Health services utilization in the Brazilian Amazon: panel of two cross-sectional studies

OBJECTIVE: To investigate the use of health services among adults living in Manaus, Amazonas. METHODS: This was a panel of two cross-sectional studies conducted in Manaus in 2015 and 2019. Individuals aged ≥ 18 years were selected by probabilistic sampling and interviewed at home. The study outcomes were doctor visits and      hospitalizations in the previous 12 months, and unmet surgical needs. Variations between 2015 and 2019 were tested using chi-squared goodness-of-fit test. Poisson regression with robust variance was employed to calculate the prevalence ratios (PR) of the outcomes with 95% confidence intervals (95%CI). RESULTS: The surveys included 5,800 participants in total. Visits to the doctor decreased from 2015 (78.7%) to 2019 (76.3%; p < 0.001), hospital admissions increased from 2015 (7.9%) to 2019 (11.5%; p < 0.001), and unmet surgical needs decreased in the period (15.9% to 12.1%; p < 0.001). These variations were particularly observed in vulnerable individuals – sicker; poorer; non-whites; and those belonging to lower social classes, with less access to education, formal jobs, and health insurance (p < 0.05). Doctor visits were higher in people with fair health status (PR = 1.09; 95%CI 1.06–1.12), health insurance (PR = 1.13; 95%CI 1.09–1.17), and chronic diseases (p < 0.001) but lower in men (PR = 0.87; 95%CI 0.84–0.90) and informal workers (PR = 0.89; 95%CI 0.84–0.94). Hospitalizations were higher in people with worse health statuses (p < 0.001), without partners (PR = 1.27; 95%CI 1.05–1.53), and with multimorbidity (PR = 1.68; 95%CI 1.33–2.12) but lower in men (PR = 0.55; 95%CI 0.44–0.68), older adults (p < 0.001), informal workers (PR = 0.67; 95%CI 0.51–0.89), and unemployed (PR = 0.72; 95%CI 0.53–0.97). Unmet surgical needs were higher in older adults (p < 0.001), middle-class people (PR = 1.24; 95%CI 1.01–1.55), worse health statuses (p < 0.001), and chronic diseases (p < 0.001) but lower in men (PR = 0.76; 95%CI 0.65–0.86). CONCLUSIONS: From 2015 to 2019, less people visited the doctor, more were admitted to hospitals, and less were in need of surgery or aware of that need, potentially indicating poorer access to health services

Prevalência e fatores associados à polifarmácia e potenciais interações medicamentosas em adultos na cidade de Manaus: estudo transversal de base populacional, 2019

