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Couret A, Lapeyre-Mestre M, Renoux A, Gardette V. Healthcare use according to deprivation among French Alzheimer's Disease and Related Diseases subjects: a national cross-sectional descriptive study based on the FRA-DEM cohort. Front Public Health 2024; 12:1284542. [PMID: 38487186 PMCID: PMC10937384 DOI: 10.3389/fpubh.2024.1284542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/06/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction Pluriprofessional and coordinated healthcare use is recommended for Alzheimer's Disease and Related Diseases (ADRD). Despite a protective health system, France is characterized by persistent and significant social inequalities in health. Although social health inequalities are well documented, less is known about social disparities in healthcare use in ADRD, especially in France. Therefore, this study aimed to describe healthcare use according to socioeconomic deprivation among ADRD subjects and the possible potentiating role of deprivation by age. Methods We studied subjects identified with incident ADRD in 2017 in the French health insurance database (SNDS). We described a large extent of their healthcare use during the year following their ADRD identification. Deprivation was assessed through French deprivation index (Fdep), measured at the municipality level, and categorized into quintiles. We compared healthcare use according to the Fdep quintiles through chi-square tests. We stratified the description of certain healthcare uses by age groups (40-64 years, 65-74 years, 75-84 years, 85 years, and older), number of comorbidities (0, 1, 2-3, 4 comorbidities and more), or the presence of psychiatric comorbidity. Results In total, 124,441 subjects were included. The most deprived subjects had less use of physiotherapy (28.56% vs. 38.24%), ambulatory specialists (27.24% vs. 34.07%), ambulatory speech therapy (6.35% vs. 16.64%), preventive consultations (62.34% vs. 69.65%), and were less institutionalized (28.09% vs. 31.33%) than the less deprived ones. Conversely, they were more exposed to antipsychotics (11.16% vs. 8.43%), benzodiazepines (24.34% vs. 19.07%), hospital emergency care (63.84% vs. 57.57%), and potentially avoidable hospitalizations (12.04% vs. 10.95%) than the less deprived ones. Discussion and conclusion The healthcare use of subjects with ADRD in France differed according to the deprivation index, suggesting potential health renunciation as in other diseases. These social inequalities may be driven by financial barriers and lower education levels, which contribute to health literacy (especially for preventive care). Further studies may explore them.
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Affiliation(s)
- Anaïs Couret
- Agence Régionale de Santé Occitanie, Toulouse, France
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Maryse Lapeyre-Mestre
- Centre Hospitalier Universitaire de Toulouse, Department of Pharmacology, Toulouse, France
- Centre d'Investigation Clinique 1436, Team PEPSS “Pharmacologie En Population cohorteS et biobanqueS,” Centre Hospitalier Universitaire de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Axel Renoux
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Virginie Gardette
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Department of Epidemiology and Public Health, Toulouse, France
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Natali I, Dewatripont M, Ginsburgh V, Goldman M, Legros P. Prescription opioids and economic hardship in France. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:1473-1504. [PMID: 36710287 PMCID: PMC9884604 DOI: 10.1007/s10198-022-01557-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 12/01/2022] [Indexed: 06/18/2023]
Abstract
This paper studies how opioid analgesic sales are empirically related to socioeconomic disparities in France, with a focus on poverty. This analysis is made possible using the OpenHealth database, which provides retail sales data for opioid analgesics available on the French market. We exploit firm-level data for each of the 94 departments in Metropolitan France between 2008 and 2017. We show that increases in the poverty rate are associated with increases in sales: a one percentage point increase in poverty is associated with approximately a 5% increase in mild opioid sales. Our analysis further shows that opioid sales are positively related to the share of middle-aged people and individuals with basic education only, while they are negatively related to population density. The granularity and longitudinal nature of these data allow us to control for a large pool of potential confounding factors. Our results suggest that additional interventions should be more intensively addressed toward the most deprived areas. We conclude that a combination of policies aimed at improving economic prospects and strictly monitoring access to opioid medications would be beneficial for reducing opioid-related harm.
