Rates of adverse events of antiretroviral therapy in women living with HIV/AIDS: a systematic review and meta-analysis.

OBJECTIVE: There is limited information regarding the incidence of treatment-related adverse events (AE) following antiretroviral therapy (ART) in women. So, this review aimed to describe the incidence of AE of ART in women living with HIV/AIDS. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline, Embase, Cochrane Library, Epistemonikos, Lilacs and Who Index, from inception to 9 April 2023. ELIGIBILITY CRITERIA: We included randomised controlled trials with at least 12 weeks of follow-up and evaluated AE of ART in women at any age living with HIV/AIDS, without restrictions on status, year or language of publication. We excluded post hoc or secondary analyses and open-label extensions without comparator, and trials involving pregnant or breastfeeding women or with a focus on coinfection with tuberculosis, hepatitis B or C. The primary outcomes were the incidence rate of participants with any clinical and/or laboratory AE related or not to ART and treatment discontinuation. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data and assessed the risk of bias using Cochrane's risk of bias tool 2. We used Bayesian random-effects meta-analysis to summarise event rates. Results were presented as event rates per 1000 person-years (95% credibility intervals, 95% CrI). The pooled incidence rate per 1000 person-years adjusted for duration and loss to follow-up was estimated. We assessed the certainty of the evidence using Grading of Recommendations, Assessment, Development and Evaluation. RESULTS: A total of 24 339 studies were identified for screening, of which 10 studies (2871 women) met the eligibility criteria, with 11 different antiretrovirals (ARVs) regimens. Seven studies included exclusively women, while in the remaining three, the proportion of women ranged from 11% to 46%. Nine studies received industry funding. The pooled analysis showed a mean incidence rate of ART-related clinical and laboratory AE of 341.60 events per 1000 person-years (95% CrI 133.60-862.70), treatment discontinuation of 20.78 events per 1000 person-years (95% CrI 5.58-57.31) and ART-related discontinuation of 4.31 per 1000 person-years (95% CrI 0.13-54.72). Summary estimates were subject to significant uncertainty due to the limited number of studies and sparse data. The certainty of the evidence was graded as very low for all outcomes assessed. CONCLUSION: Existing randomised trials do not provide sufficient evidence on the incidence rates of safety outcomes from antiretroviral treatment in women living with HIV/AIDS. Large comparative studies in well-characterised populations are needed to provide a more comprehensive landscape of the safety profile of these ARV therapies in women with HIV/AIDS. PROSPERO REGISTRATION NUMBER: CRD42021251051.

Design and validity of an instrument to assess healthcare professionals' perceptions, behaviour, self-efficacy and attitudes towards evidence-based health practice: I-SABE.

OBJECTIVES: To develop and validate an instrument to measure Brazilian healthcare professionals' perceptions, behaviour, self-efficacy and attitudes towards evidence-based health practice. DESIGN: Validation of an instrument using the Delphi method to ensure content validity and data from a cross-sectional survey to evaluate psychometric characteristics (psychometric sensitivity, factorial validity and reliability). SETTING: National Register of Health Establishments database. PARTICIPANTS: We included clinical health professionals who were working in the Brazilian public health system. RESULTS: The Instrument to assess Evidence-Based Health (I-SABE) was constructed with five domains: self-efficacy; behaviour; attitude; results/benefits and knowledge/skills. Content validity was done by 10-12 experts (three rounds). We applied I-SABE to 217 health professionals. Bartlett's sphericity test and the Kaiser-Meyer-Olkin (KMO) index were adequate (χ2=1455.810, p<0.001; KMO=0.847). Considering the factorial loads of the items and the convergence between the Scree Plot and the Kaiser criterion the four domains tested in this analysis, explaining 59.2% of the total variance. The internal consistency varied between the domains: self-efficacy (α=0.76), behaviour (α=0.30), attitudes (α=0.644), results/benefits to the patient (α=0.835). CONCLUSIONS: The results of the psychometric analysis of the I-SABE confirm the good quality of this tool. The I-SABE can be used both in educational activities as well as an assessment tool among healthcare professionals in the Brazilian public health settings.

Cardiovascular risk behavior among industrial workers in the Northeast of Brazil: a cluster analysis.

This research aimed to investigate the occurrence of clusters of cardiovascular risk behaviors and their association with social demographic and occupational characteristics in a population of industrial workers in the metropolitan area of Recife, Brazil. It was a transversal study with 727 workers of both genders. We identified cluster distribution from the variables: smoking, alcohol consumption, physical activity and waist circumference, by a combination of hierarchical and non-hierarchical analysis. We later tested the association with the social demographic and occupational variables with a multi-varied analysis. We have identified a protection cluster (sufficient physical activity, moderate alcohol consumption) and a risk cluster (high waist circumference, sedentarism, smoking, excessive alcohol consumption). The protection cluster was positively associated with night shift or variable shift work (RP: 1.66, IC95%: 1.26-2.17), and the risk cluster was associated with women (RP: 1.15, IC95%: 1.01-1.31). Cluster analysis allowed to identify that, for day shift workers and women, the shortest daytime outside the work environment can influence the adoption of cardiovascular risk behaviors.

