Análise descritiva dos índices de morbidade e mortalidade de pacientes com cardiopatia reumática crônica em Salvador, Bahia, Brasil

Introdução: a cardiopatia reumática crônica (CRC) é a manifestação clínica de maior relevância da febre reumática (FR). É a causa mais comum de insuficiência cardíaca na população infantil e em adultos jovens. Objetivo: descrever os índices de morbimortalidade em pacientes com cardiopatia reumática crônica em Salvador, Bahia, Brasil. Metodologia: trata-se de um estudo ecológico de série temporal com dados secundários, sobre os índices de morbimortalidade de usuários com doenças reumáticas crônicas do coração, entre o período de 2008 até o ano de 2017, em Salvador, Bahia, Brasil. Resultados: foi observada uma maior ocorrência de internações e mortalidade em pacientes do sexo feminino. Houve uma maioria de óbitos entre os maiores de 60 anos. De acordo com a raça, internações e óbitos predominaram na população parda, em Salvador (BA), enquanto a cor da pele branca predominou nas ocorrências da população brasileira. Conclusão: embora seja observada uma redução nos índices de morbidade e mortalidade dos pacientes com cardiopatia reumática crônica quando comparados com os de anos anteriores, ainda é necessário investir em políticas de saúde para prevenção e controle dessa doença, visto que ela representa um impacto importante nos custos financeiros do Sistema de Saúde

The potential impact of austerity on attainment of the Sustainable Development Goals in Brazil

In the recent decades, Brazil has outperformed comparable countries in its progress toward meeting the Millennium Development Goals. Many of these improvements have been driven by investments in health and social policies. In this article, we aim to identify potential impacts of austerity policies in Brazil on the chances of achieving the sustainable development goals (SDGs) and its consequences for population health. Austerity’s anticipated impacts are assessed by analysing the change in federal spending on different budget programmes from 2014 to 2017. We collected budget data made publicly available by the Senate. Among the selected 19 programmes, only 4 had their committed budgets increased, in real terms, between 2014 and 2017. The total amount of extra money committed to these four programmes in 2017, above that committed in 2014, was small (BR$9.7 billion). Of the 15 programmes that had budget cuts in the period from 2014 to 2017, the total decrease amounted to BR$60.2 billion (US$15.3 billion). In addition to the overall large budget reduction, it is noteworthy that the largest proportional reductions were in programmes targeted at more vulnerable populations. In conclusion, it seems clear that the current austerity policies in Brazil will probably damage the population’s health and increase inequities, and that the possibility of meeting SDG targets is lower in 2018 than it was in 2015

Acesso a medicamentos : relações com a institucionalização da assistência farmacêutica

