Andréia Queiroz Ribeiro

Inquérito sobre uso de medicamentos por idosos aposentados, Belo Horizonte,MG

OBJETIVO: Caracterizar o uso de medicamentos por aposentados e pensionistas idosos, com enfase nas diferencas entre generos. METODOS: Inquerito domiciliar conduzido com amostra aleatoria simples de 667 individuos com 60 anos ou mais, residentes em Belo Horizonte, MG, em 2003. Os idosos foram entrevistados por farmaceuticos, utilizando questionario padronizado. Foram estimadas a prevalencia de uso e a media de medicamentos usados nos ultimos 15 dias anteriores a entrevista, as quais foram estratificadas de acordo com o genero segundo variaveis sociodemograficas e de saude. RESULTADOS: A prevalencia de uso de medicamentos foi de 90,1%, significativamente maior entre as mulheres (93,4%) do que entre os homens (84,3%). Mulheres utilizaram em media 4,6±3,2 produtos e homens 3,3±2,6 (p<0,001). Os principios ativos mais usados pelos idosos pertenciam aos sistemas cardiovascular, nervoso, e do trato alimentar e metabolismo. O consumo foi superior entre as mulheres nesses tres grupos, assim como as medias de uso de medicamentos segundo variaveis sociodemograficas e de saude selecionadas. CONCLUSOES: O estudo identificou uso mais intenso de medicamentos pelas mulheres, fato que as torna mais vulneraveis aos prejuizos de polifarmacia, como risco de interacoes e uso inadequado.

Qualidade do uso de medicamentos por idosos: uma revisão dos métodos de avaliação disponíveis

O artigo apresenta diferentes metodos de avaliacao da adequacao da terapia farmacologica para idosos, a partir da revisao da literatura no periodo de 1990 a 2003. Na decada de 1990, foi criada uma variedade de metodos os quais sao classificados, de acordo com a utilizacao de criterios, em implicitos, explicitos e aqueles que combinam ambos. Sao apresentadas as vantagens e desvantagens de cada metodo e observa-se que os metodos que utilizam combinacao de criterios permitem uma melhor avaliacao, uma vez que incorporam um maior numero de elementos envolvidos no processo de utilizacao de medicamentos. A adequacao ou adaptacao destes metodos a realidade brasileira e a incorporacao dos mesmos as praticas avaliativas em saude podem se constituir em um passo fundamental na promocao do uso racional de medicamentos no pais.

Complexidade do regime terapêutico prescrito para idosos

OBJECTIVE: To examine factors associated with therapeutic regimen complexity of drug prescriptions for elderly people in Belo Horizonte, Minas Gerais, Brazil. METHODS: A household survey of elderly people selected by simple random sampling from Brazils social security register. The medication complexity index (MCI), a direct measurement of actions required to administer medication, was derived from information in the latest prescription. Univariate and bivariate analyses were performed to identify factors associated with the MCI. RESULTS: Of the 667 interviewees, 56.5% had prescriptions meeting the inclusion criteria; most (69.2%) were females aged 72.4 years (mean); 35.5% self-rated their health good or very good; and 37.4% reported five or more diseases. In the 15 days prior to interview, 1873 drugs were used (mean=5.1), of which 942 appeared on the prescriptions examined (mean=2.5). Over the same period, 22.3% of interviewees failed to use some prescribed drug. The MCI ranged from 1 to 24 (mean=6.1). Number of drugs prescribed (>2), less schooling, worse perception of health and a lower benefit payment associated positively with greater complexity (p<0.05). An association was observed between regimen complexity and failure to use some drug in the preceding 15 days (p=0.034). CONCLUSION: Elderly people in worse socio-economic and health conditions seem more likely to receive more complex therapeutic regimens, which are associated with non-compliance to the proposed treatment. This is an important consideration in the healthcare of elderly. Simplification of therapy could aid self-care among the elderly.

Utilização de fitoterápicos por idosos: resultados de um inquérito domiciliar em Belo Horizonte (MG), Brasil

The herbal drugs constitute an alternative or complementary therapy for the health needs and its use has been growing in the aged population of many countries. However, herbal drugs present important adverse effects and drug interactions and should not be indiscriminately used. The aim of this study was to investigate the profile of herbal drug use by elderly and pensioner residents of Belo Horizonte, Brazil. Eight hundred and eighty-one retirees were randomly selected from the Instituto Nacional do Seguro Social (INSS) database for in-home interview. The prevalence of herbal drugs use, and possible drug interactions were investigated. Results showed that 667 (80.3%) of selected individuals were interviewed. Seventy-one subjects (10.6%) used herbal drugs in the past 15 days, mainly those prepared from ginkgo (41.8%), horse chestnut (12.3%), and soya extract (8.2%). More than 60% of the herbal drugs were acquired in compounding pharmacies. Almost 45% of the herbal drug users were exposed to at least one potential herb-drug interaction, such as between ginkgo and thiazide diuretics (14) and antithrombotic/anticoagulants (8). Strategies to provide orientation for the rational use of these products in elderly people are necessary, since they are the population most exposed to polypharmacy and in consequence, most vulnerable to inappropriate uses of medications.