Cardiovascular risk behavior among industrial workers in the Northeast of Brazil: a cluster analysis / Comportamento de risco cardiovascular entre trabalhadores industriais no nordeste do Brasil: uma análise de cluster

Abstract This research aimed to investigate the occurrence of clusters of cardiovascular risk behaviors and their association with social demographic and occupational characteristics in a population of industrial workers in the metropolitan area of Recife, Brazil. It was a transversal study with 727 workers of both genders. We identified cluster distribution from the variables: smoking, alcohol consumption, physical activity and waist circumference, by a combination of hierarchical and non-hierarchical analysis. We later tested the association with the social demographic and occupational variables with a multi-varied analysis. We have identified a protection cluster (sufficient physical activity, moderate alcohol consumption) and a risk cluster (high waist circumference, sedentarism, smoking, excessive alcohol consumption). The protection cluster was positively associated with night shift or variable shift work (RP: 1.66, IC95%: 1.26-2.17), and the risk cluster was associated with women (RP: 1.15, IC95%: 1.01-1.31). Cluster analysis allowed to identify that, for day shift workers and women, the shortest daytime outside the work environment can influence the adoption of cardiovascular risk behaviors.

Resumo Esta pesquisa teve como objetivo investigar a ocorrência de clusters de comportamentos de risco cardiovascular e sua associação com características sociodemográficas e ocupacionais em uma população de trabalhadores da indústria da região metropolitana de Recife, Brasil. Trata-se de um estudo transversal com 727 trabalhadores de ambos os gêneros. Identificou-se a distribuição do cluster a partir das variáveis: tabagismo, etilismo, atividade física e circunferência da cintura, por meio de uma combinação de análise hierárquica e não hierárquica. Posteriormente, testamos a associação às variáveis sociodemográficas e ocupacionais com uma análise multivariada. Identificamos a formação consistente de um cluster de proteção (atividade física suficiente, consumo moderado de álcool) e de um cluster de risco (circunferência da cintura elevada, sedentarismo, tabagismo, consumo excessivo de álcool). O cluster de proteção associou-se positivamente ao turno noturno ou turnos variáveis (RP: 1,66, IC95%: 1,26-2,17) e o cluster de risco esteve associado às mulheres (RP: 1,15, IC95%: 1,01-1,31). A análise de cluster permitiu identificar que, para trabalhadores diurnos e mulheres, a menor jornada diurna fora do trabalho pode influenciar na adoção de comportamentos de risco cardiovascular.

Sex differences and adverse events of antiretrovirals in people living with HIV/AIDS: a systematic review and meta-analysis protocol.

INTRODUCTION: Antiretroviral therapy (ART) for HIV/AIDS is associated with adverse events (AEs). However, little is known about the differences in the risk of AEs between women and men living with HIV/AIDS. This study aims to determine (1) whether there are sex differences in the risk of AEs in people with HIV/AIDS treated with ART and (2) the prevalence of AEs to the reproductive system and bone mineral density in women. METHODS AND ANALYSIS: This systematic review (SR) will include randomised trials evaluating ART in people living with HIV/AIDS with at least 12 weeks of duration follow-up. Searches will be conducted in Medline, Embase, Cochrane Library, Epistemonikos, Lilacs, trial registries and grey literature databases, without restriction on publication status, year of publication and language. The primary outcome will be the risk of ART discontinuation or drop-outs/withdrawals of ART due to AEs and the number of any treatment-emergent AE. The secondary outcomes are the incidence of serious clinic or laboratory (grade 3 and/or 4) treatment-emergent AEs, hospitalisation, death and AEs specific to the reproductive system and bone mineral density (osteoporosis, osteopenia and fractures) of women. Selection, data extraction and quality assessment will be performed by pairs of reviewers. Cochrane collaboration tools will be used to assess the risk of bias. If appropriate, a meta-analysis will be conducted to synthesise results. The overall quality of the evidence for each outcome will be determined by the Grades of Recommendation, Assessment, Development and Evaluation. ETHICS AND DISSEMINATION: The results of this SR will assist the formulation of public policies aimed at the management and monitoring of AEs of ART in people living with HIV/AIDS. A deliberative dialogue will be scheduled with the Department of Chronic Conditions and Sexually Transmitted Infections of Brazil's Ministry of Health to align the project with policymakers' interests. PROSPERO REGISTRATION NUMBER: CRD42021251051.

Healthcare professionals' knowledge, attitudes and practices toward deprescribing: a protocol of cross-sectional study (Desmedica Study-Brazil).

