Helena Gama

Questionnaire design and the recall of pharmacological treatments: a systematic review.

We aimed to review systematically the published evidence regarding the effect of questionnaire design on the recall of pharmacological treatments.

Low prevalence of hypertension with pharmacological treatments and associated factors

OBJECTIVE To assess the determinants of the lack of pharmacological treatment for hypertension. METHODS In 2005, 3,323 Mozambicans aged 25-64 years old were evaluated. Blood pressure, weight, height and smoking status were assessed following the Stepwise Approach to Chronic Disease Risk Factor Surveillance. Hypertensives (systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg and/or antihypertensive drug therapy) were evaluated for awareness of their condition, pharmacological and non-pharmacological management, as well as use of herbal or traditional remedies. Prevalence ratios (PR) were calculated, adjusted for sociodemographic characteristics, cardiovascular risk factors and non-pharmacological treatment. RESULTS Most of the hypertensive subjects (92.3%), and nearly half of those aware of their condition were not treated pharmacologically. Among the aware, the prevalence of untreated hypertension was higher in men {PR = 1.61; 95% confidence interval (95%CI 1.10;2.36)} and was lower in subjects under non-pharmacological treatment (PR = 0.58; 95%CI 0.42;0.79); there was no significant association with traditional treatments (PR = 0.75; 95%CI 0.44;1.26). CONCLUSIONS The lack of pharmacological treatment for hypertension was more frequent in men, and was not influenced by the presence of other cardiovascular risk factors; it could not be explained by the use of alternative treatments as herbal/traditional medicines or non-pharmacological management. It is important to understand the reasons behind the lack of management of diagnosed hypertension and to implement appropriate corrective actions to reduce the gap in the access to healthcare between developed and developing countries.OBJETIVO: Analizar los determinantes de la falta de tratamiento farmacologico de la hipertension. METODOS: Se evaluaron 3.323 mozambicano de 25 a 64 anos en 2005. La presion arterial, peso, altura y tabaquismo fueron evaluados segun el estudio Stepwise Approach to Chronic Risk Factor Surveillance. Los hipertensos (presion arterial sistolica ≥ 140 mmHg y/o presion arterial diastolica i‚³90 mmHg y/o terapia anti-hipertensiva) fueron evaluados para verificar si eran conscientes de su hipertension, si recibian tratamiento farmacologico o no farmacologico, y si usaban hierbas o remedios tradicionales. Se calcularon los cocientes de prevalencia (PR) para hipertension no tratada, ajustadas para caracteristicas sociodemograficas, factores de riesgo cardiovascular y tratamiento no farmacologico. RESULTADOS: La mayoria de los hipertensos (92,3%) y casi la mitad de los conscientes de su hipertension no eran tratadas con farmacos. Entre los que sabian ser hipertensos, la hipertension sin tratamiento era mas frecuente en hombres (PR =1,61; IC95% 0,56;1,43) y no podia ser explicada por el uso de tratamiento no farmacologico (PR= 0,58; IC95% 0,42;0,79); no habia asociacion significativa con los tratamientos tradicionales (PR= 0,75; IC95% 0,44;1,26). CONCLUSIONES: La falta de tratamiento farmacologico de la hipertension, mas frecuente en hombres, no se explica por otros factores de riesgo cardiovascular, ni por el uso de tratamientos tradicionales o tratamiento no farmacologico. Es importante entender las razones de la falta de tratamiento de la hipertension diagnosticada e implementar medidas correctivas apropiadas, para reducir las diferencias en el acceso a cuidados de salud entre las poblaciones de los paises desarrollados y en vias de desarrollo.