Perfil de utilização de fitoterápicos em farmácias comunitárias de Belo Horizonte sob a influência da legislação nacional

An overview of the herbal drugs consumption in communitarian pharmacies in Belo Horizonte (MG), Brazil is used in this article as a tool to analyze the influence of the national law over this market. In order to reach this goal, individuals that had bought herbal drugs were interviewed at the pharmacies. It was observed that, in the same nation that has the highest biodiversity in the planet and is privileged by a popular culture knowledgeable in the therapeutic properties of the plants, there is a tendency in the market for the use of exotic plants, coming from developed countries. The influence of the Brazilian law about the herbal drugs, which constantly worries about the quality, efficiency and safety of these medicines, but at the same time, tends to proscribe the native drugs that are part of the popular medicine, is discussed in this assignment. It is concluded that it is pertinent to discuss the profile of the herbal drugs users in the spot of the laws of the country related to these drugs, in the field of the public health, since this legislation is reflected in the strategies and/or barriers to increase the access to the drugs by the population.

Uso de anti-hipertensivos e antidiabéticos por idosos: inquérito em Belo Horizonte, Minas Gerais, Brasil

Concern over the harmful effects of drug use by the elderly has motivated studies aimed at identifying problems in such utilization. This was a household survey with retirees aged > 60 years living in Belo Horizonte, Minas Gerais State, Brazil, in 2003, who reported having a diagnosis of diabetes and/or hypertension. Quality of anti-hypertensive and anti-diabetic medication was measured by redundancy, combinations of drugs, and inappropriate drugs. Among 283 elderly patients (89%) with self-reported hypertension and use of anti-hypertensive pharmacotherapy, 68.2% were using diuretics and 37.8% ACE inhibitors. Among the 22 (64.7%) self-reported diabetic patients under pharmacotherapy, 45.5% were using insulin and 77.3% oral anti-diabetic agents. Among the 89 self-reported diabetic and hypertensive patients, 80 (90%) were using anti-hypertensive drugs and 51 (57.3%) anti-diabetic agents. The study revealed the use of dose combinations, redundant use, and inappropriate medicines, thus indicating the need to monitor treatment protocols and improve healthcare for elderly patients.

Utilização de medicamentos por aposentados brasileiros: 1 - metodologia e resultados de cobertura de inquérito multicêntrico

This paper reports methodological aspects and response rates of a survey with the main objective of describing the drug utilization profile of retirees of the Institute of National Social Security of Brazil, 60 years of age or older, in three simple random samples: Brazil (countrywide), Belo Horizonte municipality, and Rio de Janeiro municipality. This cross-sectional study employed two approaches: mail (self-report questionnaires) and home interviews (questionnaires completed by interviewers). This strategy allowed evaluation of response agreement between the mail and home interview approaches. In the national sample of 3,000 individuals, 1,025 only responded to the self-report questionnaire. Despite this the low response rate, there was reasonable resemblance between respondents and non-respondents, suggesting that this sample is representative of the target population. In Belo Horizonte and Rio de Janeiro the initial samples of 800 individuals were replicated for both approaches, mail and home interview. The response rates to the mail surveys were 46.8% and 34.4% in Belo Horizonte and Rio de Janeiro, respectively. The response rates to the home interviews were 80.3% and 70.7% in Belo Horizonte and Rio de Janeiro, respectively, after unavoidable attrition.

Composição dos gastos privados com medicamentos utilizados por aposentados e pensionistas com idade igual ou superior a 60 anos em Belo Horizonte, Minas Gerais, Brasil

The aim of this study was to analyze the structure of private drug expenditures by individuals 60 years and older in Belo Horizonte, Minas Gerais, Brazil. The study population consisted of a representative sample of retirees under the National Social Security Institute (INSS) in the city of Belo Horizonte, interviewed through a household survey. Monthly out-of-pocket drug expenditures were calculated, and a drug cost structure analysis was performed according to drug characteristics. 667 elders answered the survey. Mean drug expenditures per month were US

Metabolic syndrome risk assessment in children: use of a single score

38.91. The therapeutic groups representing the majority of drug expenditures were: cardiovascular system (26%), nervous system (24%), and digestive/metabolic system (15%). Considering drug registration categories, brand-name drugs accounted for the majority of expenditures (54%). The results of this study can support policies to improve both access to medicines and overall health conditions for the Brazilian elderly population.

The use of nonsteroidal anti-inflammatory drugs and the occurrence of gastric lesions among patients undergoing upper endoscopy in a university hospital in Brazil

OBJECTIVE: To calculate a score of metabolic syndrome (MetS) in children and set a cutoff point of this score for the prediction of MetS risk. METHODS: The study included a random sample of 348 children aged 8 and 9 years of Viçosa, Southeast Brazil. Factor analysis by principal components (PCA) was used to determine, among various risk factors, those with higher degrees of intercorrelation. The chosen variables were: waist circumference (PC), homeostatic model assessment of insulin resistance (HOMA), high density lipoprotein (HDL), triglycerides (TAG) and mean arterial pressure (MAP). Z-scores were created for each one of these parameters and the sum of these z-scores constituted the MetS score. The receiver operating characteristic (ROC) curve was used to identify the cutoff of MetS score, using as gold standard the presence or absence of MetS determined according to criteria age-modified. RESULTS: The prevalence of MetS in the sample was 8.9% by adopting specific criteria for age, and 24% when considering the cutoff of MetS score. The selected cutoff point of 1.86 was accurate to predict the MetS risk in this sample due to its high sensitivity (96.7%), specificity (82.7%) and AUC of 0.96. CONCLUSIONS: This original Brazilian study presents the MetS score as a suitable alternative for the study of Metabolic Syndrome in children, given the lack of consensus for the definition of this syndrome in childhood.