Objective: To assess the prevalence and factors associated with polypharmacy and the presence of potential drug interactions among these individuals in Manaus, estado do Amazonas, Brazil, in 2019. Methods: Cross-sectional population-based study conducted with adults aged ≥18 years. Among people on polypharmacy (≥5 medicines), the presence of drug interactions was investigated in the icromedex database. Prevalence ratios (PR) were calculated by Poisson regression with robust variance, following hierarchical analysis and considering the complex sample design. Results: Out of the 2,321 participants were included, 2.8% (95%CI 2.1;3.6) were on polypharmacy, of which 74.0% presented drug interactions, with four or more interactions per person (40.4%) and high severity (59.5%) being the most frequent. Polypharmacy was higher among the elderly (PR=3.24 – 95%CI 1.25;8.42), poor health (PR=2.54 – 95%CI 1.14;5.67), previous hospitalization (PR=1.90 – 95%CI 1.09;3.32) and multimorbidity (PR=3.20 – 95%CI 1.53;6.67). Conclusion: Polypharmacy was more frequent among the elderly and people with health problems, who potentially had more drug interactions.Objetivo: Analizar la prevalencia y factores asociados a polifarmacia y la presencia de posibles interacciones farmacológicas en Manaus, estado do Amazonas, Brasil, en 2019. Métodos: Estudio poblacional transversal realizado con adultos con edad ≥18 años. Entre personas en polifarmacia (≥5 medicamentos), se investigó la presencia de interacciones farmacológicas en Micromedex. Razones de prevalencia (RP) se calcularon mediante regresión de Poisson con varianza robusta, siguiendo análisis jerárquico y considerando el diseño de muestra complejo. Resultados: De los 2.321 participantes, 2,8% (IC95% 2,1;3,6) se encontraban en polifarmacia, de los cuales 74,0% presentaban interacciones, siendo más frecuentes cuatro o más interacciones por persona (40,4%) y de alta gravedad (59,5%). Polifarmacia fue mayor entre los ancianos (RP=3,24 – IC95% 1,25;8,42), mala salud (RP=2,54 – IC95% 1,14;5,67), hospitalización previa (RP=1,90 – IC95% 1,09;3,32) y multimorbilidade (RP=3,20 – IC95% 1,53;6,67). Conclusión: Polifarmacia fue más frecuente entre los ancianos y personas con problemas de salud, que potencialmente tenían más interacciones farmacológicas.Objetivo: Analisar a prevalência e fatores associados à polifarmácia e a presença de potenciais interações medicamentosas em Manaus, estado do Amazonas, Brasil, em 2019. Métodos: Estudo transversal de base populacional, com adultos na idade ≥18 anos. Entre pessoas em polifarmácia (≥5 medicamentos), pesquisou-se a presença de interações medicamentosas na base Micromedex. Razões de prevalências (RP) foram calculadas por regressão de Poisson com variância robusta, seguindo análise hierárquica e considerando o delineamento amostral complexo. Resultados: Dos 2.321 participantes, 2,8% (IC95% 2,1;3,6) estavam em polifarmácia e destes, 74,0% apresentaram interações, sendo mais frequentes quatro ou mais interações por pessoa (40,4%) e gravidade alta (59,5%). Polifarmácia foi maior entre idosos (RP=3,24 – IC95% 1,25;8,42), saúde ruim (RP=2,54 –IC95% 1,14;5,67), hospitalização prévia (RP=1,90 – IC95% 1,09;3,32) e multimorbidade (RP=3,20 – IC95% 1,53;6,67). Conclusão: A polifarmácia foi mais frequente entre idosos e pessoas com problemas de saúde, que tiveram mais interações medicamentosas

Tempo de espera e duração da consulta médica na região metropolitana de Manaus, Brasil: estudo transversal de base populacional, 2015

Objective. To analyze the waiting time and the duration of medical consultations in Manaus metropolitan region, Brazil. Methods. Cross-sectional study conducted with adults living in the region in 2015. The waiting time for consultation and the duration of the consultation in minutes were self-reported by the participants. The analysis was performed by Tobit regression and weighted by the complex design. Results. 4,001 individuals were interviewed. The average waiting time was 125.4 minutes (95%CI 120.2;130.5), while consultation lasted an average of 52.5 minutes (95%CI 48.0;57.0). Women, poor people, low-educated people, indigenous individuals, countryside residents, people without health insurance, and individuals consulted by gynecologists waited longer for the consultation (p <0.05). Consultation time was shorter with non-white people, with poor health status and with health insurance (p <0.05). Conclusion. The length of the medical consultation was on average half the waiting time. Social inequalities were observed in these times.Objetivo. Analisar o tempo de espera e a duração de consulta médica na região metropolitana de Manaus, Brasil. Métodos. Estudo transversal, realizado com adultos residentes na região em 2015. O tempo de espera para consulta e a duração da consulta, em minutos, foram referidos pelos participantes. A análise foi realizada por regressão de Tobit e ponderada pelo desenho amostral. Resultados. Foram entrevistados 4.001 indivíduos. O tempo médio de espera foi de 125,4 minutos (IC95%120,2;130,5), enquanto a consulta durou, em média, 52,5 minutos (IC95%48,0;57,0). Mulheres, pessoas pobres, pessoas com baixa escolaridade, indígenas, residentes em municípios do interior, sem seguro de saúde e atendidos por ginecologistas esperaram mais pela consulta (p<0,05). O tempo de consulta foi menor em pessoas não brancas, com estado de saúde ruim e com plano de saúde (p<0,05). Conclusão. A consulta médica durou, em média, metade do tempo de espera. Observaram-se iniquidades sociais nesses períodos de tempo

Influência do clima ético na saúde do trabalhador entre profissionais de saúde: revisão sistemática

