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1.
BMC Public Health ; 21(1): 1242, 2021 06 28.
Artigo em Inglês | MEDLINE | ID: mdl-34182965

RESUMO

BACKGROUND: To guarantee prevention and adequate treatment, as required for the population to have access to health services and technologies, including medicines. The purpose of this study is to analyse the economic and regional inequalities in access to medicines for diabetes and hypertension among the adult population in Brazil. METHODS: This was a cross-sectional study with adults aged 18 and over from the VIGITEL study conducted in 2019 in all Brazilian regions. Non-access to antidiabetic and antihypertensive drugs was assessed according to formal education and housing macro-region. The slope index of inequality (SII) was used to analyse absolute inequalities. RESULTS: The total number of individuals interviewed was 52,443. Approximately 10.0% of the people with diabetes and/or hypertension reported not having access to drug treatment. The major means for having access to antihypertensive drugs, in all regions, was private pharmacies; for antidiabetics, in the North region, people had greater access through private pharmacies, while in the Northeast, Southeast and South, they had greater access through the public sector. Inequalities were found in the lack of access to medicines according to the region of residence, especially in the North region. CONCLUSION: The lack of access to medicines showed regional disparities, particularly in the most economically vulnerable regions.


Assuntos
Diabetes Mellitus , Hipertensão , Adolescente , Adulto , Brasil/epidemiologia , Estudos Transversais , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/epidemiologia , Acessibilidade aos Serviços de Saúde , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Fatores Socioeconômicos
2.
Paediatr Perinat Epidemiol ; 34(3): 267-277, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31965601

RESUMO

BACKGROUND: Over-the-counter analgesic use during pregnancy, particularly acetaminophen, may be associated with negative developmental outcomes in children. OBJECTIVE: Estimate associations of prenatal and early-life exposure to acetaminophen in early childhood with cognitive, motor, and language skills in two birth cohorts. METHODS: The American Project Viva cohort (1217 mother-child pairs enrolled 1999-2002) assessed cognition at approximately 3 years using the Peabody Picture Vocabulary Test and the Wide Range Achievement of Visual Motor Abilities (WRAVMA). The Brazilian 2015 Pelotas Birth Cohort (3818 mother-child pairs) assessed cognition at 2 years using the INTERGROWTH-21st Neurodevelopment Assessment. We used linear regression to estimate associations of acetaminophen use during pregnancy (Project Viva and Pelotas) and infancy (Project Viva) with children's cognitive scores adjusted for maternal age, pre-pregnancy body mass index, education, parity, race/ethnicity, smoking and alcohol use during pregnancy, depression during pregnancy, antibiotic and ibuprofen use during pregnancy, household income, and child's sex. RESULTS: In Project Viva, exposure to acetaminophen in both the 1st and 2nd trimester of pregnancy was associated with lower WRAVMA drawing scores (ß -1.51, 95% CI -2.92, -0.10). However, in Pelotas, exposure to acetaminophen in both the 1st and 2nd trimester of pregnancy was not associated with INTER-NDA motor scores (ß 0.02; 95% CI -0.05, 0.09) and was associated with higher INTER-NDA total scores (ß 0.08, 95% CI 0.01, 0.16). Other comparisons did not show evidence for any associations. CONCLUSIONS: Inconsistencies and lack of specificity of the findings did not clarify the research question considering that we still have a large variability and uncertainty to define the risk or safety in the use of acetaminophen related to cognition in early childhood. More studies using better exposure assessment and better confounding variables are needed to clarify these associations.


Assuntos
Acetaminofen , Transtornos do Neurodesenvolvimento , Complicações na Gravidez , Trimestres da Gravidez , Efeitos Tardios da Exposição Pré-Natal , Acetaminofen/efeitos adversos , Acetaminofen/uso terapêutico , Analgésicos não Narcóticos/efeitos adversos , Analgésicos não Narcóticos/uso terapêutico , Brasil/epidemiologia , Comportamento Infantil/efeitos dos fármacos , Desenvolvimento Infantil/efeitos dos fármacos , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Transtornos do Neurodesenvolvimento/induzido quimicamente , Transtornos do Neurodesenvolvimento/diagnóstico , Transtornos do Neurodesenvolvimento/epidemiologia , Medicamentos sem Prescrição/efeitos adversos , Medicamentos sem Prescrição/uso terapêutico , Gravidez , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/diagnóstico , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Estados Unidos/epidemiologia
3.
BMC Public Health ; 19(1): 889, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277638

RESUMO

BACKGROUND: Many low- and middle-income countries recommend micronutrient supplements for pregnant women to improve their nutritional status, prevent possible deficiencies and avoid fetal healgth consequences. This study evaluated the influence of socioeconomic status on the use of folic acid, iron salts and other vitamins and minerals among pregnant women in the 2015 Pelotas Birth Cohort. METHODS: This population-based birth cohort study was carried out with 4270 women. Participants were interviewed during pregnancy and at the maternity hospital about the antenatal period; including the use of iron salts, vitamins and other minerals. Descriptive analyses were performed to characterize the sample. The analyses were adjusted according to socioeconomic variables (maternal education, ethnicity, household income). RESULTS: The overall prevalence of the use of folic acid, iron salts or other vitamins and minerals was 91.0% (95% CI: 90.1-91.8). Specifically, 70.9% (95% CI: 69.5-72.3) used folic acid, 72.9% (95% CI: 71.5-74.3) used iron compounds, and 31.8% (95% CI: 30.3-33.2) used other vitamins or minerals. In the adjusted analysis, the use of iron salts was associated with nonwhite mothers, with ≤4 years of education and whose family income was less than or equal to the monthly minimum wage. The use of folic acid and other vitamins and minerals was associated with white mothers who were more highly educated and had a higher family income. CONCLUSION: Although folic acid and other vitamins and minerals were more frequently used in white, richer and more educated mothers, which indicates inequality, iron supplements were more frequently used in the poorer, less educated nonwhite mothers, suggesting the opposite association for this supplement.


