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Matiollo C, Rateke ECDM, Moura EQDA, Andrigueti M, Augustinho FCD, Zocche TL, Silva TE, Gomes LO, Farias MR, Narciso-Schiavon JL, Schiavon LL. Elevated calprotectin levels are associated with mortality in patients with acute decompensation of liver cirrhosis. World J Hepatol 2022; 14:1964-1976. [PMID: 36483607 PMCID: PMC9724106 DOI: 10.4254/wjh.v14.i11.1964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/18/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Acute decompensation (AD) of cirrhosis is related to systemic inflammation and elevated circulating cytokines. In this context, biomarkers of inflammation, such as calprotectin, may be of prognostic value.
AIM To evaluate serum calprotectin levels in patients hospitalized for complications of cirrhosis.
METHODS This is a prospective cohort study that included 200 subjects hospitalized for complications of cirrhosis, 20 outpatients with stable cirrhosis, and 20 healthy controls. Serum calprotectin was measured by enzyme-linked immunosorbant assay.
RESULTS Calprotectin levels were higher among groups with cirrhosis when compared to healthy controls. Higher median calprotectin was related to Child-Pugh C, ascites, and hepatic encephalopathy. Higher calprotectin was related to acute-on-chronic liver failure (ACLF) and infection in the bivariate, but not in multivariate analysis. Calprotectin was not associated with survival among patients with ACLF; however, in patients with AD without ACLF, higher calprotectin was associated with a lower 30-d survival, even after adjustment for chronic liver failure-consortium (CLIF-C) AD score. A high-risk group (CLIF-C AD score ≥ 60 and calprotectin ≥ 580 ng/mL) was identified, which had a 30-d survival (27.3%) similar to that of patients with grade 3 ACLF (23.3%).
CONCLUSION Serum calprotectin is associated with prognosis in patients with AD without ACLF and may be useful in clinical practice to early identify patients with a very low short-term survival.
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Affiliation(s)
- Camila Matiollo
- Clinical Analysis Laboratory Unit, University Hospital, Federal University of Santa Catarina, Florianopolis 88040-900, Brazil
| | | | | | - Michelle Andrigueti
- Clinical Analysis Laboratory Unit, University Hospital, Federal University of Santa Catarina, Florianopolis 88040-900, Brazil
| | | | - Tamara Liana Zocche
- Division of Gastroenterology, University Hospital, Federal University of Santa Catarina, Florianópolis 88040-900, Brazil
| | - Telma Erotides Silva
- Division of Gastroenterology, University Hospital, Federal University of Santa Catarina, Florianópolis 88040-900, Brazil
| | - Lenyta Oliveira Gomes
- Department of Pharmaceutical Sciences Health Sciences Center, Federal University of Santa Catarina, Florianópolis 88040-370, Brazil
| | - Mareni Rocha Farias
- Department of Pharmaceutical Sciences Health Sciences Center, Federal University of Santa Catarina, Florianópolis 88040-370, Brazil
| | - Janaina Luz Narciso-Schiavon
- Division of Gastroenterology, Department of Internal Medicine, Federal University of Santa Catarina, Florianopolis 88040-900, SC, Brazil
| | - Leonardo Lucca Schiavon
- Division of Gastroenterology, Department of Internal Medicine, Federal University of Santa Catarina, Florianopolis 88040-900, SC, Brazil
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Freire MDBO, Da Silva BGC, Bertoldi AD, Fontanella AT, Mengue SS, Ramos LR, Tavares NUL, Pizzol TDSD, Arrais PSD, Farias MR, Luiza VL, Oliveira MA, Menezes AMB. Benzodiazepines utilization in Brazilian older adults: a population-based study. Rev Saude Publica 2022; 56:10. [PMID: 35319670 PMCID: PMC8926397 DOI: 10.11606/s1518-8787.2022056003740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/04/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To evaluate the utilization of benzodiazepines (BZD) in Brazilian older adults, based on the Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - National Survey of Access, Use and Promotion of Rational Use of Medicines). METHODS The PNAUM is a cross-sectional study conducted between 2013 and 2014, representing the Brazilian urban population. In the present study, we included 60 years or older (n = 9,019) individuals. We calculated the prevalence of BZD utilization in the 15 days prior to survey data collection according to independent variables, using a hierarchical Poisson regression model. A semistructured interview performed empirical data collection (household interview). RESULTS The prevalence of BZD utilization in the older adults was 9.3% (95%CI: 8.3–10.4). After adjustments, BZD utilization was associated with female sex (PR = 1.88; 95%CI: 1.52–2.32), depression (PR = 5.31; 95%CI: 4.41–6, 38), multimorbidity (PR = 1.44; 95%CI: 1.20–1.73), emergency room visit or hospitalization in the last 12 months (PR = 1.42; 95%CI: 1.18–1.70 ), polypharmacy (PR = 1.26; 95%CI: 1.01–1.57) and poor or very poor self-rated health (PR = 4.16; 95%CI: 2.10–8.22). Utilization was lower in the North region (PR = 0.18; 95%CI: 0.13–0.27) and in individuals who reported abusive alcohol consumption in the last month (PR = 0.42; 95%CI: 0.19–0.94). CONCLUSION Despite contraindications, results showed a high prevalence of BZD utilization in older adults, particularly in those with depression, and wide regional and sex differences.
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Affiliation(s)
- Marina de Borba Oliveira Freire
- Universidade Federal de Pelotas . Faculdade de Medicina . Programa de Pós-Graduação em Epidemiologia . Pelotas , RS , Brasil
| | | | - Andréa Dâmaso Bertoldi
- Universidade Federal de Pelotas . Faculdade de Medicina . Departamento de Medicina Social . Pelotas , RS , Brasil
| | - Andréia Turmina Fontanella
- Universidade Federal do Rio Grande do Sul . Faculdade de Medicina . Programa de Pós-Graduação em Epidemiologia . Porto Alegre , RS , Brasil
| | - Sotero Serrate Mengue
- Universidade Federal do Rio Grande do Sul . Faculdade de Medicina . Programa de Pós-Graduação em Epidemiologia . Porto Alegre , RS , Brasil
| | - Luiz Roberto Ramos
- Universidade Federal de São Paulo . Escola Paulista de Medicina . Departamento de Medicina Preventiva . São Paulo , SP , Brasil
| | - Noemia Urruth Leão Tavares
- Universidade de Brasília . Faculdade de Ciências da Saúde . Departamento de Farmácia . Brasília , DF , Brasil
| | - Tatiane da Silva Dal Pizzol
- Universidade Federal do Rio Grande do Sul . Faculdade de Farmácia . Departamento de Produção e Controle de Medicamentos . Porto Alegre , RS , Brasil
| | - Paulo Sérgio Dourado Arrais
- Universidade Federal do Ceará . Faculdade de Farmácia, Odontologia e Enfermagem . Departamento de Farmácia . Fortaleza , CE , Brasil
| | - Mareni Rocha Farias
- Universidade Federal de Santa Catarina . Centro de Ciências da Saúde . Departamento de Ciências Farmacêuticas . Florianópolis , SC , Brasil
| | - Vera Lucia Luiza
- Fundação Oswaldo Cruz . Escola Nacional de Saúde Pública Sergio Arouca . Departamento de Política de Medicamentos e Assistência Farmacêutica . Rio de Janeiro , RJ , Brasil
| | - Maria Auxiliadora Oliveira
- Fundação Oswaldo Cruz . Escola Nacional de Saúde Pública Sergio Arouca . Departamento de Política de Medicamentos e Assistência Farmacêutica . Rio de Janeiro , RJ , Brasil
| | - Ana Maria Baptista Menezes
- Universidade Federal de Pelotas . Faculdade de Medicina . Departamento de Medicina Social . Pelotas , RS , Brasil
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Rech N, Farias MR. Health regulation and technological development: innovative strategies for accessing medicines in the SUS. Cien Saude Colet 2021; 26:5427-5440. [PMID: 34852080 DOI: 10.1590/1413-812320212611.03512021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/02/2021] [Indexed: 11/21/2022] Open
Abstract
Regulatory science involves articulating knowledge that can establish the scientific bases for the definition of adequate and efficient regulatory mechanisms and practices. The interfaces between systemic and sectoral health and technological development policies were studied based on documentary analysis, especially from the National Pharmaceutical Policy (PNAF), with impacts on health regulation and stimulating the production of medicines of interest to the Unified Health System (SUS). The initiatives for the nationalized production of ARV "Efavirenz", which was the subject of a compulsory license in 2007, and the establishment of Partnerships for Productive Development (PDP), contributed to defining innovative regulatory frameworks and practices, emphasizing the Regulatory Technical Committees (CTR) for monitoring the internalization of technologies and health registration of the resulting products. The permeation capacity of the principles and strategic axes of the PNAF was identified in the sectoral policies that were analyzed. As of 2014, no macro or sectoral policies on expanding access to medicines in the SUS with impacts on regulations were identified.
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Affiliation(s)
- Norberto Rech
- Departamento de Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina. Campus Universitário Trindade Sala 72, Trindade. 88010-970 Florianópolis SC Brasil.
| | - Mareni Rocha Farias
- Departamento de Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina. Campus Universitário Trindade Sala 72, Trindade. 88010-970 Florianópolis SC Brasil.
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Peres KC, Buendgens FB, Prates EA, Bonetti NR, Soares L, Vargas-Peláez CM, Farias MR. Vaccines in Brazil: historical analysis of the Sanitary registration and vaccine availability in the Brazilian Unified Health System. Cien Saude Colet 2021; 26:5509-5522. [PMID: 34852086 DOI: 10.1590/1413-812320212611.13932021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 07/07/2021] [Indexed: 11/22/2022] Open
Abstract
Given the COVID-19 pandemic and the importance of public social protection policies, health issues, including immunizations, have gained prominence. This paper aims to analyze the dynamics of vaccine registration in Brazil and the vaccines made available through the National Immunization Program (PNI in Portuguese), with emphasis on the 2004-2018 vaccination schedule. This descriptive, exploratory, documentary research analyzed vaccine registration procedureswith the Brazilian Health Regulatory Agency (ANVISA, in Portuguese) and the incorporation of vaccine products into the PNI. The study drew on information from the national sanitary registration database, made available by ANVISA; a document analysis of official/normative publications; and data from published literature. The data shows the incorporation of vaccines into the PNI, evidencing that Brazil is a country with industrial potential for vaccine production but that is still focused on the transfer of technologies and in need of public attention and investments for developing new technologies as a way to ensure the sector's independence.
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Affiliation(s)
- Kaite Cristiane Peres
- Centro de Ciências da Saúde, Universidade Federal de Santa Catarina. R. Delfino Conti S/N Trindade, 88040-370. Florianópolis SC Brasil.
| | | | | | - Norberto Rech Bonetti
- Centro de Ciências da Saúde, Universidade Federal de Santa Catarina. R. Delfino Conti S/N Trindade, 88040-370. Florianópolis SC Brasil.
| | - Luciano Soares
- Universidade da Região de Joinville. Joinville SC Brasil
| | | | - Mareni Rocha Farias
- Centro de Ciências da Saúde, Universidade Federal de Santa Catarina. R. Delfino Conti S/N Trindade, 88040-370. Florianópolis SC Brasil.
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5
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Rover MRM, Faraco EB, Vargas-Peláez CM, Colussi CF, Storpirtis S, Farias MR, Leite SN. Access to high-priced medicines: inequalities in the organization and the results among Brazilian states. Cien Saude Colet 2021; 26:5499-5508. [PMID: 34852085 DOI: 10.1590/1413-812320212611.27402020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/26/2020] [Indexed: 11/22/2022] Open
Abstract
This case study aimed to characterize the Specialized Component of Pharmaceutical Services (CEAF) organization in four Brazilian states from diverse regions of the country. Data were collected with representatives of CEAF management from states in different regions, who answered a 21-question questionnaire on scope, organization, financing, hurdles, and facilitators. This information was complemented with data from national health surveys, DataSUS, the applied resources, and socioeconomic indicators. Differences were observed between states on issues such as the proportion of users and the decentralization of services. These characteristics seem to be related to the level of development concerning the socioeconomic indicators used. Advances in access to medicines were highlighted, despite the difficulties complying with the CEAF's objectives, such as insufficient resources, the qualification of human resources, and the provision of necessary visits and exams. The results point to advances, different forms of organization and highlight the need for more in-depth studies on the clinical and economic outcomes achieved as a strategy to outline solutions to achieve the comprehensive and equal care for users.
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Affiliation(s)
- Marina Raijche Mattozo Rover
- Departamento de Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina. R. Delfino Conti S/N, Trindade, 88040-370. Florianópolis SC Brasil.
| | - Emília Baierle Faraco
- Grupo de Pesquisa em Políticas e Serviços Farmacêuticos, Universidade Federal de Santa Catarina. Florianópolis SC Brasil
| | | | - Claudia Flemming Colussi
- Departamento de Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina. R. Delfino Conti S/N, Trindade, 88040-370. Florianópolis SC Brasil.
| | - Sílvia Storpirtis
- Departamento de Farmácia, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo
| | - Mareni Rocha Farias
- Departamento de Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina. R. Delfino Conti S/N, Trindade, 88040-370. Florianópolis SC Brasil.
| | - Silvana Nair Leite
- Departamento de Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina. R. Delfino Conti S/N, Trindade, 88040-370. Florianópolis SC Brasil.
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Farias MR, Leite SN, Rech N, Bermudez JAZ. Access to medicines: from intellectual property through to the incorporation into the health systems. Cien Saude Colet 2021; 26:5398. [PMID: 34852077 DOI: 10.1590/1413-812320212611.17992021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Mareni Rocha Farias
- Programa de Pós-Graduação em Assistência Farmacêutica, Associação de Instituições de Ensino Superior, Universidade Federal de Santa Catarina. Florianópolis SC Brasil
| | - Silvana Nair Leite
- Programa de Pós-Graduação em Assistência Farmacêutica, Associação de Instituições de Ensino Superior, Universidade Federal de Santa Catarina. Florianópolis SC Brasil
| | - Norberto Rech
- Programa de Pós-Graduação em Assistência Farmacêutica, Associação de Instituições de Ensino Superior, Universidade Federal de Santa Catarina. Florianópolis SC Brasil
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Moura E, Daltro SRT, Sás DM, Engracia Filho JR, Farias MR, Pimpão CT. Genetic analysis of a possible case of canine X-linked ectodermal dysplasia. J Small Anim Pract 2021; 62:1127-1130. [PMID: 34076266 DOI: 10.1111/jsap.13385] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 04/07/2021] [Accepted: 05/16/2021] [Indexed: 11/30/2022]
Abstract
In the present report, we describe targeted next-generation sequencing of the EDA gene of a male poodle with a clinical and histopathological diagnosis of X-linked hypohidrotic ectodermal dysplasia. The result was compared with the reference sequence and with the result of the sequencing of a normal dog's EDA gene. No point variant, small deletion or insertion were found in the exons and splice sites, but a transition and a transversion were found in the intron 6' and 3' UTR, respectively. The cause of the dysplasia of the affected dog in this study is neither a point variant nor a small deletion or insertion in the exons and splice sites of the EDA gene. Therefore, patients with phenotype of XLHED may have other types of variants in the EDA gene or variants in other genes of the EDA signalling pathway.
