Behavioral and biological correlates of medicine use in type 2 diabetic patients attended by Brazilian public healthcare system

A relação entre atividade física e consumo de medicamentos não é clara. Assim, o objetivo do estudo foi investigar a relação entre nível de atividade física e uso de medicamentosem diabéticos tipo 2 atendidos pelo Sistema Único de Saúde. A amostra foi composta por 121 diabéticos do tipo 2 de ambos os sexos atendidos pelos sistema público de saúde. Gordura corporal (antropometria e bioimpedância elétrica), atividade física (Questionário de Baecke) e uso de medicamentos (15 dias prévios a avaliação) foram avaliados. Houve relação entre uso de medicamentos e sexo (r = 0.18; p = 0.045), índice de massa corporal (r = 0.22; p = 0.012), circunferência de cintura (r = 0.19; p = 0.029), percentual de gordura (r = 0.21; p = 0.016), idade (r = 0.23; p = 0.009) e atividade física (r = -0.22; p = 0.012). A regressão linear incluiu no modelo apenas idade (β = 0.718; p = 0.057), IMC BMI (β = 0.057; p = 0.022) e atividade física (β = -0.176; p = 0.044) no modelo multivariado. Conclui-se que a prática de atividade física diminui uso de medicamentos independente da idade e obesidade.

Pervasive transition of the Brazilian land-use system

Agriculture, deforestation, greenhouse gas emissions and local/regional climate change have been closely intertwined in Brazil. Recent studies show that this relationship has been changing since the mid 2000s, with the burgeoning intensification and commoditization of Brazilian agriculture. On one hand, this accrues considerable environmental dividends including a pronounced reduction in deforestation (which is becoming decoupled from agricultural production), resulting in a decrease of similar to 40% in nationwide greenhouse gas emissions since 2005, and a potential cooling of the climate at the local scale. On the other hand, these changes in the land-use system further reinforce the long-established inequality in land ownership, contributing to rural-urban migration that ultimately fuels haphazard expansion of urban areas. We argue that strong enforcement of sector-oriented policies and solving long-standing land tenure problems, rather than simply waiting for market self-regulation, are key steps to buffer the detrimental effects of agricultural intensification at the forefront of a sustainable pathway for land use in Brazil.

Energetic and economic analysis of a Brazilian compact cogeneration system: Comparison between natural gas and biogas

Cogeneration may be defined as the simultaneous production of electric power and useful heat from the burning of a single fuel. This technique of combined heat and power production has been applied in both the industrial and tertiary sectors. It has been mainly used because of its overall efficiency, and the guarantee of electricity with a low level of environmental impact. The compact cogeneration systems using internal combustion engine as prime movers are thoroughly applied because of the good relationship among cost and benefit obtained in such devices. The cogeneration system of this study consists of an internal combustion engine using natural gas or biogas as fuel, combined with two heat exchangers and an absorption chiller utilising water-ammonia as working mixture. This work presents an energetic and economic comparison between natural gas and biogas as fuel used for the system proposed. The results are useful to identify the feasible applications for this system, such as residential sector in isolated areas, hotels, universities etc. (C) 2014 Elsevier Ltd. All rights reserved.

Accumulation of domain-specific physical inactivity and presence of hypertension in brazilian public healthcare system

Hypertension is one of the most common noncommunicable diseases worldwide, and physical inactivity is a risk factor predisposing to its occurrence and complications. However, it is still unclear the association between physical inactivity domains and hypertension, especially in public healthcare systems. Thus, this study aimed to investigate the association between physical inactivity aggregation in different domains and prevalence of hypertension among users of Brazilian public health system. 963 participants composed the sample. Subjects were divided into quartiles groups according to three different domains of physical activity (occupational; physical exercises; and leisure-time and transportation). Hypertension was based on physician diagnosis. Physical inactivity in occupational domain was significantly associated with higher prevalence of hypertension (OR = 1.52 [1.05 to 2.21]). The same pattern occurred for physical inactivity in leisure-time (OR = 1.63 [1.11 to 2.39]) and aggregation of physical inactivity in three domains (OR = 2.46 [1.14 to 5.32]). However, the multivariate-adjusted model showed significant association between hypertension and physical inactivity in three domains (OR = 2.57 [1.14-5.79]). The results suggest an unequal prevalence of hypertension according to physical inactivity across different domains and increasing the promotion of physical activity in the healthcare system is needed.

