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Zhou X, Wang Y, Zhou L. Social participation, resilience, and coping tendency in a sample of stroke survivors: a multi-centre cross-sectional study in China. J Rehabil Med 2024; 56:jrm12448. [PMID: 38175146 PMCID: PMC10785685 DOI: 10.2340/jrm.v56.12448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVES To investigate the association between resilience and social participation and examine the mediation of resilience on coping strategies and social participation. DESIGN A multi-centre cross-sectional study performed from April to July 2022. PARTICIPANTS The study sample comprised 239 stroke survivors (53.1% male). The mean age of participants was 65.4 years. METHODS The study was conducted at 3 neurorehabilitation centres in Shanghai, China. The Utrecht Scale for Evaluation of Rehabilitation Participation (USER-P) was used to measure both objective and subjective social participation. Resilience was evaluated using the Connor-Davidson Resilience Scale (CD-RISC), while positive coping tendency was assessed using the Simplified Coping Style Questionnaire (SCSQ). Multivariate linear regression was employed, taking into account confounding factors. In cases where a significant interaction effect was observed, simple slope analysis was conducted to explore the relationship between positive coping tendency and social participation at different levels of resilience. RESULTS The mean scores of social participation frequency, restriction, and satisfaction were 21.80 ± 15.13, 38.92 ± 26.48, and 63.34 ± 22.35, respectively. Higher resilience level was independently associated with higher social participation frequency (B = 0.210, p < 0.001), less participation restriction (B = 0.584, p < 0.001), and higher participation satisfaction (B = 0.250, p < 0.001). Moreover, higher resilience was correlated with more positive coping tendency. More positive coping tendency was related to higher social participation frequency and less participation restriction, but not to social participation satisfaction. Furthermore, individuals at different resilience levels moderated the effect of positive coping tendency on social participation frequency. CONCLUSION This study underlines the importance of resilience as a potential intervention in enhancing both objective and subjective social participation in stroke survivors, and provides insights into increasing the efficacy of positive coping strategies on social participation.
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Affiliation(s)
- Xuan Zhou
- School of nursing, Naval Medical University, Shanghai, China.
| | - Ying Wang
- Department of nursing, Shanghai First Rehabilitation Hospital, Shanghai, China
| | - Lanshu Zhou
- School of nursing, Naval Medical University, Shanghai, China
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De Freitas Lopes AC, Novaes HMD, De Soárez PC. Does patient and public involvement impact public health decision-making? A 10 year retrospective analysis of public consultation in Brazil. Health Res Policy Syst 2023; 21:72. [PMID: 37438823 DOI: 10.1186/s12961-023-01018-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/14/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND The aim of this work is to characterize the processes associated with patient and public involvement (PPI) in the form of public consultations (PC) during the first 10 years of operation of the National Committee for Health Technology Incorporation in the Unified Health System (Conitec) of Brazil, and to identify factors associated with changes in Conitec's recommendations following these PC. METHODS This cross-sectional study analysed all processes related to the adoption of technologies that took place in Brazil between 2012 and 2021 based on technical reports and self-reported information collected from PC participants. A multiple logistic regression model identified factors associated with changes in Conitec's recommendations following PC. RESULTS A total of 479 technical reports were published, of which 83% (n = 400) were submitted to PC. Demands were made mainly by applicants from the government (n = 262; 55%), regarding the adoption of medicines (n = 366; 76%), in which context neoplasms and infectious diseases were the most frequent indications (n = 66; 14% for each). A total of 264 (55%) processes resulted in a final recommendation in favour of introducing the technology. Over the period of 10 years, 196 483 contributions were received in response to PC. The largest volume of contributions was made by patients and their families or representatives (n = 99 082; 50%), females (122 895; 67%), white individuals (129 165; 71%) and individuals between the ages of 25 and 59 years (145 364; 80%). Alteration of the preliminary recommendation occurred in 13% (n = 53) of the PC, with a higher proportion of recommendations being altered from 2017 onwards. Increased participation by patients had a significant impact on the alteration of the preliminary recommendation (odds ratio 3.87, 95% CI 1.33-13.35, p = 0.02). CONCLUSIONS Increased engagement of patients and their families and caregivers in PC was associated with changing the preliminary recommendation of Conitec about the adoption of technologies into the public health system in Brazil.
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Affiliation(s)
- Ana Carolina De Freitas Lopes
- Departamento de Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo 455, Cerqueira Cesar, São Paulo, SP, 01246903, Brazil.
