Prevalence of self-medication in the adult population of Brazil: a systematic review

OBJECTIVE To evaluate the prevalence of self-medication in Brazil’s adult population.METHODS Systematic review of cross-sectional population-based studies. The following databases were used: Medline, Embase, Scopus, ISI, CINAHL, Cochrane Library, CRD, Lilacs, SciELO, the Banco de teses brasileiras(Brazilian theses database) (Capes) and files from the Portal Domínio Público (Brazilian Public Domain). In addition, the reference lists from relevant studies were examined to identify potentially eligible articles. There were no applied restrictions in terms of the publication date, language or publication status. Data related to publication, population, methods and prevalence of self-medication were extracted by three independent researchers. Methodological quality was assessed following eight criteria related to sampling, measurement and presentation of results. The prevalences were measured from participants who used at least one medication during the recall period of the studies.RESULTS The literature screening identified 2,778 records, from which 12 were included for analysis. Most studies were conducted in the Southeastern region of Brazil, after 2000 and with a 15-day recall period. Only five studies achieved high methodological quality, of which one study had a 7-day recall period, in which the prevalence of self-medication was 22.9% (95%CI 14.6;33.9). The prevalence of self-medication in three studies of high methodological quality with a 15-day recall period was 35.0% (95%CI 29.0;40.0, I2 = 83.9%) in the adult Brazilian population.CONCLUSIONS Despite differences in the methodologies of the included studies, the results of this systematic review indicate that a significant proportion of the adult Brazilian population self-medicates. It is suggested that future research projects that assess self-medication in Brazil standardize their methods.

(E)xperimental study of the porosity and microstructure of self-compacting concrete (SCC) with binary and ternary mixes of fly ash and limestone filler

Self-compacting concrete (SCC) can soon be expected to replace conventional concrete due to its many advantages. Its main characteristics in the fresh state are achieved essentially by a higher volume of mortar (more ultrafine material) and a decrease of the coarse-aggregates. The use of over-large volumes of additions such as fly ash (FA) and/or limestone filler (LF) can substantially affect the concrete's pore structure and consequently its durability. In this context, an experimental programme was conducted to evaluate the effect on the concrete's porosity and microstructure of incorporating FA and LF in binary and ternary mixes of SCC. For this, a total of 11 SIX mixes were produced; 1 with cement only (C); 3 with C + FA in 30%, 60% and 70% substitution (fad); 3 with C + LF in 30%, 60% and 70% fad; 4 with C + FA + LF in combinations of 10-20%, 20-10%, 20-40% and 40-20% f(ad), respectively. The results enabled conclusions to be established regarding the SCC's durability, based on its permeability and the microstructure of its pore structure. The properties studied are strongly affected by the type and quantity of additions. The use of ternary mixes also proves to be extremely favourable, confirming the beneficial effect of the synergy between these additions. (C) 2015 Elsevier Ltd. All rights reserved.

Experimental study of the mechanical properties and durability of self-compacting mortars with nano materials (SiO2 and TiO2)

Resumo: Cement, as well as the remaining constituents of self-compacting mortars, must be carefully selected, in order to obtain an adequate composition with a granular mix as compact as possible and a good performance in the fresh state (self-compacting effect) and the hardened state (mechanical and durability-related behavior). Therefore in this work the possibility of incorporating nano particles in self-compacting mortars was studied. Nano materials are very reactive due mostly to their high specific surface and show a great potential to improve the properties of these mortars, both in mechanical and durability terms. In this work two nano materials were used, nano silica (nano SiO2) in colloidal state and nano titanium (nano TiO2) in amorphous state, in two types of self-compacting mortars (ratio binder:sand of 1:1 and 1:2). The self-compacting mortar mixes have the same water/cement ratio and 30% of replacement of cement with fly ashes. The influence of nano materials nano-SiO2 and nano-TiO2 on the fresh and hardened state properties of these self-compacting mortars was studied. The results show that the use of nano materials in repair and rehabilitation mortars has significant potential but still needs to be optimized. (C) 2015 Elsevier Ltd. All rights reserved.

Experimental study of the porosity and microstructure of self-compacting concrete (SCC) with binary and ternary mixes of fly ash and limestone filler

Abstract Self-compacting concrete (SCC) can soon be expected to replace conventional concrete due to its many advantages. Its main characteristics in the fresh state are achieved essentially by a higher volume of mortar (more ultrafine material) and a decrease of the coarse-aggregates. The use of over-large volumes of additions such as fly ash (FA) and/or limestone filler (LF) can substantially affect the concrete's pore structure and consequently its durability. In this context, an experimental programme was conducted to evaluate the effect on the concrete's porosity and microstructure of incorporating FA and LF in binary and ternary mixes of SCC. For this, a total of 11 SCC mixes were produced: 1 with cement only (C); 3 with C + FA in 30%, 60% and 70% substitution (fad); 3 with C + LF in 30%, 60% and 70% fad; 4 with C + FA + LF in combinations of 10-20%, 20-10%, 20-40% and 40-20% fad, respectively. The results enabled conclusions to be established regarding the SCC's durability, based on its permeability and the microstructure of its pore structure. The properties studied are strongly affected by the type and quantity of additions. The use of ternary mixes also proves to be extremely favourable, confirming the beneficial effect of the synergy between these additions. © 2015 Elsevier Ltd. All rights reserved.

