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Marcos Bosi Ferraz

Publications and source records attributed to Marcos Bosi Ferraz.

14 recordsLinked to original sources
PubMed2006

Cost of schizophrenia: direct costs and use of resources in the State of São Paulo.

OBJECTIVE: To estimate the direct costs of schizophrenia for the public sector. METHODS: A study was carried out in the state of São Paulo, Brazil, during 1998. Data from the medical literature and governmental research bodies were gathered for estimating the total number of schizophrenia patients covered by the Brazilian Unified Health System. A decision tree was built based on an estimated distribution of patients under different types of psychiatric care. Medical charts from public hospitals and outpatient services were used to estimate the resources used over a one-year period. Direct costs were calculated by attributing monetary values for each resource used. RESULTS: Of all patients, 81.5% were covered by the public sector and distributed as follows: 6.0% in psychiatric hospital admissions, 23.0% in outpatient care, and 71.0% without regular treatment. The total direct cost of schizophrenia was US $191,781,327 (2.2% of the total health care expenditure in the state). Of this total, 11.0% was spent on outpatient care and 79.2% went for inpatient care. CONCLUSIONS: Most schizophrenia patients in the state of São Paulo receive no regular treatment. The study findings point out to the importance of investing in research aimed at improving the resource allocation for the treatment of mental disorders in Brazil.

Brazil↗
PubMed2005

Climacteric symptoms and quality of life: validity of women's health questionnaire.

OBJECTIVE: To evaluate the reliability and validity of the Portuguese version of the Women's Health Questionnaire. METHODS: In order to evaluate the Women's Health Questionnaire (WHQ), an analytical cross-sectional study was carried out at the women's menopause outpatient clinic of a university hospital in São Paulo, Brazil. There were studied 87 women in perimenopause or menopause, defined as experiencing at least one year's absence of menstrual flow. The following variables were collected: demographic data, clinical variables (Kupperman index and correlate numeric scale) and quality of life indexes (SF-36 and utility). RESULTS: The WHQ proved to be a questionnaire easily translated into Portuguese and well-adjusted to Brazilian women. The internal consistency of the overall WHQ was excellent (Cronbach alpha =0.83; 95% CI: 0.71-0.91). Test-retest reliability was also excellent (intraclass correlation coefficient [ICC]=0.92; 95% IC: 0.86-0.96) and had good absolute agreement (0.84; 95% CI: 0.71-0.92). A satisfactory clinical validity was observed. The construct validity was corroborated by clear associations with others scales. A good index of responsiveness after the intervention was reached. CONCLUSIONS: The Portuguese version of the WHQ is of easy and fast administration and understanding. Its measuring properties were related, allowing its use in the evaluation of Brazilian climacteric women's quality of life for various purposes.

Adult↗
PubMed2005

[Cost of heart failure in the Unified Health System].

OBJECTIVE: To describe the direct and indirect costs of ambulatory and in-patient treatments of heart failure during 2002, in the University Hospital Antonio Pedro, Niterói. METHODS: A cross-sectional and retrospective study on utilization and valuation of resources in 70 patients, consecutively selected, under ambulatory and in-patient treatment. Questionnaires and records of the patients were used for data collection. The resources used were evaluated in Brazilian Reais (2002). The study's point of view was the perspective from society. The data were analyzed in the EPINFO program, 2002 version. RESULTS: The studied population consisted of 70 patients (39 women), with average age of 60.3 years old. 465 in-patients days (28.5% of the patients) took place. There were 386 ward hospitalizations and 79 in ICUs. The cost with ambulatory appointments was R$ 14.40. The expenses with ambulatory medications amounted R$ 83,430.00 (R$ 1,191.86/patient/year). The cost per hospitalized patient was R$ 4,033.62. The cost with complementary examinations totaled R$ 39,009.50 (R$ 557.28/patient/year). Twenty patients retired due to heart failure, which represented a loss in productivity of R$ 182,000.00. The total cost was R$ 444,445.20. Hospitalization represented 39.7% and the use of medications 38.3% from direct costs. CONCLUSION: The hospitalization cost and the expenses with medications represented the main components of direct costs. Indirect costs represented economic impacts similar to direct costs.

Adult↗
PubMed2005

Acute low back pain: diagnostic and therapeutic practices reported by Brazilian rheumatologists.

