Does surgically assisted maxillary expansion improve obstructive sleep apnoea in adults? A systematic review and meta-analysis.

Introduction The aim of this systematic review and meta-analysis was to evaluate the effects of maxillary expansion on adults with obstructive sleep apnoea (OSA).Methods Electronic searches up to July 2021 in eight electronic databases were conducted. Study selection, data extraction, risk of bias evaluation using ROBINS-I, quality of evidence assessment using GRADE and meta-analyses were performed.Results The electronic searches yielded 1,007 studies. Following the application of the eligibility criteria, 15 articles were fully read and five studies were included. The studies evaluated the effects of surgically assisted rapid maxillary expansion in adults with OSA. The meta-analysis demonstrated an improvement in Apnoea-Hypopnea Index (AHI) (MD = -9.91, CI = -14.57 to -5.25), Oxygen Desaturation Index (ODI) (MD = -7.95, CI = -12.23 to -3.67), and Epworth Sleepiness Scale (ESS) (MD = -4.40, CI = -6.39 to -2.40). ROBINS-I indicated serious, no information and critical risk of bias for the included studies. The quality of the evidence was very low.Conclusion The findings herein suggest that maxillary expansion could improve OSA in adults in the short term.

Assessment of screening programs as a strategy for early detection of oral cancer: a systematic review.

The present study is a systematic review of the evaluation of screening programs as a strategy for early detection of oral cancer. The aim of this study was to assess whether screening through visual inspection is able to identify injuries in early stages, to increase survival, and to decrease the incidence and mortality of oral cancer. Studies using visual inspection to screen for oral cancer and potentially malignant lesions in apparently healthy individuals over 18 years without previous diagnosis of the disease were included. The MEDLINE/PubMed, Cochrane databases Library, EMBASE, and LILACS, including manual search and gray literature, were searched through January 2021 with no language or date restrictions. The risk of bias and the methodological quality were evaluated according to the appropriate tool for each study design. The analysis of the results was narrative. Seventeen studies were reviewed that included cohort, accuracy, and randomized clinical trial studies. The tracking type performed was opportunistic and organized in a variety of environments. The age of participants ranged between 18 and 60 years old and, in some programs, only people with risk habits for oral cancer were included. The screeners were healthcare professionals, physicians, and dentists. Two studies reported data on the incidence rate of severe cases and mortality and showed a reduction when patients were at risk for the disease and participated in the program more than once. A limitation of this review was the great variability observed in the estimates of the screening effectiveness among the studies, which made comparisons difficult. If a screening program is continuous and able to ensure the inclusion of high-risk individuals, it can contribute to improvement in survival rates with a change of stage and can have a significant impact on incidence and mortality due to the disease. Registration in the Open Science Framebook (OSF) with the osf.io/zg8nr link.

Self-report instruments for assessing adherence to warfarin therapy: a systematic review.

BACKGROUND: The assessment of adherence to warfarin therapy is useful in clinical practice due to its wide variability in dose-response and risks of complications. The aim of this study was to investigate validated instruments used to assess adherence to warfarin therapy. METHODS: Information was collected from the MEDLINE (PubMed), LILACS, EMBASE, and Cochrane Library databases. Search strategies were applied for each database, with no time limit or language restriction. Inclusion criteria consisted of study participants of ≥ 18 years of age, from both sexes, on chronic anticoagulation with warfarin for any indication and the use of validated instruments to assess adherence to warfarin therapy. Exclusion criteria consisted of duplicate articles, narrative or systematic reviews, and meta-analyses, as well as case reports/series and experimental studies involving animals. Two independent reviewers performed the following steps: evaluation of titles/abstracts, selection of studies after full reading, data extraction, and evaluation of potential bias. Discrepancies were resolved by a third reviewer. RESULTS: Overall, 19 articles were selected for this systematic review, including 17 cross-sectional studies, one cohort study, and one quasi-experimental study, published from 2009 to 2019. The validated instruments identified in this review were Morisky Medication Adherence Scale (MMAS), the eight-item Morisky Medication Adherence Scale (MMAS-8), Measurement of Treatment Adherence (MTA), and Brief Medication Questionnaire (BMQ). Only MMAS-8 was tested for reliability, using the internal consistency assessment, with Cronbach's α range 0.56-0.71. CONCLUSIONS: This review highlighted a gap in knowledge regarding the scarcity of validated instruments to assess adherence to warfarin therapy. Limitations were found in instruments that comprised the assessment of the isolated use of medication and the lack of analysis of other relevant therapeutic aspects. Future studies are needed to develop and validate more comprehensive instruments in an attempt to assess adherence to warfarin therapy. PROSPERO: Registration number CRD42019128324.