Factors associated with chloroquine induced pruritus during malaria treatment in Mozambican University students

INTRODUCTION It has been suggested that reductions in chloroquine use may be followed by a resurgence of chloroquine-susceptible falciparum malaria, and chloroquine might once again be an effective treatment choice, which renews the importance of aspects related to its use and misuse. Therefore, we aimed to estimate the prevalence of chloroquine-induced pruritus and to identify risk factors for its occurrence in Mozambican University students. METHODS A cross-sectional study was conducted at a private University in Maputo. Students were approached in the classrooms to complete a self-administered questionnaire covering sociodemographic characteristics, number of previous malaria episodes, utilization of antimalarial drugs, and life prevalence of chloroquine induced pruritus. RESULTS Among 795 respondents, 77.4% (601/777) reported at least one malaria episode and 73.2% (542/740) had used chloroquine before. The life-prevalence of chloroquine-induced pruritus was 30.1% (158/525). Pruritus tended to be more frequent when chloroquine was used for treatment compared with prophylaxis only (31.2% vs. 10.3%, p<0.05), and chloroquine use in the last malaria episode was less frequent in participants recalling chloroquine-induced pruritus (52.3% vs. 65.1%, p<0.05). CONCLUSION About one third of the black population using chloroquine experienced chloroquine-induced pruritus at least once. This adverse reaction tended to be less frequent when lower doses of chloroquine were used and to influence future anti-malarial therapeutic choices.

Use of generic and essential medicines for prevention and treatment of cardiovascular diseases in Portugal

BackgroundThe successful control of cardiovascular diseases at the lowest possible cost requires the use of the most effective and affordable medicines. We aimed to describe the trends in the ambulatory use of medicines for prevention and treatment of cardiovascular diseases [Anatomic Therapeutic Chemical classification system (ATC): C and B01A] in Portugal, between 2004 and 2012, and to estimate the potential for expenditure reduction through changes in patterns of use.MethodsWe analysed sell-out data, expressed as defined daily doses (DDD) and pharmacy retail price (€), from a nationwide database. We estimated potential reduction in expenditures through the increase, up to 90% of the volume of DDD, in the use of generic and essential medicines; the latter were defined according to guidelines from Portugal and another European country.ResultsOverall consumption increased by approximately 50% from 2004 to 2012, reaching nearly 2400 million DDD, whereas expenditure decreased to 753 million € (−31.3% since 2006). Use of generics and essential medicines increased, representing 43.6 and 39.9% of DDD consumption in 2012, respectively. The 40 most used groups of medicines in 2012 accounted for just over 80% of overall consumption; among these, increase in use of generics and essential medicines would have contributed to a saving of 275 million €.ConclusionsChanges in patterns of consumption of medicines towards a more frequent use of generics, a preferential use of essential medicines and a more rational use of fixed-dose combinations may contribute to a more efficient use of health resources.

Use of medicines by homeless people in Porto, Portugal

The objective of this study was to describe patterns of medication use among homeless adults from the city of Porto, Portugal. We recruited 146 homeless participants in four social services institutions. Data on the use of medicines in the previous week were collected using face-to-face interviews. We described the prevalence and main correlates of use of medicines from different Anatomical Therapeutic Chemical classification (ATC) groups. A total of 56.8% of the homeless reported to have used at least one medicine in the previous week. The most frequently reported were benzodiazepines (21.9%) and antipsychotics (15.1%); socio-demographic characteristics, lifestyle variables and use of health care were not found to be significantly associated with their use. The prevalence was 1.4% for anti-inflammatory and antirheumatic products, and 6.2% for antihypertensives, diuretics and beta-blocking agents. Medicines pertaining to the nervous system ATC group were by far the most frequently used, while those for the treatment of other common chronic and acute conditions seem to be underused.

Uso de medicamentos por pessoas sem-teto no Porto, Portugal

The objective of this study was to describe patterns of medication use among homeless adults from the city of Porto, Portugal. We recruited 146 homeless participants in four social services institutions. Data on the use of medicines in the previous week were collected using face-to-face interviews. We described the prevalence and main correlates of use of medicines from different Anatomical Therapeutic Chemical classification (ATC) groups. A total of 56.8% of the homeless reported to have used at least one medicine in the previous week. The most frequently reported were benzodiazepines (21.9%) and antipsychotics (15.1%); socio-demographic characteristics, lifestyle variables and use of health care were not found to be significantly associated with their use. The prevalence was 1.4% for anti-inflammatory and antirheumatic products, and 6.2% for antihypertensives, diuretics and beta-blocking agents. Medicines pertaining to the nervous system ATC group were by far the most frequently used, while those for the treatment of other common chronic and acute conditions seem to be underused.

