Revista de saude publica最新文献

{"title":"Reconciling advantages and difficulties: knowledge and perceptions of event-driven PrEP among young people.","authors":"Luiz Fabio Alves de Deus, Dulce Ferraz, Lorruan Alves Dos Santos, Alexandre Grangeiro, Inês Dourado, Marcia Thereza Couto, Ramiro Fernandez Unsain, Eliana Miura Zucchi","doi":"10.11606/s1518-8787.2020054005729","DOIUrl":"10.11606/s1518-8787.2020054005729","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to analyze the knowledge about the HIV event-driven pre-exposure prophylaxis (event-driven PrEP) scheme and the perception of its potential use among young men who have sex with men (MSM), travestis, and transgender women (TrTW) who were followed up in the cohort.</p><p><strong>Methods: </strong>This qualitative study included 50 interviews with participants from the municipalities of Salvador and São Paulo, aged 15 to 19 years, who made daily use of PrEP or other preventive methods. They were addressed by different demand creation strategies. The in-depth interviews covered topics such as sexual practices, event-driven PrEP knowledge, acceptability, and motivations for its use. A two-stage thematic analysis was carried out on Nvivo, version 12.</p><p><strong>Results: </strong>Most participants were unaware of event-driven PrEP, and many questioned its effectiveness and safety when receiving information about it. However, on learning about the program, many young people saw advantages, such as not having to take daily medication and the possibility of using it only at times of greater risk. Participants also found barriers to using event-driven PrEP, such as the unpredictability of sexual relations and the difficulty in administering dosages in this modality.</p><p><strong>Conclusion: </strong>Limited knowledge and experiences with daily oral PrEP influenced interest in event-driven PrEP, which highlights the need for information strategies that enable young MSM and TrTW to read about event-driven PrEP. Young people valued the autonomy and management of preventive methods provides by this new modality, which is more in line with the dynamics of their sexual lives, but they face challenges in managing event-driven PrEP.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 suppl 1","pages":"13s"},"PeriodicalIF":2.1,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determining RE-AIM indicators for evaluating the Estratégia Amamenta e Alimenta Brasil (EAAB - Brazilian Breastfeeding and Complementary Feeding Strategy).","authors":"Daiane Sousa Melo, Sonia Isoyama Venancio, Gabriela Buccini","doi":"10.11606/s1518-8787.2024058005875","DOIUrl":"10.11606/s1518-8787.2024058005875","url":null,"abstract":"<p><strong>Objective: </strong>To confirm the diagram of the program's impact pathways and Estratégia Amamenta e Alimenta Brasil (EAAB - Brazilian Breastfeeding and Complementary Feeding Strategy) core functions, and to determine indicators for evaluating EAAB.</p><p><strong>Methods: </strong>This is a qualitative study within the field of implementation research. Data collection included two focus groups with EAAB implementers, document analysis, and literature review. The analysis included a review of the participants' suggestions and two stages of reviewing the diagram and the names of the impact pathways and core functions. Questions for evaluating the EAAB were then constructed based on the confirmed diagram. The indicators of the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance) were adapted to the EAAB context. The evaluation questions were revised according to the RE-AIM domains and, finally, indicators were determined for each evaluation question.</p><p><strong>Results: </strong>This study advanced the analysis of EAAB implementation, defining 22 indicators for its monitoring and evaluation. Most of the indicators are already used in implementation, however, the analysis with the RE-AIM framework allowed the indicators to be updated to be more specific, measurable, and relevant to the desired objectives.</p><p><strong>Conclusion: </strong>The results of the study support the pragmatic application of RE-AIM evaluation in health programs and encourage the planning of evaluation indicators for other child health and development programs in primary care.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 ","pages":"43"},"PeriodicalIF":2.1,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11548908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142352899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fiscal austerity and municipal health spending: an interrupted time series study.","authors":"Leo Ramos Maia, Mônica Rodrigues Campos, Débora Castanheira","doi":"10.11606/s1518-8787.2024058005772","DOIUrl":"10.11606/s1518-8787.2024058005772","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the impact of the fiscal austerity policy (PAF) on health spending in Brazilian municipalities, considering population size and source of funds.