Thrombocytopenia-Absent Radius (TAR): Case report of dental implant and surgical treatment.

Thrombocytopenia-absent radius (TAR) syndrome is a congenital malformation in which affected individuals present reductions in the number of platelets, hypoplasia, or absence of radial bone unilaterally or bilaterally. Hematologic, skeletal, cardiac (particularly tetralogy of Fallot and septal-atrial defects), and gastrointestinal anomalies are most commonly associated with TAR syndrome. Skeletal changes result in a higher risk of dental and craniofacial trauma in patients with the syndrome. Thus, it is important for the dentist to be aware of the characteristics of TAR syndrome and its clinical management for better care of these patients. The objective of this study is to describe a case report of a 26-year-old patient with TAR syndrome with a history of trauma and root fracture of tooth 11 and alveolar bone ridge. During anamnesis, root fractures requiring the extraction of the 11 tooth, alveolar bone ridge fracture in the adjacent region, and dental trauma were observed. A hematological evaluation and blood and radiological examinations were performed. Osseointegrated implant was performed using the guided surgery and flapless technique, as well as prosthetic rehabilitation in the affected region. This report discusses the importance of careful planning, such as the use of incisions and conservative surgery, techniques for alveolar ridge preservation, gingival manipulation, and prosthesis confection. The patient was attended by a hematologist throughout the treatment. Key words:TAR syndrome, absent radii and thrombocytopenia, dental implants, oral surgery.

Integrative Review of Managed Entry Agreements: Chances and Limitations.

BACKGROUND AND OBJECTIVE: Managed entry agreements (MEAs) consist of a set of instruments to reduce the uncertainty and the budget impact of new high-priced medicines; however, there are concerns. There is a need to critically appraise MEAs with their planned introduction in Brazil. Accordingly, the objective of this article is to identify and appraise key attributes and concerns with MEAs among payers and their advisers, with the findings providing critical considerations for Brazil and other high- and middle-income countries. METHODS: An integrative review approach was adopted. This involved a review of MEAs across countries. The review question was 'What are the health technology MEAs that have been applied around the world?' This review was supplemented with studies not retrieved in the search known to the senior-level co-authors including key South American markets. It also involved senior-level decision makers and advisers providing guidance on the potential advantages and disadvantages of MEAs and ways forward. RESULTS: Twenty-five studies were included in the review. Most MEAs included medicines (96.8%), focused on financial arrangements (43%) and included mostly antineoplastic medicines. Most countries kept key information confidential including discounts or had not published such data. Few details were found in the literature regarding South America. Our findings and inputs resulted in both advantages including reimbursement and disadvantages including concerns with data collection for outcome-based schemes. CONCLUSIONS: We are likely to see a growth in MEAs with the continual launch of new high-priced and often complex treatments, coupled with increasing demands on resources. Whilst outcome-based MEAs could be an important tool to improve access to new innovative medicines, there are critical issues to address. Comparing knowledge, experiences, and practices across countries is crucial to guide high- and middle-income countries when designing their future MEAs.

Effects of piezocision in orthodontic tooth movement: A systematic review of comparative studies.

BACKGROUND: The aim of this systematic review was to evaluate the effects of piezocision in accelerating orthodontic tooth movement (OTM) and its possible adverse effects. MATERIAL AND METHODS: The Databases Medline, Embase, CENTRAL and LILACS were searched until March 2019, for randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that used piezocision associated with orthodontic treatment. A manual search was also performed. The search, studies selection, assessment of risk of bias and data collection were carried out by two independent reviewers. RESULTS: Eleven publications were included in this review (4 CCTs and 7 RCTs). No study presented low risk of bias. Different types of tooth movement were evaluated: lower anterior alignment, en-masse retraction, overall orthodontic treatment and canine distalization. A total of 240 participants were analyzed in the included studies. Seven studies found significant acceleration in the piezocision group, while two studies found no differences. Adverse effects regarding patient's satisfaction, pain perception, or worsening of periodontal parameters were not observed. There was no consensus concerning anchorage loss and root resorption. CONCLUSIONS: The literature does not provide high-quality evidence to confirm that Piezocision results in significant OTM acceleration. Therefore, high-quality RCTs should be conducted to allow reliable conclusions about the effects of piezocision in orthodontics. Key words:Piezosurgery, tooth movement techniques, orthodontics.

Lead contamination in food consumed and produced in Brazil: Systematic review and meta-analysis.

