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1.
J Comp Eff Res ; 13(4): e230127, 2024 04.
Article in English | MEDLINE | ID: mdl-38329429

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.


Subject(s)
Medication Therapy Management , Quality of Life , Humans , Female , Adolescent , Adult , Male , Brazil , Cross-Sectional Studies , Surveys and Questionnaires
3.
Article in English | LILACS | ID: biblio-1438286

ABSTRACT

OBJECTIVE: To investigate the use of sedatives by older adults attending a private outpatient geriatric clinic in Belo Horizonte (MG), Brazil, and its association with falls and hip fractures. METHODS: Using a longitudinal design, the prevalence of benzodiazepine and nonbenzodiazepine ("z-drugs") intake by older adults was described and their association with the incidence of falls and fractures (30 days after the initial visit) was evaluated through logistic regression. RESULTS: A total of 7821 older adults were included in the study, most of them women (72.50%), with a mean age of 77.5 years and a mean Clinical-Functional Vulnerability Index (IVCF-20) score of 16.5. The overall prevalence of sedative use (any sedative) was 6.19%, with 4.48% benzodiazepines and 1.98% z-drugs. The most widely used sedatives were clonazepam (29.04%), zolpidem (28.65%), and alprazolam (23.44%). Falls were reported for 182 patients (2.33%), with a higher incidence among users of any sedatives (4.34; p = 0.002; OR = 1.94, adjusted for sex, age, and IVCF-20) and benzodiazepines (5.14%; p < 0.001; OR = 2.28) than among non-users (2.19%). Hip fractures occurred in 33 patients (0.42%), and again were more frequent among users of sedatives (1.03%; p = 0.032; OR = 2.57) and benzodiazepines (1.43%; p = 0.003; OR = 3.45) than among non-users (0.38%). CONCLUSIONS: The use of sedatives, especially benzodiazepines, is associated with an increased incidence of falls and hip fractures in older adults


OBJETIVO: Investigar a utilização de sedativos entre idosos atendidos em ambulatório privado de geriatria em Belo Horizonte (MG), bem como sua associação com quedas e fraturas de fêmur. METODOLOGIA: Trata-se de estudo longitudinal, no qual foi descrita a prevalência de uso de benzodiazepínicos e drogas Z entre idosos (60 anos ou mais) e avaliada sua associação com a incidência de queda e fratura (30 dias após consulta inicial) por meio de regressão logística. RESULTADOS: Foram incluídos no estudo 7821 idosos, com maioria feminina (72,50%), idade média de 77,5 anos e Índice de Vulnerabilidade Clínico Funcional (IVCF-20) médio de 16,5 pontos. A prevalência de uso de sedativos em geral foi de 6,19%, sendo 4,48% de benzodiazepínicos e 1,98% de drogas Z. Os medicamentos sedativos mais utilizados foram clonazepam (29,04%), zolpidem (28,65%) e alprazolam (23,44%). Relatou-se queda para 182 idosos (2,33%), com incidência maior entre usuários de sedativos (4,34; p = 0,002; OR = 1,94 ajustada por sexo, idade e IVCF-20) e de benzodiazepínicos (5,14%; p < 0,001; OR = 2,28) do que entre não usuários (2,19%). Identificou-se fratura de fêmur em 33 idosos (0,42%), sendo mais frequente entre usuários de sedativos (1,03%; p = 0,032; OR = 2,57) e de benzodiazepínicos (1,43%; p = 0,003; OR = 3,45) do que entre não usuários (0,38%). CONCLUSÃO: Concluiu-se que a incidência de quedas e fraturas de fêmur em idosos possui associação com o uso de medicamentos sedativos, em especial os benzodiazepínicos


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Benzodiazepines/administration & dosage , Accidental Falls , Femoral Fractures/drug therapy , Health Services for the Aged , Hypnotics and Sedatives/administration & dosage , Longitudinal Studies
4.
Pharmacy (Basel) ; 10(6)2022 Nov 14.
Article in English | MEDLINE | ID: mdl-36412827

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.

5.
Article in English | MEDLINE | ID: mdl-36231605

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.


Subject(s)
Pharmaceutical Services , Smoking Cessation , Antidepressive Agents , Nicotine , Tobacco Use Cessation Devices
6.
Einstein (Sao Paulo) ; 20: eAO6453, 2022.
Article in English | MEDLINE | ID: mdl-35416831

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.