</p><p><strong>Methods: </strong>The interrupted time series method was used to analyze the effect of the PAF on total expenditure, resources transferred by the Federal Government, and own/state per capita resources allocated to health in the municipalities. The time series analyzed covered the period from 2010 to 2019, every six months. The first semester of 2015 was adopted as the start date of the intervention. The municipalities were grouped into small (up to 100,000 inhabitants), medium (101,000 to 400,000 inhabitants), and large (over 400,000 inhabitants). The data was obtained from the Sistema de Informações sobre Orçamentos Públicos em Saúde (Information System on Public Health Budget).</p><p><strong>Results: </strong>The results for the national average of municipalities show that the PAF had a negative impact on the level of total expenditure and own/state resources allocated to health in the first half of 2015, without causing statically significant changes in the trends of any of the indicators analyzed in the period after 2015. Small municipalities saw a drop in total expenditure, while large municipalities saw a drop in own/state resources, and medium-sized municipalities saw a drop in both variables. There was no statistically significant drop in the volume of funds transferred by the Federal Government in the immediate aftermath of the implementation of the PAF in any of the municipal groups analyzed. In the medium-term, the PAF only had a negative impact on the large municipalities, which saw significant reductions in the trends of own/state resources and those transferred by the Union for health.</p><p><strong>Conclusion: </strong>In general, the impact of the PAF on health financing in municipalities was immediate and based on the decrease in own/state resources allocated to health. In large municipalities, however, the impact lasted from 2015 to 2019, mainly affecting health expenditure from federal funds.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 ","pages":"42"},"PeriodicalIF":2.1,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11548907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142352900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a machine learning model to estimate length of stay in coronary artery bypass grafting.","authors":"Renato Camargos Couto, Tania Pedrosa, Luciana Moreira Seara, Vitor Seara Couto, Carolina Seara Couto","doi":"10.11606/s1518-8787.2024058006161","DOIUrl":"10.11606/s1518-8787.2024058006161","url":null,"abstract":"<p><strong>Objective: </strong>To develop and validate a predictive model utilizing machine-learning techniques for estimating the length of hospital stay among patients who underwent coronary artery bypass grafting.</p><p><strong>Methods: </strong>Three machine learning models (random forest, extreme gradient boosting and neural networks) and three traditional regression models (Poisson regression, linear regression, negative binomial regression) were trained in a dataset of 9,584 patients who underwent coronary artery bypass grafting between January 2017 and December 2021. The data were collected from hospital discharges from 133 centers in Brazil. Algorithms were ranked by calculating the root mean squared logarithmic error (RMSLE). The top performing algorithm was validated in a never-before-seen database of 2,627 patients. We also developed a model with the top ten variables to improve usability.</p><p><strong>Results: </strong>The random forest technique produced the model with the lowest error. The RMLSE was 0.412 (95%CI 0.405-0.419) on the training dataset and 0.454 (95%CI 0.441-0.468) on the validation dataset. Non-elective surgery, admission to a public hospital, heart failure, and age had the greatest impact on length of hospital stay.</p><p><strong>Conclusions: </strong>The predictive model can be used to generate length of hospital stay indices that could be used as markers of efficiency and identify patients with the potential for prolonged hospitalization, helping the institution in managing beds, scheduling surgeries, and allocating resources.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 ","pages":"41"},"PeriodicalIF":2.1,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11578580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142294238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inclusion of disability in primary healthcare facilities and socioeconomic inequity in Brazil.","authors":"Hannah Kuper, Alexandro Rodrigues Pinto, Everton Nunes da Silva, Jorge Otávio Maia Barreto, Tim Powell-Jackson","doi":"10.11606/s1518-8787.2024058005634","DOIUrl":"10.11606/s1518-8787.2024058005634","url":null,"abstract":"<p><strong>Objective: </strong>To describe disability-related performance and inequality nationwide in Brazil, and the changes that took place between 2012 and 2019 after the introduction of Programme for Improving Primary Care Access and Quality (PMAQ).