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      Combined association of insufficient physical activity and sleep problems with healthcare costs: a longitudinal study

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          ABSTRACT

          BACKGROUND:

          The magnitude of economic losses attributed to sleep problems and insufficient physical activity (PA) remains unclear. This study aimed to investigate the association between insufficient PA, sleep problems, and direct healthcare costs.

          OBJECTIVE:

          To investigate the association between insufficient physical activity (PA), sleep problems, and direct healthcare costs among adults.

          DESIGN AND SETTING:

          Adults aged ≥ 50 years attended by the Brazilian National Health Service were tracked from 2010 to 2014.

          METHODS:

          Direct healthcare costs were assessed using medical records and expressed in US$. Insufficient PA and sleep problems were assessed through face-to-face interviews. Differences were identified using the analysis of covariance and variance for repeated measures.

          RESULTS:

          In total, 454 women and 166 men were enrolled. Sleep problems were reported by 28.9% (95%CI: 25.2% to 32.4%) of the sample, while insufficient PA was reported by 84.8% (95%CI: 82.1% to 87.6%). The combination of sleep problems and insufficient PA explained 2.3% of all healthcare costs spent on these patients from 2010 to 2014, which directly accounts for approximately US$ 4,765.01.

          CONCLUSION:

          The combination of sleep problems and insufficient PA plays an important role in increasing direct healthcare costs in adults. Public health stakeholders, policymakers, and health professionals can use these results to reinforce the need for strategies to improve sleep quality and increase PA, especially in nations that finance their National Health Systems.

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          Most cited references32

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          A short questionnaire for the measurement of habitual physical activity in epidemiological studies.

          The construct validity and the test-retest reliability of a self-administered questionnaire about habitual physical activity were investigated in young males (n = 139) and females (n = 167) in three age groups (20 to 22, 25 to 27, and 30 to 32 yr) in a Dutch population. By principal components analysis three conceptually meaningful factors were distinguished. They were interpreted as: 1) physical activity at work; 2) sport during leisure time; and 3) physical activity during leisure time excluding sport. Test-retest showed that the reliability of the three indices constructed from these factors was adequate. Further, it was found that level of education was inversely related to the work index, and positively related to the leisure-time index in both sexes. The subjective experience of work load was not related to the work index, but was inversely related to the sport index, and the leisure-time index in both sexes. The lean body mass was positively related the the work index, and the sport index in males, but was not related to the leisure-time index in either sex. These differences in the relationships support the subdivision of habitual physical activity into the three components mentioned above.
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            Sleep disturbances and chronic disease in older adults: results of the 2003 National Sleep Foundation Sleep in America Survey.

            To assess the association between sleep problems and chronic disease in older adults. Self-reported standardized questionnaire data from 1506 community-dwelling men and women aged 55-84 years in the continental United States who completed a 20-min telephone interview when contacted from lists of randomly selected telephone numbers. A majority of the participants (83%) reported one or more of 11 medical conditions and nearly one in four elderly respondents (age 65-84 years) had major comorbidity (i.e. four or more conditions). Depression, heart disease, bodily pain and memory problems were associated with more prevalent symptoms of insomnia. Other conditions such as obesity, arthritis, diabetes, lung diseases, stroke and osteoporosis were associated with other sleep-related problems such as breathing pauses, snoring, daytime sleepiness, restless legs or insufficient sleep (<6 h nightly). Poll findings are consistent with epidemiological studies of sleep, aging and chronic disease. These results suggest that the sleep complaints common in older adults are often secondary to their comorbidities and not to aging per se. These types of studies may be useful in promoting sleep awareness among health professionals and among older adults, especially those with heart disease, depression, chronic bodily pain or major comorbidity.
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              A Tutorial on Interaction

              In this tutorial, we provide a broad introduction to the topic of interaction between the effects of exposures. We discuss interaction on both additive and multiplicative scales using risks, and we discuss their relation to statistical models (e.g. linear, log-linear, and logistic models). We discuss and evaluate arguments that have been made for using additive or multiplicative scales to assess interaction. We further discuss approaches to presenting interaction analyses, different mechanistic forms of interaction, when interaction is robust to unmeasured confounding, interaction for continuous outcomes, qualitative or “crossover” interactions, methods for attributing effects to interactions, case-only estimators of interaction, and power and sample size calculations for additive and multiplicative interaction.
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                Author and article information