Objetivo: Avaliar a influência do clima ético na saúde do trabalhador entre os profissionais de saúde.Método: Revisão sistemática nas bases MEDLINE/PubMed, EMBASE, SciVerse Scopus (Elsevier), Cumulative Index to Nursing and Allied Health Literature e Web of Science. A seleção, a extração dos dados e a avaliação da qualidade metodológica foram realizadas por revisores capacitados. Aplicou-se a meta-análise para a síntese dos dados.Resultados: Dentre os 2644 estudos, foram incluídos 20 para análise, em que três (15,0%) artigos foram classificados como de alta qualidade (pontuação ≥ 80%), enquanto 17 (85,0%) foram classificados como regulares (pontuação 50-79%). Houve correlação negativa e moderada entre o clima ético e o sofrimento moral geral (r=-0,43; IC95% -0,50; -0,36) e a frequência de sofrimento moral (r=-0,36; IC95% -0,45; -0,25), bem como a correlação positiva e forte entre o clima ético e a satisfação no trabalho (r=0,71; IC95% 0,39-0,88).Conclusão: A percepção negativa e positiva do clima ético entre os profissionais de saúde, respectivamente, influenciou no aumento do sofrimento moral e na satisfação no trabalho.Descritores: Ética. Pessoal de saúde. Saúde ocupacional. Enfermagem. Revisão sistemátic

Seroprevalence of cytomegalovirus and its coinfection with epstein-barr virus in adult residents from manaus: A population-based study

Introduction: This study assessed the seroprevalence of cytomegalovirus, associated factors, and Epstein-Barr virus coinfection among adult residents of Manaus. Methods: Using a cross-sectional study design, we collected blood samples from 136 individuals in a household survey in 2016. Prevalence ratios were calculated using Poisson regression. Results: Cytomegalovirus and Epstein-Barr virus seroprevalences were 67.6% (95% CI: 9.7-75.6%) and 97.8% (95% CI: 95.3-100.0%), respectively. Coinfection was observed in 66.2% (95% CI: 58.1-74.2%) of participants. Bivariate analysis showed no statistical association. Conclusions: Seroprevalences were high among participants and approximately 7 out of 10 individuals had cytomegalovirus and Epstein-Barr virus coinfection. © 2020, Sociedade Brasileira de Medicina Tropical. All rights reserved

Guías de práctica clínica para el tratamiento de la enfermedad por Covid-19 en Brasil: revisión sistemática

