Training informal caregivers to care for older people after stroke: A quasi-experimental study.

AIMS: This study aimed at evaluating whether training on practical skills involved in providing care reduces the burden experienced by informal caregivers and improves their general health condition. BACKGROUND: A substantial number of informal caregivers lack skills to deliver poststroke assistance to older people after hospital discharge, which leads to burden situations as well as mental and physical health deterioration of the former. DESIGN: A quasi-experimental design. METHODS: This study involved 174 informal caregivers of older people who overcame a stroke. The control group (N = 89) received the usual type of care delivered in healthcare units. The experimental group (N = 85) adopted the InCARE programme for 1 week (T0), 1 month (T1) and 3 (T2) months and received telephone support by counselling caregivers on the subsequent 3rd, 6th, 8th and 10th weeks to hospital discharge. It aimed at facilitating the caregiver's adjustment to the demands of a poststroke stage and at increasing knowledge and practical skills to support the decision-making. Data collection occurred between February-December 2014 at the Community Home Care Services in northern Portugal. RESULTS: The experimental group obtained significantly better results regarding practical skills as well as lower burden levels and a better general mental health condition when compared with the control group 1 (T1) and 3 (T2) months after intervention. CONCLUSION: Findings suggest that our programme improved practical skills, helped reduce burden levels with better scores and improvement regarding general mental health condition of informal caregivers.

Development and psychometric properties of ECPICID-AVC to measure informal caregivers' skills when caring for older stroke survivors at home.

INTRODUCTION: Informal caregivers provide a significant part of the total care needed by dependent older people poststroke. Although informal care is often the preferred option of those who provide and those who receive informal care, informal caregivers often report lack of preparation to take care of older dependent people. This article outlines the development and psychometric testing of informal caregivers' skills when providing care to older people after a stroke - ECPICID-AVC. DESIGN: Prospective psychometric instrument validation study. METHODS: Eleven experts participated in a focus group in order to delineate, develop and validate the instrument. Data were gathered among adult informal caregivers (n = 186) living in the community in Northern Portugal from August 2013 to January 2014. RESULTS: The 32-item scale describes several aspects of informal caregiver's skills. The scale has eight factors: skill to feed/hydrate by nasogastric feeding, skill to assist the person in personal hygiene, skill to assist the person for transferring, skill to assist the person for positioning, skill to provide technical aids, skill to assist the person to use the toilet, skill to feed/hydrate and skill to provide technical aids for dressing/undressing. Analysis demonstrated adequate internal consistency (Cronbach's alpha = 0.83) and good temporal stability 0.988 (0.984-0.991). CONCLUSION: The psychometric properties of the measurement tool showed acceptable results allowing its implementation in clinical practice by the nursing community staff for evaluating practical skills in informal caregivers when providing care to older stroke survivors living at home.

Intervention in informal caregivers who take care of older people after a stroke (InCARE): study protocol for a randomised trial.

AIM: This study aims at describing an intervention based on informal caregivers' skills when taking care of older people after a stroke (InCARE). BACKGROUND: Most informal caregivers feel unprepared to deliver assistance in activities of daily living at home. This lack of preparedness can lead to misconceptions, burden and affect their health, which, consequently, may imply hospital readmissions or early institutionalization of the older adults. DESIGN: A single blinded randomised trial. METHODS: This study will recruit 198 dyads, comprising old stroke survivors and their caregivers, who will be divided into two groups: intervention and control (protocol approved in May 2013). INCLUSION CRITERIA: (informal caregivers) absence of cognitive impairment; resident in the Cávado Region; to return the informed consent (older people) are over 65 years of age; have had a first stroke and; be dependent on at least one of the self-care activities post hospital discharge. PRIMARY OUTCOME: informal caregivers' skills. SECONDARY OUTCOMES: include burden and Health Quality of Life in informal caregivers; functionality, hospital readmission and institutionalization of older people stroke survivors, measured 1 and 3 months after InCARE programme. DISCUSSION: The InCARE programme will highlight new ways to understand the feasibility of a large trial, which supports caregivers who take care of older people after a stroke. It will be expected that the level of burden decreases, thus helping informal caregivers enhance their quality of life. Also, it is expected that older people's functionality will be improved and that hospital readmission or institutionalization may be avoided.