BACKGROUND: Deprescribing is the planned and supervised process of dose reduction or stopping of medication that might be causing harm, or no longer be of benefit. It is an activity that should be a normal part of care/the prescribing cycle. Although now broadly recognised, there are still challenges in its effective implementation. OBJECTIVES: To develop and validate an instrument to measure Brazilian healthcare professionals' knowledge, attitudes and practices towards deprescribing. METHODS: This study will include the following steps: (1) development of the preliminary instrument; (2) content validation; (3) pilot study; (4) evaluation of psychometric characteristics. After the elaboration of items of the instrument through the literature review, we will use a hybrid Delphi method to develop and establish the content validity of the instrument. Further, a pilot survey will be performed with 30 healthcare professionals. Finally, for the evaluation of psychometric characteristics, a cross-sectional study will be accomplished with a representative sample of different healthcare professionals from different Brazilian states using respondent-driven sampling. Exploratory factor analysis and confirmatory factor analysis will be performed. For assessing the model fit, we will use the ratio of χ2 and df (χ2/df), comparative fit index, the goodness of fit index and root mean square error of approximation. In addition, the reliability of the instrument will be estimated by test-retest reproducibility and Cronbach's alpha coefficient (α). ETHICS AND DISSEMINATION: The Ethics Committee for Research at the University of Sorocaba (ethics approval number: 3.848.916) approved the study. Study findings will be circulated to healthcare professionals and scientists in the field through publication in peer-reviewed journals and conference presentations.

Ultraprocessed food consumption and factors associated with a sample of public school bases in the South of Brazil. / Consumo de alimentos ultraprocessados e fatores associados em uma amostra de base escolar pública no Sul do Brasil.

This study aims to evaluate the consumption of ultraprocessed foods and its association with sociodemographic, behavioral and nutritional factors in schoolchildren from public schools in Caxias do Sul-RS. A cross-sectional study was conducted with 1,309 students aged 6-16 years. The consumption of ultraprocessed foods was obtained by means of a questionnaire according to the self-report of the student. A pre-tested questionnaire was used to evaluate the characteristics of the students. A Poisson regression analysis was performed following a statistical hierarchical modeling to determine factors associated with outcome. Results with p value ≤ 0.05 were considered statistically significant. A high prevalence of ultraprocessed food consumption was identified (69.7%) among schoolchildren. After adjusted analysis, higher prevalence of ultraprocessed food consumption was associated with buying/taking snacks to school and snacking. Nutritional counseling was also associated with protection against the consumption of these foods. Nutrition education actions are necessary for schoolchildren and caregivers in order to reduce the consumption of ultraprocessed foods by schoolchildren, especially in snacks.

O estudo tem por objetivo analisar o consumo de alimentos ultraprocessados relacionando com fatores sociodemográficos, comportamentais e nutricionais em escolares da rede municipal de ensino de Caxias do Sul-RS. Trata-se de um estudo transversal, com 1.309 escolares na faixa etária entre 6 e 16 anos. O consumo de alimentos ultraprocessados foi obtido por meio de um questionário de acordo com o autorrelato do escolar. Utilizou-se um questionário pré-testado para avaliar as características do escolar e dos familiares. Utilizou-se a regressão de Poisson para análise do desfecho e fatores associados por meio de um modelo hierárquico. Considerou-se estatisticamente significtivos resultados com valor p ≤ 0,05. Resultados: Identificou-se elevada prevalência de consumo de alimentos ultraprocessados entre os escolares (69,7%). Após análise ajustada, maiores prevalências de consumo de alimentos ultraprocessados foram associadas a comprar/levar lanche para escola e realizar lanches. Já o aconselhamento nutricional foi associado à proteção em relação ao consumo destes alimentos. Conclusão: Fazem-se necessárias ações de educação nutricional para escolares e responsáveis a fim de reduzir o consumo de alimentos ultraprocessados pelos escolares principalmente nos lanches.

Consumo de alimentos ultraprocessados e fatores associados em uma amostra de base escolar pública no Sul do Brasil / Ultraprocessed food consumption and factors associated with a sample of public school bases in the South of Brazil

Resumo O estudo tem por objetivo analisar o consumo de alimentos ultraprocessados relacionando com fatores sociodemográficos, comportamentais e nutricionais em escolares da rede municipal de ensino de Caxias do Sul-RS. Trata-se de um estudo transversal, com 1.309 escolares na faixa etária entre 6 e 16 anos. O consumo de alimentos ultraprocessados foi obtido por meio de um questionário de acordo com o autorrelato do escolar. Utilizou-se um questionário pré-testado para avaliar as características do escolar e dos familiares. Utilizou-se a regressão de Poisson para análise do desfecho e fatores associados por meio de um modelo hierárquico. Considerou-se estatisticamente significtivos resultados com valor p ≤ 0,05. Resultados: Identificou-se elevada prevalência de consumo de alimentos ultraprocessados entre os escolares (69,7%). Após análise ajustada, maiores prevalências de consumo de alimentos ultraprocessados foram associadas a comprar/levar lanche para escola e realizar lanches. Já o aconselhamento nutricional foi associado à proteção em relação ao consumo destes alimentos. Conclusão: Fazem-se necessárias ações de educação nutricional para escolares e responsáveis a fim de reduzir o consumo de alimentos ultraprocessados pelos escolares principalmente nos lanches.

