Janeth de Oliveira Silva Naves

Evaluation of pharmaceutical assistance in public primary care in Brasília, Brazil

OBJECTIVE Pharmaceutical assistance is essential in health care and a right of citizens according to Brazilian law and drug policies. The study purpose was to evaluate aspects of pharmaceutical assistance in public primary health care. METHODS A cross-sectional study using WHO drug indicators was carried out in Brasilia in 2001. From a random sample of 15 out of 62 centers thirty exiting patients per center were interviewed. RESULTS Only 18.7% of the patients fully understood the prescription, 56.3% could read it, 61.2% of the prescribed drugs were actually dispensed, and mean duration of pharmaceutical dispensing was 53.2 seconds. Each visit lasted on average 9.4 minutes. Of prescribed and non-dispensed drugs, 85.3% and 60.6% were on the local essential drug list (EDL) respectively. On average 83.2% of 40 essential drugs were in stock, and only two centers had a pharmacist in charge of the pharmacy. The mean number of drugs per prescription was 2.3, 85.3% of prescribed drugs were on the EDL, 73.2% were prescribed using the generic denomination, 26.4% included antibiotics and 7.5% were injectables. The most prescribed groups were: cardiovascular drugs (26.8%), anti-infective drugs (13.1%), analgesics (8.9%), anti-asthmatic drugs (5.8%), anti-diabetic drugs (5.3%), psychoactive drugs (3.7%), and combination drugs (2.7%). CONCLUSIONS Essential drugs were only moderately available almost 30 years after the first Brazilian EDL was formulated. While physician use of essential drugs and generic names was fairly high, efficiency was impaired by the poor quality of pharmaceutical care, resulting in very low patient understanding and insufficient guarantee of supply, particularly for chronic diseases.

Análise do perfil de automedicação em mulheres idosas brasileiras

The elderly consume more medications than other age groups, being susceptible to irrational use of therapeutic drugs. This work describes a cross-sectional study that evaluated self-medication practiced by elderly women, who were assisted at the Elderly Care Facility of the hospital of the Catholic University of Brasilia. The socio-economical variables analyzed were age group, educational level and monthly family income. The pharmaceuticals were evaluated according to prevalence, suitability for the age group and possible drug interactions. Among the 218 patients interviewed, 26% declared self-medication practices, part of them (40%) were prescription drugs. Anti-inflammatory, analgesic and antipyretic drugs were the most frequently consumed without professional orientation, followed by phytotherapeutic/natural and cardiovascular agents. Among the self-medicated patients 65% had incomplete or no formal basic education whereas 32% had earnings equal to or inferior to one minimum wage. The mean consumption of drugs by self-medication was not influenced by socio-economical variables. The practice of self-medication involves potentially harmful drug interactions and use of agents inappropriate for the age group.

Retail prices of essential drugs in Brazil: an international comparison

OBJECTIVES Price is a key obstacle for consumer access to essential drugs, especially in developing countries. This study sought to compare the retail prices of essential drugs on the private market in Brazil with that of two international pricing standards. METHODS The retail price of all drugs on Brazils Essential Drugs List, July 2000 edition, were compared to the retail price of the same drugs on the Swedish market and on a referential bulk-price indicator from low-cost suppliers on the international market. Ratios of Brazils prices to Swedens prices and Brazils prices to the international bulk mean price-per-unit for each drug were calculated. Using linear regression analysis, the ratios were also studied in relation to the number of manufacturers. RESULTS For the 132 drugs that were listed on both Brazils and Swedens lists, unitary retail prices in Brazil were 1.9 times higher. Of the 94 drugs found on both Brazils list and the international unit-price indicator, Brazils national mean unit prices were 13.1 more expensive. No relationship was found between the number of manufacturers for each product and the ratios of prices. CONCLUSIONS Average retail prices of essential drugs in Brazil are significantly higher than in Sweden. Furthermore, international bulk prices indicate that drugs are brought to market by Brazils private pharmacies at prices that may be excessively high in relation to production costs, creating high profit margins. The expected price-lowering effects of competition were not identified.

Automedicação: uma abordagem qualitativa de suas motivações

A qualitative research was realized to verify the occurrence and motivations for self-medication and the quality of the information rendered by pharmacies. We conducted 3 focus groups with 25 patients of a reference public health service for STD treatment in Brasília, Brazil. We used the critical discourse analysis to interpret the data obtained during interviews. The analysis revealed that self-medication was a common practice among participants, motivated mainly by discontentment with the long waiting period and the quality of the public health services. Other motivations included: previous experience with medications, advice from friends and family members and the search for an anonymous service provided at pharmacies due to embarrassment and inadequate care environment at health care services. Care provided at pharmacies was also considered unsatisfactory. Viewed essentially as a commercial establishment, pharmacies have become, yet, an easy accessible alternative. Most of participants perceived the pharmacists as ordinary employees seeking only to increase profits. The results suggest a need to improve access to health care services, as well as to render it more humane. Community pharmacies should to be turned into health establishments to participate in health education and orientation for rational drugs use.