Introduction: Coronavirus disease (Covid-19) is an infectious disease affecting the respiratory tract, which emerged in China and spread rapidly throughout the world. Objective: To evaluate the methodological quality and transparency of Brazilian clinical practice guidelines for the treatment of coronavirus disease (Covid-19). Materials and Methods: A systematic review was conducted in 2020 on Medline (via PubMed), Embase, Scopus, LILACS, National Guideline Clearinghouse and Guidelines International Network databases, in addition to online searches on the Brazilian Ministry of Health, Brazilian Medical Association, Federal Council of Medicine, Federal Council of Nursing and Federal Council of Physical Therapy websites. The methodological quality and transparency of the guidelines were assessed using the second version of the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument developed by four authors. Results: 33 guidelines were found of which 14 were included in the analysis. There was only one guideline that scored above 60% in all domains. Among the six domains, higher scores were found in the following three domains: scope and objective, stakeholder involvement and clarity of presentation. Discussion: Despite methodological weakness found, the authors were keen to provide clear and concise recommendations through key information and therapeutic options to facilitate decision making. Conclusions: Brazilian clinical practice guidelines were found to be of poor methodological quality, from which only one guideline was recommended and classified as to be of high methodological quality and transparency. How to cite this article: Lanes, Taís Carpes; Ribeiro, Mariane Albuquerque Lima; Oliveira, Daianny Seoni de; Junior, Marcos Gabriel do Nascimento; Garcia, Filipe Reis; Melo, Jéssyca Maria França de Oliveira; Tiguman, Gustavo Magno Baldin. Diretrizes de prática clínica para o tratamento da Covid-19 no Brasil: uma revisão sistemática. Revista Cuidarte. 2021;12(2):e2025 http://dx.doi.org/10.15649/cuidarte.2025   Introdução: A Coronavirus Disease-2019 é uma doença infectocontagiosa que afeta o sistema respiratório, que surgiu na China e logo se espalhou pelo mundo. Objetivo: Avaliar a qualidade metodológica e transparência das Diretrizes de Prática Clínica brasileiras para o tratamento da Coronavirus Disease-2019. Materiais e Métodos: Trata-se de uma revisão sistemática realizada em 2020 nas fontes de dados: MEDLINE (via PubMed), EMBASE, Scopus e Literatura Latino-Americana e do Caribe em Ciências da Saúde, National Guideline Clearinghouse e Guidelines International Network, e sites do Ministério da Saúde do Brasil, Sociedades Médicas Brasileiras, Conselhos de Medicina, Conselho Federal de Enfermagem e Conselho Federal de Fisioterapia. A avaliação da qualidade metodológica e da transparência das diretrizes ocorreu por meio do instrumento Appraisal of Guidelines for Research & Evaluation, versão II, realizada por quatro autores. Resultados: Foram encontradas 33 diretrizes, das quais foram incluídas 14 para análise. Somente uma diretriz apresentou pontuações acima de 60% em todos os domínios. Entre os seis domínios, três apresentaram maiores pontuações: Escopo e finalidade, Envolvimento das partes interessadas e Clareza da apresentação.  Discussão: Apesar da fragilidade metodológica, os autores se preocuparam em apresentar as recomendações de forma clara e concisa, através de informações-chave e opções terapêuticas que facilitam a tomada de decisão. Conclusão: As diretrizes brasileiras apresentaram baixa qualidade metodológica, em que somente uma diretriz foi recomendada e classificada com alta qualidade e transparência metodológica.   Como citar este artigo: Lanes, Taís Carpes; Ribeiro, Mariane Albuquerque Lima; Oliveira, Daianny Seoni de; Junior, Marcos Gabriel do Nascimento; Garcia, Filipe Reis; Melo, Jéssyca Maria França de Oliveira; Tiguman, Gustavo Magno Baldin. Diretrizes de prática clínica para o tratamento da Covid-19 no Brasil: uma revisão sistemática. Revista Cuidarte. 2021;12(2):e2025 http://dx.doi.org/10.15649/cuidarte.2025    Introducción: La enfermedad por coronavirus (Covid-19) es una patología infecciosa que afecta al sistema respiratorio, la cual se originó en China y se extendió rápidamente por todo el mundo. Objetivo: Evaluar la calidad metodológica y la transparencia de las guías de práctica clínica brasileñas para el tratamiento de la enfermedad por coronavirus (Covid-19). Materiales y métodos: Se realizó una revisión sistemática en 2020 en las bases de datos Medline (vía PubMed), Embase, Scopus, LILACS, National Guideline Clearinghouse y Guidelines International Network, además de consultas en los sitios web del Ministerio de Salud de Brasil, Asociación Médicas Brasileña, Consejo Federal de Medicina, Consejo Federal de Enfermería y Consejo Federal de Fisioterapia. La evaluación de la calidad metodológica y la transparencia de las guías se realizó con el instrumento Appraisal of Guidelines for Research and Evaluation (AGREE), segunda versión realizada por cuatro autores. Resultados: Se encontraron 33 guías, de las que se incluyeron 14 en el análisis. Hubo una sola guía que obtuvo una puntuación superior al 60% en todos los dominios. Entre los seis dominios, se presentaron puntuaciones más altas en los siguientes tres dominios: alcance y objetivo, participación de las partes interesadas y claridad de la presentación. Discusión: A pesar de la fragilidad metodológica, los autores se interesaron por presentar las recomendaciones de forma clara y concisa a través de información clave y opciones terapéuticas que faciliten la toma de decisiones. Conclusión: Las guías de práctica clínica brasileñas mostraron tener una baja calidad metodológica, de las que solamente una guía fue recomendada y clasificada como de alta calidad y transparencia metodológica. Como citar este artículo: Lanes, Taís Carpes; Ribeiro, Mariane Albuquerque Lima; Oliveira, Daianny Seoni de; Junior, Marcos Gabriel do Nascimento; Garcia, Filipe Reis; Melo, Jéssyca Maria França de Oliveira; Tiguman, Gustavo Magno Baldin. Diretrizes de prática clínica para o tratamento da Covid-19 no Brasil: uma revisão sistemática. Revista Cuidarte. 2021;12(2):e2025 http://dx.doi.org/10.15649/cuidarte.2025  &nbsp

Consumption and lack of access to medicines and associated factors in the brazilian amazon: a cross-sectional Stusy, 2019