                Contributors
                Role: curation (equal)Role: investigation (equal)Role: methodology (equal)Role: writing – original draft (equal)Role: writing – review and editing (equal)
                Role: formal analysis (equal)Role: investigation (equal)Role: methodology (equal)Role: project administration (equal)Role: writing – original draft (equal)Role: writing – review and editing (equal)
                Role: data curation (equal)Role: investigation (equal)Role: methodology (equal)Role: writing – original draft (equal)Role: writing – review and editing (equal)
                Role: conceptualization (equal)Role: data curationRole: formal analysisRole: investigationRole: methodologyRole: project administrationRole: resources (equal)Role: supervision (equal)Role: writing – original draftRole: writing – review and editing
                Role: conceptualization (equal)Role: formal analysisRole: investigationRole: methodologyRole: project administrationRole: writing – original draftRole: writing – review and editing
                Role: conceptualization (equal)Role: formal analysisRole: investigationRole: methodologyRole: validation (equal)Role: project administrationRole: writing – original draftRole: writing – review and editing
                Role: conceptualization (equal)Role: investigationRole: methodologyRole: project administrationRole: supervision (equal)Role: writing – original draftRole: writing – review and editing
                Journal
                Sao Paulo Med J
                Sao Paulo Med J
                spmj
                São Paulo Medical Journal
                Associação Paulista de Medicina - APM
                1516-3180
                1806-9460
                17 June 2024
                2024
                : 142
                : 6
                : e2023241
                Affiliations
                [I ]Student, Department of Physical Education, Laboratory of InVestigation in Exercise (LIVE), Universidade Estadual Paulista (UNESP), Presidente Prudente (SP), Brazil.
                [II ]Assistant Professor, Physiotherapy Department, Universidade Estadual Paulista (UNESP), Presidente Prudente (SP), Brazil; Assistant Professor, Physiotherapy Department, Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), São Paulo (SP), Brazil.
                [8]Faculdade Israelita de Ciências da Saúde Albert Einstein, Physiotherapy Department, São Paulo, SP, Brazil
                [III ]Student, Laboratory of InVestigation in Exercise (LIVE), Department of Physical Education, Universidade Estadual Paulista (UNESP), Presidente Prudente (SP), Brazil.
                [IV ]Assistant Professor, Department of Physical Education, Universidade Estadual Paulista (UNESP), Bauru (SP), Brazil.
                [V ]Assistant Professor, Physical Education and Exercise Science Department, Lander University, Greenwood, United States.
                [VI ]Associate Professor, Laboratory of InVestigation in Exercise – LIVE, Department of Physical Education, Universidade Estadual Paulista (UNESP), Presidente Prudente (SP), Brazil.
                [VII ]Assistant Professor, Laboratory of InVestigation in Exercise – LIVE, Department of Physical Education, Universidade Estadual Paulista (UNESP), Presidente Prudente (SP), Brazil.
                Author notes
                Address for correspondence: Ítalo Ribeiro Lemes Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista (UNESP) Rua Roberto Simonsen, 305 - Centro Educacional CEP 19060-900 - Presidente Prudente (SP), Brasil. Tel.: (18) 3229-5388 - Ramal 5555 E-mail: itolemes@ 123456hotmail.com

                Conflicts of interests: None

                Editor responsible for the evaluation process:

                Paulo Manuel Pêgo-Fernandes, MD, PhD

                Author information
                https://orcid.org/0000-0003-2313-993X
                https://orcid.org/0000-0001-9245-287X
                https://orcid.org/0000-0003-0960-4954
                https://orcid.org/0000-0001-6639-1532
                https://orcid.org/0000-0002-1314-6258
                https://orcid.org/0000-0003-1576-8090
                https://orcid.org/0000-0003-4273-9375
                Article
                00201
                10.1590/1516-3180.2023.0241.R2.25032024
                11185864
                38896745
                63f99d50-f428-4154-b2d2-9d564178e9ac

                This is an open-access article distributed under the terms of the Creative Commons Attribution License

                History
                : 10 July 2023
                : 26 February 2023
                : 25 March 2024
                Page count
                Figures: 2, Tables: 2, Equations: 0, References: 26
                Funding
                Funded by: Fundação de Amparo à Pesquisa do Estado de São Paulo
                Award ID: 2015/17777-3 2016/11140-6
                Categories
                Original Article

                exercise,health care cost,sleep,public health,lifestyle,observational

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