1.04-1.68), >12 to 18 (HR 1.17, 95% CI 1.10-1.83), and >18 (HR 1.21, 95% CI 1.26-2.03) month intervals had elevated risk for CVD (p for trend <0.001). In total strokes, the risk-increasing effect of CVD with longer lipid testing interval is stronger than MI or CHD and this positive association was preserved among subgroups according to drug adherence and outpatient department visits. CONCLUSIONS: Lipid testing intervals of more than 6 months may lead to increased risk of CVD among newly diagnosed dyslipidemia patients. Newly diagnosed dyslipidemia patients should be encouraged to check lipid profile at 6 months interval in order to reducing risk for CVD. OBJECTIVES:To assess the value of implementation of pharmaceutical care (PC) for cardiovascular diseases in low-middle-income countries (LMICs). METHODS: This is a health care use and policy study based on health care management, which has evaluated the value of implementation (VOI) of PC from a societal and Brazilian Public Health System (BPHS) perspective. During 2009, a PC program enlisted 104 patients covered by the BPHS. Direct medical and non-medical costs and social costs were considered. Markov modeling projected over 10-years systemic arterial hypertension complications (ischemic heart disease, stroke, peripheral arterial disease, heart failure, chronic kidney disease). The treatment effect was calculated by comparing PC and conventional care and discount rates of 5% and 3% were applied to costs/outcomes, respectively. In a cash flow model, the net present value based on the return on investment (ROI) over 10 years was calculated, which represented a quantitative measure of the pharmaceutical care (PC) acceptance effect, and was converted into a net health benefit (NHB). The systematizing of the epidemiological and NHB impact provided the calculation and sensitivity analysis of VOI according to the variation for 10,000 Monte Carlo's iterations of 38 inputs from the expected value of PC implementation. RESULTS: The ROI was USD $1,712,710 (95%CI 1,146,000-2,216,000), which represented a cost-benefit ratio of 30.03 (95%CI, 26.74e34.28). The social variables presented an important impact on NHB, they were able to change the ROI from USD $1,283,206 to USD $1,962,401. Lambda was estimated as the largest limit of willingness to pay for QALY, usually in LMICs; in Brazil it is three times the GDP, USD $28,000. Thus, the calculated NHB was 2.8 per patient (95%CI 2.67 -3.04) and NHB ROI¼5.41%. CONCLUSIONS: The impact of implementation was higher than implementation of net beneficial technology, which presents a great opportunity cost for PC.
INTRODUCCIÓNActualmente es reconocida la trascendencia que reviste en las personas mayores la "capacidad funcional" como parámetro de evaluación del estado de salud, entendiéndose como funcionalidad la posibilidad de realizar determinadas acciones de la vida diaria. Surgen de este modo las actividades básicas de la vida diaria (ABVD) que permiten la subsistencia del individuo englobando las capacidades de autocuidado más elementales. Éstas son las últimas en perderse o las primeras en recuperarse después de un deterioro funcional y su dependencia es incompatible con la vida si no es sustituida por un cuidador. OBJETIVOSIdentificar las principales alteraciones que se presentan en las ABVD de las personas mayores, inscritas en el nivel primario de atención de la comuna de Chillán Viejo.Determinar la asociación entre el grado de funcionalidad de las ABVD y los factores sociodemográficos y de salud involucrados. METODOLOGÍAEstudio cuantitativo correlacional de corte transversal. La muestra se constituyó por 137 personas, seleccionada por muestreo estratificado en tres sectores dependientes de un Cesfam de la comuna de Chillán Viejo.Los datos fueron obtenidos mediante visita domiciliaria con la aplicación del Índice(1) Universidad del Biobío. roxanalara@gmail.com de Barthel para las ABVD, Escala abreviada de Depresión Geriátrica de Yesavage, Mini Mental State Examination y un instrumento de recolección de datos sociodemográficos y de salud para la determinación de variables específicas RESULTADOSEl 61.3% de los usuarios correspondió a mujeres; el promedio de edad fue de 73 años; 84,4% sabe leer, y un 69,6% tiene estudios bá-sicos. El 51,5% era casado y un 32,4% viudo. El 59,1% no participa en grupos comunitarios, el 76.6% percibe tener apoyo en emergencias, principalmente de familia con un 64.2%, 56.9% percibe su salud como buena, 25% regular y 15,3% mala.En relación a ABVD, el 70,1% puede realizarlas de manera independiente, el 12,4% con escasa dependencia y un 17,5% con dependencia moderada. Las ABVD que presentaron mayor alteración correspondieron a "subir y bajar escalones" (22%), "desplazarse" (9%) y "trasladarse entre la silla y la cama" (7%). Se asoció a la dependencia la mayor edad (p<0,05), el analfabetismo (p<0,01), el sedentarismo (p<0,05) y la hipoacusia (p<0,05). CONCLUSIONESSiguiendo la tendencia nacional e internacional, prevaleció la autovalencia por sobre la dependencia, escenario que proporciona posibilidades de intervenciones preventivas y de promoción que prolonguen la autonomía, poRev
The purpose of this study is to estimate the prevalence of and characterize the use of psychoactive drugs among drug users in a Brazilian municipality, relating the findings to factors associated with the consumption of these substances. Through a cross-sectional design, 1,355 drug users from the public health systems community pharmacies were interviewed. Sociodemographic and health-related data were collected, as well as any other prescribed drugs. The prevalence of psychoactive drug use within the last month was 31.0%, with antidepressants and benzodiazepines being the most prescribed (53.5% and 24.6% respectively). Most psychoactive drug users were female (81.9%), lived with a partner (52.6%), had private health insurance (69.2%) and a monthly per-capita income up to one minimum wage (54.0%). The adjusted Odds Ratio (OR) confirmed the following factors to be positively associated with the use of psychoactive drugs: female gender (OR=2.06; 95% CI 1.44; 2.95), age ≥60 years old (OR=1.77; 95% CI 1.26; 2.48), follow-up with a psychologist (OR=4.12; 95% CI 1.84; 5.25), absence of regular physical activity (OR=1.59; 95% CI 1.13; 2.23), and smokers (OR=1.94; 95% CI 1.26; 2.97). Approximately one out of three individuals used at least one psychoactive drug. Health managers should focus the planning and actions aimed at their rational use for these groups, leading to increased overall treatment success.
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