Work conditions and occupational health of dentists in Brazilian public health system

Conselho Nacional de Desenvolvimento Ciêntífico e Tecnológico (CNPq)

The viewpoint of health professionals on the role of basic units in the healthcare network of the Brazilian Unified Health System

In the process of creation of the Unified Health System (SUS) as a universal policy seeking to ensure comprehensive care, unscheduled assistance in primary healthcare units (UBS) is an unresolved challenge. The scope of this paper is to analyze the viewpoint of health professionals on the role of primary healthcare units in meeting this demand. It is a transversal study of qualitative data obtained through questionnaires and interviews with 106 medical practitioners from 6 emergency medical services and 190 professionals from 30 units. They explained why people seek emergency care for occurrences pertaining to primary care. The content analysis technique with thematic categories was used for data analysis. Lack of resources and problems with primary health unit work processes (50.8%) were the reasons most frequently cited by emergency care physicians to explain this inadequate demand. Only 33.3% of the health unit professionals agreed that these occurrences should be attended in the primary healthcare services. The limited viewpoint of the role of health services on the unscheduled care, particularly among primary care professionals, possibly leads to restrictive practices for access by the population.

Cost-effectiveness and budget impact of saxagliptine as additional therapy to metformin for the treatment of diabetes mellitus type 2 in the Brazilian private health system

Cost-effectiveness and budget impact of saxagliptine as additional therapy to metformin for the treatment of diabetes mellitus type 2 in the Brazilian private health system Objectives: To compare costs and clinical benefits of three additional therapies to metformin (MF) for patients with diabetes mellitus type 2 (DM2). Methods: A discrete event simulation model seas built to estimate the cost-utility ratio (cost per quality-adjusted life years [QALY)) of saxagliptine as an additional therapy to MF when compared to rosiglitazone or pioglitazone. A budget impact model (BIM) was built to simulate the economic impact of saxagliptine use in the context of the Brazilian private health system. Results: The acquiring medication costs for the hypothetical patient group analyzed in a time frame of three years, were R$ 10,850,185, R$ 14,836,265 and R$ 14,679,099 for saxagliptine, pioglitazone and rosiglitazone, respectively. Saxagliptine showed lower costs and greater effectiveness in both comparisons, with projected savings for the first three years of R$ 3,874 and R$ 3,996, respectively. The BIM estimated cumulative savings of R$ 417,958 with the repayment of saxagliptine in three years from the perspective of a health plan with 1,000,000 covered individuals. Conclusion: From the perspective of private paying source, the projection is that adding saxagliptine with MF save costs when compared with the addition of rosiglitazone or pioglitazone in patients with DM2 that have not reached the HbA1c goal with metformin monotherapy. The BIM of including saxagliptine in the reimbursement lists of health plans indicated significant savings on the three-year horizon.

Cardiometabolic risk reduction through lifestyle intervention programs in the Brazilian public health system

