Sérgia Maria Starling Magalhães

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.

Analysis of medical prescriptions dispensed at health centers in Belo Horizonte, Minas Gerais, Brazil

This article focuses on medical prescriptions dispensed at health centers under the Municipal Health Department in Belo Horizonte, Minas Gerais State, Brazil. The study analyzed 4,607 prescriptions from March to April 1999, grouped according to origin (internal or external). The analysis focused on information written on medical prescriptions. The main findings were: (a) an average of 2.4 drugs per prescription in both groups; (b) prescriptions filled out with 4 or more drugs accounted for 18.0% of internal and 17.6% of external prescriptions; (c) 84.3% of internal and 85.5% of external prescriptions provided no instructions for use of medication; (d) information on dosage regimen varied from 51.2% to 97.6% for internal and 57.9% to 96.5% for external prescriptions; (e) generic names were specified for 51.9% and 28.4% of all drugs on internal and external prescriptions, respectively; (f) prescriptions containing standard drugs from the Municipal Health Department accounted for 88.7% of internal and 76.4% of external prescriptions. Data analysis shows the need for continuing education of physicians and adoption of other methods to improve quality of prescriptions and promote rational use of drugs.

Evaluation of the potential of microalgae Microcystis novacekii in the removal of Pb2+ from an aqueous medium.

In this study, the absorption capacity of active and inactive biomass of the microalgae Microcystis novacekii to remove Pb(2+) from aqueous solutions was investigated. This is the first reported study of biosorption by a cyanobacterium species, which is abundant and easily found in eutrophic lakes and ponds in tropical areas of the world. We also evaluated the effects of different concentrations of Pb(2+) on growth rates of M. novacekii. Inactive biomass was characterized by elemental composition, surface area, potentiometric titration, infrared spectroscopy and thermogravimetric analysis (TGA). The biosorption data of Pb(2+) by inactive biomass were analyzed using the Langmuir and Freundlich isotherms. Pb(2+) concentrations higher than 0.5 mg L(-1) inhibited species growth. Potentiometric titrations showed a significantly higher negative surface charge (1.48+/-0.22 mmol g(-1)) with two acidic groups (pKa(1)=3.74+/-0.12 and, pKa(2)=7.25+/-0.30). Analysis of inactive M. novacekii cells by infrared spectroscopy suggests that the cell wall carboxyl and amide groups participate in Pb(2+) biosorption. The maximum Pb(2+) adsorbed was found to be 70 mg g(-1), and the biosorption of Pb(2+) on inactive M. novacekii correlated well (R(2)=0.931) with the Langmuir equation compared to the Freundlich isotherm equation (R(2)=0.823) in the concentration range studied.

Quality assessment of antibiotic prescriptions dispensed at public health units in Belo Horizonte, Minas Gerais, Brazil, 2002

Overuse of antibiotics is a public health problem and has raised discussions concerning their rational use. This cross-sectional study focuses on the use of systemic antibiotics under the Belo Horizonte Municipal Health Department, Minas Gerais, Brazil, evaluating prescriptions dispensed in March 2002, based on WHO indicators for antibiotic use. On average, 20% of prescriptions dispensed involved at least one systemic antibiotic, among which approximately 46% originated from health care facilities not belonging to the municipal system itself. Amoxicillin was the most frequently prescribed antibiotic, followed by benzathine penicillin. Recording of technical data (dose, intervals between doses, administration, and treatment period) varied from 23.6 to 99.6%. Some 10% of prescriptions failed to specify the treatment period. The study showed the need for rules to allow quality improvement of antibiotic prescriptions, assuring the rational use of such medication by municipal health services.

Fatores associados ao uso de benzodiazepínicos no serviço municipal de saúde da cidade de Coronel Fabriciano, Minas Gerais, Brasil

Numerous countries have witnessed increasing misuse of benzodiazepines. This cross-sectional study assessed the factors associated with prescription of benzodiazepines for users of the Municipal Health Service in Colonel Fabriciano, Minas Gerais State, Brazil. Data were collected from official records on drug prescription (n = 1,866) from September to October 2006. Bivariate and multivariate analyses using Poisson regression were performed. Prolonged benzodiazepine use was independently associated with benzodiazepine type and patient participation in health programs. Concomitant use of other psychoactive drugs was independently associated with age and participation in health programs. Type of benzodiazepine (clonazepam or diazepam) was independently associated with age and gender, as well as with participation in health programs. Factors associated with benzodiazepine prescription show the problems extent and should be considered in planning interventions to rationalize the use of these drugs in Brazil, particularly through health program planning.

A qualidade da prescrição de antimicrobianos em ambulatórios públicos da Secretaria Municipal de Saúde de Belo Horizonte, MG

This study investigates the use of antibiotics and prescribing patterns and identifies the antibiotics most frequently prescribed in public health units of Belo Horizonte, MG. The methods used were observational, cross-sectional study aimed at analyzing the consistency between a sample of medical records and antibiotic prescriptions dispensed during March 2002 in eleven public health units in Belo Horizonte, Minas Gerais, Brazil. Pediatrics showed the highest proportion of antibiotic prescribing among four specialties; amoxicillin was the most frequently prescribed antibiotic, followed by benzathine penicillin G, sulfamethoxazole/trimethoprim, and erythromycin. Upper respiratory tract infections, tonsillitis, acute otitis media and urinary tract infections were the diagnostic hypotheses most frequently recorded. Overall consistency between the recorded diagnostic hypotheses and the prescribed antibiotic was lower than 75%. The duration of the therapy prescribed varied largely and in approximately 10% of the prescriptions this information was lacking. Moreover, data on the patient such as age, body weight, co-morbidity, diagnostic hypotheses and adverse reactions, were systematically absent in the medical records. This study demonstrates the need for interventions in order to promote a more rational use of antibiotics.