Adherence and medication management by the elderly.

AIMS AND OBJECTIVES: The purpose of this study was to explore the strategies used for medication management by elderly who live at home. BACKGROUND: Non-adherence to chronic medication is a common problem among the elderly with chronic conditions. Many studies have been developed, but it did not progress in solving this multidisciplinary health care problem. The causes of non-adherence by the elderly are multiple and complex. DESIGN: Descriptive qualitative design. METHODS: Data were collected by two focus groups. The content of discussion was analysed from verbatim transcript and identifying categories and sub-categories emerged, leading to the construction of a diagram analysis. RESULTS: The finding indicated the strategies and the interpretation of people aged 65 or more and with chronic illness, managing their medication. Four content categories emerged: to live with drugs, taking medication, belief about drugs and relationship with health professionals. CONCLUSION: The study enabled us to identify and understand, by giving a 'voice' to the elderly, that living with drugs is a dynamic and complex process and that taking medication is perceived by older people as a consequence of their ageing, which requires them to include that process in their lives as a habit implying changes in their daily routines. The elderly suggest that the relationship with health professionals is essential in medication management and they reported that the information given by the nurse during consultation is very important. RELEVANCE TO CLINICAL PRACTICE: The relationship with nurses in particular is an important issue for the older people. Understanding the factors of adherence and helping people are important areas of research in nursing. The quality of this relationship may be the key to increasing adherence in this group of people.

Effects of economic recession on elderly patients' perceptions of access to health care and medicines in Portugal.

Background In view of the current financial and demographic situation in Portugal, accessibility to health care may be affected, including the ability to adhere to medication. Objective To evaluate the perceived effects of the crisis on elderly patient's access to medicines and medical care, and its implications on medicine-taking behaviour. Setting Community pharmacy. Method A cross-sectional study was undertaken during April 2013, where elderly patients answered a self-administered questionnaire based on their health-related experiences in the current and previous year. Binary logistic regression was used to ascertain the effects of potential predictors on the likelihood of adherence. Main outcome measures self-reported adherence. Results A total of 1231 questionnaires were collected. 27.3% of patients had stopped using treatments or health services in the previous year for financial motives; mostly private medical appointments, followed by dentist appointments. Almost 30% of patients stopped purchasing prescribed medicines. Over 20% of patients reduced their use of public services. Out-of-pocket expenses with medicines were considered higher in the current year by 40.1% of patients. The most common strategy developed to cope with increasing costs of medicines was generic substitution, but around 15% of patients also stopped taking their medication or started saving by increasing the interdose interval. Conclusion Reports of decreasing costs with medicines was associated with a decreased likelihood of adherence (OR 0.42; 95% CI 0.27-0.65). Lower perceived health status and having 3 or more co-morbidities were associated with lower odds of adhering, whilst less frequent medical appointments was associated with a higher likelihood of exhibiting adherence.

Primary non-adherence in Portugal: findings and implications.