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Affiliation(s)
- E Moura
- Service of Medical Genetics, Course of Veterinary Medicine, School of Life Sciences, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil
| | - S R T Daltro
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - D M Sás
- Genotyping - Diagnósticos Genéticos, Botucatu, São Paulo, Brazil
| | - J R Engracia Filho
- Graduate Program in Animal Science, School of Life Sciences, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil
| | - M R Farias
- Graduate Program in Animal Science, School of Life Sciences, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil
| | - C T Pimpão
- Graduate Program in Animal Science, School of Life Sciences, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil
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Manzini F, Diehl EE, Farias MR, Dos Santos RI, Soares L, Rech N, Lorenzoni AA, Leite SN. Analysis of a Blended, In-Service, Continuing Education Course in a Public Health System: Lessons for Education Providers and Healthcare Managers. Front Public Health 2020; 8:561238. [PMID: 33324594 PMCID: PMC7725868 DOI: 10.3389/fpubh.2020.561238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 11/03/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction: To train pharmacists working in the public health system, the Brazilian Ministry of Health developed a specialization course called Pharmaceutical Service and Access to Medicine Management (PSAMM) between 2010 and 2016. The course was free of charge and used e-learning as its main approach. In the end, 2,500 pharmacists were trained. The purpose of this study was to identify and analyze the strengths, weaknesses, opportunities, and threats of an in-service and e-learning course for pharmacists working in a public health system. Materials and Methods: Three workshops involving 67 participants were conducted at the conclusion of the course to analyze the perspective of the PSAMM course's faculty (tutors, regional coordinators, professors, and management committee) and students (pharmacists). Strengths, weaknesses, opportunities, and threats analysis and qualitative analysis methods were used. Results and Discussion: The strength dimension had the greatest number of items. The qualitative analysis resulted in six categories: the category “E-learning in continuing education” had the most cited items. Internal elements such as in-service hands-on activities directly related to the professionals' roles, course contents, faculty, and the methods to offer the course (the mixed methods and materials) were positively assessed. Nonetheless, external elements were considered critical for the course's outcomes such as investments in the infrastructure of pharmaceutical services, access to the internet, local managers' support for continuing education and innovation implementation, practice of interprofessional collaboration, and political stability. The continuing education course in the public health system was affected by internal elements such as its project and structure as well as external elements such as the sociopolitical scenario. Continuing education investment must be accompanied by infrastructure investment and coordination of services.
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Affiliation(s)
- Fernanda Manzini
- Postgraduate Program in Pharmacy, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Eliana Elisabeth Diehl
- Department of Pharmacy Sciences, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Mareni Rocha Farias
- Postgraduate Program in Pharmacy, Federal University of Santa Catarina, Florianópolis, Brazil.,Department of Pharmacy Sciences, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | - Luciano Soares
- Department of Pharmacy Sciences, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Norberto Rech
- Postgraduate Program in Pharmacy, Federal University of Santa Catarina, Florianópolis, Brazil.,Department of Pharmacy Sciences, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | - Silvana Nair Leite
- Postgraduate Program in Pharmacy, Federal University of Santa Catarina, Florianópolis, Brazil.,Department of Pharmacy Sciences, Federal University of Santa Catarina, Florianópolis, Brazil
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Costa KS, Zaccolo AV, Tavares NUL, Arrais PSD, Luiza VL, Oliveira MA, Mengue SS, Bertoldi AD, Ramos LR, Farias MR, Pizzol TDSD. Avaliação dos usuários sobre as farmácias públicas no Brasil. Ciênc saúde coletiva 2020; 25:3163-3174. [DOI: 10.1590/1413-81232020258.00202018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 11/27/2018] [Indexed: 11/21/2022] Open
Abstract
Resumo O objetivo deste artigo é avaliar aspectos relacionados aos serviços prestados nas farmácias do SUS do Brasil, segundo a percepção dos usuários. Utilizou-se dados da Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos, realizada entre 2013 e 2014. Analisou-se indivíduos que obtiveram algum medicamento nas farmácias públicas. Para o cálculo das estimativas de prevalências, foi usado como denominador o total de usuários de medicamentos com IC95%. A partir da faixa etária de 20 a 24 anos até 60 a 64 anos observa-se diferenças significativas entre homens e mulheres, em relação ao uso de farmácias públicas. Mais de 30% das pessoas de todas as classes socioeconômica que não obtiveram medicamentos nas farmácias do SUS, nunca pensaram nessa possibilidade. Não costumam esperar para obtenção dos medicamentos e avaliação positiva do horário de funcionamento tiveram uma associação mais forte em relação a avaliação positiva dos usuários das farmácias do SUS. O horário de funcionamento e o tempo de espera são potenciais barreiras nas farmácias do SUS. A avaliação dos usuários que utilizam o SUS é positiva, mas aponta diferenças regionais e a identificação da magnitude dessas pode contribuir na formulação de políticas mais eficazes e equânimes.
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Schwambach KH, Farias MR, Neto GB, Blatt CR. Cost and Effectiveness of the Treatment of Chronic Hepatitis C in Brazil: Real-World Data. Value Health Reg Issues 2020; 23:49-54. [PMID: 32702649 DOI: 10.1016/j.vhri.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 03/09/2020] [Accepted: 05/11/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To introduce and discuss the cost and effectiveness of using sofosbuvir, daclatasvir, and simeprevir antivirals, in combination or not with peginterferon alfa and ribavirin, for the treatment of hepatitis C, as based on real-world data. METHODS We analyzed the treatment and outcomes of 253 patients from a retrospective cohort held in a specialized assistance service in the municipality of Porto Alegre, Brazil. Regarding costs, we considered only the direct costs of the antiviral medications per unit (pills), according to the financial receipts of the public procurements. We calculated the total cost of treatment per individual and the cost per cure expressed in sustained virologic response (SVR). RESULTS Most patients (66.8%) were carriers of the genotype 1 of hepatitis, and 92.9% reached the SVR. The average cost of the treatment for genotype-1 patients was $5,862.31 USD per patient and $6,310.34 for the cure; for genotype-3 patients, on the other hand, the cost was $5,144.27 per patient and $5,974.76 for the cure. The drugs purchasing cost was around 40% less than was estimated for the process of incorporating them into the public health system. CONCLUSION The results indicated that good rates of effectiveness were achieved with different combinations of the medicines. The costs of the medicines were still deemed too high for the Brazilian reality, however. Therefore the results contribute to support the formulation and review of public policies based on strong evidence and on real-world data for the treatment of hepatitis C.
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Affiliation(s)
- Karin Hepp Schwambach
- Graduate Program in Medicine Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil.
| | - Mareni Rocha Farias
- Graduate Program of Pharmacy, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | - Carine Raquel Blatt
- Graduate Program in Medicine Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
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Arrais PSD, Vianna MPDN, Zaccolo AV, Moreira LIM, Thé PMP, Quidute ARP, Fontanella AT, Pizzol TDSD, Tavares NUL, Oliveira MA, Luiza VL, Ramos LR, Farias MR, Bertoldi AD, Mengue SS. [Use of artificial sweeteners in Brazil: a household survey approach]. CAD SAUDE PUBLICA 2019; 35:e00010719. [PMID: 31691774 DOI: 10.1590/0102-311x00010719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 09/03/2019] [Indexed: 11/22/2022] Open
Abstract
The objective was to estimate the prevalence of artificial sweetener use by the adult Brazilian population and users' characteristics. Analysis of data from the Brazilian National Survey on Access, Utilization, and Promotion of Rational Use of Medicines (PNAUM, 2014), a nationwide population-based survey. The target outcome was self-reported use of sweeteners by Brazilians 20 years and older. The independent variables were sex, age, major geographic region of Brazil, schooling in complete years, and economic status according to the Brazilian Economic Classification Criterion of the Brazilian Association of Research Companies (ABEP). The health condition indicators were: self-reported noncommunicable diseases (NCDs), number of NCDs, and body mass index (BMI). Prevalence of sweetener use in the Brazilian adult population was 13.4% (95%CI: 12.5-14.3), and it was higher in females and in persons 60 years or older, in the Northeast and Southeast, among individuals from economic classes A and B, and among obese individuals. Persons with chronic diseases (especially diabetes) showed the highest prevalence of use of sweeteners, and their use increased with the number of reported comorbidities. Prevalence of use of artificial sweeteners was 13.4% and was associated with sociodemographic and health characteristics.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Vera Lucia Luiza
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Foppa AA, Oliveira Gomes L, Raijche Mattozo Rover M, Dos Santos RI, Rocha Farias M, Leite SN. Teaching and Learning Pharmacy Services: A Teaching Method for Developing Competencies for Patient-Centered Care Through Experiential Learning in a Real Workplace. J Pharm Pract 2019; 34:89-96. [PMID: 31242799 DOI: 10.1177/0897190019854573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Considering the transformation process that has been occurring in pharmacy education and the urgent need to address social health needs, proposals of teaching methods for the development of competences and skills in patient-centered care have become an issue worth discussing. The study describes and discusses the method that has been used for developing of these competencies through experiential learning in a university pharmacy in Brazil. EDUCATIONAL ACTIVITY The Teaching and Learning of Pharmacy Services (TLPS) method encompasses 2 components: theoretical-reflexive one (developing protocols covering the patient care process) and practical-reflexive one (using the protocols with real patients). TLPS connects the 2 components in a way to enable students to acquire and apply theoretical knowledge for a comprehensive assessment of the patients' needs and understand how clinical reasoning and decision-making take place. The assessment process is performed, by the supervisor, which evaluates the behaviors necessary for good professional performance. DISCUSSION The active learning methodologies have been effectively used in the classroom as a way to stimulate critical thinking, problem-solving, and clinical reasoning. However, experiential learning is considered a central point in the learning process and essential for knowledge building. Thus, the method herein described is shown as an innovative tool to promote self-learning, consolidation and interrelation of the acquired knowledge, easier identification of patients' needs, normalization of behaviors, and improvement in the quality of care.
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Affiliation(s)
- Aline Aparecida Foppa
- Department of Pharmaceutical Sciences, Health and Science Center, 28117UFSC, Florianópolis, Brazil
| | - Lenyta Oliveira Gomes
- Department of Pharmaceutical Sciences, Health and Science Center, 28117UFSC, Florianópolis, Brazil
| | | | - Rosana Isabel Dos Santos
- Department of Pharmaceutical Sciences, Health and Science Center, 28117UFSC, Florianópolis, Brazil
| | - Mareni Rocha Farias
- Department of Pharmaceutical Sciences, Health and Science Center, 28117UFSC, Florianópolis, Brazil
| | - Silvana Nair Leite
- Department of Pharmaceutical Sciences, Health and Science Center, 28117UFSC, Florianópolis, Brazil
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Pizzol TDSD, Moraes CG, Arrais PSD, Bertoldi AD, Ramos LR, Farias MR, Oliveira MA, Tavares NUL, Luiza VL, Mengue SS. Medicine package inserts from the users' perspective: are they read and understood? Rev Bras Epidemiol 2019; 22:e190009. [PMID: 30892472 DOI: 10.1590/1980-549720190009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 12/01/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The written information on medicines has been acknowledged as an important tool for health education. OBJECTIVE To analyze the use and understanding of medicine package inserts by users and assess sociodemographic and medical factors associated with their comprehension. METHOD Data in this analysis are part of the PNAUM National Survey - a cross-sectional population-based study conducted in Brazil. Descriptive statistics and the Pearson χ2 tests were performed to compare proportions between sociodemographic and medical characteristics, as well as use and understanding of medicine package inserts. RESULTS A total of 28.427 individuals responded to questions related to medicine package inserts. From these, 59.6% (95%CI 57.7 - 61.5) said they usually read the inserts, and 98.4% (95%CI 98.0 - 98.8) considered them necessary. Among people who read the medicine package inserts, more than half indicated difficulties with legibility (57.4%; 95%CI 55,2 - 59,6) and readability (54.1%; 95%CI 52.1 - 56.1). People from a lower education level reported greater difficulty in understanding them. CONCLUSION The larger portion of the population usually read medicine package inserts. Nevertheless, people have difficulty in reading and understanding them.
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Affiliation(s)
- Tatiane da Silva Dal Pizzol
- Medicines Production and Control Department, Pharmacy College and Post Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul - Porto Alegre, RS, Brazil
| | | | - Paulo Sérgio Dourado Arrais
- Pharmacy Department, Pharmacy, Odontology and Nursering College, Universidade Federal do Ceará - Fortaleza,CE, Brazil
| | - Andréa Dâmaso Bertoldi
- Social Medicine Department. Medicine College, Universidade Federal de Pelotas - Pelotas, RS, Brazil
| | - Luiz Roberto Ramos
- Preventive Medicine Department, Escola Paulista de Medicina, Universidade Federal de São Paulo - São Paulo, SP, Brazil
| | - Mareni Rocha Farias
- Pharmaceutical Sciences Department, Health Sciences Center, Universidade Federal de Santa Catarina - Florianópolis, SC, Brazil
| | | | | | - Vera Lucia Luiza
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz - Rio de Janeiro, RJ, Brazil
| | - Sotero Serrate Mengue
- Post Graduate Program in Epidemiology of Universidade Federal do Rio Grande do Sul - Porto Alegre, RS, Brazil
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Gomes LO, Teixeira MR, Rosa JAD, Foppa AA, Rover MRM, Farias MR. The benefits of a public pharmacist service in chronic hepattis C treatment: The real-life results of sofosbuvir-based therapy. Res Social Adm Pharm 2019; 16:48-53. [PMID: 30853508 DOI: 10.1016/j.sapharm.2019.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/24/2018] [Accepted: 02/16/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND In Brazil, the sofosbuvir-based therapy was introduced in the public health system (SUS) in 2015 to treat Chronic Hepatitis C (CHC). This drug and other direct-acting antiviral agents (DAAs) represent a major advance in the HCV-infection treatment due to their high effectiveness and tolerability. However, the drug safety profile is limited by significant drug interactions and its use is restricted for their high cost. Pharmacists have the opportunity to improve patient care by monitoring the therapy, recommending strategies to guarantee treatment adherence, effectiveness and safety, preventing complications of the disease, and drug-related problems, thus reducing the cost for patients and payers. OBJECTIVE This study aimed to assess the results of the one of the first patient group treated with sofosbuvir in Brazil and their opinions about the benefits of clinical pharmacist services in the achievement of the cure for CHC and in the management of their therapy difficulties. METHODS This cohort study (November 2015-January 2017) enrolled 240 patients followed up by the clinical pharmacists at the University Pharmacy (UPh) of the Federal University of Santa Catarina, Brazil, during the CHC treatment. The therapeutic schemes used were sofosbuvir + daclatasvir or + simeprevir associated or not with ribavirin. At the end of the therapy, the patients provided qualitative feedback about the clinical pharmacist services. RESULTS The study demonstrated high levels of treatment adherence (99.2% of completion rates) and effectiveness rates (Sustained Virological Response rates) (92.1%). Patients reported high levels of satisfaction with the care provided on account of the good rapport built with their pharmacist, the counseling and education on HCV-infection and on sofosbuvir-based therapy utilization, motivation for adherence, and convenient access to the pharmacist. CONCLUSIONS The clinical pharmacist services provided by the UPh was beneficial to patients treated for CHC with the sofosbuvir-based therapy.
