Cultivo e uso racional de plantas medicinais e fitoterápicos / Cultivation and rational use of medicinal and herbal plants / Cultivo y uso racional de plantas medicinales y herbáceas

A utilização de plantas medicinais como alternativa terapêutica vem atingindo um público cada vez maior. Assim, os fitoterápicos podem atuar como forma opcional de terapêutica levando em consideração o menor custo, e cujos benefícios se somam aos da terapia convencional. Com isso, o objetivo deste trabalho foi enfatizar a importância do cultivo e do uso racional de medicamentos fitoterápicos e plantas medicinais. Para tanto, foram incluídos artigos em português e inglês inseridos no banco de dados: Scielo, Google acadêmico, além de revistas eletrônicas, livros com embasamento científico de referência e base de dados do Ministério da Saúde entre os anos de 2018 a 2022. As plantas medicinais e os medicamentos fitoterápicos podem provocar efeitos adversos, interferir no efeito de medicamentos utilizados concomitantemente, além da possibilidade de causar intoxicações pela presença de contaminantes em produtos de baixa qualidade. Para a produção de bioativos, em níveis quali e quantitativamente adequados, o cultivo das plantas medicinais deve ser cuidadosamente realizado, através de técnicas adequadas para preservação do solo e plantio são essenciais, como a utilização de adubos verdes e a cobertura vegetal, que além de protegerem o solo da radiação solar, prevenir a evaporação excessiva da água e melhorar as características físicas, químicas e biológicas do sol. Esses critérios influenciam a qualidade do fitoterápico, portanto a fim de garantir a eficácia terapêutica, as plantas devem ser corretamente cultivadas, coletadas, identificadas e conservadas. Sendo assim, conclui-se que a utilização de plantas medicinais para tratamentos tem sido cada vez mais indicada pelos profissionais da saúde, ressaltando a importância do uso seguro e racional, com alerta para as suas consequências.

The use of medicinal plants as a therapeutic alternative has been reaching a growing public. Thus, herbal medicines can act as an optional form of therapy taking into account the lowest cost, and whose benefits are added to those of conventional therapy. Thus, the objective of this work was to emphasize the importance of the cultivation and rational use of herbal medicines and medicinal plants. To this end, articles in Portuguese and English inserted in the database: Scielo, Google academic, in addition to electronic journals, books with scientific reference base and database of the Ministry of Health between the years 2018 to 2022 were included. herbal medicines can cause adverse effects, interfere with the effect of medicines used concomitantly, in addition to the possibility of causing poisoning due to the presence of contaminants in low-quality products. For the production of bioactives, at qualitatively and quantitatively appropriate levels, the cultivation of medicinal plants must be carefully carried out, through techniques cultivated for soil preservation and planting are essential, such as the use of green manures and vegetation cover, which in addition to protect the soil from solar radiation, prevent excessive water evaporation and improve the physical, chemical and biological characteristics of the sun. These criteria influence the quality of the herbal medicine, therefore, in order to guarantee therapeutic efficacy, as the plants must be correctly cultivated, collected, identified and conserved. Therefore, it is concluded that the use of medicinal plants for treatments has been increasingly indicated by health professionals, emphasizing the importance of safe and rational use, with an alert to its consequences.