Assuntos
Ácido Fólico/administração & dosagem , Ferro da Dieta/administração & dosagem , Gestantes , Vitaminas/administração & dosagem , Adolescente , Adulto , Brasil , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Fatores Socioeconômicos , Adulto Jovem
4.
BMC Pediatr ; 19(1): 235, 2019 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-31319811

RESUMO

BACKGROUND: Unintentional child poisoning represents a significant public health problem across the globe, placing a substantial burden on health services emergency departments. Around the world, every year, thousands of children die as a result of physical injuries, most of which involve children under 5 years old. Medicines are the main products involved in poisoning, and children under 5 years old are the most vulnerable age group. The objective of this study was to measure the prevalence of unsafe storage of medicines in households with a 4-year-old child. METHODS: We used data from the follow-up of 4-year-old in the 2004 Pelotas Birth Cohort Study in Brazil (N = 3799). "Unsafe storage" was considered present when medicines were stored unlocked and within reach of children (at a height below the eye level of the average adult). Independent variables included maternal and family socioeconomic and demographic characteristics and the child's health care. All information was collected during household interviews with the mothers using a standardized questionnaire. The overall prevalence rate with a 95% confidence interval (95% CI) and the prevalence associated with various independent variables were determined. RESULTS: The storage of medicines in unlocked areas was reported by 80.9% of the mothers, and, within reach of children for 26.5%. The overall prevalence rate of unsafe storage of medicines was 21.4% (20.1-22.7%). The main storage locations used were the kitchen (57.0%) and bedroom (53.3%). CONCLUSIONS: The results indicate that medicines were unsafely stored in a 21.4% number of homes, which can contribute to the vulnerability of children to poisoning from medicines. To minimize this risk, education about the safe storage of medicines should be reinforced by health professionals.


Assuntos
Armazenamento de Medicamentos , Acidentes Domésticos/prevenção & controle , Acidentes Domésticos/estatística & dados numéricos , Brasil/epidemiologia , Aleitamento Materno , Pré-Escolar , Estudos Transversais , Características da Família , Feminino , Seguimentos , Humanos , Masculino , Intoxicação/epidemiologia , Intoxicação/prevenção & controle , Segurança , Fatores Socioeconômicos , População Urbana
5.
AIDS Behav ; 18 Suppl 1: S75-84, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23975474

RESUMO

A non-blinded randomized controlled trial evaluated efficacy of pharmaceutical care (PC) (Dáder method) on self-reported antiretroviral adherence and undetectable plasma viral load (UPVL), compared with usual care (UC) in HIV-positive patients in Brazil. Most were male (63 %), mean age 40.3 years (SD = 10). After 12 months, 79.8 % of those receiving PC versus 73.8 % in UC were adherent (RR 1.05, 95 % CI 0.95-1.15, P = 0.35), and 50.3 versus 49.8 % (PC vs. UC, respectively) had UPVL (RR 1.08, 95 % CI 0.97-1.20, P = 0.15). Factors associated with self-reported adherence were regular employment, UPVL, no depressive symptoms, and lower pill load in the treatment regimen. Older age, education, CD4 count <200 cells/mm(3), and shorter treatment duration were associated with UPVL. Of 94 reported drug-related problems, 43 % resolved. In subgroup analyses of patients who experienced therapeutic failure and who were non-adherent at the beginning of the trial (N = 50), no differences were found in UPVL (HR 1.35, 95 % CI 0.57-3.19). Only education level (>12 years) was independently predictive of viral suppression (HR 7.47, 95 % CI 1.69-32.91). In conclusion, PC was not associated with increased self-reported adherence to ART or UPVL in patients treated at a health care facility in southern Brazil. The study suggests, however, that PC could be effective for the subgroup of patients with poor adherence.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Adesão à Medicação , Assistência Farmacêutica/estatística & dados numéricos , Farmacêuticos , Adolescente , Adulto , Idoso , Fármacos Anti-HIV/efeitos adversos , Brasil , Contagem de Linfócito CD4 , Feminino , Infecções por HIV/etiologia , Infecções por HIV/virologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Assistência Farmacêutica/organização & administração , Papel Profissional , Autorrelato , Distribuição por Sexo , Fatores Socioeconômicos , Inquéritos e Questionários , Resultado do Tratamento , Carga Viral/efeitos dos fármacos , Adulto Jovem
6.
AIDS Behav ; 18 Suppl 1: S85-8, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23955660

RESUMO

Pharmaceutical care (PC) has been shown to improve adherence to therapeutic interventions as well as improve clinical outcomes. We assessed the predictors of non-adherence to clinical follow-up (i.e., not attending three scheduled routine clinical visits over a 1 year period) among patients who participated in a clinical trial of PC intervention on adherence to HIV antiretroviral therapy uptake (the PC-HIV trial). A total of 332 patients participated: median age was 39 years, 63 % were male, 76 % had CD4 count ≥200 cells/mm³, and 52 % had undetectable viral load. About half, 52.7 %, were non-adherent to clinical follow-up. Identified risk factors for non-adherence were male gender, age <40 years, and being in the trial's "control" group (adjusted odds ratio [AOR] 1.67, 95 % CI 1.05-2.66; AOR 2.21, 95 % CI 1.42-3.47; AOR 1.67, 95 % CI 1.07-2.61, respectively). Younger, male patients may benefit from interventions such as PC, which facilitates engagement in care.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Adesão à Medicação , Assistência Farmacêutica/estatística & dados numéricos , Farmacêuticos , Adulto , Brasil , Contagem de Linfócito CD4 , Feminino , Seguimentos , Infecções por HIV/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Assistência Farmacêutica/organização & administração , Valor Preditivo dos Testes , Papel Profissional , Fatores de Risco , Resultado do Tratamento , Carga Viral/efeitos dos fármacos
7.
Rev Bras Epidemiol ; 26: e230020, 2023.
Artigo em Português, Inglês | MEDLINE | ID: mdl-36921128