- Departamento de Gestão e Incorporação de Tecnologias em Saúde, Ministry of Health, Esplanada dos Ministérios, Bloco G, Brasilia, Brazil.
| | - Hillegonda Maria Dutilh Novaes
- Departamento de Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo 455, Cerqueira Cesar, São Paulo, SP, 01246903, Brazil
| | - Patrícia Coelho De Soárez
- Departamento de Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo 455, Cerqueira Cesar, São Paulo, SP, 01246903, Brazil
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Tamachiro ST, Gonçalves FAR, Simone ALM, Aguiar PM. [Does the pharmaceutical industry interfere in the sustainability of the public health system in Brazil? A reflection on the pressure for the incorporation of medicines]. CAD SAUDE PUBLICA 2022; 38:e00233321. [PMID: 35894368 DOI: 10.1590/0102-311xpt233321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 05/17/2022] [Indexed: 11/22/2022] Open
Abstract
The objective is to analyze the contribution of the pharmaceutical industry to the sustainability of the Brazilian Unified National Health System (SUS), based on the pressure for the incorporation of medicines. For this purpose, a descriptive study was conducted on requests for the incorporation of medicines sent to Commission for Incorporation of Technologies in the SUS (CONITEC) from 2012 to 2020. Characteristics such as technology indication, economic evaluation, financing component, public consultation, and CONITEC decision were analyzed. The results were compared according to the type of solicitor using statistical tests. 514 requests were analyzed, of which 438 related to incorporation. The pharmaceutical industry accounted for 37% of the requests and 33.5% of the incorporations. Differences were observed between the solicitors regarding the type of economic evaluation and incremental cost-utility ratio value, with half of the industry's demands above the threshold of 3 PIB per capita/QALY. The pharmaceutical industry obtained more contributions in public consultations of its requests and presented concentration of requests for antineoplastic and immunomodulatory agents and for anti-infectious, especially for hepatitis C and HIV. There was also a lower number of demands from the pharmaceutical industry in the Basic and Strategic Components of Pharmaceutical Assistance. Our findings point to the tension between the significant participation of the industry as an applicant, the high mobilization of public consultations, the emphasis on Specialized Component drugs, and CONITEC's resistance to this pressure, with a tendency of greater refusal and greater participation of other solicitors in requests for expansion of use, exclusion, and incorporation of drugs that are less requested by the pharmaceutical industry.
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Affiliation(s)
| | | | | | - Patricia Melo Aguiar
- Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brasil
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Zhou X, Du M, Hu Y. The effect of self-management programs on post-stroke social participation: A systematic review and meta-analysis. Clin Rehabil 2022; 36:1141-1152. [PMID: 35765234 DOI: 10.1177/02692155221095477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to identify the effectiveness of self-management programs on the improvement of social participation among stroke survivors. Data Sources: Cochrane Library, PubMed, Web of Science database, EMBASE, Medline, CINAHL plus, and APA PsycArticles were searched from their inception to December 20, 2021. METHODS We considered randomized controlled trials and non-randomized controlled trials without language limits. Two reviewers independently screened the literature, evaluated risk of bias using the Cochrane's risk of bias tool, scored the methodological quality using criteria of the Australian Evidence-based Health Care Center, and extracted the data. The outcome was social participation. RevMan 5.3 was used, and intergroup differences were determined by calculating standardized mean difference (SMD) and 95% confidence intervals (CIs). RESULTS Of 1894 initial studies, totally 15 studies met the eligible criteria, consisting of six randomized controlled trials and nine non-randomized controlled trials. Four randomized controlled trials showed high methodological quality and two demonstrated medium quality. The randomized controlled trials involved a total of 430 stroke survivors and were published between 2007 and 2020. The meta-analysis from five randomized controlled trials demonstrates that the overall effect of self-management programs on social participation was not statistically significant (95% CI, -0.23 to 0.40; p = 0.61). Most of the non-randomized controlled trials were pre-/post-test design with an average sample size of 15.4. The effect of self-management program on social participation in most non-randomized controlled trials was insignificant as well. CONCLUSION The self-management programs seem not to be superior to usual care for the improvement on social participation in stroke survivors based on current evidence. Further well-designed investigation considering social participation as the primary outcome is still warranted.
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Affiliation(s)
- Xuan Zhou
- Department of nursing, 92323Zhongshan Hospital Fudan University, Shanghai, 200032, China
| | - Minxia Du
- Department of nursing, Xinxiang Medical University, Henan, 453000, China
| | - Yan Hu
- Department of nursing, 92323Zhongshan Hospital Fudan University, Shanghai, 200032, China
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Capucho HC, Brito A, Maiolino A, Kaliks RA, Pinto RP. Incorporation of medicines in the Unified Health System (SUS): comparison between oncology and the specialized component of pharmaceutical care. CIENCIA & SAUDE COLETIVA 2022; 27:2471-2479. [PMID: 35649033 DOI: 10.1590/1413-81232022276.16282021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 11/03/2021] [Indexed: 11/22/2022] Open
Abstract
Compliance with legal deadlines for the assessment and incorporation of technologies in Brazil's Unified Health System (SUS) is essential to ensure public access to essential medicines. The scope of this paper was to analyze the compliance with legal deadlines for incorporation and availability of medicines in the SUS, comparing Oncology and the Specialized Component of Pharmaceutical Assistance (SCPA). A comparison was made of the drugs incorporated that were submitted to Conitec in the period from January 1, 2017, to April 30, 2020. A total of 85 drugs were recommended for incorporation by Conitec, of which 15 (17.64%) were for Oncology and 70 (82.36%) were for SCPA. The time between analysis and recommendation by Conitec until the publication of the decision by the Ministry of Health was, on average, 86 days longer for oncological drugs and the availability timeframe of technologies incorporated in the oncology area was, on average, 389 days longer than for SCPA. The major progress achieved with the creation of Conitec in Brazil is acknowledged, but the results of this study point to a pressing need to improve the process of making available technologies incorporated into the SUS, especially in oncology.
