Unused medicines with potential for misuse or abuse in primary care

To assess the quantity and nature of prescribed medicines with potential for misuse returned to community pharmacies and general practice surgeries. Setting Community pharmacies (n = 51, 85% total) and general practice surgeries (n = 42, 69%) within the boundaries of Eastern Birmingham Primary Care Trust, UK. Method Medicines returned spontaneously by patients to participating sites were collected over eight weeks in May and June 2003. Data were recorded for each medicinal item including: patient sex, recommended International Non-proprietary Name (rINN), strength, form, legal classification, quantity and number of doses per day. Medicines were categorised into BWF therapeutic groups. A 'medicinal item' was defined as the total number of dose units of a medicine of the same form, strength and date of issue, returned for a given patient. Key findings Medicines were returned from 910 patients comprising 3765 medicinal items (2782 (73.9%) prescription-only medicines and 356 (9.5%) controlled drugs). Substantial amounts of unused, prescribed medicines with potential to cause harm or for misuse were returned, with analgesics, psychoactive and antiepileptic agents comprising 19.4% of returned medicinal items. Medicines of note that were returned included paracetamol-containing medicines (16 630 tablets), morphine (56 g), diamorphine (4.3 g), tramadol (2840 tablets and capsules), benzodiazepines (677 tablets) and tricyclic antidepressants (2831 tablets). Conclusions Substantial quantities of prescribed medicines with potential to cause harm or be misused are routinely present in the community. The management of these unused medicines, and in particular controlled drugs, Is currently inadequate and further work is required to identify the legislative and patient-centred processes required to minimise the potential for these medicines to be misused or cause harm. © 2007 The Authors.

Editorial

The year so far has been a slow start for many businesses, but at least we have not seen the collapse of as many businesses that we were seeing around two years ago. We are, however, still well and truly in the midst of a global recession. Interest rates are still at an all time low, UK house prices seem to be showing little signs of increase (except in London where everyone still seems to want to live!) and for the ardent shopper there are bargains to be had everywhere. It seems strange that prices on the high street do not seem to have increased in over ten years. Mobile phones, DVD players even furniture seems to be cheaper than they used to be. Whist much of this is down to cheaper manufacturing and the rest could probably be explained by competition within the market place. Does this mean that quality suffered too? Now that we live in a world when if a television is not working it is thrown away and replaced. There was a time when you would take it to some odd looking man that your father would know who could fix it for you. (I remember our local television fix-it man, with his thick rimmed bifocal spectacles and a poor comb-over; he had cardboard boxes full of resistors and electrical wires on the floor of his front room that smelt of soldering irons!) Is this consumerism at an extreme or has this move to disposability made us a better society? Before you think these are just ramblings there is a point to this. According to latest global figures of contact lens sales the vast majority of contact lenses fitted around the world are daily, fortnightly or monthly disposable hydrogel lenses. Certainly in the UK over 90% of lenses are disposable (with daily disposables being the most popular, having a market share of over 50%). This begs the question – is this a good thing? Maybe more importantly, do our patients benefit? I think it is worth reminding ourselves why we went down the disposability route with contact lenses in the first place, and unlike electrical goods it was not just so we did not have to take them for repair! There are the obvious advantages of overcoming problems of breakage and tearing of lenses and the lens deterioration with age. The lenses are less likely to be contaminated and the disinfection is either easier or not required at all (in the case of daily disposable lenses). Probably the landmark paper in the field was the work more commonly known as the ‘Gothenburg Study’. The paper, entitled ‘Strategies for minimizing the Ocular Effects of Extended Contact Lens Wear’ published in the American Journal of Optometry in 1987 (volume 64, pages 781-789) by Holden, B.A., Swarbrick, H.A., Sweeney, D.F., Ho, A., Efron, N., Vannas, A., Nilsson, K.T. They suggested that contact lens induced ocular effects were minimised by: •More frequently removed contact lenses •More regularly replaced contact lenses •A lens that was more mobile on the eye (to allow better removal of debris) •Better flow of oxygen through the lens All of these issues seem to be solved with disposability, except the oxygen issue which has been solved with the advent of silicone hydrogel materials. Newer issues have arisen and most can be solved in practice by the eye care practitioner. The emphasis now seems to be on making lenses more comfortable. The problems of contact lens related dry eyes symptoms seem to be ever present and maybe this would explain why in the UK we have a pretty constant contact lens wearing population of just over three million but every year we have over a million dropouts! That means we must be attracting a million new wearers every year (well done to the marketing departments!) but we are also losing a million wearers every year. We certainly are not losing them all to the refractive surgery clinics. We know that almost anyone can now wear a contact lens and we know that some lenses will solve problems of sharper vision, some will aid comfort, and some will be useful for patients with dry eyes. So if we still have so many dropouts then we must be doing something wrong! I think the take home message has to be ‘must try harder’! I must end with an apology for two errors in my editorial of issue 1 earlier this year. Firstly there was a typo in the first sentence; I meant to state that it was 40 years not 30 years since the first commercial soft lens was available in the UK. The second error was one that I was unaware of until colleagues Geoff Wilson (Birmingham, UK) and Tim Bowden (London, UK) wrote to me to explain that soft lenses were actually available in the UK before 1971 (please see their ‘Letters to the Editor’ in this issue). I am grateful to both of them for correcting the mistake.

