Utilização de medicamentos e fatores associados: um estudo de base populacional no Município de Campinas, São Paulo, Brasil

Este artigo analisa a prevalência da utilização de medicamentos segundo variáveis demográficas, socioeconômicas e de comportamentos relacionados à saúde, identificando fatores associados ao uso por meio de estudo transversal de base populacional, com 941 pessoas de 18 anos ou mais residentes em Campinas, São Paulo, Brasil. A amostragem foi realizada em múltiplos estágios, estratificada e por conglomerados. Utilizou-se o teste qui-quadrado, foram estimadas as razões de prevalência ajustadas por sexo e idade e os respectivos IC95%. Desenvolveu-se modelo de regressão múltipla de Poisson ficando associados ao uso: sexo feminino, idade de 40 anos e mais, morbidade referida nos últimos 15 dias e número de doenças crônicas. Os medicamentos mais consumidos foram para os sistemas cardiovascular e nervoso, e os fitoterápicos. A prevalência de uso de medicamentos em Campinas encontrou-se inferior à maioria dos estudos. Por meio de inquéritos de saúde locais espera-se conhecer o perfil de uso dos medicamentos pela população e garantir intervenções mais direcionadas para a Política de Assistência Farmacêutica.

A experiência da toxicomania e da reincidência a partir da fala dos toxicômanos

Este estudo teve como objetivo examinar o fenômeno da toxicomania e sua reincidência a partir da fala dos toxicômanos. Foi realizado em instituição especializada no tratamento da dependência química e problemas relacionados ao uso de álcool e outras drogas, contando com dados do acompanhamento de onze sujeitos. Utilizou-se o referencial teórico psicanalítico para a escuta de indivíduos em situação de toxicomania, com o dispositivo das entrevistas preliminares, dentro do referencial da clínica da urgência em psicanálise. Os resultados do trabalho de escuta e da reflexão apontaram uma série de características psicológicas dos indivíduos estudados de clara relevância para o planejamento de estratégias individuais ou coletivas de atenção ao problema. Destacamos a hipótese de duas modalidades de toxicomania relacionadas com as formas particulares da subjetividade em que ocorre. A questão da reincidência na toxicomania aparece como um falso problema para os sujeitos, que demonstraram que a desintoxicação, concomitante à abstinência e provocada pela internação, é somente um momento de privação, simultaneamente necessária e forçada, do gozo propiciado pela droga. Finda a internação segue-se, geralmente, um novo período de uso. A aceitação da abstinência não significa que os sujeitos fazem uma renúncia, correlata, ao desejo pela droga. É apenas uma parada provavelmente ligada à menor tolerância psíquica à modalidade de gozo em ação na toxicomania, um gozo capaz de confrontar o sujeito com a morte. A abstinência forçada, como estratégia da política pública de saúde, presente no tratamento comum da toxicomania, mostrou conseqüências altamente negativas para o resultado do tratamento, parecendo indicar a necessidade de sua revisão urgente. Procurou-se problematizar a questão da abertura à dimensão subjetiva da experiência dos toxicômanos como estratégia capaz de interferir na trajetória dos sujeitos na relação com as drogas a partir do momento em que buscam ajuda.

Grading and staging chronic hepatitis C and its relation to genotypes and epidemiological factors in brazilian blood donors

Progression of chronic hepatitis C is known to be associated with some factors, but influence of HCV genotypes is still controversial. Association between HCV genotypes and other risk factors was examined to determine which factors are associated with progression of infection. One hundred consecutive anti-HCV positive volunteer blood donors were evaluated for several risk factors, examined for HCV genotypes, and submitted to hepatic biopsy and biochemical exams.HCV genotyping were carried out in 89 patients and hepatic biopsy in 78. Transmission routes were found to be illicit intravenous drug use (26%), Gluconergan® use in a non-safe manner (48%) and blood transfusion (15%). HCV genotype was 1 in 45%, 3 in 40%, and it was not associated with the stage of fibrosis or with inflammatory activity. There was no significant association of factors related to infection, chronic alcohol use, or duration of illness, with progression of the lesion. There was a significant association of aminotransferase levels and the fibrosis stage. Univariate analysis showed that the age at contamination, patient's age, GT-gamma, and aminotransferase levels over three times the upper normal limits, were associated with fibrosis stages 2 to 4. Multivariate analysis detected age (odds ratio=1.19), and GT-gamma (odds ratio=2.02) as independent factors.