RESUMO

OBJECTIVE: This study aimed to assess the need for help by elderly people to take their medications, the difficulties related to this activity, the frequency of forgotten doses, and factors associated. METHODS: Cross-sectional study conducted with a cohort of elderly people (60 years and over - "COMO VAI?" [How do you do?] study), where the need for help to properly take medication and the difficulties faced in using them were evaluated. The Poisson regression model was used to estimate the crude and adjusted prevalence ratios (PR) of the outcomes and respective 95% confidence intervals according to the characteristics of the sample. RESULTS: In total, 1,161 elderly people were followed up. The prevalence of participants who reported requiring help with medication was 15.5% (95%CI 13.5-17.8), and the oldest subjects, with lower educational levels, in worse economic situations, on four or more medications and in bad self-rated health were the ones who needed help the most. Continuous use of medication was reported by 83.0% (95%CI 80.7-85.1) of the sample and most participants (74.9%; 95%CI 72.0-77.5) never forgot to take their medications. CONCLUSION: The need for help to use medications was shown to be influenced by social and economic determinants. Studies assessing the difficulties in medication use by the elderly are important to support policies and practices to improve adherence to treatment and the rational use of medications.


OBJETIVO: Este estudo visou avaliar a necessidade de ajuda dos idosos para tomar seus medicamentos, bem como as dificuldades relacionadas com a sua utilização, e a frequência de esquecimento de doses. Ainda, avaliar fatores associados à necessidade de ajuda dos idosos com os medicamentos. MÉTODOS: Corte transversal em uma coorte de idosos (60 anos ou mais ­ estudo "COMO VAI?"), em que foi avaliada a necessidade de ajuda para tomar medicamentos de forma adequada e as dificuldades apresentadas na sua utilização. Utilizou-se regressão de Poisson para estimar as razões de prevalência (RP) brutas e ajustadas dos desfechos e seus intervalos de confiança de 95% (IC95%) de acordo com as características da amostra. RESULTADOS: Participaram 1.161 idosos. A prevalência de idosos que relataram necessidade de ajuda com os medicamentos foi de 15,5% (IC95% 13,5­17,8), sendo que os mais idosos, com menor escolaridade e em pior situação econômica, em uso de quatro medicamentos ou mais e com pior autoavaliação de saúde foram os que mais necessitaram de ajuda. O uso contínuo de medicamentos foi referido por 83,0% (IC95% 80,7­85,1) e a maioria (74,9%; IC95% 72,0­77,5) nunca se esqueceu de tomar seus medicamentos. CONCLUSÃO: Observou-se a influência de determinantes sociais e econômicos e de saúde sobre a necessidade de ajuda para a utilização dos medicamentos. Estudos que estimem as dificuldades no uso de medicamentos por idosos são importantes para subsidiar políticas e práticas norteadoras de ações para melhorar a adesão e o uso racional de medicamentos.


Assuntos
Estudos de Coortes , Humanos , Idoso , Brasil/epidemiologia , Estudos Transversais , Coleta de Dados
8.
Psychoneuroendocrinology ; 150: 106027, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36702042

RESUMO

OBJECTIVE: Few large-scale studies have provided population-based estimates of hair cortisol levels and its determinants. Hair cortisol and potential determinants were measured in children and their mothers in a population-based sample in a Brazilian city with large variations in socioeconomic conditions. METHODS: We used data from the 4-year follow-up of the 2015 Pelotas (Brazil) Birth Cohort Study. Hair samples were collected by trained fieldworkers to analyze average levels of cortisol over a 3-month period. Four groups of variables were tested as potential determinants: hair characteristics (natural color, treatment, type, and frequency of wash), use of corticosteroids and oral contraceptives, sociodemographic factors (sex, age, skin color, socioeconomic level, maternal relationship, pregnancy, daycare enrollment), maternal perceived stress, and substance exposure (smoking and illicit drug use). Linear regression with log transformation was used to test associations. RESULTS: 3235 children and 3102 mothers were analyzed (80.7% and 77.4% of those interviewed when children were 4 years of age, respectively), for whom sufficient hair was collected for cortisol analysis. The median of hair cortisol concentration was 7.8 pg/mg (IQR = 5.6 - 11.0) for children, and 5.6 pg/mg (IQR = 4.2 - 7.8) for mothers. In adjusted models, sex and socioeconomic level were associated with child cortisol levels. For mothers, hair cortisol levels were associated with socioeconomic level, skin color, age, hair treatment and hair natural color. CONCLUSION: This study provides estimates of hair cortisol levels in a diverse population in a upper-middle income country. Although just a few predictors were associated with maternal/child cortisol levels, socioeconomic level was the key variable that should be incorporated in studies using hair cortisol to measure biological manifestations of stress, but other variables, such as some hair and sociodemographic characteristics are important to consider when using hair cortisol.


