Marina Guimarães Lima

Treatment of postmenopausal osteoporosis in women: a systematic review

Osteoporosis, a typical disease of the elderly, has become a frequent and relevant public health problem. Several drugs are available for treatment of osteoporosis, some of which are currently dispensed by the Brazilian Unified National Health System. The objective of this study was to present a systematic review of drugs for treatment of osteoporosis, focusing on the adequacy of clinical protocols based on existing evidence in the scientific literature. We conducted a search for randomized clinical trials in PubMed and LILACS that presented results for bone mineral density, incidence of vertebral fractures, and adverse effects. 32 articles met the reviews inclusion criteria. Bisphosphonates were reported to have consistently reduced the risk of vertebral fractures. Hormone replacement therapy showed positive outcomes, but its use has been found to increase the risk of cardiovascular disease and breast cancer. Teriparatide and monofluorophosphate also showed efficacy against osteoporosis. Calcium and vitamin D were given to patients as food supplements.

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

Incidência e fatores de risco para sífilis congênita em Belo Horizonte, Minas Gerais, 2001-2008

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.

Incidence and risk factors for congenital syphilis in Belo Horizonte, Minas Gerais, 2001-2008

In order to evaluate the strategy used by the Municipal Health Department of Belo Horizonte (SMSA/BH) for reducing the under-reporting of deaths from work-related accidents during the years of 2008 to 2010, a deterministic comparison of data on deaths from work-related accidents as reported in SINAN and SIM was conducted. As a complementary strategy to the deterministic comparison, the Investigation Data Sheets and Death Certificates were analyzed, which although not clearly declared, were suspected of involving death by work-related accident. Death from work accident was confirmed when the same victim, same accident, with a temporal connection between accident and death, were matched. The complementary strategy used by SMSA reduced the under-reporting identified by deterministic linking, with an increase of 45 deaths. Higher rates of under-reporting of deaths in the SINAN (n = 117) were found than in the SIM (n = 70). Although data linkage between SIM/SINAN is a necessary strategy to reduce the under-reporting of deaths from accidents, it is still insufficient, considering the limitations still present in both systems. The complementary strategy adopted by SMSA/BH, which is simple and easy to perform, yields good results.A sifilis congenita permanece como um problema de saude publica no Brasil. Este estudo busca descrever a evolucao da incidencia da sifilis congenita em Belo Horizonte entre 2001 e 2008 e determinar fatores de risco associados ao diagnostico da doenca. Os dados sobre os casos de sifilis congenita e sobre a populacao de nascidos vivos foram obtidos do Sistema de Informacoes de Agravos de Notificacao (SINAN) e do Sistema de Informacoes sobre Nascidos Vivos (SINASC), respectivamente. Analise de regressao logistica multivariada utilizou a populacao de nascidos vivos como grupo de referencia para identificar fatores de risco independentes para sifilis congenita. A incidencia anual da sifilis congenita apresentou uma tendencia crescente, de 0,9 para 1,6 casos por 1.000 nascidos vivos entre 2001 e 2008. Fatores de risco independentes para sifilis congenita incluiram: escolaridade materna < 8 anos (OR: 1,3; IC 95%: 1,2-1,4), cor materna parda ou negra (2,1; 1,5-2,8) e a ausencia de realizacao de pre-natal (11,4; 8,5-15,4). A forte associacao entre ausencia de pre-natal e ocorrencia de sifilis congenita indica que a universalizacao do pre-natal e crucial para o controle deste agravo. O efetivo controle do agravo no Brasil dependera tambem de acoes para reduzir as iniquidades sociais em saude.

Indicators related to the rational use of medicines and its associated factors

Congenital syphilis continues to be a public health problem in Brazil. The scope of this study is to describe the trends in the incidence of congenital syphilis in Belo Horizonte between 2001 and 2008 and determine risk factors associated with disease diagnosis. Data on cases of congenital syphilis and on the population of live births were obtained from the National Notifiable Diseases Information System (SINAN) and from the National Live Birth Information System (SINASC), respectively. Multivariate logistic regression analysis used the population of live births as the reference group to identify independent risk factors for congenital syphilis. The annual incidence of congenital syphilis revealed a rising trend from 0.9 to 1.6 cases per 1,000 live births between 2001 and 2008. Independent risk factors for congenital syphilis included: maternal schooling <8 years (OR: 1,3; 95% CI: 1,2-1,4); black or mixed maternal race (2,1; 1,5-2,8) and lack of antenatal care (11,4; 8,5-15,4). The strong association between the lack of antenatal care and congenital syphilis indicates that universalization of antenatal care is critical for the control of congenital syphilis. The effective control of the disease in Brazil will depend on actions to reduce social inequities in health.

Assistência Farmacêutica na Saúde Mental: um diagnóstico dos Centros de Atenção Psicossocial

OBJETIVO Avaliar indicadores relacionados ao uso racional de medicamentos e seus fatores associados em unidades basicas de saude. METODOS Estudo transversal realizado em amostra representativa de municipios do Brasil incluidos na Pesquisa Nacional sobre Acesso, Utilizacao e Promocao do Uso Racional de Medicamentos – Servicos, 2015. Os dados foram coletados por meio de entrevista com […]

Factors associated with the use of potentially inappropriate medications by older adults in primary health care: An analysis comparing AGS Beers, EU(7)-PIM List , and Brazilian Consensus PIM criteria

The study evaluated the conditions of Pharmaceutical Assistance (PA) in Psychosocial Care Centers (CAPS) through a cross-sectional study in 15 CAPS located in the Medio Paraopeba region of the State of Minas Gerais. Data collection was conducted through direct observation of CAPS and interviews with pharmacists and managers of PA. The instruments were based on indicators proposed by the WHO, technical documents for the organization of PA, from legislation and recommendations seeking pharmaceutical Best Practices. There were 13 dispensing units, nine of them within the CAPS. The services presented updated lists of essential medicines with high availability of the main drugs used in mental health treatment. All of the cities participated in an inter-municipal consortium for the purchase of medicines. The complete identification of drugs was present in only seven services and all had failings in traceability of medicines dispensed. In the CAPS there is only one pharmacist during part of the operating period. The need for greater participation of the pharmacist was observed in the control and standardization of the activities of CAPS and especially in care activities comprising the benchmark team in Mental Health.