BACKGROUND: Portugal is currently facing a serious economic and financial crisis, which is dictating some important changes in the health care sector. Some of these measures may potentially influence patients' access to medication and consequently adherence, which will ultimately impact on health status, especially in chronic patients. AIMS: This study aimed at providing a snapshot of adherence in patients with chronic conditions in Portugal between March and April 2012. SETTING: Community pharmacy in Portugal. METHOD: A cross-sectional pilot study was undertaken, where patients were recruited via community pharmacies to a questionnaire study evaluating the number of prescribed and purchased drugs and, when these figures were inconsistent, the reasons for this. MAIN OUTCOME MEASURES: Primary and secondary adherence measures. Failing to purchase prescription items was categorized as primary nonadherence. Secondary nonadherence was attributed to purchasing prescription items, but not taking medicines as prescribed. RESULTS: Data were collected from 375 patients. Primary nonadherence was identified in 22.8 % of patients. Regardless of the underlying condition, the most commonly reported reason for primary non-adherence was having spare medicines at home ("leftovers"), followed by financial problems. The latter appeared to be related to the class of medicines prescribed. Primary non-adherence was associated with low income (<475 /month; p = 0.026). Secondary non-adherence, assessed by the 7-MMAS was detected in over 50 % of all patients, where unintentional nonadherence was higher than intentional nonadherence across all disease conditions. CONCLUSION: This study revealed that more than one fifth of chronic medication users report primary nonadherence (22.8 %) and more than 50 % report secondary nonadherence. Data indicates that the existence of spare medicines and financial constraints occurred were the two most frequent reasons cited for nonadherence (47, 6-64, 8 and 19-45.5 %, depending on the major underlying condition, respectively).

Assessing determinants of self-medication with antibiotics among Portuguese people in the Algarve Region.

BACKGROUND: Misuse of antibiotics gives rise to numerous individual and societal problems, among which antimicrobial resistance is currently a major worldwide concern. Understanding cultural features in the public's attitudes and behaviours regarding antibiotics and their use is a prerequisite to developing effective educational interventions. OBJECTIVE: To estimate the prevalence of self-medication with antibiotics and evaluate the predictive factors associated with such self-medication. Setting The general population, drawn from town halls, supermarkets, hotels, food malls, restaurants, sports groups and Senior Colleges. METHODS: A cross-sectional study was conducted by convenience sampling the adult population living in the Algarve, Portugal. The information about self-medication with antibiotics was assessed by using a validated self-administrated questionnaire. Factors associated with self-medication were identified through bivariate analysis and a logistic regression model. RESULTS: Of the 2,000 questionnaires distributed, 1,198 were returned, representing a response rate of 59.9 %. A total of 1,192 individuals were included in the study. The mean age was 46.6 ± 16.9 years and 48.7 % (95 % CI 46-52 %) were male. The majority of individuals said that they had returned the leftover antibiotics to the pharmacy for destruction. However, 268 respondents (22.5 %, 95 % CI 20-25 %) said they had disposed of their medication through the garbage or the sewage system. 218 respondents (18.9 %, 95 % CI 17-21 %) were assumed to have already taken antibiotics without a prescription and 267 (23 %, 95 % CI 21-25 %) reported having leftover antibiotics at home. The factors that influence self-medication with antibiotics were age; in particular, the risk is higher in the youngest group 18-34 years: OR 4.57 (95 % CI 2.23-9.39; p < 0.001), and in the 50-64 year group: OR 2.33 (95 % CI 1.08-5.03; p = 0.03); and the male gender: OR 2.88 (95 % CI 1.86-4.46; p < 0.001). The risk was lower in respondents who said that it was not easy to get antibiotics without a prescription: OR 0.07 (95 % CI 0.05-0.12; p < 0.001). CONCLUSION: Non-prescription acquisition, age and gender could be determinants of self-medication with antibiotics among Portuguese people in the Algarve region.

[Evolution of outpatient antibiotic use in Portugal mainland 2000-2009]. / A evolução do consumo de antibióticos em ambulatório em Portugal continental 2000-2009.