El uso de plantas medicinales como alternativa terapéutica ha ido alcanzando un público cada vez más amplio. Así, las plantas medicinales pueden actuar como una forma opcional de terapia teniendo en cuenta el menor coste, y cuyos beneficios se suman a los de la terapia convencional. Así, el objetivo de este trabajo fue destacar la importancia del cultivo y uso racional de las hierbas medicinales y plantas medicinales. Para ello, los artículos en portugués e Inglés insertados en la base de datos: Scielo, Google académico, además de revistas electrónicas, libros con base de referencia científica y base de datos del Ministerio de Salud entre los años 2018 a 2022 fueron incluidos. medicamentos a base de hierbas pueden causar efectos adversos, interferir con el efecto de los medicamentos utilizados concomitantemente, además de la posibilidad de causar intoxicación debido a la presencia de contaminantes en productos de baja calidad. Para la producción de bioactivos, en niveles cualitativa y cuantitativamente adecuados, el cultivo de plantas medicinales debe ser realizado cuidadosamente, siendo esenciales técnicas de preservación del suelo y de plantación, como el uso de abonos verdes y cobertura vegetal, que además de proteger el suelo de la radiación solar, evitan la evaporación excesiva del agua y mejoran las características físicas, químicas y biológicas del sol. Estos criterios influyen en la calidad de la fitoterapia, por lo que, para garantizar la eficacia terapéutica, las plantas deben cultivarse, recolectarse, identificarse y conservarse correctamente. Por lo tanto, se concluye que el uso de plantas medicinales para tratamientos ha sido cada vez más indicado por los profesionales de la salud, enfatizando la importancia del uso seguro y racional, con alerta a sus consecuencias.

Ethics of Opioid Prescriber Regulations: Physicians, Patients, and Pain.

BACKGROUND: Opioid addiction affects patients of every race, sex, and socioeconomic status. Overprescribing is a known cause of the opioid crisis. Various agencies have implemented requirements and programs to combat practitioner overprescribing; however, there can be adverse ethical consequences when regulations are used to influence physician behavior. We aimed to explore the ethical aspects of some of these interventions. METHODS: We reviewed various interventions for opioid prescribing through the lens of ethical inquiry. Specifically, we evaluated (1) requirements for educational programs for prescribers and patients, (2) prescription monitoring programs, (3) prescription limits, (4) development of condition-specific pain management guidelines, (5) increased utilization of naloxone, and (6) opioid disposal programs. We also evaluated patient satisfaction survey questions relating to pain. RESULTS: The present analysis demonstrated that the following regulatory interventions are ethically sound: requirements for educational programs for prescribers and patients, robust prescription monitoring programs that cross state lines, increased prescribing of naloxone for at-risk patients, development of condition-specific pain management guidelines, improvement of opioid disposal programs, and elimination of pain-control questions from patient satisfaction surveys. However, implementation of strict prescribing limits without accommodation for procedure and patient characteristics may have negative ethical consequences. CONCLUSIONS: Although the importance of addressing the current opioid crisis cannot be understated, as surgeons, we must examine ethical implications of any new regulations that affect musculoskeletal patient care.

Drug utilization pattern among pregnant women attending maternal and child health clinic of tertiary hospital in eastern Ethiopia: Consideration of toxicological perspectives.

OBJECTIVE: This study is aimed to investigate drug utilization pattern among pregnant women attending maternal and child health clinic of tertiary hospital in eastern Ethiopia from March 1 to April 20, 2018. RESULT: A total of 369 pregnant women medical records were reviewed. The mean age of pregnant women was 24.34 (± 4.48) years and the majority of them were within the age of 18-25 years. About three-fourths (n = 277, 75.1%) of them were urban residents. Besides, 314 (85.1%) women had taken at least one drug with a total of 377 drugs prescribed. From which, supplemental drugs accounted majority of the drug therapy (84.88%) whereas non-supplemental drugs (15.12%) were used by 41 pregnant women during the review period. According to Food and Drug Administration FDA pregnancy risk classification, 320 (84.88%) drugs were prescribed from category A; 33 (8.75%) drugs were from category B; 19 (5.04%) drugs were from category C and 5 (1.33%) drugs were from category D. There was no drug prescribed from category X. As this result indicated, there is a decrease in the prevalence of drug use from Category A to X as the possibility of potential risk to fetus might outweigh the potential benefit to the mother. Some drugs were utilized from category D for treatment of chronic illnesses.

Effect of an Educational Intervention on Knowledge and Perception Regarding Rational Medicine Use and Self-medication.

