Association of hospitalization costs with demographic, socioeconomic, and lifestyle characteristics: Population-based study in Sao Paulo city, Brazil, 2003-2015.

HighlightsWhat are the main findings?Cardiovascular diseases, type 2 diabetes, and tobacco use significantly increase both the odds and duration of sick leave.Meeting recommended levels of leisure-time physical activity is associated with lower indirect costs from health-related absenteeism.What are the implications of the main findings?Public health strategies promoting physical activity and smoking cessation may reduce economic losses in productivity.Estimating indirect costs provides evidence to prioritize preventive interventions in middle-income countries, such as Brazil.Background/Objectives: Non-Communicable Diseases (NCD) impose a substantial socioeconomic burden on health systems through direct costs and indirect costs from productivity loss due to health-related absenteeism. While lifestyle factors are crucial for NCD prevention, evidence regarding their association with absenteeism in middle-income countries, such as Brazil, remains limited. In this context, the present study aims to analyze factors associated with the odds, duration, and costs of health-related absenteeism in São Paulo City, Brazil. Methods: Quantitative analysis was performed using microdata from the São Paulo Health Survey 2003, 2008, and 2015 (ISA-Capital). Logistic and negative binomial regression models identified factors associated with the odds and duration of health-related absenteeism. The human capital approach was used to estimate indirect costs (Int$ PPP), while two-part regression models (logit and generalized linear model) and average marginal effects (ME) identified cost-associated factors. Results: Tobacco use and NCD diagnoses (hypertension, type 2 diabetes, and cardiovascular diseases) significantly increased the odds and duration of absenteeism. Conversely, meeting recommended leisure-time physical activity levels was associated with lower indirect costs (ME = −33.94, p < 0.05). Higher costs were significantly driven by tobacco use (ME = 48.68, p < 0.01) and NCD, namely cardiovascular diseases (ME = 62.73), diabetes (ME = 55.18), hypertension (ME = 52.13), and obesity (ME = 36.45), all with p < 0.05. Conclusions: Promoting leisure-time physical activity and tobacco cessation may be important strategies for public health policies aiming to enhance productivity by reducing the frequency, duration, and economic burden of health-related absenteeism, complementing the necessary diagnosis and monitoring of NCD.

This study aimed to estimate the prevalence of the main perceived barriers to leisure-time physical activity (LTPA) and their associations with the frequency of LTPA in a representative sample of industrial workers from Brazil (n = 47,477), according to their income strata (low income: ≤$US280, middle income: $US281-$US1400, and high income: ≥$US1401). Data were collected between 2006 and 2008 via questionnaires about the main perceived barrier to LTPA and the frequency of LTPA. Multinomial logistic regression was performed to evaluate differences among groups. There was a lower prevalence of regular practice of LTPA in the low- (15.8%) and middle-income strata (18.2%) than among the individuals of the high-income stratum (27.6%). A large proportion of workers who regularly participated in LTPA reported no barriers (low: 43.1%; middle: 46.8%; high: 51.6%). Additional obligations and fatigue were the two most common perceived barriers in all family income strata among participants who engaged in different frequencies of LTPA. The odds for all perceived barriers showed a positive trend related to frequency of LTPA (from regular to no LTPA), with higher values according to income. In summary, the ordering of the main perceived barriers to LTPA differed according to workers' income stratum and frequency of engaging in LTPA.

The Relationship between Leisure Time Physical Activity and Cognitive Function in Older Americans.