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Affiliation(s)
- Lenyta Oliveira Gomes
- Department of Pharmaceutical Sciences, Health Sciences Center, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil.
| | - Marina Rodrigues Teixeira
- Department of Pharmaceutical Sciences, Health Sciences Center, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil.
| | - Júnior André da Rosa
- Department of Pharmaceutical Sciences, Health Sciences Center, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil.
| | - Aline Aparecida Foppa
- Department of Pharmaceutical Sciences, Health Sciences Center, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil.
| | - Marina Raijche Mattozo Rover
- Department of Pharmaceutical Sciences, Health Sciences Center, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil.
| | - Mareni Rocha Farias
- Department of Pharmaceutical Sciences, Health Sciences Center, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil.
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Gomes LO, Teixeira MR, Rosa JAD, Feltrin AA, Rodrigues JPV, Vecchi MD, Carneiro JMM, Noblat LDACB, Chachá SGF, Martinelli ADLC, Pereira LRL, Silveira MPT, Blatt CR, Farias MR. Hepatitis C in Brazil: lessons learned with boceprevir and telaprevir. Rev Inst Med Trop Sao Paulo 2018; 60:e29. [PMID: 29972466 PMCID: PMC6029893 DOI: 10.1590/s1678-9946201860029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/28/2018] [Indexed: 01/09/2023] Open
Abstract
In 2012, the first-generation protease inhibitors telaprevir (TVR) and boceprevir (BOC) were introduced in the Brazilian health system for treatment of chronic hepatitis C, after their approval by the National Committee for Health Technology Incorporation (CONITEC). However, these medicines were discontinued in 2015. The short period of use in therapy and their high cost require a discussion about the consequences for patients and for the health system of the early incorporation of new therapies. The article presents a qualitative analysis of the incorporation process of both medications in Brazil and the results of a multicenter study that included patients treated with BOC or TVR between January 2011 and December 2015 in five Brazilian cities. The study included 855 patients (BOC: n=247) and (TVR: n=608). The document analysis showed that CONITEC's decision to incorporate BOC and TVR was based on results of phase III clinical trials that compared sustained virologic response (SVR) rates of patients treated with BOC and TVR with rates of those that received placebo. However, these studies included a low percentage of cirrhotic patients. The SVR rates observed in this multicenter study were worse than clinical trials pointed out (BOC: 45.6%; TVR: 51.8%), but similar to those achieved with previously adopted therapies. The discontinuation rate due to adverse events was (BOC: 15.4%; TVR: 12.7%). Based on these unsatisfactory results, the study brings a discussion that goes beyond the therapy outcomes, exploring the incorporation of these high-cost medicines and the related decision-making process, contributing to future decisions in medicine policies and in the treatment of chronic hepatitis C.
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Affiliation(s)
- Lenyta Oliveira Gomes
- Departamento de Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Marina Rodrigues Teixeira
- Departamento de Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Júnior André da Rosa
- Departamento de Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | | | - João Paulo V Rodrigues
- Departamento de Ciências Farmacêuticas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Mariane D'Avila Vecchi
- Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | | | | | - Silvana Gama F Chachá
- Departamento de Medicina, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
| | - Ana de Lourdes C Martinelli
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Leonardo Regis L Pereira
- Departamento de Ciências Farmacêuticas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Marysabel Pinto T Silveira
- Departamento de Fisiologia e Farmacologia, Instituto de Biologia, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Carine Raquel Blatt
- Departamento de Farmacociências, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Mareni Rocha Farias
- Departamento de Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
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Foppa AA, Vargas-Peláez CM, Bagatini Buendgens F, Chemello C, Fleury Charmillot MP, Marin M, Seemann M, Rocha Farias M. Perceptions of Individuals with Parkinson’s Disease about Quality of Life. Rev Cienc salud 2018. [DOI: 10.12804/revistas.urosario.edu.co/revsalud/a.6769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Introducción: la enfermedad de Parkinson es una patología neurodegenerativa, que se mani esta por signos y síntomas motores y no motores, que comprometen la calidad de vida de los pacientes. El Parkinson Disease Questionnaire (pdq-39) es el instrumento más utilizado para evaluar la calidad de vida en pacientes con esta enfermedad. Los objetivos del trabajo fueron identificar los aspectos relacionados con la Calidad de Vida desde la perspectiva de los pacientes, compararlos con los aspectos considerados por el pdq-39 y describir las estrategias adoptadas por los pacientes para superar las di cultades. Materiales y métodos: estudio cualitativo, descriptivo. Se realizó un grupo focal con seis pacientes. Los datos fueron analizados usando el método de análisis de contenido. Resultados: aspectos relacionados a todos los dominios del pdq-39 fueron mencionados por los pacientes, destacándose aquellos relacionados con las limitaciones de la movilidad y el desarrollo de actividades diarias, y aspectos relacionados con el bienestar emocional. No obstante, algunos aspectos considerados en el dominio movilidad del pdq-39 no fueron mencionados, y fueron detectadas limitaciones del dominio bienestar emocional. Los pacientes diseñan diversas estrategias para superar las di cultades, en las que el soporte social es importante. Conclusión: conocer y re exionar sobre las percepciones de persona con Enfermedad de Parkinson so- bre su calidad de vida contribuye para la comprensión de la enfermedad y auxilia la propuesta de intervenciones clínicas adecuadas para lograr el cuidado integral. Se sugiere la revisión y adaptación del pdq-39 al contexto actual, los avances tecnológicos y de conocimientos sobre la Enfermedad de Parkinson.
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Rover MRM, Peláez CMV, Faraco EB, Farias MR, Leite SN. An evaluation of governance capacity of the specialized component of pharmaceutical services in Brazil. Cien Saude Colet 2018; 22:2487-2499. [PMID: 28793066 DOI: 10.1590/1413-81232017228.01602017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 04/20/2017] [Indexed: 11/22/2022] Open
Abstract
This paper presents application of an indicator protocol to assessment of current levels of governance capacity of the Specialized Component of Pharmaceutical Services (CEAF) in a state of the South of Brazil. We chose the theoretical referential of 'governance capacity' proposed by Carlos Matus, which reflects in the concepts of management capacity and pharmaceutical service management, due to the perception of a need to overcome the fragmentation and technicist reductionism that we believe has been imposed on the area of pharmaceutical services. Data was collected using the protocol in 74 municipal or state units. The results of the analysis indicate that the currently existing governance capacity needs improvement in all three dimensions that were evaluated, principally in relation to the aspects that seek sustainability of the governance. The model and the protocol used indicate a way forward for governance of pharmaceutical service by proposing a change from the technicist-logistical focus to an emphasis on strategic and political actions, or ones which foster greater participation and autonomy. With these results in hand, it will be possible to develop strategies for improvement of access to medicines in the SUS, in the sense that the CEAF becomes able to guarantee integrality of medicines treatments.
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Affiliation(s)
- Marina Raijche Mattozo Rover
- Departamento de Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina. Campus Universitário, Trindade. 88040-970 Florianópolis SC Brasil.
| | | | - Emília Baierle Faraco
- Departamento de Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina. Campus Universitário, Trindade. 88040-970 Florianópolis SC Brasil.
| | - Mareni Rocha Farias
- Departamento de Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina. Campus Universitário, Trindade. 88040-970 Florianópolis SC Brasil.
| | - Silvana Nair Leite
- Departamento de Ciências Farmacêuticas, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina. Campus Universitário, Trindade. 88040-970 Florianópolis SC Brasil.
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Sousa LAOD, Fonteles MMDF, Monteiro MP, Mengue SS, Bertoldi AD, Pizzol TDSD, Tavares NUL, Oliveira MA, Luiza VL, Ramos LR, Farias MR, Arrais PSD. Prevalence and characteristics of adverse drug events in Brazil. CAD SAUDE PUBLICA 2018; 34:e00040017. [PMID: 29617479 DOI: 10.1590/0102-311x00040017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 10/02/2017] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to describe the prevalence of adverse drug events (ADEs) and associated factors reported by users of medicines in Brazil. This was a cross-sectional population-based study conducted from September 2013 to February 2014 with data from the Brazilian National Survey on Access, Use, and Promotion of Rational Use of Medicines (PNAUM). The study included all individuals that reported the use of medicines and identified, among them, all those reporting at least one problem with the medicine's use. A descriptive analysis was performed to estimate ADE prevalence and 95% confidence intervals (95%CI) among the target variables. Crude and adjusted prevalence ratios were calculated using Poisson regression to investigate factors associated with ADEs. Overall ADE prevalence in Brazil was 6.6% (95%CI: 5.89-7.41), and after multivariate analysis, higher prevalence was associated with female gender, residence in the Central and Northeast regions, consumption of more medicines, "bad" self-rated health, and self-medication. The drugs most frequently reported with ADEs were fluoxetine, diclofenac, and amitriptyline. The most frequent ADEs were somnolence, epigastric pain, and nausea. Most reported ADEs were mild, avoidable, and associated with medicines used frequently by the population. The study provided knowledge on the size of the problem with use of medicines in Brazil.
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Affiliation(s)
| | | | - Mirian Parente Monteiro
- Faculdade de Farmácia, Odontologia e Enfermagem, Universidade Federal do Ceará, Fortaleza, Brasil
| | - Sotero Serrate Mengue
- Departamento de Medicina Social, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | | | | | | | | | - Vera Lucia Luiza
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Luiz Roberto Ramos
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brasil
| | - Mareni Rocha Farias
- Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, Brasil
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Leite SN, Manzini F, Álvares J, Guerra AA, Costa EA, Acurcio FDA, Guibu IA, Costa KS, Karnikowski MGDO, Soeiro OM, Farias MR. Infrastructure of pharmacies of the primary health care in the Brazilian Unified Health System: Analysis of PNAUM - Services data. Rev Saude Publica 2017; 51:13s. [PMID: 29160456 PMCID: PMC5676351 DOI: 10.11606/s1518-8787.2017051007120] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 01/17/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To characterize the infrastructure of the primary health care pharmacies of the Brazilian Unified Health System, aiming at humanizing the offered services. METHODS This is a cross-sectional study, of quantitative approach, from data obtained in the Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). Information on 1,175 pharmacies/dispensing units were gathered from direct observation and assessment of dispensing units installations conducted by trained researchers who used a standardized form. The analyzed variables refer to the physical structure of pharmacies or medicine dispensing units of the health units under research. RESULTS The pharmacy area was greater than 14 m2 in 40.3% of the sampled units, highlighting those from Midwest (56.9%) and Southeast (56.2%) regions and those of Northeast, with only 23.3%. About 80.2% units had waiting rooms with chairs for patients, 31.8% of them had dispensing areas inferior to 5m2, while in 46.2% these areas were superior to 10m2. Bars were found in service counters in 23.8% of health units, thus separating the patient from the professional; 44.1% had internet access. In most units, the area of medicine storage had no refrigerator or freezer for their exclusive storage and 13.7% had a specific room for pharmaceutical consultation. CONCLUSION Aiming at achieving care humanization and improving working conditions for professionals, the structuring of the environment of pharmacy services is necessary. This would contribute to the better qualification of pharmacy services, comprising more than medicine delivery. Data on the Northeast region indicated less favorable conditions to the development of adequate dispensing services. Based on the panorama pointed out, we suggest the expansion of stimulus concerning the physical structure of pharmaceutical services, considering regional specificities.