Uso de medicamentos por parte de personas sin techo en Oporto, Portugal

The objective of this study was to describe patterns of medication use among homeless adults from the city of Porto, Portugal. We recruited 146 homeless participants in four social services institutions. Data on the use of medicines in the previous week were collected using face-to-face interviews. We described the prevalence and main correlates of use of medicines from different Anatomical Therapeutic Chemical classification (ATC) groups. A total of 56.8% of the homeless reported to have used at least one medicine in the previous week. The most frequently reported were benzodiazepines (21.9%) and antipsychotics (15.1%); socio-demographic characteristics, lifestyle variables and use of health care were not found to be significantly associated with their use. The prevalence was 1.4% for anti-inflammatory and antirheumatic products, and 6.2% for antihypertensives, diuretics and beta-blocking agents. Medicines pertaining to the nervous system ATC group were by far the most frequently used, while those for the treatment of other common chronic and acute conditions seem to be underused.

Baja prevalencia de hipertension con tratamiento farmacologico y factores asociados

OBJECTIVE To assess the determinants of the lack of pharmacological treatment for hypertension. METHODS In 2005, 3,323 Mozambicans aged 25-64 years old were evaluated. Blood pressure, weight, height and smoking status were assessed following the Stepwise Approach to Chronic Disease Risk Factor Surveillance. Hypertensives (systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg and/or antihypertensive drug therapy) were evaluated for awareness of their condition, pharmacological and non-pharmacological management, as well as use of herbal or traditional remedies. Prevalence ratios (PR) were calculated, adjusted for sociodemographic characteristics, cardiovascular risk factors and non-pharmacological treatment. RESULTS Most of the hypertensive subjects (92.3%), and nearly half of those aware of their condition were not treated pharmacologically. Among the aware, the prevalence of untreated hypertension was higher in men {PR = 1.61; 95% confidence interval (95%CI 1.10;2.36)} and was lower in subjects under non-pharmacological treatment (PR = 0.58; 95%CI 0.42;0.79); there was no significant association with traditional treatments (PR = 0.75; 95%CI 0.44;1.26). CONCLUSIONS The lack of pharmacological treatment for hypertension was more frequent in men, and was not influenced by the presence of other cardiovascular risk factors; it could not be explained by the use of alternative treatments as herbal/traditional medicines or non-pharmacological management. It is important to understand the reasons behind the lack of management of diagnosed hypertension and to implement appropriate corrective actions to reduce the gap in the access to healthcare between developed and developing countries.OBJETIVO: Analizar los determinantes de la falta de tratamiento farmacologico de la hipertension. METODOS: Se evaluaron 3.323 mozambicano de 25 a 64 anos en 2005. La presion arterial, peso, altura y tabaquismo fueron evaluados segun el estudio Stepwise Approach to Chronic Risk Factor Surveillance. Los hipertensos (presion arterial sistolica ≥ 140 mmHg y/o presion arterial diastolica i‚³90 mmHg y/o terapia anti-hipertensiva) fueron evaluados para verificar si eran conscientes de su hipertension, si recibian tratamiento farmacologico o no farmacologico, y si usaban hierbas o remedios tradicionales. Se calcularon los cocientes de prevalencia (PR) para hipertension no tratada, ajustadas para caracteristicas sociodemograficas, factores de riesgo cardiovascular y tratamiento no farmacologico. RESULTADOS: La mayoria de los hipertensos (92,3%) y casi la mitad de los conscientes de su hipertension no eran tratadas con farmacos. Entre los que sabian ser hipertensos, la hipertension sin tratamiento era mas frecuente en hombres (PR =1,61; IC95% 0,56;1,43) y no podia ser explicada por el uso de tratamiento no farmacologico (PR= 0,58; IC95% 0,42;0,79); no habia asociacion significativa con los tratamientos tradicionales (PR= 0,75; IC95% 0,44;1,26). CONCLUSIONES: La falta de tratamiento farmacologico de la hipertension, mas frecuente en hombres, no se explica por otros factores de riesgo cardiovascular, ni por el uso de tratamientos tradicionales o tratamiento no farmacologico. Es importante entender las razones de la falta de tratamiento de la hipertension diagnosticada e implementar medidas correctivas apropiadas, para reducir las diferencias en el acceso a cuidados de salud entre las poblaciones de los paises desarrollados y en vias de desarrollo.