Self-medication in children and adolescents

Objective: To determine the prevalence of self-medication in children and adolescents in the municipalities of Limeira and Piracicaba, state of S (a) over tildeo Paulo, and to correlate results with sociodemographic indicators and with the use of health care services (public or private).Methods: Descriptive population-based study of a simple random sample from the two municipalities, comprised of 772 inhabitants from 85 urban census sectors selected through cluster sampling. Inclusion criteria: age <= 18 years; interview with one parent/tutor; consumption of at least one drug in the previous 15 days. Subjects were divided into two study groups according to their pattern of drug use: self-medication (lay advice) and medical prescription. Linear association tests, descriptive analysis of variables and multiple logistic regression tests were carried out to analyze data.Results: the prevalence of self-medication was 56.6%. Mothers (51%) and drugstore employees (20.1%) were most frequently responsible for self-medication. The main groups of self-prescribed drugs were: analgesic/antipyretic and non-hormonal anti-inflammatory drugs (52.9%); drugs acting on the respiratory tract (15.4%) and gastrointestinal drugs (9.6%); and systemic antibiotics (8.6%). The situation that most commonly motivated self-medication were respiratory diseases (17.2%), fever (15%), and headache (14%). Subjects in the age group of 7-18 years (odds ratio = 2.81) and public health care users (odds ratio = 1.52) showed increased risk for self-medication.Conclusions: the prevalence of self-medication in children and adolescents was high, which reinforces the need for public health interventions aiming at preventing this practice.

Using Mastitis Records and Somatic Cell Count Data

On-farm records are essential for managing mastitis in dairy herds. Mastitis records are a useful tool for caring for an individual cow, to monitor compliance of farm personnel working with groups of animals, to understand the epidemiology of mastitis in the herd, to ensure responsible drug utilization, and to document accountability in care of the cow. Herds have become larger and more people are involved with individual animal care. This article describes a records plan that can be used to monitor mastitis at the herd level, aid in decision-making processes for individual cows, and improve drug use on dairy herds.

EFICACIA E TOLERABILIDADE DA ASSOCIACAO CAPTOPRIL + HIDROCLOROTIAZIDA NO TRATAMENTO DA HIPERTENSAO ARTERIAL LEVE A MODERADA. ESTUDO MULTICENTRICO

Purpose. To evaluate the antihypertensive efficacy and tolerability of captopril 50 mg + hydrochlorothiazide 25 mg daily in mild to moderate primary hypertension. Methods. Out-patients (n = 471) with mild to moderate hypertension, diastolic blood pressure (DBP) 95-115 mmHg, with 15 days of washout, were included to the treatment initially with half tablet of the association of captopril 50 mg + hydrochlorothiazide 25 mg once daily, for 30 days. After this period, patients with DBP > 90 mmHg had the dosage duplicated, while the others had the same dosage for 60 days more. Evaluation was performed 15 days before and then every month during active drug. Results. Twenty six patients were withdrawn, 13 (2,7%) by adverse effects and 13 by protocol violation. At the end of the wash-out period, the blood pressure (BP), 162 ± 16/103 ± 6 mmHg decreased significantly at the 30th day to 146 ± 14/92 ± 8 mmHg (p < 0,001 vs 0th day); 139 ± 12/86 ± 7 mmHg at the 60th day, (p < 0,001 vs 30th day), and further to 136 ± 11/84 ± 5 mmHg (p < 0,001 vs day 0) till the end of the 90th day. Antihypertensive efficay (DBP ≤ 90 mmHg and decreased for the DBP ≥ 10 mmHg) was obtained in 82% of the patients. There was no difference in BP control considering race, hypertension level, previous antihypertensive treatment and obesity. Cough (4%) was the main adverse event. Conclusion. Captopril + hydrochlorothiazide was effective and safe in the treatment of mild to moderate hypertension. The favorable response was observed in 82% of the patients independently of race, hypertensive level, previous antihypertensive treatment and obesity. Low incidence of side effects was reported, with no difference from others reported in the literature.

Estudo comparativo das complicações terapêuticas no Lúpus Eritematoso Sistêmico e nas glomerulopatias idiopáticas.