Assuntos
Hidrocortisona , Mães , Feminino , Gravidez , Humanos , Pré-Escolar , Estudos de Coortes , Hidrocortisona/análise , Brasil , Estresse Psicológico , Cabelo/química
9.
Rev Saude Publica ; 57: 76, 2023.
Artigo em Inglês, Português | MEDLINE | ID: mdl-37937650

RESUMO

OBJECTIVE: To verify whether folic acid supplementation during pregnancy is associated with the occurrence of maternal depressive symptoms at three months postpartum, in the 2015 Pelotas Birth Cohort. METHODS: This study included 4,046 women, who were classified into three groups: did not use folic acid supplementation during pregnancy; used during only one trimester of pregnancy; and used for two or three trimesters. Depressive symptoms were assessed at three months postpartum using the Edinburgh Postnatal Depression Scale (EPDS), at cutoff points ≥ 10 (mild symptoms) and ≥ 13 (moderate to severe intensity). RESULTS: The overall prevalence of mild symptoms was of 20.2% (95%CI 19.0-21.5), and moderate and severe was 11% (95%CI 10.0-12.0). The prevalence of EPDS ≥ 10 was of 26.8% (95%CI 24.0-29.5) among women who did not use folic acid and 18.1% for both those who used it during one trimester of pregnancy (95%CI 16.1-20.1) and those who used it for two or three trimesters (95%CI 16.0-20.2). The prevalence of EPDS ≥ 13 was of 15.7% (95%CI 13.5-17.9) in those who did not use folic acid, 9.1% (95%CI 7.5-10.6) in those who used it for one trimester, and 9.4% (95%CI 7.8-11.0) in those who used it for two or three trimesters. In the adjusted analyses, there was no statistically significant association between the use of folic acid during pregnancy and the occurrence of depressive symptoms at three months postpartum. CONCLUSION: There was no association between folic acid supplementation during pregnancy and postpartum depression at three months.


Assuntos
Depressão Pós-Parto , Depressão , Gravidez , Feminino , Humanos , Depressão/epidemiologia , Depressão/diagnóstico , Brasil/epidemiologia , Período Pós-Parto , Depressão Pós-Parto/epidemiologia , Ácido Fólico , Prevalência , Suplementos Nutricionais
10.
Cad Saude Publica ; 38(3): e00117221, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35476048

RESUMO

Medication use is an important part of the health process and prevalence of its use among infants can reach up to 65% in their first months of life. The excessive use of medication could lead to an increase in their potential harm, surpassing their benefits. Considering this, this study aimed to describe medication use in children aged 3, 12, 24, and 48 months. Standardized questionnaires were applied to assess patterns and covariables of medication use. Medication use was investigated as an outcome and defined as the receipt of any medication within 15 days before the interview. Prevalence of medication use and 95% confidence intervals (95%CI) were described using chi-squared tests. Prescription source and frequency of use were also reported, along with the most frequent medication in each follow-up. Medication use prevalence was 67.2% (95%CI: 65.8; 68.6), 68.2% (95%CI: 66.8; 69.6), 52.4% (95%CI: 50.9; 54.0), 47.2% (95%CI: 45.7; 48.8), at 3, 12, 24, and 48 months, respectively. We observed a decrease in the proportion of medically prescribed medications and an increase in self-medication over the years. Drugs for gastrointestinal disorders (A03), vitamins (A11), analgesics (N02), anti-inflammatories (M01), and nasal formulations (R01) were the most frequently used medications. We found that children under four years of age comprised over 50% of the total use of medications and self-medication. These results highlight the need to warn caregivers on the importance of proper professional examination and prescription before they administer medications to children.


Assuntos
Coorte de Nascimento , Automedicação , Brasil/epidemiologia , Criança , Pré-Escolar , Humanos , Lactente , Prevalência , Inquéritos e Questionários
11.
Rev Bras Ginecol Obstet ; 44(11): 1059-1069, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36067799

RESUMO

OBJECTIVE: The aim of this study was to systematically review literature on the use of iron supplements (not including iron derived from diet), increased levels of hemoglobin and/or ferritin, and the risk of developing gestational diabetes mellitus (GDM). DATA SOURCE: The following databases were searched, from the study's inception to April 2021: PUBMED, Cochrane, Web of Science, Scopus, Embase, Cinahl and Lilacs. SELECTION OF STUDIES: A total of 6,956 titles and abstracts were reviewed, 9 of which met the final inclusion criteria, with 7,560 women in total. DATA COLLECTION: Data extraction was performed by two independent reviewers and disagreements were resolved by a third researcher. DATA SYNTHESIS: Methodological quality in controlled trials were assessed according to the Cochrane Collaboration tools (ROB-2 and ROBINS-1) and for the observational studies, the National Institutes of Health's (NIH) quality assessment tool was used. Among the 5 observational studies, women with a higher hemoglobin or ferritin level were more likely to develop GDM when compared with those with lower levels of these parameters. Among the 3 randomized clinical trials, none found a significant difference in the incidence of GDM among women in the intervention and control groups. However, we identified many risks of bias and great methodological differences among them. CONCLUSION: Based on the studies included in this review, and due to the important methodological problems pointed out, more studies of good methodological quality are needed to better establish the association between iron supplementation and GDM.


