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Tôrres LL, Azevedo PS, Rocha Sarmento TT, Ramalho-de-Oliveira D, Reis EA, Dias Godói IP, Guerra Júnior AA, Ruas CM. Acceptability and consumers' willingness to pay for comprehensive medication management services in Brazil. J Comp Eff Res 2024; 13:e230127. [PMID: 38329429 PMCID: PMC11044949 DOI: 10.57264/cer-2023-0127] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/18/2024] [Indexed: 02/09/2024] Open
Abstract
Aim: Comprehensive medication management (CMM) is a clinical service that aims to optimize the therapeutic results of patients at the individual level. Studies carried out in Brazil and in several parts of the world have found a positive impact of the service, mainly in the resolution of drug therapy problems and in improving clinical outcomes and patients' quality of life. This service is not widespread and its acceptability and willingness to pay were not defined by the population yet. Objective: This work aims to conduct a study with users of private health services to determine the acceptability and willingness to pay for CMM services. Methods: This is a cross-sectional survey conducted through face-to-face interviews, among residents over 18 years of age of the metropolitan region of Belo Horizonte, capital of Minas Gerais State, Brazil. Results: For this study, 563 individuals were interviewed. Most respondents were female (55.1%), had completed high school (46.8%) and were employed (62.5%). The acceptability for the service was 93,25%, and among all respondents, 37 would not accept the service even if it was free. The amount of consumers' willingness to pay for the CMM service was estimated at $17.75 (40.00 BRL). Conclusion: The research results show that most people are willing to pay for the CMM service. This study can contribute to the decision-making regarding the implementation and pricing of the service in Brazil.
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Affiliation(s)
- Lucas Lima Tôrres
- Faculty of Pharmacy – Federal University of Minas Gerais, 6627 Moacir Gomes de Freitas St., Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Pâmela Santos Azevedo
- Postgraduate Program in Medicines & Pharmaceutical Assistance, School of Pharmacy, Federal University of Minas Gerais, 6627 Moacir Gomes de Freitas St., Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Túlio Tadeu Rocha Sarmento
- Faculty of Pharmacy – Federal University of Minas Gerais, 6627 Moacir Gomes de Freitas St., Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Djenane Ramalho-de-Oliveira
- Faculty of Pharmacy – Federal University of Minas Gerais, 6627 Moacir Gomes de Freitas St., Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Edna Afonso Reis
- Statistics Department – Federal University of Minas Gerais, 308 Reitor Pires Albuquerque St., Pampulha, Belo Horizonte, Minas Gerais, 31270-010, Brazil
| | - Isabella Piassi Dias Godói
- Institute of Pharmaceutical Sciences, Federal University of Rio de Janeiro, Avenida Aluízio da Silva Gomes 50, Granja dos Cavaleiros, Macaé, Rio de Janeiro, 27930-560, Brazil
- Health Technology Assessment Center - Management, Economics, Education and Pharmaceutical Services, Federal University of Rio de Janeiro, Avenida Aluízio da Silva Gomes 50, Granja dos Cavaleiros, Macaé, Rio de Janeiro, 27930-560, Brazil
| | - Augusto Afonso Guerra Júnior
- Faculty of Pharmacy – Federal University of Minas Gerais, 6627 Moacir Gomes de Freitas St., Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
- Collaborating Center of the SUS for Technology Assessment & Excellence in Health, School of Pharmacy, Federal University of Minas Gerais, 6627 Moacir Gomes de Freitas St., Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Cristina Mariano Ruas
- Faculty of Pharmacy – Federal University of Minas Gerais, 6627 Moacir Gomes de Freitas St., Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
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Resende LC, do Nascimento MMG, Barbosa MM, Rezende CDP, Pantuzza LLN, Reis EA. Instruments to Measure Patient Satisfaction with Comprehensive Medication Management Services: A Scoping Review Protocol. Pharmacy (Basel) 2022; 10:pharmacy10060151. [PMID: 36412827 PMCID: PMC9680282 DOI: 10.3390/pharmacy10060151] [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: 09/23/2022] [Revised: 11/08/2022] [Accepted: 11/12/2022] [Indexed: 11/16/2022] Open
Abstract
Comprehensive medication management (CMM) is the service offered within the clinical practice of pharmaceutical care, which has the objective to optimize pharmacotherapeutic outcomes. Patient satisfaction is a multidimensional construct that points to the quality of the health services offered and the degree to which the patients' expectations and needs are met. The evaluation of the level of patient satisfaction is a key indicator to support decisions and to improve the quality of the service provided. This study aims to describe the protocol for a scoping review to map the instruments to measure patient satisfaction with CMM services and compare them according to their development characteristics and the applicability of patient-reported outcome measures. The literature search will be conducted using the scoping review methodology, proposed by the Joanna Briggs Institute and the PRISMA Extension for Scoping Reviews (PRISMA-ScR) method. The results will be presented in two sessions: (1) description of the search strategy; and (2) the characteristics of the satisfaction instruments, number of items and questions related to the conceptual model, content validity, construct validity, reliability, score/interpretation, and respondent burden. This review will shed light on the available satisfaction measurement instruments, allowing existing gaps to be identified for future research.
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Laborne-e-Valle MEP, Ahouagi AEDO, Braga DG, Pinto IVL, Lara-Júnior CR, Ferreira SG, Blunk PDFF, Reis AMM, Reis EA, Ramalho-de-Oliveira D, do Nascimento MMG. Assessment of Pharmaceutical Services for Smoking Cessation: An Effectiveness-Implementation Hybrid Study. Int J Environ Res Public Health 2022; 19:ijerph191912305. [PMID: 36231605 PMCID: PMC9566807 DOI: 10.3390/ijerph191912305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/18/2022] [Accepted: 09/24/2022] [Indexed: 05/28/2023]
Abstract
Smoking is the main preventable cause of illness and early death worldwide. Thus, it is better to promote smoking cessation than to treat tobacco-related diseases. The objective of this study was to assess the implementation and effectiveness of smoking cessation pharmaceutical services offered in primary health care (PHC) in a large Brazilian city through a type 1 effectiveness-implementation hybrid study. The services were offered through individual or group approaches (Jan/2018-Dec/2019). The service indicators were described and the incidence of cessation in the services was evaluated. Factors associated with cessation were assessed by Poisson regression analysis. The services were offered in most PHC centers (61.2%) and by most pharmacists (81.3%). In total, 170 individual (9.7%) and 1591 group (90.3%) approaches occurred, leading to cessation in 39.4% (n = 67) and 44.8% (n = 712) of these, respectively. The use of nicotine plus antidepressants (RR = 1.30; 95%CI = 1.08-1.57; p = 0.006) and the number of sessions with pharmacists (RR = 1.21; 95%CI = 1.19-1.23; p < 0.001) were positively associated with cessation; a very high level of dependence was negatively associated (RR = 0.77; 95%CI = 0.67-0.89; p = 0.001). The smoking cessation services were effective and should be encouraged.