BACKGROUND: Rational use of medicines is important for safe and cost-effective pharmacotherapy. However, nearly half of the medicines available in the market may be used irrationally. The present study assessed the perceptions and knowledge about rational medicine use and responsible self-medication among participants before and after an educational intervention at KIST Medical College, Lalitpur. METHODS: An educational module was conducted among healthcare professionals, media personnel and female community health volunteers. The questionnaire was administered before and immediately after the module. The areas addressed were rational medicine use, ethical prescribing, rational drug use situation in Nepal, pharmaceutical promotion, rational self-medication, safe use of antibiotics, and drug use problems in Nepal. RESULTS: Among healthcare professionals, the rational drug use situation in Nepal and the total score significantly increased post-intervention (p<0.05). Among media personnel the mean scores increased significantly in pharmaceutical promotion and drug use problems in Nepal areas but there was a significant decrease in safe use of antibiotics. The pre-intervention pharmaceutical promotion score was significantly higher among healthcare professionals compared to media personnel while the rational self-medication scores were highest among female community health volunteers, safe use of antibiotics scores were highest among the media personnel. Post-intervention the mean pharmaceutical promotion scores was highest among healthcare professionals, rational self-medication scores among female community health volunteers, safe use of antibiotics, drug use problems in Nepal and total scores were highest among the media personnel. CONCLUSIONS: There were differences in the mean pre-intervention scores among different subgroups. A single session may not be enough to bring about significant changes in knowledge and perception. The retention of knowledge could be measured in future studies.

Drug Utilization Studies in Latin America: A Scoping Review and Survey of Ethical Requirements.

BACKGROUND: Drug utilization studies (DUSs) are increasingly being conducted in Latin America, especially in countries with a universal healthcare coverage, to inform policies and decision making. The need for an ethical framework specific to DUSs in Latin America has been recognized. OBJECTIVES: To describe the ethical and/or legal requirements applicable to DUSs in Latin American countries with universal healthcare coverage. METHODS: We conducted a nonsystematic scoping review on DUSs in this region, covering the period from January 1, 2012, to July 1, 2017, and reviewed legislations and data protection requirements in each country. We also surveyed 45 ethics committees and 22 key informants to determine specific ethical requirements for various types of DUSs differing in data collection methods, study populations, and settings. RESULTS: Local legislations on DUSs are highly heterogeneous across Latin America. In Chile and Guatemala, authorization from the national health authority must be obtained for accessing clinical records, whereas in Argentina, no authorization is required for the secondary use of existing data. In Argentina, Brazil, Costa Rica, Guatemala, and Peru, a national ethics committee approval is required in addition to a site-specific approval. Requirements for patient informed consent also vary across countries and depend on the type of DUS and study population. CONCLUSIONS: The lack of consensus in the legislative and ethical frameworks applicable to DUSs across Latin America leads to operational challenges for the implementation of multinational studies. In many countries, absence of a framework leads to precautionary stringent requirements, which restricts the feasibility of DUSs.

Telling the truth about antibiotics: benefits, harms and moral duty in prescribing for children in primary care.

Antimicrobial resistance represents a growing threat to global health, yet antibiotics are frequently prescribed in primary care for acute childhood illness, where there is evidence of very limited clinical effectiveness. Moral philosophy supports the need for doctors to consider wider society, including future patients, when treating present individuals, and it is clearly wrong to waste antibiotics in situations where they are largely clinically ineffective at the expense of future generations. Doctors should feel confident in applying principles of antibiotic stewardship when treating children in primary care, but they must explain these to parents. Provision of accurate, accessible information about the benefits and harms of antibiotics is key to an ethical approach to antimicrobial stewardship and to supporting shared decision making. Openness and honesty about drivers for antibiotic requests and prescribing may further allow parents to have their concerns heard and help clinicians to develop with them an understanding of shared goals.

The Association of Industry Payments to Physicians with Prescription of Brand-Name Intranasal Corticosteroids.

