scholarly journals Exploratory analysis of requests for authorization to dispense high-cost medication to COPD patients: the São Paulo “protocol”

2019 ◽  
Vol 45 (6) ◽  
Author(s):  
Regina Maria Carvalho-Pinto ◽  
Ingredy Tavares da Silva ◽  
Lucas Yoshio Kido Navacchia ◽  
Flavia Munhos Granja ◽  
Gustavo Garcia Marques ◽  
...  

ABSTRACT Objective: A resolution passed by the government of the Brazilian state of São Paulo established a protocol for requesting free COPD medications, including tiotropium bromide, creating regional authorization centers to evaluate and approve such requests, given the high cost of those medications. Our objective was to analyze the requests received by an authorization center that serves cities in the greater metropolitan area of (the city of) São Paulo between 2011 and 2016. Methods: Data regarding the authorization, return, or rejection of the requests were compiled and analyzed in order to explain those outcomes. Subsequently, the clinical and functional data related to the patients were evaluated. Results: A total of 7,762 requests for dispensing COPD medication were analyzed. Requests related to male patients predominated. Among the corresponding patients, the mean age was 66 years, 12% were smokers, 88% had frequent exacerbations, and 84% had severe/very severe dyspnea. The mean FEV1 was 37.2% of the predicted value. The total number of requests decreased by 24.5% from 2012 to 2013 and was lowest in 2015. Most (65%) of the requests were accepted. The main reasons for the rejection/return of a request were a post-bronchodilator FEV1/FVC ratio > 0.7, a post-bronchodilator FEV1 > 50% of the predicted value, and failure to provide information regarding previous use of a long-acting β2 agonist. During the study period, the total number of requests returned/rejected decreased slightly, and there was improvement in the quality of the data included on the forms. Conclusions: Here, we have identified the characteristics of the requests for COPD medications and of the corresponding patients per region served by the authorization center analyzed, thus contributing to the improvement of local public health care measures.

2021 ◽  
Vol 1 (2) ◽  
Author(s):  
José Roberto de Magalhães Bastos

The main aim of the research developed and described here was to record and evaluate-in the light of the concept of transdisciplinarity-the conditions of health and functional capacity of institutionalized elderly persons in Bauru, a city with 400,000 inhabitants, situated close to the centre of the state of São Paulo, Brazil. A descriptive and exploratory field research was conducted with diverse objects of research and methodologies, considering the fields of Dentistry, Nursing, Physical Therapy, Biomedicine and Speech Therapy. The Government effort in Brazil must be placed on record to make it possible to understand therapid growth of its elderly population, its consequences and needs, with the aim of greatly enhancing attention to their quality of life, compatible with the expectations of the population and authorities in all fields of Brazilian health care.


2015 ◽  
Vol 61 (5) ◽  
pp. 423-430 ◽  
Author(s):  
Flávia Regina de Andrade Varela ◽  
Rozana Mesquita Ciconelli ◽  
Alessandro Gonçalves Campolina ◽  
Patricia Coelho de Soarez

Summary Objective: describe the quality of life of frail elderly assisted by the Centro de Referência à Saúde do Idoso (CRI), Campinas, São Paulo, Brazil. Methods: the convenience sample included 122 frail elderly being treated from January 2010 to July 2011, out of a total of 668 frail elderly who were referred to the CRI after application of the brief evaluation form of the elderly, recommended by Ministry of Health, which identifies the elderly with some degree of frailty. Descriptive observational study collected data through sociodemographic questionnaire and quality of life questionnaires: WHOQOL-BREF, WHOQOLOLD and SF-36. Results: the study included 122 frail elderly. Of these, 74.6% (91) were female, mean age 73 years, 46.7% (57) were married, 51.6% (63) had less than 3 years of schooling and 87.7% (107) reported income of one to four minimum wages. The mean total score of the WHOQOL-BREF was 56.6, the WHOQOL-OLD 57.6 and SF-36 Physical Component Summary 34.5 and Mental Component Summary 43.6. Conclusion: knowledge of the impairment profile of quality of life among frail elderly is, therefore, essential for planning health care to this population.


