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The prevalence of overweight increases the risk of several non-communicable diseases (NCDs) and, consequently, the costs of health care systems. In this study, we aimed to project the economic burden of NCDs attributable to overweight in Brazil between 2021 and 2030. A cohort simulation of adults (17–117 years) using multistate lifetable modeling was used to estimate the costs of NCDs attributable to overweight in Brazil. The projections of direct health care costs (outpatient and inpatient expenses in the Unified Health System) and indirect costs (years of productive life lost) considered different trajectories of the prevalence of overweight between 2021 and 2030. In 2019, the prevalence of overweight was 55.4% in the adult Brazilian population. We estimate that around 1.8 billion international dollars (Int$) would be spent on the direct health care cost of NCDs between 2021 and 2030, through the continued increase in overweight prevalence observed between 2006 and 2020. The indirect costs over the same time would be approximately 20.1 billion Int$. We estimate that halving the annual increase in body mass index slope from the beginning of 2021 until 2030 would save 20.2 million Int$ direct and indirect costs by 2030. In the scenario of keeping the prevalence of overweight observed in 2019 constant until 2030, the savings would be 40.8 million Int$. Finally, in the scenario of a 6.7% reduction in the prevalence of overweight observed in 2019 (to be achieved gradually until 2030), 74.1 million Int$ would be saved. These results highlight the high economic burden of overweight in the Brazilian adult population. [ABSTRACT FROM AUTHOR]

This article discusses Conservation Units in the conservationist perspective, as instruments to protect nature, assuring the maintenance of Brazilian biodiversity and biomes, in order to build an ecologically balanced environment under the terms of the Federal Constitution of 1988. Through deductive method, exploratory, documental, and bibliographic research, and indirect analysis of Environmental Ministry and Environmental, Sustainable Development State Office data, it makes a legal-theoretical appreciation of the issue in Brazil. By looking at the Brazilian scenario, it notices that most part of the Conservation Units were created by the States and were focused, respectively, on Mata Atlântica, Cerrado, and the Amazon, and had sustainability as a legal-political fundament. The conjuncture of Goiás indicates that stating the Conservation Units existence is not enough, since more than half of Conservation Units lack landing regularization. Also, six out of twenty-five Conservation Units still do not have an Administrative Counsel. Twenty Conservation Units do not have a working plan, which, added to financial and staff difficulties may compromise the expected protection of nature. [ABSTRACT FROM AUTHOR]

Introduction: Financial toxicity can increase healthcare costs, in addition to negatively impacting the therapeutic adherence and healthrelated quality of life of cancer patients within the public healthcare system. Objective: To correlate financial toxicity with the adults living with cancer health-related quality of life during the COVID-19 pandemic. Materials and Methods: This is an observational, cross-sectional, correlational study conducted with 179 patients receiving care from the Unified Health System in a capital city in southern Brazil. Data collection was performed from September 2021 to December 2022, using questionnaires containing sociodemographic and clinical data, and the Comprehensive Score for Financial Toxicity and the Functional Assessment of Cancer Therapy-General. The correlation between financial toxicity and health-related quality of life was assessed using Spearman's correlation coefficient at a 5 % significance level. Results: The correlation between financial toxicity and health-related quality of life was 0.41 (p-value < 0.001). The financial toxicity and health-related quality of life scores were 20.1/44 and 73.3/108, respectively. Conclusion: This study has found that the lower the financial toxicity, the better the patients' health-related quality of life. In this sense, recognizing the presence of financial toxicity in the treatment course could help improve adherence to treatment and health-related quality of life. [ABSTRACT FROM AUTHOR]