This systematic review (SR) evaluated evidence of lead (Pb) levels in foods consumed or produced in Brazil. Seventy-seven publications were included in this review, corresponding to a total of 8466 food samples that were grouped into 12 food categories with similar characteristics (infant food; sugar; beverages; meat and meat products; nuts, cocoa and products; fruits and fruit products; grains, cereals and products; milk and milk products; eggs; oil and fat spreads; vegetables and vegetable products and other foods). The random model was used to establish levels of Pb in food categories. We used the software R® to perform the meta-analysis. The overall occurrence of Pb was estimated at 0.0541 mg/kg, and ranged from 0.0004 mg/kg to 0.4842 mg/kg. The SR and meta-analysis presented relevant results about Pb contamination on foods, despite the high heterogeneity. They were understood as a viable strategy to answer questions regarding prevalence of Pb which is necessary for the risk assessment of Pb intake in foods.

Instruments for the assessment of patient adherence to oral anticoagulation with warfarin protocol for a systematic review.

BACKGROUND: Non-adherence can be highlighted as one of the main contributors to the occurrence of adverse events in patients treated with warfarin. The usefulness of self-reporting measures of drug adherence could be improved by following psychometric properties in the development of the measurement scales. Thus, we aimed to describe the protocol of a systematic literature review designed to investigate and describe validated instruments used to assess adherence to warfarin therapy. METHODS: We will perform a systematic review will include observational and experimental studies involving the use of validated instruments to assess adherence to warfarin therapy. Dimensions of adherence raised by the selected studies will be extracted to be compared. We will systematically search electronic databases including MEDLINE, LILACS, EMBASE, and Cochrane Library using a comprehensive strategy from inception to June 31, 2019. Two reviewers will revise the literature independently using a standardized form and assess the potential bias. After the comparison of results, discrepancies will be solved after the analysis of a third reviewer. RESULT: The development of the present systematic will help to summarize and evaluate the validated instruments that have been previously published to assess adherence to warfarin therapy. CONCLUSION: This review will substantiate the discussion of relevant topics that should be assessed while providing care to patients taking warfarin. This knowledge will enable a comprehensive approach for healthcare professionals to improve treatment outcomes and the design of future investigations. REGISTRATION: The systematic review is registered in the PROSPERO international prospective register of systematic review (PROSPERO# CRD42019128324).

Nutritional risk in pediatrics by StrongKids: a systematic review.

BACKGROUND/OBJECTIVE: The nutritional risk in hospitalized children and adolescents is a frequent and under-diagnosed reality. There is still no consensus regarding the best nutritional screening method in pediatrics, with StrongKids being one of the existing proposals. A systematic review was performed to evaluate the scientific evidence about StrongKids, with emphasis on the world frequency of nutritional risk, associations of interest in health, validation and reproducibility studies. METHODS: Databases Pubmed, Lilacs, Scielo, ScienceDirect, Web of Science, Scopus and Cochrane Library were searched, using keyword "StrongKids," without limit on the year of publication, in English, Spanish, and Portuguese. RESULTS: From 125 papers initially identified, 22 original were included in analysis. The sample size ranged from 43 to 2874, with a maximum of 44 hospitals. The frequency of nutritional risk (medium or high) ranged from 35.7 to 100%. The nutritional risk was mainly associated with acute and/or chronic malnutrition already installed, lower anthropometric indexes and longer length of hospital stay. The method presented satisfactory inter-rater and intra-rater agreements and was validated in the three studies performed with this proposal. CONCLUSIONS: The prevalence of nutritional risk in hospitalized children and adolescents is high. StrongKids is a valid, easy-to-use, and reproducible method, with significant associations of interest in health.

Comparative Effectiveness and Safety of Monoclonal Antibodies (Bevacizumab, Cetuximab, and Panitumumab) in Combination with Chemotherapy for Metastatic Colorectal Cancer: A Systematic Review and Meta-Analysis.