Fresh-state properties of self-compacting mortar and concrete with combined use of limestone filler and fly ash

This paper presents the results of a study on the behaviour of self-compacting concrete (SCC) in the fresh and hardened states, produced with binary and ternary mixes of fly ash (FA) and limestone filler (LF), using the method proposed by Nepomuceno. His method determines the SCC composition parameters in the mortar phase (self-compacting mortar - SCM) easily and efficiently, whilst guaranteeing the SCC properties in both the fresh and hardened states. For this, 11 SCMs were studied: one with cement (C) only; three with FA at 30%, 60% and 70% C substitution; three with LF at 30%, 60% and 70% C substitution; four with FA + LF in combinations of 10-20%, 20-10%, 20-40% and 40-20% C substitution. Once the composition of these mortars was defined, 18 SCC mixes were produced: 14 binary SCC mixes were produced with the seven binary mortar mixes, and four ternary SCC mixes were produced with the four ternary mortar mixes. In addition to the methodology proposed by Nepomuceno, the combined use of FA and LF in ternary mixtures was tested. The results confirmed that the method could yield SCC with adequate properties in both the fresh and hardened states. It was also possible to determine the SCC composition parameters in the mortar phase (self-compacting mortar - SCM) that will guarantee the SCC properties in both the fresh and hardened states, as confirmed through the optimized behaviour of the SCC in the fresh state and the promising results in the hardened state (compressive strength). The potential demonstrated by the joint use of LF and FA through the synergetic interaction of both additions is emphasized.

Study of the rheology of self-compacting concrete with fine recycled concrete aggregates

This work studies the effect of incorporating fine recycled aggregates on the rheology of self-compacting concrete over time (at 15,45 and 90 min). The fine fraction of the natural aggregates was replaced at 0%, 20%, 50% and 100% with recycled sand. The fresh-state properties were studied by empirical tests (slump-flow, J-Ring, L-Box) and fundamental ones in an ICAR rheometer. The mixes with 50% and 100% recycled sand lost their SCC characteristics at 90 min. Contrarily the mix with 20% replacement maintained suitable passing and filling ability. The causes of this trend were an initial increase of plastic viscosity and afterwards an increase of yield stress. The compressive strength of the 50% and 100% replacement mixes decreased significantly and that of the 20% replacement mix less than 10%. (C) 2015 Elsevier Ltd. All rights reserved.

Durability performance of self-compacting concrete (SCC) with binary and ternary mixes of fly ash and limestone filler

The basic objective of this work is to evaluate the durability of self-compacting concrete (SCC) produced in binary and ternary mixes using fly ash (FA) and limestone filler (LF) as partial replacement of cement. The main characteristics that set SCC apart from conventional concrete (fundamentally its fresh state behaviour) essentially depend on the greater or lesser content of various constituents, namely: greater mortar volume (more ultrafine material in the form of cement and mineral additions); proper control of the maximum size of the coarse aggregate; use of admixtures such as superplasticizers. Significant amounts of mineral additions are thus incorporated to partially replace cement, in order to improve the workability of the concrete. These mineral additions necessarily affect the concrete’s microstructure and its durability. Therefore, notwithstanding the many well-documented and acknowledged advantages of SCC, a better understanding its behaviour is still required, in particular when its composition includes significant amounts of mineral additions. An ambitious working plan was devised: first, the SCC’s microstructure was studied and characterized and afterwards the main transport and degradation mechanisms of the SCC produced were studied and characterized by means of SEM image analysis, chloride migration, electrical resistivity, and carbonation tests. It was then possible to draw conclusions about the SCC’s durability. The properties studied are strongly affected by the type and content of the additions. Also, the use of ternary mixes proved to be extremely favourable, confirming the expected beneficial effect of the synergy between LF and FA. © 2015 RILEM.

Artificial Intelligence in geospatial analysis: applications of self-organizing maps in the context of geographic information science.

A thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Information Systems.

Analysis of self-interference within DAG tasks

6th Real-Time Scheduling Open Problems Seminar (RTSOPS 2015), Lund, Sweden.

