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The Impact of Obesity on Health Care Utilization and Expenditures in a Medicare

Supplement Population


Objective: Obesity is a contributor to increased chronic conditions resulting in higher

utilization of medical services among broad populations of older adults. The objective of this
study was to evaluate the magnitude of the impact of weight on health care use patterns
among Medicare Supplement insureds. Method: We estimated the impact of weight as a
function of body mass index (BMI) on health care utilization and expenditures using
propensity weighted multivariate regression models. The outcomes were controlled initially
for demographics and socioeconomics and then additionally for chronic conditions and health
status. Results: Among the 9,484 survey respondents, 22.9% were obese. Those categorized
as obese were significantly more likely to incur inpatient admissions and orthopedic
procedures. Annualized health care expenditures were US$1,496 higher for obese compared
with normal weight. The excess utilization and expenditures associated with obesity were
explained by chronic conditions and poor health status. Conclusion: Obesity-related
expenditures associated with medical management are largely preventable and may benefit
from interventions that target lifestyle behaviors and weight management among older adults.

Self-management of health care behaviors for COPD: a systematic review and meta-

Purpose: This systematic review aimed to identify the most effective components of
interventions to facilitate self-management of health care behaviors for patients with COPD.
PROSPERO registration number CRD42011001588.

Methods: We used standard review methods with a systematic search to May 2012 for
random- ized controlled trials of self-management interventions reporting hospital admissions
or health- related quality of life (HRQoL). Mean differences (MD), hazard ratios, and 95%
confidence intervals (CIs) were calculated and pooled using random-effects meta-analyses.
Effects among different subgroups of interventions were explored including single/multiple
components and multicomponent interventions with/without exercise.

Results: One hundred and seventy-three randomized controlled trials were identified. Self-
management interventions had a minimal effect on hospital admission rates. Multicomponent
interventions improved HRQoL (studies with follow-up 6 months St George’s Respiratory

Questionnaire (MD 2.40, 95% CI 0.75–4.04, I2 57.9). Exercise was an effective individual
component (St George’s Respiratory Questionnaire at 3 months MD 4.87, 95% CI 3.96–5.79,
I2 0%). Conclusion: While many self-management interventions increased HRQoL, little
effect was seen on hospital admissions. More trials should report admissions and follow-up
participants beyond the end of the intervention.

Keywords: COPD, self-management, systematic review, meta-analysis

Assessment of Primary Health Care in the Treatment of Tuberculosis in a Brazilian

Locality of the International Triple Frontier


To evaluate the performance of Primary Health Care (PHC) in treatment of TB patients in a

triple international border municipality.


The present study was an evaluative survey of cross-sectional and quantitative approach
conducted with 225 PHC healthcare professionals. Data was collected through a structured
and validated instrument, which provided five indicators of "structure" and four indicators of
"process" classified as unsatisfactory, regular or satisfactory.


The "structure" component was unsatisfactory for the indicator of professionals involved in
TB care and training, and regular for the indicator of connection between the units and other
levels of care. The "process" component was regular for the indicators of TB information,
directly observed treatment and reference and counter reference on TB, and unsatisfactory for
external actions on TB control.


The "structure" and "process" components points out some weaknesses in terms of
management and organization of human resources. Low frequency of training and the
turnover influenced the involvement of professionals. Elements of "structure" and "process"
show the need for investing in the PHC team and improving the clinical management of

Keywords: Tuberculosis , Program Evaluation and Health Services , Primary Health Care ,
Health on the Border, Management, Decentralization.