Copyright of Enfermería Nefrológica is the property of Sociedad Espanola de Enfermeria Nefrologica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Our aim was to assess the impact of COVID-19 on depressive symptoms among mothers from a population-based birth cohort in Pelotas, Southern Brazil. Methods: A subgroup of mothers from the Pelotas 2004 Birth Cohort was assessed pre-pandemic (November,2019 to March,2020) and mid-pandemic (August-December,2021). In both follow-ups, depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Pre-pandemic (T1) and pandemic-related predictors (T2) were analyzed. Prevalence of depression (EPDS score ≥ 13) at T1 and T2 were compared with chi-square test. Changes in EPDS from T1 to T2 were estimated by multivariate latent change score modelling. Results: 1,550 women were assessed. Prevalence of depression increased 38.1% (from 18.9% at T1 to 26.1% at T2) (p < 0.001). At T1, higher schooling, higher family income and being employed or working were related to lower EPDS, whereas being beneficiary of a cash transfer program and a larger number of people living in the household predicted higher EPDS. The deterioration of ones' own perception of quality of overall health (β = 0.191; SE = 0.028; p < 0.001) and worst family financial situation due to the pandemic (β = 0.083; SE = 0.024; p = 0.001) predicted the increase in EPDS from T1 to T2. Conclusion: Almost two years after the beginning of the pandemic, the prevalence of depressive symptoms among the women was higher than before the pandemic. The deterioration of ones' own perception of quality of overall health and worst family financial situation due to the pandemic are proxies for the effect of COVID-19 pandemic (the true exposure of interest) in the women mental health. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the implications of the proportion of annual family income spent in the pre- and post-diagnosis periods in tuberculosis patients followed for after at least one year after completing tuberculosis treatment in Brazil. Methods: This was a crosssectional study of tuberculosis patients followed for at least one year after completing tuberculosis treatment in five Brazilian capitals (one in each region of the country). Results: A total of 62 patients were included in the analysis. The overall average cost of tuberculosis was 283.84 Brazilian reals (R$) in the pre-diagnosis period and R$4,161.86 in the post-diagnosis period. After the costs of tuberculosis disease, 71% of the patients became unemployed, with an overall increase in unemployment; in addition, the number of patients living in nonpoverty decreased by 5%, the number of patients living in poverty increased by 6%, and the number of patients living in extreme poverty increased by 5%. The largest proportion of annual household income to cover the total costs of tuberculosis was for the extremely poor (i.e., 40.37% vs. 11.43% for the less poor). Conclusions: Policies to mitigate catastrophic costs should include interventions planned by the health care system and social protection measures for tuberculosis patients with lower incomes in order to eliminate the global tuberculosis epidemic by 2035--a WHO goal in line with the United Nations Sustainable Development Goals. [ABSTRACT FROM AUTHOR]

This text deals with student assistance in its relationship with the issue of democratizing access and permanence in higher and professional education for students from lower classes in federal educational institutions in Brazil and, in particular, at the Federal Institute of Education, Science and Technology of the Piauí (IFPI). Thus, the objective is to examine the conditions of inclusion of poor students in a space historically marked by their exclusion. For this, research was used in documentary and bibliographic sources referring to higher, professional and student care education; among them, the following stand out: data from the National Household Sample Survey (PNAD) - Synthesis of Social Indicators, Budget Guidelines Laws and data from the socioeconomic questionnaire filled out by students at the time of entry into the IFPI courses. It appears that the democratization of higher and professional education provided by programs such as REUNI and the Quota Law resulted in an increase in students from poorer social segments. However, with the limitation of resources for the PNAES transferred to federal educational institutions, there was an increase in the degree of selectivity and focus of student assistance benefits for increasingly poor publics in the IFPI - Teresina Central Campus. Thus, the student assistance policy, while alleviating the financial difficulties of poor students served, does not effectively ensure the democratization of the conditions of access and permanence to the total number of students who need it, serving as an instrument for maintaining the conditions of social inequalities between they. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Arqueologia is the property of Revista de Arqueologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Evidenciação Contábil & Finanças is the property of Revista Evidenciacao Contabil & Financas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We sought to determine differences by low- and middle- income countries (Brazil, Romania, and Turkiye) on the degree to which health care providers (HCPs) note unmet needs among patients with cancer (N = 741). HCPs endorsed sexuality/intimacy and financial concerns as the most common. Investigating age differences in unmet needs between Brazil and Turkiye, were that should be targeted by. Results revealed that unmet needs to manage emotional distress were higher among older patients in Turkiye, whereas unmet needs to manage insomnia/fatigue were higher among pediatric patients in Brazil. Findings may guide the development of programs to address unmet needs among patients. [ABSTRACT FROM AUTHOR]

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Background: The COVID‐19 pandemic has adversely impacted child development and the well‐being of caregivers, and such evidence ought to be used to inform public policy decisions. This study investigated the impact of COVID‐19 on children's behaviours and their caregivers' needs. Methods: A cross‐sectional study was conducted with 153 caregivers of children (from 0 to 5 years old) from three public daycare centres in Brazil. The Nurturing Care Framework of the World Health Organization was used to guide the assessment of caregivers' needs. Online data collection using a questionnaire was conducted from June to July 2020. Results: The COVID‐19 pandemic increased stressors such as low family income, unemployment, sadness, depression and anxiety of caregivers. Their most commonly reported needs were related to offering age‐appropriate playful activities (49.7%), organizing the care routine of children at home (41.8%) and educating children when they do something wrong (39.9%). Additionally, the results showed that misbehaviour, aggressiveness and agitation occurred more frequently among preschoolers than infants or toddlers (p ≤ 0.05). Conclusion: During the COVID‐19 pandemic, public policies should provide mental health support to caregivers, as well as information about security, safety and early learning opportunities for childcare at home. [ABSTRACT FROM AUTHOR]