</p><p><strong>Methods: </strong>We derived scores for disability-related care and accessibility of primary healthcare facilities from PMAQ indicators collected in round 1 (2011-2013), and round 3 (2015-2019). We assessed how scores changed after the introduction of PMAQ. We used census data on per capita income of local areas to examine the disability-specific care and accessibility scores by income group. We undertook ordinary least squares regressions to examine the association between PMAQ scores and per capita income of each local area across implementation rounds.</p><p><strong>Results: </strong>Disability-related care scores were low in round 1 (18.8, 95%CI 18.3-19.3, out of a possible 100) and improved slightly by round 3 (22.5, 95%CI 22.0-23.1). Accessibility of primary healthcare facilities was also poor in round 1 (30.3, 95%CI 29.8-30.8) but doubled by round 3 (60.8, 95%CI 60.3-61.3). There were large socioeconomic inequalities in round 1, with both scores approximately twice as high in the richest compared to the poorest group. Inequalities weakened somewhat for accessibility scores by round 3. These trends were confirmed through regression analyses, controlling for other area characteristics. Disability-related and accessibility scores also varied strongly between states in both rounds.</p><p><strong>Conclusions: </strong>People with disabilities are being left behind by the Brazilian healthcare system, particularly in poor areas, which will challenge the achievement of universal health coverage.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 ","pages":"39"},"PeriodicalIF":2.1,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11578578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142294240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Updating trends in sweetened beverages consumption in Brazil from 2007 to 2021.","authors":"Luiza Eunice Sá da Silva, Thaís Cristina Marquezine Caldeira, Taciana Maia Sousa, Rafael Moreira Claro","doi":"10.11606/s1518-8787.2024058005661","DOIUrl":"10.11606/s1518-8787.2024058005661","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the time trend of sweetened beverages consumption among Brazilian adults in 26 capitals and the Federal District, from 2007 to 2021, with focus on the most recent period (2015 to 2021).</p><p><strong>Methods: </strong>Data from the Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel - Surveillance System of Risk and Protection Factors for Chronic Diseases by Telephone Survey)were used to conduct a time-series analysis (n = 731,683). The prevalence of regular consumption (five or more days/week), average daily consumption (milliliters) and nonconsumption of sweetened beverages were analyzed. Prais-Winsten regression models were used to calculate temporal trends of the indicators for the complete set of the evaluated population and by sociodemographic characteristics (sex, age group, schooling and development level of the geographic region of residence).</p><p><strong>Results: </strong>Between 2007 and 2021, a reduction in the prevalence of regular consumption (-1.23 pp/year) and daily average consumption (-8.62 milliliters/year) of sweetened beverages was observed. However, between 2015 and 2021, this downward trend did not continue. The prevalence of adults who reported not consuming sweetened beverages increased (1.14 pp/year, for 2007-21), although this trend was not significant in the most recent period.</p><p><strong>Conclusions: </strong>The consumption of sweetened beverages among Brazilian adults decreased in the 15 years studied. However, this reduction was not observed more recently, suggesting that further actions must be adopted in the country so that the trend observed in the total period is maintained.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 ","pages":"40"},"PeriodicalIF":2.1,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11578579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142294243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dietary inflammatory index and inflammatory markers in Brazilian adolescents.","authors":"Renata de Sousa Gomes, Poliana Cristina de Almeida Fonseca Viola, Roberta Rejane Santos de Carvalho, Nitin Shivappa, James R Hebert, Ana Karina Teixeira da Cunha França, Carolina Abreu de Carvalho","doi":"10.11606/s1518-8787.2024058005485","DOIUrl":"https://doi.org/10.11606/s1518-8787.2024058005485","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between the inflammatory potential of the diet measured by the energy-adjusted diet inflammatory index (E-DII) and inflammatory markers in adolescents.