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da Rosa Moraes NG, Florencio Ramires P, Silva da Cruz L, Oliveira Penteado J, Buffarini R, da Silva Júnior FMR. Ethnic-racial disparities in poisoning cases: analysis of drugs of abuse, medicines and pesticides in Brazil. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2024; 87:863-878. [PMID: 39150064 DOI: 10.1080/15287394.2024.2389413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
In Brazil, ethnic-racial inequalities exist in all fields, obstructing access to goods, services, and opportunities, including healthcare services. However, there are no apparent studies that assess, at a national level, ethnic-racial disparities in poisoning cases, emphasizing skin color as a determining factor. The study aimed to examine the relationship between race/ethnicity and general poisoning cases, by medications, pesticides, and drug of abuse in Brazilian states. Poisoning cases data were extracted for the years 2017, 2018, and 2019. Notification data for general poisoning cases and toxic agents were collected: medications, pesticides, and drugs of abuse. Data were categorized between whites and non-whites (blacks, browns, and indigenous) and without information on skin color/ethnicity. Rates of poisonings amongst ethnic-racial groups and cases of not declared skin color as well as relative risk (RR) of poisoning among non-whites were calculated. All states in the North, Northeast (states with the worst Human Development Index), Midwest, and 2 states in the Southeast exhibited higher rates of poisoning cases per 100,000 inhabitants among non-whites. The RR values for nonwhite individuals were higher in the North and Northeast regions for all types of poisonings. The type of poisoning cases that presented the highest RR for non-whites over the 3 years was drugs of abuse (2-2.44), when compared to other types of poisonings from pesticides (2-2.33) and medications (1.5-1.91). The spatial distribution of poisoning cases rates and RR of nonwhite population support public policies to reduce socioeconomic and environmental inequalities.
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Affiliation(s)
| | - Paula Florencio Ramires
- Faculdade de Medicina da Universidade Federal do Rio Grande, Rio Grande, Rio Grande do Sul, Brasil
- Faculdade de Nutriç'ão, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brasil
| | - Luíza Silva da Cruz
- Faculdade de Medicina da Universidade Federal do Rio Grande, Rio Grande, Rio Grande do Sul, Brasil
| | - Júlia Oliveira Penteado
- Faculdade de Medicina da Universidade Federal do Rio Grande, Rio Grande, Rio Grande do Sul, Brasil
- Faculdade de Nutriç'ão, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brasil
| | - Romina Buffarini
- Faculdade de Medicina da Universidade Federal do Rio Grande, Rio Grande, Rio Grande do Sul, Brasil
| | - Flavio Manoel Rodrigues da Silva Júnior
- Faculdade de Medicina da Universidade Federal do Rio Grande, Rio Grande, Rio Grande do Sul, Brasil
- Faculdade de Nutriç'ão, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brasil
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Rafati S, Baniasadi T, Dastyar N, Zoghi G, Ahmadidarrehsima S, Salari N, Rafati F. Prevalence of self-medication among the elderly: A systematic review and meta-analysis. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:67. [PMID: 37113410 PMCID: PMC10127510 DOI: 10.4103/jehp.jehp_630_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/14/2022] [Indexed: 06/19/2023]
Abstract
BACKGROUND Self-medication is the use of unprescribed drugs to treat a disease. Elderly self-medication can be more dangerous compared to other age groups because of changes in organ functions that occur due to senescence. This study aimed to estimate the prevalence of self-medication in the elderly, its related factors, and common drugs used in this regard. MATERIALS AND METHODS Electronic databases such as PubMed, Scopus, and Web of Science were searched between January 2016 and June 2021. The search strategy was built on two core concepts: "self-medication" and "aged". The search was limited to original articles in the English language. A random effect model was used to estimate the pooled prevalence of self-medication. Heterogeneity among studies was assessed using both the I2 statistic and the χ 2 test. Also, a meta-regression model was used to investigate the potential sources of heterogeneity of the studies. RESULTS Out of 520 non-duplicate studies, 38 were included in the meta-analysis. Self-medication in the elderly ranged from 0.3% to 82%. The pooled proportion of self-medication was 36% (95% CI: 27%-45%). The result of the χ 2 test and the I2 index (P < 0.001, I2= 99.90%) revealed notable heterogeneity among the included studies in the meta-analysis. The meta-regression showed a significant association between the sample size (adjusted β = -0.01; P = 0.043) and the pooled proportion of self-medication. CONCLUSION The prevalence of self-medication in the elderly is high. Education through mass media to raise awareness about the dangers of self-medication can help solve this problem.