We estimate a bi‐variate LVSTAR model to investigate the non‐linear interplay between Brazil's credit, output and financial cycles between 1999 and 2017. We use financial stress as the regime‐switching variable to assess how it impacts economic performance. We find evidence of a lengthy transition between regimes. Moreover, Granger Causality tests indicate statistical precedence of credit growth through financial intermediaries. After credit shocks, we find non‐mean‐reverting trajectories and that financial stress worsens the economic downturn. Counterintuitively, total credit growth increases after adverse output shocks. This appears to be caused by elevated public credit provision relative to private credit flows, triggered by anticyclical policy. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To report alcohol consumption during the first month of social home-isolation and physical distancing measures during the COVID-19 pandemic in an public University in Mid-West Brazil. METHODS: We designed an online observational study. Initial data of 2166 participants was obtained between April and May, 2020, less than a month after University's measures of social distancing with remote work and classes. We used Poisson regression model with robust variance to identify the significant factors associated with self-reported increase in alcohol consumption during social and physical distancing measures. RESULTS: Increased alcohol consumption during social and physical distancing was reported by 22.9% of 1371 alcohol drinkers. Factors associated with reporting increased alcoholic consumption during University's physical and social distancing measures were: not professing any religion (1.52, 95% CI 1.25-1.83), having signs/symptom suggesting SARS-COV-2 infection (1.56, 95% CI 1.26-1.93), missing social interaction with peers carried out without any mediating technology (1.57, 95% CI 1.13-2.20), experiencing financial distress/hardship (1.25, 95% CI 1.02-1.54), perceiving duration of social isolation as long (1.62, 95% CI 1.10-2.41), reporting worsening of emotional/mental wellbe-ing (1.76, 95% CI 1.34-2.33), and previous psychological disorders (1.25, 95% CI 1.03-1.52). CONCLUSIONS: This study highlights several individual, psychological, and social determinants of increase in consumption of alcoholic beverages during physical and social distancing measures due to the pandemic and the results may reflect the presence of emotional changes due to the COVID-19 pandemic. It urges that sanitary authorities adopt measures to avoid excessive alcohol consumption during social distancing measures. [ABSTRACT FROM AUTHOR]

Objective: to evaluate the adherence of Brazilian long-term care facilities to the World Health Organization Infection Prevention and Control guidance, and assess the association of their size with the adherence to these recommendations. Method: cross-sectional study conducted with facilities' managers. Authors developed a 20-item questionnaire based on this guidance, and a global score of adherence, based on the adoption of these recommendations. Adherence was classified as (1) excellent for those who attended ≥14 out of 20 recommendations; (2) good for 10 to 13 items; and (3) low for those with less than ten items. Facilities' sizes were established as small, intermediate, and large according to a two-step cluster analysis. Descriptive statistics and chi-square tests were used at a 5% significance level. Results: among 362 included facilities, 308 (85.1%) adhered to 14 or more recommendations. Regarding its size, adherence to screening COVID-19 symptoms of visitors (p=0.037) and isolating patients until they have had two negative laboratory tests (p=0.032) were lower on larger ones compared to medium and small facilities. Conclusion: adherence to COVID-19 mitigation measures in Brazilian facilities was considered excellent for most of the recommendations, regardless of the size of the units. [ABSTRACT FROM AUTHOR]