Evolução espaço-temporal da ocupação urbana sobre áreas naturais no município de Natal-RN

In this work the landscape morphodynamics was used to check the strength and importance of the changes carried out by man on the environment over time, in Natal-RN municipality. The occupation of partially preserved natural areas was analyzed, but environmentally fragile, such as riparian forests, vegetation on the banks of waterways, which play regulatory role of the water flow, and the dunes, which guarantee the rapid recharge of aquifers. The impacts of urban sprawl in Natal Southern and West zones Were identified and characterized, through a detailed mapping in the period between 1969 and 2013 the main Permanent Preservation Areas - PPA (banks of rivers and lagoons, and dunes remaining) and their temporal changes. For this were used aerial photographs and satellite imagery, altimetry data, and pre-existing information, which allowed the creation of a spatial database, and evolution of maps of impervious areas, evolution of the use and occupation and Digital Terrain Model (DTM) from contour lines with contour interval of 1 meter. Based on this study presents a diagnosis of the environmental situation and the state of conservation of natural areas, over the last 44 years, compared to human pressures. In general, it was found that the urban settlement has advanced about 60% of studied natural areas. This advance was growing by the year 2006, when there was a slowdown in the process, except for the Environmental Protection Zone (EPZ) 03, where the river Pitimbú and your PPA, which experienced a more significant loss area. The urban occupation affected the natural drainage and contributed to the contamination of groundwater Natal, due to increased sealed area, the release of liquid and solid waste, as well as the removal of riparian vegetation. Changed irreversibly the natural landscape, and reduced the quality and quantity of water resources necessary for the population. Thus, it is necessary to stimulate the adoption of use and protection of PPA planning measures, to the preservation of the San Valley Region inserted into the EPZ 01, and integrate more remaining dunes, in good condition, this EPZ, due to the importance of those remaining on the environment and the maintenance of quality of life. It is suggested, also, protection of catchment areas, such as PPA ponds and Pitimbú River. Finally, it is expected that this study can assist the managers in making decisions in urban and environmental planning of the municipality

Pesca artesanal entre mudanças socioambientais: estudo de caso na APA Bonfim-Guaraíra/RN-Brasil