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Affiliation(s)
- Silvana Nair Leite
- Departamento de Ciências Farmacêuticas. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
| | - Fernanda Manzini
- Programa de Pós-Graduação em Farmácia. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
| | - Juliana Álvares
- Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Augusto Afonso Guerra
- Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Ediná Alves Costa
- Instituto de Saúde Coletiva. Universidade Federal da Bahia. Salvador, BA, Brasil
| | - Francisco de Assis Acurcio
- Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Ione Aquemi Guibu
- Departamento de Saúde Coletiva. Faculdade de Ciências Médicas. Santa Casa de São Paulo. São Paulo, SP, Brasil
| | - Karen Sarmento Costa
- Núcleo de Estudos de Políticas Públicas. Universidade Estadual de Campinas. Campinas, SP, Brasil
- Programa de Pós-Graduação em Saúde Coletiva. Departamento de Saúde Coletiva. Faculdade de Ciências Médicas. Universidade Estadual de Campinas. Campinas, SP, Brasil
- Programa de Pós-Graduação em Epidemiologia. Faculdade de Medicina. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | | | - Orlando Mário Soeiro
- Faculdade de Ciências Farmacêuticas. Pontifícia Universidade Católica de Campinas. Campinas, SP, Brasil
| | - Mareni Rocha Farias
- Departamento de Ciências Farmacêuticas. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
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Farias MR, Storb BH, Storpirtis S, Leite SN. Impact Factor: an appropriate criterion for the Qualis journals classification in the Pharmacy area? BRAZ J PHARM SCI 2017. [DOI: 10.1590/s2175-97902017000301001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Mareni Rocha Farias
- Universidade Federal de Santa Catarina, Brazil; Universidade Federal de Santa Catarina, Brazil
| | | | | | - Silvana Nair Leite
- Universidade Federal de Santa Catarina, Brazil; Universidade Federal de Santa Catarina, Brazil
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Mengue SS, Bertoldi AD, Boing AC, Tavares NUL, Pizzol TDSD, Oliveira MA, Arrais PSD, Ramos LR, Farias MR, Luiza VL, Bernal RTI, Barros AJDD. National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM): household survey component methods. Rev Saude Publica 2017; 50:4s. [PMID: 27982381 PMCID: PMC5157905 DOI: 10.1590/s1518-8787.2016050006156] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 08/16/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To describe methodological aspects of the household survey National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM) related to sampling design and implementation, the actual obtained sample, instruments and fieldwork. METHODS A cross-sectional, population-based study with probability sampling in three stages of the population living in households located in Brazilian urban areas. Fieldwork was carried out between September 2013 and February 2014. The data collection instrument included questions related to: information about households, residents and respondents; chronic diseases and medicines used; use of health services; acute diseases and events treated with drugs; use of contraceptives; use of pharmacy services; behaviors that may affect drug use; package inserts and packaging; lifestyle and health insurance. RESULTS In total, 41,433 interviews were carried out in 20,404 households and 576 urban clusters corresponding to 586 census tracts distributed in the five Brazilian regions, according to eight domains defined by age and gender. CONCLUSIONS The results of the survey may be used as a baseline for future studies aiming to assess the impact of government action on drug access and use. For local studies using a compatible method, PNAUM may serve as a reference point to evaluate variations in space and population. With a comprehensive evaluation of drug-related aspects, PNAUM is a major source of data for a variety of analyses to be carried out both at academic and government level. OBJETIVO Descrever aspectos metodológicos do inquérito domiciliar da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM) quanto ao desenho e implementação da amostragem e da amostra efetivamente obtida, seus instrumentos e implementação do campo. MÉTODOS Estudo transversal de base populacional com amostra probabilística em três estágios da população residente nos domicílios localizados na zona urbana do Brasil. O trabalho de campo foi desenvolvido entre setembro de 2013 e fevereiro de 2014. O instrumento de coleta de dados incluiu questões relativas a: informações do domicílio, dos moradores e dos entrevistados; doenças crônicas e medicamentos utilizados; uso de serviços de saúde; doenças e eventos agudos tratados com medicamentos; uso de contraceptivos; uso de serviços de farmácia; comportamentos que podem afetar o uso de medicamentos; bulas e embalagens; estilo de vida e planos de saúde. RESULTADOS Foram realizadas 41.433 entrevistas em 20.404 domicílios e 576 conglomerados que correspondem a 586 setores censitários distribuídos nas cinco regiões do Brasil, segundo oito domínios definidos por grupos de idade e sexo. CONCLUSÕES Os resultados obtidos no inquérito podem ser utilizados como uma linha de base para futuros estudos que pretendam avaliar o impacto de ações governamentais nas áreas de acesso e de utilização de medicamentos. Para estudos locais que venham a usar um método compatível, a PNAUM pode servir como ponto de referência para avaliação de variações do espaço e da população. Com ampla avaliação dos aspectos relacionados aos medicamentos, a PNAUM é uma grande fonte de dados para as mais variadas análises, que podem ser conduzidas tanto no meio acadêmico como no âmbito governamental.
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Affiliation(s)
- Sotero Serrate Mengue
- Programa de Pós-Graduação em Epidemiologia. Faculdade de Medicina. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Andréa Dâmaso Bertoldi
- Departamento de Medicina Social. Faculdade de Medicina. Universidade Federal de Pelotas. Pelotas, RS, Brasil
| | - Alexandra Crispim Boing
- Departamento de Saúde Pública. Centro de Ciências da Saúde. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
| | - Noemia Urruth Leão Tavares
- Departamento de Farmácia. Faculdade de Ciências da Saúde. Universidade de Brasília. Brasília, DF, Brasil
| | - Tatiane da Silva Dal Pizzol
- Departamento de Produção e Controle de Medicamentos. Faculdade de Farmácia. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Maria Auxiliadora Oliveira
- Departamento de Farmácia. Faculdade de Ciências da Saúde. Universidade de Brasília. Brasília, DF, Brasil
| | - Paulo Sérgio Dourado Arrais
- Departamento de Farmácia. Faculdade de Farmácia, Odontologia e Enfermagem. Universidade Federal do Ceará. Fortaleza, CE, Brasil
| | - Luiz Roberto Ramos
- Departamento de Medicina Preventiva. Escola Paulista de Medicina. Universidade Federal de São Paulo. São Paulo, SP, Brasil
| | - Mareni Rocha Farias
- Departamento de Ciências Farmacêuticas. Centro de Ciências da Saúde. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
| | - Vera Lucia Luiza
- Departamento de Política de Medicamentos e Assistência Farmacêutica. Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Regina Tomie Ivata Bernal
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde. Departamento de Nutrição. Faculdade de Saúde Pública. Universidade de São Paulo. São Paulo, SP, Brasil
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Tavares NUL, Bertoldi AD, Mengue SS, Arrais PSD, Luiza VL, Oliveira MA, Ramos LR, Farias MR, Pizzol TDSD. Factors associated with low adherence to medicine treatment for chronic diseases in Brazil. Rev Saude Publica 2017; 50:10s. [PMID: 27982378 PMCID: PMC5157921 DOI: 10.1590/s1518-8787.2016050006150] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 02/25/2016] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To analyze factors associated with low adherence to drug treatment for chronic diseases in Brazil. METHODS Analysis of data from Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - Brazilian Survey on Access, Use and Promotion of Rational Use of Medicines), a population-based cross-sectional household survey, based on a probabilistic sample of the Brazilian population. We analyzed the association between low adherence to drug treatment measured by the Brief Medication Questionnaire and demographic, socioeconomic, health, care and prescription factors. We used Poisson regression model to estimate crude and adjusted prevalence ratios, their respective 95% confidence interval (95%CI) and p-value (Wald test). RESULTS The prevalence of low adherence to drug treatment for chronic diseases was 30.8% (95%CI 28.8-33.0). The highest prevalence of low adherence was associated with individuals: young adults; no education; resident in the Northeast and Midwest Regions of Brazil; paying part of the treatment; poor self-perceived health; three or more diseases; reported limitations caused by a chronic disease; using five drugs or more. CONCLUSIONS Low adherence to drug treatment for chronic diseases in Brazil is relevant, and regional and demographic differences and those related to patients’ health care and therapy regime require coordinated action between health professionals, researchers, managers and policy makers.
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Affiliation(s)
- Noemia Urruth Leão Tavares
- Departamento de Farmácia. Faculdade de Ciências da Saúde. Universidade de Brasília. Brasília, DF, Brasil
| | - Andréa Dâmaso Bertoldi
- Departamento de Medicina Social. Faculdade de Medicina. Universidade Federal de Pelotas. Pelotas, RS, Brasil
| | - Sotero Serrate Mengue
- Programa de Pós-Graduação em Epidemiologia. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Paulo Sergio Dourado Arrais
- Departamento de Farmácia. Faculdade de Farmácia, Odontologia e Enfermagem. Universidade Federal do Ceará. Fortaleza, CE, Brasil
| | - Vera Lucia Luiza
- Departamento de Política de Medicamentos e Assistência Farmacêutica. Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Maria Auxiliadora Oliveira
- Departamento de Política de Medicamentos e Assistência Farmacêutica. Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Luiz Roberto Ramos
- Departamento de Medicina Preventiva. Escola Paulista de Medicina. Universidade Federal de São Paulo. São Paulo, SP, Brasil
| | - Mareni Rocha Farias
- Departamento de Ciências Farmacêuticas, Centro de Ciências da Saúde. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
| | - Tatiane da Silva Dal Pizzol
- Departamento de Produção e Controle de Medicamentos. Faculdade de Farmácia. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
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Farias MR, Leite SN, Tavares NUL, Oliveira MA, Arrais PSD, Bertoldi AD, Pizzol TDSD, Luiza VL, Ramos LR, Mengue SS. Use of and access to oral and injectable contraceptives in Brazil. Rev Saude Publica 2017; 50:14s. [PMID: 27982384 PMCID: PMC5157909 DOI: 10.1590/s1518-8787.2016050006176] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 02/25/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To analyze the prevalence of current use of oral and injectable contraceptives by Brazilian women, according to demographic and socioeconomic variables and issues related to access to those medicines. METHODS A cross-sectional, population-based analytical study with probability sampling based on data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), carried out between September 2013 and February 2014 in 20,404 Brazilian urban households. Prevalence was calculated based on reports from non-pregnant women aged 15-49 on the use of oral or injectable contraceptives. The independent variables were gender, age, level of education, socioeconomic class, Brazilian region and marital status. Also analyzed were access, means of payment, sources, and reported medicines. Statistical analyses considered 95% confidence intervals (95%CI) and Pearson Chi-square test to evaluate the statistical significance of differences between groups, considering a 5% significance level. RESULTS Prevalence of use was 28.2% for oral contraceptives (OC) and 4.5% for injectable contraceptives (IC). The highest prevalence of oral contraceptives was in the South region (37.5%) and the lowest in the North region (15.7%). For injectable contraceptives there was no difference between regions. Access was higher for oral contraceptive users (90.7%) than injectable contraceptives users (81.2%), as was direct payment (OC 78.1%, IC 58.0%). Users who paid for contraceptives acquired them at retail pharmacies (OC 95.0% and IC 86.6%) and at Farmácia Popular (Popular Pharmacy Program) (OC 4.8% and IC 12.7%). Free of charge contraceptives were mostly obtained from the Brazilian Unified Health System – SUS (OC 86.7%; IC 96.0%). Free samples were reported by 10.4% of users who did not pay for oral contraceptives. Most of paying users did not try to obtain contraceptives from SUS. Monophasic combined oral contraceptives were the most frequently reported (71.6%) and low-level levonorgestrel + ethinylestradiol combination accounted for 38.7% of them. The most frequently reported medicines are included in the Relação Nacional de Medicamentos Essenciais (RENAME – National List of Essential Medicines. CONCLUSIONS Most women aged 15 to 49 who reported using contraceptives had access to the medicine and use monophasic combined oral contraceptives of appropriate efficiency and safety purchased by direct payment, mainly from retail pharmacies.
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Affiliation(s)
- Mareni Rocha Farias
- Departamento de Ciências Farmacêuticas. Centro de Ciências da Saúde. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
| | - Silvana Nair Leite
- Departamento de Ciências Farmacêuticas. Centro de Ciências da Saúde. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
| | - Noemia Urruth Leão Tavares
- Departamento de Farmácia. Faculdade de Ciências da Saúde. Universidade de Brasília. Brasília, DF, Brasil
| | | | - Paulo Sergio Dourado Arrais
- Departamento de Farmácia. Faculdade de Farmácia, Odontologia e Enfermagem. Universidade Federal do Ceará. Fortaleza, CE, Brasil
| | - Andréa Dâmaso Bertoldi
- Departamento de Medicina Social. Faculdade de Medicina. Universidade Federal de Pelotas. Pelotas, RS, Brasil
| | - Tatiane da Silva Dal Pizzol
- Departamento de Produção e Controle de Medicamentos. Faculdade de Farmácia. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Vera Lucia Luiza
- Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Luiz Roberto Ramos
- Escola Paulista de Medicina. Universidade Federal de São Paulo. São Paulo, SP, Brasil
| | - Sotero Serrate Mengue
- Programa de Pós-Graduação em Epidemiologia. Faculdade de Medicina. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
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Bertoldi AD, Pizzol TDSD, Ramos LR, Mengue SS, Luiza VL, Tavares NUL, Farias MR, Oliveira MA, Arrais PSD. Sociodemographic profile of medicines users in Brazil: results from the 2014 PNAUM survey. Rev Saude Publica 2017; 50:5s. [PMID: 27982375 PMCID: PMC5157907 DOI: 10.1590/s1518-8787.2016050006119] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 07/06/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the prevalence of medicine use by the Brazilian population and its distribution according to sociodemographic factors. METHODS Study using data from the Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), a nationwide household survey of a representative sample of the Brazilian urban population. The data were collected between September 2013 and February 2014. The overall use of medicines, defined as the use of any medicine, use of medicines for treating chronic medical conditions and for acute health conditions, was evaluated. The independent variables included gender, age group, socioeconomic position, and region of Brazil. Analyzes included prevalence calculations, 95% confidence intervals (95%CI) and Pearson Chi-square tests to evaluate the differences between groups, considering a 5% level of significance. RESULTS The prevalence of medicines use was 50.7% (95%CI 49.3–52.2), with 39.3% (95%CI 37.5–41.1) accounting for men and 61.0% (95%CI 59.3–62.6) for women. Medicines use was observed to increase with increasing age, except among children within the zero to four years age group. The lowest prevalence for medicines use was found among those with a low socioeconomic position and those who reside in the North region of Brazil. The prevalence of medicine use to treat chronic diseases was 24.3% (95%CI 23.3–25.4), whereas it was 33.7% (95%CI 32.1–35.4) for treating acute diseases. CONCLUSIONS We found extensive variability in the prevalence of medicines use across regions of Brazil. The poorest regions (North, Northeast, and Midwest) have a lower prevalence of medicines use to treat chronic diseases, indicating the need to minimize inequalities in access to medicines within the country.