Abstract This study aims to evaluate the consumption of ultraprocessed foods and its association with sociodemographic, behavioral and nutritional factors in schoolchildren from public schools in Caxias do Sul-RS. A cross-sectional study was conducted with 1,309 students aged 6-16 years. The consumption of ultraprocessed foods was obtained by means of a questionnaire according to the self-report of the student. A pre-tested questionnaire was used to evaluate the characteristics of the students. A Poisson regression analysis was performed following a statistical hierarchical modeling to determine factors associated with outcome. Results with p value ≤ 0.05 were considered statistically significant. A high prevalence of ultraprocessed food consumption was identified (69.7%) among schoolchildren. After adjusted analysis, higher prevalence of ultraprocessed food consumption was associated with buying/taking snacks to school and snacking. Nutritional counseling was also associated with protection against the consumption of these foods. Nutrition education actions are necessary for schoolchildren and caregivers in order to reduce the consumption of ultraprocessed foods by schoolchildren, especially in snacks.

Potentially inappropriate prescriptions to Brazilian older people with Alzheimer disease: A cross-sectional study.

ABSTRACT: Older adults are the leading users of medications, where this can be associated with a high number of potentially inappropriate medications (PIMs) and of potentially inappropriate prescribing (PIP) and consequent harm to health. No Brazilian study evaluating potentially inappropriate prescribing in older patients with Alzheimer's disease (AD) was found. This study determined and analyzed the prevalence of PIP and PIM prescribed for older people with AD.A cross-sectional study was carried out at the Specialty Drugs Pharmacy in the city of Sorocaba, São Paulo State, Brazil. The MEDEX system provided the register in older people with AD and data were collected during interviews with patients and/or caregivers between June and September 2017. The PIMs were identified according to the 2019 Beers Criteria. The association between PIMs and independent variables was analyzed by Poisson regression.This study included 234 older patients with AD. The prevalence of PIP prescribed was 66.7% (n = 156). Of the 1073 medications prescribed, 30.5% (n = 327) were inappropriate with most affecting the central nervous system or cardiovascular, particularly quetiapine (12.8%) and acetylsalicylic acid (11.6%), respectively. Around 45.2% of the PIMs should be avoided in older people, especially sertraline (14.2%) and clonazepam (7.4%). After adjusted analysis, the PIMs were associated with the diagnosis of depression (P = 0.010) and the number of comorbidities (P = 0.005).There was a high number of PIMs among older people, a substantial number of which should have been avoided in this population. Health care professionals can apply these findings to improve safety in the use of medications for treating patients with AD.

Feasibility of De-Escalation Implementation for Positive Blood Cultures in Patients With Sepsis: A Prospective Cohort Study.

Purpose: The aim of the present study was to determine whether de-escalation guided by blood cultures for patients with a diagnosis of sepsis, severe sepsis or septic shock reduces mortality, and antimicrobial drug resistance (ADR). Methods: A prospective, single-center, cohort study was conducted with adults admitted to the ICU with a diagnosis of sepsis, severe sepsis, or septic shock at a public hospital in Sorocaba, State of São Paulo, Brazil, from January 2013 to December 2013. We excluded patients who had negative blood cultures. Patients who had replaced the initial empirical broad-spectrum antibiotic therapy (EAT) by the antibiotic therapy guided by blood cultures were compared with those who continued receiving EAT. The outcome included mortality and antimicrobial drug resistance. We used the Cox regression (proportional hazards regression) and the Poisson regression to analyze the association between antibiotic therapy guided by blood cultures (ATGBC) and outcomes. The statistical adjustment in all models included the following variables: sex, age, APACHE II (Acute Physiology And Chronic Health Evaluation II) score and SOFA (Sequential Organ Failure Assessment) score. Results: Among the 686 patients who were admitted to the intensive care unit, 91 were included in this study. The mean age of the patients was 52.7 years (standard deviation = 18.5 years) and 70.3% were male. EAT was replaced by ATGBC in 33 patients (36.3%) while 58 patients (63.7%) continued receiving EAT. Overall hospital mortality decreased from 56.9% in patients who received EAT to 48.5% in patients who received ATGBC [Hazard ratio- HR 0.44 (95% CI 0.24-0.82), p = 0.009]. There was no association between ATGBC and ADR [HR 0.90 (95% CI 0.78 - 1.03) p = 0.15]. Conclusions: Although the early and appropriate empirical EAT is undoubtedly an important factor prognostic, ATGBC can reduce the mortality in these patients.

Pain and Inflammation Management in Older Adults: A Brazilian Consensus of Potentially Inappropriate Medication and Their Alternative Therapies.