STUDY DESIGN: A cross-sectional study. OBJECTIVES: To assess resource utilization in the diagnosis, management, and hospitalization of patients with low back pain (LBP) as prescribed by Brazilian rheumatologists. SUMMARY OF BACKGROUND DATA: LBP is an important cause of disability, suffering, and social costs. Two to five percent of patients miss workdays because of LBP; it is the second highest cause of physician visits and absenteeism. METHODS: Rheumatologists taking part in a national rheumatology medical congress answered a questionnaire to assess management of patients with LBP. It consisted of two hypothetical scenarios describing patients with acute LBP (scenario 1) and sciatica (scenario 2). There were 29 questions mainly related to education, protective measures, rest, and medication. RESULTS: A total of 207 questionnaires were returned. In scenario 1, 70% of the participants ordered some diagnostic test at first visit; lumbar radiograph was the most ordered (92%), while more than 80% prescribed rest and 100% at least one drug. Nonsteroidal anti-inflammatory drugs were prescribed by 69% of the participants. In scenario 2, 93% of the physicians ordered diagnostic tests at first visit, with computed tomography being the most ordered test (69%). Rest was prescribed by 90% (average 18 days) of the participants and physical therapy was counseled by 84%. CONCLUSIONS: Considering the hypothetical scenarios, participants overused diagnostic and therapeutic procedures. A dissemination of guidelines for optimizing resource use in LBP diagnosis and management is needed.

Acute Disease↗
PubMed2004

[Quality of life in patients with inflammatory bowel diseases: translation to Portuguese language and validation of the "Inflammatory Bowel Disease Questionnaire" (IBDQ)].

BACKGROUND: Crohn's disease comprises, together with ulcerative colitis, the inflammatory bowel diseases, which because their morbidity and chronic evolution have a considerable impact on the patient's quality of life. The measurement of quality of life requires the determination of the degree of subjective well-being attributed to the lack of symptoms, to psychological state and daily activity, and is useful as an instrument of evaluation, both in clinical trials and health programs. Inflammatory Bowel Disease Questionnaire is an instrument developed by North-American investigators of McMaster University which reproducibility and validity has been determined in several countries studies, and has shown its use in the measurement of the quality of life of patients with inflammatory bowel diseases. AIMS: Our purpose was to translate that instrument into Portuguese language, its adaptation to Brazilian culture and verify its psychometric properties (validity and reproducibility). METHODS: It was applied to a population of 50 inflammatory bowel diseases patients (24 with Crohn's disease, 26 with ulcerative colitis). To test the criteria and construction validity of the instrument's, it was compared with SF-36, a general questionnaire for establishing quality of life, and the Crohn's Disease Activity Index and Lichtiger's Index. RESULTS: The correlations obtained were mostly moderate. About the intestinal diseases activity index, Lichtiger's index showed better correlations than Crohn's Disease Activity Index. To evaluate its reproducibility, the instrument was applied on three occasions, twice by the same observer (12 days average between applications) and once by a second observer, resulting in a high degree of intra- and interobserver correlation. CONCLUSIONS: Portuguese version of Inflammatory Bowel Disease Questionnaire is a valid and reproducible instrument which can be used to evaluate the quality of life of Brazilian inflammatory bowel diseases patients.

Adult↗
PubMed2004

Prevalence of rheumatic diseases in Brazil: a study using the COPCORD approach.

OBJECTIVE: To estimate the prevalence of rheumatic diseases in residents of Montes Claros, Brazil, of both sexes, aged above 16 years, using the COPCORD questionnaire. METHODS: This was a cross-sectional study of 3038 people; the sample was probabilistic, by conglomerates, multiple stages, within homogeneous strata, the sampling unit being the domicile. The COPCORD questionnaire was used for all subjects, and a rheumatologist evaluated those patients who presented pain and/or functional disability. Laboratory tests and radiographs of small and large joints were done in some patients to confirm the diagnosis. Subjects were identified by socioeconomic level in quintiles A, B, C, D, and E, A being the highest. RESULTS: Two hundred nineteen patients were identified with rheumatic diseases, mean age 37 (SD 27) years, with female predominance. Seventy-seven (35.2%) were unemployed and socioeconomic level D was the most prevalent. Of all patients with rheumatic disease, osteoarthritis (OA) was observed in 126 (57.5%) patients, fibromyalgia (FM) in 76 (34.7%), rheumatoid arthritis (RA) in 14 (6.4%), and lupus in 3 (1.4%). Women were predominant in all diseases except OA. The mean (SD) age was 56 (12.7) years for OA, 43.2 (9.1) for FM, 53.4 (13.9) for RA, and 40 (14) for lupus. CONCLUSION: The prevalence of rheumatic diseases evaluated by the COPCORD questionnaire was 4.14% for OA, 2.5% for FM, 0.46% for RA, and 0.098% for lupus.

Adolescent↗
PubMed2004

Resource utilization in postmenopausal osteoporosis without incident fractures.