Subject(s)
Antirheumatic Agents , Arthritis, Psoriatic , Arthritis, Rheumatoid , Rheumatic Diseases , Spondylitis, Ankylosing , Aged , Antirheumatic Agents/therapeutic use , Arthritis, Psoriatic/drug therapy , Arthritis, Rheumatoid/drug therapy , Female , Humans , Male , Prospective Studies , Public Health , Rheumatic Diseases/drug therapy , Spondylitis, Ankylosing/drug therapy
7.
J Comp Eff Res ; 11(4): 263-274, 2022 03.
Article in English | MEDLINE | ID: mdl-35029122

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.


Subject(s)
Malaria Vaccines , Brazil , Cross-Sectional Studies , Female , Humans , Malaria Vaccines/therapeutic use , Surveys and Questionnaires
8.
Expert Rev Pharmacoecon Outcomes Res ; 22(3): 513-520, 2022 Apr.
Article in English | MEDLINE | ID: mdl-31815561

ABSTRACT

BACKGROUND: Chikungunya fever is an important infectious disease transmitted by the bite of the mosquitoes. Information about consumers' willingness to pay (WTP) for a hypothetical vaccine can help with future discussions about its possible price. METHODS: A cross-sectional study conducted among residents of Minas Gerais, Brazil, regarding their WTP for a hypothetical chikungunya vaccine defined by the authors as having a mean effective protection of 80%. RESULTS: We interviewed 496 individuals. Among these, 23 were excluded from the analysis. Most of the respondents were female (57.3%), had completed at least high school (90.7%), were employed (87.7%) and had private health insurance (62.6%). The median value of the WTP was US$ 31.17 (120.00 BRL) for a unique dose vaccine. The WTP showed a statistical significant correlation with monthly family income and access to private health insurance. CONCLUSION: This study can contribute to decision-making about potential prices for a chikungunya vaccine once it becomes available in Brazil. We demonstrated the relevance of the anchoring effect as a possible influence applied to the maximum value of the WTP associated with respondents' preference for a new vaccine. Finally, we encourage the development of a chikungunya virus vaccine to benefit the Brazilian population.


Subject(s)
Chikungunya Fever , Vaccines , Animals , Brazil , Chikungunya Fever/prevention & control , Cross-Sectional Studies , Female , Humans , Surveys and Questionnaires
9.
Braz. J. Pharm. Sci. (Online) ; 58: e19946, 2022. tab, graf
Article in English | LILACS | ID: biblio-1383979

ABSTRACT

Abstract The present study evaluated 56 patients diagnosed with Chronic Lymphocytic Leukemia (CLL) and a control group of 44 clinically healthy subjects with no previous history of leukemia. Genetic expressions of AKT and microRNAs were evaluated by quantitative PCR (qPCR). A significant increase in AKT gene expression in patients when compared to controls was observed (p = 0.017). When the patients were stratified according to Binet subgroups, a significant difference was observed between the subgroups, with this protein kinase appearing more expressed in the B+C subgroup (p = 0.013). Regarding miRNA expression, miR-let-7b and miR-26a were reduced in CLL patients, when compared to controls. However, no significant differences were observed in these microRNA expressions between the Binet subgroups (A versus B+C). By contrast, miR-21 to miR-27a oncogenes showed no expression difference between CLL patients and controls. AKT protein kinase is involved in the signaling cascade that occurs with BCR receptor activation, leading to increased lymphocyte survival and protection against the induction of cell death in CLL. Thus, increased AKT protein kinase expression and the reduction of miR-let-7b and miR-26a, both tumor suppressors, may explain increased lymphocyte survival in CLL patients and may be promising markers for the prognostic evaluation of this disease.


Subject(s)
Humans , Male , Female , Protein Kinases , Leukemia, Lymphocytic, Chronic, B-Cell/pathology , Patients , Gene Expression/genetics , Apoptosis , MicroRNAs/pharmacology , Healthy Volunteers
10.
J Comp Eff Res ; 10(8): 659-672, 2021 06.
Article in English | MEDLINE | ID: mdl-33851872

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.


Subject(s)
Chagas Disease , Vaccines , Brazil , Chagas Disease/prevention & control , Cross-Sectional Studies , Humans , Latin America , Surveys and Questionnaires
11.
Cien Saude Colet ; 26(4): 1553-1564, 2021 Apr.
Article in Portuguese | MEDLINE | ID: mdl-33886782

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.


