Vanessa Sgnaolin

Adesão ao tratamento farmacológico de pacientes em hemodiálise

INTRODUCTION: Adherence to treatment in patients on hemodialysis is not a simple process. Strategies to promote adherence will meet the need for improvements in the process of orientation concerning the disease and its pharmacological treatment. OBJECTIVES: To identify compliance with pharmacological treatment of patients on hemodialysis and the main factors related to it we used the Adherence Scale. METHODS: Observational, descriptive and cross-sectional study. Interviews were conducted to collect socioeconomic, pharmacological data, as well as those regarding self-reported adherence to drug. RESULTS: Out of the 65 participants, 55.4% showed non-compliance. The mean number of drugs used was 4.1 ± 2.5 (self-report) and 6.2 ± 3.0 (prescription). Statistical analysis showed significant differences concerning compliance at different ages (> 60 years are more adherent). CONCLUSIONS: A significant proportion of patients have difficulty to comply with treatment and the main factor was forgetfulness. Regarding age, elderly patients are more adherent to treatment. The low level of knowledge about the used drugs may be one of the reasons for the lack of adherence, and the patients orientation process by a team of multiprofessionals involved in assisting is a strategy to promote adherence.

Hematological parameters and prevalence of anemia among free-living elderly in south Brazil

Objective The aims of this study were to analyze the hematological parameters, the prevalence of anemia and the association between anemia and socioeconomic conditions in an elderly community-based population. Methods A population-based study was performed as part of the Multidimensional Study of the Elderly in Porto Alegre, Brazil (EMIPOA). An initial total of 1058 community residents aged 60 years and older were interviewed. Of these, 392 agreed to have a physical evaluation and a blood sample was taken from each. The hematological parameters analyzed in the blood samples included the hemoglobin concentration, mean cell volume (MCV), mean corpuscular hemoglobin concentration (MCHC) and red cell distribution width (RDW). The association between the variables and the diagnosis of anemia was assessed using the chi-squared test and a multiple logistic regression model. Results The overall prevalence of anemia was 12.8%. Anemia was present in 13.7% of women and in 10.4% of men. Normocytic normochromic anemia without anisocytosis was the most common type of anemia (46%). The assessment of erythrocyte morphology showed significant differences between anemic and non-anemic individuals (microcytosis = 12% vs. 1.5%, hypochromia = 40% vs. 8.8%, and anisocytosis = 26% vs. 7%). In the analysis of socioeconomic conditions, significant differences were found in respect to age and race. Conclusion The prevalence of anemia increases with age and is associated with race, microcytosis, hypochromia and anisocytosis. Anemia is not a condition that should be associated only with the aging process, as it may be due to pathological conditions that occur most frequently in this age group. As a result, a diagnosis of anemia warrants adequate clinical attention.

Tabagismo em idosos

Smoking cigarettes is an important accelerator of the aging process which compromises the life expectancy, and the quality of life. Smokers over 50 years old have a higher dependence on nicotine, smoke more cigarettes, smoke longer, have more health problems related to smoking and have more difficulty in quitting smoking. The main causes of death from smoking are cardiovascular diseases, chronic obstructive pulmonary disease and lung cancer. Nowadays, there are a number of strategies to stop smoking cigarettes, non-pharmacological and pharmacological, which are also advantageous for the elderly. This study aims to report data on smoking in Brazil and in the world, the pathology involved and the toxic effects of cigarette components as well as suggest treatment strategies, especially in the elderly. We examined published articles from the databases: Pubmed, Scielo, Portal Capes, Ministerio da Saude, Instituto Nacional do Cancer, IBGE and the World Health Organization. We concluded that smoking is a source of risk and major cause of numerous diseases. But the desire to quit is higher among those who recognize that this habit affects their health. While the benefits of stopping smoking are higher among younger, smoking cessation at any age reduces the risk of death and improves the general health condition.