Analysis of Potential Drug Interactions in Brazilian Mental Health Services: Prevalence and Associated Factors

Background: Potentially inappropriate medications (PIM) for the older adults are those with an unfavorable risk‐benefit ratio when more effective and safe therapeutic alternatives are available and is an important public health problem. Purpose: To analyze the factors associated with the use of PIM by the older adults and to investigate the agreement of PIM use frequency using the 2015 American Geriatric Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults ‐ 2015 AGS Beers Criteria, the Brazilian consensus on potentially inappropriate medication for older adults (BCPIM) and the European union list of potentially inappropriate medications ‐ EU (7)‐PIM List. Methods: This is a cross‐sectional study conducted in two primary health care centers in southeastern Brazil. The 2015 AGS Beers Criteria, BCPIM, and EU (7)‐PIM List were used for the classification of PIM. The association between PIM use and independent variables was assessed by multiple logistic regression. The level of agreement of PIM use among the three criteria was measured with the Cohens kappa coefficient. Results: A total of 227 patients ≥60 years of age were included in the study. The frequency of PIM use was 53.7% for 2015 AGS Beers, 55.9% for BCPIM and 63.4% for the EU (7)‐PIM List. The agreement between 2015 AGS Beers and BCPIM and between this and the EU (7)‐PIM List was high, and moderate between the 2015 AGS Beers and the EU (7)‐PIM List. Logistic regression showed association of PIM use with polypharmacy, self‐reported neuropsychiatric and musculoskeletal diseases, age ≤70 years, preserved cognition and positive self‐perception of health. Conclusion: The frequency of PIM use by the older adults of health centers investigated is high. Strategies for improving the pharmacotherapy of the older adults in primary health care should be implemented.

Prescrições em serviços de saúde mental: aspectos legais e indicadores do uso racional de medicamentos

Background: In the mental health field, the psychotropic polypharmacy is frequently observed, a significant risk factor for the occurrence of drug interactions. Objective: Identify potential drug interactions on the prescriptions of mental health services users and describe the associated factors. Methods: A cross-sectional study was conducted in 11 services. Sociodemographic data and information about the use of drug were obtained through interviews of users, analysis of prescriptions and medical charts, using a semi-structured questionnaire. Potential drug interactions were identified using the Micromedex® database, the association with sociodemographic characteristics and aspects related to the medicines prescribed were analyzed using the prevalence ratio. Results: The number of medicines prescribed ranged from 0 to 9, with an average of 3.38 (SD=1.76) per user, the most prescribed being haloperidol (12.3%), clonazepam (8.2%) and biperiden (7.9%). The proportion of interactions considering the number of users interviewed was 35.1%. The most frequent between potential interactions were haloperidol and fluoxetine (9.1%); haloperidol and carbamazepine (8.8%); and carbamazepine and chlorpromazine (5.9%). The highest prevalence ratio (PR) for the occurrence of potential interactions was in women (PR=1.36; 95% CI 1.08:1.71), users who had reported improper medicine use (PR=1.36; 95% CI: 1.07:1.72) and those with more than 5 prescribed medicines (PR=1.87; 95% CI: 1.49:2.33). Conclusion: Potential drug interactions were observed in more than one-third of the user’s Brazilian mental health services. The profile of interactions detected could guide the pharmacotherapeutic follow-up of priority users, and help the multidisciplinary team identify signs and symptoms that can influence the treatment of users. Key words: Drug interactions, Drug prescriptions, Psychotropic drugs, Mental health, Mental health services.

Incidence of hospitalizations due to adverse drug events in Minas Gerais, Brazil

*** Prescriptions in mental health services: legal aspects and indicators of rational drug use *** AIMS: To evaluate the legal aspects and indicators of rational drug use in prescriptions issued by mental health services. METHODS: Prescriptions dispensed by pharmacies of reference of the Psychosocial Care Centers located in the Medio Paraopeba region, Minas Gerais, Brazil, were evaluated. A semi-structured questionnaire was developed for the collection of data, including the World Health Organization prescribing indicators and the criteria for compliance of prescriptions with the Brazilian legislation. RESULTS: A total of 390 prescriptions were analyzed, and the average number of drugs in each prescription was 2.17. It was observed that 96.78% of the drugs were prescribed by their generic names and that 97.13% were on the essential medicines list of municipalities. Legal aspects of the prescriptions were met for several criteria: 99.23% of the prescriptions had the prescriber’s signature, 98.97% showed the date of issue, and 97.69% contained minimum information for the user regarding the use of the medications. None of the assessed health centers issued prescriptions with all the necessary patient data and with information about the dispensed medications, as required by law. CONCLUSIONS: The study indicated that most of the prescriptions analyzed complied with the legal requirements and that the indicators of rational medication use were satisfactory. However, information on dispensing control and records of users was incomplete, demonstrating problems with patient identification and with the traceability of dispensed medicines.