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Affiliation(s)
- Helaine Carneiro Capucho
- Departamento de Farmácia, Universidade de Brasília. Asa Norte s/n, Campus Universitário Darcy Ribeiro. 70910-900 Brasília DF Brasil.
| | - Artur Brito
- Secretaria de Estado da Saúde do Distrito Federal. Brasília DF Brasil
| | - Angelo Maiolino
- Departamento de Medicina Interna, Universidade Federal do Rio de Janeiro. Rio de Janeiro RJ Brasil
| | | | - Roney Pereira Pinto
- Assistência Farmacêutica, Secretaria Estadual de Saúde de Goiás. Goiânia GO Brasil
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A framework for action to improve patient and public involvement in health technology assessment. Int J Technol Assess Health Care 2021; 38:e8. [DOI: 10.1017/s0266462321000647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background
Patient and public involvement (PPI) in the Brazilian Health Technology Assessment (HTA) process occurs in response to a legislative mandate for “social participation.” This resulted in some limited patient participation activities, and, therefore, a more systematic approach was needed. The study describes the development of a suggested framework for action to improve PPI in HTA.
Methods
This work used formal methodology to develop a PPI framework based on three-phase mixed-methods research with desktop review of Brazilian PPI activities in HTA; workshop, survey, and interviews with Brazilian stakeholders; and a rapid review of international practices to enact effective patient involvement. Patient partners reviewed the draft framework.
Results
According to patient group representatives, their involvement in the Brazilian HTA process is important but could be improved. Different stakeholders perceived barriers, identified values, and made suggestions for improvement, such as expansion of communication, capacity building, and transparency, to support more meaningful patient involvement. The international practices identified opportunities for earlier, more active, and collaborative PPI during all HTA stages, based on values and principles that are relevant for Brazilian patients and the public. These findings were synthesized to design a framework that defines and systematizes actions to support PPI in Brazil, highlighting the importance of evaluating these strategies.
Conclusions
Since the publication of this framework, some of its suggestions are being implemented in the Brazilian HTA process to improve PPI. We encourage other HTA organizations to consider a systematic and planned approach with regular evaluation when pursuing or strengthening involvement practices.
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Lopes ACDF, Novaes HMD, de Soárez PC. Patient and public involvement in health technology decision-making processes in Brazil. Rev Saude Publica 2020; 54:136. [PMID: 33331420 PMCID: PMC7702417 DOI: 10.11606/s1518-8787.2020054002453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/11/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The study aims to characterize and discuss the processes of patient and public involvement (PPI) in the Brazilian Health Regulatory Agency (Anvisa), the National Committee for Health Technology Incorporation (Conitec), and the National Agency for Supplementary Health (ANS) in Brazil. METHODS This is an exploratory, descriptive, and comparative study, conducted by analyzing the public documents and regulation of the three institutions. RESULTS The mechanisms for PPI included public consultations, public hearings, participation in advisory committees, and health technology evaluation requests. Anvisa conducted 187 public consultations between 1999 and 2018, gathering 10,699 contributions. In total, 76 (41%) public consultations did not present information about the contributions received. Conitec carried out 234 public consultations and received 53,174 contributions between 2011 and 2018. It was identified that 70 (23%) recommendations from Conitec did not go through public consultation, and 26 (8%) recommendations changed after public consultation. Recommendation changes seemed to have occurred especially in cases with a greater number of contributions in the public consultation process. ANS conducted eight public consultations regarding the list of health procedures and events covered by health insurances between 2000 and 2018, and it received 31,498 contributions. For three public consultations, there was no information about the number of contributions received. CONCLUSIONS There are regulatory advances and institutional activity supporting PPI in highly technical decision-making processes in Brazil, although heterogeneously among the analyzed institutions. The power of PPI to influence health technology deliberative processes still requires in-depth studies, including the characterization of stakeholders and the legitimacy of decisions.
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Affiliation(s)
- Ana Carolina de Freitas Lopes
- Universidade de São PauloFaculdade de MedicinaPrograma de Pós-Graduação em Saúde ColetivaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Coletiva. São Paulo, SP, Brasil
| | - Hillegonda Maria Dutilh Novaes
- Universidade de São PauloFaculdade de MedicinaDepartamento de Medicina PreventivaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Preventiva. São Paulo, SP, Brasil
| | - Patricia Coelho de Soárez
- Universidade de São PauloFaculdade de MedicinaDepartamento de Medicina PreventivaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Preventiva. São Paulo, SP, Brasil
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Novaes HMD, Soárez PCD. [Health Technologies Assessment: origins, development, and current challenges. In the international and Brazilian scenarios]. CAD SAUDE PUBLICA 2020; 36:e00006820. [PMID: 32901662 DOI: 10.1590/0102-311x00006820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/25/2020] [Indexed: 11/22/2022] Open
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