South Africa is an upper middle–income country with a population of 59.6 million people (1). Gauteng is the most densely populated province, and houses 26% of the population, followed by KwaZulu-Natal (19%), and the Western Cape (12%). About 29% of the population are <15 years old and 9% are ≥60 years. Approximately 13% of the population are seropositive for HIV. Life expectancy is estimated at 68.5 years for females and 62.5 years for males, whereas the infant mortality rate is 23.6 per 1000 live births. In 2019, the gross national income per capita was approximately $6040 (Atlas method, current US$), with 8% of the country’s gross domestic product spent on health care (2). Despite the transition to democracy in 1994, a high level of inequality remains, reflected in a Gini coefficient of 0.63 and an unemployment rate of 30% (2,3). This inequality is also reflected in a two-tiered health system. Access to a well-resourced private health care sector depends on the ability to pay for services, usually via medical insurance. Treatment for CKD is included in the set of “prescribed minimum benefits” that all registered medical insurance schemes in South Africa are obliged to provide for their members. The majority of South Africans (84%), however, are dependent on an under-resourced, government-funded, public health care sector. Public health care facilities use a sliding scale, where the fees charged are dependent on income. Indigent patients are able to access services free of charge (4). South Africa is faced with a high burden of infectious diseases (such as tuberculosis and HIV infection), noncommunicable diseases, maternal and childhood diseases, and injury-related diseases (5). These factors drive an epidemic of AKI and CKD. Two studies have estimated the population prevalence of CKD in South Africa. Adeniyi et al. (6) reported the …

Purpose : Strategic performance measurement and management (SPMM) as a subject has come over increased research radar over the last four or so decades. The so-called “performance measurement revolution” of the 1980s to 1990s concentrated on the private sector. “Business managerialism” and “accountingisation” kicked-in into the public sector with transplanting of hitherto private sector management techniques under New Public Management (NPM) and other administrative reform programmes by various governments internationally. Specifically, the 1990s saw the implementation of modern multi-dimensional SPMM systems originally in the private sector. Considering the nuanced nature of the public sector, the transfer of SPMM systems from the private to the public sector has not been straightforward due to technical, conceptual and behavioral factors. This paper contrasts the features of the private and public sectors and investigates the implication of the distinctive nature of the public sector on the application of SPMM in the public sector. This will augment our perceptions and comprehension of existing public sector SPMM theory and practice. Design/Methodology/Approach: The study adopted a systematic literature review (SLR), a mode of research which has been widely adopted and strongly justified for adoption in business and management research since the turn of the 21st century. The study conducted a content and thematic analysis on the commonalities and differences between private and public sectors and implication of the differences on public sector strategic performance measurement and management. The study itself covered 233 published and unpublished documents covering the seven decades to 2023 which to our knowledge constitutes the most comprehensive update on the public-private debate trends to date. Findings: The study thoroughly interrogated the literature perspectives or models on the commonalities and differences between the public and private sectors. The study then deep-dived into the underlying characteristics which differentiate the public and private sectors producing one of the most detailed side-by-side analyses of public-private differentiation based on organisational characteristics, dimension, or concept of all time. The systematic review further identified and derived several thematic areas related to public-private differences and went on to establish the implications of the public-private divergences from an SPMM perspective especially as it relates to the derivation and application of public sector performance measures. These findings are critical for both practitioners and academics as they explore the subject of transplanting private sector SPMM practices into the public sector which is another overripe area for research. The findings provide public managers with a comprehensive and critical cog in their management toolbox as they navigate the practical realities and difficulties of implementing SPMM in the public sector’s unique and complex environment. Research Limitations: The main challenge with conducting a comprehensive research of this magnitude relates mainly to the broad range of literature covered, the unwieldy and onerous analysis and lots of judgement calls which could impact bias and replicability. Practical Implications - This paper conducts a comparative analysis of the key features of the private and public sectors found in the literature and evaluates how they drive attendant management practices in the two sectors and specifically how the public sector’s distinctive nature impacts on the measures of performance. Originality/value - Studying the differences and how they impact the choice of public sector KPIs is crucial in attempting to address the myriad of challenges and potential hindrances to future institutionalisation of SPMM in contemporary PSOs. Exploring and understanding the differences and similarities between public and private sectors is a beneficial springboard to cultivate erudition, cross-pollination and facilitation of knowledge transfer between the two sectors of the contemporary global political economy. Keywords: Strategic, performance management, performance measurement, performance measures, key performance indicators, public-private differences DOI: 10.7176/PPAR/13-2-03 Publication date: March 31 st 2023