Objectives To examine the association of industry payments for brand-name intranasal corticosteroids with prescribing patterns. Study Design Cross-sectional retrospective analysis. Setting Nationwide. Subjects and Methods We identified physicians prescribing intranasal corticosteroids to Medicare beneficiaries 2014-2015 and physicians receiving payment for the brand-name intranasal corticosteroids Dymista and Nasonex. Prescription and payment data were linked by physician, and we compared the proportion of prescriptions written for brand-name intranasal corticosteroids in industry-compensated vs non-industry-compensated physicians. We associated the number and dollar amount of industry payments with the relative frequency of brand-name prescriptions. Results In total, 164,587 physicians prescribing intranasal corticosteroids were identified, including 7937 (5%) otolaryngologists; 10,800 and 3886 physicians received industry compensation for Dymista and Nasonex, respectively. Physicians receiving industry payment for Dymista prescribed more Dymista as a proportion of total intranasal corticosteroid prescriptions than noncompensated physicians (3.1% [SD = 9.6%] vs 0.2% [SD = 2.5%], respectively, P < .001). Similar trends were seen for Nasonex (12.0% [SD = 16.8%] vs 4.8% [SD = 13.6%], P < .001). The number and dollar amount of payment were significantly correlated to the relative frequency of Dymista (ρ = 0.26, P < .001 and ρ = 0.20, P < .001, respectively) and Nasonex prescriptions (ρ = 0.09, P < .001 and ρ = 0.15, P < .001, respectively). For Dymista, this association was stronger in otolaryngologists than general practitioners ( P < .001). There was a stronger correlation between the percentage of prescriptions and the number and dollar amount of payments for Dymista than for Nasonex ( P = .014 and P < .001). Conclusions Industry compensation for brand-name intranasal corticosteroids is significantly associated with prescribing patterns. The magnitude of association may depend on physician specialty and the drug's time on the market.

Amoxicillin Quality and Selling Practices in Urban Pharmacies and Drug Stores of Blantyre, Malawi.

This study evaluated a newly developed paper analytical device (PAD) for screening amoxicillin samples in Blantyre urban townships. Covert shoppers attempted to buy amoxicillin from a geographically stratified selection of private pharmacies (N = 22 out of 26) and drug stores (N = 23 out of 103) in the township area. According to the PAD results, all 42 samples obtained by the shoppers contained amoxicillin and none contained suspicious filler materials. Next, the products were assayed using high-performance liquid chromatography. Consistent with the PAD results, all samples contained the correct amount of amoxicillin with no unexpected ingredients. However, one sample was purchased as amoxicillin and contained that ingredient, but was packaged in capsules that are normally used to package ampicillin. Almost every sample failed a simple packaging analysis. Nine in 10 samples were missing their original packaging and/or inserts (52.4% repackaged capsules and 35.7% repackaged blister packs). Only 33.3% of the packages had expiry dates, 16.7% had batch numbers, and 47.6% had the manufacturer's name. Dispensing practices were likewise unsatisfactory. Ninety-five percentage of the sellers sold the amoxicillin without a prescription, even though this medicine is regulated as prescription-only in Malawi. Although the chemical analysis showed that amoxicillin quality was good, our market survey revealed poor adherence to prescription-only medicine dispensing of antibiotics, which threatens antimicrobial stewardship efforts. Furthermore, the wide prevalence of repackaging deprives medicines of important information needed during patient's use, regulatory investigations, and pharmacovigilance reporting.

Antibiotic resistance: An ethical challenge.