BACKGROUND: The last decade has seen the increasing use of biological medicines in combination with chemotherapy containing 5-fluorouracil/oxaliplatin or irinotecan for the treatment of metastatic colorectal cancer (mCRC). These combinations have resulted in increased progression-free survival (PFS) in patients with mCRC; however, there are remaining concerns over the extent of their effect on overall survival (OS). Published studies to date suggest no major differences between the three currently available monoclonal antibodies (MoAbs); however, there are differences in costs. In addition, there is rising litigation in Brazil in order to access these medicines as they are currently not reimbursed. OBJECTIVE: The aim was to investigate the comparative effectiveness and safety of three MoAbs (bevacizumab, cetuximab and panitumumab) associated with fluoropyrimidine-based chemotherapy regimens and compared to fluoropyrimidine-based chemotherapy alone in patients with mCRC, through an updated systematic review and meta-analysis of concurrent or non-concurrent observational cohort studies, to guide authorities and the judiciary. METHOD: A systematic review and meta-analysis was performed based on cohort studies published in databases up to November 2017. Effectiveness measures included OS, PFS, post-progression survival (PPS), Response Evaluation Criteria In Solid Tumors (RECIST), response rate, metastasectomy and safety. The methodological quality of the studies was also evaluated. RESULTS: A total of 21 observational cohort studies were included. There were statistically significant and clinically relevant benefits in patients treated with bevacizumab versus no bevacizumab mainly around OS, PFS, PPS and the metastasectomy rate, but not for the disease control rates. However, there was an increase in treatment-related toxicities and concerns with the heterogeneity of the studies. CONCLUSION: The results pointed to an advantage in favor of bevacizumab for OS, PFS, PPS, and metastasectomy. Although this advantage may be considered clinically modest, bevacizumab represents a hope for increased survival and a chance of metastasectomy for patients with mCRC. However, there are serious adverse events associated with its use, especially severe hypertension and gastrointestinal perforation, that need to be considered.

Instruments for the Evaluation of Alcohol Use in Indigenous Communities - A Systematic Review / Instrumentos para a Avaliação do Uso de Álcool em Comunidades Indígenas - Revisão Sistemática / Instrumentos para la Evaluación del Uso del Alcohol en las Comunidades Indígenas - Revisión Sistemática

Abstract The measurement of alcohol consumption in indigenous populations has been important in order to understand their reasons and thoughts on alcohol use as well as the resulting losses. This study aimed to verify which data collection instruments are nationally and internationally used in the evaluation of alcohol use in indigenous populations, and it was conducted through a systematic review of studies that evaluated alcoholism in the indigenous populations. We searched the databases Medline (Pubmed), Cochrane library, PsycINFO, Lilacs, including gray literature and manual search. A total of 716 selected publications were identified, and after a stepwise evaluation, the final analysis included 30 studies that met the inclusion criteria. Twenty different instruments were used in the studies to evaluate alcohol use in indigenous people, such as questionnaires created from the specificities of the groups and instruments common used in non-indigenous groups, World Health Organization recommends some of them. By allowing greater knowledge about the instruments validated to understand the consumption of alcoholic beverage in these populations, this study contributes to the research about the processes of indigenous alcoholization, allowing a progress in the development of interventions. It also provides an important discussion in the area of psychological assessment and the use of instruments in different cultural contexts.

Resumo A mensuração do consumo de álcool nas populações indígenas tem sido importante para entender suas razões e pensamentos sobre o uso de álcool, bem como as perdas resultantes. Este estudo teve como objetivo verificar instrumentos de coleta de dados utilizados na avaliação do consumo de álcool em populações indígenas nacional e internacionalmente. Para isso, foi realizada uma revisão sistemática de estudos que avaliaram o uso de álcool em populações indígenas, nas bases de dados Medline (Pubmed), biblioteca Cochrane, PsycINFO, Lilacs, incluindo literatura cinza e busca manual. Foram identificadas 716 publicações selecionadas e, após uma avaliação escalonada, a análise final incluiu 30 estudos que atenderam aos critérios de inclusão. Vinte instrumentos diferentes foram utilizados nos estudos para avaliar o consumo de álcool em povos indígenas, como questionários criados a partir das especificidades desses grupos e instrumentos comumente utilizados em populações não indígenas, sendo alguns preconizados pela Organização Mundial de Saúde. Ao permitir um maior conhecimento sobre os instrumentos validados para entender o consumo de bebidas alcoólicas nessas populações, este estudo contribui para a pesquisa sobre os processos de alcoolização indígena, permitindo progresso no desenvolvimento de intervenções. Fornece, ademais, uma importante discussão na área de avaliação psicológica e uso de instrumentos em diferentes contextos culturais.

Resumen La medición del consumo de alcohol en las poblaciones indígenas ha sido importante para comprender sus razones y pensamientos sobre el consumo de alcohol, así como las pérdidas resultantes. Este estudio tuvo objetivo verificar qué instrumentos de recopilación de datos se utilizan a nível nacional e internacional en la evaluación del consumo de alcohol en las poblaciones indígenas, y se realizó a través de una revisión sistemática de estudios que evaluaron el alcoholismo en las poblaciones indígenas. Se realizaron búsquedas en las bases de datos Medline (Pubmed), Cochrane, PsycINFO, Lilacs, incluyendo literatura gris y búsqueda manual. Se identificaron un total de 716 publicaciones seleccionadas, y después de una evaluación escalonada, el análisis final incluyó 30 estudios que cumplieron con los criterios de inclusión. Se utilizaron 20 instrumentos diferentes en los estudios para evaluar el consumo de alcohol en los pueblos indígenas. Al permitir un mayor conocimiento sobre los instrumentos validados para entender el consumo de bebidas alcohólicas en estas poblaciones, el presente estudio contribuye a la investigación sobre los procesos de alcoholismo indígena, permitiendo un avance en el desarrollo de intervenciones. Además, proporciona una discusión importante en el área de la evaluación psicológica y el uso de instrumentos en diferentes contextos culturales.

