scholarly journals Trends and disparities in the use of cholinesterase inhibitors to treat Alzheimer’s disease dispensed by the Brazilian public health system – 2008 to 2014: a nation-wide analysis

2018 ◽  
Vol 76 (7) ◽  
pp. 444-451 ◽  
Author(s):  
Flávia Silva de Moraes ◽  
Mariana Lima Cerqueira de Souza ◽  
Giancarlo Lucchetti ◽  
Alessandra Lamas Granero Lucchetti
Keyword(s):  
Public Health ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Health System ◽  
Cholinesterase Inhibitors ◽  
Public Health System ◽  
Disease Treatment ◽  
Free Distribution ◽  
Unified Health System ◽  
Over Time

ABSTRACT In light of the high cost of dementia treatment, there is legislation authorizing free distribution of cholinesterase inhibitors to those suffering from Alzheimer’s disease in Brazil. However, the existence of this free distribution does not guarantee adequate distribution. Objectives The present study aimed to investigate the trends of prescriptions and the coverage of Alzheimer’s disease treatment using cholinesterase inhibitors from public pharmacies dispensing high-cost drugs in Brazil. Methods This was a retrospective study that collected data from the Brazilian public Unified Health System. All cholinesterase inhibitors distributed at no cost to Brazilians during the year 2014, as well as the estimated number and percentages of patients who used these medications, were evaluated and compared to data from the year 2008. Results Our estimates indicated that 9.7% of the population having dementia syndromes used cholinesterase inhibitors, as well as 16.1% of those with Alzheimer’s disease in Brazil. A clear disparity was noted between the use and distribution of cholinesterase inhibitors, depending on the region in which they were found. Over time, an increase in the distribution of cholinesterase inhibitors has been noted. In 2008, that use was 12.0% whereas, in 2014, it was 16.1%, an increase of 34% in six years. Conclusion It was estimated that 16.1% of patients with Alzheimer’s disease in Brazil use cholinesterase inhibitors. These values have increased and, in spite of not being satisfactory, they indicate a potential for improvement. However, there is still a significant disparity among the regions.

scholarly journals Frequency and Severity of Adverse Drug Reactions to Medications Prescribed for Alzheimer’s Disease in a Brazilian City: Cross-Sectional Study

2020 ◽  
Vol 11 ◽  
Author(s):  
Tânia Regina Ferreira ◽  
Luciane Cruz Lopes ◽  
Cristiane de Càssia Bergamaschi
Keyword(s):  
Public Health ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Health System ◽  
Psychiatric Disorders ◽  
Public Health System ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Drug Reactions ◽  
Cross Sectional

Background: There is lack of national studies that assess the risks associated with the drugs provided under the Brazilian public health system for treating Alzheimer’s disease. Then, this study determined the prevalence and severity of self-reported adverse drug reactions (ADRs) prescribed to patients with Alzheimer’s disease in the Brazilian public health system.Methods: A cross-sectional study was carried out based on public data from the MEDEX system (information on dispensing data, known as exceptional dispensing medications) and interviews with patients and/or caregivers who get access to Alzheimer’s drugs at a public pharmacy in a large Brazilian city, between July and September 2017, inquiring about ADRs and serious adverse events (SAEs).Results: The subjects were asked about ADRs and SAEs related to the use of donepezil, galantamine, rivastigmine and memantine. Out of 285 patients enrolled on the database, 250 participated in the study (87.7%). Among the participants, approximately 63.0% were female, 70.3% aged ≥75 years and 70.3% had comorbidities. Overall, 209 patients (83.6%) reported at least one ADR (total 1,149 ADRs) and rivastigmine was associated with the largest number of ADRs per patient (7.9 ADRs/patient). The predominant adverse effects were psychiatric disorders with common frequency (57.1%) and mild severity (89.0%). Six patients (2.4%) had SAEs that required hospitalization. The use of antipsychotics was the variable associated with ADR (OR = 4.95; 95% CI: 1.45–16.93; p = 0.011).Conclusion: There was a large number of reported ADRs and most of them were of common frequency and mild severity, being mainly related to psychiatric disorders. Considering the fragility of these patients, it is important to improve safety-related care in the use of drugs for treating this disease.