Objetivo: analisar as relações entre o acesso a medicamentos pela população e a institucionalização da assistência farmacêutica, na atenção básica. Métodos: este artigo integra a Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços 2015, estudo transversal, exploratório, de natureza avaliativa, composto por um levantamento de informações em amostra representativa de municípios, estratificada pelas regiões do Brasil. O acesso a medicamentos foi definido a partir do referencial de obtenção pelo usuário, variando entre: total, parcial ou nulo. A institucionalização da assistência farmacêutica foi analisada a partir das informações prestadas por responsáveis pela assistência farmacêutica e por responsáveis pela entrega de medicamentos. Na análise estatística foram utilizados o teste Qui-quadrado e regressão logística multinomial. Resultados: o acesso total a medicamentos foi maior quando os profissionais afirmaram haver aspectos das dimensões: “ferramentas de gestão”, “participação e controle social”, “financiamento” e “estrutura de pessoal”, constatando-se associações significantes na análise bivariada. A dimensão “atenção farmacêutica” não obteve tal associação. Após regressão logística multinomial, o acesso total foi mais prevalente quando responsáveis pela assistência farmacêutica afirmaram: participar sempre ou repetidamente das reuniões do Conselho Municipal de Saúde, RP= 3,3 (IC95% 1,5–7,3); existir protocolos para a entrega de medicamentos, RP= 2,7 (IC95% 1,2–6,1); existir sistema informatizado para gestão da assistência farmacêutica, RP= 3,9 (IC95% 1,9–8,0); e quando responsáveis pela entrega de medicamentos afirmaram ter participado de curso ou capacitação para profissionais nos últimos dois anos, RP= 2,0 (IC95% 1,1–3,5) e haver sistema informatizado para gestão da assistência farmacêutica, RP= 4,3 (IC95% 2,4–7,5). Conclusões: aspectos relacionados com a institucionalização da assistência farmacêutica se mostraram fortemente relacionados com o acesso a medicamentos. Os resultados indicam a necessidade de priorizar a sua implementação, contribuindo para sua consolidação no Brasil e efetividade dos serviços de saúde quanto às finalidades das políticas de assistência farmacêutica.Objetive: to analyze the relationship between access to medicines by the population and the institutionalization of pharmaceutical services in Brazilian primary health care. Methods: this study is 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), a cross-sectional, exploratory, and evaluative study composed of an information survey in a representative sample of cities, stratified by Brazilian regions. Access was defined based on the acquisition of medicines reported by the patient, ranging between: total, partial, or null. The institutionalization of pharmaceutical services was analyzed based on information provided by pharmaceutical services providers and by those responsible for medicines delivery. Chi-square test and multinomial logistic regression were used in the statistical analysis. Results: full access to medicines was greater when professionals affirmed there were the following aspects of the dimensions: “management tools,” “participation and social control,” “financing,” and “personnel structure,” with significant associations in the bivariate analysis. The “pharmaceutical care” dimension did not achieve such an association. After multinomial logistic regression, full access was more prevalent when those in charge of pharmaceutical services stated that: they always or repeatedly attend meetings of the Municipal Health Council, OR = 3.3 (95%CI 1.5-7.3); there are protocols for medicines delivery, OR = 2.7 (95%CI 1.2-6.1); there is computerized system for managing pharmaceutical services, OR = 3.9 (95%CI 1.9-8.0); those responsible for medicines delivery reported having participated in a course or training for professionals in the past two years, OR = 2.0 (95%CI 1.1-3.5); there is computerized system for pharmaceutical services management, OR = 4.3 (95%CI 2.4-7.5). Conclusions: aspects related to the institutionalization of pharmaceutical services have been strongly related to access to medicines. Our results indicate the need to prioritize its implementation, contributing to its consolidation in Brazil and to the effectiveness of health services regarding the purposes of pharmaceutical services policies

Access to medicines:: relations with the institutionalization of pharmaceutical services