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Affiliation(s)
| | | | | | | | - Célio Rezende Lara-Júnior
- Center for Pharmaceutical Care Studies, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Minas Gerais, Brazil
- Belo Horizonte Municipality, Belo Horizonte 30130-003, Minas Gerais, Brazil
| | - Sabrina Gonçalves Ferreira
- Center for Pharmaceutical Care Studies, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Minas Gerais, Brazil
| | - Paula de Fátima Fernandes Blunk
- Center for Pharmaceutical Care Studies, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Minas Gerais, Brazil
| | - Adriano Max Moreira Reis
- Pharmaceutical Products Department, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Minas Gerais, Brazil
| | - Edna Afonso Reis
- Statistics Department, Exact Sciences Institute, Federal University of Minas Gerais, Belo Horizonte 31270-901, Minas Gerais, Brazil
| | - Djenane Ramalho-de-Oliveira
- Center for Pharmaceutical Care Studies, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Minas Gerais, Brazil
| | - Mariana Martins Gonzaga do Nascimento
- Center for Pharmaceutical Care Studies, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Minas Gerais, Brazil
- Pharmaceutical Products Department, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Minas Gerais, Brazil
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Rodrigues VA, Ceccato MDGB, de Oliveira Costa J, Almeida-Brasil CC, Silveira MR, Afonso Reis E. Levels of adherence to contemporary antiretroviral regimens and the likelihood of viral suppression: a cohort study in a Brazilian metropolis. AIDS Care 2022; 35:976-981. [PMID: 35635108 DOI: 10.1080/09540121.2022.2072802] [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] [Indexed: 10/18/2022]
Abstract
Levels of adherence to antiretroviral therapy (ART) can affect the likelihood of viral suppression differentially among ART regimens. In this prospective cohort conducted in Belo Horizonte, Brazil, we included 354 individuals who initiated ART containing tenofovir disoproxil fumarate/lamivudine/efavirenz in fixed-dose combination (TDF/3TC/EFV) or tenofovir disoproxil fumarate/lamivudine associated with dolutegravir (TDF/3TC + DTG). Viral suppression (viral load <50 copies/mL) was evaluated within six months of follow-up at different adherence levels and by therapeutic regimen. Adherence was measured by the Proportion of Days Covered (PDC) and classified into low (≤84%), intermediate (85-89%) or high (≥90%). The association between viral suppression, adherence levels, and other explanatory variables was analyzed using chi-square and multivariable logistic regression. Viral suppression was achieved by 76.0% of individuals and was more frequent among those who achieved higher levels of adherence (high adherence: 79.3%, intermediate: 71.4% and low: 45.2%), those on TDF/3TC + DTG, and those who had viral load ≤100,000 copies/mL at the onset of treatment (p < 0.05). Moreover, individuals on TDF/3TC + DTG had an approximately 90% probability of achieving viral suppression at intermediate adherence levels. These results add new insights on the possibility of lower adherence levels for contemporary antiretroviral regimens currently used as first-line therapy worldwide.
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Affiliation(s)
- Vanessa Aracele Rodrigues
- Post-Graduate Program in Drug Utilization and Pharmaceutical Policy. Department of Social Pharmacy, Universidade Federal de Minas Gerais. School of Pharmacy, Belo Horizonte, Brazil
| | - Maria das Graças Braga Ceccato
- Post-Graduate Program in Drug Utilization and Pharmaceutical Policy. Department of Social Pharmacy, Universidade Federal de Minas Gerais. School of Pharmacy, Belo Horizonte, Brazil
| | - Juliana de Oliveira Costa
- Post-Graduate Program in Public Health. Department of Social and Preventive Medicine, Universidade Federal de Minas Gerais. School of Medicine, Belo Horizonte, Brazil
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Celline Cardoso Almeida-Brasil
- Post-Graduate Program in Drug Utilization and Pharmaceutical Policy. Department of Social Pharmacy, Universidade Federal de Minas Gerais. School of Pharmacy, Belo Horizonte, Brazil
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Micheline Rosa Silveira
- Post-Graduate Program in Drug Utilization and Pharmaceutical Policy. Department of Social Pharmacy, Universidade Federal de Minas Gerais. School of Pharmacy, Belo Horizonte, Brazil
| | - Edna Afonso Reis
- Statistics Department, Universidade Federal de Minas Gerais. Institute of Exact Sciences, Belo Horizonte, Brazil
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Souza ENBD, Silva MRRD, Santos JBRD, Reis EA, Alvares-Teodoro J, Acurcio FDA, Almeida AM. Functionality assessment in patients with rheumatic diseases undergoing treatment in the Public Health System. Einstein (São Paulo) 2022; 20:eAO6453. [PMID: 35416831 PMCID: PMC9648950 DOI: 10.31744/einstein_journal/2022ao6453] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/08/2021] [Indexed: 12/02/2022] Open
Abstract
Objective To evaluate the therapeutic response (functionality) and its associated factors in patients on biological drugs on the Public Health System for treatment of rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. Methods An open prospective cohort was carried out from 2011 to 2019, in Belo Horizonte (MG). Functionality was assessed using the Health Assessment Questionnaire Disability-Index at baseline, and after 6 and 12 months of follow-up. Factors associated with poor functionality were identified through logistic regression. Results The median Health Assessment Questionnaire Disability-Index at baseline was 1.5 (interquartile range of 0.8-1.9), with poor functionality observed in patients with rheumatoid arthritis. Improved functionality was seen at 6 months of treatment for the three diseases. The predictors of poor functionality at 6 months for psoriatic arthritis and ankylosing spondylitis were female sex, low education levels, and high disease activity; and for rheumatoid arthritis and psoriatic arthritis were female sex, advanced age, and high disease activity. In 12 months, the three diseases had predictors of worse functionality: female sex, low education, and high disease activity. Conclusion There was a significant improvement in functionality during the follow-up, with better response at 6 months of treatment. Poor functionality was observed in older, female patients, with low education and high disease activity.
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Labis da Costa MJ, Nascimento GC, Athie TS, Sales Silva JD, Reis EA, Martin AP, Godman B, Dias Godói IP. Willingness to pay for a hypothetical malaria vaccine in Brazil: a cross-sectional study and the implications. J Comp Eff Res 2022; 11:263-274. [PMID: 35029122 DOI: 10.2217/cer-2021-0073] [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] [Indexed: 11/21/2022] Open
Abstract
Aim: Malaria is an infection caused by protozoa of genus Plasmodium, considered the one associated with increasingly large outbreaks. Methods: A cross-sectional study was conducted with residents in the northern region of Brazil on the willingness to pay (WTP) for a hypothetical vaccine against malaria (effective protection of 80%). Results: Of 616 people interviewed, most interviewees were female (61%) and were employed (97%). The median individual maximum WTP for a hypothetical malaria vaccine was US$11.90 (BRL 50). Conclusion: The northern region of Brazil is one of the largest markets for a malaria vaccine due to its epidemiological relevance. Consequently, economic studies will be important to assist in the assessment of the potential price and value of new vaccines.
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Affiliation(s)
- Maria José Labis da Costa
- Instute of Health & Biological Studies - Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará 68.500-000, Brazil
| | - Gesiane Cavalcante Nascimento
- Instute of Health & Biological Studies - Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará 68.500-000, Brazil
| | - Thannuse Silva Athie
- Instute of Health & Biological Studies - Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará 68.500-000, Brazil
| | - Juliana de Sales Silva
- Institute of Studies in Agricultural & Regional Development - Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará 68.500-000, Brazil
| | - Edna Afonso Reis
- Departament of Stascs, Exact Sciences Institute, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil.,Researcher of the Group (CNPq) for Epidemiological, Economic & Pharmacological Studies of Arboviruses (EEPIFARBO) - Universidade Federal do Sul e Sudeste do Pará; Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará, Brazil
| | - Antony Paul Martin
- Faculty of Health & Life Sciences, Brownlow Hill, Liverpool L69 3BX, UK.,QC Medica, York, North Yorkshire, UK
| | - Brian Godman
- Department of Pharmacoepidemiology, Institute of Pharmacy & Biomedical Sciences, 161 Cathedral Street, Glasgow G4 0RE, UK.,Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Isabella Piassi Dias Godói
- Instute of Health & Biological Studies - Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará 68.500-000, Brazil.,Researcher of the Group (CNPq) for Epidemiological, Economic & Pharmacological Studies of Arboviruses (EEPIFARBO) - Universidade Federal do Sul e Sudeste do Pará; Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará, Brazil
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Gomes LC, Resende RR, Parreira RC, Ferreira CN, Reis EA, Duarte RCF, Alves LCV, Araújo SSDS, Carvalho MDG, Sabino ADP. Chronic Lymphocytic Leukemia (CLL): evaluation of AKT protein kinase and microRNA gene expression related to disease pathogenesis. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e19946] [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
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Dias-Godói IP, Tadeu Rocha Sarmento T, Afonso Reis E, Peres Gargano L, Godman B, de Assis Acurcio F, Alvares-Teodoro J, Guerra Júnior AA, Mariano Ruas C. Acceptability and willingness to pay for a hypothetical vaccine against SARS CoV-2 by the Brazilian consumer: a cross-sectional study and the implications. Expert Rev Pharmacoecon Outcomes Res 2021; 22:119-129. [PMID: 33993823 DOI: 10.1080/14737167.2021.1931128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/24/2022]
Abstract
INTRODUCTION The new coronavirus pandemic has appreciably impacted morbidity and mortality, as well as having an economic impact worldwide. New vaccines are a potential way forward to reduce transmission rates and subsequent infection. In Brazil, vaccines are being distributed via the public sector; however, in the future, they will be available in the private market. Information about consumers' willingness to pay (WTP) for a hypothetical vaccine against SARS CoV-2 can help future price setting discussions. METHODS A cross-sectional study was conducted with consumers in the five regions of Brazil regarding the WTP for a hypothetical vaccine against SARS CoV-2 with a 50% efficacy. RESULTS A total of 1402 individuals over 18 years of age who declared not having COVID-19 at the time of the survey were interviewed. The acceptability for this hypothetical vaccine was 80.7%. In addition, the amount of WTP by Brazilian consumers for a hypothetical SARS CoV-2 vaccine was estimated at US$ 22.18(120.00 BRL). CONCLUSION This study can contribute to decision-making to inform potential pricing for a hypothetical SARS CoV-2 vaccine.