OBJETIVO: O objetivo deste estudo foi revisar sistematicamente a literatura sobre o uso de suplementos de ferro (não incluindo o ferro derivado da dieta), aumento dos níveis de hemoglobina e/ou ferritina e o risco de desenvolver diabetes mellitus gestacional (DMG). FONTES DOS DADOS: as bases de dados PUBMED, Cochrane, Web of Science, Scopus, Embase, Cinahl e Lilacs foram pesquisadas até abril de 2021. SELEçãO DOS ESTUDOS: Foram revisados 6.956 títulos e resumos, dos quais 9 preencheram os critérios finais de inclusão, totalizando 7.560 mulheres. COLETA DE DADOS: A extração de dados foi realizada por dois revisores independentes e as divergências foram resolvidas por um terceiro revisor. SíNTESE DOS DADOS: A qualidade metodológica dos ensaios controlados foi avaliada de acordo com as ferramentas da Colaboração Cochrane (ROB-2 e ROBINS-1) e para os estudos observacionais, foi utilizada a ferramenta de avaliação de qualidade do National Institutes of Health (NIH). Entre os 5 estudos observacionais, as mulheres com maiores níveis de hemoglobina ou ferritina apresentaram maior probabilidade de desenvolver DMG quando comparadas àquelas com níveis mais baixos nesses parâmetros. Entre os 3 ensaios clínicos randomizados, nenhum deles encontrou diferença significativa na incidência de DMG entre as mulheres dos grupos de intervenção e controle. No entanto, identificamos muitos riscos de viés e enormes diferenças metodológicas entre eles. CONCLUSãO: Com base nos estudos incluídos nesta revisão e devido aos importantes problemas metodológicos apontados, são necessários mais estudos de boa qualidade metodológica para melhor estabelecer a associação entre suplementação de ferro e DMG.


Assuntos
Diabetes Gestacional , Estados Unidos , Gravidez , Feminino , Humanos , Diabetes Gestacional/epidemiologia , Ferritinas , Sais , Ferro , Hemoglobinas
12.
Cien Saude Colet ; 27(3): 1087-1095, 2022 Mar.
Artigo em Português | MEDLINE | ID: mdl-35293446

RESUMO

The pattern of morbidity and mortality has changed in recent years due to the increase in chronic noncommunicable diseases, leading to multiple comorbidities and the use of several medications. The scope of the study was to evaluate the anticholinergic drugs used by elderly people, according to risk scales. It involved a population-based cross-sectional study with elderly people. Socioeconomic factors, health problems, and medication use were investigated in the previous 15 days. The Anticholinergic Drug Scale (ADS), the Anticholinergic Risk Scale (ARS) and the Anticholinergic Cognitive Burden Scale (ACB) were used for risk classification according to anticholinergic activity of the drugs. A total of 1451 elderly people were interviewed and 1305 used medications, 60.7% of which with anticholinergic action, especially among the 80-year-old age bracket and the less educated. In total, 5703 drugs were used, 1282 (22.5%) of which with anticholinergic action. Kappa agreement of 0.63 was observed when assessing the ACB and ADS risk scales. The prevalence of the use of drugs with anticholinergic action was high, and attention should be paid to the consequences related to their use, with a view to more rational decision-making in clinical practice.


O padrão de morbimortalidade tem-se modificado nos últimos anos com aumento das doenças crônicas não-transmissíveis levando a múltiplas comorbidades e ao uso de muitos medicamentos. O objetivo foi avaliar o uso de medicamentos com ação anticolinérgica por idosos. Estudo transversal de base populacional, com indivíduos de 60 anos ou mais. Foram investigados fatores socioeconômicos, problemas de saúde e utilização de medicamentos nos últimos 15 dias. Para a classificação dos medicamentos com atividade anticolinérgica foram utilizadas as escalas: Anticholinergic Drug Scale (ADS), Anticholinergic Risc Scale (ARS), Anticolinergic Cognitive Burden Scale (ACB). Entrevistados 1.451 idosos, destes, 1.305 utilizaram medicamentos, sendo que 60,7% usaram fármacos com ação anticolinérgica, sobretudo aqueles com mais de 80 anos e os menos escolarizados. No total, 5.703 medicamentos foram usados, 1.282 (22,5%) com ação anticolinérgica. Observou-se concordância kappa de 0,63 quando se avaliou as escalas de risco ACB e ADS. A prevalência de uso de fármacos com ação anticolinérgica foi alta, deve-se estar atento às consequências relativas ao seu uso, tendo em vista a tomada de decisão mais racional na prática clínica.


Assuntos
Antagonistas Colinérgicos , Pesquisa , Idoso , Idoso de 80 Anos ou mais , Antagonistas Colinérgicos/efeitos adversos , Estudos Transversais , Humanos , Prevalência
13.
Cad Saude Publica ; 38(7): e00168021, 2022.
Artigo em Português | MEDLINE | ID: mdl-35976345

RESUMO

Indiscriminate use of anti-bacterial agents during pregnancy can increase antimicrobial resistance and endanger both the mother's and the children's health. Currently, Brazil has the Collegiate Directive Resolution n. 20/2011, which controls prescription and dispensation of anti-bacterial agents. Given this scenario, this study compared the use of anti-bacterial agents by pregnant women participating in the 2004 and 2015 Pelotas (Brazil) birth cohorts, in Rio Grande do Sul, Brazil, considering the regulation issued between the two cohorts. Data were collected in the perinatal period of the two studies. The main outcome was the use of anti-bacterial agents during pregnancy. Prevalence scans were described based on independent variables and differences in percentage points (p.p.) between the two cohorts. The prevalence of anti-bacterial use was 41.9% (95%CI: 40.4; 43.3) in 2004 and 39.2% (95%CI: 37.7; 40.6) in 2015. Considering the pregnant women who reported having infection during pregnancy, a greater reduction in use was observed in 2015, when compared to 2004, in poor women (-15.4p.p., 95%CI: 9.59; 21.20) and in those who had less consultations (-17.1p.p., 95%CI: 2.81; 31.36). Considering total medications, the proportion of anti-bacterial used dropped from 20.6% (95%CI: 19.9; 21.4) in 2004 to 12.6% (95%CI: 12.1; 13.1) in 2015. The reductions found in both the prevalence of use and the proportion of anti-bacterial agents over total medications used may be a reflection of the regulatory policy implemented in 2011.


