Avaliação da composição química de águas do Sistema Guarapiranga: estudo de caso nos anos de 2002 e 2003

The supply of drinking water in the Metropolitan Area of São Paulo City has been a great and serious challenge in the latest years. This work demonstrates the viability of the evaluation of the degree of contamination of the water reservoirs using analytical procedures, which allow the analysis of several compounds at relatively low cost: stripping square wave voltammetry (SSWV) and capillary zone electrophoresis with contactless conductivity detection (CZE-CCD). The results of ionic composition indicated significant contamination of the Guarapiranga water system by human activities on the reservoir banks. In fact, the Guavirutuba and Itupu streams presented high concentrations of phosphate and ammonium ions. This can be directly related to misuse and unruled occupation of the soil and precarious sanitary infrastructure.

Inappropriate prescribing to the oldest old patients admitted to hospital: prevalence, most frequently used medicines, and associated factors

Background: Scientific evidence on treatments of chronic diseases in patients 85 years old or older is very limited, as is available information on inappropriate prescription (IP) and its associated factors. The study aimed to describe medicine prescription, potentially inappropriate medicines (PIM) and potentially prescribing omissions (PPO) and their associated factors on this population. Methods: In the context of an observational, prospective and multicentric study carried out in elderly patients admitted to seven Spanish hospitals for a year, a sub-analysis of those aged 85 years and over was performed. To assess PIMs, the Beers and STOPP criteria were used, and to assess PPOs, the START and the ACOVE-3 criteria were used. To assess factors associated with IP, a multivariate logistic regression analysis was performed. Patients were selected randomly every week on consecutive days from the hospitalization lists. Results: A total of 336 patients were included in the sub-analysis with a median (Q1-Q3) age of 88 (8690) years. The median medicines taken during the month prior to admission was 10 (713). Forty-seven point two per cent of patients had at least one Beers-listed PIM, 63.3% at least one STOPP-listed PIM, 53.6% at least one START-listed PPO, and 59.4% at least one ACOVE-3-listed PPO. Use of benzodiazepines in patients who are prone to falls (18.3%) and omission of calcium and vitamin D supplements in patients with osteoporosis (13.3%) were the most common PIM and PPO, respectively. The main factor associated with the Beers-listed and the STOPP-listed PIM was consumption of 10 or more medicines (OR = 5.7, 95% CI 1.8-17.9 and OR = 13.4, 95% CI 4.0-44.0, respectively). The main factors associated with the START-listed PPO was a non-community dwelling origin (OR 2.3, 95% CI 1.0-5.0), and multimorbidity (OR1.8, 95% CI 1.0-3.1). Conclusions: Prescribed medicines and PIM and PPO prevalence were high among patients 85 years and over. Benzodiazepine use in those who are prone to falls and omission of calcium and vitamin D in those with osteoporosis were the most frequent PIM and PPO, respectively. Factors associated with PIM and PPO differed with polypharmacy being the most important factor associated with PIM.

Selective and non-extractive spectrophotometric determination of cefdinir in formulations based on donor-acceptor complex formation

Cefdinir has broad spectrum of activity and high prescription rates, hence its counterfeiting seems imminent. We have proposed a simple, fast, selective and non-extractive spectrophotometric method for the content assay of cefdinir in formulations. The method is based on complexation of cefdinir and Fe under reducing condition in a buffered medium (pH 11) to form a magenta colored donor-acceptor complex (λ max = 550 nm; apparent molar absorptivity = 3720 L mol-1 cm-1). No other cephalosporins, penicillins and common excipients interfere under the test conditions. The Beer's law is followed in the concentration range 8-160 µg mL-1.