Purpose: The aim of the present study was to develop and validate a Potentially Inappropriate Medications (PIM) list and alternative therapies for treatment of pain and inflammation in older people adapted to the Brazilian context. Methods: A preliminary PIM list suitable for the Brazilian market was developed on the basis of three published international PIM lists [Beers 2015, Screening Tool of Older People's Potentially Inappropriate Prescriptions - 2015, European Union (7) PIM list]. We used the modified Delphi technique (two-round) to validate concerns of use and alternative therapies related to PIM for treatment of pain and inflammation in older adults ≥65 years in Brazil. The panel involved nine Brazilian experts in geriatric pharmacotherapy. All items with mean Likert scale score ≥4.0 (agree) and the lower limit of 95% confidence interval ≥4.0 were considered validated in this study. Results: At the end of the consensus process, 94 (65.3%) items of 144 were validated. In total, consensus was reached for 33/35 (94.3%) concerns about drugs that should be avoided in older patients regardless of diagnosis, for 22/23 (95.7%) concerns about drugs that should be avoided in older patients with specific conditions or diseases, for 11/23 (47.8%) with special considerations of use, and for 28/63 (44.4%) of therapeutic alternatives. Conclusion: Although these criteria are not designed to replace clinical judgement, PIM and alternative therapies lists can be useful to inform prescribers, pharmacists, and health care planners and may serve as a starting point for safe and effective use of medications in older people.

Potentially inappropriate medication in the elderly: a systematic review of validated explicit criteria.

PURPOSE: Potentially inappropriate medication (PIM) use causes preventable adverse drug reactions in older patients. Several assessment tools have been published to identify and avoid PIM use. In this systematic literature review, we aim to provide summaries and comparisons of validated PIMs lists published between 1991 and 2017 internationally. METHODS: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA), we performed a systematic review of articles describing the development and validation of criteria for identification of PIMs among older people published between January 1991 and April 2017. The searches were conducted on PUBMED, AgeLine, Academic Search, Academic Search Premier, and CINAHL. We identified the most common medications/classes described as PIM. We also identified the drug-disease interactions and drug-drug interactions reported among criteria. RESULTS: From 2933 articles screened, 36 met our inclusion criteria. The majority used the Delphi method to validate their criteria. We identified 907 different medications/classes, 536 different drug disease interactions involving 84 diseases/conditions, and 159 drug-drug interactions. Benzodiazepines and nonsteroidal anti-inflammatory drugs were the medications most commonly reported as potentially inappropriate for older people. CONCLUSION: Although approaches aimed at detecting inappropriate prescribing have intensified in recent years, we observed limited overlap between different PIM lists. Additionally, some PIM lists did not provide special considerations of use and alternative therapies to avoid PIMs. These facts may compromise the use of PIM lists in clinical practice. Future PIM lists should integrate information about alternative therapies and special considerations of use in order to help clinicians in the drug prescription.

Pharmacotherapeutic profile of users and expenditure on high-cost drugs in São Leopoldo, Rio Grande do Sul State, Brazil, 2014. / Perfil farmacoterapêutico dos usuários e gasto com medicamentos de alto custo em São Leopoldo, Rio Grande do Sul, Brasil, 2014.

OBJECTIVE: to describe the pharmacotherapeutic profile of users of the Specialized Program for Pharmaceutical Assistance, and to measure the expenditure on the most prevalent and the most expensive medications. METHODS: descriptive study conducted in São Leopoldo-RS, Brazil, with secondary data regarding information about requests accepted in 2014, through administrative proceedings; delivery notes of the State Health Department/RS were used to assess the costs. RESULTS: 1,528 users were included in the study, mostly women (56.7%), and the average age was 52 years (standard deviation=17.9); the most frequent diagnoses were allergic asthma (17.1%), chronic kidney disease (11.5%) and rheumatoid arthritis (8.4%); the most prevalent drug was budesonide+formoterol fumarate (18.3%); among the most prevalent drugs, the highest total monthly expense was with epoetin alfa (BRL37,922.34) and among the most expensive drugs, infliximab (BRL72,503.28). CONCLUSION: the data show the importance of the Specialized Program for Pharmaceutical Assistance in the high-cost treatment of highly prevalent.

Perfil farmacoterapêutico dos usuários e gasto com medicamentos de alto custo em São Leopoldo, Rio Grande do Sul, Brasil, 2014 / Perfil farmacoterapéutico de los usuarios y gasto en medicamentos de alto costo en São Leopoldo, Rio Grande do Sul, Brasil, 2014 / Pharmacotherapeutic profile of users and expenditure on high-cost drugs in São Leopoldo, Rio Grande do Sul State, Brazil, 2014

OBJETIVO: descrever o perfil farmacoterapêutico dos usuários do Componente Especializado da Assistência Farmacêutica (CEAF) e mensurar os gastos com os medicamentos mais prevalentes e os mais onerosos. MÉTODOS: estudo descritivo, realizado no município de São Leopoldo-RS, Brasil; utilizaram-se dados secundários sobre solicitações de medicamentos deferidas em 2014 via processo administrativo; para avaliar os custos, foram consultadas as guias de remessa da Secretaria de Estado da Saúde/RS. RESULTADOS: foram incluídos 1.528 usuários, sobretudo mulheres (56,7%), e idade média de 52 anos (desvio-padrão=17,9); os diagnósticos mais frequentes foram asma alérgica (17,1%), doença renal crônica (11,5%) e artrite reumatoide (8,4%); o medicamento mais prevalente foi o fumarato de formoterol+budesonida (18,3%); o maior gasto total mensal entre os medicamentos mais prevalentes foi com alfaepoetina (R$37.922,34), e entre os mais onerosos, com infliximab (R$72.503,28). CONCLUSÃO: os dados apontam para a importância do CEAF no tratamento de alto custo de morbidades com elevada prevalência.