OBJECTIVE: To evaluate the annual utilization and cost incurred by postmenopausal women with osteoporosis in a public tertiary healthcare facility. METHODS: One hundred consecutive patients with postmenopausal osteoporosis were selected from the Universidade Federal de São Paulo (UNIFESP), Brazil. The socioeconomic and clinical characteristics, quality of life, and resource utilization and costs in the last year were assessed using 3 questionnaires. Each resource used had its unitary cost based on the Public Healthcare System Table of Fees (1998). RESULTS: The mean age was 66 years and the monthly family income was 456 US dollars (1998). There was a mean of 7 visits/patient/year. Seventy-seven percent of the patients used calcium and 38% used estrogens. There were no incident fractures during the study. The mean total annual cost for osteoporosis treatment, considering the societal perspective, was 775 US dollars (1998) per patient/year. CONCLUSION: The costs of all treatment drugs related and not related to osteoporosis represented 9% of the monthly household income. Among some drugs used, many are lacking evidence of effectiveness, such as shark cartilage. The costs related to transportation were significant, representing 21% of the total directly spent by the patients. Further studies are necessary to rationally drive treatment, based on the best cost-effectiveness strategies of osteoporosis management.

Adult↗
PubMed2003

Translation and cultural adaptation of quality of life questionnaires: an evaluation of methodology.

OBJECTIVE: To evaluate the methodological steps currently proposed in translation and cultural adaptation of quality of life questionnaires. METHODS: Fifty patients with rheumatoid arthritis were invited to participate. Two versions each of the Stanford Health Assessment Questionnaire (HAQ), the MOS 36 Item Short-Form Health Survey (SF-36), and the Arthritis Impact Measurement Scales 2 (AIMS-2) were administered: version 1 was a literal translation of the questionnaire; version 2 resulted from a process of translation and cultural adaptation following internationally accepted guidelines. For each patient we applied 2 questionnaires before and after consultation. The questionnaire, the order of administration, and the version were randomly assigned. The interviews were performed by a single interviewer. Several clinical and laboratory outcome measures were assessed simultaneously. Descriptive statistical analysis was used to characterize the data. Spearman and intraclass correlation coefficients were used to evaluate reliability and validity of each version of each questionnaire. RESULTS: Patients' mean (SD) age was 47 (12) years and mean (SD) disease duration was 10 (7) years. The differences of the mean in the physical and affective AIMS-2 components between the literal and adapted versions (0.21 and 0.11, respectively) were similar to the differences in the intraobserver application of the same version of culturally adapted AIMS-2 components (0.03 and 0.20) (the component scores range from 0 to 10). The same results were observed when considering other components of AIMS and SF-36, as well as HAQ scores. Version 1 and 2 presented a similar clinically and statistically significant correlation with clinical and laboratory measures used in the validation process of the questionnaires. CONCLUSION: The complex methodologies proposed in the translation and validation of the questionnaires should be carefully reevaluated. The simplification of this methodology should be studied.

Adult↗
PubMedDate not supplied

Critical appraisal of published economic evaluations of home care for the elderly.

The goal of the study was to appraise the economic evaluations published between 1980 and 2004 of "home care" for the elderly, focusing on the methodological aspects. MEDLINE was searched to identify and assess economic evaluations (defined as an analysis comparing two or more strategies, involving the assessment of both costs and consequences) related to "home care" exclusively for the elderly (65 years or more) and to critically appraise the methodology using five accepted principles used worldwide for conducting economic evaluations. Twenty-four economic evaluations of "home care" for the elderly were identified and the articles were assessed. All five principles were satisfactorily addressed in two studies (8.3%), four principles in four studies (16.7%), three principles in five studies (20.8%), two principles in eight studies (33.3%) and only one principle in five studies (20.8%). A disparity in the methodology of writing economic evaluations compromises the comparisons among outcomes and lately jeopardizes decisions on the choice of the most appropriate healthcare interventions. The methodological principles represent important guidelines but the discussion of the context of the economic evaluation and the special characteristics of some services and populations should be considered for the appropriate use of economic evaluations.

Aged↗
PubMedDate not supplied

Translation into Brazilian Portuguese, cultural adaptation and validation of the oral health impact profile (OHIP-49).

The aim of this study is to develop a Portuguese version of the OHIP-49 to be used in Brazil. The adopted methodology involves translation, back-translation, revision of the first version, cultural adaptation and evaluation of its measurement properties. The questionnaire was administered in interviews with 60 year-old and older Brazilian people. The Kendall-tau correlation coefficient was used to assess reproducibility; the Cronbach alpha coefficient was used to verify internal consistency and the Kruskal-Wallis and Mann-Whitney U tests were used to assess validity. Reproducibility was shown to be statistically significant, with coefficients ranging from 0.72 to 0.74 between dimensions of three interviews. The Cronbach alpha coefficients were 0.96 and 0.90 respectively for the dimensions of the interviews and for total items. Constructive validity, demonstrated through a comparison between the questionnaire dimensions and the clinical parameters, showed statistical significance for "presence of carious lesion" (p < 0.05). Significant correlations between similar dimensions of the OHIP-49 and the SF-36 were also identified (p < 0.05). In the present sample, the Portuguese version of the OHIP-49 presented results similar to those found in the literature and proved to be a reproducible and valid parameter for evaluating the impact of oral conditions on the quality of life of Brazilians.

Brazil↗
PubMedDate not supplied

[COPCORD studies].

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Health Promotion↗