A utilização indiscriminada de antibacterianos no período gestacional pode aumentar a resistência antimicrobiana e colocar em risco a saúde da gestante e da criança. Atualmente, está em vigência no Brasil a Resolução da Diretoria Colegiada nº 20/2011, que controla a prescrição e fornecimento de antibacterianos. O objetivo deste estudo foi comparar o uso de antibacterianos pelas gestantes participantes das coortes de nascimentos de Pelotas, Rio Grande do Sul, Brasil, de 2004 e 2015, considerando a regulamentação implementada entre as duas coortes. Foram utilizados dados coletados no período perinatal dos dois estudos. O desfecho principal foi o uso de antibacterianos na gestação. As prevalências de uso foram descritas a partir de variáveis independentes e diferenças em pontos percentuais (p.p.) entre as duas coortes. A prevalência do uso de antibacterianos foi de 41,9% (IC95%: 40,4; 43,3) em 2004 e 39,2% (IC95%: 37,7; 40,6) em 2015. Considerando-se as gestantes que relataram ter infecção durante a gestação, observou-se maior redução de uso em 2015, quando comparado a 2004, nas gestantes mais pobres (-15,4p.p., IC95%: 9,59; 21,20) e naquelas que foram a menos consultas (-17,1p.p., IC95%: 2,81; 31,36). Houve redução na proporção de antibacterianos usados, considerando o total de medicamentos de 20,6% (IC95%: 19,9; 21,4) em 2004 para 12,6% (IC95%: 12,1; 13,1) em 2015. As reduções encontradas, tanto nas prevalências de uso quanto na proporção dos antibacterianos sobre o total de medicamentos utilizados, podem ser reflexo da política de regulamentação implementada em 2011.


El uso indiscriminado de antibacterianos durante el embarazo puede aumentar la resistencia a los antimicrobianos y poner en riesgo la salud de la gestante y del niño. Actualmente, está vigente en Brasil la Resolución de la Dirección Colegiada nº 20/2011, que controla la prescripción y dispensación de antibacterianos. El objetivo de este estudio fue comparar el uso de antibacterianos por gestantes participantes de las cohortes de nacimientos de Pelotas, Rio Grande do Sul, Brasil, del 2004 y del 2015, considerando la regulación implementada entre las dos cohortes. Se utilizaron los datos recopilados en el período perinatal de los dos estudios. El resultado principal fue el uso de antibacterianos durante el embarazo. Las prevalencias de uso se describieron con base en las variables independientes y diferencias en puntos porcentuales (p.p.) entre las dos cohortes. La prevalencia de uso de antibacterianos fue del 41,9% (IC95%: 40,4; 43,3) en el 2004 y del 39,2% (IC95%: 37,7; 40,6) en el 2015. Teniendo en cuenta que las gestantes que reportaron haber tenido infección durante el embarazo, hubo una mayor reducción de uso en el 2015, en comparación con el 2004, en las gestantes más pobres (-15,4p.p., IC95%: 9,59; 21,20) y en las que consultaron menos (-17,1p.p., IC95% 2,81;31,36). Hubo una reducción en la proporción de antibacterianos usados, considerando la cantidad total de medicamentos del 20,6% (IC95%: 19,9; 21,4) en el 2004 al 12,6% (IC95%: 12,1; 13,1) en el 2015. Las reducciones encontradas, tanto en las prevalencias de uso como en la proporción de antibacterianos sobre la cantidad total de medicamentos utilizados, pueden ser reflejo de la política regulatoria implementada en el 2011.


Assuntos
Coorte de Nascimento , Gestantes , Antibacterianos/uso terapêutico , Brasil/epidemiologia , Criança , Feminino , Humanos , Gravidez , Prevalência
14.
Cien Saude Colet ; 26(10): 4783-4794, 2021 Oct.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34730663

RESUMO

This article aims to evaluate the conformity between drug package inserts (DPIs) and evidence-based bibliographic sources regarding the presence of contraindications to the use of contraceptives and anti-infective agents during breastfeeding. Contraceptive and anti-infectives were selected, according to ATC, with the updated record in the ANVISA and present in the bibliographic sources Breastfeeding and Use of Medicines and Other Substances, Medications and Mother's Milk, LactMed®, Micromedex® and UpToDate®. Information was extracted from the DPI "Contraindications" and "Warnings and precautions" sections and compared with the information in the bibliographic sources. The contraindication of the drug during breastfeeding was evaluated. Contraindications were found in the DPIs of five (55.5%) of the nine contraceptives. The contraindication percentage ranged from 0 to 55.5% among the bibliographic sources, depending on the source. The percentage was 46.3% in the DPIs, ranging from 0 to 12.9% in the bibliographic sources for anti-infectives. There is an agreement between the DPIs and the bibliographic sources regarding contraceptives; regarding anti-infectives, the DPIs are more often contraindicated for use during breastfeeding.