</p><p><strong>Methods: </strong>This cross-sectional study was conducted among 518 adolescents aged 18 and 19 years from São Luís, Maranhão, Brazil in 2016. A semiquantitative food frequency questionnaire (FFQ) was used to assess dietary intake from which E-DII scores were calculated to determine the inflammatory potential of the diet. The associations between E-DII and inflammatory markers (hs-CRP, IL-6, IL-4, TNF-α, and IFNγ) were analyzed using multivariable linear regression. The variables included in the adjusted model were identified using the directed acyclic graph.</p><p><strong>Results: </strong>The diet of these adolescents was mostly pro-inflammatory; mean E-DII score was 1.71 and ranged from -2.44 to 5.58. Higher E-DII scores were positively associated with higher levels of IFNγ in the adjusted analysis (Adjusted Coef.: 1.19; 95%CI: 0.36-12.04). We observed no associations between E-DII and other inflammatory markers (hs-CRP, IL-6, IL-4, TNF-α). Study results indicate that E-DII is useful in evaluating the inflammatory potential of the diet of Brazilian adolescents.</p><p><strong>Conclusions: </strong>Cross-sectionally E-DII scores were positively associated with IFNγ concentrations. Future research should examine the association between changes in E-DII scores and levels of inflammatory markers longitudinally.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 ","pages":"29"},"PeriodicalIF":2.1,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11319037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142294239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trend of incompleteness of the race/color variable in hospitalizations due to COVID-19 whose outcome was death in Brazil, 2020-2022.","authors":"Hebert Luan Pereira Campos Dos Santos, Emmanuel Santos Trindade, Esly Rebeca Amaral Oliveira, Marcos Vinicius da Silva Cordeiro, Rian Silva de Oliveira, Elvira Caires de Lima, Adriano Maia Dos Santos, Nília Maria de Brito Lima Prado","doi":"10.11606/s1518-8787.2024058006032","DOIUrl":"10.11606/s1518-8787.2024058006032","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the incompleteness and trend of incompleteness of the race/color variable in hospitalizations due to COVID-19 whose outcome was death, in Brazil, between April 2020 and April 2022.</p><p><strong>Methods: </strong>Ecological time series study on the incompleteness of the race/color variable in hospitalizations due to COVID-19 whose outcome was death in Brazil, its macro-regions and Federative Units (FU), by joinpoint regression, calculation of Monthly Percent Change (MPC) and Average Monthly Percent Change (AMPC), based on data from the Hospital Information System of the Unified Health System (SIH/SUS).</p><p><strong>Results: </strong>The incompleteness of the race/color variable in COVID-19 hospitalizations with a death outcome in Brazil was 25.85%, considered poor. All regions of the country had a poor degree of incompleteness, except for the South, which was considered regular. In the period analyzed, the joinpoint analysis revealed a stable trend in the incompleteness of the race/color variable in Brazil (AMPC = 0.54; 95%CI: -0.64 to 1.74; p = 0.37) and in the Southeast (AMPC = -0.61; 95%CI: -3.36 to 2.22; p = 0.67) and North (AMPC = 3.74; 95%CI: -0.14 to 7.78; p = 0.06) regions. The South (AMPC = 5.49; 95%CI: 2.94 to 8.11; p = 0.00002) and Northeast (AMP = 2.50; 95%CI: 0.77 to 4.25; p = 0.005) regions showed an increase in the incompleteness trend, while the Midwest (AMPC = -2.91 ; 95%CI: -5.26 to -0.51; p = 0.02) showed a downward trend.</p><p><strong>Conclusion: </strong>The proportion of poor completeness and the stable trend of incompleteness show that there was no improvement in the quality of filling in the race/color variable during the COVID-19 pandemic in Brazil, a fact that may have increased health inequalities for the black population and made it difficult to plan strategic actions for this population, considering the pandemic context. The results found reinforce the need to encourage discussion on the subject, given that the incompleteness of health information systems increases inequalities in access to health services and compromises the quality of health data.