OBJETIVO: describir el perfil farmacoterapéutico de usuarios del Programa de Asistencia Farmacéutica Especializada (CEAF), y medir los costos de los medicamentos más comunes y más costosos. MÉTODOS: estudio descriptivo realizado en São Leopoldo/RS, con datos secundarios sobre solicitudes de drogas diferidas en 2014 a través de procesos administrativos; para evaluar el costo, utilizamos las entregas de Secretaría Estatal de Salud/RS. RESULTADOS: se incluyeron 1.528 usuarios, la mayoría mujeres (56,7%), edad media 52 años (desviación estándar=17,9); los diagnósticos más frecuentes fueron asma alérgica (17,1%), enfermedad renal crónica (11,5%) y artritis reumatoide (8,4%); la droga más frecuente fue budesónida+formoterol fumarato (18,3%); el mayor gasto total mensual de los fármacos más prevalentes fue con alfaepoetina (R$37.922,34) y entre los más caros, con infliximab (R$72.503,28). CONCLUSIÓN: los datos señalan la importancia de este componente en el tratamiento de alto costo de morbilidad con altas prevalencias.

OBJECTIVE: to describe the pharmacotherapeutic profile of users of the Specialized Program for Pharmaceutical Assistance, and to measure the expenditure on the most prevalent and the most expensive medications. METHODS: descriptive study conducted in São Leopoldo-RS, Brazil, with secondary data regarding information about requests accepted in 2014, through administrative proceedings; delivery notes of the State Health Department/RS were used to assess the costs. RESULTS: 1,528 users were included in the study, mostly women (56.7%), and the average age was 52 years (standard deviation=17.9); the most frequent diagnoses were allergic asthma (17.1%), chronic kidney disease (11.5%) and rheumatoid arthritis (8.4%); the most prevalent drug was budesonide+formoterol fumarate (18.3%); among the most prevalent drugs, the highest total monthly expense was with epoetin alfa (BRL37,922.34) and among the most expensive drugs, infliximab (BRL72,503.28). CONCLUSION: the data show the importance of the Specialized Program for Pharmaceutical Assistance in the high-cost treatment of highly prevalent.

Regular access and adherence to medications of the specialized component of pharmaceutical services.

OBJECTIVE: To investigate the prevalence of the adherence to the medications of the Specialized Component of Pharmaceutical Services and its association with regular access in users of these medications in the municipality of São Leopoldo, State of Rio Grande do Sul, Brazil. METHODS: This is a cross-sectional study with adults aged 20 years and over, who are users of medications of the Specialized Component of Pharmaceutical Services. Sampling was carried out consecutively for users who accessed the service of the Specialized Component of Pharmaceutical Services during the period from December 2014 to March 2015. Adherence was measured by the Brief Medication Questionnaire, and adherents were defined as those who did not present barriers to adherence in the three domains. Regular access was defined as getting all medications in the last three months, regardless of how it was obtained (paying or for free). Data analysis was performed using Poisson regression with robust variance. RESULTS: We interviewed 414 subjects, being them mostly women (60.9%), with mean age of 55 years (SD = 13), and using a single medication of the Specialized Component of Pharmaceutical Services (68.1%). The prevalence of adherence to the medications used in the last seven days was 28.3% and the prevalence of free regular access was 46.1%, and 25.7% did not have access to all treatment. After adjusting for the number of medications in the Specialized Component of Pharmaceutical Services and the number of medications of continuous use, users who had free regular access in the last three months were 60% more likely to show adherence. For individuals with paid regular access, no association was found between access and adherence. CONCLUSIONS: The regularity in the free access to the medications of the Specialized Component of Pharmaceutical Services has an impact on the behavior of users, contributing to their commitment to treatment and self-care. The Specialized Component of Pharmaceutical Services needs programming in order to avoid irregular access, which suggests a significant limitation of the drug policies in Brazil.

Regular access and adherence to medications of the specialized component of pharmaceutical services / Acesso regular e adesão a medicamentos do componente especializado da assistência farmacêutica