Epidemiology of Cytochrome P450-mediated Drug-Drug Interactions

Drug-drug interactions (DDIs) comprise an important cause of adverse drug reactions leading to excess hospitalizations. Drug metabolism is catalyzed by 75% by cytochrome P450 (CYP) enzymes and thus they are often involved in pharmacokinetic DDIs. In general, DDIs are studied in randomized controlled clinical trials in selected study populations. The overall aim of the present studies was to perform observational pharmacoepidemiological surveys on CYP-mediated DDIs in diseases important at the population level. The prevalence of co-administrations of four prodrugs (losartan, codeine, tramadol, and clopidogrel), three sulphonylureas (glibenclamide, glimepiride, and glipizide), or two statins (lovastatin and simvastatin) with well established agents altering CYP activity, as well as of statins with fibrates, was studied in Finland utilizing data from a university hospital medication database (inpatients) and the National Prescription Register of the Social Insurance Institution of Finland, Kela (outpatients). Clinical consequences of potential DDIs were estimated by reviewing laboratory data, and information from hospital care and cause-of-death registers. Concomitant use of study substrates with interacting medication was detected in up to one fifth of patients in both hospital and community settings. Potential CYP3A4 interactions in statin users did not manifest in clear adverse laboratory values but pharmacodynamic DDIs between statins and fibrates predisposed patients to muscular toxicity. Sulphonylurea DDIs with CYP2C9 inhibitors increased the risk of hypoglycaemia. CYP3A4 inhibitor use with clopidogrel was not associated with significant changes in mortality but non-fatal thrombosis and haemorrhage complications were seen less often in this group. Concomitant administration of atorvastatin with clopidogrel moderately attenuated the antithrombotic effect by clopidogrel. The overall mortality was increased in CYP3A4 inducer and clopidogrel co-users. Atorvastatin used concomitantly with prodrug clopidogrel seems to be beneficial in terms of total and LDL cholesterol concentrations, and overall mortality compared with clopidogrel use without interacting medication. In conclusion, CYP-mediated DDIs are a common and often unrecognized consequence of irrational drug prescribing.

Apteekkien kannattavuuden kehittäminen toimintolaskentaa soveltaen

Apteekkiliiketoiminta eroaa tavallisesta liiketoiminnasta erilaisten lakisääteisten velvoitteiden vuoksi. Alan regulaation viimeaikainen kehitys, kuten lääkevaihto, viitehintajärjestelmä sekä näiden tuoma lääkkeiden tiukentunut hintakilpailu, ovat tuoneet haasteita apteekkien kannattavuuteen. Tuotevalikoima- ja varastonhallinta ovat nousseet yhä tärkeämpään rooliin. Tutkimuksen tavoitteena oli kehittää apteekkien kannattavuutta toimintolaskentaa soveltaen. Toimintolaskennalla kahdelle apteekille tuotettiin kustannus- sekä tuotekannattavuustietoa. Tutkimuksen teoreettinen viitekehys koostui toimintolaskennan sekä apteekkiliiketoiminnan aikaisemmasta tutkimuksesta. Tutkimuksesta kävi ilmi, että kummassakin apteekissa oli erittäin laaja tuotesortimentti. Itsehoito- sekä vapaan kaupan tuotteiden tuotesortimenttia järkeistämällä kannattavuutta voitaisiin parantaa. Monesti tuotekategorioissa on useita saamaa vaikuttavaa ainetta sisältävää valmistetta usealta eri toimittajalta mikä heikentää kannattavuutta. Tuloksista kävi ilmi myös, että tulevaisuudessa vapaan kaupan tuotteet tulevat olemaan tärkeässä roolissa, mikä korostaa markkinointi- ja myyntiosaamisen tärkeyttä. Reseptilääkkeissä kate ei näyttäisi kattavan kustannuksia, minkä vuoksi varastonhallintaan on kiinnitettävä huomiota.

Curriculum innovation in teacher education : exploring conceptions among Tanzanian teacher educators