Purpose We conducted a large cross-sectional study to investigate the relationship between leisure-time physical activity and perceived stress among workers in Japan. Methods 7192 workers in Japan were surveyed about their lifestyle habits, frequency of leisure-time physical activity (never, only specific seasons, once or twice a month, once a week, more than twice a week), and perceived occupational stress. According to the frequency of leisure-time physical activity, participants were classified into five groups. Logistic regression models were used to explore the relationship between leisure-time physical activity and perceived stress after adjustment for several confounding factors. Multivariable-adjusted odds ratios and 95% confidence intervals for the prevalence of perceived occupational stress were calculated. Results A total of 848 participants reported perceived occupational stress. Using the low leisure-time physical activity group (never) as reference, multivariable-adjusted odds ratios and 95% confidence intervals were 0.79 (0.59−1.07) for “only specific seasons,” 0.84 (0.66−1.08) for “once or twice a month,” 0.80 (0.63−1.03) for “once a week,” and 0.60 (0.46−0.79) for “more than twice a week” (p for trend 0 &lt; 0.001). Conclusion In this large cross-sectional study, there was a negative association between leisure-time physical activity frequency and perceived occupational stress was observed among workers in Japan.

Frequency of leisure-time physical activity and pulse pressure in the Brazilian population: a population-based study

To investigate the association between life-style and socioeconomic factors and coping strategies in a community sample in Iran. As part of a community-based study called Isfahan Healthy Heart Program, we studied 17593 individuals older than 19 living in the central part of Iran. Demographic and socioeconomic factors (age, sex, occupation status, marital status, and educational level) and lifestyle variables (smoking status, leisure time physical activity, and psychological distress), and coping strategy were recorded. Data were analyzed by Pearson correlation and multiple linear regression. Not smoking (women beta=-11.293, P<0.001; men beta=-3.418, P=0.007), having leisure time physical activity (women beta=0.017, P=0.046; men beta=0.005, P=0.043), and higher educational level (women beta=0.344, P=0.015; men beta=0.406, P=0.008) were predictors of adaptive coping strategies, while smoking (women beta=11.849, P<0.001; men beta=9.336, P<0.001), high stress level (women beta=1.588, P=0.000; men beta=1.358, P<0.001), and lower educational level (women beta=-0.443, P=0.013; men beta=-0.427, P=0.013) were predictors of maladaptive coping strategies in both sexes. Non-manual work was a positive predictor of adaptive (beta=4.983, P<0.001) and negative predictor of maladaptive (beta=-3.355, P=0.023) coping skills in men. Coping strategies of the population in central Iran were highly influenced by socioeconomic status and life-style factors. Programs aimed at improving healthy life-styles and increasing the socioeconomic status could increase adaptive coping skills and decrease maladaptive ones and consequently lead to a more healthy society.

Physical inactivity leads to higher morbidity and mortality from chronic non-communicable diseases. In high income countries, studies have measured school population level physical activity and substance use, but comparable data are lacking from most African countries. To study the relationship between self-reported leisure time physical activity frequency and sedentary behavior and alcohol, tobacco, and other drug use behaviors among school children. A cross-sectional survey was conducted with the total sample of 24,593 school children aged 13 to 15years from nationally representative samples from eight African countries. Univariate and multivariate analyses were conducted to assess the relationship between physical activity frequency, six measures of alcohol, tobacco, and other drug use, socioeconomic status, and mental health variables. In all, only 14.2% of the school children were frequently physically active (5days and more in a week, at least 60min/day) during leisure time; this was significantly higher among boys than girls. Ugandan and Kenyan school children were most physically active (17.7% and 16.0%, respectively), and Zambian and Senegalese the least (9.0% and 10.9%, respectively). Frequency of alcohol consumption and higher socioeconomic status were significantly associated with leisure time physical activity, while tobacco, illicit drug use, and mental health variables were not. Leisure time sedentary behavior of five and more hours spent sitting on a usual day were highly associated with all substance use variables. These findings suggest that leisure time physical activity frequency is associated with frequency of alcohol use and not with tobacco and illicit drug use, and leisure time sedentary behavior is highly associated with alcohol, tobacco, and drug use among adolescents.