ABSTRACT OBJECTIVE To investigate the prevalence of the adherence to the medications of the Specialized Component of Pharmaceutical Services and its association with regular access in users of these medications in the municipality of São Leopoldo, State of Rio Grande do Sul, Brazil. METHODS This is a cross-sectional study with adults aged 20 years and over, who are users of medications of the Specialized Component of Pharmaceutical Services. Sampling was carried out consecutively for users who accessed the service of the Specialized Component of Pharmaceutical Services during the period from December 2014 to March 2015. Adherence was measured by the Brief Medication Questionnaire, and adherents were defined as those who did not present barriers to adherence in the three domains. Regular access was defined as getting all medications in the last three months, regardless of how it was obtained (paying or for free). Data analysis was performed using Poisson regression with robust variance. RESULTS We interviewed 414 subjects, being them mostly women (60.9%), with mean age of 55 years (SD = 13), and using a single medication of the Specialized Component of Pharmaceutical Services (68.1%). The prevalence of adherence to the medications used in the last seven days was 28.3% and the prevalence of free regular access was 46.1%, and 25.7% did not have access to all treatment. After adjusting for the number of medications in the Specialized Component of Pharmaceutical Services and the number of medications of continuous use, users who had free regular access in the last three months were 60% more likely to show adherence. For individuals with paid regular access, no association was found between access and adherence. CONCLUSIONS The regularity in the free access to the medications of the Specialized Component of Pharmaceutical Services has an impact on the behavior of users, contributing to their commitment to treatment and self-care. The Specialized Component of Pharmaceutical Services needs programming in order to avoid irregular access, which suggests a significant limitation of the drug policies in Brazil.

RESUMO OBJETIVO Investigar a prevalência de adesão a medicamentos do Componente Especializado da Assistência Farmacêutica e sua associação com o acesso regular em usuários desses medicamentos no município de São Leopoldo, RS. MÉTODOS Estudo transversal com adultos de 20 anos ou mais, usuários de medicamentos do Componente Especializado da Assistência Farmacêutica no município de São Leopoldo, RS. A amostragem foi realizada de forma consecutiva de usuários que acessaram o atendimento do Componente Especializado da Assistência Farmacêutica durante o período de dezembro de 2014 a março de 2015. A adesão foi mensurada pelo Brief Medication Questionnaire, sendo definidos como aderentes indivíduos que não apresentaram barreiras para a adesão nos três domínios. O acesso regular foi definido como a obtenção de todos os medicamentos nos últimos três meses, independentemente da forma de obtenção (pago ou gratuito). A análise dos dados foi realizada por regressão de Poisson com variância robusta. RESULTADOS Foram entrevistados 414 indivíduos, a maioria mulheres (60,9%), média de idade de 55 anos (DP = 13), utilizando um único medicamento do Componente Especializado da Assistência Farmacêutica (68,1%). A prevalência de adesão aos medicamentos utilizados nos últimos sete dias foi de 28,3%, a prevalência de acesso regular gratuito foi de 46,1%; e 25,7% não tiveram acesso a todo o tratamento. Após ajuste para número de medicamentos do Componente Especializado da Assistência Farmacêutica e número de medicamentos de uso contínuo, usuários que tiveram acesso regular gratuito nos últimos três meses apresentaram 60% mais probabilidade de adesão. Para indivíduos com acesso regular mantido mediante pagamento, não foi encontrada associação entre o acesso e a adesão. CONCLUSÕES A regularidade no acesso gratuito aos medicamentos do Componente Especializado da Assistência Farmacêutica tem impacto no comportamento do usuário, contribuindo para seu comprometimento com o tratamento e para o autocuidado. O Componente Especializado da Assistência Farmacêutica necessita de programação, a fim de evitar a irregularidade no acesso, que sugere uma importante limitação das políticas de medicamentos no país.

[Evaluation of knowledge on blood pressure levels and chronicity of hypertension among users of a public pharmacy in Southern Brazil]. / Avaliação do conhecimento sobre níveis tensionais e cronicidade da hipertensão: estudo com usuários de uma Farmácia Básica no Sul do Brasil.

The aim of this study was to evaluate patients' knowledge on hypertension and associated factors through a cross-sectional study of adults using antihypertensive medication dispensed by the São Francisco de Paula Public Pharmacy in Rio Grande do Sul State, Brazil. The study evaluated knowledge on the normal limits for systolic and diastolic blood pressure and chronicity of hypertension. Multinomial regression was used to measure knowledge (satisfactory/moderate/unsatisfactory); satisfactory was defined as correct knowledge on two or more items. Of the 635 users with hypertension, 27.7% showed satisfactory knowledge, while 47.2% were only aware of the chronic nature of hypertension. After adjustment, female gender, more education, not living alone, healthy lifestyle, and greater time since diagnosis were associated with satisfactory knowledge on hypertension. Considering the importance of patient autonomy in monitoring blood pressure and continuous treatment to control hypertension, the study showed a low prevalence of satisfactory knowledge.

