Assessment of pharmacotherapeutic safety of medical prescriptions for elderly residents in a long-term care facility

The present study aimed to estimate the prevalence of elderly using potentially inappropriate medications (PIM) and with occurrence of potentially hazardous drug interactions (PHDI), to identify the risk factors for the prescription of PIM and to evaluate the impact of pharmaceutical intervention (PI) for the prescription of safer therapeutic alternatives. Therefore, a cross-sectional study was performed in a long-term care facility in São Paulo State, between December/2010 and January/2011. The medical records of the patients >= 60 years old who took any drugs were consulted to assess the pharmacotherapeutic safety of the medical prescriptions, in order to identify PIM and PHDI, according to the Beers (2003) and World Health Organization criteria, respectively. PI consisted of a guidance letter to the physician responsible for the institution, with the suggestions of safer equivalent therapeutics. Approximately 88% of the elderly took at least one drug, and for 30% of them the PIM had been prescribed. Most of the PIM identified (53.4%) act on the central nervous system. Among the 13 different DI detected, 6 are considered PHDI. Polypharmacy was detected as a risk factor for PIM prescription. After the PI there was no change in medical prescriptions of patients who had been prescribed PIM or PHDI. The data suggests that PI performed by letter, as the only interventional, method was ineffective. To contribute it a wide dissemination of PIM and PHDI among prescriber professionals is necessary for the selection of safer treatment for elderly. Additionally, a pharmacist should be part of the health care team in order to help promote rational use of medicines.

La conformación del Area de Libre Comercio de las Américas, ALCA: aspectos institucionales y comerciales

Resumen En la Cumbre de las Américas, celebrada en Miami en diciembre de 1994 se acordó establecer un Área de Libre Comercio de las Américas (ALCA), a fin de crear un espacio continental de libre comercio antes del 2005. Desde una perspectiva institucional, el ALCA reconoce sus antecedentes en la Iniciativa de las Américas (IA), que privilegiaba las negociaciones entre grupos de países, en detrimento de las bilaterales. En un principio se había planteado como una propuesta de profundizar las reformas económicas implantadas por los países latinoamericanos con objeto de abrir sus economías a la competencia externa y permitir que el mercado se transformara en el principal asignador de recursos. El ALCA representa el más importante acuerdo de integración regional firmado entre países desarrollados y no desarrollados con miras a establecer el libre flujo comercial entre sus economías. Coherente con las disposiciones multilaterales de la Organización Mundial del Comercio (OMC), el acuerdo pretende incorporar a la negociación la inversión en bienes y servicios siguiendo reglas comerciales definidas y transparentes; compras del sector público y políticas de competencia; y sentar las bases para la inclusión de temas tales como la agricultura y acceso a mercados, servicios e inversión, políticas de competencia y subsidios, procedimientos antidumping y derechos compensatorios. La actual estructura de negociación se compone de la presidencia, el comité de negociaciones comerciales, los grupos de negociación y el grupo consultivo sobre economías pequeñas. Los beneficios comerciales del ALCA se han concebido utilizando el análisis tradicional de las uniones aduaneras de creación y desviación de comercio, aunque se reconoce que este acuerdo, único en la historia, puede tener consecuencias impredecibles. Entre los obstáculos a su pleno cumplimiento sobresalen la ausencia de una política definida de 'vía rápida' y de un liderazgo significativo. Entre los posibles escenarios de conformación del ALCA, se distingue entre uno real, en el que los países pequeños y grandes cumplen con los compromisos adoptados, y otro llamado formal, en el que el ALCA se integra de manera incompleta por la ausencia de países o de algún país clave, por lo que carecería de significado político y económico. En el plano económico el ALCA se concibe como una unidad geográfica con 757 millones de personas, un producto interno bruto (PIB) de 8 billones de dólares y un comercio total de 2.4 billones de dólares. Uno de los fines de la creación de un área de libre comercio apunta al aprovechamiento del potencial del comercio intramericano. En principio, dicho potencial así como su materialización se reflejarían en la intensidad esperada de un intercambio comercial bilateral desde un país exportador hacia un país importador. A su vez la intensidad puede medirse mediante el grado de correspondencia o similitud entre la composición de las exportaciones e importaciones de los países del hemisferio americano. Este análisis de similitud puede llevarse a cabo entre países grandes y pequeños. En este documento se analiza en dos grandes apartados la institucionalidad del ALCA y el potencial del comercio vinculado con dicho tratado. Los aspectos institucionales incluyen los antecedentes del acuerdo 1, la estructura significativa actual, los beneficios derivados del comercio y los posibles escenarios de conformación del ALCA. Los aspectos económicos se centran en el cálculo de indicadores de similitud en los flujos comerciales de los países, utilizando una muestra de 15 miembros que integrarían el ALCA. Entre éstos no se incluyó a los Estados Unidos porque su estrecha relación comercial con los latinoamericanos podría sesgar los resultados obtenidos. Así, los indicadores de similitud en los flujos comerciales internacionales se limitarían a reflejar la intensidad comercial de países latinoamericanos seleccionados en ausencia de vínculos comerciales con los Estados Unidos. La metodololgía seguida es la propuesta por Van Beers y Linnemann (1993). Una vez obtenidos los indicadores de similitud por país y luego estos mismos a nivel de capítulo, se procedió a estimar su poder explicativo de los flujos comerciales actuales utilizando ecuaciones de gravedad.