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 ","pages":"37"},"PeriodicalIF":2.1,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11548909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142294242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality trends and years of potential life lost due to suicide in adolescents.","authors":"Beatriz Catarina Dos Santos de Oliveira, Ruth Ellery Lima Flores, Amanda Cristina de Souza Andrade, Roberta Mendes Abreu Silva, Katiene Rodrigues Menezes de Azevedo, Vanessa Moraes Bezerra","doi":"10.11606/s1518-8787.2024058005564","DOIUrl":"https://doi.org/10.11606/s1518-8787.2024058005564","url":null,"abstract":"<p><strong>Objective: </strong>To assess the trend in mortality rates and years of potential life lost (YPLL) due to suicide among adolescents in Northeast Brazil.</p><p><strong>Methods: </strong>This is an ecological time series study, with secondary data from 2011 to 2020 from the Mortality Information System for adolescents aged 10 to 19 years in the Northeast region of Brazil. Groups of causes from the 10th Revision of the International Classification of Diseases were included: X60-X84 (intentionally self-inflicted injuries), Y10-Y19 (poisoning of undetermined intent), and Y87 (sequelae of intentional self-harm). Mortality coefficients and frequency distribution by sociodemographic variables, place of occurrence, and method of suicide were estimates. YPLL were estimated by gender and age. Joinpoint regression analysis was used, and the annual percentage change (APC) was determined with 95% confidence intervals.</p><p><strong>Results: </strong>A total of 2,410 deaths were recorded, with a predominance of adolescents aged between 15 and 19, males, of mixed-race, low schooling, and home was the main place of occurrence. The trend in the death rate was increasing in the Northeast (APC: 3.6%; p = 0.001), in girls aged 10 to 14 (APC: 8.7%; p = 0.003), in boys aged 15 to 19 (APC: 4.6%; p = 0.002) and in Bahia (APC: 8.1%; p = 0.012). Hanging/strangulation was the main method adopted by both sexes. The YPLL due to suicide were 11,110 in 2011 and 14,960 in 2020.</p><p><strong>Conclusion: </strong>The precociousness of suicide committed by girls and the increase in mortality among older adolescents are noteworthy, and specific preventive measures need to be adopted for these groups in order to reduce this preventable cause of death.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 ","pages":"30"},"PeriodicalIF":2.1,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11319033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142294241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Judicialization of Zolgensma in the Ministry of Health: costs and clinical profile of patients.","authors":"Ana Katheryne Miranda Kretzschmar, Ellen Teixeira, Dayani Galato, Everton Nunes da Silva","doi":"10.11606/s1518-8787.2024058005899","DOIUrl":"10.11606/s1518-8787.2024058005899","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the costs and profile of patients who have filed a lawsuit against the Ministry of Health for the treatment of spinal muscular atrophy (SMA) with the onasemnogene abeparvovec (Zolgensma®).</p><p><strong>Methods: </strong>This is a cross-sectional, descriptive study with a census design, based on records of lawsuits filed against the Ministry of Health between January 2019 and September 2022. Data was requested from the Ministry of Health via the Access to Information Act. Information was extracted on the epidemiological profile of the beneficiaries of the lawsuits, as well as the expenses spent by the Ministry of Health in cases where the requests were granted.</p><p><strong>Results: </strong>136 lawsuits were identified, of which 113 (83%) were favorable to patients at a cost of R$ 944.8 million in the period analyzed. Demographic (gender and age), clinical (SMA subtypes, use of ventilatory or nutritional support), and lawsuit (type of legal service) characteristics were not associated with the granting of lawsuits. Prior use of medication (nusinersena or ridisplam) was associated with the dismissal of lawsuits. Of the 113 lawsuits granted in favor of patients, only six (5.3%) would meet the criteria currently established by the National Committee for Health Technology Incorporation - Conitec (children up to six months without ventilatory and nutritional support). R$ 146 million was spent on supplying Zolgensma to children over the age of two, which is outside the recommendation contained in the drug's package leaflet.</p><p><strong>Conclusions: </strong>The Ministry of Health incurs a high cost with the judicialization of Zolgensma for SMA, representing 2.45% of total spending on medicines in the Unified Health System, including spending by the three administrative spheres. Some of the lawsuits have been granted in disagreement with the criteria established by health technology assessment agencies and the drug manufacturer's recommendations.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 ","pages":"36"},"PeriodicalIF":2.1,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11319041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}