The focus of the study is to understand curriculum innovation from the perspective of Tanzanian teacher educators. It is argued that the deterioration of quality of education in schools is partly to be attributed to the way in which teachers are educated. Curriculum innovation is considered as an essential strategy for bringing about improvement in teacher education. Therefore, in 2000 a new curriculum was introduced; however, right from the inception the curriculum was criticised by teacher educators. The overall aim of the study is to investigate teacher educators’ conceptions of curriculum innovation. In the theoretical framework the main focus is on discussion about different curriculum approaches for teacher education and innovation. In order to achieve the aim of the study, a phenomenographic approach is employed. This approach is used in order to identify similarities and variation in educators’ conceptions of curriculum innovation. The empirical basis of the study consists of interviews with thirty teacher educators working in eight teachers’ colleges situated in various parts of Tanzania. The findings, in brief, reveal variation in teacher educators’ conceptions of the dominant domains of innovation. Two broad conceptions of teaching with six aspects are identified. Conceptions of educational studies are presented in four broad categories of description with four aspects. Similarly, in methodology subjects two conceptions are described with four aspects. On the integration of subject matter studies and subject methods, two broad conceptions are presented with six aspects. Conceptions of textbook prescription policy are characterised in two broad categories of description with four aspects. With the use of modules two broad conceptions are identified with six aspects. In addition, the study identifies four broad conceptions of future curriculum approaches with eight aspects. Looking across the categories of description, the results indicate that educators cope with innovation individually. Three character types of teacher educators are presented: loyal, creative and critical. Furthermore, four types of phenomena suggesting critical areas about teacher educators’ conceptions of innovation are described: educators’ prior educational background, technical factors, student teachers’ factors and shifting from teaching to learning. On the whole, educators express a number of frame factors in the process of change towards the aim of curriculum innovation. This indicates that the new curriculum (2000) is not implemented as intended by curriculum developers. Constraints to the implementation are presented and discussed in detail. From these findings, two models of educators’ stance towards curriculum innovation are presented and can be used as a framework for planning successful curriculum innovations and analysing practice in teachers’ colleges.

Litium-ioniakun tasapainon hallinta

Nykyaikaisen liikkuvan sähkökäytön energianlähteenä voi toimia jopa sadoista yksittäisistä sarjaankytketyistä litium-ionikennoista muodostuva akusto. Luotettaviin mittauksiin perustuva valvonta ja käytönohjaus on erityisen tärkeää litium-ioniakuissa, jotka ovat herkkiä yli- ja alijännitteille sekä korkeille lämpötiloille. Monipuolinen hallintajärjestelmä auttaa hyödyntämään akun koko kapasiteetin sekä säilyttämään akun suorituskyvyn estämällä väärinkäytön. Tässä työssä keskitytään tarkastelemaan monikennoisten litium-ioniakkujen sovelluksissa ilmeneviä haasteita sekä eri julkaisuissa esitettyjä ratkaisumalleja akun tasapainon hallitsemiseksi.

Tiedonhallinnan kehittäminen prosessikuvausten ja sähköisen dokumentoinnin avulla

Tämän diplomityön tavoitteena on selkeyttää apteekin ydinprosesseja mallintamalla prosessit ja tehostaa apteekin tiedonhallintaa sähköisen toimintajärjestelmän avulla. Ydinprosessien mallintaminen lisää apteekin työntekijöiden tietoisuutta prosessien oikeasta suoritustavasta. Dokumenttien sijoittaminen yhteen paikkaan helpottaa niiden löytymistä ja käytettävyyttä. Tässä työssä tutkittiin yhtä yritystä, joten tutkimusmenetelmänä käytettiin tapaustutkimusta. Työn keskeinen sisältö rakentuu tiedonhallinnan, prosessijohtamisen sekä sähköisen toimintajärjestelmän teorioiden pohjalta. Teoriaa hyödynnetään käytännön tutkimuksessa, jossa kartoitetaan apteekin dokumentit ja kehitetään niiden organisointia. Työssä tunnistetaan ja mallinnetaan apteekin ydinprosessit sekä kerätään tietoa niiden ongelmakohdista. Apteekin ydinprosesseiksi tunnistettiin reseptiasiakkaan palvelu ja neuvonta, itsehoitoasiakkaan palvelu ja neuvonta, kotisairaanhoidon ja hoivakotien palvelu sekä tavaranhallinta. Apteekissa luodut dokumentit luokiteltiin toimintaohjeiksi, työohjeiksi, lomakkeiksi ja rekisteriselosteiksi. Työn tuloksena apteekin tiedonhallinta tehostui dokumenttien sähköistämisellä ja organisoinnilla toimintajärjestelmään. Ydinprosessien mallintaminen selkeytti apteekin ydinprosesseja sekä lisäsi työntekijöiden tietoisuutta prosessien oikeasta toimintatavasta.