Copyright of Roteiro is the property of Roteiro and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Psicologia. Organizacoes e Trabalho is the property of Sociedade Brasileira de Psicologia Organizacional e do Trabalho and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective -- This paper aimed to understand the elements in cooperative arrangements of agribusiness that facilitate and hinder cooperation. Design/methodology/approach - A descriptive research was carried out based on the 50 questionnaires applied to farmers´ members of cooperatives in Rio Grande do Sul, Brazil. Results - Results indicated that farmers are increasingly expanding their role in making productive activities possible through cooperation promoted by cooperatives. Better access to information, sales opportunities, technical assistance, and, mostly, a favorable environment for the exchange of knowledge are the main responsible facts. As for cooperation, the relationship of trust established between cooperative members and cooperatives stands out, as well as the fidelity of membership that sustains the system, which can be weakened by opportunistic actions that may affect the continuity and fulfillment of the cooperatives' objectives over time. Cooperative relationship face to competition is a good alternative for promoting the achievement of objectives by farmers that would be challenging or impossible in isolation. Originality - The cooperation promoted by cooperative organizations, broadens the understanding that by joining forces they can enter restricted markets. This occurs especially when it comes to the studied farmers -- different sizes and patterns of production and activities that are constantly under economic and financial pressure. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Originating in metropoles in the Global North, the creative cities model has increasingly been replicated in locations around the globe. However, betting on the creative industries to reinvigorate stagnant economies might not be a solution compatible with every context. To analyse this issue, this article presents the case of the small Brazilian city of Cabaceiras, which was the target of a project aimed at revitalizing its economy through film and tourism in 2007. Based on 25 interviews with residents and policy makers, we examine whether the initiative was, in their view, successful in stimulating a creative hub. We argue that the creative cities model has not yet proven feasible in Cabaceiras due to financial and infrastructural challenges that the city experiences, its positioning outside of Brazil's cultural and creative centres and the uncertainties of investing in the audiovisual sector in the country. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Direito Internacional Econômico e Tributário (RDIET) is the property of Revista de Direito Internacional Economico e Tributario (RDIET) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Brasileira de Pesquisa em Turismo is the property of Associacao Nacional de Pesquisa e Pos-Graduacao em Turismo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: This study aimed to estimate the economic costs of excessive sodium consumption in terms of hospitalizations and outpatient procedures of medium and high complexity (OPMHC) for the Brazilian Unified Health System (SUS) and its states in 2019., Study Design: Ecological study., Method: This study used population attributable fractions (PAFs) of excessive sodium consumption estimated by the Global Burden of Disease study based on the theoretical minimum risk exposure level (3 g of sodium per day), the average population consumption, and relative risks of sodium-outcome pairs. PAFs were applied to the total costs of hospitalizations and OPMHC paid by SUS for each outcome obtained from the Outpatient and Hospital Information Systems. The costs per 10,000 inhabitants in all the Brazilian states were calculated and converted into international dollars (Int$), considering the purchasing parity power in the year 2019., Results: Excessive sodium consumption resulted in Int$ 98,882,386.36 (95% uncertainty interval: Int$ 3,398,343.53-312,065,319.80) in hospitalizations and OPMHC costs in Brazil in 2019. Males and the 55- to 69-year-old age group had the highest expenditures attributable to excessive sodium consumption. Cardiovascular diseases were the most significant contributors to the costs associated with the risk factor. Southern and southeastern states had the highest costs of diseases attributable to sodium., Conclusion: Excessive sodium consumption has a significant economic burden on SUS, particularly among men and more developed states. This underscores the inequalities in socio-economic factors and access to health services throughout the country. Economic analyses at the subnational level can provide evidence for public policy planning to define the most appropriate actions for the population's sociodemographic reality., (Copyright © 2024 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Sugar-sweetened beverages (SSBs) are a major source of added sugar and are associated with noncommunicable diseases (NCDs) such as obesity and diabetes. This study assessed the impact of SSBs consumption on disease burden in Brazil, including deaths, disability-adjusted life years (DALYs), and healthcare costs. A 3-stage methodology was used to assess the direct effects of SSBs on diabetes, cardiovascular diseases, and body mass index (BMI), along with the influence of BMI on disease incidence. These assessments were then used to estimate the economic and health burden using population-attributable factors. Results showed that 2.7% and 11% of adult and children overweight/obesity cases were attributable to SSBs, respectively. SSBs consumption in Brazil led to 1,814,486 cases, 12,942 deaths, 362,088 DALYs, and USD 2,915.91 million in medical costs related to diabetes, cardiovascular diseases, oncological diseases, and other NCDs. Urgent implementation of public policies is crucial to address the consumption of SSBs, recognized as a key risk factor for NCDs.