Consumo de nutrientes em idosos residentes em Porto Alegre (RS), Brasil: um estudo de base populacional

A cross-sectional, population-based study was conducted on a random sample of 427 elderly individuals living in Porto Alegre, Brazil, to establish the nutrient consumption profile and verify its association with sociodemographic and health variables. Dietary intake was assessed using the 24-hour Food Recall Survey and the Dietetic Research Investigation technique. Seventy percent of the elderly respondents were women: 48.5% were between 60 and 69 years old; 68.8% had less than 8 years of schooling; 39% had a family income of between 2 and 5 minimum wages and 58.4% took no physical exercise. Hypertension was the most prevalent disease among the elderly and 54.9% were underweight. Men consumed more calories, protein, fiber, minerals and vitamins than women. Carbohydrate and calcium intake increases with advancing age, while zinc intake decreases. Physical exercise increased the intake of calories, magnesium, potassium and phosphorus. The higher the schooling the greater the intake of vitamins B6 and B12; the higher the family income, the greater the consumption of vitamin B6 and folic acid. The results show that there are nutritional deficiencies in the daily diet of the Brazilian elderly population, especially among women and individuals over 80 years of age.A cross-sectional, population-based study was conducted on a random sample of 427 elderly individuals living in Porto Alegre, Brazil, to establish the nutrient consumption profile and verify its association with sociodemographic and health variables. Dietary intake was assessed using the 24-hour Food Recall Survey and the Dietetic Research Investigation technique. Seventy percent of the elderly respondents were women: 48.5% were between 60 and 69 years old; 68.8% had less than 8 years of schooling; 39% had a family income of between 2 and 5 minimum wages and 58.4% took no physical exercise. Hypertension was the most prevalent disease among the elderly and 54.9% were underweight. Men consumed more calories, protein, fiber, minerals and vitamins than women. Carbohydrate and calcium intake increases with advancing age, while zinc intake decreases. Physical exercise increased the intake of calories, magnesium, potassium and phosphorus. The higher the schooling the greater the intake of vitamins B6 and B12; the higher the family income, the greater the consumption of vitamin B6 and folic acid. The results show that there are nutritional deficiencies in the daily diet of the Brazilian elderly population, especially among women and individuals over 80 years of age.

Patterns of chronic benzodiazepine use in the elderly

Background In several countries, prevalence studies demonstrate that chronic use of BZD in the elderly population is very high. This scenario has reached pandemic proportions for decades and is an important public health problem. Objectives To examine the independent association between chronic benzodiazepine use in depression, anxiety and bipolar disorder, as well as other clinical and sociodemographic factors. Methods This cross-sectional study was developed from a population-based survey and conducted from March, 2011 to December, 2012 using a random sample of 550 elderly people who were enrolled in the Family Health Strategy in Porto Alegre, Brazil. Data was collected from identifying epidemiological and health data (sociodemographic, self-perception health, self-reported diseases, smoking, alcohol and pharmacotherapeutic evaluation) and from the diagnoses of mood and anxiety disorders. Results Elderly patients diagnosed with depression, anxiety, concomitant depression/anxiety and bipolar disorders, and those who were using antidepressants have a higher risk of benzodiazepine use. Individuals who self-reported drinking alcohol had a lower risk of benzodiazepine use. Discussion Benzodiazepines are often used by the elderly for long periods, which has a direct impact on the treatment of mood and anxiety disorders and on vulnerable groups such as the elderly, who may be unnecessarily taking these drugs.

New red blood cell and reticulocyte parameters and reference values for healthy individuals and in chronic kidney disease

Introduction: The importance of local references values has been well described in the literature; this is because the characteristics of the population may influence the laboratory tests. Objective: To establish the reference range for traditional and extended red blood cell parameters and reticulocyte indices in order to investigate its application in patients with chronic kidney disease (CKD). Materials and methods: 249 blood donors (125 males and 124 females) were selected to establish the reference values. The hemodialysis sample consisted of 62 patients with terminal CKD (48 male and 14 female). All analyzes were performed using the Sysmex XE-5000 automated hematology analyzer. Results: Differences between reference values was observed in relation to gender: red blood cells (RBC), hemoglobin (HGB), hematocrit (HCT), mean corpuscular hemoglobin concentration (MCHC), percentage of hyperchromic red blood cells (%HYPER), percentage of microcytosis (%MICRO), percentage of macrocytosis (%MACRO), absolute reticulocyte count (RET), reticulocyte hemoglobin content (RET-He), immature reticulocyte fraction (IFR), low fluorescence reticulocytes (LFR), medium fluorescence reticulocytes (MFR), and high fluorescence reticulocytes (HFR). Individuals with CKD presented RBC, HGB, HCT, MCHC, red cell distribution width expressed as coefficient of variation (RDW-CV), percentage of hypochromic red blood cells (%HYPO), percentage of reticulocytes (RET%), RET (female group), IFR, LFR, MFR, and HFR results compatible with the anemic state, which can be observed in 91.8% of patients. All studied parameters were in the area under the curve (AUC) > 0.4. In male group, %HYPO (AUC: 0.806) and IFR (AUC: 0.762) presented higher AUC values, while female group presented %HYPO (AUC: 0.806), %HYPER (AUC: 0.815), and IFR (AUC: 0.660). Conclusion: The medical advancement, the development of new techniques and hematological parameters have revealed important information about functional integrity of bone marrow, diagnosis of anemia and recombinant human erythropoietin monitoring therapy used in hemodialysis patients.

