Estratégias para operacionalização da logística reversa de medicamentos

O descarte de medicamentos envolve dois fluxos: o fluxo institucional, dos resíduos de fármacos, classificados como resíduos de serviços de saúde, utilizados na indústria e nas instituições de saúde; e o fluxo domiciliar, dos medicamentos vencidos/em desuso em poder da população. O descarte dos resíduos de medicamentos de origem domiciliar pode ser promovido pela logística reversa, onde este tipo de resíduo é devolvido ao setor empresarial para destinação final ambientalmente segura. O objetivo deste estudo foi identificar as estratégias mais viáveis para operacionalização da logística reversa de medicamentos. Trata-se de uma pesquisa exploratória, descritiva, com abordagem quantitativa. As estratégias foram avaliadas junto a atores da cadeia de valor farmacêutica: representantes do poder público, da indústria e distribuição farmacêutica, e consumidores/potenciais consumidores de medicamentos. Foram elaborados três questionários de avaliação de estratégias segundo seis critérios: mediação (articulação entre atores da cadeia produtiva farmacêutica por meio de políticas públicas); fiscalização (das ações); complexidade (de implantação e operacionalização); custos (de implantação e manutenção); adesão (potencialidade de ser inserida no cotidiano da população) e abrangência (potencialidade de alcançar a população). As estratégias foram hierarquizadas em ordem decrescente de viabilidade: rientações à população por profissionais de saúde, farmácias e internet, sinalização de informações nas embalagens e bulas de medicamentos, campanhas publicitárias e de educação ambiental e a disponibilização de postos de entrega voluntária. Os resultados poderão contribuir para a operacionalização de um sistema de logística reversa de medicamentos, considerando todos os atores envolvidos e buscando conciliar suas necessidades, possibilidades, limitações e interesses

Critical analysis of the regulations regarding the disposal of medication waste

Expired or unused medication at people's homes is normally disposed of in normal garbage, sewage system or, in certain cases, returned to the public health system. There is still no specific legislation regarding this leftover medication to regulate and orient the handling and correct disposal of medication waste. However, there is defined regulation regarding health services' solid waste. This article has the objective of discussing management models for the disposal of medication waste and the recommendations made by pertinent national and international legislation. By means of literature reviews, the management structure for medication waste of international legislation and the regulations regarding the environment, as well as the national legislation for the solid waste from health services was analyzed. Through the analysis it was possible to present better clarifications as to the possible impacts to the environment, to the public's health and alternatives in order to obtain the efficient disposal of medication, reducing and/or avoiding sanitary risk, guaranteeing the quality and safety of public health.

Reducing medicines waste in the community

There is increasing concern at the amount and cost of prescribed medicines that are unused or wasted and then have to be disposed of. Previous studies have used health promotion and Dispose Unwanted Medicines Properly campaigns targeted at the patient to describe and quantify the annual cost of waste. The reasons patients return unused drugs to pharmacies have also been explored. The paper focuses on patient explanations for not needing medication; categorized as: over-collection in the past, self-management strategies, changes in medical condition, other changes in patient circumstances, or the repeat medicines policy at the surgery. The aim of the original study was to make a measurable change in prescribed medicines with a reduction in medicines wastage, whilst at the same time achieving improved standards of pharmaceutical care. Information on patient needs and behaviour came from consultation in the pharmacy monitoring forms and interview. The study was based on two medical practices in the West Midlands, UK, comparing an outer city and an inner city population. The participants were general practitioners, pharmacists and 350 repeat prescription patients. Prescriptions were issued for two three-month periods. The outcome was that 23.8% of the prescribed items were not dispensed, at a value of £13.1K, 58% of the medications that would be expected to be regularly supplied were collected. The study suggests that closer professional management at the point of dispensing and an understanding of patient experiences can help reduce the amount of unwanted medication collected by patients.

Fat Substitutes In Processing Of Sausages Using Piramutaba Waste.