Orientação farmacêutica para DST: uma proposta de sistematização

As DST se constituem num grave problema de saude publica. Diante da baixa notificacao de casos, a OMS estima que 70% dos portadores de DST no Brasil nao busquem tratamento em unidades de saude. Em todo o mundo a farmacia comunitaria e um importante local de busca por atendimento primario de saude e os farmaceuticos sao numerosos e se constituem nos profissionais de saude mais acessiveis para o publico em geral. A dificuldade de acesso a servicos de saude, a falta de orientacao para o uso racional de medicamentos ao usuario e a automedicacao sao uma realidade no Brasil, onde se convive, de um lado, com a falta de acesso de grande parcela da populacao a medicamentos essenciais, e de outro, com o uso abusivo e irracional pelos segmentos que tem poder de compra. As farmacias devem, portanto, ser consideradas locais de intervencao para o estabelecimento de parcerias no sentido de divulgar e disseminar praticas educativas quando se pensa em campanhas educativas e prevencao de doencas como as DST. Propoe-se, entao, uma sistematizacao da orientacao farmaceutica com relacao as DST, na tentativa de concretizar um melhor atendimento aos possiveis portadores que procuram a resolucao de seu problema de saude na farmacia e contribuir para o enfraquecimento da cadeia de transmissao dessas doencas.

Lessons from genome-wide association studies findings in Alzheimer's disease.

Alzheimers disease (AD) is the most common neurodegenerative disorder with a complex genetic background. Recent genome‐wide association studies (GWAS) have placed important new contributors into the genetic framework of early‐ and late‐onset forms of this dementia. Besides confirming the major role of classic allelic variants (e.g. apolipoprotein E) in the development of AD, GWAS have thus far implicated over 20 single nucleotide polymorphisms in AD. In this review, we summarize the findings of 16 AD‐based GWAS performed to date whose public registries are available at the National Human Genome Research Institute, with an emphasis on understanding whether the polymorphic markers under consideration support functional implications to the pathophysiological role of the major genetic risk factors unraveled by GWAS.

Cytokine gene polymorphisms and Alzheimer's disease in Brazil.

Background: Single-nucleotide polymorphisms in genes encoding immunological mediators can affect the biological activity of these molecules by regulating transcription, translation, or secretion, modulating the genetic risk of inflammatory damage in Alzheimers disease (AD). Nonetheless, the Brazilian contingent is highly admixed, and few association trials performed herein with AD patients have considered genetic ancestry estimates as co-variables when investigating markers for this complex trait. Methods: We analyzed polymorphisms in 10 inflammatory genes and compared the genotype distribution across outpatients with late-onset AD and noncognitively impaired subjects from Midwest Brazil under a strict criterion, and controlling for ancestry heritage and ApoE genotype. Results: Our findings show an almost 40% lower chance of AD (p = 0.004) among homozygotes of the IL10 -1082A allele (rs1800896). Dichotomization to ApoE and mean ancestry levels did not affect protection, except among those with greater European or minor African heritage. Conclusion: The IL10 locus seems to affect the onset of AD in a context sensitive to the genetic ancestry of Brazilian older adults.

Práticas de atendimento a DST nas farmácias do Distrito Federal, Brasil: um estudo de intervenção

A quantitative survey was conducted to analyze the type of assistance provided by pharmacy employees for cases of STDs. Simulated customer visits and interviews were conducted in 70 pharmacies in Brasilia and Taguatinga, Brazil, randomly assigned to two groups, one of which participated in educational activities on STDs. There were 411 simulated client visits to the pharmacies, with the following results: recommendation to seek medical care in 30% of cases, while in 70% of cases the pharmacy employees themselves recommended some drug treatment (although only 16.4% admitted to such practice). None of these suggested treatments was appropriate, based on the syndromic approach. Recommendations for prevention and treatment of partners were rare. Pharmacists recommended consulting a physician more frequently than attendants, and the latter recommended medicines more frequently than the former. Pharmacy workers had only superficial knowledge of STDs. After an educational intervention, none of the indicators showed a significant improvement in either group. The observations point to the need for regulation and intervention to publicize educational practices for the control of diseases like STDs and for the rational use of medicines in pharmacies.

Circadian rhythm in Alzheimer disease after trazodone use.

A circadian rhythm is a cycle of approximately 24 h, responsible for many physiological adjustments, and ageing of the circadian clock contributes to cognitive decline. Rhythmicity is severely impaired in Alzheimer disease (AD) and few therapeutic attempts succeeded in improving sleep disorders in such context. This study evaluated sleep parameters by actigraphy in 30 AD patients before and after trazodone use for 2 weeks, and we show a significant improvement in relative rhythm amplitude (RRA), compatible with a more stable daytime behavioral pattern. So, trazodone appears to produce a stabilization of the circadian rhythms in individuals with AD.

Mirtazapine does not improve sleep disorders in Alzheimer's disease: results from a double-blind, placebo-controlled pilot study

The aim of this study was to test the efficacy and safety of mirtazapine in the treatment of sleep disorders in patients with Alzheimers disease by means of a randomized, double‐blind, placebo‐controlled trial. Measurements were obtained for 7 days before intervention (baseline) and for 2 weeks after the onset of treatment.