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Affiliation(s)
- Andréa Dâmaso Bertoldi
- Departamento de Medicina Social. Faculdade de Medicina. Universidade Federal de Pelotas. Pelotas, RS, Brasil
| | - Tatiane da Silva Dal Pizzol
- Departamento de Produção e Controle de Medicamentos. Faculdade de Farmácia. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Luiz Roberto Ramos
- Departamento de Medicina Preventiva. Escola Paulista de Medicina. Universidade Federal de São Paulo. São Paulo, SP, Brasil
| | - Sotero Serrate Mengue
- Programa de Pós-Graduação em Epidemiologia. Faculdade de Medicina. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Vera Lucia Luiza
- Departamento de Política de Medicamentos e Assistência Farmacêutica. Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Noemia Urruth Leão Tavares
- Departamento de Farmácia. Faculdade de Ciências da Saúde. Universidade de Brasília. Brasília, DF, Brasil
| | - Mareni Rocha Farias
- Departamento de Ciências Farmacêuticas. Centro de Ciências da Saúde. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
| | - Maria Auxiliadora Oliveira
- Departamento de Política de Medicamentos e Assistência Farmacêutica. Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Paulo Sergio Dourado Arrais
- Departamento de Farmácia. Faculdade de Farmácia, Odontologia e Enfermagem. Universidade Federal do Ceará. Fortaleza, CE, Brasil
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Mengue SS, Bertoldi AD, Ramos LR, Farias MR, Oliveira MA, Tavares NUL, Arrais PSD, Luiza VL, Pizzol TDSD. Access to and use of high blood pressure medications in Brazil. Rev Saude Publica 2017; 50:8s. [PMID: 27982380 PMCID: PMC5157910 DOI: 10.1590/s1518-8787.2016050006154] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 03/12/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To analyze the access to and use of medicines for high blood pressure among the Brazilian population according to social and demographic conditions. METHODS Analysis of data from Pesquisa Nacional Sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), a nationwide cross-sectional, population-based study, with probability sampling, carried out between September 2013 and February 2014 in urban households in the five Brazilian regions. The study evaluated the access and use of medicines to treat people with high blood pressure. The independent variables were gender, age, socioeconomic status and Brazilian region. The study also described the most commonly used drugs and the percentage of people treated with one, two, three or more drugs. Point estimations and confidence intervals were calculated considering the sample weights and sample complex plan. RESULTS Prevalence of high blood pressure was 23.7% (95%CI 22.8–24.6). Regarding people with this condition, 93.8% (95%CI 92.8–94.8) had indication for drug therapy and, of those, 94.6% (95%CI 93.5–95.5) were using the medication at the time of interview. Full access to medicines was 97.9% (95%CI 97.3–98.4); partial access, 1.9% (95%CI 1.4–2.4); and no access, 0.2% (95%CI 0.1–0.4). The medication used to treat high blood pressure, 56.0% (95%CI 52.6–59.2) were obtained from SUS (Brazilian Unified Health System), 16.0% (95%CI 14.3–17.9) from Popular Pharmacy Program, 25.7% (95%CI 23.4–28.2) were paid for by the patients themselves and 2.3% (95%CI 1.8–2.9) were obtained from other locations. The five most commonly used drugs were, in descending order, hydrochlorothiazide, losartan, captopril, enalapril and atenolol. Of the total number of patients on treatment, 36.1% (95%CI 34.1–37.1) were using two medicines and 13.5% (95%CI 12.3–14.9) used three or more. CONCLUSIONS Access to medicines for the treatment of high blood pressure may be considered high and many of them are available free of charge. The most commonly used drugs are among those recommended as first-line treatment for high blood pressure control. The percentage of people using more than one drug seems to follow the behavior observed in other countries.
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Affiliation(s)
- Sotero Serrate Mengue
- Programa de Pós-Graduação em Epidemiologia. Faculdade de Medicina. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Andréa Dâmaso Bertoldi
- Departamento de Medicina Social. Faculdade de Medicina. Universidade Federal de Pelotas. Pelotas, RS, Brasil
| | - Luiz Roberto Ramos
- Departamento de Medicina Preventiva. Escola Paulista de Medicina. Universidade Federal de São Paulo. São Paulo, SP, Brasil
| | - Mareni Rocha Farias
- Departamento de Ciências Farmacêuticas. Centro de Ciências da Saúde. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
| | - Maria Auxiliadora Oliveira
- Departamento de Política de Medicamentos e Assistência Farmacêutica. Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Noemia Urruth Leão Tavares
- Departamento de Farmácia. Faculdade de Ciências da Saúde. Universidade de Brasília. Brasília, DF, Brasil
| | - Paulo Sergio Dourado Arrais
- Departamento de Farmácia. Faculdade de Farmácia, Odontologia e Enfermagem. Universidade Federal do Ceará. Fortaleza, CE, Brasil
| | - Vera Lucia Luiza
- Departamento de Política de Medicamentos e Assistência Farmacêutica. Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Tatiane da Silva Dal Pizzol
- Departamento de Produção e Controle de Medicamentos. Faculdade de Farmácia. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
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Oliveira MA, Luiza VL, Tavares NUL, Mengue SS, Arrais PSD, Farias MR, Pizzol TDSD, Ramos LR, Bertoldi AD. Access to medicines for chronic diseases in Brazil: a multidimensional approach. Rev Saude Publica 2017; 50:6s. [PMID: 27982382 PMCID: PMC5157920 DOI: 10.1590/s1518-8787.2016050006161] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 08/09/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To analyze the access to medicines to treat non-communicable diseases in Brazil according to socioeconomic, demographic, and health-related factors, from a multidimensional perspective. METHODS Analysis of data from the National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM), household survey, sampling plan by conglomerates with representativeness of the Brazilian population and large areas of the country, according to sex and age domains. Data collected in 2013–2014 with sample of adults (≥ 20 years) who reported having non-communicable diseases and medical indication for use of medicines (n = 12,725). We assessed the prevalence of access to medicines for self-reported non-communicable diseases, considering four dimensions: availability, geographic accessibility, acceptability, and affordability. We applied Pearson’s Chi-square test to assess the statistical significance of the differences between strata, considering the level of significance of 5%. We found prevalence of 94.3%, 5.2%, and 0.5% for full, partial, and null access, respectively. Higher prevalence was observed among seniors in the South compared to the Northeast; for those who reported having one non-communicable disease compared to those who reported having two or more; for those who needed one medicine compared to those who needed three or more; and for those who self-assessed their health as good or very good. Geographic accessibility was similar in the Unified Health System and in the private pharmacies (72.0%). Total availability of medicines was 45.2% in the Unified Health System, 67.4% in the Popular Pharmacy Program, and 88.5% in private pharmacies. Acceptability was 92.5% in the Unified Health System, 97.8% in the Popular Pharmacy Program, and 98.7% in private pharmacies. As to affordability, 2.6% of the individuals failed to take the medicines they should in the 30-day period prior to the interview due to financial difficulty. Prevalence of full access to medicines for non-communicable diseases in Brazil is high and presents significant differences for age group, region of the country, number of non-communicable diseases, and for medicines prescribed and self-assessment of health. The major barriers to access to medicines were identified in the dimensions analyzed.
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Affiliation(s)
- Maria Auxiliadora Oliveira
- Departamento de Política de Medicamentos e Assistência Farmacêutica. Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Vera Lucia Luiza
- Departamento de Política de Medicamentos e Assistência Farmacêutica. Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Noemia Urruth Leão Tavares
- Departamento de Farmácia. Faculdade de Ciências da Saúde. Universidade de Brasília. Brasília, DF, Brasil
| | - Sotero Serrate Mengue
- Programa de Pós-Graduação em Epidemiologia. Faculdade de Medicina. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Paulo Sergio Dourado Arrais
- Departamento de Farmácia. Faculdade de Farmácia, Odontologia e Enfermagem. Universidade Federal do Ceará. Fortaleza, CE, Brasil
| | - Mareni Rocha Farias
- Departamento de Ciências Farmacêuticas. Centro de Ciências da Saúde. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
| | - Tatiane da Silva Dal Pizzol
- Departamento de Produção e Controle de Medicamentos. Faculdade de Farmácia. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Luiz Roberto Ramos
- Departamento de Medicina Preventiva. Escola Paulista de Medicina. Universidade Federal de São Paulo. São Paulo, SP, Brasil
| | - Andréa Dâmaso Bertoldi
- Departamento de Medicina Social. Faculdade de Medicina. Universidade Federal de Pelotas. Pelotas, RS, Brasil
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Arrais PSD, Fernandes MEP, Pizzol TDSD, Ramos LR, Mengue SS, Luiza VL, Tavares NUL, Farias MR, Oliveira MA, Bertoldi AD. Prevalence of self-medication in Brazil and associated factors. Rev Saude Publica 2017; 50:13s. [PMID: 27982373 PMCID: PMC5157904 DOI: 10.1590/s1518-8787.2016050006117] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 02/25/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze the prevalence and associated factors regarding the use of medicines by self-medication in Brazil. METHODS This cross-sectional population-based study was conducted using data from the PNAUM (National Survey on Access, Use and Promotion of Rational Use of Medicines), collected between September 2013 and February 2014 by interviews at the homes of the respondents. All people who reported using any medicines not prescribed by a doctor or dentist were classified as self-medication practitioners. Crude and adjusted prevalence ratios (Poisson regression) and their respective 95% confidence intervals were calculated in order to investigate the factors associated with the use of self-medication by medicines. The independent variables were: sociodemographic characteristics, health conditions and access to and use of health services. In addition, the most commonly consumed medicines by self-medication were individually identified. RESULTS The self-medication prevalence in Brazil was 16.1% (95%CI 15.0–17.5), with it being highest in the Northeast region (23.8%; 95%CI 21.6–26.2). Following the adjusted analysis, self-medication was observed to be associated with females, inhabitants from the North, Northeast and Midwest regions and individuals that have had one, or two or more chronic diseases. Analgesics and muscle relaxants were the therapeutic groups most used for self-medication, with dipyrone being the most consumed medicines. In general, most of the medicines used for self-medication were classified as non-prescriptive (65.5%). CONCLUSIONS Self-medication is common practice in Brazil and mainly involves the use of non-prescription medicines; therefore, the users of such should be made aware of the possible risks.
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Affiliation(s)
- Paulo Sérgio Dourado Arrais
- Departamento de Farmácia. Faculdade de Farmácia, Odontologia e Enfermagem. Universidade Federal do Ceará. Fortaleza, CE, Brasil
| | - Maria Eneida Porto Fernandes
- Departamento de Farmácia. Faculdade de Farmácia, Odontologia e Enfermagem. Universidade Federal do Ceará. Fortaleza, CE, Brasil
| | - Tatiane da Silva Dal Pizzol
- Departamento de Produção e Controle de Medicamentos. Faculdade de Farmácia. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Luiz Roberto Ramos
- Departamento de Medicina Preventiva. Escola Paulista de Medicina. Universidade Federal de São Paulo. São Paulo, SP, Brasil
| | - Sotero Serrate Mengue
- Departamento de Medicina Social. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Vera Lucia Luiza
- Departamento de Política de Medicamentos e Assistência Farmacêutica. Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Noemia Urruth Leão Tavares
- Departamento de Farmácia. Faculdade de Ciências da Saúde. Universidade de Brasília. Brasília, DF, Brasil
| | - Mareni Rocha Farias
- Departamento de Ciências Farmacêuticas. Centro de Ciências da Saúde. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
| | - Maria Auxiliadora Oliveira
- Departamento de Política de Medicamentos e Assistência Farmacêutica. Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Andréa Dâmaso Bertoldi
- Departamento de Medicina Social. Faculdade de Medicina. Universidade Federal de Pelotas. Pelotas, RS, Brasil
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Luiza VL, Tavares NUL, Oliveira MA, Arrais PSD, Ramos LR, Pizzol TDSD, Mengue SS, Farias MR, Bertoldi AD. Catastrophic expenditure on medicines in Brazil. Rev Saude Publica 2017; 50:15s. [PMID: 27982383 PMCID: PMC5157912 DOI: 10.1590/s1518-8787.2016050006172] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 08/09/2016] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To describe the magnitude of the expenditure on medicines in Brazil according to region, household size and composition in terms of residents in a situation of dependency. METHODS Population-based data from the national household survey were used, with probabilistic sample, applied between September 2013 and February 2014 in urban households. The expenditure on medicines was the main outcome of interest. The prevalence and confidence intervals (95%CI) of the outcomes were stratified according to socioeconomic classification and calculated according to the region, the number of residents dependent on income, the presence of children under five years and residents in a situation of dependency by age. RESULTS In about one of every 17 households (5.3%) catastrophic health expenditure was reported and, in 3.2%, the medicines were reported as one of the items responsible for this situation. The presence of three or more residents (3.6%) and resident in a situation of dependency (3.6%) were the ones that most reported expenditure on medicines. Southeast was the region with the lowest prevalence of expenditure on medicines. The prevalence of households with catastrophic health expenditure and on medicines in relation to the total of households showed a regressive tendency for economic classes. CONCLUSIONS Catastrophic health expenditure was present in 5.3%, and catastrophic expenditure on medicines in 3.2% of the households. Multi-person households, presence of residents in a situation of economic dependency and belonging to the class D or E had the highest proportion of catastrophic expenditure on medicines. Although the problem is important, permeated by aspects of iniquity, Brazilian policies seem to be protecting families from catastrophic expenditure on health and on medicine.
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Affiliation(s)
- Vera Lucia Luiza
- Departamento de Política de Medicamentos e Assistência Farmacêutica. Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Noemia Urruth Leão Tavares
- Departamento de Farmácia. Faculdade de Ciências da Saúde. Universidade de Brasília. Brasília, DF, Brasil
| | - Maria Auxiliadora Oliveira
- Departamento de Política de Medicamentos e Assistência Farmacêutica. Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Paulo Sergio Dourado Arrais
- Departamento de Farmácia. Faculdade de Farmácia, Odontologia e Enfermagem. Universidade Federal do Ceará. Fortaleza, CE, Brasil
| | - Luiz Roberto Ramos
- Departamento de Medicina Preventiva. Escola Paulista de Medicina. Universidade Federal de São Paulo. São Paulo, SP, Brasil
| | - Tatiane da Silva Dal Pizzol
- Departamento de Produção e Controle de Medicamentos. Faculdade de Farmácia. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Sotero Serrate Mengue
- Programa de Pós-Graduação em Epidemiologia. Faculdade de Medicina. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Mareni Rocha Farias
- Departamento de Ciências Farmacêuticas. Centro de Ciências da Saúde. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
| | - Andréa Dâmaso Bertoldi
- Departamento de Medicina Social. Faculdade de Medicina. Universidade Federal de Pelotas. Pelotas, RS, Brasil
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Bertoldi AD, Arrais PSD, Tavares NUL, Ramos LR, Luiza VL, Mengue SS, Dal-Pizzol TDS, Farias MR, Oliveira MA. Use of generic medicines by the Brazilian population: an evaluation of PNAUM 2014. Rev Saude Publica 2016; 50:11s. [PMID: 27982376 PMCID: PMC5157911 DOI: 10.1590/s1518-8787.2016050006120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 02/25/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To analyze the existence of differences in the use of generic medicines in Brazil according to demographic and socioeconomic variables and acquisition sources of the medicines. METHODS Population-based cross-sectional study, conducted with data from the Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines). Data collection took place between September, 2013 and February, 2014 in homes of Brazilian cities (urban area). The use of medicines has been investigated in relation to the treatment of chronic diseases and, in the case of acute events, regarding use over the previous 15 days. Generics were identified by visualization of packaging presented by the users of the medicines. The independent variables used were sex, age, education level, economic class, and region of the Country. The statistical significance of differences between the groups was evaluated by Pearson’s Chi-squared test, considering a 5% significance level. RESULTS The prevalence of generic medicines use was 45.5% (95%CI 43.7–47.3). There was no difference considering education level. The prevalence was higher in females (47.0%; 95%CI 44.9–49.0) than in males (43.1%; 95%CI 40.5–45.8), and were higher with increasing age. Generic medicines were more used in the economic class C (47.0%; 95%CI 44.9–49.1) and in the South (50.6%; 95%CI 46.6–54.6) and Southeast (49.9%; 95%CI 46.8–53.0) regions. Generics accounted for 37.3% of the medicines provided by the Brazilian Unified Health System. CONCLUSIONS Currently, there is a choice of purchase or free provision by the Brazilian Unified Health System, characterized by quality assurance and reduced price regarding branded medicines considered as reference. In the private market, a considerable part of the population is choosing generic medicines thanks to the availability of this option for virtually all medicines most used by the population.