O objetivo deste artigo é avaliar a concordância entre bulas e fontes bibliográficas baseadas em evidências científicas quanto à presença de contraindicação do uso de anticoncepcionais e anti-infecciosos durante a amamentação. Foram selecionados medicamentos anticoncepcionais e anti-infecciosos, segundo a ATC, com registro na ANVISA e presentes nas fontes bibliográficas: Manual Amamentação e Uso de Medicamentos e Outras Substâncias, Medications and Mother's Milk, LactMed®, Micromedex® e UpToDate®. As informações foram extraídas das seções "Contraindicações" e "Advertências e precauções" das bulas e comparadas com as informações das fontes. Foi avaliada a presença de informação contraindicando o uso do medicamento durante a amamentação. Em cinco (55,5%) dos nove anticoncepcionais foi verificada contraindicação na bula. Entre as fontes bibliográficas, o percentual variou de 0% a 55,5%, dependendo da fonte. Para os anti-infecciosos, o percentual de contraindicação foi de 46,3% na bula, variando de 0% a 12,9% nas fontes. Existe concordância entre as bulas e as fontes bibliográficas com relação aos anticoncepcionais; no caso dos anti-infecciosos, as bulas apresentam contraindicação para o uso durante a amamentação com mais frequência.


Assuntos
Anti-Infecciosos , Preparações Farmacêuticas , Aleitamento Materno , Anticoncepcionais , Rotulagem de Medicamentos , Feminino , Humanos
15.
Epidemiol Serv Saude ; 30(1): e2020089, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33605375

RESUMO

OBJECTIVE: To analyze the prevalence of medication use, sources of access, and associated factors among rural residents in Pelotas, RS, Brazil. METHODS: This was a cross-sectional study conducted in 2016 with adults ≥18 years old. Participants reported on medication use and sources of access to medication in the month prior to the interview. Poisson regression was used. RESULTS: Among the 1,519 respondents, 54.7% (95%CI 48.7;60.5) used some form of medication and 3.3% (95%CI 2.4;4.5) stopped taking necessary medication. Higher prevalence of use occurred in: women (PR=1.23 - 95%CI 1.12;1.34), the elderly (PR=2.36 - 95%CI 2.05;2.73), people with poorer self-perceived health (PR=1.29 - 95%CI 1.14;1.46) and people with a higher number of diseases (PR=2.37 - 95%CI 2.03;2.77). A total of 14.0% (95%CI 11.2;17.4) obtained medication exclusively from the Brazilian National Health System, prevalence of which was higher among those who self-reported themselves to be non-white and from lower economic classification. CONCLUSION: A low number stopped taking medication they needed to take. Use of free-of-charge medication was greater in groups with lower income.


Assuntos
Acessibilidade aos Serviços de Saúde , População Rural , Adolescente , Adulto , Idoso , Brasil , Estudos Transversais , Feminino , Humanos , Fatores Socioeconômicos
16.
Rev Bras Epidemiol ; 23: e200023, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32401917

RESUMO

AIM: To verify the prevalence of recommendation of iron supplementation among children aged 12 and 24 months. METHODOLOGY: All children born in the maternities of Pelotas/RS in 2015 were eligible for the Cohort. The outcomes were the recommendation of ferrous sulphate by health professionals and its use. RESULTS: The cohort followed up 4,275 children. Approximately 64.0% of them were recommended to receive iron supplementation until 12 months of age. Among these, 68.8% used iron. From 12 to 24 months, 39.4% of the children received a prescription of iron supplementation, and among them, 26.2% actually used it. At 12 months, after adjusted analysis, higher maternal education, higher family income, lower parity, and low birth weight remained associated with the outcome. At 24 months, after adjusted analysis, we observed a higher recommendation of iron supplementation among mother with lower parity and for children with low birth weight. CONCLUSION: There was a low frequency of recommendation and low rate of use of iron among children. These findings are highly relevant given the high prevalence of anemia observed in children this year. The low recommendation of iron use among children up to 24 months of age, and the low use among those who are recommended to use it reflect the need for coordinated actions among health professionals and the expansion of knowledge among mothers to enable a wider reach of this important public policy.


Assuntos
Suplementos Nutricionais/estatística & dados numéricos , Compostos Ferrosos/uso terapêutico , Fatores Etários , Anemia Ferropriva/prevenção & controle , Brasil , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido de Baixo Peso , Masculino , Mães/estatística & dados numéricos , Recomendações Nutricionais , Fatores Socioeconômicos , Cooperação e Adesão ao Tratamento
17.
Rev Bras Epidemiol ; 23: e200026, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32401919

RESUMO

OBJECTIVE: To classify the drugs used during childbirth in relation to risks in breastfeeding, by using different sources of information and determining their disagreements. METHODS: Cross-sectional study, within the 2015 Pelotas Birth Cohort. Information about the use of drugs was collected, classified and compared regarding risk according to: 1) Brazil Ministry of Health Manual (MS), 2) World Organization (WHO), 3) Newton and Hale's classification and 4) American Academy of Pediatrics (AAP). RESULTS: A total of 1,409 mothers participated, and they had used 14,673 medicines, with 143 different drugs, of which 28 showed discordant classification with regard to breastfeeding risk. These 28 drugs included the following: morphine (64%), classified by AAP and WHO as compatible and as judicious use use by MS and Newton and Hale; hyoscine (23%), classified as judicious use by MS and compatible (A) by AAP; and metoclopramide (18%), classified as compatible by MS, of effects unknown (D) by AAP, and should be avoided according to WHO. Of the total drugs, 49.7% were classified as compatible during breastfeeding. Almost all women used oxytocin (97.4%), followed by lidocaine (75%), ketoprofen (69%), cephalothin (66%) and diclofenac (65%), which were classified as compatible. CONCLUSION: There was extensive use of drugs by mothers in labor during admission, most of the drugs being classified at the same risk and almost half classified as compatible with breastfeeding. However, there was disagreement between the sources for 19.6% of the drugs analyzed, which could endanger the infant's health or leave doubts about the use of the drug or breastfeeding.