Enhanced muscle strength with carbohydrate supplement two hours before open cholecystectomy: a randomized, double-blind study

Objective: to investigate the effects of preoperative fasting abbreviation with oral supplementation with carbohydrate in the evolution of grip strength in patients undergoing cholecystectomy by laparotomy. Methods : we conducted a clinical, randomizeddouble blind study with adult female patients, aged 18-60 years. Patients were divided into two groups: Control Group, with fasting prescription 6-8h until the time of operation; and Intervention Group, which received prescription of fasting for solids 6-8h before surgery, but ingested an oral supplement containing 12.5% carbohydrate, six (400ml) and two (200ml) hours before theprocedure. The handgrip strength was measured in both hands in both groups, at patient's admission (6h before surgery), the immediate pre-operative time (1h before surgery) and 12-18h postoperatively. Results : we analyzed 27 patients, 14 in the intervention group and 13 in the control group. There was no mortality. The handgrip strength (mean [standard deviation]) was significantly higher in the intervention group in the three periods studied, in at least one hand: preoperatively in the dominant hand (27.8 [2.6] vs 24.1 [3.7] kg; p=0.04), in the immediate preoperative in both hands, and postoperatively in the non-dominant hand (28.5 [3.0] vs 21.3 [5.9] kg; p=0.01). Conclusion : the abbreviation of preoperative fasting to two hours with drink containing carbohydrate improves muscle function in the perioperative period.

Pilvipalvelun identiteetin- ja pääsynhallinta palveluna

Työn tavoite on ollut tutkia ja rakentaa pilvipalvelun identiteetin- ja pääsynhallinta liiketoimintapalveluksi yrityksille ja organisaatioille. Lähtökohtana on ollut valmiiden identiteetinhallintaohjelmistotuotteiden käyttäminen kehitettävän palvelutuotteen osana. Työssä on ollut tarkoitus selvittää, voiko identiteetinhallintaa ja pääsynhallintaa tuottaa ja tarjota pilvipalveluna kannattavasti. Tutkimusote on ollut konstruktiivinen ja triangulaatiossa on käytetty useaa menetelmää, jotta on saatu selvä kuva liiketoiminnan luonteesta ja tarpeista. Menetelmiä ovat olleet kyselytutkimus ja peste-analyysi. Lisäksi on tehty liiketoimintasuunnitelma ja palveluliiketoiminnan kuvaus Orsterwalderin canvas- menetelmällä. Jokainen tutkimusosa on ollut oleellinen määritettäessä palvelutuotteen ominaisuuksia, koska tavoite on ollut saada mahdollisimman luotettava ja helppokäyttöinen tuote nopeasti kasvaville pilvipalvelumarkkinoille. Tutkimuksen tuloksena on määritelty malli palveluliiketoiminnan tarpeisiin sopivasta turvallisesta palvelualustasta, joka skaalautuu hyvin pilvipalveluiden käytön lisääntyessä voimakkaasti. Liiketoimintasuunnitelman laskelmien avulla on löydetty käyttäjämäärien alarajat kannattavaan liiketoimintaan. Lisäksi on huomattu palvelun rakenteen auttavan yrityksiä ja organisaatiota suojaamaan pilvipalveluiden käyttäjätunnukset ja salasanat väärinkäytöksiltä, mikä on tarpeellista ja ajankohtaista kaikille organisaatioille, jotka harkitsevat pilvipalveluiden käyttöä ja haluavat tehdä sen tietoturvallisesti. Tutkimuksen tuloksena on pystytty määrittelemään, onko liiketoiminta kannattavaa vai ei sekä palvelun tarvitsemat liiketoimintaelementit.

Reseptilääkkeiden markkinoinnin eettisyys

Tutkielmassa tarkastellaan reseptilääkkeiden markkinointia Suomessa alan toimijoiden päätöksenteon ja eettisten ohjeiden kautta. Tutkimuksen keskeisimpänä tavoitteena on esitellä lääkealan eri toimijoiden näkökulmia heidän eettisen tai epäeettisen päätöksentekonsa kautta. Mahdollisesti vaikuttavista tekijöistä tavoitteena on myös esitellä eettisiä ohjeita ja pohtia millainen rooli niillä on toimijoiden päätöksenteossa. Tutkimuksessa pyritään myös tuomaan ilmi eettisiä ongelmia lääketeollisuudessa ja avaamaan alan toimijoiden yleistä näkemystä reseptilääkkeiden markkinointiin liittyen. Lisäksi tutkimuksessa tutustutaan lääketeollisuuteen toimialana.