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Affiliation(s)
- Isabella Piassi Dias-Godói
- College of Public Health, Institute of Health and Biological Studies, Universidade Federal do Sul e Sudeste do Pará, Marabá, Pará, Brazil.,Researcher of the Group (Cnpq) for Epidemiological, Economic and Pharmacological Studies of Arboviruses (EEPIFARBO) - Universidade Federal Do Sul E Sudeste Do Pará; Avenida Dos Ipês, Marabá, Pará, Brazil
| | - Túlio Tadeu Rocha Sarmento
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, Sala 1042, Faculdade De Farmácia, Universidade Federal De Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Edna Afonso Reis
- Researcher of the Group (Cnpq) for Epidemiological, Economic and Pharmacological Studies of Arboviruses (EEPIFARBO) - Universidade Federal Do Sul E Sudeste Do Pará; Avenida Dos Ipês, Marabá, Pará, Brazil.,Department of Statistics, Exact Sciences Institute, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil
| | - Ludmila Peres Gargano
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, Sala 1042, Faculdade De Farmácia, Universidade Federal De Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais, Brazil.,Programa De Pós-Graduação Em Medicamentos E Assistência Farmacêutica, School of Pharmacy, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil
| | - Brian Godman
- Department of Pharmacoepidemiology, Institute of Pharmacy and Biomedical Sciences, Glasgow, UK.,Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.,Health Economics Centre, Liverpool University Management School, Liverpool, UK.,School of Pharmacy, Department of Public Health and Pharmacy Management, Sefako Health Sciences University, Pretoria, South Africa
| | - Francisco de Assis Acurcio
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, Sala 1042, Faculdade De Farmácia, Universidade Federal De Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais, Brazil.,Programa De Pós-Graduação Em Medicamentos E Assistência Farmacêutica, School of Pharmacy, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil
| | - Juliana Alvares-Teodoro
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, Sala 1042, Faculdade De Farmácia, Universidade Federal De Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais, Brazil.,Programa De Pós-Graduação Em Medicamentos E Assistência Farmacêutica, School of Pharmacy, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil
| | - Augusto Afonso Guerra Júnior
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, Sala 1042, Faculdade De Farmácia, Universidade Federal De Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais, Brazil.,Programa De Pós-Graduação Em Medicamentos E Assistência Farmacêutica, School of Pharmacy, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil
| | - Cristina Mariano Ruas
- Programa De Pós-Graduação Em Medicamentos E Assistência Farmacêutica, School of Pharmacy, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil
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Athie TS, Nascimento GC, Labis da Costa MJ, Sales Silva JD, Reis EA, Martin AP, Godman B, Dias Godói IP. Consumer willingness to pay for a hypothetical Chagas disease vaccine in Brazil: a cross-sectional study and the implications. J Comp Eff Res 2021; 10:659-672. [PMID: 33851872 DOI: 10.2217/cer-2020-0241] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Aim: Chagas disease is a serious public health problem, endemic in 21 countries in Latin America. A future vaccine can contribute to decreasing the number of cases and its complications. Methods: A cross-sectional study was conducted with residents of the northern region of Brazil, on the willingness to pay for a hypothetical vaccine against Chagas disease (effective protection of 80%). Results: We interviewed 619 individuals and seven were excluded from the analysis and the value of willingness to pay was US$23.77 (100.00 BRL). Conclusion: The Northern region of Brazil is one of the largest markets for this vaccine, due to its epidemiological relevance, so economic studies with this vaccine will be important to assist in the assessment of technologies.
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Affiliation(s)
- Thannuse Silva Athie
- Institute of Health & Biological Studies - Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará, Brazil
| | - Gesiane Cavalcante Nascimento
- Institute of Health & Biological Studies - Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará, Brazil
| | - Maria José Labis da Costa
- Institute of Health & Biological Studies - Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará, Brazil
| | - Juliana de Sales Silva
- Institute of Studies in Agricultural & Regional Development - Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará, Brazil
| | - Edna Afonso Reis
- Department of Statistics, Exact Sciences Institute, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Researcher of the Group (CNPq) for Epidemiological, Economic & Pharmacological Studies of Arboviruses (EEPIFARBO), Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará, Brazil
| | - Antony Paul Martin
- Faculty of Health & Life Sciences, Brownlow Hill, Liverpool, L69 3BX, UK.,QC Medica, York, North Yorkshire, YO23 2BD, UK
| | - Brian Godman
- Department of Pharmacoepidemiology, Institute of Pharmacy & Biomedical Sciences, 161 Cathedral Street, Glasgow G4 0RE, UK.,Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital, Stockholm SE-141 86, Sweden.,Department of Public Health & Pharmacy Management, School of Pharmacy, Sefako Health Sciences University, Pretoria, South Africa
| | - Isabella Piassi Dias Godói
- Institute of Health & Biological Studies - Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará, Brazil.,Researcher of the Group (CNPq) for Epidemiological, Economic & Pharmacological Studies of Arboviruses (EEPIFARBO), Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará, Brazil
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Duarte RCF, Moreira PSS, Ferreira CN, Figueiredo EL, Sternick E, Silveira FR, Alves LCV, Mota APL, Reis EA, Carvalho MDG, Reis HJD. Atrial Fibrillation and Use of Rivaroxaban: Performance of the Prothrombin Time / INR as a Function of Time After Blood Collection. International Journal of Cardiovascular Sciences 2020. [DOI: 10.36660/ijcs.20190141] [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: 11/18/2022] Open
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11
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Zuppo IDF, Ruas CM, de Oliveira HN, Godman B, Castel S, Wainberg ML, Reis EA. Health equity and the usage of atypical antipsychotics within the Brazilian national health system: findings and implications. Expert Rev Pharmacoecon Outcomes Res 2020; 21:743-751. [DOI: 10.1080/14737167.2020.1804873] [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: 12/15/2022]
Affiliation(s)
- Isabella de Figueiredo Zuppo
- Postgraduate Program in Medicines and Pharmaceutical Services, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Cristina Mariano Ruas
- Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Helian Nunes de Oliveira
- Psychiatrist and Professor in the Department of Preventive and Social Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Division of Clinical Pharmacology, Karolinska, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
- Health Economics Centre, University of Liverpool Management School, Liverpool, UK
| | - Saulo Castel
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Milton L. Wainberg
- New York State Psychiatric Institute, Columbia University, New York, United States
| | - Edna Afonso Reis
- Department of Statistics, Federal University of Minas Gerais, Belo Horizonte, Brazil
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12
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Duarte RCF, Rios DRA, Figueiredo EL, Caiaffa JRS, Silveira FR, Lanna R, Alves LCV, Martins GL, Reis HJ, Reis EA, Ferreira CN, Sternick EB, Campos FMF, das Graças Carvalho M. Thrombin Generation and other hemostatic parameters in patients with atrial fibrillation in use of warfarin or rivaroxaban. J Thromb Thrombolysis 2020; 51:47-57. [PMID: 32377955 DOI: 10.1007/s11239-020-02126-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Patients with atrial fibrillation (AF) present hyperactivation of both platelets and coagulation leading to a hypercoagulable state which contributes to an increased risk of thromboembolism. Therefore, one of the main strategies for treatment of AF is prevention of these events through the use of oral anticoagulants (OAC). The aim of this study was to evaluate hemostasis as a whole in patients with non-valvular AF undergoing warfarin or rivaroxaban by thrombin generation test (TGT), in addition to monocyte-platelet aggregates (MPA), glycoprotein IIb/IIIa (GPIIb/IIIa), and platelet (PMP) and endothelium (EMP) microparticles, compared to age and sex matched controls. PT/INR for OAC use was also determined. In patients taking OAC, compared to control group, a decrease in TGT (p = 0.000 for all parameters) were observed. Patients taking warfarin showed to be more hypocoagulable, presenting lower levels of ETP (p = 0.000) and peak (p = 0.002) than patients using rivaroxaban. Patients on warfarin use with INR > 3 had also lower levels of ETP (p = 0.01) and peak (p = 0.006). A decrease in ETP (p = 0.03) and peak (p = 0.02) values was also observed in patients using rivaroxaban with PT > 21.4 s. Patients using warfarin (p = 0.000) and rivaroxaban (p = 0.000) presented lower levels of MPA in relation to control group. It was also observed in patients using warfarin, lower GPIIb/IIIa levels in relation to control group (p = 0.011). Patients taking rivaroxaban (p = 0.003) and warfarin (p = 0.001) had higher PMP levels compared to control group. There was no difference in levels of EMP between the groups (p = 0.0536). The present study reinforces the usefulness of OAC in AF, which decisively contribute to a better management of the disease preventing possible complications.