Author(s):  
Suelen Rocha Silva ◽  
Adriana Rahal Rebouças de Carvalho

Introdução: A qualidade de uma voz depende da fonte produtora e do filtro. Características da voz devem estar adequadas como, por exemplo, a ação da fonte com o filtro e a frequência, pois se estiverem alteradas e se essa voz for utilizada de forma inadequada, pode causar várias alterações vocais, que são chamadas de disfonias comportamentais. Essas disfonias ocorrem por conta do mau uso ou abuso vocal. Objetivo: Verificar se há maior prevalência de alterações de frênulo de língua em cantores com disfonia comportamental atendidos no Ambulatório de Artes Vocais da Santa Casa de São Paulo quando comparados a população. Método: participaram 18 cantores com idades entre 18 e 40 anos e 11 meses, de ambos os sexos que possuíam diagnóstico de disfonia comportamental e 23 indivíduos da população geral, da mesma faixa etária sem queixa de disfonia. A presença da disfonia comportamental foi verificada após análise do prontuário do Ambulatório de Artes Vocais da Santa Casa de São Paulo. Os dois grupos foram submetidos a avaliação clínica do frênulo de língua por meio de protocolo descrito por Marchesan (2010). Resultados: a média de idade dos cantores foi de 35,4 anos e da população geral de 26,57 anos. As medidas realizadas com paquímetro com a boca aberta e com a ponta da língua na papila palatina geram uma média que auxilia na avaliação do frênulo de língua. Em nosso estudo, 63,8% dos cantores e 71,1% da população geral apresentaram média superior a 50%, o que é considerado normal. As alterações apresentadas nos dois grupos foram: 5 cantores e 6 indivíduos da população geral apresentaram alteração nas provas de mobilidade de língua, 2 cantores e 9 indivíduos da população geral apresentaram alguma alteração em relação a praxia de língua e quanto a alteração de frênulo de língua, 5 cantores e 6 indivíduos da população geral apresentaram alguma alteração. Conclusão: Não houve diferença significativa entre os dois grupos nos aspectos avaliados. Desta maneira, não podemos concluir que há maior prevalência de alteração de frênulo de língua no grupo de cantores. Palavras chave: Frênulo da língua, Disfonia, Voz, PrevalênciaABSTRACT Introduction: The quality of a voice depends on the producing source and the filter. Voice characteristics must be appropriate, such as the action of the source with the filter and the frequency, because if they are altered and if this voice is used inappropriately, it can cause various vocal alterations, which are called behavioral dysphonias. These dysphonias occur because of vocal misuse or abuse. Objective: to verify if there is a higher prevalence of tongue frenulum alterations in singers with behavioral dysphonia seen at the Vocal Arts Outpatient Clinic of Santa Casa de São Paulo when compared to the general population. Method: 18 singers aged 18-40 years and 11 months, of both sexes who were diagnosed with behavioral dysphonia, after analysis of the medical records of the Vocal Arts Outpatient Clinic of Santa Casa de Sao Paulo and 23 individuals from the general population in the same age group without complaints of dysphonia. Both groups underwent clinical evaluation of the tongue frenulum using the protocol described by Marchesan (2010). Results: the mean age of the singers was 35.4 years and the mean age of the general population was 26.57 years. The measurements taken with a pachymeter with an open mouth and with the tip of the tongue on the palatal papilla generate an average that assists in the assessment of the tongue frenulum. In our study, 63.8% of singers and 71.1% of the general population had an average greater than 50%, which is considered normal. The alterations seen in both groups were: 5 singers and 6 individuals from the general population had altered tongue mobility tests; 2 singers and 9 individuals from the general population had some alteration in relation to tongue praxis, and as for tongue frenulum alterations, 5 singers and 6 individuals from the general population had some alteration. Conclusion: There was no significant difference between the two groups in all the aspects evaluated. Thus, we cannot conclude that there is a higher prevalence of tongue frenulum alteration in the group of singers. Keywords: Lingual frenum, Dysphonia, Voice, Prevalence


2019 ◽  
Vol 10 (3) ◽  
Author(s):  
Larissa Giovanna Cazella ◽  
Letícia Yamawaka De Almeida ◽  
Jaqueline Lemos De Oliveira ◽  
Ana Carolina Guidorizzi Zanetti ◽  
Jacqueline De Souza