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Affiliation(s)
- Ilaria Natali
- Université Libre de Bruxelles, Avenue F. D. Roosevelt, 50, 1050, Brussels, Belgium.
- European Center for Advanced Research in Economics and Statistics (ECARES), Université Libre de Bruxelles, Brussels, Belgium.
- Institute for Interdisciplinary Innovation in Healthcare (I3h), Université Libre de Bruxelles, Brussels, Belgium.
- Toulouse School of Economics (TSE), Université Toulouse 1 Capitole, Toulouse, France.
| | - Mathias Dewatripont
- European Center for Advanced Research in Economics and Statistics (ECARES), Université Libre de Bruxelles, Brussels, Belgium
- Institute for Interdisciplinary Innovation in Healthcare (I3h), Université Libre de Bruxelles, Brussels, Belgium
| | - Victor Ginsburgh
- European Center for Advanced Research in Economics and Statistics (ECARES), Université Libre de Bruxelles, Brussels, Belgium
- Institute for Interdisciplinary Innovation in Healthcare (I3h), Université Libre de Bruxelles, Brussels, Belgium
| | - Michel Goldman
- Institute for Interdisciplinary Innovation in Healthcare (I3h), Université Libre de Bruxelles, Brussels, Belgium
| | - Patrick Legros
- European Center for Advanced Research in Economics and Statistics (ECARES), Université Libre de Bruxelles, Brussels, Belgium
- Institute for Interdisciplinary Innovation in Healthcare (I3h), Université Libre de Bruxelles, Brussels, Belgium
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Tough H, Gross-Hemmi M, Stringhini S, Eriks-Hoogland I, Fekete C. Who is at Risk of Loneliness? A Cross-sectional Recursive Partitioning Approach in a Population-based Cohort of Persons With Spinal Cord Injury. Arch Phys Med Rehabil 2021; 103:305-312. [PMID: 34560050 DOI: 10.1016/j.apmr.2021.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To develop a more thorough understanding of the risk factors for loneliness in persons with a physical impairment, using a population-based sample of persons with spinal cord injury (SCI), based on regression modeling and a recursive partitioning approach. DESIGN Cross-sectional, observational cohort. SETTING Community, Switzerland. PARTICIPANTS Community-dwelling persons with spinal cord injury (N=1283) 16 years or older. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Loneliness was assessed using a modified version of the UCLA Three-Item Loneliness Scale. RESULTS Those with the most disadvantaged socioeconomic characteristics in terms of education, income, subjective social position, employment status, and financial hardship demonstrated the highest risk for loneliness. Of the sociodemographic characteristics, only age had an association with loneliness, whereby persons aged 31-45 had the highest propensity for experiencing loneliness. We also saw that those with higher lesion levels and less functional independence were associated with higher levels of loneliness. In conditional inference tree analysis subjective social position, financial hardship, and functional independence had the highest discriminative power, with nationality and living arrangement having a less important role. CONCLUSIONS Our findings highlight the vulnerability of persons with SCI with unfavorable socioeconomic status to loneliness. Furthermore, our findings show that persons who are more constrained because of functional limitations may face restrictions to social participation and therefore be at a higher risk of loneliness. This population-based evidence contributes to the better targeting of services aimed at alleviating loneliness for persons with a lower socioeconomic position and those with more functional limitations in everyday life.
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Affiliation(s)
- Hannah Tough
- Swiss Paraplegic Research, Nottwil; Department of Health Sciences and Medicine, University of Lucerne, Lucerne.