The aim of this study was to evaluate fat substitute in processing of sausages prepared with surimi of waste from piramutaba filleting. The formulation ingredients were mixed with the fat substitutes added according to a fractional planning 2(4-1), where the independent variables, manioc starch (Ms), hydrogenated soy fat (F), texturized soybean protein (Tsp) and carrageenan (Cg) were evaluated on the responses of pH, texture (Tx), raw batter stability (RBS) and water holding capacity (WHC) of the sausage. Fat substitutes were evaluated in 11 formulations and the results showed that the greatest effects on the responses were found to Ms, F and Cg, being eliminated from the formulation Tsp. To find the best formulation for processing piramutaba sausage was made a complete factorial planning of 2(3) to evaluate the concentrations of fat substitutes in an enlarged range. The optimum condition found for fat substitutes in the sausages formulation were carrageenan (0.51%), manioc starch (1.45%) and fat (1.2%).

Clinical Influence Of Different Intracanal Medications On Th1-type And Th2-type Cytokine Responses In Apical Periodontitis.

This clinical study assessed the influence of different intracanal medications on Th1-type and Th2-type cytokine responses in apical periodontitis and monitored the levels of bacteria from primarily infection during endodontic procedures. Thirty primarily infected teeth were randomly divided into 3 groups according to the medication selected: chlorhexidine (CHX), 2% CHX gel; Ca(OH)2/SSL, Ca(OH)2 + SSL; and Ca(OH)2/CHX, Ca(OH)2 + 2% CHX gel (all, n = 10). Bacterial sample was collected from root canals, and the interstitial fluid was sampled from lesions. Culture techniques were used to determine bacterial counts (colony-forming units/mL). Th1 (tumor necrosis factor-α, interferon-γ, and interleukin [IL]-2) and Th2 cytokines (IL-4, IL-5, and IL-13) were measured by enzyme-linked immunosorbent assay. All intracanal medication protocols were effective in reducing the bacterial load from root canals (all P < .05) and lowering the levels of Th1-type cytokines in apical lesions (all P < .05), with no differences between them (P > .05). Both Ca(OH)2 treatment protocols significantly increased the levels of Th2-type cytokines (P < .05), with no differences between them (P > .05). Thus, chlorhexidine medication showed the lowest effectiveness in increasing the levels of Th2-type cytokine. After treatment, regardless of the type of medication, the linear regression analysis indicated the down-regulation of Th2-type cytokines by Th1-type cytokines. All intracanal medication protocols were effective in reducing bacterial load and lowering the levels of Th1-type cytokines. Thus, the use of Ca(OH)2 medications contributed to the increase in the Th2-type cytokine response in apical periodontitis.

Elaboration of sausage using minced fish of Nile tilapia filleting waste

The objective of this study was to evaluate the inclusion of minced fish (MF) (0, 20, 40, 60, 80 and 100%), obtained from Nile tilapia filleting waste, in sausage and determine their physicochemical, nutritional and sensory properties. The sausages showed a decrease in protein and increase in fat content with increasing inclusion of MF. The nutritional quality of the products was high, with digestibility over 85%. The parameters of texture instrumental and yellow color (b*) decreased with the increasing inclusion of MF. The sensory evaluation of the color showed that the maximum level of inclusion of MF was not well accepted by the panelists. The sausage with the best acceptance for the flavor attribute was those with 60% of MF. The results showed good nutritional quality of sausages utilizing MF of Nile tilapia filleting waste and according to the sensory evaluation, the maximum level of inclusion should not exceed 60%.

Safety Assessment of Potentially Inappropriate Medications (PIM) use in Older People and the Factors Associated with Hospital Admission

Purpose: Potentially Inappropriate Medications (PIM) use in elderly people may be responsible for the development of Adverse Drug Reaction (ADR) which, when severe, leads to hospital admissions. Objectives: to estimate the prevalence of elderly who had used PIM before being admitted to hospital and to identify the risk factors and the hospitalizations related to ADR arising from PIM. Methods: A descriptive and cross-sectional study was performed in the internal medicine ward of a teaching hospital (Brazil), in 2008. With the aid of a validated form, patients aged >= 60 years, with length of hospital stay >= 24 hours, were interviewed about drugs taken prior to the hospital admission and the complaints/reasons for hospitalization. Results: 19.1% (59/308) of older patients had taken PIM before hospital admission and in 4.9%; there were a causal relation between the PIM taken and the complaint reported. PIM responsible for admissions were: amiodarone, amitriptyline, cimetidine, clonidine, diazepam, digoxin, estrogen, fluoxetine, lorazepam, short-acting nifedipine and propranolol. 47.0% of the clinical manifestations of PIM-related ADR were: dizziness, fatigue, digoxin toxicity and erythema. Only polypharmacy was detected as a risk factor for the occurrence of ADR of PIM (p = 0.02). Conclusion: PIM use in elderly people is not a risk factor for ADR-related hospital admission. Probably, severe ADR, which lead to hospitalizations of older people, can be explained by idiosyncratic response or the predisposition of these patients to develop adverse drug events, whether or not drugs are classed as PIM.