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Affiliation(s)
- Shideh Rafati
- Social Factors in Health Promotion Research Center, Hormozgan Health Research Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Tayebeh Baniasadi
- Department of Health Information Technology, Faculty of Paramedicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Neda Dastyar
- Department of Midwifery, Nursing and Midwifery School, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Ghazal Zoghi
- Endocrinology and Metabolism Research Center, Hormozgan Univesity of Medical Sciences, Bandar Abbas, Iran
| | - Sudabeh Ahmadidarrehsima
- Department of Nursing, Nursing and Midwifery School, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Nasibeh Salari
- Department of Nursing, Nursing and Midwifery School, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Foozieh Rafati
- Department of Nursing, Nursing and Midwifery School, Jiroft University of Medical Sciences, Jiroft, Iran
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Sánchez-Sánchez E, Fernández-Cerezo FL, Díaz-Jimenez J, Rosety-Rodriguez M, Díaz AJ, Ordonez FJ, Rosety MÁ, Rosety I. Consumption of over-the-Counter Drugs: Prevalence and Type of Drugs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115530. [PMID: 34064096 PMCID: PMC8196755 DOI: 10.3390/ijerph18115530] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/07/2021] [Accepted: 05/15/2021] [Indexed: 01/30/2023]
Abstract
Recently, there has been an increase in the use of over-the-counter (OTC) drugs. The consumption of these medicines can be unsafe, as incorrect self-diagnosis or the ingestion of inappropriate doses can lead to side effects and the occurrence of adverse reactions and drug–drug interactions. A cross-sectional descriptive observational study was carried out, targeting the entire Spanish population by using an online questionnaire. The results showed that 78.9% of the subjects had previously taken or were currently taking OTC drugs. This consumption decreased as the age of the subjects increased, with a prevalence of 36.4% of subjects aged ≥ 71 taking OTC drugs. Analgesics were the most consumed OTC drugs (49.1%) especially in women, youngsters with non-formal educational qualifications, and individuals of a low–medium socioeconomic level residing in urban areas. Measures should be implemented to optimize the safe use of OTC drugs in order to avoid the occurrence of secondary events associated with the lack of knowledge related to their the usage.
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Affiliation(s)
- Eduardo Sánchez-Sánchez
- Internal Medicine Department, Punta de Europa Hospital, Algeciras, 11207 Cádiz, Spain;
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Hospital Universitario Puerta del Mar, Universidad de Cádiz, 11009 Cádiz, Spain
- Correspondence: ; Tel.: +34-671569320
| | | | - Jara Díaz-Jimenez
- Doctoral School of the University of Cádiz (EDUCA), Campus Cádiz, Edificio Hospital Real (Primera Planta), Plaza Falla 8, 11003 Cádiz, Spain;
| | - Manuel Rosety-Rodriguez
- Medicine Department, School of Medicine, University of Cádiz, Plaza Fragela s/n, 11003 Cadiz, Spain;
| | - Antonio Jesús Díaz
- Medicine Department, School of Nursing, University of Cadiz, Plaza Fragela s/n, 11003 Cadiz, Spain;
| | - Francisco Javier Ordonez
- Human Anatomy Department, School of Medicine, University of Cádiz, Plaza Fragela s/n, 11003 Cadiz, Spain; (F.J.O.); (I.R.)
| | - Miguel Ángel Rosety
- Move-It Research Group, Biomedical Research and Innovation Insitute of Cadiz, Puerta del Mar University Hospital, University of Cádiz, Plaza Fragela s/n, 11003 Cadiz, Spain;
| | - Ignacio Rosety
- Human Anatomy Department, School of Medicine, University of Cádiz, Plaza Fragela s/n, 11003 Cadiz, Spain; (F.J.O.); (I.R.)