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Affiliation(s)
- Rita Carolina Figueiredo Duarte
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy - Federal, University of Minas Gerais, Av. Antônio Carlos, 6627 - Pampulha, Belo Horizonte, 31270-910, Brazil
| | | | | | | | | | | | - Luan Carlos Vieira Alves
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy - Federal, University of Minas Gerais, Av. Antônio Carlos, 6627 - Pampulha, Belo Horizonte, 31270-910, Brazil
| | - Gabriela Lopes Martins
- Institute of Biological Sciences of Federal, University of Minas Gerais, Belo Horizonte, Brazil
| | - Helton José Reis
- Institute of Biological Sciences of Federal, University of Minas Gerais, Belo Horizonte, Brazil
| | - Edna Afonso Reis
- Institute of Exact Sciences of Federal, University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Fernanda Magalhães Freire Campos
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy - Federal, University of Minas Gerais, Av. Antônio Carlos, 6627 - Pampulha, Belo Horizonte, 31270-910, Brazil
| | - Maria das Graças Carvalho
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy - Federal, University of Minas Gerais, Av. Antônio Carlos, 6627 - Pampulha, Belo Horizonte, 31270-910, Brazil.
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13
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Furtado Dos Santos S, Almeida-Brasil CC, Costa JDO, Reis EA, Afonso Cruz M, Silveira MR, Ceccato MDGB. Does switching from multiple to single-tablet regimen containing the same antiretroviral drugs improve adherence? A group-based trajectory modeling analysis. AIDS Care 2020; 32:1268-1276. [PMID: 32148071 DOI: 10.1080/09540121.2020.1736258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 10/24/2022]
Abstract
Combination Antiretroviral Therapy (cART) in single-tablet regimens (STR) is a simplification strategy that can potentially improve medication adherence and clinical outcomes. We conducted a retrospective cohort study of 1206 patients using efavirenz, tenofovir and lamivudine in multiple-tablet regimen who switched to the STR containing the same active ingredients in a southeast metropolis in Brazil. We measured adherence using the proportion of days covered (PDC≥95%) and evaluated this outcome before and after the switch using paired non-parametric statistics. Additionally, we used group-based trajectory modeling to identify adherence patterns to cART for each period and evaluate the migration behavior of patients between the trajectory groups. We observed a 14% increase in the proportion of adherent patients after switching to STR and a 6.2% increase in the proportion of patients with CD4 count>500 cells/μl (p < 0.001), without changes in viral load outcomes. We identified four adherence trajectories in each period. Most patients (60%, n = 722) migrated towards a group with better adherence trajectory or remained in the trajectory group with the highest probability of adherence after the switch. Our findings suggest that the implementation of the STR had a positive impact on adherence and CD4 count. This may potentially improve virologic outcomes later on treatment.
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Affiliation(s)
- Simone Furtado Dos Santos
- Department of Social Pharmacy, School of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Celline Cardoso Almeida-Brasil
- Department of Social Pharmacy, School of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Juliana de Oliveira Costa
- Department of Social and Preventive Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Edna Afonso Reis
- Department of Statistics, Institute of Exact Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Márcio Afonso Cruz
- Graduation in Information Systems and Knowledge Management, Fundação Mineira de Educação e Cultura, Brazil
| | - Micheline Rosa Silveira
- Departamento de Farmácia Social - Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Sarmento TTR, Godói IP, Reis EA, Godman B, Ruas CM. Consumer willingness to pay for a hypothetical chikungunya vaccine in Brazil and the implications. Expert Rev Pharmacoecon Outcomes Res 2019; 22:513-520. [DOI: 10.1080/14737167.2020.1703181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
| | - Isabella Piassi Godói
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, sala 1042, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais, CEP, Brazil
- College of Public Health, Institute of Health and Biological Studies, Universidade Federal do Sul e Sudeste do Pará, Pará, Brazil
| | - Edna Afonso Reis
- Departament of Statistics, Exact Sciences Institute, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Brian Godman
- Department of Pharmacoepidemiology, Institute of Pharmacy and Biomedical Sciences, Glasgow, UK
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
- Health Economics Centre, Liverpool University Management School, Liverpool, UK
- School of Pharmacy, Department of Public Health and Pharmacy Management, Sefako Health Sciences University, Pretoria, South Africa
| | - Cristina Mariano Ruas
- Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica, School of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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15
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Pantuzza LLN, das Graças Braga Ceccato M, Reis EA, Silveira MR, Almeida-Brasil CC, Almeida TA, Pinto IVL, Reis AMM. Factors associated with high medication regimen complexity in primary care older adults in Brazil. Eur Geriatr Med 2019; 11:279-287. [PMID: 32297189 DOI: 10.1007/s41999-019-00275-0] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 11/25/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE Complex medication regimens are common among older adults and contribute to the occurrence of undesirable health outcomes. This study aims to investigate the factors associated with high medication regimen complexity in older people. METHODS A cross-sectional study was conducted with older adults selected from two primary healthcare units. Medication regimen complexity was measured using the Brazilian version of the Medication Regimen Complexity Index. The Pearson's Chi square test was used to analyse the individual association of each independent variable with high medication regimen complexity. The backward stepwise method was used to obtain the final multivariate logistic regression model. RESULTS We included 227 older adults with a median age of 70 years who were mostly females (70.9%). The median total Medication Regimen Complexity Index was 20.8 for high complexity and 10.5 for patients that were not using high complexity regimens. The Medication Regimen Complexity Index section with higher median scores in both groups was dosing frequency, followed by additional instructions. High complexity was associated with diabetes (OR 5.42; p = 0.00 2.69-10.93) and asthma/Chronic Obstructive Pulmonary Disease (OR 2.96(1.22-7.18); p = 0.02). CONCLUSIONS Older people in primary care with diabetes and respiratory disease were most likely to have complex medication regimens. Dosing frequency and additional instructions were medication regime complexity index components that most contributed to the high complexity in medication regime of older adults.
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Affiliation(s)
- Laís Lessa Neiva Pantuzza
- Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia, Universidade Federal de Minas Gerais, 6627 Presidente Antônio Carlos Ave, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Maria das Graças Braga Ceccato
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, 6627 Presidente Antônio Carlos Ave, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Edna Afonso Reis
- Instituto de Ciências Exatas da Universidade Federal de Minas Gerais, 6627 Presidente Antônio Carlos Ave, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Micheline Rosa Silveira
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, 6627 Presidente Antônio Carlos Ave, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Celline Cardoso Almeida-Brasil
- Center for Outcomes Research and Evaluation (CORE), Research Institute at the McGill University Health Centre, 5252 Bd. de Maisonneuve O, Montreal, QC, H4A 3S9, Canada
| | - Thiago Augusto Almeida
- Prefeitura Municipal de Belo Horizonte, Farmácia Distrital Leste, 141 Joaquim Felício st., Sagrada Família, Belo Horizonte, Minas Gerais, Brazil
| | - Isabela Vaz Leite Pinto
- Prefeitura Municipal de Belo Horizonte, Farmácia Distrital Leste, 141 Joaquim Felício st., Sagrada Família, Belo Horizonte, Minas Gerais, Brazil
| | - Adriano Max Moreira Reis
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, 6627 Presidente Antônio Carlos Ave, Pampulha, Belo Horizonte, Minas Gerais, Brazil.