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Affiliation(s)
- Andréa Dâmaso Bertoldi
- Departamento de Medicina Social. Faculdade de Medicina. Universidade Federal de Pelotas. Pelotas, RS, Brasil
| | - Paulo Sergio Dourado Arrais
- Departamento de Farmácia. Faculdade de Farmácia, Odontologia e Enfermagem. Universidade Federal do Ceará. Fortaleza, CE, Brasil
| | - Noemia Urruth Leão Tavares
- Departamento de Farmácia. Faculdade de Ciências da Saúde. Universidade de Brasília. Brasília, DF, Brasil
| | - Luiz Roberto Ramos
- Departamento de Medicina Preventiva. Escola Paulista de Medicina. Universidade Federal de São Paulo. São Paulo, SP, Brasil
| | - Vera Lucia Luiza
- Departamento de Política de Medicamentos e Assistência Farmacêutica. Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Sotero Serrate Mengue
- Programa de Pós-Graduação em Epidemiologia. Faculdade de Medicina. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Tatiane da Silva Dal-Pizzol
- Departamento de Produção e Controle de Medicamentos. Faculdade de Farmácia. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Mareni Rocha Farias
- Departamento de Ciências Farmacêuticas. Centro de Ciências da Saúde. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
| | - Maria Auxiliadora Oliveira
- Departamento de Política de Medicamentos e Assistência Farmacêutica. Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
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Ramos LR, Tavares NUL, Bertoldi AD, Farias MR, Oliveira MA, Luiza VL, Pizzol TDSD, Arrais PSD, Mengue SS. Polypharmacy and Polymorbidity in Older Adults in Brazil: a public health challenge. Rev Saude Publica 2016; 50:9s. [PMID: 27982377 PMCID: PMC5157903 DOI: 10.1590/s1518-8787.2016050006145] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 04/22/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze variations in the prevalence of chronic use of medicines by older adults in Brazil according to its possible association with the most prevalent chronic diseases and demographic and health factors, and to identify risk factors for polypharmacy. METHODS A study based on data from the National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM), a cross-sectional, population-based survey with probability sampling in Brazilian urban areas. The independent variable was the number of chronic-use medicines taken by older adults, linked to eight chronic diseases investigated. The intervening variables were gender, age group, marital status, level of education, socioeconomic status, Brazilian region, body mass index, smoking, self-perceived health, hospitalization in the previous year and having health insurance, besides the investigated chronic diseases. A multivariable analysis identified risk factors for polypharmacy. RESULTS Prevalence of at least one chronic-use medicines among older adults was 93.0%. Of the total number of older adults, 18.0% used at least five medications (polypharmacy). Polypharmacy was higher among the oldest individuals (20.0%), in the South region (25.0%), in those with poor self-perceived health (35.0%), in obese individuals (26.0%), in those with reported health insurance (23.0%) or hospitalization in the previous year (31.0%), and among those who reported any of the investigated diseases, particularly diabetes (36.0%) and heart diseases (43.0%). The variables remaining in the final risk model for polypharmacy were age, region, perceived health, health insurance, hospitalization in the previous year and all investigated diseases except stroke. CONCLUSIONS Older adults with specific diseases have risk factors for polypharmacy modifiable by actions aimed at the rational use of medicines. With the current population aging and successful drug access policy, the trend is an increase in drug use by older adults, which should feature as a priority in the planning agenda of the Brazilian Unified Health System (SUS). OBJETIVO Analisar as variações da prevalência do uso crônico de medicamentos por idosos no Brasil segundo sua possível associação com as doenças crônicas mais prevalentes, fatores sociodemográficos e de saúde, e identificar fatores de risco para polifarmácia. MÉTODOS Estudo com dados da Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos, de caráter transversal e amostra probabilística populacional em municípios brasileiros urbanos. A variável independente foi o número de medicamentos de uso crônico por idosos, vinculados às oito doenças crônicas investigadas. As variáveis intervenientes foram sexo, faixa etária, situação conjugal, escolaridade, nível socioeconômico, região do País, índice de massa corporal, hábito de fumar, percepção da própria saúde, internação no último ano e posse de plano de saúde privado, além das doenças crônicas referidas. Uma análise multivariável identificou os fatores de risco para polifarmácia. RESULTADOS A prevalência de pelo menos um medicamento de uso crônico entre idosos foi de 93,0%. Do total de idosos, 18,0% utilizavam pelo menos cinco medicamentos (polifarmácia). A polifarmácia foi maior entre os mais idosos (20,0%), na região Sul (25,0%), nos que avaliaram a própria saúde como ruim (35,0%), nos obesos (26,0%), nos que referiram ter plano de saúde (23,0%) ou internação no último ano (31,0%) e entre os que referiram qualquer uma das doenças investigadas, particularmente diabetes (36,0%) e doenças cardíacas (43,0%). No modelo final de risco para polifarmácia permaneceram idade, região, percepção de saúde, posse de plano de saúde, internação no último ano e todas as doenças investigadas exceto acidente vascular cerebral. CONCLUSÕES Idosos com doenças específicas têm fatores de risco para polifarmácia modificáveis por ações que visem o uso racional de medicamentos. Com o envelhecimento populacional em curso e a política exitosa de acesso a medicamentos, a tendência é aumentar a utilização de medicamentos por idosos, que deve ser prioridade na agenda de planejamento do Sistema Único de Saúde.
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Affiliation(s)
- Luiz Roberto Ramos
- Departamento de Medicina Preventiva. Escola Paulista de Medicina. Universidade Federal de São Paulo. São Paulo, SP, Brasil
| | - Noemia Urruth Leão Tavares
- Departamento de Farmácia. Faculdade de Ciências da Saúde. Universidade de Brasília. Brasília, DF, Brasil
| | - Andréa Dâmaso Bertoldi
- Departamento de Medicina Social. Faculdade de Medicina. Universidade Federal de Pelotas. Pelotas, RS, Brasil
| | - Mareni Rocha Farias
- Departamento de Ciências Farmacêuticas. Centro de Ciências da Saúde. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
| | - Maria Auxiliadora Oliveira
- Departamento de Política de Medicamentos e Assistência Farmacêutica. Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Vera Lucia Luiza
- Departamento de Política de Medicamentos e Assistência Farmacêutica. Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Tatiane da Silva Dal Pizzol
- Departamento de Produção e Controle de Medicamentos. Faculdade de Farmácia. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Paulo Sérgio Dourado Arrais
- Departamento de Farmácia. Faculdade de Farmácia, Odontologia e Enfermagem. Universidade Federal do Ceará. Fortaleza, CE, Brasil
| | - Sotero Serrate Mengue
- Programa de Pós-Graduação em Epidemiologia. Faculdade de Medicina. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
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Pizzol TDSD, Tavares NUL, Bertoldi AD, Farias MR, Arrais PSD, Ramos LR, Oliveira MA, Luiza VL, Mengue SS. Use of medicines and other products for therapeutic purposes among children in Brazil. Rev Saude Publica 2016; 50:12s. [PMID: 27982372 PMCID: PMC5157919 DOI: 10.1590/s1518-8787.2016050006115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 02/25/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the prevalence of the use of medicines and other products for therapeutic purposes in the Brazilian pediatric population and test whether demographic, socioeconomic and health factors are associated with use. METHODS A cross-sectional population-based study (National Survey on Access, Use and Promotion of Rational Use of Medicines - PNAUM), including 7,528 children aged 12 or younger, living in urban areas in Brazil. Medicine use to treat chronic or acute diseases was reported by the primary caregiver present at the household interview. Associations between independent variables and medicine use were investigated by Poisson regression. RESULTS The overall prevalence of medicine use was 30.7% (95%CI 28.3-33.1). The prevalence of medicine use for chronic diseases was 5.6% (95%CI 4.7-6.7) and for acute conditions, 27.1% (95%CI 24.8-29.4). The factors significantly associated with overall use were five years old or under, living in the Northeast region, having health insurance and using health services in the last 12 months (emergency visits and hospitalizations). The following were associated with drug use for chronic diseases: age ≥ 2 years, Southeast and South regions, and use of health services. For drug use in treating acute conditions, the following associated factors were identified: ≤ 5 years, North, Northeast or Midwest regions, health insurance, and one or more emergency visits. The most commonly used drugs among children under two years of age were paracetamol, ascorbic acid, and dipyrone; for children aged two years or over they were dipyrone, paracetamol, and amoxicillin. CONCLUSIONS The use of medicine by children is considerable, especially in treating acute medical conditions. Children using drugs for chronic diseases have a different demographic profile from those using drugs for acute conditions in relation to gender, age, and geographic region. OBJETIVO Estimar a prevalência de uso de medicamentos e outros produtos com finalidade terapêutica na população pediátrica brasileira e testar se fatores demográficos, socioeconômicos e médicos estão associados ao uso. MÉTODOS Estudo transversal de base populacional (Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - PNAUM), incluindo 7.528 crianças com 12 anos ou menos de idade, residentes na zona urbana do território brasileiro. O uso de medicamentos para tratar doenças crônicas ou agudas foi referido pelo principal cuidador da criança presente na entrevista domiciliar. Associações entre as variáveis independentes e o uso de medicamentos foram investigadas por meio de regressão de Poisson. RESULTADOS A prevalência de uso global de medicamentos foi de 30,7% (IC95% 28,3-33,1). A prevalência de uso de medicamentos para doenças crônicas foi de 5,6% (IC95% 4,7-6,7) e para condições agudas, 27,1% (IC95% 24,8-29,4). Os fatores significativamente associados com o uso global foram ter no máximo cinco anos de idade, residir na região Nordeste, ter plano de saúde e utilizar serviços de saúde nos últimos 12 meses (consultas de emergência e internações). Associaram-se ao uso de medicamentos para doenças crônicas: idade ≥ 2 anos, regiões Sudeste e Sul e utilização de serviços de saúde. Para o uso de medicamentos em condições agudas, foram identificados os seguintes fatores associados: ≤ 5 anos, Norte, Nordeste ou Centro-Oeste, plano de saúde e uma ou mais consultas de emergência. Os medicamentos com maior prevalência de uso pelas crianças menores de dois anos foram paracetamol, ácido ascórbico e dipirona; nas crianças com 2 ou mais anos, foram dipirona, paracetamol e amoxicilina. CONCLUSÕES O uso de medicamentos na população infantil é substancial, principalmente no tratamento de condições médicas agudas. As crianças usuárias de medicamentos para doenças crônicas apresentam perfil demográfico diferente das usuárias de medicamentos para condições agudas, em relação ao sexo, à idade e à região geográfica.
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Affiliation(s)
- Tatiane da Silva Dal Pizzol
- Departamento de Produção e Controle de Medicamentos. Faculdade de Farmácia. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Noemia Urruth Leão Tavares
- Departamento de Farmácia. Faculdade de Ciências da Saúde. Universidade de Brasília. Brasília, DF, Brasil
| | - Andréa Dâmaso Bertoldi
- Departamento de Medicina Social. Faculdade de Medicina. Universidade Federal de Pelotas. Pelotas, RS, Brasil
| | - Mareni Rocha Farias
- Departamento de Ciências Farmacêuticas, Centro de Ciências da Saúde. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
| | - Paulo Sergio Dourado Arrais
- Departamento de Farmácia. Faculdade de Farmácia, Odontologia e Enfermagem. Universidade Federal do Ceará. Fortaleza, CE, Brasil
| | - Luiz Roberto Ramos
- Departamento de Medicina Preventiva. Escola Paulista de Medicina. Universidade Federal de São Paulo. São Paulo, SP, Brasil
| | - Maria Auxiliadora Oliveira
- Departamento de Política de Medicamentos e Assistência Farmacêutica - Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Vera Lucia Luiza
- Departamento de Política de Medicamentos e Assistência Farmacêutica - Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Sotero Serrate Mengue
- Programa de Pós-Graduação em Epidemiologia. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
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Vargas FMDA, Trindade MCND, Gouveia GDA, Farias MR. A educação a distância na qualificação de profissionais para o Sistema Único De Saúde: metaestudo. Trab educ saúde 2016. [DOI: 10.1590/1981-7746-sol00018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Este estudo objetivou caracterizar concepções teórico-pedagógicas em educação a distância na formação/qualificação de trabalhadores do Sistema Único de Saúde e identificar cursos em educação a distância, amparados neste contexto. A busca sistematizada envolveu estudos qualitativos, utilizando os termos: ‘educação a distância' e ‘saúde'. Selecionaram-se 21 estudos para compor o metaestudo, que consistiu de três etapas: metateoria, metamétodos e metanálise. Na metateoria, identificaram-se quatro categorias: construtivismo; pedagogia de Paulo Freire; educação permanente em saúde; e concepções próprias da educação a distância. Na etapa metamétodos, 11 estudos eram relatos de experiência; dois, estudos de caso; três envolveram análise de conteúdo; um envolvia pesquisa-ação; e outro, análise do discurso. Na metanálise, identificaram-se resultados que marcaram: formação de comunidades de aprendizagem; fortalecimento dos espaços de gestão; e formação de redes para projetos em educação permanente. As discussões enfatizaram: fortalecimento do Sistema Único de Saúde; protagonismo dos sujeitos; e formação de redes de cuidados. Constata-se que os estudos se restringiram mais aos aspectos conceituais e teóricos do que aos metodológicos. Ficaram evidentes conceitos amparados no construtivismo, na educação permanente em saúde e em referencial teórico próprio da educação a distância. Nos estudos, a educação a distância foi considerada indispensável para formação/qualificação de profissionais no Sistema Único de Saúde.