Assessment of used medications and drug-drug interactions among chronic renal failure patients

Aims: To describe the drugs most frequently used by patients in hemodialysis and to identify potential drug-drug interactions. Methods: Cross-sectional study conducted in a hospital hemodialysis unit. Each combination of drugs prescription was analyzed in Micromedex

Prevalência e caracterização da anemia em idosos atendidos pela Estratégia Saúde da Família

OBJECTIVE: To evaluate the prevalence of anemia among elderly people related to socioeconomic and health conditions in elderly attended by the Family Health Strategy (FHS) in the city of Porto Alegre-RS, Brazil. METHODS: Observational, cross-sectional and exploratory study in which epidemiological information, and blood sampling. The hematological parameters evaluated were hemoglobin concentration, mean corpuscular volume, mean corpuscular hemoglobin concentration and red cell distribution width. RESULTS: We assessed 556 senior citizens. The prevalence of anemia, assessed by hemoglobin measurement was 8.8%, representing 10.1% for men and 8.1 % for women. A normochromic normocytic anemia was the type of anemia most commonly found (34.0%), suggesting chronic disease. Furthermore, the prevalence of normocytic and hypochromic anemia was 32.0%, suggesting an evolution of anemia by chronic disease in early stages of iron deficiency. Analyzing health and socioeconomic conditions, significant differences were found among age range, color, educational level, presence or absence of primary caregiver, hospitalization, thyroid disease, report of weakness and use of anti-anemic medications. CONCLUSION: Low prevalence of anemia in the elderly in Porto Alegre-RS was observed. Numerous are the triggering factors of low hemoglobin levels. Factors such as age, color, family income, education, care, associated diseases are relevant to influence this event. Anemia should not be considered only associated with aging condition, but to many diseases that are common in this population and therefore deserves appropriate medical attention. Characterization of anemia should be carefully performed to aid its correct treatment.

Atenção farmacêutica e bioética: o pressuposto da beneficência

A atencao farmaceutica tem como principio acoes voltadas para a promocao, a protecao e a recuperacao da saude, promovendo ao usuario o uso racional de medicamentos. Essa pratica consiste na orientacao adequada quanto ao armazenamento e forma de utilizacao do mesmo. Esse estudo tem o proposito refletir sobre a atencao farmaceutica na luz do principio bioetico da beneficencia. Trata-se de uma analise bibliografica nas bases de dados Pubmed e Scielo com os descritores bioetica, beneficencia e atencao farmaceutica. Com a evolucao da profissao farmaceutica, a atencao farmaceutica passou a ser incorporada na sua atuacao cotidiana, juntamente com as demais funcoes ja reconhecidas por esta categoria. A atencao farmaceutica tem permitido um atendimento centrado ao paciente, responsabilizando-se quanto ao desenvolvimento de acoes e tomada de decisoes direcionadas a utilizacao de medicamentos. O processo de cuidado farmaceutico implica em uma reflexao etica, tendo em seus deveres o servico para o individuo e a sua comunidade. O farmaceutico deve orientar sua pratica por principios bioeticos consistentes. Dentro de um dos principios da bioetica, a beneficencia se refere a uma acao realizada em beneficio do outro, exigindo a promocao de atos positivos que visem promover o bem aos demais. A beneficencia na atencao farmaceutica esta presente em todos os seus pontos fundamentais: no acolhimento do individuo, na avaliacao das suas necessidades terapeuticas e nos problemas relacionados a farmacoterapia, no estabelecimento do plano de cuidado e na monitorizacao da evolucao clinica. A atencao farmaceutica e um acordo entre o usuario e o profissional, que compartilham de necessidades voltadas para o processo de regulacao para o acesso de uma melhor qualidade do uso de medicamentos, tendo em vista a promocao de uma visao humanista e de responsabilizacao.