| | | | - Silvia Stringhini
- Department of Population Health, Epidemiology, and Public Health, HUG - Hôpitaux Universitaires de Genève, Geneva
| | | | - Christine Fekete
- Swiss Paraplegic Research, Nottwil; Department of Health Sciences and Medicine, University of Lucerne, Lucerne
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Fekete C, Reinhardt JD, Arora M, Patrick Engkasan J, Gross-Hemmi M, Kyriakides A, Le Fort M, Tough H. Socioeconomic status and social relationships in persons with spinal cord injury from 22 countries: Does the countries' socioeconomic development moderate associations? PLoS One 2021; 16:e0255448. [PMID: 34388150 PMCID: PMC8362947 DOI: 10.1371/journal.pone.0255448] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/19/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Social relationships are powerful determinants of health and inequalities in social relationships across socioeconomic status (SES) groups may contribute to social inequalities in health. This study investigates inequalities in social relationships in an international sample of persons with spinal cord injury and explores whether social gradients in relationships are moderated by the countries' socioeconomic development (SED). METHODS Data from 12,330 participants of the International SCI Community Survey (InSCI) performed in 22 countries were used. We regressed social relationships (belongingness, relationship satisfaction, social interactions) on individual SES (education, income, employment, financial hardship, subjective status) and countries' SED (Human Development Index) using multi-level models (main effects). To test potential moderation of the SED, interaction terms between individual SES and countries' SED were entered into multi-level models. RESULTS Paid work, absence of financial hardship and higher subjective status were related to higher belongingness (OR, 95% CI: 1.50, 1.34-1.67; 1.76, 1.53-2.03; 1.16, 1.12-1.19, respectively), higher relationship satisfaction (OR, 95% CI: 1.28, 1.15-1.42; 1.97, 1.72-2.27; 1.20, 1.17-1.24, respectively) and fewer problems with social interactions (Coeff, 95% CI: 0.96, 0.82-1.10; 1.93, 1.74-2.12; 0.26, 0.22-0.29, respectively), whereas associations with education and income were less consistent. Main effects for countries' SED showed that persons from lower SED countries reported somewhat higher relationship satisfaction (OR, 95% CI: 0.97, 0.94-0.99) and less problems with social interactions (Coeff, 95% CI: -0.04, -0.09- -0.003). Results from moderation analysis revealed that having paid work was more important for relationships in lower SED countries, while education and subjective status were more important for relationships in higher SED countries (interaction terms p<0.05). CONCLUSION Social relationships in persons with spinal cord injury are patterned according to individual SES and the countries' SED and larger socioeconomic structures partly moderate associations between individual SES and social relationships.
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Affiliation(s)
- Christine Fekete
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Jan D. Reinhardt
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Institute for Disaster Management and Reconstruction of Sichuan University and Hong Kong Polytechnic University, Sichuan University, Chengdu, China
| | - Mohit Arora
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, Australia
- Sydney Medical School - Northern, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | | | | | - Marc Le Fort
- Neurological Physical and Rehabilitation Medicine Department, University Hospital, Nantes Cedex, France
| | - Hannah Tough
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Zürcher C, Tough H, Fekete C. Mental health in individuals with spinal cord injury: The role of socioeconomic conditions and social relationships. PLoS One 2019; 14:e0206069. [PMID: 30785880 PMCID: PMC6382129 DOI: 10.1371/journal.pone.0206069] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 01/27/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To evaluate socioeconomic inequalities in social relationships, and to assess whether socioeconomic conditions and social relationships are independently related to mental health problems in individuals with a physical disability due to spinal cord injury (SCI). METHODS We analyzed cross-sectional data from 511 individuals with SCI aged over 16 years who participated in the community survey of the Swiss SCI Cohort Study (SwiSCI). Indicators for socioeconomic conditions included years of formal education, household income, and financial strain. Social relationships were operationalized by three structural (partner status; social contact frequency; number of supportive relationships) and four functional aspects (satisfaction with: overall social support; family relationships; contacts to friends; partner relationship). General mental health was assessed by the Mental Health Inventory (MHI-5) of SF-36 and depressive symptoms were measured by the Hospital Anxiety and Depression Scale (depression subscale, HADS-D). Established cut-offs for general mental health problems (MHI-5 ≤56) and depressive symptomatology (HADS-D ≥8) were used to dichotomize outcomes. Associations were assessed using logistic regressions. RESULTS Lower household income was predominantly associated with poor structural social relationships, whereas financial strain was robustly linked to poor functional social relationships. Financial strain was associated with general mental health problems and depressive symptomatology, even after controlling for social relationships. Education and household income were not linked to mental health. Poor structural and functional social relationships were related to general mental health problems and depressive symptomatology. Notably, trends remained stable after accounting for socioeconomic conditions. CONCLUSION This study provides evidence for socioeconomic inequalities in social relationships as well as for independent associations of financial strain and poor social relationships with mental health problems in individuals with SCI. Further research may develop strategies to improve mental health in SCI by strengthening social relationships. Such interventions may be especially beneficial for individuals with low income and financial strain.