Consumo de medicamentos no período de internação para o parto

OBJECTIVE Drug use in birth delivery has not been enough explored in the literature. It is a significant issue to be discussed on the theme of rational drug use. The objective was to study drug use during birth delivery stay in maternity hospitals. METHODS A cross-sectional study was carried out using medical records of two private and public maternity hospitals of Belo Horizonte, Brazil. Data were collected on pregnant womens identification, pregnancy, delivery and drug prescribed from medical records of public hospitals and medical records and billing invoice of private maternity hospitals. Statistical analysis was conducted using odds ratio by the Chi-square test and means by t-Student test. RESULTS Mean in-hospital stay was 2.2 days and it was lower in the private maternity hospital. Cesarean sections were performed in 52.7% of all births, 31.3% in the public hospital and 64.5% in the private hospital. Peridural anesthesia was used in 72.8% of births and local anesthesia in 22.4% (25.3% and 63.7% of births in the public and 98.2% and 0.4% in the private hospital). All women received drugs (minimum of 3 and maximum of 19 different drugs) during their hospital stay. Eighty-three medications (97 active ingredients) were utilized at a total frequency of 3,429. The higher average drug use was 8.5 drugs per woman, in the private maternity hospital. CONCLUSIONS There was a significant difference in drug use between the two maternity hospitals, being it higher in pre- and during birth delivery procedures. The results suggest a preeminent drug use compared to those of other few studies available in the literature. The disproportionate number of cesarean sections and anesthesia explain the differences observed.

Evaluation of the capacity of the cyanobacterium Microcystis novacekii to remove atrazine from a culture medium.

The bioaccumulation of atrazine and its toxicity were evaluated for the cyanobacterium Microcystis novacekii. Cyanobacterial cultures were grown in WC culture medium with atrazine at 50, 250 and 500 μg L−1. After 96 hours of exposure, 27.2% of the atrazine had been removed from the culture supernatant. Spontaneous degradation was found to be insignificant (< 9% at 500 μg L−1), indicating a high efficiency for the bioaccumulation of atrazine by M. novacekii. There were no atrazine metabolites detected in the culture medium at any of the doses studied. The acute toxicity (EC50) of atrazine to the cyanobacterium was 4.2 mg L−1 at 96 hours demonstrating the potential for M. novacekii to tolerate high concentrations of this herbicide in fresh water environments. The ability of M. novacekii to remove atrazine combined with its tolerance of the pesticide toxicity showed in this study makes it a potential biological resource for the restoration of contaminated surface waters. These findings support continued studies of the role of M. novacekii in the bioremediation of fresh water environments polluted by atrazine.

Factors associated to antidepressant prescription for civil servants of Belo Horizonte, MG

Selecting the most suitable drug for the treatment of depression has clinical and economic implications, since both safety and cost of antidepressants (AD) vary among therapeutic subgroups. This study aimed to evaluate the prescription of antidepressants for users of the pharmacy for civil servants of PBH (FARMASERV) in 2005. Univariate, bivariate and multivariate analyzes using logistic regression were performed. Of the total prescriptions analyzed (652), the majority were for women (81.7%) and individuals aged between 19 and 59 years (81.7%). The variables independently associated with the selection of AD were gender, age and the specialty of the prescriber. Women and young adults were more likely to be prescribed an SSRI compared to their congeners, with statistically significant differences. Psychiatrists were more likely to prescribe an SSRI than neurologists or general physicians. The determinant factors for selecting antidepressants may aid the planning of interventions aimed at patients and prescribers which can enable rationalization of the use of antidepressants.

Arsenic tolerance of Microcystis novacekii (Komárek-Compère, 1974) and its arsenic decontamination potential

Cyanobacteria possess metallic ion interaction properties that should be explored with the aim of recovering arsenic (As) contaminated areas. Contamination of As is an issue of worldwide concern due to the risk of human chronic intoxication and negative environmental health effects. In this study the potential decontamination of As(III) and As(V) using cyanobacteria cultures was assessed. Microcystis novacekii (Komárek-Compere, 1974) showed normal growth in concentrations of As(V) similar to those found in natural environments contaminated with As, demonstrating its resistance to As(V). Growth rates gradually decreased upon exposure to high As(V) concentrations from 600 to 5630 mg.L while As(III) affected growth from 14.7 85.7 mg.L. The As(III) EC50 value (41.0 mg.L) was 140-fold lower possibly due to differences in As(III) and As(V) absorption pathways. Upon exposure to 14.7 mg.L As(III), 21.2% of As was removed from culture medium. The absorption capacity (12000 mg.kg) remained constant with increasing As(III) concentrations in a dose independent effect. The potential of M. novacekii for As decontamination was demonstrated in this study. This microorganism is recommended in As bioremoval studies due to its autotrophicmixotrophic growth, low nutritional requirements and high As(III) absorption capacity.