DEFAR - Artigos publicados em periódicos
URI permanente para esta coleçãohttp://www.hml.repositorio.ufop.br/handle/123456789/531
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Item Prevalence and factors associated with anxiety among university students of health sciences in Brazil : findings and implications.(2021) Alves, Júlia Vasconcelos de Sá; Paula, Waléria de; Netto, Patrícia Ribeiro Rezende; Godman, Brian; Nascimento, Renata Cristina Rezende Macedo do; Vital, Wendel CouraObjective: The aim was to evaluate the prevalence and factors associated with anxiety disorders among university students of health sciences at Federal University of Ouro Preto, Brazil. Methods: A cross-sectional study between March to June 2019. Data were collected through a self-administered questionnaire including sociodemographic, academic, family and behavioral issues. The Beck Anxiety Inventory was used to assess anxiety. Estimates were obtained through the prevalence ratio and Poisson multivariate analysis. Results: Four hundred and ninety-three students participated with a mean age of 23.1 and predominantly women (79.9%). All students had some degree of anxiety, with the frequency of the severe, moderate and mild forms being 28.0%, 29.8% and 27.0%, respectively. The factors associated with anxiety included having suffered psychological and/or physical violence in childhood, having suicidal thoughts, having a deceased parent, living with parents, being dissatisfied with the course and being in the exam period. Conclusions: The prevalence of anxiety was high in our study and family problems prior to entering university seem to significantly influence the degree of anxiety, which may compromise the student’s academic and social performance.Item Strategies to improve antimicrobial utilization with a special focus on developing countries.(2021) Godman, Brian; Nascimento, Renata Cristina Rezende Macedo do; Seaton, Ronald AndrewAntimicrobial resistance (AMR) is a high priority across countries as it increases morbidity, mortality and costs. Concerns with AMR have resulted in multiple initiatives internationally, na- tionally and regionally to enhance appropriate antibiotic utilization across sectors to reduce AMR, with the overuse of antibiotics exacerbated by the COVID-19 pandemic. Effectively tackling AMR is crucial for all countries. Principally a narrative review of ongoing activities across sectors was undertaken to improve antimicrobial use and address issues with vaccines including COVID-19. Point prevalence surveys have been successful in hospitals to identify areas for quality improvement programs, principally centering on antimicrobial stewardship programs. These include reducing prolonged antibiotic use to prevent surgical site infections. Multiple activities centering on education have been successful in reducing inappropriate prescribing and dispensing of antimicrobials in ambulatory care for essentially viral infections such as acute respiratory infections. It is imperative to develop new quality indicators for ambulatory care given current concerns, and instigate programs with clear public health messaging to reduce misinformation, essential for pandemics. Regular access to effective treatments is needed to reduce resistance to treatments for HIV, malaria and tuberculosis. Key stakeholder groups can instigate multiple initiatives to reduce AMR. These need to be followed up.Item The current situation regarding long-acting insulin analogues including biosimilars among African, Asian, European, and South American countries : findings and implications for the future.(2021) Godman, Brian; Nascimento, Renata Cristina Rezende Macedo do; Jakovljevic, MihajloBackground: Diabetes mellitus rates continue to rise, which coupled with increasing costs of associated complications has appreciably increased global expenditure in recent years. The risk of complications are enhanced by poor glycaemic control including hypoglycaemia. Long-acting insulin analogues were developed to reduce hypoglycaemia and improve adherence. Their considerably higher costs though have impacted their funding and use. Biosimilars can help reduce medicine costs. However, their introduction has been affected by a number of factors. These include the originator company dropping its price as well as promoting patented higher strength 300 IU/ml insulin glargine. There can also be concerns with different devices between the manufacturers. Objective: To assess current utilisation rates for insulins, especially long-acting insulin analogues, and the rationale for patterns seen, across multiple countries to inform strategies to enhance future utilisation of long-acting insulin analogue biosimilars to benefit all key stakeholders. Our approach: Multiple approaches including assessing the utilisation, expenditure and prices of insulins, including biosimilar insulin glargine, across multiple continents and countries. Results: There was considerable variation