INTRODUCTION: In the latest years, the increasing resistance to antibiotics has become a serious public health issue. The resistance to antimicrobial agents is multifactorial although several studies have shown that the large use of antibiotics for therapeutical and prophylactic purposes, and particularly their misuse, is one factor that contributes most to this problem. AIM: To assess the evolution of antibiotic consumption in Portugal, Health Regions and Districts of Portugal, from 2000 to 2009. MATERIAL AND METHODS: Descriptive observational study using as source of information a database of outpatient antibiotic prescription provided by Infarmed, National Authority of Medicines and Health Products. Antibiotic consumption is estimated up from medical prescription, and expressed in DDD/1000 inhabitants/day (DHD). RESULTS: From 2000 to 2009 antibiotic total consumption varied between 24,12 DHD and 22,03 DHD, which means a decrease by 8,65%. The use of tetracyclines (J01A), cephalosporins (J01D), sulphonamides (J01E), quinolones (J01M) and other antibacterials (J01B, J01G and J01X) decreased during the aforesaid time period. By contrast, there was an increase in the use of the combination penicillin and beta-lactamases inhibitor, and macrolides (J01F). Between 2000 and 2009 there was a significant decrease in the use of outpatient cephalosporins (- 43,50%). Most notable is the large reduction of the use of cephalosporins between 2000 and 2009 (-43.50%) and also the decrease in the consumption of quinolones (-15.31%). CONCLUSION: Although there has been a decrease in the use of antibiotics in Portugal, their consumption is still high. The current study provides information that may be useful to regional Health Authorities in order to develop educational activities, for the population or health professionals, which can promote the rational use of antibiotics.

Anti-Helicobacter pylori activity of Terminalia macroptera root.

The root of Terminalia macroptera Guill. & Perr. (Combretaceae) is widely used in African traditional medicine to treat various infectious diseases, including stomach-associated diseases. This study investigates the in vitro activity of T. macroptera root extract against reference strains and clinical isolates of H. pylori and attempts to localize the extract bioactivity. T. macroptera hydroethanol (80% V/V) root extract (Tmr) activity was tested against three standard strains and sixty two clinical strains of H. pylori. Tmr liquid-liquid partition fractions were screened against twenty H. pylori strains. Qualitative analysis of Tmr and its fractions was performed by HPLC-UV/DAD. The antibiotic characterization of the H. pylori strains revealed that 20% of the tested clinical isolates were resistant to at least two of the three antibiotics belonging to the main groups of antibiotics used in multi-therapy to eradicate H. pylori infections. In contrast, Tmr showed anti-H. pylori activity against the majority (92%) of the tested strains (MIC(50) and MIC(90)=200 µg/ml). The Tmr water liquid-liquid fraction (Tmr-3) and the precipitate obtained from this fraction (Tmr-5) were the most active tested samples, showing a MIC(50) of 100 µg/ml. The present work proves the in vitro activity of T. macroptera against H. pylori, thus confirming the utility of this traditional medicinal plant to treat stomach complaints due to H. pylori infection. The main compounds of Tmr and of Tmr-3 were the ellagitannins terchebulin and punicalagin. These compounds can be considered as markers of T. macroptera root active extracts against H. pylori.

[Tools to evaluate potentially inappropriate prescription in the elderly: a systematic review]. / Critérios de avaliação de prescrição de medicamentos potencialmente inapropriados: uma revisão sistemática.

INTRODUCTION: Prescription of potentially inappropriate medication (PIM) in the elderly has gained growing attention from healthcare professionals, researchers, healthcare providers and politicians worldwide for safety issues. Taking into consideration the increased susceptibility of elderly patients to certain medicines, criteria to identify PIM and to alert professionals to prevent their prescription have been created. OBJECTIVES: To gather published evidence regarding the characteristics and use of criteria to identify PIM. METHODS: systematic review of studies published between 1990 and 2007. A literature retrieval using Pubmed and The Cochrane Database of Systematic Reviews was performed followed by a manual search of cited references. Cross-sectional studies using the most recent version of PIM criteria in patients aged 65 years or more were included. Studies which analyzed PIM in a single clinical condition of therapeutic class exclusively or those not attaining 75% of the quality score were excluded. RESULTS: the search retrieved 124 studies, being 10 of them selected for inclusion in the systematic review. The studies selected were conducted in Europe and the United States and the Beers criteria updated in 2003 were the most frequently used. Some authors, adapted PIM criteria according to differences in authorized medicines in their respective countries. Studies revealed a high prevalence of PIM, especially those using the 2003 Beers criteria. Most articles suggested strategies to reduce the PIM prevalence in the elderly such as: pre- and post-graduate education, the use of computerized systems to alert healthcare professionals, and creating restrictive policies by means of formularies. CONCLUSIONS: The Beers criteria were the most commonly used criteria to identify PIM in the elderly, revealing a high prevalence of inappropriate prescription in this population. Criteria were adapted to country specific needs when used outside the United States. Different strategies to reduce PIM prevalence in the elderly have been suggested.