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Cardoso TS, Costa JDO, Reis EA, Silveira MR, Bonolo PDF, Santos SFD, Ceccato MDGB. Which antiretroviral regimen is associated with higher adherence in Brazil? A comparison of single, multi, and dolutegravir-based regimens. CAD SAUDE PUBLICA 2019; 35:e00115518. [PMID: 31531518 DOI: 10.1590/0102-311x00115518] [Citation(s) in RCA: 4] [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] [Received: 06/12/2018] [Accepted: 04/05/2019] [Indexed: 11/22/2022] Open
Abstract
We evaluated adherence to highly active antiretroviral therapy (HAART) and its associated factors according to the type of regimen in patients initiating treatment in Belo Horizonte, Minas Gerais State, Brazil. We measured adherence using the eight items Morisky Therapeutic Adhesion Scale (MMAS-8) and compared the use of "backbone" tenofovir/lamivudine plus efavirenz one tablet once-daily (STR) or dolutegravir in multi-tablet once-daily (MTR-DTG), or other multi-tablet regimens (MTR-other). We conducted a multivariate logistic regression analysis to address factors associated with adherence. A total of 393 patients were included, 254 used STR, 106 MTR-DTG, and 33 MTR-other. The overall adhesion rate was 44.8% (95%CI: 39.4; 50.1), 50% for MTR-DTG, 43.3% for STR and 39.4% for MTR-other. Multivariate analysis showed a higher chance of adherence among patients using MTR-DTG, those who received and understood counseling about their treatment and with a higher quality of life. Prior use of illicit drugs in the lifetime was associated with poorer adherence. Overall adherence was low, highlighting the need for strategies focusing on counseling about medicines and substance use. Pill burden was not an issue for patients using MTR-DTG once-daily, who achieved better results.
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Oliveira PCD, Silveira MR, Ceccato MDGB, Reis AMM, Pinto IVL, Reis EA. [Prevalence and factors associated with polypharmacy among the elderly treated in Primary Healthcare in Belo Horizonte, State of Minas Gerais, Brazil]. Cien Saude Colet 2019; 26:1553-1564. [PMID: 33886782 DOI: 10.1590/1413-81232021264.08472019] [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: 06/22/2018] [Accepted: 07/01/2019] [Indexed: 11/21/2022] Open
Abstract
The scope of this article is to analyze the prevalence of polymedication and excessive polypharmacy, as well as associated factors, among the elderly attended at two Basic Health Units in Belo Horizonte, State of Minas Gerais. A cross-sectional observational study was conducted using information obtained from a structured interview of the patient. The individual associations of each explanatory variable with polypharmacy and with excessive polypharmacy were analyzed. For the variables that showed a significant association with polypharmacy, multivariate analysis was performed using the logistic regression model. The elderly used, on average, 5.2 drugs. The prevalence of polymedication was 57.7% and excessive polypharmacy was 4.8%. In univariate analysis the conditions associated with polypharmacy were: age ≤ 70 years, schooling > 8 years, presence of more than three diseases and presenting symptoms of depression. For excessive polypharmacy, the presence of more than three diseases, self-perception of negative health, and partial dependence on instrumental activities of daily living were associated with the conditions. In the final multivariate model for polypharmacy, the age ≤ 70 years and presence of more than three disease variables remained.
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Affiliation(s)
- Patrícia Carvalho de Oliveira
- Departamento de Estatística, Instituto de Ciências Exatas, UFMG Av. Antônio Carlos 6627/ICEx/DEST/s4054, Pampulha. 31270-901 Belo Horizonte MG Brasil.
| | | | | | | | - Isabela Vaz Leite Pinto
- Departamento de Estatística, Instituto de Ciências Exatas, UFMG Av. Antônio Carlos 6627/ICEx/DEST/s4054, Pampulha. 31270-901 Belo Horizonte MG Brasil.
| | - Edna Afonso Reis
- Departamento de Estatística, Instituto de Ciências Exatas, UFMG Av. Antônio Carlos 6627/ICEx/DEST/s4054, Pampulha. 31270-901 Belo Horizonte MG Brasil.
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18
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Ferreira KS, Cicarini WB, Alves LCV, Loures CDMG, Campos FMF, Santos LID, da Silva MVF, Guimarães TMD, Toledo VDPCPD, Reis EA, Neiva CLS, Consoli RV, de Pádua PM, Carvalho MDG. Correlation between active disease and hypercoagulability state in patients with systemic lupus erythematosus. Clin Chim Acta 2019; 490:107-112. [DOI: 10.1016/j.cca.2018.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/26/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
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Silva MRRD, Diniz LM, Santos JBRD, Reis EA, Mata ARD, Araújo VED, Álvares J, Acurcio FDA. Drug utilization and factors associated with polypharmacy in individuals with diabetes mellitus in Minas Gerais, Brazil. Cien Saude Colet 2018; 23:2565-2574. [PMID: 30137126 DOI: 10.1590/1413-81232018238.10222016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/25/2016] [Indexed: 12/23/2022] Open
Abstract
The objective of this study was to evaluate the use of drugs and the factors associated with polypharmacy in patients with diabetes mellitus (DM) in Minas Gerais. Descriptive analysis of drugs in use and logistic regression to estimate the association between socio-demographic and clinical characteristics with polypharmacy were performed. Of the 2619 respondents, 56.5% were in polypharmacy. Drugs for DM, agent in renin-angiotensin system, and diuretics are the most frequently used. Factors such as age, comorbidities and increased access to health services were associated with polypharmacy. It was observed high prevalence of polypharmacy, which requires a suitable care and better quality of drug use in this population.
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Affiliation(s)
- Michael Ruberson Ribeiro da Silva
- Departamento de Farmácia Social, Faculdade de Farmácia, Universidade Federal de Minas Gerais (UFMG). Av. Antônio Carlos 6627, Pampulha. 31270-901 Belo Horizonte MG
| | | | - Jéssica Barreto Ribeiro Dos Santos
- Departamento de Farmácia Social, Faculdade de Farmácia, Universidade Federal de Minas Gerais (UFMG). Av. Antônio Carlos 6627, Pampulha. 31270-901 Belo Horizonte MG
| | | | - Adriana Rodrigues da Mata
- Departamento de Farmácia Social, Faculdade de Farmácia, Universidade Federal de Minas Gerais (UFMG). Av. Antônio Carlos 6627, Pampulha. 31270-901 Belo Horizonte MG
| | - Vânia Eloisa de Araújo
- Departamento de Odontologia, Pontifícia Universidade Católica de Minas Gerais. Belo Horizonte MG Brasil
| | - Juliana Álvares
- Departamento de Farmácia Social, Faculdade de Farmácia, Universidade Federal de Minas Gerais (UFMG). Av. Antônio Carlos 6627, Pampulha. 31270-901 Belo Horizonte MG
| | - Francisco de Assis Acurcio
- Departamento de Farmácia Social, Faculdade de Farmácia, Universidade Federal de Minas Gerais (UFMG). Av. Antônio Carlos 6627, Pampulha. 31270-901 Belo Horizonte MG
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Muniz Júnior RL, Godói IP, Reis EA, Garcia MM, Guerra-Júnior AA, Godman B, Ruas CM. Consumer willingness to pay for a hypothetical Zika vaccine in Brazil and the implications. Expert Rev Pharmacoecon Outcomes Res 2018; 19:473-482. [PMID: 30468095 DOI: 10.1080/14737167.2019.1552136] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 10/27/2022]
Abstract
ABSTRACT Background: Zika virus is a newly emerging infection, associated with increasingly large outbreaks especially in tropical countries such as Brazil. A future Zika vaccine can contribute to decreasing the number of cases and associated complications. Information about consumers' willingness to pay (WTP) for a hypothetical Zika vaccine can help price setting discussions in the future in Brazil, starting with the private market. METHODS A cross-sectional study conducted among residents of Minas Gerais, Brazil, regarding their WTP for a hypothetical Zika Vaccine. The mean effective protection was 80%, with the possibility of some local and systemic side- effects. RESULTS 517 people were interviewed. However, 28 would not be vaccinated even if the vaccine was free. Most of the resultant interviewees (489) were female (58.2%), had completed high school (49.7%), were employed (71.2%), had private health insurance (52.7%), and did not have Zika (96.9%). The median individual maximum WTP for this hypothetical Zika vaccine (one dose) was US$31.34 (BRL100.00). CONCLUSION Such discussions regarding WTP can contribute to decision-making about prices once a Zika vaccine becomes available in Brazil alongside other ongoing programs to control the virus.