Background: One of the three main targets of the World Health Organization (WHO) End TB Strategy (2015-2035) is that no tuberculosis (TB) patients or their households face catastrophic costs (defined as exceeding 20% of the annual household income) because of the disease. Our study seeks to determine, as a baseline, the magnitude and main drivers of the costs associated with TB disease for patients and their households and to monitor the proportion of households experiencing catastrophic costs in Brazil., Methods: A national cross-sectional cluster-based survey was conducted in Brazil in 2019-2021 following WHO methodology. TB patients of all ages and types of TB were eligible for the survey. Adult TB patients and guardians of minors (<18 years old) were interviewed once about costs, time loss, coping measures, income, household expenses, and asset ownership. Total costs, including indirect costs measured as reported household income change, were expressed as a percentage of annual household income. We used descriptive statistics to analyze the cost drivers and multivariate logistic regression to determine factors associated with catastrophic costs., Results: We interviewed 603 patients, including 538 (89%) with drug-sensitive (DS) and 65 (11%) with drug-resistant (DR) TB. Of 603 affected households, 48.1% (95%CI: 43-53.2) experienced costs above 20% of their annual household income during their TB episode. The proportion was 44.4% and 78.5% among patients with DS- and DR-TB, respectively. On average, patients incurred costs of US$1573 (95%CI: 1361.8-1785.0) per TB episode, including pre-diagnosis and post-diagnosis expenses. Key cost drivers were post-diagnosis nutritional supplements (US$317.6, 95%CI: 232.7-402.6) followed by medical costs (US$85.5, 95%CI: 54.3-116.5) and costs of travel for clinic visits during treatment (US$79.2, 95%CI: 61.9-96.5). In multivariate analysis, predictors of catastrophic costs included positive HIV status (aOR = 3.0, 95%CI:1.1-8.6) and self-employment (aOR = 2.7, 95%CI:1.1-6.5); high education was a protective factor (aOR = 0.1, 95%CI:0.0-0.9)., Conclusions: Although the services offered to patients with TB are free of charge in the Brazilian public health sector, the availability of free diagnosis and treatment services does not alleviate patients' financial burden related to accessing TB care. The study allowed us to identify the costs incurred by patients and suggest actions to mitigate their suffering. In addition, this study established a baseline for monitoring catastrophic costs and fostering a national policy to reduce the costs to patients for TB care in Brazil., Competing Interests: JE works for the CDC and participated in the elaboration of the initial proposal and in the writing of the article, but neither she nor the agency had a decision on the analysis of the data and the publication of the research., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

Longitudinal monitoring of indicators of accidental falls can facilitate the planning of effective care and prevention actions. This article aims to analyze temporal trends in variables related to falls among older persons in Brazil and in the state of São Paulo during the period 2000-2020 and estimate the projected economic burden on the health system in 2025. We conducted a quantitative retrospective observational study using data from the Health Information System. The Joinpoint Regression Program version 4.7.0 and SPSS version 20.0 were used to perform linear regression and calculate the Average Annual Percent Change (AAPC), adopting a 95% confidence interval. There was an increase in mean and total admissions costs due to falls at national level in both intervals of the study period. There was an increase in total admissions costs and the total number of admissions due to falls in the state of São Paulo (AAPC of 8.5% and 4.3%, respectively). Projections for the year 2025 suggest that the total number of admissions due to falls in Brazil will be around 150,000, resulting in costs of approximately R$ 260 million. There was an increase in the variables analyzed by this study, revealing the importance of fall prevention programs associated with national public policies.

Copyright of Direito da Cidade is the property of Editora da Universidade do Estado do Rio de Janeiro (EdUERJ) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To evaluate the implications of the proportion of annual family income spent in the pre- and post-diagnosis periods in tuberculosis patients followed for after at least one year after completing tuberculosis treatment in Brazil., Methods: This was a cross-sectional study of tuberculosis patients followed for at least one year after completing tuberculosis treatment in five Brazilian capitals (one in each region of the country)., Results: A total of 62 patients were included in the analysis. The overall average cost of tuberculosis was 283.84 Brazilian reals (R$) in the pre-diagnosis period and R$4,161.86 in the post-diagnosis period. After the costs of tuberculosis disease, 71% of the patients became unemployed, with an overall increase in unemployment; in addition, the number of patients living in nonpoverty decreased by 5%, the number of patients living in poverty increased by 6%, and the number of patients living in extreme poverty increased by 5%. The largest proportion of annual household income to cover the total costs of tuberculosis was for the extremely poor (i.e., 40.37% vs. 11.43% for the less poor)., Conclusions: Policies to mitigate catastrophic costs should include interventions planned by the health care system and social protection measures for tuberculosis patients with lower incomes in order to eliminate the global tuberculosis epidemic by 2035-a WHO goal in line with the United Nations Sustainable Development Goals.