Artisanal fishing is one of the important economic activities of Rio Grande do Norte (RN), becoming the main form of survival and income for many families. The southern coast of RN has strong fishing tradition, both in exploitation of fish as in the collection of mollusks on the banks of Guaraíra Lagoon (APA Bonfim-Guaraíra). In recent years, fishing communities have become more vulnerable to outside influences, since the socio-economic and environmental changes are exposed. These changes require adjustments to the fishermen to different environmental conditions, as the social and natural systems are driven by reorganization and upgrading processes. The living conditions in fishing communities are objective and necessary in different ways, according to a selection that is cultural, so adaptable. This study has the general objective to analyze the main environmental changes in fishing communities, based on the understanding of fishermen and mollusk fisherwomen about this problem. The specific objectives searched to: describe the socioeconomic profile, prospects and difficulties of fishermen and mollusk fisherwomen; investigate the major social and environmental changes in the fishing communities of Patané and Camocim (Arez/RN). The methodology was qualitative-quantitative with the techniques of observation in the field and open and semistructured interviews applied to representatives of Cologne fishing, fishermen and mollusk fisherwomen. Between the months of January to July 2014 were applied semistructured interviews with 41 interlocutors in Patané and 23 of Camocim; totaling 64 people. The results indicated that the interlocutors are aged 40 to 60 years; have only completed elementary school level; are married and have children; survive on less than a minimum wage income and they are not receiving employment insurance. The case study also revealed that the socioeconomic and environmental problems reflected in changes in reproduction, organization and social division of labor, which generates adaptive changes of families to external influences, resulting directly from other economic activities and market pressure and indirectly from tourism. Therefore, adaptations to changes scenario presented as favorable to economic aspects and unfavorable to the social and environmental aspects. In short, the fishery develops on technical, bureaucratic and financial obstacles, in the everyday needs of men and women is the determining factor in willingness to continue exercising fishing and shell fishing on Guaraíra Lagoon, space representing relations social, practices and customs transmitted in the course of local history through social memory of the oldest to the youngest.

Beta-blockers in COPD : time for reappraisal

Peer reviewed

Childhood obesity in relation to poor asthma control and exacerbations : A meta-analysis

Peer reviewed

Desempenho térmico de coberturas: Um estudo comparativo entre as telhas de material reciclado, de fibra e betume, fibrocimento e cerâmica

This study aims to compare the thermal performance of tiles made from recycled material (waste packaging cardboard with aluminized film) with the tiles of fiber and bitumen, fiber cement and red ceramic with the aim of verifying the suitability of tile to be used in hot and humid climate of low latitude. The samples were selected according to the availability from Natal - RN market, as they are sold to the consumers. The methodology was based on studies that used experimental apparatus composed of thermal chambers heated by banks of incandescent bulbs, to analyze the thermal performance of materials. The tiles in the study were submitted to analysis of thermal performance, thermophysical properties and absorptance, using chambers of thermal performance, measuring the thermophysical properties and portable spectrometer, respectively. Comparative analysis of thermal performance between two samples of the recycled material with dimple sizes and different amounts of aluminum were made, in order to verify, if these characteristics had some interference on the thermal performance of them; the results showed no significant performance differences between the samples. The data obtained in chambers of thermal performance and confirmed by statistical analysis, showed, that the tile of recycled material have similar thermal performance to the tile of fiber cement. In addition to these tests was carried out the automatic monitoring of a building covered with tiles of recycled material, to verify its thermal performance in a real situation. The results showed that recycled shingles must be used with technical criteria similar to those used for fiber cement tiles, with regard to the heat gain into the building. Within these criteria should be taken into account local characteristics, especially in regions with hot and humid climate, and its use must be associated, according to the literature, to elements of thermal insulation and use of passive techniques such as vented attics, ceilings and right foot higher

O Palácio dos Câmara "aos Mártires" : um caso excecional da opulência seiscentista