Public health strategies to reduce cardiovascular morbidity and mortality should focus on global cardiometabolic risk reduction. The efficacy of lifestyle changes to prevent type 2 diabetes have been demonstrated, but low-cost interventions to reduce cardiometabolic risk in Latin-America have been rarely reported. Our group developed 2 programs to promote health of high-risk individuals attending a primary care center in Brazil. This study compared the effects of two 9-month lifestyle interventions, one based on medical consultations (traditional) and another with 13 multi-professional group sessions in addition to the medical consultations (intensive) on cardiometabolic parameters. Adults were eligible if they had pre-diabetes (according to the American Diabetes Association) and/or metabolic syndrome (International Diabetes Federation criteria for Latin-America). Data were expressed as means and standard deviations or percentages and compared between groups or testing visits. A p-value < 0.05 was considered significant. Results: 180 individuals agreed to participate (35.0% men, mean age 54.7 ± 12.3 years, 86.1% overweight or obese). 83 were allocated to the traditional and 97 to the intensive program. Both interventions reduced body mass index, waist circumference and tumor necrosis factor-α. Only intensive program reduced 2-hour plasma glucose and blood pressure and increased adiponectin values, but HDL-cholesterol increased only in the traditional. Also, responses to programs were better in intensive compared to traditional program in terms of blood pressure and adiponectin improvements. No new case of diabetes in intensive but 3 cases and one myocardial infarction in traditional program were detected. Both programs induced metabolic improvement in the short-term, but if better results in the intensive are due to higher awareness about risk and self-motivation deserves further investigation. In conclusion, these low-cost interventions are able to minimize cardiometabolic risk factors involved in the progression to type 2 diabetes and/or cardiovascular disease.

The Illinois property tax system /

Mode of access: Internet.

The Illinois property tax system.

Mode of access: Internet.

Expanding unemployment is no benefit : an economic analysis of proposed changes in the federal unemployment tax system /

"This study was prepared by the Republican staff of the Joint Economic Committee: Dolores Tremewan Martin ... [et al.] " - note, p. 15.

Using the tax system to collect fines

In this article we consider the possibility that fines could be collected through the tax and social welfare systems in the same way as higher education contributions and child support payments are currently administered. We argue that the existing system of fine collection and enforcement leads to high default rates and reduces the usefulness of fines as a sanction. We consider a range of models for the implementation of an income-related fine collection system, and discuss their possible implications for issues including judicial independence, the time taken to repay fines and aggregate fine revenue.

Adómorál és adócsalás - társadalmi preferenciák és korlátozott racionalitás = Tax morale and tax system: social preferences and bounded rationality

Az adócsalásnak egy olyan modellcsaládját vizsgáljuk, ahol az egykulcsos adó kizárólag a közjavakat finanszírozza. Két megközelítés összehasonlítására összpontosítunk. Az elsőben minden dolgozó jövedelme azonos, és ebből minden évben annyit vall be, amennyi maximalizálja a nála maradó jövedelemből fedezhető fogyasztás nyújtotta hasznosság és a jövedelembevallásból fakadó hasznosság összegét. A második hasznosság három tényező szorzata: a dolgozó exogén adómorálja, a környezetében előző évben megfigyelt átlagos jövedelembevallás és saját bevallásából fakadó endogén hasznossága. A második megközelítésben az ágensek egyszerű heurisztikus szabályok szerint cselekszenek. Míg az optimalizáló modellben hagyományos Laffer-görbékkel találkozunk, addig a heurisztikán alapuló modellekben (lineárisan) növekvő Laffer-görbék jönnek létre. E különbség oka, hogy a heurisztikán alapuló modellben egy sajátos viselkedésfajta jelentkezik: számos ágens ingatag helyzetbe kerül, amelyben altruizmus és önzés között ingadozik. ________ The authors study a family of models of tax evasion, where a flat-rate tax only finances the provision of public goods and audits and wage differences are ne-glected. The paper focuses on comparing two modelling approaches. The first is based on optimizing agents, endowed with social preferences, their utility being the sum of private consumption and moral utility. The second approach involves agents acting according to simple heuristics. While the traditionally shaped Laffer curves are encountered in the optimizing model, the heuristics models exhibit (linearly) increasing Laffer curves. This difference is related to a peculiar type of behaviour: within the agent-based approach lurk a number of agents in a moral state of limbo, alternating between altruism and selfishness.