Assuntos
Aleitamento Materno , Parto Obstétrico/efeitos adversos , Uso de Medicamentos/classificação , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Hospitalização , Medição de Risco/métodos , Adolescente , Adulto , Brasil , Contraindicações de Medicamentos , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Leite Humano/efeitos dos fármacos , Mães , Fatores de Risco , Organização Mundial da Saúde , Adulto Jovem
18.
Artigo em Inglês | MEDLINE | ID: mdl-31963112

RESUMO

Background: This study describes medication use by women up to 3 months postpartum and evaluates the association between medication use by women who were still breastfeeding at 3 months postpartum and weaning at 6 and 12 months. Methods: Population-based cohort, including women who breastfed (n = 3988). Medications were classified according to Hale's lactation risk categories and Brazilian Ministry of Health criteria. Duration of breastfeeding was analysed using Cox regression models and Kaplan-Meier curves, including only women who were still breastfeeding at three months postpartum. Results: Medication use with some risk for lactation was frequent (79.6% regarding Hale's risk categories and 12.3% regarding Brazilian Ministry of Health criteria). We did not find statistically significant differences for weaning at 6 or 12 months between the group who did not use medication or used only compatible medications and the group who used medications with some risk for lactation, according to both criteria. Conclusions: Our study found no association between weaning rates across the different breastfeeding safety categories of medications in women who were still breastfeeding at three months postpartum. Therefore, women who took medications and stopped breastfeeding in the first three months postpartum because of adverse side-effects associated with medications could not be addressed in this analysis.


Assuntos
Aleitamento Materno , Uso de Medicamentos/estatística & dados numéricos , Adolescente , Adulto , Brasil , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Desmame , Adulto Jovem
19.
Artigo em Inglês | MEDLINE | ID: mdl-32033282

RESUMO

Background: Medication use during pregnancy is a common practice that has been increasing in recent years. The aim of this study is to describe medication use among pregnant women from the 2015 Pelotas (Brazil) Birth Cohort Study. Methods: This paper relies on a population-based cohort study including 4270 women. Participants completed a questionnaire about the antenatal period, including information about medication use. We performed descriptive analyses of the sample and the medications used and adjusted analyses for the use of medications and self-medication. Results: The prevalence of medication use was 92.5% (95% CI 91.7-93.3), excluding iron salts, folic acid, vitamins, and other minerals. The prevalence of self-medication was 27.7% (95% CI 26.3-29.1). In the adjusted analysis, women who had three or more health problems during pregnancy demonstrated higher use of medicines. Self-medication was higher in lower income groups and among smokers and multiparous women (three pregnancies or more). Acetaminophen, scopolamine, and dimenhydrinate were the medications most commonly used. Conclusions: This study describes the pattern of drug use among pregnant women in a population-based cohort study, with a high prevalence of self-medication. Greater awareness of the risks of self-medication during pregnancy is required, focusing on groups more prone to this practice, as well as ensuring qualified multidisciplinary prenatal care.


Assuntos
Automedicação , Acetaminofen/administração & dosagem , Adulto , Brasil , Estudos de Coortes , Suplementos Nutricionais , Feminino , Ácido Fólico/administração & dosagem , Humanos , Entrevistas como Assunto , Farmacoepidemiologia , Gravidez , Cuidado Pré-Natal , Prevalência , Pesquisa Qualitativa , Automedicação/estatística & dados numéricos , Inquéritos e Questionários , Vitaminas/administração & dosagem , Adulto Jovem
20.
Rev Saude Publica ; 53: 51, 2019 May 30.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31166379

RESUMO

OBJECTIVE: Trace the pattern of drug use during delivery hospitalization. METHOD: Cross-sectional study carried out from June to October 2015, included in the 2015 Pelotas births cohort. All women living in the urban area of the city who were hospitalized for delivery were part of the sample. We collected information regarding drug prescription and drug use by mothers during the whole period of hospitalization. Sociodemographic data were obtained in interview after delivery, and other data were obtained from medical charts. The drugs were classified according to the Anatomical Therapeutic Chemical system. RESULTS: All study participants (1,392 women) used at least one drug, with the mean amount being larger the higher the age of the mother, both prepartum/during delivery and postpartum. It was also higher in cases of spinal anesthesia or general anesthesia, cesarean deliveries, school hospitals, and longer hospitalizations. Analysis of the sample as a whole showed no significant difference in the number of drugs used according to hospitalization type, but when stratified by length of hospital stay the mean was higher in SUS hospitalizations than in private and health insurance hospitalizations. Drugs for the nervous system were the most used (30.5%), followed by drugs for the alimentary tract and metabolism (13.8%). The use of anti-infective agents and drugs that act on the cardiovascular and respiratory systems was higher in mothers who underwent cesarean delivery. This study showed high drug consumption in the delivery hospitalization period, and showed cesarean delivery and epidural anesthesia as the main factors related to high drug consumption in this period. CONCLUSIONS: We found high drug consumption in the delivery hospitalization period, and the main factors were cesarean delivery and epidural anesthesia. Drugs that act on the nervous system were the most used.


Assuntos
Cesárea/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Adolescente , Adulto , Anestesia Epidural , Anestesia Geral , Raquianestesia , Brasil , Estudos de Coortes , Estudos Transversais , Prescrições de Medicamentos/classificação , Feminino , Hospitalização , Humanos , Pessoa de Meia-Idade , Período Pós-Parto , Gravidez , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
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