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Bertoldi AD, Silveira MPT, Machado AKF, Xavier MO, Martins RC. Sources of access to medication and its use in the rural area of Pelotas, Rio Grande do Sul, Brazil, in 2016: a cross-sectional population-based study. ACTA ACUST UNITED AC 2021; 30:e2020089. [PMID: 33605375 DOI: 10.1590/s1679-49742021000100005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/04/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To analyze the prevalence of medication use, sources of access, and associated factors among rural residents in Pelotas, RS, Brazil. METHODS This was a cross-sectional study conducted in 2016 with adults ≥18 years old. Participants reported on medication use and sources of access to medication in the month prior to the interview. Poisson regression was used. RESULTS Among the 1,519 respondents, 54.7% (95%CI 48.7;60.5) used some form of medication and 3.3% (95%CI 2.4;4.5) stopped taking necessary medication. Higher prevalence of use occurred in: women (PR=1.23 - 95%CI 1.12;1.34), the elderly (PR=2.36 - 95%CI 2.05;2.73), people with poorer self-perceived health (PR=1.29 - 95%CI 1.14;1.46) and people with a higher number of diseases (PR=2.37 - 95%CI 2.03;2.77). A total of 14.0% (95%CI 11.2;17.4) obtained medication exclusively from the Brazilian National Health System, prevalence of which was higher among those who self-reported themselves to be non-white and from lower economic classification. CONCLUSION A low number stopped taking medication they needed to take. Use of free-of-charge medication was greater in groups with lower income.
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Affiliation(s)
- Andrea Dâmaso Bertoldi
- Universidade Federal de Pelotas, Programa de Pós-Graduação em Epidemiologia, Pelotas, RS, Brasil
| | | | | | - Mariana Otero Xavier
- Universidade Federal de Pelotas, Programa de Pós-Graduação em Epidemiologia, Pelotas, RS, Brasil
| | - Rafaela Costa Martins
- Universidade Federal de Pelotas, Programa de Pós-Graduação em Epidemiologia, Pelotas, RS, Brasil
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Maia LO, Daldegan-Bueno D, Fischer B. Opioid use, regulation, and harms in Brazil: a comprehensive narrative overview of available data and indicators. Subst Abuse Treat Prev Policy 2021; 16:12. [PMID: 33499891 PMCID: PMC7836143 DOI: 10.1186/s13011-021-00348-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Global opioid consumption increased multifold post-2000, disproportionately in high-income countries, with severe mortality/morbidity consequences. Latin America features comparatively low opioid availability; Brazil, the region's most populous country, makes an interesting case study concerning opioid use/harms. In this comprehensive overview, we aimed to identify and summarize medical and non-medical data and indicators of opioid availability and use, regulation/control, and harm outcomes in Brazil since 2000. METHODS We searched multiple scientific databases to identify relevant publications and conducted additional 'grey' literature searches to identify other pertinent information. RESULTS Despite some essential indicators, opioid-related data are limited for Brazil. Data indicate that population-level availability of prescription opioids represents only a small fraction of use in comparison to high-income countries. However, within Latin America, Brazil ranks mid-level for opioid consumption, indicating relatively moderate consumption compared to neighboring jurisdictions. Brazil has implemented restrictive regulations to opioid prescribing and is considered 'highly restricted' for opioid access. Codeine remains the major opioid analgesic utilized, but stronger opioids such as oxycodone are becoming more common. Professional knowledge regarding medical opioid use and effects appears limited. National surveys indicate increases in non-medical use of prescription opioids, albeit lower than observed in North America, while illicit opioids (e.g., heroin) are highly uncommon. CONCLUSIONS Overall population-level opioid availability and corresponding levels of opioid-related harms in Brazil remain substantially lower than rates reported for North America. However, the available surveillance and analytical data on opioid use, policy/practice, and harms in Brazil are limited and insufficient. Since existing and acute (e.g., pain-related) needs for improved opioid utilization and practice appear to be substantiated, improved indicators for and understanding of opioid use, practice, and harms in Brazil are required.