Potentially inappropriate medications used by the elderly: Prevalence and risk factors in Brazilian care homes

Abstract. Background: The use of potentially inappropriate medications (PIM) among the elderly is a serious public health problem because it is intrinsically linked to increased morbidity and mortality, causing high costs to public health systems. This study's objective was to verify the prevalence of and the factors associated with the use of PIMs by elderly Brazilians in institutional settings. Methods. We performed a transversal study, by consulting the case files of elderly people living in Long Term Care for the Elderly (LTC) in towns in the State of São Paulo, Brazil, as well as structured interviews with the nurses responsible for them.We identified PIMs using the list of recently updated Beers criteria developed by a group of specialists from the American Geriatrics Society (AGS), who reviewed the criteria based on studies with high scientific evidence levels. We defined the factors studied to evaluate the association with PIM use prior to the statistical analyses, which were the chi-square test and multiple logistic regression. Results: Among the elderly who used drugs daily, 82.6% were taking at least one PIM, with antipsychotics (26.5%) and analgesics (15.1%) being the most commonly used. Out of all the medications used, 32.4% were PIMs, with 29.7% of these being PIMs that the elderly should avoid independent of their condition, 1.1% being inappropriate medication for older adults with certain illnesses or syndromes, and 1.6% being medications that older adults should use with caution. In the multivariate analysis, the factors associated with PIM use were: polypharmacy (p = 0.0187), cerebrovascular disease (p = 0.0036), psychiatric disorders (p < 0.0001) and dependency (p = 0.0404). Conclusions: The results of this study showed a high prevalence of PIM use in institutionalized elderly Brazilian patients. and the associated factors were polypharmacy, psychiatric disorders, cerebrovascular diseases and dependency. © 2013 Lima et al.; licensee BioMed Central Ltd.

Produção de cerveja com mel: características físico-químicas, energética e sensorial

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Estudo fisiológico do efeito da complexidade estrutural da fonte de nitrôgenio no meio de cultura no metabolismo de leveduras

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Produção de cerveja utilizando cevada como adjunto de malte

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Determinação de ocratoxinas em cervejas, por injeção direta, empregando cromatografia líquida de alta eficiência

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Caracterização físico-química de cervejas elaboradas com mel

The aim of this study was to produce and physicochemically characterize beer elaborated with honey. Beer production assays were carried out with nine treatments, the combination of three concentrations of the original extract (11, 13 and 15 ºBrix) with three percentages of honey in the wort formulation (0, 20 and 40%). The experiment was completely randomized with two replicates, giving a total of eighteen trials. Mashing was carried out by infusion and the honey was added during the boiling step. After clarification, the extract content was corrected with water and the wort then inoculated with bottom-fermenting yeast. Fermentation was at 10 ºC. The beer was bottled manually and stored in a freezer at a temperature of 0 ºC for 15 days, for maturation. The beers were analyzed for their alcohol content, true extract, apparent extract, colour, bitterness, turbidity, pH, total acidity, carbon dioxide, foam density and total foam. The results of the physicochemical analysis were subjected to an analysis of variance, and the means compared by Tukey's test at 5% probability. All beers were considered to be pale. The presence of honey in the formulation enhanced carbonation, foam density and total foam, but the beers were less bitter and less acid.