OBJETIVO: Analisar as relações entre o acesso a medicamentos pela população e a institucionalização da assistência farmacêutica, na atenção básica. MÉTODOS: Este artigo integra a Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços 2015, estudo transversal, exploratório, de natureza avaliativa, composto por um levantamento de informações em amostra representativa de municípios, estratificada pelas regiões do Brasil. O acesso a medicamentos foi definido a partir do referencial de obtenção pelo usuário, variando entre: total, parcial ou nulo. A institucionalização da assistência farmacêutica foi analisada a partir das informações prestadas por responsáveis pela assistência farmacêutica e por responsáveis pela entrega de medicamentos. Na análise estatística foram utilizados o teste Qui-quadrado e regressão logística multinomial. RESULTADOS: O acesso total a medicamentos foi maior quando os profissionais afirmaram haver aspectos das dimensões: “ferramentas de gestão”, “participação e controle social”, “financiamento” e “estrutura de pessoal”, constatando-se associações significantes na análise bivariada. A dimensão “atenção farmacêutica” não obteve tal associação. Após regressão logística multinomial, o acesso total foi mais prevalente quando responsáveis pela assistência farmacêutica afirmaram: participar sempre ou repetidamente das reuniões do Conselho Municipal de Saúde, RP= 3,3 (IC95% 1,5–7,3); existir protocolos para a entrega de medicamentos, RP= 2,7 (IC95% 1,2–6,1); existir sistema informatizado para gestão da assistência farmacêutica, RP= 3,9 (IC95% 1,9–8,0); e quando responsáveis pela entrega de medicamentos afirmaram ter participado de curso ou capacitação para profissionais nos últimos dois anos, RP= 2,0 (IC95% 1,1–3,5) e haver sistema informatizado para gestão da assistência farmacêutica, RP= 4,3 (IC95% 2,4–7,5). CONCLUSÕES: Aspectos relacionados com a institucionalização da assistência farmacêutica se mostraram fortemente relacionados com o acesso a medicamentos. Os resultados indicam a necessidade de priorizar a sua implementação, contribuindo para sua consolidação no Brasil e efetividade dos serviços de saúde quanto às finalidades das políticas de assistência farmacêuticaOBJETIVE: To analyze the relationship between access to medicines by the population and the institutionalization of pharmaceutical services in Brazilian primary health care. METHODS: This study is 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), a cross-sectional, exploratory, and evaluative study composed of an information survey in a representative sample of cities, stratified by Brazilian regions. Access was defined based on the acquisition of medicines reported by the patient, ranging between: total, partial, or null. The institutionalization of pharmaceutical services was analyzed based on information provided by pharmaceutical services providers and by those responsible for medicines delivery. Chi-square test and multinomial logistic regression were used in the statistical analysis. RESULTS: Full access to medicines was greater when professionals affirmed there were the following aspects of the dimensions: “management tools,” “participation and social control,” “financing,” and “personnel structure,” with significant associations in the bivariate analysis. The “pharmaceutical care” dimension did not achieve such an association. After multinomial logistic regression, full access was more prevalent when those in charge of pharmaceutical services stated that: they always or repeatedly attend meetings of the Municipal Health Council, OR = 3.3 (95%CI 1.5-7.3); there are protocols for medicines delivery, OR = 2.7 (95%CI 1.2-6.1); there is computerized system for managing pharmaceutical services, OR = 3.9 (95%CI 1.9-8.0); those responsible for medicines delivery reported having participated in a course or training for professionals in the past two years, OR = 2.0 (95%CI 1.1-3.5); there is computerized system for pharmaceutical services management, OR = 4.3 (95%CI 2.4-7.5). CONCLUSIONS: Aspects related to the institutionalization of pharmaceutical services have been strongly related to access to medicines. Our results indicate the need to prioritize its implementation, contributing to its consolidation in Brazil and to the effectiveness of health services regarding the purposes of pharmaceutical services policie

Caracterização da institucionalização da assistência farmacêutica na atenção básica no Brasil

Objetivo: caracterizar o estágio atual da institucionalização da assistência farmacêutica nos municípios brasileiros. Métodos: artigo integrante da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos, um estudo transversal, exploratório, de natureza avaliativa, composto por um levantamento de informações numa amostra representativa de municípios estratificada pelas regiões do Brasil. Foram entrevistados os secretários municipais de saúde, responsáveis pela assistência farmacêutica e farmacêuticos responsáveis pela dispensação dos medicamentos. As variáveis selecionadas das entrevistas foram agrupadas em cinco dimensões, definindo-se três estágios de institucionalização da assistência farmacêutica: incipiente (0–34%), parcial (35%–69%), avançada (70%–100%), estimados com base nas respostas dos entrevistados. Foram estimadas frequências com intervalos de 95% de confiança. Para análise de associação estatística aplicou-se o teste do qui-quadrado, com nível de significância de p < 0,05. Resultados: os resultados mostram um processo heterogêneo e parcial da institucionalização da assistência farmacêutica no Brasil e grau avançado nas estruturas formais, como nos planos municipais de saúde e existência de lista padronizada de medicamentos. As variáveis analisadas na dimensão organização, estrutura e financiamento configuraram estágios que variam de parcial a avançado. A gestão apresentou grau parcial de institucionalização, revelando positivamente a existência de sistema informatizado, e resultados discrepantes no tocante à autonomia na gestão dos recursos financeiros. Itens imprescindíveis relacionados à estrutura expressaram disparidades entre as regiões, com diferenças estatísticas significantes. Conclusões: o estudo mostrou um processo de institucionalização heterogêneo e parcial da assistência farmacêutica em municípios brasileiros, revelando desigualdades regionais. Destacaram-se positivamente as variáveis relacionadas aos aspectos normativos da institucionalização em todas as dimensões, entretanto faz-se necessário novos estudos para avaliar a institucionalização das atividades finalísticas da assistência farmacêutica.Objective: to characterize the current stage of the institutionalization of pharmaceutical services in Brazilian cities. Methods: this study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), a cross-sectional, exploratory, and evaluative study composed by an information survey in a representative sample of cities, stratified by Brazilian regions. We interviewed municipal secretaries of health, responsible for pharmaceutical services, and pharmacists responsible for the dispensing of medicines. The variables selected from the interviews were grouped into five dimensions that defined three stages of pharmaceutical services institutionalization: incipient (0%-34.0%), partial (35.0%-69.0%), and advanced (70.0%-100%), estimated based on the interviewees’ answers. Frequencies were estimated with 95% confidence intervals. For the statistical association analysis, the Chi-square test was applied, with significance level of p<0.05. Results: our results show a partial and heterogeneous process of institutionalization of pharmaceutical services in Brazil, and an advanced stage in formal structures, such as the municipal health plans and the existence of a standardized list of medicines. The analysed variables in the “organization, structure, and financing” dimension configured stages that range from partial to advanced. The management presented partial institutionalization, positively showing the existence of computerized system, but also disparate results regarding the autonomy in the management of financial resources. Indispensable items related to the structure expressed disparities between the regions, with statistically significant differences. Conclusion: the study showed a partial and heterogeneous process of institutionalization of pharmaceutical services in Brazilian cities, showing regional disparities. Variables related to the normative aspects of institutionalization were positively highlighted in all dimensions; however, it is necessary to conduct new studies to evaluate the institutionalization of pharmaceutical services’ finalistic activities