Drug utilization and factors associated with polypharmacy in individuals with diabetes mellitus in Minas Gerais, Brazil. / Uso de medicamentos e fatores associados à polifarmácia em indivíduos com diabetes mellitus em Minas Gerais, Brasil.

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.

O objetivo deste estudo foi avaliar o uso de medicamentos, a prevalência e os fatores associados à polifarmácia em pacientes com diabetes mellitus (DM) em Minas Gerais. Realizou-se um estudo transversal com descrição dos medicamentos em uso e análise da associação entre características sociodemográficas e clínicas com polifarmácia, por meio de regressão logística. Dos 2619 entrevistados, 56,5% estavam em polifarmácia. Medicamentos para DM, agentes no sistema renina-angiotensina e diuréticos foram os mais usados. Fatores como envelhecimento, presença de comorbidades e maior acesso aos serviços de saúde foram associados à polifarmácia. Observou-se elevada prevalência de polifarmácia, o que requer um cuidado adequado e melhor qualidade do uso de medicamentos para essa população.

Uso de medicamentos e fatores associados à polifarmácia em indivíduos com diabetes mellitus em Minas Gerais, Brasil / Drug utilization and factors associated with polypharmacy in individuals with diabetes mellitus in Minas Gerais, Brazil

Resumo O objetivo deste estudo foi avaliar o uso de medicamentos, a prevalência e os fatores associados à polifarmácia em pacientes com diabetes mellitus (DM) em Minas Gerais. Realizou-se um estudo transversal com descrição dos medicamentos em uso e análise da associação entre características sociodemográficas e clínicas com polifarmácia, por meio de regressão logística. Dos 2619 entrevistados, 56,5% estavam em polifarmácia. Medicamentos para DM, agentes no sistema renina-angiotensina e diuréticos foram os mais usados. Fatores como envelhecimento, presença de comorbidades e maior acesso aos serviços de saúde foram associados à polifarmácia. Observou-se elevada prevalência de polifarmácia, o que requer um cuidado adequado e melhor qualidade do uso de medicamentos para essa população.

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.

The long-term costs for treating multiple sclerosis in a 16-year retrospective cohort study in Brazil.

BACKGROUND: Multiple Sclerosis (MS) is a disease that appreciably impacts on the quality of life of patients and is associated with high expenditure. MS is a chronic multifactorial disease, characterized by inflammation, demyelination and axonal loss. The Brazilian public health system provides pharmacological treatment as well as hospital and outpatient care for patients with relapsing-remitting and secondary progressive multiple sclerosis. However, we are not aware of any previous publications assessing total direct medical costs in patients with a long follow-up within the Brazilian healthcare system. Consequently, the objective is to analyze public spending on patients with MS to guide stakeholders in future investment and disinvestment decisions. METHODS AND FINDINGS: We retrospectively analyzed public Brazilian spending on patients with MS between 2000 and 2015 using the patient-centered registry of all patients in the public health system (SUS) obtained through deterministic-probabilistic record linkage of the Outpatient Information System, Hospital Information System and Mortality Information Systems in Brazil. Descriptive data analysis and a multiple linear regression model was performed to evaluate the associations between the mean annual cost per patient and the clinical and demographic variables. The suitability of the model was verified from a residue analysis and the level of significance adopted was 5%. RESULTS: 28,401 patients were identified and subsequently 23,082 patients were analyzed. The majority of the patients were female (73.3%), lived in the southeast region (58.9%), had a mean age of 36.8 (± 12.2) years and started treatment using one of the interferons beta (78.9%). The total direct medical cost spending in the sixteen years of the follow-up was US $ 2,308,393,465.60, and the mean annual expenditure per patient was US $ 13,544.40 (± 4,607.05). In the best fit model (p <0.001), approximately 40% of the variability of the mean annual cost per patient was explained by the region of residence; medication used (intention to treat); if the patient was a non-exclusive user of medicines, i.e., used SUS for other procedures other than high-cost medicines; year of treatment start; and presence of events (death; Relapse; change of treatment and/or comorbidity). CONCLUSIONS: In the public health system of Brazil, disease modifying therapies currently represent almost all of the total direct costs of multiple sclerosis treatment. Around the world, new and emerging health technologies to treat of MS impose a challenge to health budgets, highlighting the need for cost-effectiveness studies comparing these technologies to those already available. Our regression model may help in this process, and calls attention to the need to access the real world performance of new therapies available in SUS, with the potential for disinvestment and/ or price reductions if needed.