Objetivo: analisar as características sociodemográficas associadas à percepção da qualidade de vida de mulheres atendidas na atenção primária. Metodologia: estudo transversal, quantitativo, desenvolvido com 113 mulheres em uma unidade de saúde do interior de São Paulo. Utilizou-se um questionário sociodemográfico e a versão abreviada do instrumento de avaliação de qualidade de vida. Para análise dos dados, foram empreendidos testes de associação. Resultados: a maioria das participantes era de classes sociais menos favorecidas e apresentava boa percepção de qualidade de vida e saúde. Os fatores renda, escolaridade e idade foram os mais relevantes na associação com a qualidade de vida. Conclusão: Apesar de mencionarem boa qualidade de vida e saúde, foram identificados piores resultados nos domínios físicos, psicológicos e meio ambiente.  Os achados reforçam a necessidade de que as ações de saúde estejam contextualizadas aos aspectos sociais/territoriais e vinculadas a políticas mais amplas de redução da vulnerabilidade social. WOMEN'S QUALITY OF LIFE AND ASSOCIATED SOCIO DEMOGRAPHIC CHARACTERISTICSObjective: to analyze the sociodemographic characteristics associated to the perception of the quality of life of the women attended in the Primary Health Care. Methodology: this cross-sectional quantitative study was carried out with 113 women aged 20 to 65 years in a health unit in the interior of São Paulo. A sociodemographic questionnaire and the abbreviated version of the WHOQOL-bref quality of life assessment instrument were used. For data analysis, association tests were undertaken. Results: the majority of participants were from less favored social classes and had a good perception of quality of life and health. The factors income, schooling and age were the most relevant in the association with quality of life. Conclusion: in view of the sociodemographic characteristics associated with quality of life in the present study, it is emphasized that health actions should be linked to broader policies to reduce social vulnerability, enabling empowerment strategies and, above all, increasing women's access to education and income.Descriptors: Quality of Life; Health Centers; Social Vulnerability; Women; Primary Health Care.CALIDAD DE VIDA DE LAS MUJERES Y LAS CARACTERÍSTICAS SOCIODEMOGRÁFICAS ASSOCIADASObjetivo: analizar las características sociodemográficas asociadas a la percepción de la calidad de vida de mujeres que acuden a atención primaria. Métodos: este estudio cuantitativo transversal se realizó con 113 mujeres de 20 a 65 años en una unidad de salud en el interior de São Paulo. Se utilizó un cuestionario sociodemográfico y la versión abreviada del instrumento de evaluación de calidad de vida WHOQOL-bref. Para el análisis de los datos, se realizaron pruebas de asociación. Resultados: la mayoría de los participantes provenían de clases sociales más bajas y tenían una buena percepción de la calidad de vida y la salud. Los factores ingresos, educación y edad fueron los más relevantes en asociación con la calidad de vida. Conclusión: en vista de las características sociodemográficas asociadas con la calidad de vida en el presente estudio, se enfatiza que las acciones de salud están vinculadas a políticas más amplias para reducir la vulnerabilidad social, permitiendo estrategias de empoderamiento y, sobre todo, aumentando el acceso de las mujeres a educación e ingresos.Descriptores: Calidad de Vida; Centros de Salud; Vulnerabilidad Social; Mujeres; Atención Primaria de Salud.


2009 ◽  
Vol 39 (6) ◽  
pp. 1836-1841 ◽  
Author(s):  
Thaís Mioto Martineli ◽  
Oswaldo Durival Rossi Junior ◽  
Natacha Deboni Cereser ◽  
Marita Vedovelli Cardozo ◽  
Cristianne Lino Fontoura ◽  
...  

The consumption of lamb meat in Brazil has increased in the last years but little information about the microbiological quality of this product is available. To evaluate the hygienic-sanitary conditions of lamb carcasses, the quantification of microorganism populations indicators (mesophiles and psychrotrophs; total and thermotolerant coliforms; Escherichia coli; moulds and yeasts) and the pathogenic microorganisms indentification (Salmonella sp. and Listeria spp.) were performed. A total of 60 lamb carcasses were sampled from one abattoir in São Paulo. Swab samples were collected from three points (forequarter, back and hindquarter) on the muscle surface after carcasses final washing. Statistical analysis consisted of descriptive evaluation of the results whose counts were grouped by intervals of microorganism populations. Counts ranged from 1.0 x 10¹ to 8.0 x 10(4) colony-forming unit cm-2 (CFU cm-2) for mesophiles; 1.0 x 10(0) to 4.4 x 10(4)CFU cm-2 for psychrotrophs; < 1.0 x 10(0) to 4.4 x 10(4)CFU cm-2 for moulds and yeasts; < 0.3 to > 32.0 most probable number/cm² (MPN cm-2) for total and thermotolerant coliforms and Escherichia coli. Salmonella sp. and Listeria spp. were not found in any of the carcasses. Most carcasses presented low counts for all microorganisms. Overall results may be explained by the small size of the industry where the study was taken. Results suggest that good microbiological quality lamb meat is possible to be obtained, but improvement in hygienic-sanitary conditions is still required.