Baixa prevalencia de hipertensao com tratamento farmacologico e fatores associados

OBJECTIVE To assess the determinants of the lack of pharmacological treatment for hypertension. METHODS In 2005, 3,323 Mozambicans aged 25-64 years old were evaluated. Blood pressure, weight, height and smoking status were assessed following the Stepwise Approach to Chronic Disease Risk Factor Surveillance. Hypertensives (systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg and/or antihypertensive drug therapy) were evaluated for awareness of their condition, pharmacological and non-pharmacological management, as well as use of herbal or traditional remedies. Prevalence ratios (PR) were calculated, adjusted for sociodemographic characteristics, cardiovascular risk factors and non-pharmacological treatment. RESULTS Most of the hypertensive subjects (92.3%), and nearly half of those aware of their condition were not treated pharmacologically. Among the aware, the prevalence of untreated hypertension was higher in men {PR = 1.61; 95% confidence interval (95%CI 1.10;2.36)} and was lower in subjects under non-pharmacological treatment (PR = 0.58; 95%CI 0.42;0.79); there was no significant association with traditional treatments (PR = 0.75; 95%CI 0.44;1.26). CONCLUSIONS The lack of pharmacological treatment for hypertension was more frequent in men, and was not influenced by the presence of other cardiovascular risk factors; it could not be explained by the use of alternative treatments as herbal/traditional medicines or non-pharmacological management. It is important to understand the reasons behind the lack of management of diagnosed hypertension and to implement appropriate corrective actions to reduce the gap in the access to healthcare between developed and developing countries.OBJETIVO: Analizar los determinantes de la falta de tratamiento farmacologico de la hipertension. METODOS: Se evaluaron 3.323 mozambicano de 25 a 64 anos en 2005. La presion arterial, peso, altura y tabaquismo fueron evaluados segun el estudio Stepwise Approach to Chronic Risk Factor Surveillance. Los hipertensos (presion arterial sistolica ≥ 140 mmHg y/o presion arterial diastolica i‚³90 mmHg y/o terapia anti-hipertensiva) fueron evaluados para verificar si eran conscientes de su hipertension, si recibian tratamiento farmacologico o no farmacologico, y si usaban hierbas o remedios tradicionales. Se calcularon los cocientes de prevalencia (PR) para hipertension no tratada, ajustadas para caracteristicas sociodemograficas, factores de riesgo cardiovascular y tratamiento no farmacologico. RESULTADOS: La mayoria de los hipertensos (92,3%) y casi la mitad de los conscientes de su hipertension no eran tratadas con farmacos. Entre los que sabian ser hipertensos, la hipertension sin tratamiento era mas frecuente en hombres (PR =1,61; IC95% 0,56;1,43) y no podia ser explicada por el uso de tratamiento no farmacologico (PR= 0,58; IC95% 0,42;0,79); no habia asociacion significativa con los tratamientos tradicionales (PR= 0,75; IC95% 0,44;1,26). CONCLUSIONES: La falta de tratamiento farmacologico de la hipertension, mas frecuente en hombres, no se explica por otros factores de riesgo cardiovascular, ni por el uso de tratamientos tradicionales o tratamiento no farmacologico. Es importante entender las razones de la falta de tratamiento de la hipertension diagnosticada e implementar medidas correctivas apropiadas, para reducir las diferencias en el acceso a cuidados de salud entre las poblaciones de los paises desarrollados y en vias de desarrollo.