in the use of long-acting insulin analogues as a percentage of all insulins prescribed and dispensed across countries and continents. This ranged from limited use of long-acting insulin analogues among African countries compared to routine funding and use across Europe in view of their perceived benefits. Increasing use was also seen among Asian countries including Bangladesh and India for similar reasons. However, concerns with costs and value limited their use across Africa, Brazil and Pakistan. There was though limited use of biosimilar insulin glargine 100 IU/ml compared with other recent biosimilars especially among European countries and Korea. This was principally driven by small price differences in reality between the originator and biosimilars coupled with increasing use of the patented 300 IU/ml formulation. A number of activities were identified to enhance future biosimilar use. These included only reimbursing biosimilar long-acting insulin analogues, introducing prescribing targets and increasing competition among manufacturers including stimulating local production. Conclusions: There are concerns with the availability and use of insulin glargine biosimilars despite lower costs. This can be addressed by multiple activities.Item Initiatives and reforms across Scotland in recent years to improve prescribing; fndings and global implications of drug prescriptions.(2021) MacBride-Stewart, Sean; McTaggart, Stuart; Kurdi, Amanj Baker; Sneddon, Jacqueline; McBurney, Stephen; Nascimento, Renata Cristina Rezende Macedo do; Mueller, Tanja; Kwon, Hye-Young; Morton, Alec; Seaton, Ronald Andrew; Timoney, Angela; Bennie, Marion; Sefah, Israel Abebrese; Pisana, Alice; Meyer, Johanna Catherine; Godman, BrianObjective: Global expenditure on medicines is increasingly driven by a number of factors. These include the launch of new premium-priced medicines for complex diseases including oncology, a rise in non-communicable diseases especially with ageing populations and changes in clinical practice. There are also concerns with the rise in antimicrobial resistance due to inappropriate prescribing of antimicrobials as well as concerns with polyphar- macy. Both situations increase morbidity, mortality and costs. We are aware of ongoing activities across Scotland to improve the managed entry of new medicines, including new oncology medicines, improve the prescribing of antimicrobials as well as enhance the prescribing of low-cost multiple sourced medicines and biosimilars without compromising care. In addition, we are seeking to address concerns with polypharmacy. Consequently, we wanted to document these multiple measures and their outcomes to provide an overview to inform all key stakeholders in Scotland as well as the global community as resource pressures grow. Methods: A narrative review of the literature documenting examples of ongoing national and regional initiatives across Scotland to infuence future prescribing and their impact where known across multiple disease areas. Signifcant fndings: The coordinated approach to improve the prescribing of new medicines limited the prescribing of dabigatran when frst launched with recent research providing guidance on the effectiveness and safety of different direct oral anticoagulants as more are launched. The patient reported outcome measures project and other ongoing research activities, including linking datasets, is progressing under the Cancer Medicines Outcomes Programme in Scotland to improve future care with typical differences in the effectiveness of new cancer medicines in routine care versus clinical trials. The Scottish Antimicrobial Prescribing Group is also active in Scotland instigating multiple measures to improve antimicrobial prescribing. This includes improving the dosing of gentamicin and vancomycin as well as reducing the prescribing of antibiotics for women with urinary tract infections. Multiple activities have also resulted in high International Non- proprietary Name (INN) prescribing in Scotland at between 91.4% and 100% across a range of medicines. In addition, increased prescribing of low-cost multiple sourced medicines versus patented medicines in a class or related class, as well as biosimilars, leading to considerable savings without compromising care. There have also been initiatives to address concerns with the rising costs of combination inhalers for patients with respiratory diseases as well as areas of polypharmacy with varying success. Conclusion: Multiple and coordinated approaches have improved the quality and effciency of prescribing pharmaceuticals in Scotland. Additional measures are still needed and we will continue to monitor this situation.Item Prevalence and factors associated with anxiety among university students of health sciences in Brazil : findings and implications.