Background: A full understanding of the economic burden associated with treatment-related adverse events (AEs) can aid estimates of the incremental costs associated with incorporating new technologies and support cost-effective economic modeling in Brazil. In this context, the main objective of this work was to evaluate in a real-life database: (i) the direct medical cost of monitoring the occurrence of AEs (CMO); (ii) the direct medical cost of managing an identified AE (CMN); and (iii) the total direct medical cost of monitoring and managing AEs (TMC), in quarterly periods from 0 to 24 months of the monitoring of cancer patients who used a PD-1 inhibitor from the perspective of the supplementary health system in Brazil., Methods: This study was conducted from the supplementary health system (SSS) perspective and followed the methodological guidelines related to cost-of-illness studies. A bottom-up (person-based) approach was used to assess the use of health resources to monitor and manage AEs during the use of PD-1 inhibitors, which made it possible to capture differences in the mean frequency of the use of health services with stratification results for different subgroups. As the Brazilian SSS is complex, asymmetric, and fragmented, this study used information from different sources. The methodology was divided into three parts: (i) Data Source: clinical management of AEs; (ii) Microcosting: management of the economic burden of AEs; (iii) Statistical analysis: stratification of results for different subgroups., Results: Analysis of the economic burden of toxicity showed higher CMO costs than CMN in all the periods analyzed. In general, for every BRL 100 on average invested in the TMC of AEs, BRL 95 are used to monitor the occurrence of the AE and only BRL 5 to manage an identified AE. This work also showed that the sociodemographic characteristics of patients, the journey of oncological treatment, and the toxicity profile affect the economic burden related to AE., Conclusion: This study provided real-world evidence of the economic burden of AEs associated with the use of PD-1 inhibitors in Brazil. This work also made methodological contributions by evaluating the economic burden of AE of PD-1 inhibitors considering the kinetics of toxicity occurrence and categorizing the costs in terms of CMO, CMN and TMC., (© 2023. The Author(s).)

Objectives: Low back pain (LBP) is the leading cause of disability and work absenteeism globally, and it poses significant clinical and economic burden to individuals, health systems and the society. This study aimed to synthesise the clinical and economic burden of LBP in low-income and middle-income countries (LMICs)., Methods: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. PubMed, Medline, CINAHL, PsycINFO, AMED, Embase and Scopus databases were systematically searched for studies that examined the clinical and economic burden of LBP in LMICs, published from inception to 10 December 2021. Only studies with clearly stated methodologies and published in English were eligible for review., Results: Nine studies met the inclusion criteria and were reviewed. Of these, three of them were clinical burden studies. The mean Newcastle-Ottawa Quality Assessment Scale (NOS) score of the included studies was 4, with an average from 3 to 6. The included studies were conducted in Argentina, Brazil, China, Ethiopia, Nigeria and Republic of Serbia. The rates of hospitalisation due to LBP ranged between 13.4% and 18.7%. Due to variation of methodological approaches, the reported cost estimates were inconsistent across the studies. A total cost of US$2.2 billion per population and US$1226.25 per patient were reported annually due to LBP., Conclusion: This systematic literature review suggests that LBP is associated with significantly high rates of hospitalisation and costs. As LBP is an important threat to the population, health professionals and policymakers are to put in place appropriate programmes to reduce the clinical and economic burden associated with LBP and improve the health outcomes of individuals with this condition in LMICs., Prospero Registration Number: CRD42020196335., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Depression is disabling disorder and cause functional impairments, and high costs for the health and social security system., Objective: The direct and indirect costs of depression from the societal perspective were estimated for the period 2010 to 2018., Methods: This cost-of-illness study in adults is based on prevalence, with a top-down approach, from the societal perspective. Direct (hospital and outpatient) and indirect (absenteeism) costs were included. Data were extracted from the Hospital and Outpatient Information Systems and the National Social Security Institute., Results: The cost of depression was Int$ 2,288,511,607.39 in the analyzed period, with an average annual cost of Int$ 254,279,067.49. From 2014 to 2018, had a sharp and persistent decrease in the cost of depression (-44.24%), mainly in indirect costs (-55.83%). In the period investigated, indirect costs represented 74.85% of the total cost. Over time, outpatient surpassed hospital cost. In 2017 and 2018, outpatient costs represented 43.22% and 39.57% of total costs. In all the years and cost components analyzed, women predominated., Conclusions: Depression is a disease with a high economic burden for the healthcare system. Investments are still needed, such as higher coverage of services, multidisciplinary teams, and training of health professionals for psychosocial care.