Avaliação do conhecimento sobre níveis tensionais e cronicidade da hipertensão: estudo com usuários de uma Farmácia Básica no Sul do Brasil / Evaluation of knowledge on blood pressure levels and chronicity of hypertension among users of a public pharmacy in Southern Brazil / Evaluación de los conocimientos acerca de los niveles de presión y de la cronicidad de la hipertensión arterial: estudio con usuarios de una Farmacia Comunitaria en el Sul de Brasil

Objetivou-se avaliar o conhecimento sobre hipertensão arterial sistêmica (HAS) e fatores associados, por meio de estudo transversal com adultos usuários de medicamentos anti-hipertensivos adquiridos na Farmácia Básica de São Francisco de Paula, Rio Grande do Sul, Brasil. Avaliou-se o conhecimento sobre os limites de normalidade para a pressão arterial sistólica e diastólica e sobre a condição crônica da HAS. Utilizou-se regressão multinomial para conhecimento (satisfatório/moderado/insatisfatório) e considerou-se como satisfatório o conhecimento sobre dois ou mais aspectos avaliados. Dos 635 usuários, portadores de HAS, 27,7% apresentaram conhecimento satisfatório e 47,2% conheciam apenas a cronicidade da HAS. Após ajuste, sexo feminino, maior escolaridade, não morar só, comportamento saudável e maior tempo de diagnóstico associaram-se ao conhecimento satisfatório sobre a HAS. Considerando a importância da autonomia do portador no monitoramento dos níveis tensionais e da continuidade do tratamento no controle da pressão arterial, encontrou-se baixa prevalência de conhecimento satisfatório.

The aim of this study was to evaluate patients' knowledge on hypertension and associated factors through a cross-sectional study of adults using antihypertensive medication dispensed by the São Francisco de Paula Public Pharmacy in Rio Grande do Sul State, Brazil. The study evaluated knowledge on the normal limits for systolic and diastolic blood pressure and chronicity of hypertension. Multinomial regression was used to measure knowledge (satisfactory/moderate/unsatisfactory); satisfactory was defined as correct knowledge on two or more items. Of the 635 users with hypertension, 27.7% showed satisfactory knowledge, while 47.2% were only aware of the chronic nature of hypertension. After adjustment, female gender, more education, not living alone, healthy lifestyle, and greater time since diagnosis were associated with satisfactory knowledge on hypertension. Considering the importance of patient autonomy in monitoring blood pressure and continuous treatment to control hypertension, the study showed a low prevalence of satisfactory knowledge.

Este estudio objetivó evaluar el conocimiento sobre la hipertensión arterial (HTA) y los factores asociados. Estudio transversal con usuários de fármacos antihipertensivos que obtuvieron sus medicamentos en una farmacia comunitaria de São Francisco de Paula, Rio Grande do Sul, Brasil. Se evaluó los conocimientos acerca de los niveles de presión arterial sistólica y diastólica y de la condición crónica de la HTA. Se utilizó la regresión multinomial para evaluar el conocimiento (insuficiente/parcialmente suficiente/ suficiente), considerado conocimiento suficiente cuando el usuario sabía dos o más de los aspectos evaluados. De los 635 usuários, 27,7% tenían un conocimiento suficiente y sólo 47,2% conocían la cronicidad de la HTA. El sexo femenino, la educación superior, no vivir solo, el comportamiento saludable y el tiempo de diagnóstico se asociaron con el conocimiento suficiente. Considerando la importancia de la autonomía del usuário en el monitoreo de la presión arterial y la adesión al tratamiento en el control de la HTA, se ha encontrado una baja prevalencia de conocimiento suficiente.

Conhecimento sobre a farmacoterapia por portadores de Hipertensão Arterial Sistêmica / Knowledge about pharmacotherapy among hypertensive patients

O objetivo do estudo foi avaliar o conhecimento sobre a farmacoterapia em usuários de medicamentos para hipertensão arterial. Estudo quantitativo transversal com adultos de 20 anos ou mais de idade, usuários de anti-hipertensivos dispensados na Farmácia Básica de São Francisco de Paula, RS. Avaliou-se o conhecimento sobre o nome do medicamento, indicação terapêutica, dose, frequência/horários de administração e duração do tratamento, por meio de um escore (0-5). Utilizou-se regressão linear múltipla para investigar a relação com características dos usuários. Entrevistou-se 678 usuários de medicamentos. A média de escore de conhecimento foi de 3,27 (dp = 1,16). Menor idade, maior escolaridade, cor da pele branca, melhor percepção de saúde e menor número de medicamentos prescritos mostraram-se associados a um maior escore de conhecimento. Observou-se um conhecimento limitado em relação a todos os aspectos avaliados, o que pode comprometer o uso correto e seguro da farmacoterapia, sugerindo a necessidade de melhor orientação e acompanhamento dos usuários para o controle dessa morbidade.

The scope of this study was to evaluate the knowledge of pharmacotherapy among users of arterial hypertension medication. A quantitative cross-sectional study was conducted with adults aged 20 years or older, who were users of antihypertensive drugs dispensed by the Public Pharmacy of São Francisco de Paula in the State of Rio Grande do Sul. The study evaluated the knowledge of patients about the drug name, therapeutic indication, dose, administration routine, and duration of treatment, attributing a score (0-5). Multiple linear regression was used to investigate the relationship between the patients' knowledge and characteristics and 678 medication users were interviewed. The mean knowledge score was 3.27 (SD = 1.16). Lower age, higher schooling, Caucasian, better self-reported health and lower number of prescribed drugs were associated with higher knowledge scores. It was observed that the patients' knowledge of all the aspects evaluated is limited, a result that could compromise the correct and safe use of the drugs, and suggesting the need for better counseling and follow-up of users, to control this morbidity.