A greener and highly sensitive flow-based procedure for carbaryl determination exploiting long pathlength spectrophotometry and photochemical waste degradation

An environmentally friendly analytical procedure with high sensitivity for determination of carbaryl pesticide in natural waters was developed. The flow system was designed with solenoid micro-pumps in order to improve mixing conditions and minimize reagent consumption as well as waste generation. A long pathlength (100 cm) flow cell based on a liquid core waveguide (LCW) was employed to increase the sensitivity in detection of the indophenol formed from the reaction between carbaryl and p-aminophenol (PAP). A clean-up step based on cloud-point extraction was explored to remove the interfering organic matter, avoiding the use of toxic organic solvents. A linear response was observed within the range 5-200 mu g L(-1) and the detection limit, coefficient of variation and sampling rate were estimated as 1.7 mu g L(-1) (99.7% confidence level), 0.7% (n=20) and 55 determinations per hour, respectively. The reagents consumption was 1.9 mu g of PAP and 5.7 mu g of potassium metaperiodate, with volume of 2.6 mL of effluent per determination. The proposed procedure was selective for the determination of carbaryl, without interference from other carbamate pesticides. Recoveries within 84% and 104% were estimated for carbaryl spiked to water samples and the results obtained were also in agreement with those found by a batch spectrophotometric procedure at the 95% confidence level. The waste of the analytical procedure was treated with potassium persulphate and ultraviolet irradiation, yielding a colorless residue and a decrease of 94% of total organic carbon. In addition, the residue after treatment was not toxic for Vibrio fischeri bacteria. (c) 2010 Elsevier B.V. All rights reserved.

Determination of Cr, Fe, Co, Ni, Cu, Zn, As and Pb in liquid chemical waste by energy dispersive X-ray fluorescence

A method for simultaneous determination of Cr, Fe, Co, Ni, Cu, Zn, As e Pb in liquid chemical waste using Energy Dispersive X-Ray Fluorescence (EDXRF) technique was evaluated. A small sample amount (200 mu L) was dried on a 6.35 mu m thickness Mylar film at 60 degrees C and the analyses were carried out using an EDXRF spectrometer operated with an X-ray Mo tube (Zr filter) at 30 kV/20 mA. The acquisition time was 300 s and the Ga element was utilized as internal standard at 25 mg/L for quantitative analysis. The method trueness was assessed by spiking and the detection limit for those elements ranged from 0.39 to 1.7 mg/L. This method is notable because it assists the choice of the more appropriated waste treatment procedure, in which inter elemental interference is a matter of importance. In addition, this inexpensive method allows a non-destructive determination of the elements from (19)K to (92)U simultaneously.

Optimisation of environmental gas cleaning routes for solid wastes cogeneration systems - Part I - Analysis of waste incineration steam cycle

Research of advanced technologies for energy generation contemplates a series of alternatives that are introduced both in the investigation of new energy sources and in the improvement and/or development of new components and systems. Even though significant reductions are observed in the amount of emissions, the proposed alternatives require the use of exhaust gases cleaning systems. The results of environmental analyses based on two configurations proposed for urban waste incineration are presented in this paper; the annexation of integer (Boolean) variables to the environomic model makes it possible to define the best gas cleaning routes based on exergetic cost minimisation criteria. In this first part, the results for steam cogeneration system analysis associated with the incineration of municipal solid wastes (MSW) is presented. (c) 2007 Elsevier Ltd. All rights reserved.

Optimisation of environmental gas cleaning routes for solid wastes cogeneration systems. Part II - Analysis of waste incineration combined gas/steam cycle

In the first paper of this paper (Part I), conditions were presented for the gas cleaning technological route for environomic optimisation of a cogeneration system based in a thermal cycle with municipal solid waste incineration. In this second part, an environomic analysis is presented of a cogeneration system comprising a combined cycle composed of a gas cycle burning natural gas with a heat recovery steam generator with no supplementary burning and a steam cycle burning municipal solid wastes (MSW) to which will be added a pure back pressure steam turbine (another one) of pure condensation. This analysis aims to select, concerning some scenarios, the best atmospheric pollutant emission control routes (rc) according to the investment cost minimisation, operation and social damage criteria. In this study, a comparison is also performed with the results obtained in the Case Study presented in Part I. (c) 2007 Elsevier Ltd. All rights reserved.