PURPOSE: To evaluate the therapeutic complications due to the use of immunosupressors in patients with nephropathy. METHODS: 76 patients who had used steroids and cyclophosphamide were retrospectively studied. The cases were divided into three groups: G1= 15 patients with Systemic Lupus Erythematosus without renal lesion; G2= 33 patients with lupus nephritis and G3= 28 patients with nephrotic syndrome owing to idiopathic glomerulopathy. RESULTS: There were no differences related to time of follow up (G1= 42.4 +/- 51, G2= 52.3 +/- 51, G3= 41.8 +/- 47.8 months), total used dosage of steroids (G1= 20, G2= 28, G3= 16 grams) and time of drug use (G1= 20, G2= 26, G3= 14.5 months). About cyclophosphamide use, there was no difference in the percentage of patients who used it (13% in G1, 51% in G2, 28% in G3), but the patients from G1 received lower total dosage than those from G2 (p<0.05). Cushingoid appearance, epigastric distress, psychiatric disorders, diabetes mellitus and ocular alterations occurred in all the three groups, with no statistically significant differences. The infections complications, those considered more severe clinically, were more frequent in G2 (G1= 6%, G2= 15%, G3= 0% - p<0.05), the same occurring with the deaths (7% in G1, 30% in G2, 0% in G3 - p<0.05). CONCLUSION: In patients with lupus nephritis there were more infections complications owing to prolonged immunosuppresion what may indicate a severity marker of this type of lesion.

Das plantas medicinais aos fitofármacos

The plants, since the antiquity, have been a resource within reach of the human being. Along millenniums, the man empirically deepened its knowledge for the improvement in the alimentation and cure conditions of its illnesses, demonstrating a narrow relation between plant use and its own evolution. A lot of people described the herbs utilization like medication form in their records and manuscripts, but many centuries have been passed until the true power of the plants was recognized. The great discoveries of the active plants principles only were possible after technological advances for the isolation and structural elucidation. Several active substances with pharmacological activity, many times indicated by the popular use, were going proved scientifically. Nowadays, the man still seeks solutions for several diseases and health problems and maybe the plants can contribute of more significant way for resolve them.

Doença pulmonar obstrutiva crônica

The chronic obstructive lung disease is reviewed with emphasys on its epidemiology and risk factors. The diagnosis, clinical aspects pulmonary, functional alterations and laboratorial findings are discussed. The treatment is also reviewed, based on the actual consensus, considering the following classes of approaches: bronchodilators, inhaled β-agonists, corticoids, methilxanthines, prolonged domiciliar-orygen therapy.

Consumo de medicamentos por idosos segundo prescrição médica em Jaú-SP

This study was carried out in order to identify the interactions that occur most often between prescribed drugs as they are taken by elderly patients attending municipal public health centers in the city of Jaú, São Paulo State, Brazil. It is known that older people frequently have to live with chronic health problems, which oblige them to use the health service a great deal and to consume large quantities of medicines. When concomitant diseases are present, and polytherapy is being applied, the likelihood of adverse reactions and interactions between drugs increases. The population under study consisted of 148 persons aged 65 or more who frequented the pharmacy at the Núcleo de Gestão Assistencial (Municipal Health Centre, NGA25) in Jaú, between August and December 2004. Data were collected from medical prescriptions, the independent variables being the age and sex of the patient. For each patient, the pharmacological classes of drugs taken and drug-drug interactions were recorded. It was found that the mean numbers of drugs consumed were 3.8 among women and 3.9 among men. In terms of age, the highest number of drugs (4.2) was used in the group aged 75 to 84 years. The most frequently prescribed classes, in decreasing order, were: antihypertensives, 25.0%, heart drugs, 15.5%, diuretics, and anti-diabetic drugs, 10.7%. It was concluded that the classes most involved in drug-drug interactions were heart drugs, diuretics and antihypertensives. The most problematic active constituents were digoxin, amiodarone, frusemide, captopril, propranolol and nifedipine.

