Roger dos Santos Rosa

Fatores de risco para doenças não-transmissíveis em área metropolitana na região sul do Brasil: prevalência e simultaneidade

Tres quartos da mortalidade no Estado do Rio Grande do Sul (Brasil) ocorrem por doencas nao-transmissiveis. Dentre elas as doencas cardiovasculares, por si so, correspondem a 35% das causas de morte. Para avaliar a prevalencia de fatores de risco para essas doencas, foi realizado inquerito domiciliar no periodo de 1986/87. Foram entrevistados 1.157 individuos entre 15-64 anos, residentes em setores censitarios de 4 areas docente-assistenciais do Municipio de Porto Alegre, RS. A prevalencia padronizada de tabagismo foi de 40%, hipertensao 14%, obesidade 18%, sedentarismo geral 47% e consumo excessivo de alcool, 7%. Trinta e nove por cento da amostra acumulavam dois ou mais desses cinco fatores de risco, somente 22% de homens e 21% de mulheres nao apresentaram esses fatores de risco. As elevadas frequencias e concomitâncias desses fatores de risco alertam para sua importância em programas que visam a prevencao das doencas nao-transmissiveis.

Diabetes mellitus : magnitude das hospitalizações na rede pública do Brasil, 1999-2001

Background: Diabetes mellitus (DM) is one of the main causes of morbi/mortality in western societies due to the burden of suffering, disabilities, loss of productivity and premature death that encompasses. Its economic impact is unknown in Brazil. Objectives: To dimension the share of DM hospitalizations on the Brazilian national health system (1999-2001), helping on evaluating direct costs. Specifically, to analyze hospitalizations (327.800) and hospitalization deaths (17.760) caused by DM as first-listed diagnosis (ICD-10 E10-E14 and procedure done) and to estimate the magnitude of DM attributable hospitalizations, including DM itself, chronic complications (CC) and general medical conditions (GMC). Methods: Data from the Hospital Information System of the National Health System (SIH/SUS) (37 millions of hospitalizations). Indicators were calculated by residence region of the patients and sex (adjusted by direct method for age with 95% confidence intervals), age intervals, average length of stay and expenditure by admission and population in US

Monitoramento da doença renal crônica terminal pelo subsistema de Autorização de Procedimentos de Alta Complexidade - Apac - Brasil, 2000 a 2006

. Multiple logistic regression was performed for death as outcome. Combinations of DM prevalence and hospitalization relative risks for CC and GMC were added to DM first-listed hospitalizations (attributable risk methodology). Sensitivity analyze was used for different prevalences and relative risks. Results: Hospitalizations and hospitalization deaths coefficients and lethality by DM as first-listed diagnosis were 6.4/10inhab., 34.9/10inhab. and 5.4% respectively. Coefficients were higher for women, although lethality was for men in every five region. Average expenditure (US

Estimated hospitalizations attributable to Diabetes Mellitus within the public healthcare system in Brazil from 2008 to 2010: study DIAPS 79

150,59) differed significantly between those with/without death but presented equal average length of stay (6.4). Population expenditure was US

Mortalidade por complicações agudas do diabetes melito no Brasil, 2006-2010

969.09/10inhab. Odds-ratio for dying were larger for men, patients ≥75 yrs, and inhabitants of northeast and southeast. Hospitalizations attributable to DM were estimated at 836.3 thousand/year (49.3/10inhab.) reaching US

Avaliação da situação de saúde por profissionais da atenção primária em saúde com base no georreferencimento dos sistemas de informação

243.9 millions/year (US

Alterações cognitivas em trabalhadores de uma empresa de processamento de dados

14.4 thousand/10inhab.). DM as fist-list diagnosis (13.1%), CC (41.5%) and GMC (45.4%) depicted 6.7%, 51.4% e 41.9% respectively of annual expenditures. Average value of attributable hospitalizations (US

Saúde urbana e indicadores intraurbanos do Programa das Nações Unidas para o Desenvolvimento (PNUD) - três relatos em Porto Alegre : resultados, limitações e potencialidades

292) was 36% higher than non-attributable. Peripheral vascular diseases posed the largest excess based on average values (24%) although cardiovascular ones represented the major quantity (27%) and expenditure group (37%). Men were less admitted (48%) than women, but incurred more expenditure (53%). People 45-64 years old consisted the largest (45%) and most expensive (48%) group while 75+ generated the highest coefficients of hospitalization (350/10inhab.) and expenditure (US

Annual Direct Medical Costs of Diabetic Foot Disease in Brazil: A Cost of Illness Study