Use of medicines by patients of the primary health care of the Brazilian Unified Health System.

OBJECTIVE: To characterize the use of medicines by patients of the primary health care of the Brazilian Unified Health System (SUS). METHODS: This is a cross-sectional, exploratory, and descriptive study, part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). Interviews were carried out with patients present in the services by semi-structured questionnaires. Sociodemographic, clinical, and use of medicines variables were assessed and the use of medicines in the 30 days prior to the interview was also verified. The population was stratified into three age groups: 18 to 44, 45 to 64, and 65 years or more. The differences between the age groups were verified using the Student's t-test for continuous variables and chi-square test for the categorical ones. The complex samples analysis plan was employed. The medicines were classified according to the Anatomical Therapeutic Chemical Classification System. RESULTS: Of the 8,803 patients interviewed, 6,511 (76.2%) reported to have used medicines in the 30 days prior to the interview. On average, each patient used 2.32 medicines, without difference between the sexes. Among medicine users, 18.2% were aged 65 years or more. Compared to the other age groups, older adults presented more comorbidities, used more medicines, and self-reported worse health conditions. They were also less educated, reported worse economic situation, and lived alone. The medicines that were mostly used were "other analgesics and antipyretics" (3rd ATC level) and Losartan (5th ATC level). CONCLUSIONS: Most medicine users had lower education level and presented comorbidities. The most used medicines were the antihypertensive ones. Self-medication was higher among young people. Most patients reported to use generic medicines. The average number of medicines and the prevalence of use increased with age. Due to the characteristics observed and the difficulties in the use of medicines, older adults are in a situation of greater vulnerability.

Access to medicines by patients of the primary health care in the Brazilian Unified Health System.

OBJECTIVE: To evaluate the access to medicines in primary health care of the Brazilian Unified Health System (SUS), from the patients' perspective. METHODS: This is a cross-sectional study that used data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Services, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), conducted by interviews with 8,591 patients in cities of the five regions of Brazil. Evaluation of access to medicines used concepts proposed by Penshansky and Thomas (1981), according to the dimensions: availability, accessibility, accommodation, acceptability, and affordability. Each dimension was evaluated by its own indicators. RESULTS: For the "availability" dimension, 59.8% of patients reported having full access to medicines, without significant difference between regions. For "accessibility," 60% of patients declared that the basic health unit (UBS) was not far from their house, 83% said it was very easy/easy to get to the UBS, and most patients reported that they go walking (64.5%). For "accommodation," UBS was evaluated as very good/good for the items "comfort" (74.2%) and "cleanliness" (90.9%), and 70.8% of patients reported that they do not wait to receive their medicines, although the average waiting time was 32.9 minutes. For "acceptability," 93.1% of patients reported to be served with respect and courtesy by the staff of the dispensing units and 90.5% declared that the units' service was very good/good. For "affordability," 13% of patients reported not being able to buy something important to cover expenses with health problems, and 41.8% of participants pointed out the expense with medicines. CONCLUSIONS: Results show 70%-90% compliance, which is compatible with developed countries. However, access to medicines remains a challenge, because it is still heavily compromised by the low availability of essential medicines in public health units, showing that it does not occur universally, equally, and decisively to the population.

Efficacy of Mobile Apps to Support the Care of Patients With Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Diabetes Mellitus (DM) is a chronic disease that is considered a global public health problem. Education and self-monitoring by diabetic patients help to optimize and make possible a satisfactory metabolic control enabling improved management and reduced morbidity and mortality. The global growth in the use of mobile phones makes them a powerful platform to help provide tailored health, delivered conveniently to patients through health apps. OBJECTIVE: The aim of our study was to evaluate the efficacy of mobile apps through a systematic review and meta-analysis to assist DM patients in treatment. METHODS: We conducted searches in the electronic databases MEDLINE (Pubmed), Cochrane Register of Controlled Trials (CENTRAL), and LILACS (Latin American and Caribbean Health Sciences Literature), including manual search in references of publications that included systematic reviews, specialized journals, and gray literature. We considered eligible randomized controlled trials (RCTs) conducted after 2008 with participants of all ages, patients with DM, and users of apps to help manage the disease. The meta-analysis of glycated hemoglobin (HbA1c) was performed in Review Manager software version 5.3. RESULTS: The literature search identified 1236 publications. Of these, 13 studies were included that evaluated 1263 patients. In 6 RCTs, there were a statistical significant reduction (P<.05) of HbA1c at the end of studies in the intervention group. The HbA1c data were evaluated by meta-analysis with the following results (mean difference, MD -0.44; CI: -0.59 to -0.29; P<.001; I²=32%).The evaluation favored the treatment in patients who used apps without significant heterogeneity. CONCLUSIONS: The use of apps by diabetic patients could help improve the control of HbA1c. In addition, the apps seem to strengthen the perception of self-care by contributing better information and health education to patients. Patients also become more self-confident to deal with their diabetes, mainly by reducing their fear of not knowing how to deal with potential hypoglycemic episodes that may occur.