The complexity and costs of hematopoietic cell transplantation (HCT) have increased over the last decades with the popularization of unrelated donor (URD) transplantation and the introduction of haploidentical transplantation with posttransplant cyclophosphamide. Few studies have addressed this issue. The objective of this study was to analyze HCT costs in a single FACT-accredited private non-profit hospital. We included 79 patients who underwent HCT between 2018 and 2020. We have included all costs from admission day until D + 180. We used a lognormal regression. Median age was 53 y/o and most donors were unrelated (51%). Costs were higher with haploidentical donor (42%, p = 0.017, compared with URD), higher HCT-CI (15% for each point, p = 0.0056), and in patients with liver or gastrointestinal GVHD (45%, p = 0.033), and lower in patients who received CD34 > 2.5 × 10E6/kg (42%, p = 0.0038). We built a score based on the following risk factors: HCT-CI > 3, CD34 ≤ 2.5 × 10E6/kg, haploidentical donor, and donor age > 30 y/o. Patients with 2 + risk factors (N = 53) had a median cost of USD 226,156.00, compared with USD 93,048.00 in patients with zero or 1 point (N = 26, p < 0.0001). In summary, we have shown that HCT costs are higher with lower doses of CD34 cells, haploidentical HCT (provided that the costs of stem cell procurement and ATG are not included), and in patients with higher HCT-CI. Prospective and refined cost analyses comparing haploidentical and URD transplants, as well as effective strategies for patients with higher HCT-CI scores, are warranted. We found no difference in costs between URD and MSD transplantation., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Alongside the rising prevalence of overweight and obesity in Brazil, there is expected to be increased direct healthcare costs of cancers. Herein, we estimated the economic costs of cancer attributable to overweight in the Brazilian Unified Health System (SUS), according to sex, type of cancer and geographic location (Federative Units)., Methods: The population attributable fraction (PAF) of fifteen types of cancer were estimated using body mass index (BMI) data of 85,715 adults (≥ 20 years) involved in the 2019 National Health Survey and relative risks of cancers from a meta-analysis. Inpatients and outpatient procedures and costs of cancer treatment were obtained from the SUS systems., Results: Costs of cancers included in this study were Int$ 1 billion in 2019, of which 9 % or Int$ 95 million were attributable to overweight and obesity. PAFs were higher in men (11 %) than in women (8 %), while the attributable cancer costs were higher in women (Int$ 55 million) than in men (Int$ 40 million). Cancers with the highest PAFs were endometrial cancer (40 %) and esophageal cancer (26 %), whereas cancers with the highest attributable costs were colorectal cancer (Int$ 25 million) and breast cancer (Int$ 24 million)., Conclusion: Overweight was responsible for approximately Int$ 95 million (9 %) cancer direct healthcare cost in Brazil. Public policies and programs aimed at encouraging healthy diets and physical activity may decrease the economic burden of cancer in Brazil., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: The aim of this paper is to estimate the economic burden of children with congenital Zika Syndrome (CZS) in Brazil over 5-10 years., Methods: We conducted a modelling study based on data collected in a case-control study in Brazil, including children with CZS (cases) and typically developing children (controls), born in 2015 and 2016. In total, 484 participants were recruited in two sites, Recife and Rio de Janeiro. Social and economic information was collected in a survey from the carers of cases and controls, and detailed healthcare utilisation was recorded for each child in the Rio de Janeiro cohort prospectively in a database. We used this information to estimate the cost per child with severe, moderate and no CZS and incremental cost per child with severe and moderate versus no CZS from a disaggregated societal perspective. These estimates were incorporated into an economic burden model to estimate the incremental burden of the CZS epidemic in Brazil over 5 years and 10 years., Findings: The societal cost per child with severe CZS was US$50 523 to 10 years of age (born in 2015 and 2016), substantially higher than the costs for moderate CZS (US$29 283) and without CZS (US$12 331). The incremental economic burden of severe versus no CZS in Brazil over 10 years was US$69.4 million from the household and US$129.0 million from the government perspective. For moderate CZS, these figures amounted to US$204.1 million and US$86.6 million. Over 10 years, 97% of the total societal economic cost of severe CZS is borne by the government, but only 46% for moderate CZS., Interpretation: The economic burden of CZS is high at the household, provider and government levels. The compensatory government payments helped to alleviate some of the additional costs incurred by families with a child qualifying for the disability benefits, and could be scaled to include the children with moderate CZS., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Sickle cell disease (SCD) may cause several impacts to patients and the whole society. About 4% of the population has the sickle cell trait in Brazil, and 60,000 to 100,000 have SCD. However, despite recognizing the significant burden of disease, little is known about SCD costs., Objective: To estimate SCD societal costs based on disease burden modelling, under Brazilian societal perspective., Methods: A disease burden model was built considering the societal perspective and a one-year time horizon, including direct medical and indirect costs (morbidity and mortality). The sum of life lost and disability years was considered to estimate disability-adjusted life years (DALYs). Data from a public database (DATASUS) and the prevalence obtained from literature or medical experts were used to define complications prevalence and duration. Costs were defined using data from the Brazilian public healthcare system table of procedures and medications (SIGTAP) and the human capital method., Results: Annual SCD cost was 413,639,180 USD. Indirect cost accounted for the majority of burden (70.1% of the total; 290,158,365 USD vs 123,480,816 USD). Standard of care and chronic complications were the main source of direct costs among adults, while acute conditions were the main source among children. Vaso-occlusive crisis represented the complication with the highest total cost per year in both populations, 11,400,410 USD among adults and 11,510,960 USD among children., Conclusions: SCD management may impose an important economic burden on Brazilian society that may reach more than 400 million USD per year., Competing Interests: The authors have declared that no competing interests exist.