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Affiliation(s)
- Roberto Lúcio Muniz Júnior
- a College of Pharmacy - Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627 , Campus Pampulha, Belo Horizonte, Minas Gerais, CEP 31270-901 , Brazil
| | - Isabella Piassi Godói
- b Programa de Pós-graduação em Medicamentos e Assistência Farmacêutica, sala 1023, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627 , Campus Pampulha, Belo Horizonte, Minas Gerais, CEP 31270-901 , Minas Gerais , Brazil.,c SUS Collaborating Centre for Technology Assessment and Excellence in Health, sala 1042, Faculdade de Farmácia , Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais, CEP 31270-901 , Brazil.,d Institute of Health and Biological Studies - Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês , s/n, Cidade Universitária, Cidade Jardim, Marabá , Pará , Brazil
| | - Edna Afonso Reis
- e Department of Statistics - Exact Sciences Institute - Universidade Federal de Minas Gerais (UFMG) - Av. Presidente Antônio Carlos 6627 - Pampulha - CEP 31.270-901 - Belo Horizonte , Brazil
| | - Marina Morgado Garcia
- f Strathclyde Institute of Pharmacy and Biomedical Sciences , Strathclyde University , Glasgow , United Kington.,g Division of Clinical Pharmacology , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
| | - Augusto Afonso Guerra-Júnior
- b Programa de Pós-graduação em Medicamentos e Assistência Farmacêutica, sala 1023, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627 , Campus Pampulha, Belo Horizonte, Minas Gerais, CEP 31270-901 , Minas Gerais , Brazil.,c SUS Collaborating Centre for Technology Assessment and Excellence in Health, sala 1042, Faculdade de Farmácia , Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais, CEP 31270-901 , Brazil
| | - Brian Godman
- f Strathclyde Institute of Pharmacy and Biomedical Sciences , Strathclyde University , Glasgow , United Kington.,g Division of Clinical Pharmacology , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden.,h Health Economics Centre , Liverpool University Management School , Liverpool , UK.,i Department of Public Health Pharmacy and Management, School of Pharmacy , Sefako Makgatho Health Sciences University , Garankuwa , South Africa
| | - Cristina Mariano Ruas
- b Programa de Pós-graduação em Medicamentos e Assistência Farmacêutica, sala 1023, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627 , Campus Pampulha, Belo Horizonte, Minas Gerais, CEP 31270-901 , Minas Gerais , Brazil
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21
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Costa JDO, Ceccato MDGB, Silveira MR, Bonolo PDF, Reis EA, Acurcio FDA. Effectiveness of antiretroviral therapy in the single-tablet regimen era. Rev Saude Publica 2018; 52:87. [PMID: 30462751 PMCID: PMC6280632 DOI: 10.11606/s1518-8787.2018052000399] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 08/04/2017] [Accepted: 01/10/2018] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of antiretroviral therapy and the associated factors according to the type of regimen used: Single Tablet Regimen or Multiple Tablet Regimen. METHODS Prospective cohort of 440 patients (male, 74.3%, median age, 36 years old) who initiated antiretroviral therapy between Jan/14 and Dec/15 at a referral service in Belo Horizonte. Efficacy was defined as viral suppression (viral load, VL < 50 copies/ml) and evaluated after six and twelve months of treatment. Sociodemographic, clinical and behavioral data were collected from clinical charts and from Information Systems. Multivariate analysis of overall effectiveness was performed by logistic regression. RESULTS Most patients initiated Multiple Tablet Regimen antiretroviral therapy (n = 255, 58%). At six months, overall viral suppression was 74.6%, being higher among patients who used Single Tablet Regimen (80.6%, p = 0.04). At twelve months, 83.2% of patients reached viral suppression, with no difference between groups (p = 0.93). Factors independently associated with viral suppression at six and twelve months varied, being negatively associated with effectiveness: VL ≥ 100,000 copies/ml, symptoms of AIDS, longer interval time between diagnosis and initiation of antiretroviral therapy, antiretroviral switching, smoking or current illicit drugs usage (p < 0.05). Factors positively associated with viral suppression included adherence to antiretroviral therapy and category of risk/exposure of men who have sex with men (p < 0.05). Reaching viral suppression at six months was the main predictor of effectiveness at one year (OR = 8.96 and p < 0.01). CONCLUSIONS Viral suppression was high and better results were achieved for patients who used Single Tablet Regimen regimens at six months. Clinical, behavioral, and antiretroviral therapy -related factors influence viral suppression and highlight the need for interventions to increase early diagnosis and initiation of antiretroviral therapy, patient’s adherence, and to reduce illicit drugs and cigarette smoking in this population.
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Affiliation(s)
- Juliana de Oliveira Costa
- Universidade Federal de Minas Gerais. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Pública. Belo Horizonte, MG, Brasil
| | - Maria das Graças Braga Ceccato
- Universidade Federal de Minas Gerais. Faculdade de Farmácia. Departamento de Farmácia Social. Belo Horizonte, MG, Brasil
| | - Micheline Rosa Silveira
- Universidade Federal de Minas Gerais. Faculdade de Farmácia. Departamento de Farmácia Social. Belo Horizonte, MG, Brasil
| | - Palmira de Fátima Bonolo
- Universidade Federal de Minas Gerais. Faculdade de Medicina. Departamento de Medicina Preventiva e Social. Belo Horizonte, MG, Brasil
| | - Edna Afonso Reis
- Universidade Federal de Minas Gerais. Instituto de Ciências Exatas. Departamento de Estatística. Belo Horizonte, MG, Brasil
| | - Francisco de Assis Acurcio
- Universidade Federal de Minas Gerais. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Pública. Belo Horizonte, MG, Brasil.,Universidade Federal de Minas Gerais. Faculdade de Farmácia. Departamento de Farmácia Social. Belo Horizonte, MG, Brasil
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Pereira FB, Dutra WO, Gollob KJ, Reis EA, Oliveira ALGD, Rocha MODC, Menezes CADS. Vasoactive intestinal peptide degradation might influence Interleukin-17 expression in cardiac chagasic patients. Rev Inst Med Trop Sao Paulo 2018; 60:e57. [PMID: 30365640 PMCID: PMC6199123 DOI: 10.1590/s1678-9946201860057] [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: 05/11/2018] [Accepted: 08/14/2018] [Indexed: 12/03/2022] Open
Abstract
The vasoactive intestinal peptide (VIP) expression is lower in cardiac chagasic patients and is related to worse cardiac function. The reduction of VIP in patients with Chagas disease may be a result of its enhanced degradation. To test this hypothesis, the tryptase and chymase expression was evaluated. We also related VIP levels with interleukin-17 (IL-17) expression since VIP may modulate IL-17 production. Plasma levels of chymase were higher in chagasic patients. Conversely, VIP/chymase and VIP/tryptase ratios were lower in chagasic patients when compared to non-infected individuals. Besides, the VIP/chymase ratio was lower in chagasic cardiac patients in comparison with the indeterminate group. A positive correlation between tryptase and chymase levels was observed in chagasic cardiac patients. In relation to IL-17, we observed a higher expression of this cytokine in the cardiac form of the disease than in the indeterminate form. IL-17/VIP ratio was higher in the cardiac form in comparison with non-infected or indeterminate form. These results suggest that the low levels of VIP observed in chagasic patients could be due to an increased production of chymase and/or to the additive effect of the interaction between chymase and tryptase in the cardiac form. Moreover, the decreased VIP expression may contribute to the increase of IL-17 in chagasic cardiac patients.