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Affiliation(s)
- Carmen Zürcher
- Bern University of Applied Sciences, Department of Health Professions, Bern, Switzerland
| | - Hannah Tough
- Swiss Paraplegic Research, Nottwil, Switzerland
- University of Lucerne, Department of Health Sciences and Health Policy, Lucerne, Switzerland
| | - Christine Fekete
- Swiss Paraplegic Research, Nottwil, Switzerland
- University of Lucerne, Department of Health Sciences and Health Policy, Lucerne, Switzerland
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Jiao J, Drewnowski A, Moudon AV, Aggarwal A, Oppert JM, Charreire H, Chaix B. The impact of area residential property values on self-rated health: A cross-sectional comparative study of Seattle and Paris. Prev Med Rep 2016; 4:68-74. [PMID: 27413663 PMCID: PMC4929065 DOI: 10.1016/j.pmedr.2016.05.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 04/09/2016] [Accepted: 05/16/2016] [Indexed: 11/29/2022] Open
Abstract
This study analyzed the impact of area residential property values, an objective measure of socioeconomic status (SES), on self-rated health (SRH) in Seattle, Washington and Paris, France. This study brings forth a valuable comparison of SRH between cities that have contrasting urban forms, population compositions, residential segregation, food systems and transportation modes. The SOS (Seattle Obesity Study) was based on a representative sample of 1394 adult residents of Seattle and King County in the United States. The RECORD Study (Residential Environment and Coronary Heart Disease) was based on 7131 adult residents of Paris and its suburbs in France. Socio-demographics, SRH and body weights were obtained from telephone surveys (SOS) and in-person interviews (RECORD). All home addresses were geocoded using ArcGIS 9.3.1 (ESRI, Redlands, CA). Residential property values were obtained from tax records (Seattle) and from real estate sales (Paris). Binary logistic regression models were used to test the associations among demographic and SES variables and SRH. Higher area property values significantly associated with better SRH, adjusting for age, gender, individual education, incomes, and BMI. The associations were significant for both cities. A one-unit increase in body mass index (BMI) was more detrimental to SRH in Seattle than in Paris. In both cities, higher area residential property values were related to a significantly lower obesity risk and better SRH. Ranked residential property values can be useful for health and weight studies, including those involving social inequalities and cross-country comparisons. We studied the impact of area property values on health in Seattle and Paris. Higher area property values associated with better SRH in both cities Ranked area property values can be useful for health and weight studies. BMI was more detrimental to SRH in Seattle than in Paris.