Objectives: Parallel to rising obesity prevalence in Brazil, there is expected to be increased direct health care costs related to non-communicable diseases (NCDs). In this study, we estimated the economic burden of NCDs attributable to overweight and obesity in the Brazilian Unified Health System (SUS)., Methods: We used self-reported body mass index of 85,715 adults from the 2019 Brazilian National Health Survey. Annual costs (1 US$ = 2.281 Reais) with inpatient and outpatient procedures were obtained from the Hospital and Ambulatory Information Systems of the Brazilian SUS. Relative risks for cardiovascular disease, chronic respiratory disease, neoplasm, digestive disease, musculoskeletal disorders, diabetes and kidney diseases, sense organ diseases, and neurological disorders were retrieved from the Global Burden of Disease study., Results: Annually, US$ 654 million (95% uncertainty interval: US$ 418.4 to US$ 893.2) direct health care costs related to NCDs were attributable to overweight and obesity. Attributable costs were higher in women than men. Cardiovascular diseases had the highest attributable costs (US$ 289 million), followed by chronic respiratory diseases (US$ 110 million), neoplasms (US$ 96 million), digestive diseases (US$ 60 million), musculoskeletal disorders (US$ 44 million), diabetes and kidney disease (US$ 31 million), sense organ diseases (US$ 22 million) and neurological disorders (US$ 11 million)., Conclusions: Overweight and obesity account for US$ 654 million direct costs of NCDs annually. Effective policies to promote healthy body weight may have economic benefits., (Copyright © 2022 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Emerging economies, e.g. India, China and Brazil etc., face challenges to adopt food safety (FS) practices in their food supply chains. Considering food industry's operations and processes, this study identifies 25 challenges to the FS initiatives involving the opinions of practitioners from six major Indian food producers and academic experts. The challenges are grouped into five categories, viz. organisational, government and policy, global, knowledge and financial. We identify the best and worst challenges to the FS initiatives along with causality among them using combined Best Worst Method (BWM) and 'Decision Making Trial and Evaluation Laboratory' (DEMATEL) approaches. BWM prioritises these challenges, while DEMATEL identifies causal relationship maps for the prioritised challenges. The BWM results demonstrate that the government and policy related challenges are the key challenges followed by the organisational, global, knowledge and financial related challenges. The DEMATEL results exhibit the organisational, government and policy, and global related challenges as the cause group challenges. The knowledge and financial related challenges represent the effect group challenges. Mitigation of these challenges inherently necessitates stakeholders' involvement in the food supply chains. We identify constructs for food safety initiatives policy in the emerging economies to raise public awareness while encouraging greater collaboration and efficiency in food supply chains to help achieve the second Sustainable Development Goal (SDG) for securing food for everyone. The results of the study offer guidance and deeper insights to supply chain managers about synergy requirements between the government policymakers and key players of the industry in the emerging economies. Image 1 • To meet demand for safe and secure food, food industries face several challenges. • The research identified 25 challenges relating to food safety. • BWM is applied to prioritise the challenges. • DEMATEL evaluates the challenges through causal and impact relationship maps. • This work assists business managers in meeting the goals of sustainable and healthy food. [ABSTRACT FROM AUTHOR]

Aims: Depression is more prevalent in people with diabetes, and is associated with worse diabetes outcomes. Depression in diabetes is more treatment resistant, and as underlying mechanisms are unknown, development of more effective treatment strategies is complicated. A biopsychosocial model may improve our understanding of the pathophysiology, and therewith help improving treatment options., Methods: Diabetes was diagnosed according to American Diabetes Association (ADA) criteria and a current depressive episode according to the International Classification of Diseases (ICD-10), based on the Clinical Interview Schedule Revised (CIS-R). From the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), we included 455 participants without diabetes with a current depressive episode and 10 900 without either diabetes or a current depressive episode. Furthermore, 2183 participants had diabetes alone and 106 had both diabetes and a current depressive episode. Variable selection was based on their relationship with depression and/or diabetes. Multinomial multivariate logistic regression was used to determine how the models differed between participants with and without diabetes., Results: A current depressive episode in diabetes was related to being older and female, having poorer education, financial problems, experiencing discrimination at work, home and school, higher waist circumference, albumin to creatinine ratio and insulin resistance, and the presence of hypertension and cardiovascular disease. In non-diabetes, a current depressive disorder was related to being female, not being black, low income, psychological and social factors, non-current alcohol use, lower HDL cholesterol, higher insulin resistance and the presence of cardiovascular disease., Conclusions: A current depressive episode in the presence compared with the absence of diabetes was related more to biological than to psychosocial factors., (© 2020 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.)