Perfil da farmacoterapia utilizada por idosos institucionalizados: uma análise dos problemas relacionados ao uso de medicamentos em instituições de longa permanência para idosos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Safety assessment of essential medicines for elderly people: a bibliographic survey

Certain medicines are considered potentially inappropriate (PIM) for elderly people as they increase the risk of adverse drug events (ADE) and because safer alternative therapies are available on the market. In this context, in order to identify the instruments that assess the quality of medical prescriptions for elderly and to determine which drugs are considered PIM, a bibliographic survey was conducted in PUBMED, LILACS and PAHO databases, in February and March/2010. The search strategy included the use of health descriptors and a manual search in the references cited by selected papers. During the period of data collection, 15 instruments were identified. In 2012, with the publication of the update of Beers criteria, this instrument was included in the study. We identified 163 PIM of 25 therapeutic classes, of which 125 (76.7%) are marketed in Brazil. Of these, 31 (24.8%) are essential medicines (RENAME 2012), of which 13 have safer therapeutic equivalents and 19 (15.2%) are over-the-counter drugs. Data suggest the need for inclusion of safer alternatives for the elderly in the national list of essential medicines and the pharmaceutical care for early detection of ADE in this age group, in order to contribute to the safe use of medicines.

Medicamentos inadequados para idosos na estratégia da saúde da família

The ageing process can change the pharmacodynamics and pharmacokinetics parameters. Therefore, some medications are considered potentially inappropriate (PIM) for the elderly people, since they can increase the likelihood of occurrence of adverse drug events. The objectives are to estimate the frequency of use of PIM in the elderly people, with potentially hazardous drug interactions (PHDI) and to evaluate the impact of pharmaceutical intervention (PI) for the prescription of safer therapeutic alternatives. A cross-sectional study was performed in a Health Family Strategy (region of Araraquara, SP), between January and February/2012. The medical records of patients aged ≥60 years, that use at least one drug, were consulted for identification of PIM, according to the Beers criteria. The MPI identified were classified considering the Anatomical Therapeutic Chemical Classification System (ATC) and the essentiality of the drug (safety, effectiveness, quality and cost parameters) The inclusion criteria were met by 358 elderly, being that 93 of them (26%) had taken at least one PIM. Of the 114 different drugs prescribed for elderly, ten were classified as PIM, of which four of them act on the central nervous system, four on cardiovascular system and two on the digestive tract. Seven MPI are essential medicines, belonging to national list of essential drugs (RENAME-2010). Fourteen drug interactions were identified, of which two are PHDI (fluoxetine/amitriptyline and digoxin/hydrochlorothiazide).After the PI, there was no change in medical prescriptions of patients with PIM use or with DI. Medical prescriptions of elderly attended in the Health Family Strategy show pharmacotherapeutic safety problems, of which may be responsible for health hazardous for this age group. Although the intervention carried out by letter had been ineffective for the adherence of doctors in prescribing safe alternatives, wide dissemination of the lists that contain PIM and PHDI is need, as well as the inclusion of safer equivalents in RENAME, in order to contribute for rational use of drugs.

Gênero, masculinidades e alcoolismo na modernidade: a Revista Illustração Brasileira, as comemorações do Centenário da Independência e a as elites urbanas cariocas no início do Século XX

Pós-graduação em Ciências Sociais - FFC

Análise energética de cerveja eleborada com mel

The objective of this study was to characterize energetically beersmade withhoney. The tests of beer production weremade withninetreatments,threecombination of the originalextract concentrations (11, 13and 15 °Brix) and threepercentagesof honeyin the wort formulation(0, 20 and 40%).The experimentwas completely randomizedwith two replications, totaling eighteenplots.Themashingprocesswas performed byinfusion, with honey added in the boiling step. After clarified, the wort had its extract contents corrected with the addition of filtered water and was inoculated withlowfermentation yeast .The fermentation occurred at 10 ° C. The beer was manually bottled and stored in a freezer at 0 °C for 15 days, formaturation. The beers were chemically analyzed on proximate composition (moisture, protein, lipid, ash, and carbohydrate), alcohol content (% m / m) and then calculated the energy value. The results ofchemical analysis andenergetic valuesof the beerswere subjected to analysisof variance (F test) and the means werecompared byTukey testat 5% probability. The commonbeershad the lowestenergy value (31.05 to 31.95 kcal100g-1) in relation toextra(36.42 to 38.42 kcal100g-1) and strong(38.20 to 40.17 kcal100g-1) beers. Theincrease in the original extractin beerraises theircaloric values. The presenceof honeyin the formulationincreasedthe energetic valuesincommon andextrabeersand decreasedin strong.The levelsof alcohol andcarbohydratewere predominant in thebeer energetic values,beingpossible to observeadirect relation amongthese components ofbeer and theircaloric value.

Análise calorimétrica de cervejas produzidas utilizando cevada como adjunto de malte

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

William Douglas Beer - Accession 290 - M123 (156)

The William Douglas Beer Journals collection consists of photocopied journals which are accounts of Mr. Beer’s preparation for and participation in World War I. The journal gives an account of the hardships of war and its effects on American soldiers. Willie Beer was born in Columbia, Missouri on September 20, 1891 and died on February 4, 1950.