No abstract

Fiscal austerity policies have been used as responses to economic crises and fiscal deficits in both developed and developing countries. While they vary in regard to their content, intensity and implementation, such models recommend reducing public expenses and social investments, retracting the public service and substituting the private sector in lieu of the State to provide certain services tied to social policies. The present article discusses the main effects of the recent economic crisis on public health based on an updated review with consideration for three dimensions: health risks, epidemiological profiles of different populations, and health policies. In Brazil, the combination of economic crisis and fiscal austerity policies is capable of producing a direr situation than those experienced in developed countries. The country is characterized by historically high levels of social inequality, an under-financed health sector, highly prevalent chronic degenerative diseases and persisting preventable infectious diseases. It is imperative to develop alternatives to mitigate the effects of the economic crisis taking into consideration not only the sustainability of public finance but also public well-being.

The aim of this study was to estimate the global burden of disease from external causes in 2008 in Brazil, based on DALYs (disability-adjusted life years). YLLs (years of life lost) were estimated according to the method proposed by Murray & Lopez (1996). Meanwhile, the method for estimating YLDs (years lived with disability) included methodological adjustments taking the Brazilian reality into account. The study showed a total of 195 DALYs per 100 thousand inhabitants, of which 19 DALYs were related to external causes. Among YLLs, 48% were from unintentional causes and 52% from intentional causes. Among YLDs, unintentional causes predominated, with 95%. The share of YLLs in DALYs was 90%. The cause with the highest proportion of YLLs was "homicide and violence" (43%), followed by "road traffic accidents" (31%). Falls accounted for the highest share of YLDs (36%). The sex ratio (male-to-female) was 4.8 for DALYs, and the predominant age bracket was 15-29 years. Since external causes are avoidable, the study provides potentially useful information for policymakers in public security and health.

This study aimed to describe and analyze factors associated with emergency care and hospitalization of hypertensive and diabetic patients in the municipality of Rio de Janeiro, especially those related to the use of medicines. This is across-sectional study using secondary database from a household survey that approached hypertensive and diabetic patients. The outcome variables were: 1) seek for emergency careasa resultof complications related to hypertension and diabetes in the 12months preceding the interviews; 2) hospitalizationin the same period andfor the same reasons. Uni and bivariate analysis between exposure variables and each of the outcomes were performed using chi-square test at a significance level of 10%, which originated multivariate logistic regression analysis. Negative self-evaluation of health status was associated with both outcomes in the multivariate analysis. Having stopped taking the medications was associated with hospitalization and having missed a medical appointment in the last six months was associated with search for emergency care.

Pharmaceutical services in rio de

Resumo O objetivo foi comparar as estimativas das causas externas provenientes do estudo Carga Global de Doenças, entre os anos 1998 e 2008. A estimação do DALY (disability-adjusted life year) e do YLL (years of life lost) foi baseada em metodologia do estudo Carga Global de Doenças. Para o cálculo do YLD (years lived with disability), foram incluídas informações sobre atendimentos em emergências. Para comparabilidade, fez-se necessária a aplicação da mesma metodologia nos dois momentos analisados, tendo sido a mais recente eleita como padrão de referência. Em ambos os anos as causas externas foram responsáveis por cerca de 10% do total do DALY. Entretanto, sua distribuição interna apresentou marcada diferença entre as regiões do Brasil, com queda no Sudeste e aumento no Norte e Nordeste. Houve aumento das causas intencionais e o DALY se tornou mais letal (maior parcela de YLL). Espera-se que tais resultados balizem a formulação de políticas e/ou o aprimoramento das já existentes com vistas ao efetivo enfrentamento das causas externas.

Uso racional de medicamentos entre indivíduos com diabetes mellitus e hipertensão arterial no município do Rio de Janeiro, BrasilRational use of medicines by individuals with diabetes mellitus and arterial hypertension in the municipality of Rio de Janeiro, Brazil

This article aims to describe the inappropriate use of medicines in the Brazilian urban population and to identify associated factors. We conducted a data analysis of a household survey carried out in Brazil in 2013–14. The sampling plan was done by clusters with representativeness of the urban population and large regions of the country, according to gender and age domains. For this analysis, we considered a sample of adults (≥20 years) who reported having chronic non-communicable diseases, medical indication for drug treatment and medicine use (n = 12 283). We evaluated the prevalence of inappropriate use in the domains: non-adherence, inappropriate use behaviour and inadequate care with medicines, all verified in the following groups of independent variables: demographic and socio-economic characteristics, health and pharmaceutical care, health status and use of medicines. Crude and adjusted prevalence ratios were obtained using robust Poisson regression. It was found 46.1% of people having at least one behaviour of inappropriate use of medicines. The worst results were found for the domain of inappropriate use behaviour, a situation of 36.6% of the users, which included unauthorized prescriber, inadequate source of information and indication of the medicines by non-authorized prescribers. The best result was found for the lack of medicines care, informed by only 4.6% of users who kept expired drugs at home. The inappropriate use of medicines was associated with gender (female), region of residence (Northeast), not visiting the doctor regularly or visiting more than one doctor, not having free access to medicines and using of five or more medicines. There was a high prevalence of inappropriate use, which was associated with both individual and health system characteristics pointing out the need to set priorities as for health education and public interventions.