Um dos edifícios de tipologia palaciana que se destaca na iconografia da Lisboa antiga corresponde ao desaparecido Palácio dos Câmara, condes de Vila Franca (1583) e de Ribeira Grande (depois de 1662). Situava-se na colina de S. Francisco, uma área de ocupação aristocrática da cidade, frente à igreja de Nossa Senhora dos Mártires, a leste do Paço dos Duques de Bragança e a norte do Corpo Santo, onde se erguia perto da margem do Tejo, o também já desaparecido Palácio Corte Real. Porventura ofuscada pela grandiosidade destes imóveis, a historiografia olisiponense não tem prestado a devida atenção ao palácio dos Câmara que, no entanto, deve ser encarado como um dos mais significativos palácios urbanos da primeira metade de seiscentos. Com base no cruzamento de fontes iconográficas, judiciais, administrativas e epistolares, o presente estudo dá conta dos aspetos da encomenda, da autoria e datação envolvidos na sua construção, procurando, acima de tudo, caracterizá-lo do ponto de vista tipológico, espacial e distributivo, por forma a entender as opções arquitetónicas, os padrões de gosto e as vivências do espaço interior protagonizados por um dos mais destacados membros da nobreza titular portuguesa.

Magnetic Theory and Applications in the Naples Bay (Southern Tyrrhenian Sea, Italy): Magnetic Anomaly Fields and Relationships with Morpho-Structural Lineaments

Magnetic theory and application to a complex volcanic area located in Southern Italy are here discussed showing the example of the Gulf of Naples, located at Southern Italy Tyrrhenian margin. A magnetic anomaly map of the Gulf of Naples has been constructed aimed at highlighting new knowledge on geophysics and volcanology of this area of the Eastern Tyrrhenian margin, characterized by a complex geophysical setting, strongly depending on sea bottom topography. The theoretical aspects of marine magnetometry and multibeam bathymetry have been discussed. Magnetic data processing included the correction of the data for the diurnal variation, the correction of the data for the offset and the leveling of the data as a function of the correction at the cross-points of the navigation lines. Multibeam and single-beam bathymetric data processing has been considered. Magnetic anomaly fields in the Naples Bay have been discussed through a detailed geological interpretation and correlated with main morpho-structural features recognized through morphobathymetric interpretation. Details of magnetic anomalies have been selected, represented and correlated with significant seismic profiles, recorded on the same navigation lines of magnetometry. They include the continental shelf offshore the Somma-Vesuvius volcanic complex, the outer shelf of the Gulf of Pozzuoli offshore the Phlegrean Fields volcanic complex, the relict volcanic banks of Pentapalummo, Nisida and Miseno, the Gaia volcanic bank on the Naples slope, the western slope of the Dohrn canyon, the Magnaghi canyon’s head and the magnetic anomalies among the Ischia and Procida islands.

Os moinhos do Rio Almansor no Concelho de Montemor-o-Novo : Um património a conhecer, preservar e valorizar

Esta dissertação tem como tema "Os Moinhos do Rio Almansor no Concelho de Montemor-o-Novo- um património a conhecer, preservar e valorizar", é composta por cinco capítulos, nos quais se pretendeu demonstrar a importância que o património molinológico tem na actualidade, abordar a própria evolução do conceito que abrange hoje os moinhos na vertente cultural, apresentação de alguns estudos e experiências de valorização a nível nacional e internacional deste património, breve descrição da evolução tecnológica tradicional da moagem e análise dos factores geomorfológicos e históricos que estiveram na origem desta actividad em Montemor-o-Novo, o que possibilitou um melhor conhecimento e compreensão do seu desenvolvimento. Um dos principais objectivos foi dar a conhecer os moinhos existentes ao longo das margens do Rio Almansor no Concelho de Montemor, a partir do levantamento patrimonial realizado no terreno, durante o estágio realizado na Câmara Municipal, nomeadamente a sua identificação e caracterização arquitectónica e molinológica. No último capítulo apresenta-se, em resposta ao objectivo principal desta dissertação, uma proposta de valorização dos moinhos, que possa contribuir para a preservação e salvaguarda do pouco, que ainda existe deste património, neste Concelho. A metodologia que se seguiu para a realização desta dissertação assentou em cinco vertentes: em primeiro lugar no levantamento de campo, que foi alvo de pesquisa de localização e identificação dos moinhos no terreno; realização de entrevistas; pesquisa de fontes e de documentação antiga e recolha de bibliografia. Como resultados obtidos pode-se destacar ao longo deste trabalho de dissertação, um conhecimento geral do desenvolvimento da moagem em Portugal, a caracterização e identificação dos moinhos hidráulicos existentes no rio Almansor neste Concelho e a proposta de preservação e valorização deste património molinológico montemorense que poderá servir como exemplo para outras propostas similares, assim como também contribuir para a melhoria de futuras propostas. ABSTRACT; The theme of this dissertation is "The mills of the River Almansor in Montemor­o-Novo County - a cultural heritage to know, preserve and treasure". It's constituted by five chapters, in which we intended to demonstrate the importance that the molinological heritage has nowadays. ln a cultural view it is disseminated on a national and international level by the approaching of the evolution of the concept like it is demonstrated by some studies and experiments here presented, as well as a brief description of the technological evolution of the traditional grinding and analysis of the geomorphologic and historical factors that were in the origin of this activity in Montemor-o-Novo, which allowed a better knowledge and understanding of their development. One of the main goals was to portray the existing mills alongside the river banks of Almansor, in the County of Montemor. lt was made throughout a survey of the patrimonial background on the field, during the training held by the City Hall, including its identification and molinological architectural characterization. ln the last chapter was presented as a response to the main reason of this dissertation, a revival proposal of the mills, which may contribute to the preservation and protection of the few that still remains, in this County. The methodology that was followed for this thesis was based on five aspects: first, the field survey, revealing the research and identification of the location of the mills on the field; interviews, research of sources, old documentation and collection of bibliography.