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Affiliation(s)
- Lucas O. Maia
- Centre for Applied Research in Mental Health and Addiction, SFU Faculty of Health Sciences, Simon Fraser University, 515 W. Hastings Street, V6B 5K3 Vancouver, BC Canada
| | - Dimitri Daldegan-Bueno
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, 1023 Grafton, Auckland New Zealand
| | - Benedikt Fischer
- Centre for Applied Research in Mental Health and Addiction, SFU Faculty of Health Sciences, Simon Fraser University, 515 W. Hastings Street, V6B 5K3 Vancouver, BC Canada
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, 1023 Grafton, Auckland New Zealand
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, M5T 1R8 Toronto, ON Canada
- Department of Psychiatry, Federal University of São Paulo, R. Dr. Ovídio Pires de Campos, 785, 05403-903 São Paulo, Brazil
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Monteiro CN, Santos FTC, Costa KS, Barros MBDA, Cesar CLG, Goldbaum M. Use of medicines in São Paulo, Brazil, and State Health Care Coverage, 2003 and 2015. Clinics (Sao Paulo) 2021; 76:e2781. [PMID: 34287478 PMCID: PMC8266172 DOI: 10.6061/clinics/2021/e2781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/31/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To analyze the use and acquisition of medicines in São Paulo, Brazil, in 2003 and 2015, according to sociodemographic factors, socioeconomic status, and health conditions of the population. METHODS Data were obtained from population health surveys "ISA-Capital". Descriptive analysis, bivariate analysis, and logistic regression models were used to evaluate the use of medicines and coverage by the Brazilian Unified Health System (SUS) according to socioeconomic status and health conditions in two periods: 2003 and 2015. RESULTS From 2003 to 2015, the surveys showed an increase in the income and education level of the study population. There was no increase in the prevalence of chronic diseases and use of medicines from 2003 to 2015. The provision of medicines by SUS was higher in 2015 than in 2003, and the coverage by SUS was higher in the population with lower education level and income in both 2003 and 2015. CONCLUSIONS The use of medicines, mainly for chronic disease control, did not change over the years, and there was an increase in SUS coverage for medicines during 2003-2015 in all population groups, with a greater impact on the lower socioeconomic status population. The programs of the provision of medicines implanted since 2003 had influenced the greater SUS coverage for medicines and in the reduction of inequalities in access to medicines.
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Affiliation(s)
- Camila Nascimento Monteiro
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Nucleo de Indicadores e Sistemas de Informacao, Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | | | - Karen Sarmento Costa
- Faculdade de Ciencias Medicas, Universidade Estadual de Campinas, Campinas, SP, BR
| | | | | | - Moisés Goldbaum
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Tiguman GMB, Silva MT, Galvão TF. Consumption and Lack of Access to Medicines and Associated Factors in the Brazilian Amazon: A Cross-Sectional Study, 2019. Front Pharmacol 2020; 11:586559. [PMID: 33123016 PMCID: PMC7573467 DOI: 10.3389/fphar.2020.586559] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/14/2020] [Indexed: 01/20/2023] Open
Abstract
Objective We aimed to investigate the consumption and lack of access to medicines in the adult population of Manaus, Amazonas. Methods A population-based study was conducted in Manaus in 2019. Individuals aged ≥18 years were selected by probabilistic sampling performed in three stages. Study outcomes included the consumption of medicines in the previous fortnight and the lack of access to treatments in those who used any medicine. We calculated the prevalence ratios (PR) for the outcomes with 95% confidence intervals (CI) by Poisson regression with robust variance, considering the complex sampling design. Results Out of the 2,321 participants, 53.2% (95%CI 50.7-55.7%) consumed medicines, of which 14.4% (95% CI 11.9-16.8%) could not obtain appropriate treatments. Analgesics were the most used medicines (557/2,702; 21.4%), whereas antibiotics were the most inaccessible treatments (18/228; 7.9%). Lack of financial resources was the main reason for not accessing treatments (104/228; 45.6%). Consumption was significantly associated with older age (≥60 years: PR = 1.27; 95%CI 1.09-1.49), lower social class (D/E: PR = 0.84; 95%CI 0.72-0.99), lower educational level (p = 0.039), poor health status (PR = 1.30; 95%CI 1.11-1.52), use of health care services (PR = 1.37; 95%CI 1.26-1.49), and chronic diseases (PR = 1.36; 95%CI 1.22-1.52). Lack of access was higher in people with poor health status (PR = 2.46; 95%CI 1.50-4.04) and chronic diseases (PR = 1.84; 95%CI 1.16-2.92). Conclusion Half of Manaus' population used medicines, which was higher in socially privileged and sicker individuals. Among those, 14 in every 100 could not access drug therapies, which was more frequent in people with poor health and with chronic diseases.