2014 ◽  
Vol 23 (3) ◽  
pp. 348-354 ◽  
Author(s):  
Maurício Orlando Wilmsen ◽  
Bruna Fernanda Silva ◽  
César Cristiano Bassetto ◽  
Alessandro Francisco Talamini do Amarante

Gastrointestinal nematode infections were evaluated in sheep raised in Botucatu, state of São Paulo, Brazil between April 2008 and March 2011. Every month, two tracer lambs grazing with a flock of sheep were exposed to natural infection with gastrointestinal nematodes for 28 consecutive days. At the end of this period, the lambs were sacrificed for worm counts. Haemonchus contortus presented 100% of prevalence. The seasons exerted no significant influence on the mean intensity of H. contortus, which ranged from 315 worms in November 2010 to 2,5205 worms in January 2011. The prevalence of Trichostrongylus colubriformis was also 100%, with the lowest mean intensity (15 worms) recorded in February 2011 and the highest (9,760 worms) in October 2009. In the case of T. colubriformis, a significant correlation coefficient was found between worm counts vs. rainfall (r = −0.32; P <0.05). Three other nematodes species were found in tracer lambs, albeit in small numbers. Their prevalence and mean intensity (in parenthesis) were as follows: Oesophagostomum columbianum 28% (25.2), Cooperia curticei 7% (4.5) and Trichuris spp. 2% (1). In conclusion, the environmental conditions of the area proved to be highly favorable for the year-round transmission of H. contortus and T. colubriformis.


1982 ◽  
Vol 12 (2) ◽  
pp. 215-229 ◽  
Author(s):  
Charles H. Wood

After the military took power in Brazil in 1964, the government adopted a wide range of policies designed to stimulate economic growth. A central aspect of the Brazilian model of development was the control of wages. From 1964 to 1975 this strategy caused the purchasing power of the minimum wage in the city of São Paulo to fall. The decline in the real wage index was associated with a rise in infant mortality during the period. When real wages rose after 1974, the death rate dropped off. The infant mortality trend cannot be explained by other factors that affect the actual or the reported death rate, such as changes in cityward migration, shifts in the distribution of income, and improvements in the quality of vital statistics. The findings of this study indicate a causal relationship between the infant mortality trend and changes in the purchasing power of the urban poor. Additional data on nutrition, changes in household behavior, and shifts in the cause structure of mortality support this conclusion.


2020 ◽  
Vol 28 (1) ◽  
pp. 7-11
Author(s):  
Renan Gonçalves Leão ◽  
Marina Mayumi Azuma ◽  
Gustavo Henrique Carillo Ambrosio ◽  
Flavio Faloppa ◽  
Eduardo Shoiti Takimoto ◽  
...  

ABSTRACT Objective: To evaluate the effectiveness of single-dose focal shockwave therapy in plantar fasciitis treatment. Methods: a primary, prospective study of a series of cases, conducted in the city of São Paulo, Brazil, by the Department of Orthopedics and Traumatology of the Universidade Federal de São Paulo, in Hospital São Paulo. All outcomes were measured at the time of inclusion of the patient in the study and at the post-intervention moments as it follows: three, six and twelve weeks. The VAS, AOFAS and SF-36 scales were applied by teams other than those who performed the SWT. Results: Data from 56 patients were collected during 2017 and 2018. There was improvement of the parameter evaluated (p < 0.005 and 95%CI) in all the periods in which the patients were reevaluated (3, 6 and 12 weeks), progressive improvement were observed in the three outcomes evaluated. Conclusion: Shock wave therapy was effective for plantar fasciitis treatment according to the proposed protocol considering pain, function and quality of life. Level of Evidence Ic, Case-series Study.


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