Estudo da incorporação de cascalho proveniente da perfuração de poços de petróleo em formulações para tijolos de solo-cimento

The present work is to study the characteristics and technological properties of soil-cement bricks made from binary and ternary mixtures of Portland cement, sand, water, with or without addition of gravel from the drilling of oil wells, which could be used by industry, aiming to improve its performance and reduce cost by using the residue and, consequently, increasing its useful life. The soil-cement bricks are one of the alternatives to masonry construction. These elements, after a short curing period, provide compressive strength similar to that of solid bricks and ceramic blocks, and the higher the resistance the higher the amount of cement used. We used the soil from the city of São José do Mipibu / RN, the banks of the River Baldun, cement CPIIZ-32 and residue of drill cuttings from oil wells drilling onshore wells in the town of Mossley, RN, provided Petrobras. To determine the optimum mix, we studied the inclusion of different residues (100%, 80%, 70%, 60% and 50%) where 15 bodies were made of the test piece. The assessment was made of bricks made from simple compression tests, mass loss by immersion and water absorption. The experimental results proved the efficiency and high utilization of the waste from the drilling of oil wells, making the brick-cement-soil residue with a higher strength and lower water absorption. The best result in terms of mechanical strength and water absorption for the ternary mixture was 10% soil, 14% cement and 80% residue. In terms of binary mixtures, we obtained the best result for the mix-cement residue, which was 14% cement incorporated in the residue

Parques lineares ao longo de corpos hídricos urbanos : conflitos e possibilidades; o caso da orla do lago Paranoá – DF

Tese (doutorado)—Universidade de Brasília, Faculdade de Arquitetura e Urbanismo, Programa de Pesquisa e Pós-Graduação da Faculdade de Arquitetura e Urbanismo, 2016.

Desempenho térmico de coberturas: Um estudo comparativo entre as telhas de material reciclado, de fibra e betume, fibrocimento e cerâmica