CYD-TDV dengue vaccine: systematic review and meta-analysis of efficacy, immunogenicity and safety.

INTRODUCTION: Dengue virus (DENV) is a serious global health problem. CYD-TDC (Dengvaxia®) was the first vaccine to gain regulatory approval to try and address this problem. AIM: Summarize all available evidence on the immunogenicity, efficacy and safety of the CYD-TDV dengue vaccine. METHOD: Meta-analysis and systematic review. RESULTS: The best and worst immunogenicity results were for DENV4 and DENV1, respectively. Vaccine efficacy of 60% was derived from studies with participants aged 2-16 years old, with DENV4 and DENV2 presenting the best and worst results, respectively. Erythema and swelling were more frequent with CYD-TDV. No differences were detected for systemic adverse events. CONCLUSION: CYD-TDV showed moderate efficacy in children and adolescents. From the immunogenicity results in adults, we can expect satisfactory efficacy from vaccination in this population.

Use of medicines by patients of the primary health care of the Brazilian Unified Health System / Utilização de medicamento pelos usuários da atenção primária do Sistema Único de Saúde

ABSTRACT OBJECTIVE To characterize the use of medicines by patients of the primary health care of the Brazilian Unified Health System (SUS). METHODS This is a cross-sectional, exploratory, and descriptive study, part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). Interviews were carried out with patients present in the services by semi-structured questionnaires. Sociodemographic, clinical, and use of medicines variables were assessed and the use of medicines in the 30 days prior to the interview was also verified. The population was stratified into three age groups: 18 to 44, 45 to 64, and 65 years or more. The differences between the age groups were verified using the Student's t-test for continuous variables and chi-square test for the categorical ones. The complex samples analysis plan was employed. The medicines were classified according to the Anatomical Therapeutic Chemical Classification System. RESULTS Of the 8,803 patients interviewed, 6,511 (76.2%) reported to have used medicines in the 30 days prior to the interview. On average, each patient used 2.32 medicines, without difference between the sexes. Among medicine users, 18.2% were aged 65 years or more. Compared to the other age groups, older adults presented more comorbidities, used more medicines, and self-reported worse health conditions. They were also less educated, reported worse economic situation, and lived alone. The medicines that were mostly used were "other analgesics and antipyretics" (3rd ATC level) and Losartan (5th ATC level). CONCLUSIONS Most medicine users had lower education level and presented comorbidities. The most used medicines were the antihypertensive ones. Self-medication was higher among young people. Most patients reported to use generic medicines. The average number of medicines and the prevalence of use increased with age. Due to the characteristics observed and the difficulties in the use of medicines, older adults are in a situation of greater vulnerability.

RESUMO OBJETIVO Caracterizar o perfil de utilização de medicamentos pelos usuários da Atenção Primária do Sistema Único de Saúde no Brasil. MÉTODOS Estudo transversal, exploratório, de natureza descritiva, integrante da Pesquisa Nacional Sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015. Foram realizadas entrevistas com usuários presentes nos serviços por meio de questionários semiestruturados. Foram avaliadas as variáveis sociodemográficas, clínicas e relacionadas ao uso de medicamentos e verificado o uso de medicamentos nos 30 dias anteriores à entrevista. A população foi estratificada em três faixas etárias: 18 a 44, 45 a 64 e 65 anos ou mais. As diferenças entre as faixas etárias foram verificadas por meio do teste t de Student para variáveis contínuas e teste qui-quadrado para categóricas. Utilizou-se o plano de análises de amostras complexas. Os medicamentos foram classificados conforme Anatomical Therapeutical Chemical Classification System. RESULTADOS De 8.803 usuários entrevistados, 6.511 (76,2%) relataram uso de medicamentos nos 30 dias anteriores à entrevista. Em média, cada usuário utilizou 2,32 medicamentos, sem diferença entre os sexos. Dentre os usuários de medicamentos, 18,2% tinham 65 anos de idade ou mais. Em comparação com as demais faixas etárias os idosos apresentaram mais comorbidades, usaram mais medicamentos e autorrelataram pior condição de saúde; eram menos escolarizados, relataram pior situação econômica e viviam sozinhos. Os medicamentos mais utilizados foram "outros analgésicos e antipiréticos" (3º nível ATC) e losartana (5º nível ATC). CONCLUSÕES A maioria dos usuários de medicamentos possuía baixa escolaridade e comorbidades. Os medicamentos mais utilizados foram os anti-hipertensivos. A automedicação foi maior entre os jovens. A maioria dos usuários relatou utilização de medicamentos genéricos. O número médio de medicamentos e a prevalência de uso aumentaram com a idade. Devido às características observadas e as dificuldades no uso de medicamentos, os idosos estão em situação de maior vulnerabilidade.