In this paper, we argue that antibiotic resistance (ABR) raises a number of ethical problems that have not yet been sufficiently addressed. We outline four areas in which ethical issues that arise in relation to ABR are particularly pressing. First, the emergence of multidrug-resistant and extensively drug-resistant infections exacerbates traditional ethical challenges of infectious disease control, such as the restriction of individual liberty for the protection of the public's health. Second, ABR raises issues of global distributive justice, both with regard to the overuse and lack of access to antibiotics. Third, the use of antibiotics in veterinary medicine raises serious concerns for animal welfare and sustainable farming practices. Finally, the diminishing effectiveness of antibiotics leads to questions about intergenerational justice and our responsibility for the wellbeing of future generations. We suggest that current policy discussions should take ethical conflicts into account and engage openly with the challenges that we outline in this paper.

Historia de la investigación en pediatría / History of pediatric investigation

La investigación en niños es necesaria, ya que los niños no son adultos pequeños como se ha asumido durante las últimas tres décadas. Sin embargo, es necesario conciliar esta necesidad con la protección que la sociedad debe proporcionarles para evitar que se repitan abusos ocurridos en décadas previas. Tanto las agencias reguladoras como otras autoridades sanitarias y organizaciones e instituciones públicas internacionales, han elaborado una serie de recomendaciones para que estos estudios sean realizados respetando los principios y normas éticas básicas en investigación clínica, particularmente en las poblaciones consideradas vulnerables, como los niños. También, las agencias reguladoras de Estados Unidos, Canadá y Europa, han establecido una serie de medidas para fomentar la investigación en el campo de la población pediátrica a nivel mundial, y tratar de cambiar el concepto generalizado de que los niños son considerados "Huérfanos Terapéuticos...(AU)

Investigation in children is necessary, since children are not small adults as has been assumed during the last three decades. However, it is necessary to reconcile this need with the protection that society must provide them to avoid repeating abuses that occurred in previous decades. Regulatory agencies and other health authorities and international public institutions and organizations have prepared a series of recommendations for these studies to be carried out respecting the basic ethical principles and standards in clinical research, particularly in populations considered vulnerable, such as children. Also, the regulatory agencies of the United States, Canada and Europe, have established a series of measures to promote research in the field of pediatric population worldwide, and try to change the generalized concept that children are considered "Therapeutic Orphans"...(AU)

Rational use of medicines: prescribing indicators at different levels of health care

This multicenter study aimed to investigate prescribing patterns of drugs at different levels of health care delivery in university-affiliated outpatient clinics located in eight cities in the South and Midwest of Brazil. All prescriptions collected were analyzed for various items, including WHO prescribing indicators. A total of 2,411 prescriptions were analyzed, and 469 drugs were identified. The number of drugs prescribed per encounter, the frequency of polypharmacy, and the percentage of encounters with at least one injection or antibiotic prescribed were higher in centers providing primary health care services, compared to those where this type of care is not provided. Most drugs (86.1%) were prescribed by generic name. In centers with primary health care services, drug availability was higher, drugs included in the National and Municipal Lists of Essential Medicines were more frequently prescribed, and patients were given more instructions. However, warnings and non-pharmacological measures were less frequently recommended. This study reveals trends in drug prescribing at different levels of health care delivery in university-affiliated outpatient clinics and indicates possible areas for improvement in prescribing practices.

Este estudo multicêntrico teve como objetivo investigar o padrão de prescrição de medicamentos para pacientes ambulatoriais atendidos em serviços de saúde vinculados a universidades com diferentes níveis de atenção, em oito cidades do sul e centro-oeste do Brasil. As prescrições coletadas foram submetidas à análise de diversos itens, incluindo os indicadores de prescrição propostos pela OMS. No total, 2.411 prescrições foram analisadas e 469 medicamentos foram identificados. O número de medicamentos prescritos por consulta, a frequência de polifarmácia e a porcentagem de consultas com pelo menos um medicamento injetável ou um antimicrobiano prescrito foram maiores em centros de saúde que ofereciam cuidados de atenção básica, em comparação com aqueles que não dispunham desse tipo de atendimento. A maioria dos medicamentos foi prescrita pelo nome genérico (86,1%). Em unidades com cuidados de atenção básica, a acessibilidade foi maior, a prescrição de medicamentos presentes nas Listas Nacional e Municipais de Medicamentos Essenciais foi mais frequente e instruções foram fornecidas aos pacientes mais comumente. Entretanto, advertências e medidas não farmacológicas foram indicadas com menor frequência. Este estudo revela tendências de prescrição de medicamentos em serviços de saúde ligados a universidades, com diferentes níveis de atenção, e indica possíveis áreas de melhoria na prática da prescrição.

