How can I buy cocaine online in Manaus

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How can I buy cocaine online in Manaus

Official websites use. Share sensitive information only on official, secure websites. This article was submitted to Pharmaceutical Medicine and Outcomes Research, a section of the journal Frontiers in Pharmacology. The use, distribution or reproduction in other forums is permitted, provided the original author s and the copyright owner s are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. We aimed to investigate the consumption and lack of access to medicines in the adult population of Manaus, Amazonas. A population-based study was conducted in Manaus in Study outcomes included the consumption of medicines in the previous fortnight and the lack of access to treatments in those who used any medicine. Out of the 2, participants, Among those, 14 in every could not access drug therapies, which was more frequent in people with poor health and with chronic diseases. Keywords: drug utilization, Access to Essential Medicines and Health Technologies, health services accessibility, cross-sectional studies, Brazil. The use and access to medicines are important indicators of population health due to their role in promoting health maintenance and reducing global morbidity and mortality Ofori-Asenso, Non-communicable chronic diseases and multimorbidity are increasingly prevalent globally James et al. Expansion of the access to medicines and innovations on pharmacological treatments are powerful strategies to decrease the burden of chronic diseases Mokdad et al. Nearly 2 billion people have no access to basic medicines, which results in greater suffering, prolonged illness, needless disabilities, and preventable deaths Chan, Access to high-quality essential medicines with affordable prices is essential to reduce the financial burden of care and improve the population health worldwide Ozawa et al. In health systems, access to medicines depends on five main dimensions: availability, affordability, accessibility, acceptability, and quality Bigdeli et al. Medicines represent important health expenditures in Brazilian households, especially for socioeconomically disadvantaged families Luiza et al. The free availability of medicines and access to health care services from SUS are imperative for these individuals Andrade et al. Even if prescribed, essential medicines may not be available at SUS due to deficiencies in the governmental supply chain management, including constraints in the funding of pharmaceutical policies Nascimento et al. Brazil lacks information systems that can provide data about the utilization of medicines by the general population. The aim of this study was to investigate the prevalence of consumption and lack of access to medicines among adults in the Brazilian Amazon. A population-based cross-sectional study was conducted between April and June with adults living in Manaus, Amazonas. This study is part of a major survey that aimed to investigate the use of health care services and supplies in the city Silva et al. Manaus is the capital of Amazonas state, located in the North region of Brazil. The participants were selected through a probabilistic sampling method performed in three stages, stratified by sex and age: census tracts random , household systematic , and individual random Silva et al. In total, 2, individuals were planned to participate in the study Silva et al. The primary outcome was the consumption of medicines in the previous 15 days. The secondary outcome was the lack of access to treatments, defined as the unmet need for pharmacological treatments among those who reported using medicines in the period. All medicines were classified in their full ATC code all levels. The name of the medicine was optionally confirmed in the medical prescriptions or drug packages if available at the moment of the interview. We considered the consumption of medicines in the last 15 days prior to the interview to avoid recall bias. If available at the households, the consumed medicines were confirmed by the medical prescription or drug package. We conducted a pilot study with participants to evaluate their understanding of the questionnaire, who were included in the final sample. The audio of the interviews was recorded and the location where the interviews were conducted was georeferenced by the device. We used descriptive statistics to characterize the sample. The pharmacological or therapeutic subgroups second level of the ATC were described according to their frequency. All analyses were conducted in Stata This study was approved by the Ethics Research Committee from the University of Amazonas through the approval letter No. All of the participants signed an Informed Consent Form before any study procedure was performed. Out of the 2, participants who were included in the study Supplementary Material 1 , 1, used medicines in the previous 15 days prevalence: Just over half of the participants were men The consumption of medicines was more frequent among women Lack of access to treatments was higher in women Out of the 2, medicines used among the participants, The lack of access to treatments was positively associated with fair PR 1. Half of the adult population of Manaus used medicines in the previous 15 days, which was associated with older age, lower social class and educational level, worse health statuses, use of health care services, and presence of chronic diseases. Among those who used medicines, 14 in every reported lack of access to treatments; unmet need for medicines was higher people with worse health statuses and people with chronic diseases. This study presents limitations, such as those present in cross-sectional designs Thiese, Recall bias may have underestimated the results as the participants may have forgotten to report the use of some medicines. Since the study was conducted in the first semester, seasonality may have also influenced the results as some diseases e. In the present study, drugs were not restricted only to essential medicines, thus policy makers should interpret our results with caution. Sample size calculations were performed considering estimates of health care services usage; therefore, the survey was not specifically powered based on the outcomes of the present analysis. Previous data from population-based studies reinforce the differences in the access to treatments between Brazilian regions, particularly in the North and Northeast regions, the