93.4 thousands/10inhab.). Most developed regions accounted for nearly twice expenses than other regions. Conclusions and Recommendations: Patterns of hospitalization were similar to those most developed countries. Important regional and gender inequalities did exist. Governmental expenditures related exclusively to DM attributable hospitalizations was meaningful (2.2% of the budget of the Ministry oh Health). Broadening preventive health care actions could diminish the incidence of DM, reduce the need for hospitalizations, minimize complications and minors the severity of general medical conditions. KEY-WORDS: Diabetes/epidemiology, Morbidity, Hospitalization, Health resources, Health economics. LISTA DE ABREVIATURAS, SIGLAS E SIMBOLOS ABRASCO – Associacao Brasileira de Pos-Graduacao em Saude Coletiva ADA – American Diabetes Association (Associacao Americana de Diabetes EUA) AEI – Amputacao de extremidade inferior AHRQ Agency for Healthcare Research and Quality (Agencia para Pesquisa e Qualidade da Assistencia a Saude EUA) AIH – Autorizacao de Internacao Hospitalar AIH-1 – Autorizacao de Internacao Hospitalar do Tipo 1 – Normal AIH-5 – Autorizacao de Internacao Hospitalar do Tipo 5 – Longa Permanencia ANS – Agencia Nacional de Saude Suplementar AP – Area Programatica API – Anos Perdidos por Incapacidade BRASIL/ANS – Brasil / Agencia Nacional de Saude Suplementar BRASIL/MS – Brasil / Ministerio da Saude BRASIL/MS/CENEPI – Brasil /Ministerio da Saude/Centro Nacional de Epidemiologia BRASIL/IBGE – Brasil / Fundacao Instituto Brasileiro de Geografia e Estatistica BRASIL/INCA – Brasil / Instituto Nacional de Câncer BRASIl/TCU – Brasil / Tribunal de Contas da Uniao BVS Biblioteca Virtual de Saude C. Oeste – Regiao Centro-Oeste CC – Complicacoes cronicas CD-ROM – Compact Disk Read-Only Memory (Disco Compacto com Memoria Somente para Leitura) CDC – Centers for Disease Control and Prevention (Centros de Controle e Prevencao de Doencas EUA) CENEPI – Centro Nacional de Epidemiologia CID-9 Classificacao Internacional de Doencas – 9a revisao CID-10 – Classificacao Internacional de Doencas – 10a revisao CODE-2 – Cost of Diabetes in Europe – Type II study (Estudo do Custo do Diabetes Tipo II na Europa) CPDH – Centro de Processamento de Dados Hospitalares CMG – Condicoes medicas gerais CV – Coeficiente de variacao DALY – Disability Adjusted Life Years (Anos de Vida Ajustados por Incapacidade) DM – Diabetes Mellitus DATASUS Departamento de Informatica do Sistema Unico de Saude DRG – Diagnostic Related Groups (Grupo de Diagnosticos Relacionados) E10-E14 – categorias correspondentes a Diabetes Mellitus de acordo com a CID-10 EUA – Estados Unidos da America F – Feminino FGV – Fundacao Getulio Vargas FMRP – Faculdade de Medicina de Ribeirao Preto FUNASA Fundacao Nacional de Saude Hab. Habitante HMO – Health Maintenance Organization (Organizacao Mantenedora de Saude EUA) IBGE – Fundacao Instituto Brasileiro de Geografia e Estatistica IC – Intervalo de confianca ICC – Indice de comorbidade de Charlson IDDM Insulin-Dependent Diabetes Mellitus (Diabetes Mellitus insulino-dependente) IGP-DI – Indice Geral de Precos – Disponibilidade Interna IGP-M – Indice Geral de Precos do Mercado INAMPS – Instituto Nacional de Assistencia Medica da Previdencia Social INCA –Instituto Nacional de Câncer inf. – limite inferior INPC – Indice Nacional de Precos ao Consumidor LILACS – Literatura Latino-Americana em Ciencias da Saude M Masculino MMWR Morbidity and Mortalilty Weekly Report (Relatorio Semanal de Morbidade e Mortalidade – EUA) MS – Ministerio da Saude n. Numero N.S. – Nao-significativo NHIS National Health Interview Survey (Inquerito Nacional de Saude EUA) NHDS National Hospital Discharge Survey (Pesquisa Nacional de Altas Hospitalares – EUA) NIS Nationwide Inpatient Sample (Amostra Nacional de Internacoes – EUA) NCHS – National Center of Health Statistics (Centro Nacional de Estatisticas de Saude – EUA) NMERS National Medical Expenditure Survey (Pesquisa Nacional de Despesas Medicas EUA) OMS – Organizacao Mundial da Saude OR – Odds ratio (razao de chances) P – Prevalencia p. Pagina PNAD – Pesquisa Nacional por Amostra de Domicilios PPGEpi – Programa de Pos-Graduacao em Epidemiologia da UFRGS QUALIDIAB Programa Piloto de Controle da Qualidade da Atencao as Pessoas Portadoras de Diabetes Mellitus r – Coeficiente de determinacao RAi – Fracao de risco atribuivel para a condicao medica “i” RAPi – Fracao de risco atribuivel populacional para a condicao medica “i” RC – Razao de chances RPH – Razao das proporcoes de hospitalizacoes RR – Risco relativo RRi – Risco relativo da condicao medica “i” SADT Servicos Auxiliares de Diagnose e Terapia SAMHPS Sistema de Assistencia Medico-Hospitalar da Previdencia Social SIH/SUS – Sistema de Informacoes Hospitalares do Sistema Unico de Saude SIM Sistema de Informacoes de Mortalidade SPSS – Statistical Package for the Social Sciences (Pacote Estatistico para as Ciencias Sociais) SUS – Sistema Unico de Saude TCU – Tribunal de Contas da Uniao UFRGS – Universidade Federal do Rio Grande do Sul US

Disease and Economic Burden of Hospitalizations Attributable to Diabetes Mellitus and Its Complications: A Nationwide Study in Brazil

Dolar norte-americano USP – Universidade de Sao Paulo UTI – Unidade de Tratamento Intensivo WSDH – Washington State Department of Health (Departamento de Saude do Estado de Washington EUA) v. Volume VA – Veterans Administration (Rede hospitalar da Administracao dos Veteranos EUA) YLD – Years Lived with Disability (Anos Vividos com Incapacidade) YLL – Years of Life Lost (Anos de Vida Perdidos) vs. Versus