Dependência psicológica de Benzodiazepínicos: Psychological dependence on Benzodiazepines

O crescente&nbsp;aumento do seu uso&nbsp;no&nbsp;começo&nbsp;do século XXI, os ansiolíticos&nbsp;vêm&nbsp;se tornando a&nbsp;“porta de fuga” para nova e&nbsp;também&nbsp;velha geração. Geração&nbsp;essa,&nbsp;que cada vez mais vem&nbsp;sendo consumida&nbsp;por distúrbios de ansiedade, insônia e quadros depressivos&nbsp;de forma exponencial. (Faculdade de Ciências Farmacêuticas de Ribeirão Preto – 2019).&nbsp;Este trabalho, avalia o uso e possível dependência psicológica dos benzodiazepínicos, a partir de um levantamento&nbsp;bibliográfico de forma&nbsp;sistemática de&nbsp;pesquisas&nbsp;dentro da literatura científica acerca do assunto.&nbsp

Aspectos anatomopatológicos das neoplasias malignas renais: Anatomopathological aspects of malignant renal neoplasms

As neoplasias renais correspondem ao crescimento exacerbado de células tumorais no interior dos rins, classificadas como benignas ou malignas. Neste estudo será abordado sobre as neoplasias malignas renais, a qual correspondem a maior prevalência e são representadas pelo carcinoma de células renais e o tumor de Wilms, com a finalidade de descrever a respeito dos aspectos anatomopatológicos, disseminando informações para o diagnóstico e manejo precoce. O carcinoma de células renais é mais prevalente no sexo masculino, indivíduos mais velhos, geralmente assintomático, contribuindo para o diagnóstico tardio junto a existência de metástases e terapêutica irresponsiva. Não se trata de uma doença genética, sendo o caráter esporádico o predominante, neste contexto os fatores de risco, sobretudo o tabagismo em seguida de obesidade hemodiálise e doenças genéticas são potenciais desencadeantes da enfermidade. Os exames complementares associado a clínica, junto ao acompanhamento eleva a possibilidade de identificação antes de avanços metastáticos. O tumor de Wilms é típico de crianças, acometendo um ou ambos os rins, normalmente com alguma anomalia genética, sendo os sinais inespecíficos, mas sempre manifestando massa palpável e dor abdominal, a qual os métodos de imagem confirmam o diagnóstico e estimam o prognóstico deste. Neste contexto, elucida-se a transcendência que os aspectos anatomopatológicos das neoplasias malignas renais oferecem para a diagnose precoce, devido a escassez e inespecificidafe das manifestações clínicas. Logo, a junção do perfil de cada neoplasia abordado conduz ao manejo adequado e reduz a incidência de tratamentos agressivos e irresponsivos

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants.

BACKGROUND: Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS: We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS: The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION: Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. FUNDING: WHO