Incidence and Predictors of Adverse Drug Reactions Caused by Drug-Drug Interactions in Elderly Outpatients: A Prospective Cohort Study

Purpose. The primary objective of this study was to investigate the incidence of drug-drug interactions (DDIs) related to adverse drug reactions (ADRs) in elderly outpatients who attended public primary healthcare units in a southeastern region of Brazil. The secondary objective was to investigate the possible predictors of DDI-related ADRs. Methods. A prospective cohort study was conducted between November 1, 2010, and November 31, 2011, in the primary public healthcare system in the Ourinhos micro-region in Brazil. Patients who were at least 60 years old, with at least one potential DDI, were eligible for inclusion in the study. Eligible patients were assessed by clinical pharmacists for DDI-related ADRs for 4 months. The causality of DDI-related ADRs was assessed independently by four clinicians using three decisional algorithms. The incidence of DDI-related ADRs during the study period was calculated. Logistic regression analysis was used to study DDI-related ADR predictors. Results. A total of 433 patients completed the study. The incidence of DDI-related ADRs was 6.5%. A multivariate analysis indicated that the adjusted odds ratios (ORs) rose from 0.91 (95% confidence interval [CI] = 0.75-1.12, p = 0.06) in patients aged 65-69 years to 4.40 (95% CI = 3.00-6.12, p < 0.01) in patients aged 80 years or older. Patients who presented two to three diagnosed diseases presented lower adjusted ORs (OR = 0.93 [95% CI = 0.68-1.18, p = 0.08]) than patients who presented six or more diseases (OR = 1.12 [95% CI = 1.02-2.01, p < 0.01]). Elderly patients who took five or more drugs had a significantly higher risk of DDI-related ADRs (OR = 2.72 [95% CI = 1.92-3.12, p < 0.01]) than patients who took three to four drugs (OR = 0.93 [95% CI = 0.74-1.11, p = 0.06]). No significant difference was found with regard to sex (OR = 1.08 [95% CI 0.48-2.02, p = 0.44]). Conclusion. The incidence of DDI-related ADRs in elderly outpatients was significant, and most of the events presented important clinical consequences. Because clinicians still have difficulty managing this problem, highlighting the factors that increase the risk of DDI-related ADRs is essential. Polypharmacy was found to be a significant predictor of DDI-related ADRs in our sample.

Adverse drug reactions caused by drug-drug interactions in elderly outpatients: a prospective cohort study

Although the prevalence of drug-drug interactions (DDIs) in elderly outpatients is high, many potential DDIs do not have any actual clinical effect, and data on the occurrence of DDI-related adverse drug reactions (ADRs) in elderly outpatients are scarce. This study aimed to determine the incidence and characteristics of DDI-related ADRs among elderly outpatients as well as the factors associated with these reactions. A prospective cohort study was conducted between 1 November 2010 and 31 November 2011 in the primary public health system of the Ourinhos micro-region, Brazil. Patients aged a parts per thousand yen60 years with at least one potential DDI were eligible for inclusion. Causality, severity, and preventability of the DDI-related ADRs were assessed independently by four clinicians using validated methods; data were analysed using descriptive analysis and multiple logistic regression. A total of 433 patients completed the study. The incidence of DDI-related ADRs was 6 % (n = 30). Warfarin was the most commonly involved drug (37 % cases), followed by acetylsalicylic acid (17 %), digoxin (17 %), and spironolactone (17 %). Gastrointestinal bleeding occurred in 37 % of the DDI-related ADR cases, followed by hyperkalemia (17 %) and myopathy (13 %). The multiple logistic regression showed that age a parts per thousand yen80 years [odds ratio (OR) 4.4; 95 % confidence interval (CI) 3.0-6.1, p < 0.01], a Charlson comorbidity index a parts per thousand yen4 (OR 1.3; 95 % CI 1.1-1.8, p < 0.01), consumption of five or more drugs (OR 2.7; 95 % CI 1.9-3.1, p < 0.01), and the use of warfarin (OR 1.7; 95 % CI1.1-1.9, p < 0.01) were associated with the occurrence of DDI-related ADRs. With regard to severity, approximately 37 % of the DDI-related ADRs detected in our cohort necessitated hospital admission. All DDI-related ADRs could have been avoided (87 % were ameliorable and 13 % were preventable). The incidence of ADRs not related to DDIs was 10 % (n = 44). The incidence of DDI-related ADRs in elderly outpatients is high; most events presented important clinical consequences and were preventable or ameliorable.

Roberto Carlos e a identidade brasileira na canção

Roberto Carlos é, ao mesmo tempo, o mais popular e o mais rejeitado dos artistas brasileiros. Nosso artigo pretende compreender as raízes dessa contradição, compreendendo tanto a positividade e o valor de sua obra - buscando relativizar uma série de estigmas e preconceitos que rondam sua figura, demonstrando, por assim dizer, a legitimidade de sua coroa - quanto o lugar a partir de onde falam seus antagonistas, de modo a perceber o conjunto de interesses e posições envolvidas nesses juízos críticos.

esempio di tavola 1: rilievo a vista di un oggetto e proiezioni ortogonali. designer: Roberto Paoli, Milano

esempio della prima esercitazione in aula

Estética y (micro)política en la narrativa de Roberto Echavarren

Doctorado en Literatura y Teoría de la Literatura

Le parole incrociate. Lucio Dalla e Roberto Roversi: Nascita di un cantautore (1973-1976)

La produzione Dalla-Roversi si iscrive nella cornice storica degli anni’70, quelli che nell'immaginario comune vengono chiamato “anni piombo”. In realtà gli anni ’70, in particolare il Settantasette bolognese, sono molto altro: sono anni di fervore culturale e di sperimentazione del linguaggio, grazie anche alla nascita delle radio libere. La collaborazione tra i due artisti dura tre anni, dal 1973 al 1976, e porterà alla pubblicazione di tre album: Il giorno aveva cinque teste, Anidride solforosa e Automobili. I tre dischi cambieranno la vita di Lucio Dalla, sia dal punto di vista professionale che personale. Nel 1977, infatti, dopo la “rottura” con Roversi, Dalla pubblicherà il suo capolavoro: Come è profondo il mare, primo album scritto e musicato interamente dal cantautore. A questo punto della sua carriera può essere definito tale, in quanto dimostra di essere capace di scrivere testi che possono essere considerati e poetici e di musicarli in maniera consapevole.

Robert il Diavolo, Act I., Scene 4 : Alice: Più non vie. Roberto: Che intendo! Ah madre! io gelo. ; Alice: She is no more. Robert: What! my mother? O torture.

Signatur des Originals: S 36/G03301

La teatralidad: eje temático de la narrativa de Roberto Arlt y Leopoldo Marechal

A partir de la común afición de Roberto Arlt y Leopoldo Marechal por el género dramático, se analizan los elementos teatralizadores presentes en sus novelas, en orden a señalar la importancia que adquieren en la configuración total de la obra y también el diverso fundamento ideológico que en cada uno de los escritores es dable advertir. En efecto, así como ambos mantienen la convicción de que hay una escisión entre el ser y la apariencia, Marechal entiende que Dios es el Espectador de una vistosa comedia interpretada por los hombres. De ahí que Sujeto y Objeto de la representación se distingan nítidamente. En Arlt, por el contrario, la actuación reúne dentro de un mismo personaje al Actor y al Espectador, que así se debate alocadamente en un juego sin fin.