Factors associated with arterial hypertension in pharmacy users in Portugal.

OBJECTIVE: To estimate the prevalence, treatment and control of hypertension, and to identify factors associated in community pharmacy users. METHODS: A cross-sectional study was conducted with 1,042 pharmacy users, aged between 40 and 65 years, in 60 community pharmacies of continental Portugal, between October 2005 and January 2006. Data were obtained with the application of a questionnaire and measurement of biological parameters. A total of three sequential logistic regressions were performed to verify an association among variables. RESULTS: Mean age was 53.7 years and the male/female ratio was 0.68. Prevalence of arterial hypertension was 54.8%. Approximately 70% of hypertensive individuals were undergoing antihypertensive treatment and, of these, 47.7% were controlled. Hypertension was positively associated with older age, male sex, being married, higher body mass index and higher total cholesterol level, being a diabetic, having a family or personal history of premature cardiovascular disease, and reporting more medical visits per year. When treated, hypertension was found to be positively associated with the female sex, not being married, being a diabetic, living in an urban area, and reporting more than three medical visits per year. In hypertensive users who were treated, being controlled was positively associated with self-reporting adherent behavior towards antihypertensive treatment, perceiving the effect of these drugs and having a low cardiovascular risk. The predictive models showed areas under the respective ROC curves between 0.72 and 0.78, with an acceptable discriminatory power. CONCLUSIONS: The prevalence of hypertension was high, although similar to that found in other studies conducted in Portugal. The proportion of hypertensive individuals under treatment was satisfactory, in contrast to an insufficient level of control.

[Operationalization to Portugal: Beers criteria of inappropriate medication use in the elderly]. / Operacionalização para Portugal: critérios de Beers de medicamentos inapropriados nos doentes idosos.

INTRODUCTION: Elderly drug therapy needs special care considering physiopathological alterations of this age group that increase the risk of adverse drug events occurrence and due to the high number of drugs used. Several tools have been created, as tables of drugs and groups of drugs to be avoided in patients 65 years old and over. Beers Criteria of 2002 update is the most used tool. GOALS: To operationalize Beers Criteria to be used by health care professionals in Portugal. METHODS: Analysis of the drugs and therapeutic classes included into the Beers Criteria approved for market in Portugal and the identification of other approved substances included in the pharmacological classes mentioned in Beers Criteria. The two tables in the Beers criteria were adapted to substances approved in Portugal, even including other marketed active substances belonging to therapeutic classes mentioned in Beers criteria. Levels of inappropriateness and the potential effects after their use in elderly were also included. In Beers table 1, 34 included substances don't have approval in Portugal, and 4 have different denominations. In Beers table 2, three tricyclic antidepressants, 12 typical antipsychotics, 5 doses for short-action benzodiazepines, and 28 NSAIDs (being two coxibs) were included. CONCLUSIONS: The Portuguese operationalization of the Beers Criteria allows the creation of a tool that helps prescribers to choose drugs and doses for a safer prescription to the elderly. These adapted tables allow benchmarking among studies assessing inappropriateness of use of drugs in different countries using Beers Criteria.