Fitoterapia no sistema de saúde pública (SUS) no Estado de São Paulo, Brasil

Phytotherapy is a form of familiar treatment throughout the world and recommended by the World Health Organisation to be used in all regions, especially in the poorer countries, to improve the state of health of their people. The aim of this study was to describe the use of herbal medicine as an alternative therapy in the public health system in Sao Paulo State. The fieldwork consisted in obtaining information, from all the Regional Health Authorities in the State, about which municipal health areas use this therapy and sending them a questionnaire requesting details about the application of phitotherapy: when the therapy had been adopted, which plants were used, whether the programme had been discontinued or not and if so, for what reason. The cities that use the phytotherapy are: Campinas; Canas; Guaratingueta; Herculandia; Piquete; Pindamonhangaba; Roseira e Sao Jose do Barreiro, Ribeirao Preto, Sao Lourenço da Serra, Cruzeiro e Dobrada. And the three plant more used are: Guaco (Mikania glomerate); Calendula (Calendula officinalis) e Babosa (Aloe vera) The lack of support has led some Authorities to discontinue their active in 08 programmes. Nevertheless, it is concluded that the efficacy and low cost of herbal treatments has engendered a growing interest among health professionals in placing proposals for implanting this therapy in 13 cities in the Municipal Health. Thus, there should be growing practical support for the establishment of such programmes in the future.

Medicação de alto custo para portador de sofrimento psíquico: Um estudo preliminar dos custos

The present work aims to raise the costs of high-cost drugs used to treat patients of Refractory Schizophrenia in ambulatory unit. The study was carried out in the Psychosocial Support Center, which treated 33 patients with these medications, during the period of June, 2005 to May, 2006. Data analysis disclosed that the mostly used drugs to treat the carriers of Refractory Schizophrenia were: clozapina and risperidona. It was observed that the treatment with olanzapina is more expensive than that with risperidona. The study concluded that the analysis of the consumption and costs of drugs of high cost is necessary to subside better management of the expenses and new investments in the service. Moreover, the necessity of more studies in the area was also identified to contribute with the control of costs.

Treatment of atherosclerotic renovascular disease

Treatment of atherosclerotic renovascular disease is controversial and revascularization is not a beneficial approach to all patients. Conditions as progressive deterioration of renal function, refractory hypertension or accelerated cardiovascular disease, especially recurrent pulmonary edema, could profit from renal angioplasty with stent placement. Surgical revascularization is a good option for patients who will need concomitant surgical corrections of abdominal aortic lesions. Treatment of all other patients must be individualized. Medical therapy is indicated for all patients with atherosclerotic renovascular disease. Observational studies pointed out to the beneficial effect of controlling blood pressure (<130/80 mm Hg), glucose and lipids profile, lifestyle modifications, specific use of platelet antiaggregant therapy, Angiotensin Conversion Enzyme Inhibitors (ACEI) and statins. All others cardiovascular risk factors must be controlled. The evaluation and management of other systemic atherosclerotic vascular lesions is important, especially coronary, carotid and abdominal aortic. This paper presents a review of evidences to rationale the atherosclerotic renovascular disease treatment. © 2008 Bentham Science Publishers Ltd.

Análise da prescrição de medicamentos de pacientes hipertensos atendidos pelo SUS da rede municipal de saúde de Rincão - SP

The purpose of this study was to identify the drugs most often prescribed for hypertension at the Municipal Health Care Center of the town of Rincäo, State of São Paulo, Brazil, and the principal interactions arising from their association with other drugs, both anti-hypertensives and those in other classes. The study included 725 hypertensive patients registered at this health care center who were regularly seen by a physician every three months. Data were collected on age, sex, occurrence of diabetes, smoking, sedentary lifestyle and overweight, to obtain a profile of the hypertensive population of the area. Control records of all patients were available at the pharmacy in the health care center, where patients obtained their drugs once a month. Of the 725 patients, 38% were male and 62% female. Most (57%) were between 50 and 70 years of age, 21% used tobacco and 43% led a sedentary lifestyle. Single-drug therapy accounted for 33% of the prescriptions, multidrug therapy for 66%. In addition to anti-hypertensives, 50% of the patients took drugs of other therapeutic classes. Of those receiving multidrug therapy, 34% used three or more anti-hypertensives and 66% used only two of these drugs. Drug interactions were detected in as many as 47% of the prescriptions. Captopril was the drug that showed most interactions with others (54%), followed by hydrochlorothiazide (27%), furosemide (14%), propanolol (4%), and nifedipine (1%). The analysis revealed that drug consumption by the patients investigated is high, with a concomitantly high number of episodes of drug interaction.