(2021) Alves, Júlia Vasconcelos de Sá; Paula, Waléria de; Netto, Patrícia Ribeiro Rezende; Godman, Brian; Nascimento, Renata Cristina Rezende Macedo do; Vital, Wendel CouraObjective: The aim was to evaluate the prevalence and factors associated with anxiety disorders among university students of health sciences at Federal University of Ouro Preto, Brazil. Methods: A cross-sectional study between March to June 2019. Data were collected through a self-administered questionnaire including sociodemographic, academic, family and behavioral issues. The Beck Anxiety Inventory was used to assess anxiety. Estimates were obtained through the prevalence ratio and Poisson multivariate analysis. Results: Four hundred and ninety-three students participated with a mean age of 23.1 and predominantly women (79.9%). All students had some degree of anxiety, with the frequency of the severe, moderate and mild forms being 28.0%, 29.8% and 27.0%, respectively. The factors associated with anxiety included having suffered psychological and/or physical violence in childhood, having suicidal thoughts, having a deceased parent, living with parents, being dissatisfied with the course and being in the exam period. Conclusions: The prevalence of anxiety was high in our study and family problems prior to entering university seem to significantly influence the degree of anxiety, which may compromise the student’s academic and social performance.Item Fixed dose drug combinations - are they pharmacoeconomically sound? : findings and implications especially for lower- and middle-income countries.(2020) Godman, Brian; McCabe, Holly; Leong, Trudy D.; Mueller, Debjani; Martin, Antony P.; Hoxha, Iris; Mwita, Julius C.; Rwegerera, Godfrey Mutashambara; Massele, Amos; Costa, Juliana de Oliveira; Nascimento, Renata Cristina Rezende Macedo do; Lemos, Livia Lovato Pires de; Tachkov, Konstantin; Milushewa, Petya; Patrick, Okwen; Niba, Loveline Lum; Laius, Ott; Sefah, Israel; Abdulsalim, Suhaj; Soleymani, Fatemeh; Guantai, Anastasia N.; Achieng, Loice; Oluka, Margaret; Jakupi, Arianit; Logvissee, Konstantīns; Hassali, Mohamed Azmi; Kibuule, Dan; Kalemeera, Francis; Mubita, Mwangana; Fadare, Joseph; Ogunleye, Olayinka O.; Saleem, Zikria; Hussain, Shazhad; Bochenek, Tomasz; Mardare, Ileana; Alrasheedy, Alian A.; Furst, Jurij; Tomek, Dominik; Pekovic, Vanda Markovic; Rampamba, Enos M.; Alfadl, Abubakr; Amuuu, Adefolarin A.; Matsebula, Zinhle; Phuong, Thuy Nguyen Thi; Thanh, Binh Nguyen; Kalungia, Aubrey Chichonyi; Zaranyika, Trust; Masuka, Nyasha; Olaru, Ioana D.; Waleccc, Janney; Hill, Ruaraidh; Kurdi, Amanj; Timoney, Angela; Campbell, Stephen; Meyer, Johanna C.Introduction: There are positive aspects regarding the prescribing of fixed dose combinations (FDCs) versus prescribing the medicines separately. However, these have to be balanced against concerns including increased costs and their irrationality in some cases. Consequently, there is a need to review their value among lower- and middle-income countries (LMICs) which have the greatest prevalence of both infectious and noninfectious diseases and issues of affordability. Areas covered: Review of potential advantages, disadvantages, cost-effectiveness, and availability of FDCs in high priority disease areas in LMICs and possible initiatives to enhance the prescribing of valued FDCs and limit their use where there are concerns with their value. Expert commentary: FDCs are valued across LMICs. Advantages include potentially improved response rates, reduced adverse reactions, increased adherence rates, and reduced costs. Concerns include increased chances of drug:drug interactions, reduced effectiveness, potential for imprecise diagnoses and higher unjustified prices. Overall certain FDCs including those for malaria, tuberculosis, and hypertension are valued and listed in the country’s essential medicine lists, with initiatives needed to enhance their prescribing where currently low prescribing rates. Proposed initiatives include robust clinical and economic data to address the current paucity of pharmacoeconomic data. Irrational FDCs persists in some countries which are being addressed.Item Real-world evaluation of the impact of statin intensity on adherence and persistence to therapy : a Scottish population-based study.(2020) Nascimento, Renata Cristina Rezende Macedo do; Mueller, Tanja; Godman, Brian; Stewart, Sean MacBride; Hurding, Simon; Acúrcio, Francisco de Assis; Guerra Júnior, Augusto Afonso; Teodoro, Juliana Alvares; Morton, Alec; Bennie, Marion; Kurdi, Amanj BakerAim: To assess associations between statin intensity and adherence, persistence and discontinuation of statin therapy in Scotland. Method: Retrospective cohort study, using linked electronic health records covering a period from January 2009 to December 2016. The study cohort included adult patients (≥18 years) newly initiating statins within Greater Glasgow and Clyde, Scot land. Study outcomes comprised adherence, discontinuation and persistence to treat ment, stratified by three exposure groups (high, moderate and low intensity). Discontinuation and persistence were calculated