O objetivo deste artigo é analisar a prevalência de polifarmácia e de polifarmácia excessiva, bem como seus fatores associados, entre idosos atendidos em duas Unidades Básicas de Saúde de Belo Horizonte-MG. Foi conduzido um estudo observacional transversal, realizado por meio de informações resultantes de uma entrevista estruturada ao paciente. Foram analisadas as associações individuais de cada variável explicativa com a polifarmácia e polifarmácia excessiva. Para as variáveis que apresentaram associação significativa com polifarmácia, foi realizada análise multivariada por meio do modelo de regressão logística. Os idosos utilizavam, em média, 5,2 fármacos. A prevalência de polifarmácia foi de 57,7% e de polifarmácia excessiva foi de 4,8%. Na análise univariada, mostraram-se associadas à polifarmácia as condições idade ≤ 70 anos, escolaridade > 8 anos, presença de mais de três doenças e presença de sintomas de depressão. Para polifarmácia excessiva, mostraram-se associadas as condições presença de mais de três doenças, autopercepção da saúde negativa e dependência parcial nas atividades instrumentais de vida diária. No modelo multivariado final para polifarmácia, permaneceram as variáveis idade ≤ 70 anos e presença de mais de três doenças.


Subject(s)
Activities of Daily Living , Polypharmacy , Aged , Brazil/epidemiology , Cross-Sectional Studies , Humans , Prevalence , Primary Health Care , Socioeconomic Factors
12.
Ann Hematol ; 100(2): 375-382, 2021 Feb.
Article in English | MEDLINE | ID: mdl-33404693

ABSTRACT

Sickle cell disease (SCD) comprises a group of genetic disorders characterized by the presence of the hemoglobin (Hb) S in homozygosis or in heterozygosis with some other Hb variant or in interaction with thalassemia. SCD is characterized by a very complex pathophysiology, which determines a wide variability of clinical manifestations, including a chronic state of hypercoagulability responsible for the increased risk of thromboembolic events. ADAMTS13 and von Willebrand factor (VWF) play an important role in arterial and venous thrombosis. Thus, the aim of this study was to understand how the ADAMTS13-VWF axis behaves in sickle cell disease, as well as whether there is an association of these markers with the use of hydroxyurea (HU). This is a cross-sectional study conducted with 40 patients diagnosed with SCD and 40 healthy individuals. The analysis of the ADAMTS13-VWF axis was comparatively performed between groups of patients and controls and, afterwards, between patients with SCD who were users and non-users of HU. ADAMTS13 activity, ADAMTS13 activity/VWF:Ag, and ADAMTS13:Ag/VWF:Ag ratios were significantly lower and VWF:Ag levels significantly higher in SCD patients when compared to the controls. There was no statistically significant difference in ADAMTS13:Ag and VWF collagen binding (VWF:CB) levels between the groups evaluated. Among the categories of HU use, there was no statistically significant difference in any of the evaluated markers. As a conclusion, we could observe that the ADAMTS13-VWF axis is altered in SCD when compared to healthy individuals and that there is no association between these markers and the use of HU.


Subject(s)
ADAMTS13 Protein/blood , Anemia, Sickle Cell/blood , von Willebrand Factor/metabolism , Adolescent , Adult , Anemia, Sickle Cell/complications , Anemia, Sickle Cell/drug therapy , Cross-Sectional Studies , Female , Humans , Hydroxyurea/administration & dosage , Male , Venous Thrombosis/blood , Venous Thrombosis/etiology
13.
Expert Rev Pharmacoecon Outcomes Res ; 21(4): 743-751, 2021 Aug.
Article in English | MEDLINE | ID: mdl-32779944

ABSTRACT

BACKGROUND: There is a need to evaluate the health equity of atypical antipsychotics users who obtain their medicines from the Brazilian National Health System (SUS) through the identification of key factors that influence their health status due to concerns with equity of care. RESEARCH DESIGN AND METHODS: Cross-sectional study among patients attending state pharmacies in Brazil. Individuals were included if they used atypical antipsychotics, aged ≥18 years, and answered the EQ-5D-3 L questionnaire. Sociodemographic, behavioral, and clinical data were collected. The dependent variable was health status. Associations between the independent variables and the dependent variable were analyzed by adjusting a linear regression model. RESULTS: Overall, 388 individuals met the eligibility criteria and were included in the analysis. The final multiple linear regression model demonstrated a statistically significant association between VAS and suicide attempts, private care, current antipsychotics, comorbidities, and perceived family support. EXPERT COMMENTARY: The study identified several factors both individual and collective that correlate with the health status of atypical antipsychotic users and confirmed the importance of providing medicines for treating psychotic disorders. However, other factors are involved including social support. Our results suggest additional activities and policies are necessary including strategies to address the differences in private and public health care.


Subject(s)
Antipsychotic Agents/administration & dosage , Health Equity , Health Status , Psychotic Disorders/drug therapy , Adult , Brazil , Cross-Sectional Studies , Delivery of Health Care/organization & administration , Female , Humans , Male , Middle Aged , National Health Programs/organization & administration , Social Support , Surveys and Questionnaires , Young Adult
14.
J Thromb Thrombolysis ; 51(1): 47-57, 2021 Jan.
Article in English | MEDLINE | ID: mdl-32377955

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.