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Tavares NUL, Luiza VL, Oliveira MA, Costa KS, Mengue SS, Arrais PSD, Ramos LR, Farias MR, Pizzol TDSD, Bertoldi AD. Free access to medicines for the treatment of chronic diseases in Brazil. Rev Saude Publica 2016; 50:7s. [PMID: 27982374 PMCID: PMC5157908 DOI: 10.1590/s1518-8787.2016050006118] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 02/25/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze the free access to medicines for the treatment of chronic diseases in the Brazilian population, according to demographic and socioeconomic factors. We also analyzed the most used pharmacological groups, according to funding source: free-of-charge or out-of-pocket paid. METHODS Analysis of data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), a population-based household survey, of cross-sectional design, based on probabilistic sample of the Brazilian population. We analyzed as outcome the prevalence of free access (free-of-charge) to all medicines for treatment of the reported chronic diseases, in the last 30 days. We studied the following independent variables: sex, age group, education in complete years of school, economic class, health plan, and geographical region of residence. We estimated the prevalences and 95% confidence intervals (95%CI) and applied the Pearson's Chi-squared test to assess the differences between the groups, considering a 5% significance level. RESULTS About half of adults and older adults who have had full access to the treatment of chronic diseases in Brazil obtained all needed medicines for free (47.5%; 95%CI 45.1-50.0). The prevalences of free access were higher among men (51.4%; 95%CI 48.1-54.8), age group of 40-59 years (51.1%; 95%CI 48.1-54.2), and in the poorest social classes (53.9%; 95%CI 50.2-57.7). The majority of medicines that act on the cardiovascular system, such as diuretics (C03) (78.0%; 95%CI 75.2-80.5), beta-blockers (C07) (62.7%; 95%CI 59.4-65.8), and the agents that work in the renin-angiotensin system (C09) (73.4%; 95%CI 70.8-75.8), were obtained for free. Medicines that act on the respiratory system, such as agents against obstructive airway diseases (R03) (60.0%; 95%CI 52.7-66.9) were mostly paid with own resources. CONCLUSIONS Free access to medicines for treatment of chronic diseases occurs to a considerable portion of the Brazilian population, especially for the poorest ones, indicating decreased socioeconomic inequalities, but with differences between regions and between some classes of medicines. OBJETIVO Analisar o acesso gratuito ao tratamento medicamentoso para doenças crônicas na população brasileira, segundo fatores socioeconômicos e demográficos. Analisaram-se também os grupos farmacológicos mais utilizados, segundo fonte de financiamento: gratuito ou pago do próprio bolso. MÉTODOS Análise de dados oriundos da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM), inquérito domiciliar de base populacional, de delineamento transversal, baseado em amostra probabilística da população brasileira. O desfecho analisado foi a prevalência de acesso gratuito (sem pagamento) a todos os medicamentos para tratamento das doenças crônicas referidas, nos últimos 30 dias. As variáveis independentes investigadas foram: sexo, faixa etária, escolaridade em anos completos de estudo, classe econômica, plano de saúde e região geográfica de residência. Foram estimadas as prevalências e calculados intervalos de 95% de confiança (IC95%) e aplicado o teste Qui-quadrado de Pearson para avaliação das diferenças entre os grupos, considerando nível de significância de 5%. RESULTADOS Cerca de metade dos adultos e idosos que tiveram acesso total ao tratamento de doenças crônicas no Brasil obtiveram todos os medicamentos que necessitavam gratuitamente (47,5%; IC95% 45,1-50,0). As prevalências de acesso gratuito foram maiores entre os homens (51,4%; IC95% 48,1-54,8), na faixa etária de 40-59 anos (51,1%; IC95% 48,1-54,2) e nas classes sociais mais pobres (53,9%; IC95% 50,2-57,7). Grande parte dos medicamentos que atuam no sistema cardiovascular, como os diuréticos (C03) (78,0%; IC95% 75,2-80,5), betabloqueadores (C07) (62,7%; IC95% 59,4-65,8) e os agentes que atuam no sistema renina-angiotensina (C09) (73,4%; IC95% 70,8-75,8) foram obtidos de forma gratuita. Os medicamentos que atuam no sistema respiratório como os agentes contra doenças obstrutivas das vias aéreas (R03) (60,0%; IC95% 52,7-66,9) foram na sua maioria pagos do próprio bolso. CONCLUSÕES O acesso gratuito aos medicamentos para tratamento das doenças crônicas ocorre para uma considerável parcela da população brasileira, principalmente para os mais pobres, indicando diminuição das desigualdades socioeconômicas, mas com diferenças regionais e entre algumas classes de medicamentos.
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Affiliation(s)
- Noemia Urruth Leão Tavares
- Departamento de Farmácia. Faculdade de Ciências da Saúde. Universidade de Brasília. Brasília, DF, Brasil
| | - Vera Lucia Luiza
- Departamento de Política de Medicamentos e Assistência Farmacêutica. Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Maria Auxiliadora Oliveira
- Departamento de Política de Medicamentos e Assistência Farmacêutica. Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Karen Sarmento Costa
- Núcleo de Estudos de Políticas Públicas. Universidade Estadual de Campinas. Campinas, SP, Brasil
| | - Sotero Serrate Mengue
- Programa de Pós-graduação em Epidemiologia. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Paulo Sergio Dourado Arrais
- Departamento de Farmácia. Faculdade de Farmácia, Odontologia e Enfermagem. Universidade Federal do Ceará. Fortaleza, CE, Brasil
| | - Luiz Roberto Ramos
- Departamento de Medicina Preventiva. Escola Paulista de Medicina. Universidade Federal de São Paulo. São Paulo, SP, Brasil
| | - Mareni Rocha Farias
- Departamento de Ciências Farmacêuticas, Centro de Ciências da Saúde. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
| | - Tatiane da Silva Dal Pizzol
- Departamento de Produção e Controle de Medicamentos. Faculdade de Farmácia. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Andréa Dâmaso Bertoldi
- Departamento de Medicina Social. Faculdade de Medicina. Universidade Federal de Pelotas. Pelotas, RS, Brasil
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Abstract
Background Parkinson’s disease (PD) is a neurodegenerative disease characterized by motor manifestations, autonomic and neurological disorders and sensorial symptoms. Medication therapy management (MTM) consists of a service undertaken by pharmacists to optimize pharmacological therapy results. This way, the pharmacist monitors the treatment prescribed by the doctor and formulates a healthcare plan to guarantee the treatment’s effectiveness, safety and convenience, thereby improving the patient’s quality of life (QoL). Objective To analyze the effect of MTM upon medicine-related problems, motor symptoms, autonomic disorders and QoL of patients with Parkinson’s disease, and describe the pharmaceutical interventions. Methods Quasi-experimental uncontrolled before-and-after study carried out between September 2012 and March 2013 in a community pharmacy. Pharmacotherapy data were collected from medical prescriptions, patient diaries, medical charts and all the medicines (over-the-counter and prescription) brought by the patients to the appointment with the pharmacist. The medicine-related problems were classified as indication, effectiveness, safety and adherence. Adherence was measured through clinical interviews and the Morisky questionnaire. PD symptoms were assessed according to the patients’ and/or caregivers’ perceptions about the On/Off state of the motor symptoms and relief of the nonmotor symptoms. QoL was assessed using the PDQ-39 scores. The interventions were targeted to patients/caregivers and/or doctors, with pharmacological and non-pharmacological measures. Results Seventy patients were followed up, showing a decrease in medicine-related problems (1.67 ± 1.34 to 0.8 ± 0.9 (p < 0.001), positive impact on adherence (from 37 to 10 non-adherent patients, p < 0.001), QoL improvement related to emotional wellbeing (p = 0.012) and autonomic disorder. Most interventions were performed directly with the patients (73.8%), including non-pharmacological guidance (28.5%), pharmacological guidance (24.3%) and rescheduling (13.6%). Conclusions To carry out MTM with PD patients, the pharmacist’s expertise needs to transcend the technical knowledge about the PD pharmacological treatment. The study showed a positive effect with a decrease in the medicine-related problems after the interventions, especially improving adherence and patients’ QoL.
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Affiliation(s)
- Aline Aparecida Foppa
- Farmácia Escola UFSC/PMF, Post-Graduate Program in Pharmaceutical Assistance, UFSC, Florianópolis, SC, Brazil.
| | - Clarice Chemello
- Department of Social Pharmacy, Faculty of Pharmacy, UFMG, Belo Horizonte, MG, Brazil
| | | | - Mareni Rocha Farias
- Department of Pharmaceutical Sciences, Health and Science Center, UFSC, Florianópolis, SC, Brazil
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Nakamura CA, Soares L, Farias MR, Leite SN. Pharmaceutical services and health promotion: how far have we gone and how are we faring? Scientific output in pharmaceutical studies. BRAZ J PHARM SCI 2014. [DOI: 10.1590/s1984-82502014000400013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The objective of this study was to investigate the scientific output on health promotion within the pharmaceutical field and its relation with the development of pharmaceutical services within health systems. A comprehensive review of published scientific articles from the Medline and Lilacs databases was carried out. The review comprised articles published until December 2011, and used combinations of the terms 'health promotion' or 'health education' and 'pharmacy', 'pharmacist' or 'pharmaceutical'. The articles were selected according to inclusion and exclusion criteria. A total of 170 full texts and 87 indexed abstracts were analyzed, evidencing that most described actions of health promotion in community pharmacies and other services. Following the Ottawa Charter, most of the studies dealt with new guidance of the service and the supply of pharmaceutical information and services. It was concluded that there is a lack of theoretical background on health promotion in the pharmaceutical field to sustain the professional education and practice required by the health system and the population.
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Vargas-Peláez CM, Rover MRM, Leite SN, Rossi Buenaventura F, Farias MR. Right to health, essential medicines, and lawsuits for access to medicines--a scoping study. Soc Sci Med 2014; 121:48-55. [PMID: 25306409 DOI: 10.1016/j.socscimed.2014.08.042] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 07/17/2014] [Accepted: 08/13/2014] [Indexed: 11/18/2022]
Abstract
Despite countries' efforts to ensure access to essential medicines, some people do not have their needs met, and often resort to the Judiciary to get access to the medicines they need. This phenomenon, known as "judicialization of access to medicines", has aroused the academia's interest in law, health and social fields. In this context, this scoping study investigates, through qualitative thematic analysis, the approach to judicialization of access to medicines (normative or social) and its possible impacts (positive or negative) described in articles published in scientific journals indexed in the main health databases prior to July 2012. 65 of 384 papers met the inclusion criteria of focusing on lawsuits for access to medicines or judicialization of access to medicines as a phenomenon; empiric studies, review articles or theoretical discussions, written in English, Portuguese or Spanish; most of them were about Brazil, Colombia and England. Results show that judicialization is a complex phenomenon that involves technical-scientific, legal and social aspects. The judicialization impacts mentioned have changed over time. In the late 1990s and early 2000s the emphasis of positive impacts predominated both on the normative and social approaches, having as main reference the movements that claimed from the States the guarantee of access to HIV/AIDS treatment. In the mid-2000s, however, there was an emphasis of the negative effects of judicial intervention, when lawsuits for access to medicines became a problem in some countries. Few studies used the social approach to judicialization. For this reason, there is not enough information about whether lawsuits for access to medicines are related to a real recognition of the right to health as an exercise of citizenship. Such aspects need to be further studied.
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Affiliation(s)
| | | | - Silvana Nair Leite
- Programa de pós-graduação em Farmácia, Universidade Federal de Santa Catarina, Brazil
| | | | - Mareni Rocha Farias
- Programa de pós-graduação em Farmácia, Universidade Federal de Santa Catarina, Brazil.
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Blatt CR, Storb B, Mühlberger N, Farias MR, Siebert U. Chronic Hepatitis C treatment for genotype 2 or 3 in Brazil: cost effectiveness analysis of peginterferon plus ribavirin as first choice treatment. BRAZ J PHARM SCI 2014. [DOI: 10.1590/s1984-82502014000200014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Brazilian Guidelines to HCV treatment (2007) recommended that the first choice treatment for patients with chronic hepatitis C (CHC) and genotype 2 or 3 is interferon alpha (IFN) plus ribavirin (RBV) for 24 weeks. The aim of this study is compare the cost and effectiveness to Hepatitis C treatment in patients with genotype 2 or 3 of peginterferon alpha (PEG) as the first choice of treatment within PEG for those that do not respond to IFN. The target population is CHC patients with genotype 2 or 3 in Brazil. The interventions are: PEG-SEC (first IFN plus RBV for 24 weeks, after, for non-responders and relapsers subsequently PEG plus RBV for 48 weeks); PEG-FIRST24 (PEG+RBV for 24 weeks). The type of the study is cost-effectiveness analysis. The data sources are: Effectiveness data from meta-analysis conducted on the Brazilian population. Treatment cost from Brazilian micro costing study is converted into USD (2010). The perspective is the Public Health System. The outcome measurements are Sustained Viral Response (SVR) and costs. PEG-FIRST24 (SVR: 87.8%, costs: USD 8,338.27) was more effective and more costly than PEG-SEC (SVR: 79.2%, costs: USD 5,852.99). The sensitivity analyses are: When SVR rates with IFN was less than 30% PEG-FIRST is dominant. On the other hand, when SVR with IFN was more then 75% PEG-SEC is dominant (SVR=88.2% and costs USD $ 3,753.00). PEG-SEC is also dominant when SVR to PEG24 weeks was less than 54%. In the Brazilian context, PEG-FIRST is more effective and more expensive than PEG-SEC. PEG-SEC could be dominant when rates of IFN therapy are higher than 75% or rates of PEG24 therapy are lower than 54%.
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Affiliation(s)
- Carine Raquel Blatt
- Federal University of Santa Catarina, Brazil; Departament Public Health, Austria; Federal University of Health Science from Porto Alegre, Brazil
| | - Bernd Storb
- Federal University of Santa Catarina, Brazil; Departament Public Health, Austria
| | | | - Mareni Rocha Farias
- Federal University of Santa Catarina, Brazil; Departament Public Health, Austria
| | - Uwe Siebert
- Departament Public Health, Austria; , Austria; Harvard University, United States of America
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Chemello C, Souza FD, Patricio EDS, Farias MR. Pharmaceutical care as a strategy to improve the safety and effectiveness of patients? pharmacotherapy at a pharmacy school: a practical proposal. BRAZ J PHARM SCI 2014. [DOI: 10.1590/s1984-82502011000100019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Several patients experience at least one drug-related problem and Pharmaceutical Care can change this reality. This work describes a model for structuring the pharmaceutical care service at a pharmacy training unit of the Brazilian Public Health System based on pharmacotherapy follow-up program of Parkinson’s disease patients’ results. From the follow-up results (phase 1), a Therapy Management Scheme was designed (phase 2). Of the 57 patients followed-up, 30 presented at least one drug-related problem and 42% were non-adherent to treatment, which supported the need of pharmacotherapy management. The Pharmacotherapy Management Scheme was proposed as a pharmaceutical care service model, which presents 6 steps: first, the pharmacist fills out the dispensing form and assesses patient´s pharmacotherapy, if there is a suspect problem, he is invited to the follow-up (steps 1 and 2) and they agree the first appointment. After that, pharmacist studies the patient’s case (study phase, steps 3 and 4). At the second meeting, the pharmacist proposes the intervention needed, and at the third, assesses the intervention results and new problems (steps 5 and 6, respectively). The process ends when all therapeutics outcomes are reached. This practical model can significantly contributed to the development and organization of pharmaceutical care services.