Purpose. The study shows social differences in the context of health-related fitness and its basic components: physical activity, somatic parameters and motor fitness. The number of siblings was adopted as a social factor related to the differences. Basic procedures. 1652 boys aged 10 to 15 years from a large city environment were tested. They were divided into: (1) only children, (2) having one brother or sister, and (3) having two or more siblings. Their leisure time physical activity (LTPA) was assessed, basic somatic parameters were measured and motor tests were carried out. Main findings. LTPA frequency and duration were very similar regardless of the number of siblings. Differences in LTPA forms and LTPA partners have been revealed. Somatic parameters and motor fitness level were significantly different depending on the number of siblings. However, the analysis of motor fitness level in separate somatic categories resulted in disappearing of motor fitness differences. Conclusions. The inequality of social positions of urban boys is connected with the differences in the level of health-related fitness but its components are socially modified to a different degree.

BACKGROUND Breast cancer is the most common cancer among Brazilian women. HER-2 targeted therapy improves overall survival in HER-2 overexpressing patients but immunohistochemistry testing for HER2 is not standardized in Brazil and is not available universally. In Brazil the health system includes a public and private sector. The aim of our study was to delineate the patterns of testing of HER-2 over time in Brazil in both of these settings and to determine if any disparities exist in testing and treatments received. METHODS Observational, retrospective study involving practice patterns of over 2000 cancer physicians in Brazil. We obtained de-identified data from a commercial database, which included 54,829 patients with breast cancer treated between 2012 and 2016. We analyzed the frequency of HER-2 testing, the percentage of positive results and the most common treatments used in the first line setting in both the private and public sector. The chi-squared test was used for proportions. RESULTS HER-2 testing was frequently performed in both the private and public sector (87% vs. 81%, p&amp;lt;0.0001. Between 2012 and 2016 most patients had HER-2 testing (88%, 73%, 79%, 90% and 88%, respectively) but coverage was not universal. The percentage of HER-2 positivity was 25%. The most common first line regimens used were docetaxel/trastuzumab, paclitaxel/trastuzumab and trastuzumab monotherapy. In the private sector trastuzumab/pertuzumab/docetaxel was the most commonly used regimen. In the public sector taxanes were frequently used as monotherapy without HER-2 targeted therapy. CONCLUSIONS To our knowledge this is the largest dataset assessing HER-2 testing and treatment patterns in Brazil. The frequency of testing has remained stable over the last 5 years, but is higher in the private sector and this finding was highly statistically significant. There are also differences in the regimens used in the private vs. public sector. Pertuzumab was approved in 2013 in the US and its use has increased in Brazil over the last two years. This trend however was only seen in the private sector. In the public sector there is still significant use of chemotherapy without HER-2 directed therapy despite HER-2 overexpression, which is possibly related to the restricted access of anti-HER2 therapy in the public health system for metastatic patients. Taxanes are used widely in both the public and private sector, which is possibly related to the availability of generics. HER 2 Testing in the Public Sector20122013201420152016Tested4,2853,7114,5924,6884,126%92%76%80%94%91%Non Tested36211441134322428%8%24%20%6%9%Total4,6474,8555,7265,0104,554 HER 2 Testing in the Public Sector20122013201420152016Tested5,3913,9964,9175,2084,945%85%71%78%87%85%Non Tested9491,6611,367761842%15%29%22%13%15%Total6,3405,6576,2845,9695,787 Citation Format: Palacio S, Torres A, Prado E, Lopes G. Breast cancer in Brazil: HER-2 testing and treatment patterns [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-20.

Can Cyprus overcome its health-care challenges?

Leisure-time physical activity in relation to depressive symptoms in African-Americans: Results from the National Survey of American Life

Best practices, policy and innovations in the administration of healthcare in developing communities and countries. For administrators, academics, researchers and policy leaders. Includes peer reviewed research papers. Edited by Dr. Judith Shamian, President Emeritus, International Council of Nurses, Professor and Co-investigator with the Nursing Health Services Research Unit, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON

The operations and effectiveness of public and private provision of solid waste collection services in Kampala