using the refill-gap and anniversary methods, respectively. Proportion of days covered (PDC) was used as a proxy for adherence. Kaplan-Meier survival curves and Cox proportional hazard models were used to evaluate discontinuation, and associations between adherence/persistence and statin intensity were assessed using logistic regression. Results: A total of 73 716 patients with a mean age of 61.4 ± 12.6 years were included; the majority (88.3%) received moderate intensity statins. Discontinuation rates differed between intensity levels, with high-intensity patients less likely to dis continue treatment compared to those on moderate intensity (prior cardiovascular disease [CVD]: HR 0.43 [95% CI 0.34-0.55]; no prior CVD: 0.80 [0.74-0.86]). Persis tence declined over time, and high-intensity patients had the highest persistence rates. Overall, 52.6% of patients were adherent to treatment (PDC ≥ 80%), but adher ence was considerably higher among high-intensity patients (63.7%). Conclusion: High-intensity statins were associated with better persistence and adherence to treatment, but overall long-term persistence and adherence remain a challenge, particularly among patients without prior CVD. This needs addressing.Item Statin use in Brazil : findings and implications.(2018) Nascimento, Renata Cristina Rezende Macedo do; Guerra Júnior, Augusto Afonso; Teodoro, Juliana Alvares; Gomes, I. C.; Godman, Brian; Bennie, Marion; Kurdi, Amanj Baker; Acúrcio, Francisco de AssisIntroduction and objectives: Stains have become an integral part of treatment to reduce cardiac events in patients with cardiovascular disease. However, their use within the public healthcare system in Brazil is unknown. Consequently, we sought to determine and characterize statin use in primary healthcare delivered by the public health system (SUS) in Brazil and evaluate associated patient factors to improve future use. Methods: Cross-sectional study with a national representative sample from five Brazilian regions, derived from the National Survey on Access, Use and Promotion of Rational Use of Medicines using a multi-stage complex sampling plan. Patients over 18 years old were interviewed from July/2014 to May/2015. Prevalence of statin use and statins’ self-reported adherence were determined amongst medicine users. The association between statin use and sociodemographic/health condition variables were assessed using logistic regression. Results: 8,803 patients were interviewed; of which, 6,511 were medicines users. The prevalence of statins use was 9.4% with simvastatin (90.3%), atorvastatin (4.7%) and rosuvastatin (1.9%) the most used statins. Poor adherence was described by 6.5% of patients. Statins use was significantly associated with age ≥65 years old, higher educational level, residence in the South, metabolic and heart diseases, alcohol consumption and polypharmacy. Conclusions: This is the first population based study in Brazil to assess statin use in SUS primary healthcare patients. Addressing inequalities in access and use of medicines including statins is an important step in achieving the full benefit of statins in Brazil, with the findings guiding future research and policies.Item Ongoing activities to optimize the quality and efficiency of lipid-lowering agents in the Scottish National Health System : influence and implications.(2018) Leporowski, Axel; Godman, Brian; Kurdi, Amanj Baker; MacBride-Stewart, Sean; Ryan, Margaret; Hurding, Simon; Nascimento, Renata Cristina Rezende Macedo do; Bennie, Marion; Morton, AlecBackground: Prescribing of lipid-lowering agents (LLAs) has increased worldwide including in Scotland with increasing prevalence of coronary heart disease, and higher dose statins have been advocated in recent years. There have also been initiatives to encourage prescribing of generic versus patented statins to save costs without compromising care. There is a need to document these initiatives and outcomes to provide future direction. Method: Assessment of utilization (items dispensed) and expenditure of key LLAs (mainly statins) between 2001 and 2015 in Scotland alongside initiatives. Results: Multiple interventions over the years have increased international nonproprietary name prescribing (99% for statins) and preferential prescribing of generic versus patented statins, and reduced inappropriate prescribing of ezetimibe. This resulted in a 50% reduction in expenditure of LLAs between 2001 and 2015 despite a 412% increase in utilization, increased prescribing of higher dose statins (71% in 2015) especially atorvastatin following generic availability, and reduced prescribing of ezetimibe (reduced by 72% between 2010 and 2015). As a result, the quality of prescribing has improved. Conclusion: Generic availability coupled with multiple measures has resulted in appreciable shifts in statin prescribing behavior and reduced ezetimibe prescribing, resulting in improvements in both the quality and efficiency of prescribing.