The Self-Inflicted Burns - Typology and its Prognostic Relevance in a 14-Year Review of Self-Inflicted Burns in a Tertiary Referral Centre

Self-inflicted burns (SIB) are responsible for 2-6% of admissions to Burn Units in Europe and North America, and for as many as 25% of admissions in developing nations. Recently, a promising new tool was proposed to stratify SIB patients in the following subgroups: "typical", "delirious", and "reactive". However, as far as the authors know, the clinical usefulness of this instrument has not yet been validated by others. We retrospectively reviewed the clinical records of 56 patients admitted to our Burn Unit with the diagnosis of SIB injury in the past 14 years. The following parameters were evaluated: demographic features; psychiatric illness; substance abuse; mechanism of injury; burn depth, total body surface area (TBSA) involved, Abbreviated Burn Severity Index (ABSI); length of hospital stay, and mortality. All patients were followed up by a psychologist and a psychiatrist, and were classified according to the SIB-Typology Tool, into three classes: "typical", "delirious" and "reactive". There was a slight predominance of the "typical" type (44.6%), followed by the "delirious" type (30.4%), and, finally the "reactive" type (25.0%). Mortality was significantly higher in the "typical" subgroup. In conclusion, the SIB-Typology Tool appears to be a valuable instrument in the clinical management of SIB patients.

Effects of self-administered exercises based on Tuina techniques on musculoskeletal disorders of professional orchestra musicians: a randomized controlled trial

Background Musicians are frequently affected by playing-related musculoskeletal disorders (PRMD). Common solutions used by Western medicine to treat musculoskeletal pain include rehabilitation programs and drugs, but their results are sometimes disappointing. Objective To study the effects of self-administered exercises based on Tuina techniques on the pain intensity caused by PRMD of professional orchestra musicians, using numeric visual scale (NVS). Design, setting, participants and interventions We performed a prospective, controlled, single-blinded, randomized study with musicians suffering from PRMD. Participating musicians were randomly distributed into the experimental (n = 39) and the control (n = 30) groups. After an individual diagnostic assessment, specific Tuina self-administered exercises were developed and taught to the participants. Musicians were instructed to repeat the exercises every day for 3 weeks. Main outcome measures Pain intensity was measured by NVS before the intervention and after 1, 3, 5, 10, 15 and 20 d of treatment. The procedure was the same for the control group, however the Tuina exercises were executed in points away from the commonly-used acupuncture points. Results In the treatment group, but not the control group, pain intensity was significantly reduced on days 1, 3, 5, 10, 15 and 20. Conclusion The results obtained are consistent with the hypothesis that self-administered exercises based on Tuina techniques could help professional musicians controlling the pain caused by PRMD. Although our results are very promising, further studies are needed employing a larger sample size and double blinding designs.

The Risks of Self - Medication: Case Report of Familial Misuse of AM3 (Immunoferon®)

Over the last decades extended medical knowledge has been an important health care benefit in terms of disease prevention and management. However, probably with no exception, most pharmaceutical products are not devoid of adverse consequences. Immunomodulators are commonly considered a “benign” drug whose advantages bypass consequences. The immunomodulator AM3 (Immunoferon®) is a clinically used, orally administered compound whose active principle is stabilised in an inorganic matrix of calcium. We report the misuse of AM3 in three members of a family; father and two children. The drug was prescribed to the father who subsequently administered it to the children without seeking medical advice. Two months later, all subjects developed abdominal and/or flank colicky pain. Hypercalciuria was diagnosed in the children with different degrees of severity. It is likely that the calcium content of the inorganic matrix played an important role in the onset of symptoms. No adverse side effects related to the inorganic matrix of calcium of immunoferon® have been documented so far. This family case report calls attention to the risks of self -medication in a susceptible family. Paediatric patients are vulnerable as they rely on adults for the supply of medications. Concerning the use of drugs in family, especially nonprescription drugs, the quality of health care provided to the children depends on the health literacy of their parents.

Skew(er)ing Identities: the assertion of self in Gish Jen’s Mona in the promised land and Colson Whitehead’s Sag Harbor

Dissertação apresentada para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Línguas Literatura e Cultura

The sense of ending: the closing of a psychiatric hospital in Lisbon - Hospital Miguel Bombarda