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Affiliation(s)
| | - Walderez O. Dutra
- Universidade Federal de Minas Gerais, Brazil; Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais, Brazil
| | - Kenneth J. Gollob
- Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais, Brazil; A.C. Camargo Cancer Center, Brazil
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Almeida TA, Reis EA, Pinto IVL, Ceccato MDGB, Silveira MR, Lima MG, Reis AMM. Factors associated with the use of potentially inappropriate medications by older adults in primary health care: An analysis comparing AGS Beers, EU(7)-PIM List , and Brazilian Consensus PIM criteria. Res Social Adm Pharm 2018; 15:370-377. [PMID: 29934277 DOI: 10.1016/j.sapharm.2018.06.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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: 06/11/2018] [Accepted: 06/11/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Potentially inappropriate medications (PIM) for the older adults are those with an unfavorable risk-benefit ratio when more effective and safe therapeutic alternatives are available and is an important public health problem. PURPOSE To analyze the factors associated with the use of PIM by the older adults and to investigate the agreement of PIM use frequency using the 2015 American Geriatric Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults - 2015 AGS Beers Criteria, the Brazilian consensus on potentially inappropriate medication for older adults (BCPIM) and the European union list of potentially inappropriate medications - EU (7)-PIM List. METHODS This is a cross-sectional study conducted in two primary health care centers in southeastern Brazil. The 2015 AGS Beers Criteria, BCPIM, and EU (7)-PIM List were used for the classification of PIM. The association between PIM use and independent variables was assessed by multiple logistic regression. The level of agreement of PIM use among the three criteria was measured with the Cohen's kappa coefficient. RESULTS A total of 227 patients ≥60 years of age were included in the study. The frequency of PIM use was 53.7% for 2015 AGS Beers, 55.9% for BCPIM and 63.4% for the EU (7)-PIM List. The agreement between 2015 AGS Beers and BCPIM and between this and the EU (7)-PIM List was high, and moderate between the 2015 AGS Beers and the EU (7)-PIM List. Logistic regression showed association of PIM use with polypharmacy, self-reported neuropsychiatric and musculoskeletal diseases, age ≤70 years, preserved cognition and positive self-perception of health. CONCLUSION The frequency of PIM use by the older adults of health centers investigated is high. Strategies for improving the pharmacotherapy of the older adults in primary health care should be implemented.
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Affiliation(s)
- Thiago Augusto Almeida
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, 6627 Presidente Antônio Carlos Ave., Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil
| | - Edna Afonso Reis
- Instituto de Ciências Exatas da Universidade Federal de Minas Gerais, 6627 Presidente Antônio Carlos Ave., Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil
| | - Isabela Vaz Leite Pinto
- Prefeitura Municipal de Belo Horizonte, Farmácia Distrital Leste, Rua Joaquim Felício 141 Sagrada Família, Belo Horizonte, Minas Gerais, 31030-200, Brazil
| | - Maria das Graças Braga Ceccato
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, 6627 Presidente Antônio Carlos Ave., Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil
| | - Micheline Rosa Silveira
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, 6627 Presidente Antônio Carlos Ave., Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil
| | - Marina Guimarães Lima
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, 6627 Presidente Antônio Carlos Ave., Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil
| | - Adriano Max Moreira Reis
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, 6627 Presidente Antônio Carlos Ave., Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil.
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Santos JCD, Cortez DN, Macedo MML, Reis EA, Reis IA, Torres HC. Comparison of education group strategies and home visits in type 2 diabetes mellitus: clinical trial. Rev Lat Am Enfermagem 2017; 25:e2979. [PMID: 29267547 PMCID: PMC5738960 DOI: 10.1590/1518-8345.2315.2979] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 07/04/2017] [Accepted: 10/26/2017] [Indexed: 12/02/2022] Open
Abstract
Objective: to compare the adherence and empowerment of patients with type 2 diabetes mellitus
for self-care practices and glycemic control in group education strategies and
home visits. Method: Clinical trial with ten randomized clusters, performed with 238 patients with type
2 diabetes mellitus distributed in group education, home visit, and control group.
Socio-demographic data, glycated hemoglobin and those obtained from the self-care
and empowerment questionnaires were collected. Statistical analysis was performed
separately by educational strategy. Results: the mean age of the patients was 57.8 years old (SD = 9.4 years old), with a
predominantly female participation (66.4%). Both strategies presented similar
results regarding adherence to self-care practices and patient empowerment. There
was also a reduction in glycated hemoglobin levels; however, only in the education
group, the difference presented statistical significance (p <0.001). Conclusion: the strategies were effective; however, group education presented better glycemic
control results in relation to the home visit. International registry: NCT02132338
and national: RBR-92j38t in the clinical trials registry.
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Affiliation(s)
- Jéssica Caroline Dos Santos
- Master's student, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil. Scholarship holder at Coordenadoria de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Daniel Nogueira Cortez
- PhD, Adjunct Professor, Universidade Federal de São João del Rei, Divinópolis, MG, Brazil
| | - Maísa Mara Lopes Macedo
- MSc, RN, Hospital da Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Edna Afonso Reis
- PhD, Associate Professor, Departamento de Estatística, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Ilka Afonso Reis
- PhD, Adjunct Professor, Departamento de Estatística, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Heloísa Carvalho Torres
- PhD, Associate Professor, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Barbosa MM, Garcia MM, Nascimento RCRMD, Reis EA, Guerra Junior AA, Acurcio FDA, Álvares J. Avaliação da infraestrutura da Assistência Farmacêutica no Sistema Único de Saúde em Minas Gerais. Ciênc saúde coletiva 2017; 22:2475-2486. [DOI: 10.1590/1413-81232017228.10952017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 05/15/2017] [Indexed: 11/22/2022] Open
Abstract
Resumo Em 2008, o estado de Minas Gerais criou o Programa Rede Farmácia de Minas (RFM), uma estratégia para garantir infraestrutura adequada das farmácias. O objetivo deste artigo é caracterizar a infraestrutura da Assistência Farmacêutica (AF) de Minas Gerais, comparando municípios contemplados ou não pela RFM, no intuito de verificar se os gastos estaduais implicaram em melhoria das AF municipais. Estudo transversal de avaliação da AF de Minas Gerais. Foram realizadas entrevistas presenciais e telefônicas com usuários, médicos, responsáveis pela AF e dispensadores de medicamentos, além de observação das instalações. Foram selecionados 104 municípios, dos quais 41,3% haviam adotado a RFM. Os dados foram coletados de julho de 2014 a maio de 2015. Municípios com RFM apresentaram taxas significativamente maiores de regularização da documentação legal, maior conforto para os usuários e funcionários, melhores condições de armazenamento de medicamento e realização de atividades clínicas. O maior volume de investimentos estadual na AF dos municípios com RFM gerou melhores condições de infraestrutura que foram avaliadas positivamente tanto por profissionais de saúde como pelos usuários do SUS.
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26
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Braga LP, Mendicino CCP, Reis EA, Carmo RA, Menezes de Pádua CA. Effectiveness of second-line antiretroviral therapy: the impact of drug switches. AIDS Care 2017; 29:1585-1588. [PMID: 28490196 DOI: 10.1080/09540121.2017.1322680] [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] [Indexed: 10/19/2022]
Abstract
Including antiretroviral drug switches as a measure of ART failure could be more suitable than conventional measures to evaluate health outcomes in "real-world" settings. This is part of a historical cohort of HIV-infected adults who initiated ART from 2001-2005, and were followed up for a maximum of five years in three HIV/AIDS centers in Belo Horizonte, Brazil. Follow-up information included data from 2001-2010. All patients switched from first-line ART were included. Second-line ART effectiveness was measured as the time-to-ART failure. Failure was defined simulating two scenarios: (1) Clinical, immunological and virological failure (scenario 1); and scenario 1 plus ART switches (scenario 2). Descriptive analysis, Kaplan-Meier curves, log-rank test, and Cox proportional hazards model were performed. We identified 119 eligible patients; most had protease inhibitor (PI)-based regimens prescribed as second-line. The incidence of failure was different for the two scenarios (29.4% vs. 54.6% for scenario 1 and 2, respectively; p < 0.001). The main identifiers of failure were increase in viral load (31.1%) for scenario 1 and ART switches (42.8%) for scenario 2. Median duration on second-line ART was 36.8 vs. 19.8 months for scenario 1 and 2, respectively. In the Cox analysis of scenario 2, increased risk was found for patients given PI-based second-line regimens (HR = 2.26; 95% CI: 1.09-3.17). There is a high incidence of ART failure associated with PI-based regimens when ART switches are considered as an indicator of failure. This demonstrates the impact of ART switches in representing lack of ART effectiveness.