We aimed to investigate the consumption and lack of access to medicines in the adult population of Manaus, Amazonas. A population-based study was conducted in Manaus in 2019. Individuals aged ≥18 years were selected by probabilistic sampling performed in three stages. Study outcomes included the consumption of medicines in the previous fortnight and the lack of access to treatments in those who used any medicine. We calculated the prevalence ratios (PR) for the outcomes with 95% confidence intervals (CI) by Poisson regression with robust variance, considering the complex sampling design. Out of the 2,321 participants, 53.2% (95%CI 50.7-55.7%) consumed medicines, of which 14.4% (95% CI 11.9–16.8%) could not obtain appropriate treatments. Analgesics were the most used medicines (557/2,702; 21.4%), whereas antibiotics were the most inaccessible treatments (18/228; 7.9%). Lack of financial resources was the main reason for not accessing treatments (104/228; 45.6%). Consumption was significantly associated with older age (≥60 years: PR = 1.27; 95%CI 1.09–1.49), lower social class (D/E: PR = 0.84; 95%CI 0.72–0.99), lower educational level (p = 0.039), poor health status (PR = 1.30; 95%CI 1.11–1.52), use of health care services (PR = 1.37; 95%CI 1.26–1.49), and chronic diseases (PR = 1.36; 95%CI 1.22–1.52). Lack of access was higher in people with poor health status (PR = 2.46; 95%CI 1.50–4.04) and chronic diseases (PR = 1.84; 95%CI 1.16–2.92). Half of Manaus’ population used medicines, which was higher in socially privileged and sicker individuals. Among those, 14 in every 100 could not access drug therapies, which was more frequent in people with poor health and with chronic diseases11CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQ404990/2013-4; 448093/2014-6; 3064482017-

Inequity in utilizing health services in the brazilian Amazon: a population-based survey, 2015

Although Brazil has a public and universal healthcare system, utilization of health services is marked by social and regional discrepancies. Objective To assess the prevalence and factors associated with underutilization of healthcare services in the Brazilian Amazon. Method Cross-sectional, population-based study. Adults aged over 18 years old were selected through probabilistic sampling. Underutilization of healthcare services was defined as never seeing a physician or a dentist. Poisson regression with robust variance was performed to calculate prevalence ratios (PRs) and 95% confidence intervals (CIs). A complex sample design was considered. Results A total of 4001 individuals were included, of which 419 (10.4%; 95% CI, 9.5-11.4%) never visited a physician or a dentist. In the adjusted analysis, underutilization was higher among poorer people (PR = 3.32; 95% CI, 2.16-5.11), men (PR = 1.34; 95% CI, 1.10-1.65), people with brown skin color (Brazilian mixed race; PR = 1.34; 95% CI, 1.02-1.76), and people who are separated (PR = 1.40; 95% CI, 1.01-1.94) and widowed (PR = 1.55; 95% CI, 1.02-2.37), when compared with the reference categories. Individuals with informal jobs, those who are retired, students/housewives, and unemployed people were more vulnerable to underutilization than formal workers (P < .04). Conclusion Underutilization of healthcare services occurs in one-tenth of adults in Manaus Metropolitan Region and is associated with social and economic inequitiesCNPQ - Conselho Nacional de Desenvolvimento Científico e Tecnológico404990/2013-4; 448093/2014-

Adverse events related to oral hormonal contraceptive use in undergraduate pharmacy students: a cross-sectional study

We aimed to measure the prevalence of adverse events related to oral hormonal contraceptive (OHC) use and their associated factors in undergraduate pharmacy students. A cross-sectional study was conducted by using an online questionnaire for female students of the Faculty of Pharmaceutical Sciences of the University of São Paulo from July to August 2020. A descriptive analysis of the data was carried out, which was followed by determining the prevalence ratios to identify possible factors associated with adverse events resulting from OHC. A total of 269 valid responses were obtained, among which 50.2% (n = 135) of the students reported using OHC as a contraceptive method and 21.2% (n = 57) affirmed that they had at least one adverse event related to OHC use, which corresponds to 42.2% of those who had used OHC. The most common adverse event was headache (70.2%), and a period of less than one month was the most cited (49.1%). Only migraine comorbidity was associated with the occurrence of adverse events related to OHC. These findings reinforce the high incidence of adverse events among OHC users and the low rate of discontinuation due to these events. There is a need to provide more information on contraceptive methods to users, including its risks and contraindications