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Affiliation(s)
| | - Marcus Tolentino Silva
- Post-Graduate Program of Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Brazil
| | - Taís Freire Galvão
- Faculty of Pharmaceutical Sciences, State University of Campinas, Campinas, Brazil
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Medication use and climacteric syndrome: a cross-sectional population-based study. ACTA ACUST UNITED AC 2020; 26:1133-1140. [PMID: 31361701 DOI: 10.1097/gme.0000000000001381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate medication use during the climacteric period and assess its association with sociodemographic factors, morbidities, and climacteric symptoms. METHODS Secondary analysis of data from a previous exploratory cross-sectional population-based study, conducted with 749 women (45-60 y), with the help of home interviews. Associations between medication use and climacteric symptoms were analyzed, and their correlations with other variables were made. Univariate analysis was made using the χ test, followed by Bonferroni correction (multiple comparison method). Values were adjusted for age using the polytomic logistic multivariate regression analysis. Using Poisson regression analysis, simple and multiple, we identified the main factors for medication use, with forward stepwise variable selection criteria (95% CI). RESULTS The mean age was 52.5 years and menopause occurred at 46.5 years (mean). The overall prevalence of medication use was 68.8%. The use of exclusive medications for relieving climacteric symptoms was associated with the absence of diseases (prevalence ratio [PR] = 8.2; 95% CI = 3.5-18.9; P<0.001) and menopause onset between 40 and 44 years (PR = 4.9; 95% CI = 2.0-11.9; P<0.001). Polypharmacy was associated with the highest number of diseases (PR = 10.6; 95% CI = 4.6-24.2; P<0.001) and somatic Menopause Rating Scale (MRS) score >3 (PR = 1.4; 95% CI = 1.01-1.96; P = 0.044). CONCLUSIONS The prevalence of medication use among middle-aged women was high and was associated with the age of menopause onset, chronic diseases, and obesity/overweight status.
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Santos JS, Cruz AJSD, Castilho LSD, Abreu MHNG. Availability of Analgesic and Anti-Inflammatory Medicines in Primary Health Care. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2020. [DOI: 10.1590/pboci.2020.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Rodrigues-de-Paula F, Lana RDC, Lopes LKR, Cardoso F, Lindquist ARR, Piemonte MEP, Correa CL, Israel VL, Mendes F, Lima LO. Determinants of the use of physiotherapy services among individuals with Parkinson's disease living in Brazil. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 76:592-598. [PMID: 30365622 DOI: 10.1590/0004-282x20180087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 06/05/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To identify the factors affecting the use of physiotherapy services among individuals with Parkinson's disease (PD) living in Brazil. METHODS Overall, 479 individuals with idiopathic PD, of both sexes, at any stage of the Hoehn & Yahr (HY) scale, and from seven capital cities in Brazil were recruited from 2014 to 2016. Multivariate logistic regression was the main statistical tool. For the construction of the logistic model, the association of the dependent variable "physiotherapy" with the independent sociodemographic/economic and clinical variables: age, education, family income, time of PD since onset, HY, the activities of daily living and motor subscales of the Unified Parkinson's Disease Rating Scale, cognitive aspects, depressive symptoms, fear of falling, freezing gait, history of falls, physical activity level, gait speed, walking performance and balance, were verified. RESULTS The 479 individuals had an average age of 65.2 ± 11.0 years, 88% were in the HY I-III stages and 43.4% were under physiotherapy treatment. The analysis identified two determinant variables related to the use of the physiotherapy service: level of education (OR = 1.24) and walking performance (OR = 0.82). Decreased walking performance and a higher educational level increased the use of a physiotherapy service in individuals with PD living in Brazil. CONCLUSIONS The present study shows that individuals with PD, residents from different regions of Brazil, have limited access to physiotherapy services. In addition, the Brazilian Public Health Care System, as well as local programs, need to target PD individuals with a low educational level to improve their access to physiotherapy services. Goals should aim towards the development of physical exercise programs to improve the patients' functional performance for a longer period.
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Affiliation(s)
| | - Raquel de Carvalho Lana
- Universidade Federal de Minas Gerais, Departamento de Fisioterapia, Belo Horizonte MG, Brasil
| | | | - Francisco Cardoso
- Universidade Federal de Minas Gerais, Departamento de Clínica Médica, Belo Horizonte MG, Brasil
| | | | | | - Clynton Lourenço Correa
- Universidade Federal do Rio de Janeiro, Departamento de Fisioterapia, Rio de Janeiro RJ, Brasil
| | - Vera Lúcia Israel
- Universidade Federal do Paraná, Universidade de Fisioterapia, Curitiba PR, Brasil
| | - Felipe Mendes
- Universidade de Brasília, Departamento de Fisioterapia, Brasília DF, Brasil
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