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Abstract
Access to medication emphasizes the availability of the product at the expense of providing a service. The goal of this paper is to propose a theoretical model for a drug dispensing service, beginning with a reflection on the current realities of the Unified Health System and drug dispensation in Brazil. A conceptual analytical research made by a methodological course called disciplined imagination was mainly the approach applied to develop the model. The drug dispensing service is part of the care process, which considers access as an attribute; reception, connection and accountability, management, and clinical pharmaceutical aspects as components; and the rational use of drugs as the purpose. The proposed model addresses access to the dispensing service and demands a reorientation of routines, instruments, and practices.
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Buendgens FB, Blatt CR, Marasciulo ACE, Leite SN, Farias MR. Estudo de custo-análise do tratamento da artrite reumatoide grave em um município do Sul do Brasil. CAD SAUDE PUBLICA 2013; 29 Suppl 1:S81-91. [DOI: 10.1590/0102-311x00013513] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 07/19/2013] [Indexed: 01/17/2023] Open
Abstract
O tratamento da artrite reumatoide envolve a utilização de medicamentos, terapias não farmacológicas, consultas médicas, exames complementares, entre outros procedimentos. O artigo apresenta, conforme as fontes pagadoras, os custos diretos médicos relacionados ao tratamento da artrite reumatoide. Trata-se de um estudo de custo-análise envolvendo 103 pacientes com artrite reumatoide grave atendidos por meio do Componente Especializado da Assistência Farmacêutica em Florianópolis, Santa Catarina, Brasil. O custo direto médico total foi R$ 2.045.596,55/ano, correspondendo a R$ 19.860,16 por paciente/ano. Do custo total, 90,8% foram para despesas com medicamentos, 2,5% às hospitalizações, 2,2% aos exames complementares, 2,1% às consultas médicas e 2,4% à soma dos demais componentes. O setor público foi responsável por 73,6% do custo direto médico total e por 79,3% do custo com a aquisição de medicamentos. A análise dos custos permitiu traçar um perfil de como uma população portadora de doença crônico-degenerativa altamente demandante de recursos transita pela composição público-privada que caracteriza o sistema de saúde brasileiro.
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Blatt CR, Bernardo NLMDC, Rosa JA, Bagatini F, Alexandre RF, Balbinotto Neto G, Siebert U, Rocha Farias M. An Estimate of the Cost of Hepatitis C Treatment for the Brazilian Health System. Value Health Reg Issues 2012; 1:129-135. [DOI: 10.1016/j.vhri.2012.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Canabarro A, Valle C, Farias MR, Santos FB, Lazera M, Wanke B. Association of subgingival colonization of Candida albicans and other yeasts with severity of chronic periodontitis. J Periodontal Res 2012; 48:428-32. [PMID: 23137301 DOI: 10.1111/jre.12022] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2012] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVE The aim of this study is to analyze the relationship between the subgingival colonization by Candida albicans and other yeasts with the severity of chronic periodontitis (CP). MATERIAL AND METHODS After sample size calculation, 40 patients with CP and 20 healthy subjects (HS) were included in the study. Cases of slight-moderate (MCP, n = 23) and severe CP (SCP, n = 17) were defined according to the Centers for Disease Control/American Association of Periodontology classification. Subgingival samples were acquired using sterile paper-points from the sulcus or the deepest periodontal pocket of each healthy and subject with CP, respectively, and were cultured aerobically on three selective media. Yeast colonies that grew on the surface of plates were later identified by biochemical reactions. Statistical tests were used to analyze the association between subgingival yeast colonization (number of yeast-positive individuals and colony forming units (CFU) per subject) and periodontal disease status, considering statistical significance when P < 0.05. RESULTS Although several yeast species were found (C. parapisilosis, Rhodotorula sp., C. dubliniensis and C. tropicalis), only C. albicans was present in all the patients with yeast-positive CP. Twelve patients (30%) with CP presented yeasts in the subgingival biofilm while only three patients (15%) in the HS group were positive for these microorganisms. No statistical difference was found between the CP and HS groups (P = 0.084). However, when the CP group was divided on the basis of severity, statistical differences were observed between the SCP and MCP groups (47% vs. 17%, P = 0.043), and between the SCP and HS groups (47% vs. 15%, P = 0.033). No statistical difference was observed between the MCP and HS groups (17% vs. 15%, P = 0.832). High densities of yeasts were found only in patients with MCP and SCP (mean and range 61.25 (0-100) CFU/plate and mean and range 51 (0-101) CFU/plate, respectively). CONCLUSION In this group of patients, subgingival colonization of some yeasts, especially C. albicans, was associated with the severity of CP.
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Affiliation(s)
- A Canabarro
- Department of Periodontology, Universidade Veiga de Almeida, Rio de Janeiro, Brazil.
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Rosa JAD, Blatt CR, Peres KC, Storb BH, Silva R, Farias MR. Sustained virological response to treatment of chronic hepatitis C with peginterferon alfa and ribavirin. BRAZ J PHARM SCI 2012. [DOI: 10.1590/s1984-82502012000200002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
This study aimed to evaluate the rate of sustained virological response (SVR) and the clinical and treatment characteristics of patients with chronic hepatitis C (CHC). A retrospective uncontrolled cohort study was conducted among patients who received treatment for CHC between 2005 and 2008 attended at the Center for the Application and Monitoring of Injectable Medications, in Florianopolis, SC, Brazil. The inclusion criteria were: patients over 18 years of age, with a confirmed diagnosis of chronic hepatitis C according to Brazilian guidelines, treated with PEG-IFN alfa-2a or 2b associated with RBV. A total of 188 patients were included in the study: 70% men, 59% genotype 1, 27% coinfected with HIV, 31% with cirrhosis. The SVR rate, calculated by probability theory, was determined as 26% (max=57.4% and min=12.8%) and the intention to treat was 12.8%. Associations between Sustained Virological Response (SVR) and the variables sex (p=0.017), age (p=0.003), genotype (p=0.648) and cirrhosis (p=0.275), were determined in the bivariate analysis and only sex and age were significantly associated with SVR. The SVR rate was considered low, which can be partially explained by patients' unfavorable pretreatment characteristics.
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Bevilacqua G, Farias MR, Blatt CR. <b>Aquisição de medicamentos genéricos em município de médio porte</b>. Rev Saude Publica 2011. [DOI: 10.1590/s0034-89102011000300017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Bevilacqua G, Farias MR, Blatt CR. Aquisição de medicamentos genéricos em município de médio porte. Rev Saude Publica 2011; 45:583-9. [DOI: 10.1590/s0034-89102011005000020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 11/14/2010] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Analisar o impacto financeiro da aquisição de medicamentos com a exigência da apresentação de testes de biodisponibilidade e/ou bioequivalência para o componente da Assistência Farmacêutica Básica. MÉTODOS: Estudo retrospectivo, documental, em atas dos processos licitatórios para aquisição de medicamentos em município de médio porte de Santa Catarina. Foram analisadas licitações sem (2007) e com (2008) a exigência de testes de bioequivalência e/ou de biodisponibilidade. Avaliaram-se o número de recursos apresentados pelos fornecedores, o número de processos licitatórios anuais necessários para a aquisição de todos os medicamentos padronizados, o tempo para a finalização do processo licitatório, o número de itens fracassados, o custo unitário dos medicamentos e o valor total da aquisição. RESULTADOS: Foram observados 2,6% de itens fracassados em 2007 e 56,9% em 2008. Entre os medicamentos, 60,0% tiveram acréscimo e 29,3,0% decréscimo em 2008 em relação a 2007. Os custos totais de aquisição para 150 medicamentos, considerando valores unitários praticados e o consumo médio anual, foram de R$ 2.288.120,00 para 2007 e de R$ 4.270.425,00 para 2008. CONCLUSÕES: A exigência dos testes de bioequivalência e/ou de biodisponibilidade elevou em mais de 100% os custos com o financiamento do Componente da Assistência Farmacêutica Básica, indicando necessidade de discussão de uma Política de Medicamento Genérico em consonância com a Política de Assistência Farmacêutica e com a Relação Nacional de Medicamentos Essenciais.
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Affiliation(s)
| | | | - Carine Raquel Blatt
- Universidade Federal de Santa Catarina, Brasil; UFSC, Brasil; Universidade do Sul de Santa Catarina, Brasil
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Bagatini F, Blatt CR, Maliska G, Trespash GV, Pereira IA, Zimmermann AF, Storb BH, Farias MR. Potenciais interações medicamentosas em pacientes com artrite reumatoide. Rev Bras Reumatol 2011. [DOI: 10.1590/s0482-50042011000100003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Bagatini F, Blatt CR, Maliska G, Trespash GV, Pereira IA, Zimmermann AF, Storb BH, Farias MR. Potential drug interactions in patients with rheumatoid arthritis. Rev Bras Reumatol 2011; 51:20-39. [PMID: 21412604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 12/16/2010] [Indexed: 05/30/2023] Open
Abstract
INTRODUCTION The term polypharmacy, meaning the concomitant use of multiple medications by one individual, has been widely reported in institutionalized or elderly patients. It can, however, occur in patients with chronic diseases, such as rheumatoid arthritis (RA). OBJECTIVE To quantify polypharmacy in a group of RA patients and to assess the risk of potential undesirable interactions between medications used for managing RA and those used for non-chronic diseases. METHODS A cohort study was carried out with 103 RA patients registered at the Strategy of Access to Medications from the Brazilian Health Ministry, at the School of Pharmacy of the city of Florianópolis, state of Santa Catarina. Patients were monthly followed up by use of form completion. Drug interactions were identified by use of the Drugdex System - Thomson Micromedex® - Interactions database. RESULTS Polypharmacy was found in 95.1% of the patients, and 19 potential undesirable interactions were observed between the drugs used by 74 patients (mean of 3.0 ± 1.2 interactions/patient). All potential interactions were related to methotrexate. Omeprazole was the major representative, accounting for 29.3% of the interactions, followed by diclofenac sodium (17.6%), and metamizole sodium (13.2%). CONCLUSION Considering that this study confirms that polypharmacy is a common therapeutic practice in RA patients, it is worth emphasizing the need for greater surveillance regarding the adverse effects or effectiveness reduction of certain drugs due to drug interaction.
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Freitas AM, Almeida MTR, Andrighetti-Fröhner CR, Cardozo FTGS, Barardi CRM, Farias MR, Simões CMO. Antiviral activity-guided fractionation from Araucaria angustifolia leaves extract. J Ethnopharmacol 2009; 126:512-517. [PMID: 19761825 DOI: 10.1016/j.jep.2009.09.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 08/21/2009] [Accepted: 09/03/2009] [Indexed: 05/28/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Araucaria angustifolia (Bert.) O. Kuntze (Araucariaceae) is a Brazilian medicinal plant traditionally used for the treatment of various illnesses including dried skin, wounds, shingles, and sexually transmitted diseases. AIM OF THE STUDY The rationale of the study was to provide evidence of its antiherpes activity in order to confirm its popular use that could be related to herpes disease. MATERIALS AND METHODS The crude hydroethanolic extract (HE) obtained from Araucaria angustifolia leaves was submitted to a sequential liquid-liquid extraction with solvents of increased polarity. The HE and fractions obtained were evaluated for cytotoxicity and antiherpes activity (Herpes Simplex Virus type 1) by MTT assay. The most active fractions were selected to perform an in vitro antiviral activity-guided chromatographic fractionation. RESULTS The ethyl acetate (EA) and n-butanol (NB) fractions have shown the best results for antiherpetic activity and their further fractionation yielded 22 subfractions. From these subfractions, 14 were active, and the most potent antiherpetic activity was obtained for NB1-4 subfraction with selectivity index (SI) of 57.51. Chemical analysis of NB1-4 subfractions revealed the presence of proanthocyanidins and the known biflavonoids (bilobetin, II-7-O-methyl-robustaflavone and cupressuflavone). The same biflavonoids have been detected in EA subfractions. CONCLUSION The present study has shown that the hydroethanolic extract from Araucaria angustifolia leaves as well as many different fractions and subfractions exhibited antiherpes activity, supporting the use of this plant species in folk medicine.
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Affiliation(s)
- A M Freitas
- Departamento de Química, Centro Politécnico, Universidade Federal do Paraná, CP 19.081, CEP 81.531-990, Curitiba, PR, Brazil
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Krepsky PB, Cervelin MDO, Porath D, Peters RR, Ribeiro-do-Valle RM, Farias MR. High performance liquid chromatography determination of cucurbitacins in the roots of Wilbrandia ebracteata Cogn. Rev bras farmacogn 2009. [DOI: 10.1590/s0102-695x2009000500011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Lindner LM, Marasciulo AC, Farias MR, Grohs GEM. Avaliação econômica do tratamento da esquizofrenia com antipsicóticos no Sistema Único de Saúde. Rev Saude Publica 2009; 43 Suppl 1:62-9. [DOI: 10.1590/s0034-89102009000800010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Accepted: 04/28/2009] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar as relações de custo-utilidade entre medicamentos antipsicóticos de primeira e segunda gerações no tratamento da esquizofrenia. MÉTODOS: Foi construído um modelo de Markov de cinco anos, a partir de um levantamento em prontuários de pacientes atendidos em um centro de atenção psicossocial em Florianópolis (SC), 2006. Os custos foram avaliados sob a perspectiva o Sistema Único de Saúde. As utilidades foram medidas em anos de vida ajustados pela qualidade obtidas na literatura. RESULTADOS: No modelo de Markov, a alternativa mais custo-efetiva foi a utilização de risperidona e haloperidol antes de olanzapina. CONCLUSÕES: Os antipsicóticos haloperidol e risperidona apresentaram melhor relação de custo-efetividade quando comparados à olanzapina. Estratégias que priorizem a utilização de antipsicóticos com melhor relação de custo-efetividade podem otimizar recursos, sem necessariamente implicar prejuízos à saúde dos pacientes atendidos no Sistema Único de Saúde.
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