Evaluation of the performance of biodiesel from waste vegetable oil in a flame tube furnace

This work presents a theoretical and experimental study of the biodiesel (ethyl ester from a waste vegetable oil) performance in a flame tube furnace. The heat transfer rate was analysed in several sections along the furnace and the performance of the biodiesel was compared to that of diesel oil. The flow of heat from the burn of each fuel in the direction of the walls of the combustion chamber was evaluated under the same fuel injection pressure. The peak of the heat transfer occurred around 0.45 m far from the fuel injection nozzle in a 0.305 m inner diameter combustion chamber. The diesel oil showed a higher heat transfer rate in most parts exposed to the flame. In the region where the body of the flame is not present, the heat transfer of biodiesel becomes higher. (C) 2008 Elsevier Ltd. All rights reserved.

Constitutive model for long term municipal solid waste mechanical behavior

This paper presents some improvements in the model proposed by Machado et al. [Machado SL, Carvalho MF, Vilar OM. Constitutive model for municipal solid waste. J Geotech Geoenviron Eng ASCE 2002; 128(11):940-51] now considering the influence of biodegradation of organic matter in the mechanical behavior of municipal solid waste. The original framework considers waste as composed of two component groups; fibers and organic paste. The particular laws of behavior are assessed for each component group and then coupled to represent waste behavior. The improvements introduced in this paper take into account the changes in the properties of fibers and mass loss due to organic matter depletion over time. Mass loss is indirectly calculated considering the MSW gas generation potential through a first order decay model. It is shown that as the biodegradation process occurs the proportion of fibers increases, however, they also undergo a degradation process which tends to reduce their ultimate tensile stress and Young modulus. The way these changes influence the behavior of MSW is incorporated in the final framework which captures the main features of the MSW stress-strain behavior under different loading conditions. (C) 2007 Elsevier Ltd. All rights reserved.

On the classification of mixed construction and demolition waste aggregate by porosity and its impact on the mechanical performance of concrete

The properties of recycled aggregate produced from mixed (masonry and concrete) construction and demolition (C&D) waste are highly variable, and this restricts the use of such aggregate in structural concrete production. The development of classification techniques capable of reducing this variability is instrumental for quality control purposes and the production of high quality C&D aggregate. This paper investigates how the classification of C&D mixed coarse aggregate according to porosity influences the mechanical performance of concrete. Concretes using a variety of C&D aggregate porosity classes and different water/cement ratios were produced and the mechanical properties measured. For concretes produced with constant volume fractions of water, cement, natural sand and coarse aggregate from recycled mixed C&D waste, the compressive strength and Young modulus are direct exponential functions of the aggregate porosity. Sink and float technique is a simple laboratory density separation tool that facilitates the separation of cement particles with lower porosity, a difficult task when done only by visual sorting. For this experiment, separation using a 2.2 kg/dmA(3) suspension produced recycled aggregate (porosity less than 17%) which yielded good performance in concrete production. Industrial gravity separators may lead to the production of high quality recycled aggregate from mixed C&D waste for structural concrete applications.

Characterization of mixed waste of granite and LD slag

This study focuses on the technical feasibility of the utilization of waste from the cutting of granite to adjust the chemical composition of slag from steelworks LD, targeting the addition of clinker Portland cement. For this, chemical characterization of the waste, its mixture and fusion was performed, obtaining a CaO/SiO(2) relationship of around 0.9 to 1.2 for the steelworks slag. We selected samples of the waste, mixed, melted and cooled in water and in the oven. Samples cooled in water, after examining with X-ray difractrograms, had been predominantly amorphous. For samples cooled in the furnace, which had vitreous, there was the presence of mineralogical phases Akermanita and Gehlenita, which is considered as the ideal stage for the mineral water activity of the slag. The adjustment of the chemical composition of the slag from steel works by the addition of waste granite was efficient, transforming the waste into a product that is the same as blast furnace slag and can be used in the manufacture of cement.