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Affiliation(s)
- Junfeng Jiao
- School of Architecture, University of Texas at Austin, Austin, TX, United States
| | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA, United States
| | - Anne Vernez Moudon
- Urban Form Lab, College of Built Environments, University of Washington, Seattle, WA, United States
| | - Anju Aggarwal
- Center for Public Health Nutrition, University of Washington, Seattle, WA, United States
| | | | - Helene Charreire
- The Institute of Urbanism of Paris, Paris 12 Val de Marne University, Paris, France
| | - Basile Chaix
- Pierre Louis Institute of Efpidemiology and Public Health, Paris, France
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Grimaud O, Roussel P, Schnitzler A, Demmer R, Menvielle G. Do socioeconomic disparities in stroke and its consequences decrease in older age? Eur J Public Health 2016; 26:799-804. [DOI: 10.1093/eurpub/ckw058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Audureau E, Rican S, Coste J. Worsening trends and increasing disparities in health-related quality of life: evidence from two French population-based cross-sectional surveys, 1995-2003. Qual Life Res 2014; 22:13-26. [PMID: 22298202 DOI: 10.1007/s11136-012-0117-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2012] [Indexed: 01/10/2023]
Abstract
PURPOSE To investigate time trends in health-related quality of life (HRQoL) in France and to report existing and changing demographic, socioeconomic, and geographic disparities. METHODS Data were drawn from two independent national cross-sectional surveys conducted in 1995 and 2003, including 3,243 individuals aged 18–84 in 1995 and 22,743 in 2003. HRQoL was measured with the 8 subscales of the French version of the SF-36. RESULTS After multiple linear regression, a significant decrease was observed between 1995 and 2003 in all scales scores, from −0.11 adjusted standard deviations for Social Functioning (95% CI: −0.15 to −0.08) to −0.23 for Vitality (−0.26 to −0.19). Increasing age, female gender, divorce/widowhood, lowest educational levels, chronic conditions, and living in the Northern region were identified as independent predictors of lower HRQoL scores. Testing interactions showed significantly greater differences between 1995 and 2003 for subjects aged 75–84 and for least educated subjects (Physical Functioning, General Health). The Gini index increased for all scales. CONCLUSIONS We report evidence of worsening trends and possibly increasing demographic, socioeconomic, and regional disparities in HRQoL between 1995 and 2003 in France. Monitoring HRQoL in populations can provide unique and sensitive data, complementary to classical indicators based on mortality and morbidity.
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Affiliation(s)
- Etienne Audureau
- Biostatistics and Epidemiology Unit, Assistance Publique-Hôpitaux de Paris, Hôtel-Dieu, Nancy-Université, Université Paris-Descartes, Université Metz Paul Verlaine, Research Unit APEMAC, EA 4360, 1 place du Parvis Notre-Dame, 75181 Paris Cedex 4, France.
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Santos JN, Maciel FJ, Martins VDO, Rodrigues ALV, Gonzaga AF, Silva LFD. Inserção dos fonoaudiólogos no SUS/MG e sua distribuição no território do estado de Minas Gerais. REVISTA CEFAC 2011. [DOI: 10.1590/s1516-18462011005000088] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: investigar a distribuição dos fonoaudiólogos no estado de Minas Gerais, sua inserção no SUS e as variações geográficas dessa distribuição e suas desigualdades. MÉTODO: análise dos Cadernos de Informações de Saúde dos 853 municípios do estado de Minas Gerais referentes a 2009, disponíveis no Sistema de Informações em Saúde brasileiro, o DATASUS. Foram pesquisados os indicadores: população municipal, número total de fonoaudiólogos da rede SUS e da rede privada e número médio de fonoaudiólogos (SUS e rede privada) por mil habitantes. RESULTADOS: a análise dos dados revelou a presença de 1.733 fonoaudiólogos atuando no estado em 2009. Destes, 67,8% atendiam à rede SUS. Dos 853 municípios, 505 (59%) não possuíam o profissional fonoaudiólogo no período investigado. Observou-se que entre as 13 macrorregiões estaduais as regiões Centro-Sul e Sul apresentaram a melhor média de fonoaudiólogos por 10.000 habitantes (1/10.000) e as regiões Norte de Minas e Nordeste, as piores: 0,16 e 0,05/10.000, respectivamente. Observou-se a presença de 0,58 fonoaudiólogos/10.000 habitantes disponíveis na rede SUS e 0,86 fonoaudiólogos/10.000 atendendo à rede privada e ao SUS no estado. CONCLUSÃO: a inclusão de fonoaudiólogos na assistência à saúde estadual ainda é deficitária, sendo observada grande disparidade na distribuição dos profissionais. É notório o estrangulamento da assistência fonoaudiológica no SUS em Minas Gerais, visto que para cada 17.000 mineiros existia somente um fonoaudiólogo no SUS estadual em 2009. Ressalta-se a necessidade de uma mobilização dos profissionais e dos gestores de saúde para garantir a integralidade da atenção à saúde no estado.
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