2,55]). CONCLUSÃO: Nossos resultados mostraram que sobrepeso, menor nível de atividade física e hipertensão são fatores de risco independentes associados com maiores gastos com saúde na atenção primária.

ABSTRACT CONTEXT AND OBJECTIVE: One of the big challenges facing governments worldwide is the financing of healthcare systems. Thus, it is necessary to understand the factors and key components associated with healthcare expenditure. The aim here was to identify demographic, socioeconomic, lifestyle and clinical factors associated with direct healthcare expenditure within primary care, among adults attended through the Brazilian National Health System in the city of Bauru. DESIGN AND SETTING: Cross-sectional study conducted in five primary care units in Bauru (SP), Brazil. METHODS: Healthcare expenditure over the last 12 months was assessed through medical records of adults aged 50 years or more. Annual healthcare expenditure was assessed in terms of medication, laboratory tests, medical consultations and the total. Body mass index, waist circumference, hypertension, age, sex, physical activity and smoking were assessed through face-to-face interviews. RESULTS: The total healthcare expenditure for 963 participants of this survey was US$ 112,849.74 (46.9% consultations, 35.2% medication and 17.9% laboratory tests). Expenditure on medication was associated with overweight (odds ratio, OR = 1.80; 95% confidence interval, CI: 1.07-3.01), hypertension (OR = 3.04; 95% CI: 1.91-4.82) and moderate physical activity (OR = 0.56; 95% CI: 0.38-0.81). Expenditure on consultations was associated with hypertension (OR = 1.67; 95% CI: 1.12-2.47) and female sex (OR = 1.70; 95% CI: 1.14-2.55). CONCLUSIONS: Our results showed that overweight, lower levels of physical activity and hypertension were independent risk factors associated with higher healthcare expenditure within primary care.