least developed of the country Paniz et al. The promotion of rational use of medicines among the elderly is particularly important since older age is associated with higher rates of potentially inappropriate medications Lutz et al. Consumption of medicines was negatively associated with lower social class, similar to a previous national survey with 41, people, which observed that the lowest prevalence of medicine consumption occurred in poorer individuals and in the North region of Brazil — where Manaus is located Bertoldi et al. Indeed, previous analyses conducted in this region showed that socioeconomic inequalities play an important role in the access and use of health care services among adults Araujo et al. Since then, dismantling of public policies related to the access to essential medicines Trindade, may explain the current influence of socioeconomic variables in the use of medicines in present analysis. In the present study, as consumption was not restricted only to essential medicines provided by SUS, it is possible that individuals from higher social classes used more medicines due to their higher purchasing power, as indicated by a previous analysis Vogler et al. We also found that the use of medicines was lower among those with lower educational level. This contrasts with the results of a national cross-sectional study conducted with 8, patients from the Brazilian Unified Health System in , which indicated that the majority of those who consumed medicines in the previous 30 days had lower educational levels Costa et al. The results from the Brazilian National Health Survey from also endorses our findings: the percentage of individuals who obtained all medications prescribed in the last health care visit was higher among people with higher levels of education in comparison to those with lower educational attainment Stopa et al. The use of medicines was higher in people with worse health statuses, chronic diseases, and who used health care services recently. These findings may be explained by the significant inequities in the access to health care services Araujo et al. Lack of financial resources was the most reported reason for not accessing treatments in our study. The high prices of medicines can increase catastrophic expenditures for patients, especially in low- and middle-income countries Ahmadiani and Nikfar, In the present analysis, the unavailability of medicines in health care services and pharmacies was also a common reason for the lack of access. Previous analyses showed that the availability of medicines, notably in SUS, does not supply essential medicines to the entire population, which impacts mainly the poorest people Bertoldi et al. Our study also showed that individuals with worse health statuses and with chronic diseases had lower access to required treatment, that is, the sicker individuals were not accessing all the medicines they needed. In a national population-based study conducted in with 12, people who reported having chronic diseases, lack of access was highest in the North region, and people with worse health status had significantly less access to treatment Oliveira et al. The South and Southeast regions of Brazil also have greater access to health care services, especially when compared to underserved areas, such as the Amazon Stopa et al. The sicker inhabitants of Manaus have lower access to health care services and appropriate treatment, which may result in higher expenditures from both individual and health system perspectives Luiza et al. Participants mostly used symptomatic drugs, antibiotics, and drugs for the treatment of hypertension and diabetes in the two weeks prior the interview. Some of these therapeutic classes were also frequently not accessible. Although we could not assess if the drug therapies were appropriate, it is possible that the lack or insufficiency of treatment of previously minor conditions could increase the burden of diseases and related costs Fielding et al. Lack of access was measured only in individuals who reported using at least one medicine in the recall period to avoid memory bias; therefore, lack of access to medicines is potentially underestimated in our analysis. The restriction to people using medicines recently may reflect decisions that this sample had to make when obtaining the products since the main reason for not assessing treatments was the lack of money, such as the prioritization to buy cheaper medicines Weiner, ; Gronde et al. Antibiotics were reported as the main inaccessible treatments. Brazilian federal expenditures on anti-infectives for systemic use and drugs for alimentary tract and metabolism significantly decreased from to , whereas expenditures on immunomodulating agents increased Magarinos-Torres et al. Interestingly, an analysis conducted in Manaus showed that self-medication with antibiotics increased between and , suggesting that the population had to seek for alternative sources to obtain treatment and that self-medication persists even after the regulation of antibiotics sales was implemented Baldin Tiguman et al. In conclusion, half of the adult population of Manaus used medicines in the previous 15 days, which was higher in socially privileged people and sicker individuals. Lack of access to treatments was reported by 14 out of inhabitants who consumed medicines and was higher in people with worse health statuses, and people with chronic diseases. Higher investments in pharmaceutical services and access policies are necessary to improve the rational consumption and proper access to medicines in the region. The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. The studies involving human participants were reviewed and approved by Ethics Research Committee from the University of Amazonas. MS and TG designed the work, analyzed and interpreted the data, critically reviewed the work for important intellectual content, and approved the final version of this manuscript. GT analyzed and interpreted the data and drafted the work. All authors contributed to the article and approved the submitted version. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. Front Pharmacol. Find articles by Gustavo Magno Baldin Tiguman. Find articles by Marcus Tolentino Silva. Received Jul 23; Accepted Sep 14; Collection date Open in a new tab. 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How can I buy cocaine online in Manaus

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How can I buy cocaine online in Manaus