Access to medicines by patients of the primary health care in the Brazilian Unified Health System / Acesso aos medicamentos pelos usuários da atenção primária no Sistema Único de Saúde

ABSTRACT OBJECTIVE To evaluate the access to medicines in primary health care of the Brazilian Unified Health System (SUS), from the patients' perspective. METHODS This is a cross-sectional study that used data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Services, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), conducted by interviews with 8,591 patients in cities of the five regions of Brazil. Evaluation of access to medicines used concepts proposed by Penshansky and Thomas (1981), according to the dimensions: availability, accessibility, accommodation, acceptability, and affordability. Each dimension was evaluated by its own indicators. RESULTS For the "availability" dimension, 59.8% of patients reported having full access to medicines, without significant difference between regions. For "accessibility," 60% of patients declared that the basic health unit (UBS) was not far from their house, 83% said it was very easy/easy to get to the UBS, and most patients reported that they go walking (64.5%). For "accommodation," UBS was evaluated as very good/good for the items "comfort" (74.2%) and "cleanliness" (90.9%), and 70.8% of patients reported that they do not wait to receive their medicines, although the average waiting time was 32.9 minutes. For "acceptability," 93.1% of patients reported to be served with respect and courtesy by the staff of the dispensing units and 90.5% declared that the units' service was very good/good. For "affordability," 13% of patients reported not being able to buy something important to cover expenses with health problems, and 41.8% of participants pointed out the expense with medicines. CONCLUSIONS Results show 70%-90% compliance, which is compatible with developed countries. However, access to medicines remains a challenge, because it is still heavily compromised by the low availability of essential medicines in public health units, showing that it does not occur universally, equally, and decisively to the population.

RESUMO OBJETIVO Avaliar o acesso aos medicamentos na Atenção Primária em Saúde do Sistema Único de Saúde na perspectiva do usuário. MÉTODOS Estudo transversal que utilizou dados da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional no Brasil - Serviços, 2015, realizado por meio de entrevistas com 8.591 usuários em municípios das cinco regiões do Brasil. A avaliação do acesso aos medicamentos utilizou conceitos propostos por Penshansky e Thomas (1981), segundo as dimensões: disponibilidade, acessibilidade geográfica, adequação, aceitabilidade e capacidade aquisitiva. Cada uma das dimensões foi avaliada por meio de indicadores próprios. RESULTADOS Para dimensão disponibilidade, 59,8% dos usuários declararam ter acesso total aos medicamentos, sem diferença significante entre regiões. Para acessibilidade geográfica, 60% dos usuários declararam que a unidade básica de saúde não ficava longe de sua residência, 83% afirmaram ser muito fácil/fácil chegar até a unidade e a maioria dos usuários relatou caminhar (64,5%). Para adequação, a unidade foi avaliada como muito bom/bom para os itens conforto (74,2%) e limpeza (90,9%), e 70,8% dos usuários relataram não ter de esperar para retirar seus medicamentos, embora o tempo médio de espera tenha sido 32,9 minutos. Para aceitabilidade: 93,1% dos usuários relataram ser atendidos com respeito e cortesia pelos funcionários das unidades dispensadoras e 90,5% declararam ser muito bom/bom o atendimento das unidades. Para capacidade aquisitiva 13% dos usuários relataram ter deixado de comprar algo importante para cobrir gastos com problemas de saúde, 41,8% dos participantes apontaram a despesa com medicamentos. CONCLUSÕES Os resultados mostram 70%-90% de conformidade, compatível com países desenvolvidos. No entanto, o acesso aos medicamentos continua sendo um desafio pois ainda é fortemente comprometido pela baixa disponibilidade de medicamentos essenciais em unidades públicas de saúde, demonstrando que não ocorre de forma universal, equânime e resolutiva à população.