Comorbilidad, estado funcional y terapéutica farmacológica en pacientes geriátricos / Comorbidity, functional state and drug therapy in geriatric patients

Introducción: el envejecimiento poblacional es un desafío para las sociedades y es necesario que los recursos humanos dedicados a la atención del anciano se nutran de conocimientos que dinamicen un adecuado manejo farmacoterapéutico a este grupo poblacional muy vulnerable por su comorbilidad y por una respuesta peculiar a los medicamentos. Objetivo: determinar la interrelación entre comorbilidad, estado funcional y consumo de medicamentos. Métodos: investigación descriptiva, de tipo transversal, cuyo universo estuvo conformado por todos los ancianos de 60 años y más que ingresaron en el Hospital Calixto García durante el año 2007. Se acopió información de una muestra aleatoria de 267 pacientes. Se consideraron variables de respuesta la comorbilidad, el deterioro funcional y la polifarmacia. Se creó una base de datos validada automáticamente para la confirmación de su congruencia. Resultados: el mayor consumo de medicamentos correspondió a las edades comprendidas entre 80 y 89 años; 263 (98,5 porciento) ancianos presentaban comorbilidad y de ellos 211 (79 porciento) tenían polifarmacia asociada a un promedio de 5 fármacos por paciente. Los adultos mayores que clasificaron en la categoría más afectada de la evaluación funcional fueron los de mayor edad, los que también se relacionaron con mayor comorbilidad y consumo de medicamentos. Conclusiones: la comorbilidad y el deterioro funcional en ancianos se relacionan estrechamente con el consumo elevado de medicamentos, lo que repercute negativamente en su estado de salud, de ahí que es imprescindible que los profesionales de la atención primaria pongan especial atención en el manejo fármacoterapéutico en sus adultos mayores

Introduction: population aging represents a challenge for all the societies, hence it is necessary that the human resources devoted to take care of aged persons be well documented for the adequate drug and therapeutic management of this particular population, which is highly vulnerable due to its comorbidity and its particular drug response. Objective: to determine the interrelation between comorbidity, functional state and drug consumption. Method: a cross-sectional and descriptive study was carried out, which included all 60 and over years-old patients, admitted to Calixto García hospital in 2007. The response variables were comorbidity, functional deterioration and multiple drug consumption. Data was collected on a random sample of 267 patients. An automatically-validated database was created to confirm congruency. Results: the greatest use of drugs was found in the 80 to 89 years old age group. It was found that 263 older people (98.5 percent) suffered comorbidity and 211 of them (79 percent) took 5 drugs as an average. The oldest persons accounted for the worst functional state evaluation, the highest index of comorbidity and the greatest use of drugs. Conclusions: both comorbidity and functional deterioration are closely related to drug consumption in the older people, all of which has a negative impact on their health state. It is indispensable that the primary health professionals pay special attention to the drug and therapeutic management of the older adults under their care

Informed consent and phase IV non-interventional drug research.

Most of the literature on informed consent in pharmaceutical drug research works on the assumption that informed consent is something that is homogeneous and thus can be rendered procedurally universal. This may be justifiable to a certain extent owing to the fact these are all drug trials anyway. Nevertheless, in spite of this general similarity, we also know that the clinical drug development phases are characteristically different, and that phase IV is very different from the other phases because, owing to its postmarketing nature, it is much more varied in scope and in type. Thus, it is worthwhile looking into the ethical nuances relevant to the informed consent process in phase IV non-interventional drug research. We shall deal with the issues on the necessity of informed consent for this type of research and then discuss the possibilities for an opt-out system. We conclude that informed consent is necessary for non-interventional studies, and thus any form of waiving of rights of participants to informed consent must have a valid substantial justification. The distinct character of phase IV accounts for the difference in content of the informed consent document compared to that of earlier phases, and both opt-in and opt-out procedures are ethically justifiable as long as the participant's participation remains informed and voluntary.