Using a pharmaco-epidemiological approach to estimate diabetes type 2 prevalence in Portugal.

PURPOSE: To estimate the prevalence of drug-treated diabetes type 2 in Portugal using drug consumption data and accounting for the proportion of patients treated with combinations of oral hypoglycaemic agents (OHAs). METHODS: The prevalence of diabetes treated by OHAs was calculated on the basis of: IMS-Health data for Portugal (2003) and two measures of daily drug intake-defined daily dose (DDD) and prescribed daily dose (PDD), after correcting for the proportion of patients treated with two or more OHAs. The PDD and proportion of patients in combination therapies have been obtained in a descriptive, cross-sectional national survey, conducted in 2003, by inquiry of 1,046 type 2 diabetics country wide distributed. RESULTS: Drug use study: We have studied 1046 type 2 diabetics (539 women, 501 men, 6 sex unknown), with a mean age of 64.5 (SD=11) years. OHAs were prescribed as monotherapy in 46.8% (489/1,046) of the patients and the remaining 557 (53.2%) received from 2 to 4 OHAs concomitantly.Diabetes prevalence: Using DDD as the mean daily intake consumption unit, the prevalence of drug-treated type 2 diabetes was 4.15%, which dropped to 2.52% when the proportion of OHAs associations was taken into account. Using PDD these values were 4.48% and 2.72%, respectively. CONCLUSIONS: Since a high proportion of patients are treated with combination of OHAs in clinical practice, it is imperative to account for that confounder in order to improve the accuracy of estimate from drug consumption data. The use of this methodology provided a slight under-estimation of diabetes prevalence, compared with the National Health Authorities values (3%-5%). Nevertheless we consider this as an efficient tool to estimate drug-treated diabetes prevalence that should be implemented in a regular way for longitudinal observations, in order to generate signals.

How to measure (or not) compliance to eradication therapy.

This study aimed to test a novel method of compliance measurement in Portuguese community pharmacy in Helicobacter pylori patients. A case series design was used where compliance indicators were electronically measured, aside with patients' reports. Experienced adverse drug reactions, perceived benefit of therapy and quality of life were also measured. Mean compliance proportion was 56% and a positive impact on patients' perceived health status was found. The method used was welcomed by community pharmacists, albeit having an influence on patients' normal behaviour.

Inappropriate drug use by Portuguese elderly outpatients--effect of the Beers criteria update.

OBJECTIVE: To characterize the use of medicines and to evaluate the inappropriateness of drugs in elderly outpatient population. SETTING: Twelve community pharmacies in different districts of Lisbon-Portugal. METHOD: Observational cross-sectional survey, in a sample of 213 elderly outpatients (age>or=65-years-old) presenting a prescription with two or more drugs, for their own use. MAIN OUTCOME MEASURES: Drug use pattern and prevalence of potentially inappropriate medication. RESULTS: We have studied 213 outpatients, who were taking a total of 1,543 drugs, with an average of 7.23 per patient. The drugs were distributed mainly in the following 3 ATC (Anatomical Therapeutic Chemical Classification) classes: C (cardiovascular system), N (nervous system) and A (alimentary tract). Using the 1997 Beers Explicit criteria, 75 occurrences of inappropriate medicines were detected in 59 patients (27.7%), while with the 2003 Beers Explicit criteria we detected 114 cases of inappropriate medication in 82 patients (38.5%). The occurrence of inappropriate medicines was significantly associated with the consumption of a high number of drugs. According to the ATC Classification, more than one half of the cases of inappropriateness were related with long acting benzodiazepines and with ticlopidine. The 2003 version detected a significantly higher prevalence of inappropriate drug use having potentially adverse outcomes of high severity. CONCLUSIONS: The application of the updated Beers criteria lead to higher rates of potentially inappropriate medication, and especially those responsible for more severe adverse outcomes. The results suggest that there is a need for interventions to improve instructions for safe drug use in the elderly patients and to decrease the number of medications whenever it is possible. This study suggests a high prevalence of potentially inappropriate drug use by the elderly patients of Lisbon region, Portugal.