Half-inhibition Concentrations of New Cholinesterase Inhibitors

2004 ◽  
Vol 59 (3-4) ◽  
pp. 293-296 ◽  
Author(s):  
Pavla Zdražilová ◽  
Šárka Štĕpánková ◽  
Karel Komers ◽  
Karel Ventura ◽  
Alexander Čegan
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Enzyme Activity ◽  
Cholinesterase Inhibitors ◽  
Molar Concentration ◽  
Disease Treatment ◽  
Hydrolysis Of

The power of chosen carbamates and hydrazinium derivatives (carbazates) to inhibit the hydrolysis of acetylthiocholine by butyrylcholinesterase or acetylcholinesterase was tested. The determined pI50 values (= negative logarithm of the molar concentration inhibiting the enzyme activity by 50%) of the tested substances were compared with pI50 values of the commercially used drugs for the Alzheimer’s disease treatment - rivastigmine and galanthamine.

scholarly journals Mild cognitive impairment and progression to dementia of Alzheimer's disease

2017 ◽  
Vol 63 (7) ◽  
pp. 651-655 ◽  
Author(s):  
Ana Beatriz Quintes Steiner ◽  
Alessandro Ferrari Jacinto ◽  
Vânia Ferreira de Sá Mayoral ◽  
Sonia Maria Dozzi Brucki ◽  
Vanessa de Albuquerque Citero
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Health System ◽  
Public Health System ◽  
The Public ◽  
Preclinical Phase ◽  
Long Duration ◽  
The Subject ◽  
Clinical Conditions

Summary The increase in life expectancy in the Brazilian population raises questions about the preparation of the public health system in identifying elderly patients with signs of cognitive impairment. Currently, as a consequence of the long duration of preclinical phase of Alzheimer's disease, efforts of early detection have been emphasized. Clinical dementia presents an important impact on the individual's caregivers, family, society and economy. Identifying individuals who already have some cognitive impairment, despite remaining functional, as well as analyzing associated comorbidities, constitutes an opportunity to analyze possibilities for future interventions. Dementias are clinical conditions that impose a burden on the health system with its high costs, whereas the identification of individuals with cognitive impairment without dementia can aid patients and their families to plan the future and mitigate costs. This narrative revision can provide general practitioners with more information on the subject.

Amiridine-piperazine hybrids as cholinesterase inhibitors and potential multitarget agents for Alzheimer's disease treatment

2021 ◽  
Vol 112 ◽  
pp. 104974
Author(s):  
Galina F. Makhaeva ◽  
Sofya V. Lushchekina ◽  
Nadezhda V. Kovaleva ◽  
Tatiana Yu. Astakhova ◽  
Natalia P. Boltneva ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cholinesterase Inhibitors ◽  
Disease Treatment

scholarly journals Profile of the appendectomies performed in the Brazilian Public Health System

2017 ◽  
Vol 44 (1) ◽  
pp. 4-8 ◽  
Author(s):  
FERNANDA DOS SANTOS ◽  
GABRIEL FLAMARIM CAVASANA ◽  
TERCIO DE CAMPOS
Keyword(s):  
Public Health ◽  
Health System ◽  
Laparoscopic Appendectomy ◽  
Public Health System ◽  
Statistical Significance ◽  
Hospital Costs ◽  
Laparoscopic Approach ◽  
Total Expenditure ◽  
Unified Health System ◽  
Total Growth

ABSTRACT Objective: to analyze the profile of appendectomies performed in the Brazilian Public Health System (SUS) and to compare the laparoscopic and laparotomic techniques of appendectomy. Methods: This work used information from DataSus from 2008 to 2014 (http://datasus.saude.gov.br). We compared the data of patients submitted to laparotomic appendectomy with those submitted to laparoscopic one. Results: when comparing the total growth of appendectomies, the laparoscopic route increased 279.7%, while the increase in laparotomic surgery was 25% (p <0.001) in the study period. With regard to medical and hospital costs, laparoscopic appendectomy accounted for only 2.6% of the total expenditure on appendectomies performed by the Unified Health System (SUS) hospitals, with an average cost 7.6% lower than that of laparotomy procedures, but without statistical significance. The mortality rate was 57.1% lower in the laparoscopic approach when compared with laparotomy. Conclusion: there has been a significant increase in the laparoscopic route in the treatment of appendicitis, but the method is still rarely used in SUS patients. The costs of laparoscopic appendectomy were similar to those observed in laparotomic access.

scholarly journals Pharmaceutical assistance within the SUS: the experience of students in Rural Internship from a Pharmacy Course

2009 ◽  
Vol 45 (4) ◽  
pp. 819-827
Author(s):  
Luciana Tarbes Mattana Saturnino ◽  
Zélia Profeta Luz ◽  
Edson Perini ◽  
Celina Maria Modena
Keyword(s):  
Public Health ◽  
Content Analysis ◽  
Focus Groups ◽  
Health System ◽  
Public Health System ◽  
The Public ◽  
Unified Health System ◽  
Adequate Information ◽  
Perceptions Of Students ◽  
Before And After