A ritalina no Brasil: produções, discursos e práticas / Ritalin in Brazil: production, discourse and practices / La "ritalina" en Brasil: producciones, discursos y prácticas

O objetivo do artigo é apresentar uma pesquisa em andamento sobre as representações sociais da ritalina no Brasil entre 1998 e 2008. Nesse período, houve um incremento considerável do uso da medicação e sua expansão para outros fins além dos terapêuticos. A ritalina tem sido usada tanto para o tratamento de patologias da atenção como para melhoria de funções cognitivas em pessoas saudáveis. A pesquisa se desdobra em dois campos de investigação, com metodologias diferenciadas. O primeiro campo investiga as publicações brasileiras, científicas e em mídia popular, sobre a ritalina, analisando os argumentos que justificam seu uso e a difusão dos resultados científicos para o público leigo nos jornais de grande circulação. O segundo campo de investigação usa a metodologia de grupos focais para explorar as representações sociais de universitários, pais de universitários e profissionais de saúde, acerca do uso da ritalina para o aprimoramento do desempenho cognitivo.

The aim of this paper was to present ongoing research on the social representations relating to ritalin in Brazil between 1998 and 2008. Over this period, there was a considerable increase in ritalin usage and expansion of its use to purposes other than therapeutic use. Ritalin has been used not only for treating attention disorders, but also to enhance cognitive functions in healthy individuals. The research has developed through two fields of investigation with different methodologies. In the first field, Brazilian scientific and popular publications have been investigated, with analysis on the arguments justifying ritalin usage and how scientific results are disseminated to the lay public in large-circulation newspapers. In the second field, focus groups have been used to explore the social representations that university students, students' parents and healthcare professionals have in relation to the use of ritalin for enhancing cognitive performance.

El objeto del artículo es el presentar una investigación en marcha sobre las representaciones sociales de la "ritalina" en Brasil entre 1998 y 2008. En este período hubo un incremento considerable de la medicación y su expansión hacia otros fines fuera de los terapéuticos. La "ritalina" se ha usado tanto para el tratamiento de patologías de la atención como para la mejora de funciones cognitivas en personas saludables. La investigación se desdobla en dos campos con metodologías diferenciadas. El primer campo investiga las publicaciones brasileñas, científicas y en medios de información populares sobre la "ritalina", analizando los argumentos que justifican su uso y la difusión de los resultados científicos para el público lego en los periódicos de gran circulación. El segundo campo de investigación usa la metodología de grupos focales para explorar las representaciones sociales de universitarios, padres de universitarios y profesionales de salud sobre el uso de la "ritalina" para la mejora del desempeño cognitivo.

Variable use of opioid pharmacotherapy for chronic noncancer pain in Europe: causes and consequences.

According to the 2005 Pain in Europe Survey, the use of opioids to treat patients with chronic noncancer pain varies considerably among different countries in Europe. Undertreatment of chronic pain is common. This review examines the possible causes and consequences of limiting opioid availability to these patients. The causes of inadequate opioid use include medical, ethical, and cultural factors that influence prescribing decisions; legislative and health care system controls that serve to restrict the use of opioids for long-term treatment of non-cancer-related pain conditions; and poor treatment acceptance by patients. The validity of these restrictions is discussed in relation to the need to protect patients and society from harm due to adverse events, and the potential for misuse and abuse with prescribed opioids. This is balanced against the therapeutic goal of providing the best available pain-relieving treatment and to avoid the consequences of unnecessary suffering in patients with chronic noncancer pain.