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Affiliation(s)
- Letícia Penna Braga
- a Department of Social Pharmacy, Faculty of Pharmacy , Federal University of Minas Gerais , Belo Horizonte , Brazil
| | | | - Edna Afonso Reis
- b Department of Statistics , Exact Sciences Institute, Federal University of Minas Gerais , Belo Horizonte , Brazil
| | - Ricardo Andrade Carmo
- c Municipal Health Division , Infectious Disease Reference Center, CTR/DIP Orestes Diniz, Federal University of Minas Gerais , Belo Horizonte , Brazil
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Gomes KDO, Reis EA, Guimarães MDC, Cherchiglia ML. [Use of health services by quilombo communities in southwest Bahia State, Brazil]. CAD SAUDE PUBLICA 2014; 29:1829-42. [PMID: 24068228 DOI: 10.1590/0102-311x00151412] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 04/16/2013] [Indexed: 11/22/2022] Open
Abstract
Use of health services is increasing in Brazil as a whole, but geographic and social inequalities persist, especially among minority groups. The aim of this study was to analyze the use of health services by members of quilombos (slavedescendant African-Brazilian communities) in Vitória da Conquista, Bahia State, Brazil. This cross-sectional health survey in 2011 focused on 797 adults (≥ 18 years old) belonging to quilombos. The magnitude of the associations between explanatory variables and use of services was estimated by the prevalence ratio obtained from Poisson regression with 95% confidence interval. Of the total sample, 455 (57.1%) reported having used health services in the 12 months prior to the interview. Higher rates of health services utilization were associated with female gender, non-single conjugal status, fair, poor, or very poor self-rated health, enrolment in the Family Health Program, and referral to a health facility for regular or on-going care. The results showed underutilization of health services by members of quilombos, thus demonstrating the need to improve health services provision for this population group.
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Gomes KDO, Reis EA, Guimarães MDC, Cherchiglia ML. Utilização de serviços de saúde por população quilombola do Sudoeste da Bahia, Brasil. CAD SAUDE PUBLICA 2013. [DOI: 10.1590/s0102-311x2013001300022] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [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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Ribeiro AJF, Reis EA, Barbosa JB. Construção de tábuas de mortalidade de inválidos por meio de modelos estatísticos bayesianos. Rev bras estud popul 2010. [DOI: 10.1590/s0102-30982010000200006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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30
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Santiago M, Martinelli R, Ko A, Reis EA, Fontes RD, Nascimento EG, Pierangeli S, Espinola R, Gharavi A. Anti-beta2 glycoprotein I and anticardiolipin antibodies in leptospirosis, syphilis and Kala-azar. Clin Exp Rheumatol 2001; 19:425-30. [PMID: 11491498] [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] [Indexed: 02/21/2023]
Abstract
OBJECTIVE Reports have shown that anticardiolipin (aCL) antibodies present in patients with autoimmune diseases are dependent on the cofactor,beta2 glycoprotein I (beta2 GPI), as opposed to aCL antibodies seen in infectious diseases such as syphilis, HIV hepatitis C, etc. The assay for anti-beta2GPI antibodies has been reported to be more specific for antiphospholipid syndrome (APS). However, the prevalence of these antibodies in diseases such as leishmaniasis and leptospirosis remains unknown. The aim of the present study was determine the prevalence of antibodies to cardiolipin and to beta2GPI in patients with different infectious diseases, including leptospirosis, syphilis and leishmaniasis. METHODS Samples from patients with Kala-azar (visceral leishmaniasis), syphilis or leptospirosis were tested for IgG and IgM anticardiolipin and IgG anti-beta2GPI antibodies by ELISA. RESULTS In patients with Kala-azar the prevalence of IgG aCL, IgM aCL and anti-beta2GPI was 6% (2/30), 3% (1/30) and 53% (16/30), respectively. In syphilis the prevalence was 18% (14/74), 13% (10/74) and 10% (8/70), respectively. In leptospirosis the frequency of these antibodies was 23% (9/39), 10% (4/39) and 17% (6/34), respectively. There was no statistical correlation between aCL and anti-beta2GPI antibodies in these diseases. DISCUSSION This study clearly shows a significant prevalence of anti-beta2GPI antibodies in leptospirosis and leishmaniasis and syphilis. This indicates that the assay for antibeta2GPI antibodies should be thoroughly validated before it is introduced as a definitive tool for the diagnosis of APS, testing a larger number of sera from patients with a wider range of clinical conditions.
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Affiliation(s)
- M Santiago
- Escola Bahiana de Medicina e Saúde Pública/Hospital Santa Izabel, Bahia, Brazil.
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Abstract
We analyse the effect of using prevalence rates based on populations with different sizes in the power of spatial independence tests. We compare the well known spatial correlation Moran's index to three indexes obtained after adjusting for population density, one proposed by Oden, another proposed by Waldhör, and a third proposed by us in this paper. We find an effect of spatially correlated populations in the type I error probability on the test based on Moran's and Waldhör's indexes. We conclude also that the test proposed by Oden is powerful to test risk heterogeneity, but it has disadvantages when the interest is solely on the spatial correlation of morbidity risks. In this latter case, we recommend using our proposed test which is more powerful than the usual Moran's index applied directly to the rates.
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Affiliation(s)
- R M Assunção
- Departamento de Estatística e CEDEPLAR, UFMG - Universidade Federal de Minas Gerais, Caixa Postal 702, Belo Horizonte, MG 30161 - 970, Brazil.
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Secor WE, del Corral H, dos Reis MG, Ramos EA, Zimon AE, Matos EP, Reis EA, do Carmo TM, Hirayama K, David RA, David JR, Harn DA. Association of hepatosplenic schistosomiasis with HLA-DQB1*0201. J Infect Dis 1996; 174:1131-5. [PMID: 8896524 DOI: 10.1093/infdis/174.5.1131] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Major histocompatibility class II alleles of 351 persons living in an area endemic for Schistosoma mansoni in northeastern Brazil were characterized at three loci (DRB1, DQA1, and DQB1). Contingency analyses were used to compare allele frequencies with high egg excretion, proliferative response to schistosome soluble egg antigens (SEA), and occurrence of severe, biopsy-confirmed hepatosplenic disease. There were no associations of HLA-DR or DQ with egg excretion. Patients positive for DRB1*01, DQA1*0101, or DQB1*0501 were less likely to respond to SEA than was the overall study population. However, using stringent Bonferroni correction (multiplying P values by the number of alleles tested; P x 35), none of these associations with SEA responsiveness remained significant. Hepatosplenic disease was less likely in patients positive for DRB1*11 and was more likely in patients positive for DRB1*07 or DQB1*0201. However, only the DQB1*0201 association remained significant (odds ratio = 3.72; P < .005) following Bonferroni correction.
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Affiliation(s)
- W E Secor
- Department of Tropical Public Health, Harvard School of Public Health, Boston, Massachusetts, USA
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Secor WE, dos Reis MG, Ramos EA, Matos EP, Reis EA, do Carmo TM, Harn DA. Soluble intercellular adhesion molecules in human schistosomiasis: correlations with disease severity and decreased responsiveness to egg antigens. Infect Immun 1994; 62:2695-701. [PMID: 7516309 PMCID: PMC302870 DOI: 10.1128/iai.62.7.2695-2701.1994] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Granuloma formation, the principal pathologic consequence of infection with Schistosoma mansoni, is a complex process involving intricate cell-cell interactions in which intercellular adhesion molecules are likely to participate. To examine this possibility, sera of schistosomiasis patients in various clinical groups were assayed for the presence of soluble intercellular adhesion molecule 1 (sICAM-1) and soluble E-selectin (sE-selectin). Comparisons were made between groups with different infection intensities (as predicted by fecal egg count) as well as between groups with severe (hepatosplenic) or milder (intestinal) pathology. All groups had elevated levels of sICAM-1 compared with controls. Also, patients in the high egg-excreting and hepatosplenic groups had significantly higher levels of serum sICAM-1 than patients in the low-egg-excreting and intestinal groups, respectively. The levels of sE-selectin were significantly elevated in the sera of all patients except those in the hepatosplenic group compared with controls. Patients in the intestinal group had significantly higher levels of sE-selectin in their sera than did hepatosplenic group patients, but serum sE-selectin levels of high- and low-egg-excreting patients were comparable. A striking finding of this study was the inverse correlation observed between sICAM-1 levels and peripheral blood mononuclear cell responses to schistosome soluble egg antigens (SEA) but not with responses to other schistosome antigens, purified protein derivative, or mitogen. Because ICAM-1 can perform a costimulatory function in antigen-presenting cell-T cell interactions, it is possible that shedding of ICAM-1 in the granuloma microenvironment interrupts proper costimulation, leading to unresponsive SEA-specific T cells. In this way, sICAM-1 could be one factor contributing to the observed modulation of cellular responses to SEA in chronic human schistosomiasis.
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Affiliation(s)
- W E Secor
- Department of Tropical Public Health, Harvard School of Public Health, Boston, Massachusetts
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