Combined effects of diethylpropion and alcohol on locomotor activity of mice: participation of the dopaminergic and opioid systems

The widespread consumption of anorectics and combined anorectic + alcohol misuse are problems in Brazil. In order to better understand the interactive effects of ethanol (EtOH) and diethylpropion (DEP) we examined the locomotion-activating effects of these drugs given alone or in combination in mice. We also determined whether this response was affected by dopamine (DA) or opioid receptor antagonists. A total of 160 male Swiss mice weighing approximately 30 g were divided into groups of 8 animals per group. The animals were treated daily for 7 consecutive days with combined EtOH + DEP (1.2 g/kg and 5.0 mg/kg, ip), EtOH (1.2 g/kg, ip), DEP (5.0 mg/kg, ip) or the control solution coadministered with the DA antagonist haloperidol (HAL, 0.075 mg/kg, ip), the opioid antagonist naloxone (NAL, 1.0 mg/kg, ip), or vehicle. On days 1, 7 and 10 after the injections, mice were assessed in activity cages at different times (15, 30, 45 and 60 min) for 5 min. The acute combination of EtOH plus DEP induced a significantly higher increase in locomotor activity (day 1: 369.5 ± 34.41) when compared to either drug alone (day 1: EtOH = 232.5 ± 23.79 and DEP = 276.0 ± 12.85) and to control solution (day 1: 153.12 ± 7.64). However, the repeated administration of EtOH (day 7: 314.63 ± 26.79 and day 10: 257.62 ± 29.91) or DEP (day 7: 309.5 ± 31.65 and day 10: 321.12 ± 39.24) alone or in combination (day 7: 459.75 ± 41.28 and day 10: 427.87 ± 33.0) failed to induce a progressive increase in the locomotor response. These data demonstrate greater locomotion-activating effects of the EtOH + DEP combination, probably involving DA and/or opioid receptor stimulation, since the daily pretreatment with HAL (day 1: EtOH + DEP = 395.62 ± 11.92 and EtOH + DEP + HAL = 371.5 ± 6.76; day 7: EtOH + DEP = 502.5 ± 42.27 and EtOH + DEP + HAL = 281.12 ± 16.08; day 10: EtOH + DEP = 445.75 ± 16.64 and EtOH + DEP + HAL = 376.75 ± 16.4) and NAL (day 1: EtOH + DEP = 553.62 ± 38.15 and EtOH + DEP + NAL = 445.12 ± 55.67; day 7: EtOH + DEP = 617.5 ± 38.89 and EtOH + DEP + NAL = 418.25 ± 61.18; day 10: EtOH + DEP = 541.37 ± 32.86 and EtOH + DEP + NAL = 427.12 ± 51.6) reduced the locomotor response induced by combined administration of EtOH + DEP. These findings also suggest that a major determinant of combined anorectic-alcohol misuse may be the increased stimulating effects produced by the combination.

Efficacy, safety, quality control, marketing and regulatory guidelines for herbal medicines (phytotherapeutic agents)

This review highlights the current advances in knowledge about the safety, efficacy, quality control, marketing and regulatory aspects of botanical medicines. Phytotherapeutic agents are standardized herbal preparations consisting of complex mixtures of one or more plants which contain as active ingredients plant parts or plant material in the crude or processed state. A marked growth in the worldwide phytotherapeutic market has occurred over the last 15 years. For the European and USA markets alone, this will reach about $7 billion and $5 billion per annum, respectively, in 1999, and has thus attracted the interest of most large pharmaceutical companies. Insufficient data exist for most plants to guarantee their quality, efficacy and safety. The idea that herbal drugs are safe and free from side effects is false. Plants contain hundreds of constituents and some of them are very toxic, such as the most cytotoxic anti-cancer plant-derived drugs, digitalis and the pyrrolizidine alkaloids, etc. However, the adverse effects of phytotherapeutic agents are less frequent compared with synthetic drugs, but well-controlled clinical trials have now confirmed that such effects really exist. Several regulatory models for herbal medicines are currently available including prescription drugs, over-the-counter substances, traditional medicines and dietary supplements. Harmonization and improvement in the processes of regulation is needed, and the general tendency is to perpetuate the German Commission E experience, which combines scientific studies and traditional knowledge (monographs). Finally, the trend in the domestication, production and biotechnological studies and genetic improvement of medicinal plants, instead of the use of plants harvested in the wild, will offer great advantages, since it will be possible to obtain uniform and high quality raw materials which are fundamental to the efficacy and safety of herbal drugs.