Factores associados à hipertensão arterial nos utentes de farmácias em Portugal / Factores asociados con la hipertensión arterial en los usuarios de farmacias en Portugal / Factors associated with arterial hypertension in pharmacy

OBJETIVO: Estimar a prevalência, tratamento e controlo da hipertensão e identificar factores associados em utentes de farmácias comunitárias. MÉTODOS: Estudo transversal com 1.042 utentes de 40 a 65 anos em 60 farmácias comunitárias de Portugal Continental entre outubro de 2005 e janeiro de 2006. Os dados foram obtidos pela aplicação de questionário e medição de parâmetros biológicos. Foram realizadas três regressões logísticas sequenciais para verificar associação entre as variáveis. RESULTADOS: A idade média foi de 53,7 anos e a razão homem/mulher foi 0,68. A prevalência da hipertensão arterial foi de 54,8 por cento. Cerca de 70 por cento dos hipertensos encontravam-se sob tratamento anti-hipertensivo e, destes, 47,7 por cento estavam controlados. A hipertensão esteve positivamente associada à idade mais elevada, sexo masculino, ser casado, apresentar índice de massa corporal e nível de colesterol total mais alto, ser diabético, ter doença cardiovascular pessoal ou familiar precoce e reportar mais consultas médicas por ano. A hipertensão tratada mostrou-se positivamente associada a ser mulher, não casado, ser diabético, viver numa área urbana e reportar mais de três consultas médicas por ano. Nos hipertensos tratados, estar controlado foi positivamente associado a ter comportamento aderente à terapêutica anti-hipertensiva (auto-reporte), percepcionar o efeito desta medicação e ser de baixo risco cardiovascular. Os modelos preditivos apresentaram áreas sob as respectivas curvas ROC entre 0,72 e 0,78, com capacidade discriminatória aceitável. CONCLUSÕES: A prevalência da hipertensão foi elevada, mas similar à encontrada em outros estudos realizados em Portugal. A proporção de doentes tratados foi satisfatória, em contraste com o nível insuficiente de controlo.

OBJETIVO: Estimar la prevalencia de la hipertensión, tratamiento y control, así como identificar factores asociados en usuarios de farmacias comunitarias.MÉTODOS: Estudio transversal con 1.042 usuarios de 40 a 65 años en 60 farmacias comunitarias de Portugal Continental entre octubre de 2005 y enero de 2006. Los datos fueron obtenidos por la aplicación de cuestionario y medición de parámetros biológicos. Se realizaron tres regresiones logísticas secuenciales para verificar asociación entre las variables.RESULTADOS: La edad promedio fue de 53,7 años y el cociente hombre/mujer fue 0,68. La prevalencia de la hipertensión arterial fue de 54,8%. Cerca de 70% de los hipertensos se encontraban bajo tratamiento anti-hipertensivo y, de estos, 47,7% estaban controlados. La hipertensión estuvo positivamente asociada con la edad más elevada, sexo masculino, ser casado, presentar índice de masa corporal y nivel de colesterol total más alto, ser diabético, tener enfermedad cardiovascular personal o familiar precoz y reportar más consultas médicas por año. La hipertensión tratada se mostró positivamente asociada a ser mujer, no casado, ser diabético, vivir en un área urbana y reportar más de tres consultas médicas por año. En los hipertensos tratados, estar controlado fue positivamente asociado a tener comportamiento adherente a la terapia anti-hipertensiva (auto-reportada), tener percepción del efecto de este medicamento y ser de bajo riesgo cardiovascular. Los modelos predictivos presentaron áreas bajo las respectivas curvas ROC entre 0,72 y 0,78, con capacidad discriminatoria aceptable. CONCLUSIONES: La prevalencia de la hipertensión fue elevada, más similar a la encontrada en otros estudios realizados en Portugal. La proporción de enfermos tratados fue satisfactoria, en contraste con el nivel insuficiente de control.