This study aims to compare the thermal performance of tiles made from recycled material (waste packaging cardboard with aluminized film) with the tiles of fiber and bitumen, fiber cement and red ceramic with the aim of verifying the suitability of tile to be used in hot and humid climate of low latitude. The samples were selected according to the availability from Natal - RN market, as they are sold to the consumers. The methodology was based on studies that used experimental apparatus composed of thermal chambers heated by banks of incandescent bulbs, to analyze the thermal performance of materials. The tiles in the study were submitted to analysis of thermal performance, thermophysical properties and absorptance, using chambers of thermal performance, measuring the thermophysical properties and portable spectrometer, respectively. Comparative analysis of thermal performance between two samples of the recycled material with dimple sizes and different amounts of aluminum were made, in order to verify, if these characteristics had some interference on the thermal performance of them; the results showed no significant performance differences between the samples. The data obtained in chambers of thermal performance and confirmed by statistical analysis, showed, that the tile of recycled material have similar thermal performance to the tile of fiber cement. In addition to these tests was carried out the automatic monitoring of a building covered with tiles of recycled material, to verify its thermal performance in a real situation. The results showed that recycled shingles must be used with technical criteria similar to those used for fiber cement tiles, with regard to the heat gain into the building. Within these criteria should be taken into account local characteristics, especially in regions with hot and humid climate, and its use must be associated, according to the literature, to elements of thermal insulation and use of passive techniques such as vented attics, ceilings and right foot higher

A Bestança - Pedras do Pão

O presente trabalho surge como resultado da investigação efetuada ao longo das margens do rio Bestança, no concelho de Cinfães, consistindo este não só num contributo para a defesa, preservação, conhecimento e divulgação do notável património molinológico que as margens deste rio albergam, mas também, no estudo do seu estado atual e numa reflexão que questiona o futuro destas, outrora imprescindíveis, estruturas. No sentido de uma melhor fundamentação desta investigação, assim como do estudo e reflexão do tema, foi elaborado o inventário dos moinhos de água localizados nas margens do rio Bestança. Além do inventário, foi também recolhida, analisada e tratada, informação respeitante às suas características, ao seu estado de conservação, sistemas e materiais de construção utilizados. Para um melhor entendimento e contextualização dos temas (moinhos e património), apresentase, de forma sintética, no decurso deste trabalho, um resumo da evolução histórica e tecnológica dos moinhos, assim como uma descrição das várias tipologias existentes. Assim, e da mesma forma, se procede relativamente ao tema património, elaborando-se uma descrição da evolução que o conceito de património, da sua proteção, conservação e restauro, sofreu ao longo dos tempos, assim como de algumas teorias de intervenção a ele associadas. Este trabalho tem o intuito de não só alertar para o estado de degradação e abandono em que se encontra este importante património e de sensibilizar a população, e os poderes administrativos, da sua importância enquanto elemento cultural e identitário do vale do Bestança, como também de apresentar soluções que visem a sua recuperação e valorização, integrando-o de forma sustentável numa nova realidade. Para tal, apresenta-se no final deste trabalho uma proposta de recuperação e adaptação de um moinho a novas funções, que visem potenciar o desenvolvimento económico e social, do local onde este se insere. Apesar de esta investigação se limitar às margens do rio Bestança, foi possível apurar que este património se encontra disseminado por todo o vale, marginando os afluentes deste rio, com capacidade para mover "rodas", espera-se também, que este trabalho seja o mote inicial para a realização da inventariação, estudo, conservação e restauro de todo o extenso espólio patrimonial, molinológico ou não, do vale do rio Bestança.

Evaluación de bancos naturales de invertebrados marinos comerciales, Región La Libertad-Perú, 2012

En la Región la Libertad, la mayor producción pesquera artesanal descansa en tres pesquerías del ámbito costero: cangrejo violáceo, caracol negro y pulpo. La pesca de altura de la pota, es importante por los volúmenes que aporta a la pesquería. La evaluación, se realizó en el litoral de la Región La Libertad, desde Chérrepe (7°9’35,4”S – 79°41’8,2”W) hasta isla Corcovado (8°56’25,8”S - 78°41’49,4”W), del 8 al 28 de octubre 2012. El trabajo se efectuó en dos etapas: 16 días por mar y 5 días por mar somero, y comprendió los diversos tipos de muestreos en las estaciones, tanto biológicas como oceanográficas. El estudio se efectuó en treinta y nueve bancos de invertebrados marinos: siete de caracol negro, cuatro de pulpo, dos de concha de abanico, dos de almeja, dos de muy muy, cuatro de pepino de mar, y dieciocho de cangrejo violáceo.