BackgroundAlthough the cost of Crohn’s disease (CD) treatment differs considerably, hospitalization and surgery costs account for most of the total treatment cost. Decreasing hospitalization and surgery rates are pivotal issues in reducing health-care costs.Material/MethodsWe evaluated the effect of azathioprine (AZA) compared with mesalazine on incidence of re-hospitalizations due to all causes and for CD-related surgeries. In this controlled, randomized study, 72 subjects with sub-occlusive ileocecal CD were randomized for AZA (2–3 mg/kg per day) or mesalazine (3.2 g per day) therapy during a 3-year period. The primary end point was the re-hospitalization proportion due to all causes, as well as for surgical procedures during this period evaluated between the groups.ResultsOn an intention-to-treat basis, the proportion of patients re-hospitalized within 36 months due to all causes was lower in patients treated with AZA compared to those on mesalazine (0.39 vs. 0.83, respectively; p=0.035). The AZA group had also significantly lower proportions of re-hospitalization for surgical intervention (0.25 vs. 0.56, respectively; p=0.011). The number of admissions (0.70 vs. 1.41, p=0.001) and the length of re-hospitalization (3.8 vs. 7.7 days; p=0.002) were both lower in AZA patients.ConclusionsPatients with sub-occlusive ileocecal CD treated with AZA had lower re-hospitalization rates due to all causes and for surgical management of CD compared to those treated with mesalazine during a 3-year period. The long-term use of AZA in ileocecal CD patients recovering from a sub-occlusion episode can save healthcare costs.

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BackgroundPatients with subocclusive Crohn’s disease (CD) who received azathioprine (AZA) therapy had lower re-hospitalization rates due to all causes and for surgical management of CD compared to those treated with mesalazine during a 3-year period. We investigated whether AZA also was effective for prevention of recurrent bowel obstruction.Material/MethodsRates of recurrent bowel occlusion were compared between patients treated with AZA and those treated with mesalazine. We assessed the time interval-off intestinal obstruction as well as the occlusion-free survival for both groups.ResultsThere was a significantly lower cumulative rate of patients with recurrent subocclusion in the AZA group (56%) compared with the mesalazine group (79%; OR 3.34, 95% CI 1.67–8.6; P=0.003), with the number needed to treat in order to prevent 1 subocclusion episode of 3.7 favoring AZA. The occlusion-free time interval was longer in the AZA group compared with the mesalazine group (28.8 vs. 18.3 months; P=0.000). The occlusion-free survival at 12, 24, and 36 months was significantly higher in the AZA group (91%, 81%, and 72%, respectively) than in the mesalazine group (64.7%, 35.3%, and 23.5%, respectively; P<0.05 for all comparisons).ConclusionsIn an exploratory analysis of patients with subocclusive ileocecal CD, maintenance therapy with AZA is more effective than mesalazine for eliminating or postponing recurrent intestinal obstruction during 3 years of therapy.

Objetivo: Delinear um perfil epidemiológico do diabetes mellitus (DM) em uma zona urbana de Juiz de Fora usando os dados obtidos no cadastramento do Programa de Saúde da Família da Prefeitura Municipal de Juiz de Fora. Metodologia: Foram colhidas informações em 12.695 domicílios através da aplicação de um questionário baseado no Programa Avançado de Gerência em Atenção Primária a Saúde. A aplicação foi realizada por 180 entrevistadores acadêmicos da área de saúde. Os dados foram transferidos para o programa epidemiológico EPI-INFO versão 6.03. A análise do banco de dados referentes a população entre 30 e 69 anos permitiu a elaboração de um estudo sobre a prevalência do DM e sua relação com outros fatores. Resultados: A prevalência do DM auto-referido foi de 4,2% (861 pessoas) e variou de 0,9% (76) entre 30 e 39 anos a 11,6% (297) entre 60 e 69 anos. 17,1% (147) relataram não tratar ou tratar irregularmente. Nos homens, a idade não interferiu no tratamento; nas mulheres, quanto menor a faixa etária, menor a adesão ao tratamento. O DM estava relacionado com outros agravos à saúde: cardiopatia (r=4,8), hipertensão arterial sistêmica (r=4,7), cegueira (r=3,1) e incapacidade de locomoção (r=3,9). Conclusão: A prevalência do DM auto-referido foi semelhante a de outros estudos nacionais. O índice de diabéticos com tratamento irregular foi muito alto e relaciona-se com baixa renda e faixas etárias mais jovens no sexo feminino. O DM apresentou alta correlação com outros agravos à saúde: cardiopatia, hipertensão arterial sistêmica, cegueira e incapacidade de locomoção.
Background: by using data from Juiz de Fora's Family Health Program survey, we aimed to assess the epidemiological profile of Diabetes Mellitus (DM) in an urban area in Juiz de Fora, MG, Brazil. Methodology: The source of information was a questionnaire, prepared according to the Primary Health Care Advancement Management Program, for the 12,695 homes visited. 180 students were selected from health courses to make the interviews, after having undergone a methodological training. Data obtained were organized using the software EPI-INFO 6.03 (WHO). Data bank analysis for the population between 30 and 69 years of age has led to the extensive study of DM prevalence and its association with other diseases. Results: Prevalence of self-reported DM was 4.2% (n=861) in general population, reaching 11.6%(n=297) of those between 60 and 69 years old and only 0,9% (n=76) among those between 30 and 39 years old. Irregular or no treatment was reported by 147 diabetics (17.1%). Among men, age did not interfere with compliance; for women there was a correlation between age and adherence to treatment. Other health disturbances were significantly associated with DM: cardiopathy (r=4.8), hypertension (r=4.7), blindness (r=3.1) and walking disabilities (r=3.9). Conclusions: Self-reported DM prevalence was similar to other national surveys. The high prevalence of non-adherence to treatment was significantly associated with low income and younger age in female gender. There was...

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