Evaluation of a pharmaceutical care program for hypertensive patients in rural Portugal.

OBJECTIVES: To evaluate the community pharmacist's capacity to positively influence the results of antihypertensive drug therapy through a pharmaceutical care program and to determine what factors limit the program. DESIGN: Randomized, controlled study. SETTING: Private pharmacy caring for a semiliterate, rural Portuguese population. PATIENTS: Random sample of 100 patients with a diagnosis of essential hypertension who had been on drug treatment for less than 6 months. Patients were randomly assigned to an intervention (n = 50) or a control (n = 50) group. INTERVENTION: Individualized health promotion by a research pharmacist involving monthly appointments for 6 months to monitor blood pressure; assess adherence to treatment; prevent, detect, and resolve drug-related problems (DRPs); and encourage nonpharmacologic measures for blood pressure control. Control patients received traditional care. MAIN OUTCOME MEASURES: Control of blood pressure; decreases in systolic/diastolic blood pressure; number of detected, resolved, and prevented DRPs. RESULTS: From the initial sample of 100 patients, 41 patients in the intervention group and 41 patients in the control group completed the longitudinal study. After 6 months, prevalence of uncontrolled blood pressure decreased by 77.4% in the intervention group (P < .0001) and by 10.3% in the control group (P = .48). Systolic blood pressure fell from a mean +/- standard deviation of 152 mm Hg +/- 23 mm Hg to 129 +/- 15 mm Hg in intervention patients and 148 +/- 16 mm Hg to 143 +/- 20 mm Hg in control patients (P < .001). Twenty-four of 29 (83%) detected actual DRPs were resolved. About 40% of potential DRPs were prevented. CONCLUSION: In this rural community, a pharmaceutical care program was associated with significant improvements in blood pressure control in hypertensive patients.

Patterns and determinants of psychoactive drug use in Lisbon University students--a population-based study.

OBJECTIVE: To study the patterns and determinants of psychoactive drug use by Lisbon University students. MATERIALS AND METHODS: A cross-sectional survey was conducted, from January to April 2000, in a probabilistic sample of 1,147 students. Information about use of psychoactive drugs and co-variates was collected by a questionnaire administered by trained interviewers. Psychoactive drugs were considered to be all medicines classified in group N (nervous system) of the ATC system except the anesthetics (subgroup N01) and the analgesics (subgroup N02). RESULTS: 91 students (7.9%) had taken psychoactive drugs during the fortnight before the interview, 39 of whom (42.8%) mentioned continuous use. The prevalence of use was significantly higher in females (9.6%), older than 25 years (13.1%), married (16%), who considered themselves to have a weak health status (21.7%), as under intense stress (15.5%). After adjustment by multivariate analysis the variables sex, self-evaluation of health status and daily stress retained a higher significant association with psychoactive drug use. A total of 132 drugs were reported as being used in that period. Tranquilizers (ATC = N05B or N05C) were used by 82 students (7.2%), while 22 (1.9%) consumed psychoactive stimulants (N06B) and 19 (1.7%) antidepressants (N06A). In all of these therapeutical subgroups, females had higher consumption prevalence than males, but the difference was statistically significant only for tranquilizers (P < 0.001). Anxiety, depression and insomnia were the most frequently stated health problems. More than 90% of drug consumers considered they had a compliant attitude and about 60% considered themselves well-informed about adverse effects of the drug used. The reported prevalence of self-medication for psychoactive drugs used was 12.8%. CONCLUSIONS: The prevalence of psychoactive drug use among students of Lisbon University was higher than expected, considering age group and the usual health status of this population. The administration of a questionnaire was a very useful tool to characterise the pattern of use and the consumer's knowledge about the drugs consumed.