RESUMO: Este estudo foi realizado com o objectivo de conhecer os efeitos da desinstitucionalização dos doentes psiquiátricos crónicos durante o processo de encerramento do Hospital Miguel Bombarda (2007-2011). Este processo incluiu a fusão, em 2008, dos dois principais hospitais psiquiátricos de Lisboa- Hospital Miguel Bombarda (HMB) e Hospital Júlio de Matos (HJM), no Centro Psiquiátrico Hospitalar de Lisboa (CHPL). Foi criado um grupo controlo de pacientes ainda hospitalizados no CHPL (n=166) para comparação com o grupo de casos desinstitucionalizados (n=146). Desta amostra inicial (n=312) apenas 142 (76 casos e 66 controlos) foram incluídos, sendo as principais causas de exclusão: diagnóstico (patologia orgânica, demência ou debilidade mental, como diagnóstico primário) e transferência entre hospitais. A desinstitucionalização foi principalmente avaliada em termos de psicopatologia, utilização de serviços, satisfação, crime, condição de “sem abrigo” ou morte. Os resultados mostraram que a maioria dos doentes crónicos pode sair do hospital psiquiátrico para a comunidade sem agravamento da psicopatologia, aumento do crime ou da condição de “sem abrigo”. A satisfação parece estar aumentada na população desinstitucionalizada. A mortalidade, por outro lado, revelou-se uma questão problemática: apesar de não ter sido possível estabelecer uma comparação entre casos e controlos, a Taxa de Mortalidade Standard encontrada neste estudo foi muito superior ao esperado, de acordo com os resultados encontrados na literatura. Um estudo longitudinal da mesma população poderá ser objecto de futura investigação, possivelmente comparada com outra população similar de um programa de desinstitucionalização noutro país.--------- RÉSUMÉ: Cette étude a été menée afin de déterminer les effets de la désinstitutionnalisation des patients chroniques lors de la fermeture de l'hôpital Miguel Bombarda (2007-2011). Ce processus comprenait la fusion en 2008 de deux grands hôpitaux psychiatriques de Lisbonne: À savoir, Hôpital Miguel Bombarda (HMB) et Hôpital Julio de Matos (HJM), maintenant Centre de l'Hôpital Psychiatrique de Lisbonne (CHPL). Il a été créé un groupe contrôle des patients toujours hospitalisés à CHPL (n = 166) pour comparer avec les cas désinstitutionnalisés (n = 146). De cet échantillon initial (n= 312) à peine 142 (76 cas et 66 contrôles) ont été inclus, les principales raisons d'exclusion: diagnostique (maladie organique, démence ou d'arriération mentale comme diagnostic primaire) et les transferts entre hôpitaux. La désinstitutionnalisation a été principalement évaluée en termes de psychopathologie, de l'utilisation des services, la satisfaction, la criminalité, les “sans abri” et de la mort. Les résultats ont montré que la majorité des malades chroniques peuvent quitter l'hôpital psychiatrique et s´intégrer dans la communauté sans aggravation de la psychopathologie, augmentation de la criminalité ou du nombre de “sans-abri”. La satisfaction semble être en hausse dans la population désinstitutionnalisée. Toutefois, la mortalité s'est avéré être une question problématique, même si il n´a pas été possible d'établir une comparaison entre les cas et les contrôles, le Taux de Mortalité Standard estimé dans cette étude fut beaucoup plus élevé que prévu, en tenant compte des résultats établis dans la littérature. Une étude longitudinale de la même population pourra faire l'objet de futures recherches, peut-être comparé à une population similaire d'un programme de désinstitutionnalisation dans un autre pays. ----------- ABSTRACT:This study was conducted to assess the effects of deinstitutionalization of “long-stay” patients during the process of closing Hospital Miguel Bombarda (2007-2011). This process included the fusion, in 2008, of the two main psychiatric hospitals in Lisbon- Hospital Miguel Bombarda (HMB) and Hospital Júlio de Matos (HJM), into Centro Psiquiátrico Hospitalar de Lisboa (CHPL). A control group of still institutionalized patients in CHPL (n=166) was used as a comparison with the deinstitutionalized population (n=146). Of this 312 initial sample only 142 (76 cases and 66 controls) were included, the main causes of exclusion being diagnoses (organic disease, dementia and mental retardation- as first diagnoses) and transference between hospitals. Deinstitutionalization is mainly evaluated in terms of psychopathology, use of services, satisfaction, crime, vagrancy and deaths. The results show that most long-stay patients can successfully leave psychiatric hospitals and be relocated in the community without an increase in psychopathology, crime or vagrancy. Satisfaction seems to be improved in those patients. On the other hand, mortality remains an issue of concern: Although there was no possibility of comparing it between cases and controls, the Standard Mortality Rate (SMR) in our study was found to be much higher than expected judging by other studies results. A longitudinal further study of this same population will be the matter for a future investigation, possibily compared with another similar population from a desinstitutionalization programme in another country.

Enhancing physical activity coaching through personalized motivational strategies and self-adaptive goal-setting: development of self-adaptive processes in a monitoring and coaching smartphone application

Dissertação para obtenção do Grau de Mestre em Engenharia Biomédica