Subject(s)
Anticoagulants/therapeutic use , Atrial Fibrillation/drug therapy , Rivaroxaban/therapeutic use , Thrombin/analysis , Warfarin/therapeutic use , Aged , Aged, 80 and over , Atrial Fibrillation/blood , Blood Coagulation/drug effects , Factor Xa Inhibitors/therapeutic use , Female , Hemostasis/drug effects , Humans , Male
15.
Eur Geriatr Med ; 11(2): 279-287, 2020 04.
Article in English | MEDLINE | ID: mdl-32297189

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.


Subject(s)
Medication Adherence , Polypharmacy , Aged , Brazil , Cross-Sectional Studies , Female , Humans , Infant, Newborn , Male , Primary Health Care
16.
AIDS Care ; 32(10): 1268-1276, 2020 10.
Article in English | MEDLINE | ID: mdl-32148071

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.


Subject(s)
Anti-HIV Agents , HIV Infections , Medication Adherence , Anti-HIV Agents/therapeutic use , Antiretroviral Therapy, Highly Active , Brazil , HIV Infections/drug therapy , Humans , Retrospective Studies , Tablets/therapeutic use , Treatment Outcome , Viral Load
17.
Cad Saude Publica ; 35(9): e00115518, 2019 09 16.
Article in English | MEDLINE | ID: mdl-31531518

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.


Subject(s)
Anti-Retroviral Agents/therapeutic use , HIV Infections/drug therapy , HIV Integrase Inhibitors/administration & dosage , Heterocyclic Compounds, 3-Ring/administration & dosage , Medication Adherence/statistics & numerical data , Adult , Brazil , Educational Status , Female , Humans , Male , Oxazines , Piperazines , Pyridones , Quality of Life , Self Report , Viral Load
18.
Res Social Adm Pharm ; 15(4): 370-377, 2019 04.
Article in English | MEDLINE | ID: mdl-29934277

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.


Subject(s)
Inappropriate Prescribing/statistics & numerical data , Aged , Aged, 80 and over , Brazil , Female , Humans , Male , Middle Aged , Polypharmacy , Primary Health Care
19.
Expert Rev Pharmacoecon Outcomes Res ; 19(4): 473-482, 2019 Aug.
Article in English | MEDLINE | ID: mdl-30468095

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.


Subject(s)
Financing, Personal/statistics & numerical data , Patient Acceptance of Health Care/statistics & numerical data , Viral Vaccines/administration & dosage , Zika Virus Infection/prevention & control , Adult , Brazil , Cross-Sectional Studies , Decision Making , Female , Humans , Male , Middle Aged , Surveys and Questionnaires , Viral Vaccines/adverse effects , Viral Vaccines/economics , Young Adult , Zika Virus Infection/economics
20.
Clin Chim Acta ; 490: 107-112, 2019 Mar.
Article in French | MEDLINE | ID: mdl-30543791

ABSTRACT

OBJECTIVE: This study has investigated whether high levels of Reticulocytes-C4d (R-C4d) and Platelets-C4d (P-C4d) reflecting recent activity in SLE patients are correlated with changes in natural anticoagulation components, coagulation activation and endothelial injury markers. METHODS: This study included three groups: 1) healthy women (control, n = 30); 2) women with low activity of the disease (SLEDAI 2 K ≤ 4, n = 30); 3) women with active disease (moderate or high activity) (SLEDAI 2 K > 4, n = 30). Median fluorescence intensity (MFI) of R-C4d and P-C4d were determined by flow cytometry using double labeling with specific monoclonal antibodies. Endothelial injury and hypercoagulability were evaluated by measuring Thrombomodulin and D-dimer levels. RESULTS: Higher MFI index of R-C4d were related to the recent activity of SLE, and higher expression of P-C4d indicated an elevated risk of thrombotic complications. Increased levels of soluble thrombomodulin and D-dimer were observed in patients with active SLE. CONCLUSION: R-C4d is helpful to monitor early disease activity and PC4-d may be an important tool to detect a prothrombotic phenotype in SLE. Elevated levels of D-dimer and thrombomodulin add value to P-C4d data and corroborate a hypercoagulable profile in women with SLE, contributing to an increased prothrombotic risk associated with inflammation.


Subject(s)
Blood Coagulation , Blood Platelets/metabolism , Lupus Erythematosus, Systemic/blood , Lupus Erythematosus, Systemic/physiopathology , Peptide Fragments/blood , Reticulocytes/metabolism , Adult , Aged , Case-Control Studies , Complement C4b , Female , Humans , Middle Aged , Young Adult
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