The 2002 Brazilian Curricular Lines established a new curriculum for Pharmacy Programs, including amplified information about the Unified Health System (SUS). Following this, some Colleges have implemented a Rural Internship (RI) discipline, as a way to promote: a) adequate information on the SUS, and b) students' interaction with pharmaceutical assistance. In this study we analyzed the perceptions of students enrolled in the Rural Internship program of the undergraduate Pharmacy Program at the Federal University of Minas Gerais. Eight students participated in this study and their perceptions and ideas were obtained by focus groups, both before and after the RI. This information was analyzed by content analysis. The students had a fragmented, distorted view on assistance, before as well as after taking the RI. Nevertheless, the RI provided students with a view of the professional realities and difficulties routinely faced by pharmacists in the public health system. The RI course of the Pharmacy Programs was viewed as an opportunity to improve the professional work within the SUS.

Increasing rational use of cholinesterase inhibitors for Alzheimer's disease in Brazil: Public health strategy combining guideline with peer-review of prescriptions

2010 ◽  
Vol 26 (2) ◽  
pp. 205-210 ◽  
Author(s):  
Paulo Dornelles Picon ◽  
Ana Luiza Camozzato ◽  
Elaine A. Lapporte ◽  
Rafael V. Picon ◽  
Humberto Moser Filho ◽  
...  
Keyword(s):  
Public Health ◽  
Health System ◽  
Cholinesterase Inhibitors ◽  
Public Health System ◽  
National Guideline ◽  
Expert Committee ◽  
Public Health Strategy ◽  
Rational Use ◽  
The Public ◽  
Health Strategy

Objectives: Since 2002, the treatment with cholinesterase inhibitors (CHEIs) for Alzheimer's disease (AD) has been paid for by the public health system of the Brazilian Ministry of Health for any patient that fulfills clinical criteria established by an evidence-based guideline developed and published by the Ministry. The aim of this study was to evaluate compliance of prescription patterns to the national guideline for use of CHEIs’ in the southern Brazilian state of Rio Grande do Sul.Methods: We created a regional expert-committee reference center to review all prescriptions of CHEIs and to send feedback to physicians whenever prescriptions without compliance to the guideline were noted. One thousand three hundred ninety-nine (1,399) CHEI prescriptions presented to the public health system from 2005 to 2007 were evaluated by an expert team of neurologists and psychiatrists. Clinical history, performance on mental status screening by Mini Mental State Examination (MMSE), Clinical Dementia Rating scale (CDR), laboratory results, and neuroimaging findings were evaluated in relation to the adherence to the national guideline's recommendations. If the prescription was rejected because of lack of adherence to the criteria of the guideline, a written response was sent by the expert committee to physicians concerning the request.Results: The majority of the requests (n = 1,044; 75 percent) did not meet the AD guideline's criteria, either for diagnosis or for treatment, and were not granted. A diagnostic mistake was evident in 64.3 percent of cases. Findings of vascular or Parkinson's dementia or severe AD were the main reasons for rejection. Rivastigmine was the most prescribed cholinesterase inhibitor, used in 86 percent of cases. Of note was the reduction in the number of CHEIs prescriptions in the years following this intervention.Conclusions: The public health strategy of using expert-review of prescriptions and their compliance to national guideline revealed a low rate of rational use of CHEIs for dementia. Such a strategy is relevant for protecting patients from unproven medical interventions and for reducing waste of resources.

scholarly journals Public Health System in Brazil nowadays: challenges for its operation and funding

2016 ◽  
Vol 5 (3) ◽  
pp. 65 ◽  
Author(s):  
Alethele De Oliveira Santos ◽  
Sandra Mara Campos Alves
Keyword(s):  
Public Health ◽  
Health System ◽  
Public Health System ◽  
Political Crisis ◽  
The Public ◽  
Unified Health System ◽  
The Individual ◽  
The Right ◽  
Effective Public Health ◽  
Collective Dimension

This paper has the aim to revisit the theme of the brazilian public health system from the perspective of its operation and funding of its actions and services, analyzing some of the main obstacles to its effectiveness. Endowed with its own logic of organization, planning and funding of its actions and services, the Brazilian Unified Health System (SUS) finds barriers to its sustainability when it comes to funding and the judicialization of health. Historical under-funding worsened by the economic and political crisis the country currently faces plus the increase in casuistic judicial decisions that prioritize the individual logic over the collective right have produced serious shocks in the system. These are just some of the challenges to an effective public health system. This is why the work of public bodies must be responsible and always take into consideration the collective dimension of the right to health under penalty of causing the collapse of the public health system altogether

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