Therapeutic procedures and use of alternating antipyretic drugs for fever management in children.

OBJECTIVE: The evidence on the effectiveness of alternating antipyretics in fever management is scarce and indicates clinically negligible differences. The present study aimed to describe therapeutic procedures and the use of alternating antipyretics in children, and to evaluate associated factors. METHODS: This was a cross-sectional study with 692 children aged 0 to 6 years, living in Southern Brazil. Household interviews of the children's caregivers were conducted through cluster sampling using a structured questionnaire. A descriptive analysis was carried out, and the association between the use of alternating antipyretics and sociodemographic factors was evaluated. A total of 630 cases were analyzed (91.0%), corresponding to children with a history of fever. RESULTS: Approximately 73% of caregivers reported that the first measure adopted during the last fever episode was the administration of medication. The mean temperature considered as fever by caregivers was 37.4°C, and as high fever, 38.7°C. The use of alternating antipyretic therapy was reported by 26.7% of respondents, justified by the lack of response to monotherapy and medical indication, in most cases. The drugs most often used were dipyrone and paracetamol. Children whose primary caregiver was a parent with higher socioeconomic status and higher educational level received more alternating medications. Approximately 70% of the doses used were below the minimum recommended dose for the treatment of fever. CONCLUSIONS: The use of medication to control fever is a common practice, including alternating antipyretic regimens. Most caregivers consider as fever temperatures lower than those established and they reported lack of response to monotherapy and medical indication as the main reasons for alternating medication.

Condutas terapêuticas e uso alternado de antipiréticos no manejo da febre em crianças / Therapeutic procedures and use of alternating antipyretic drugs for fever management in children

OBJETIVO: As evidências sobre a eficácia do uso alternado de antitérmicos no manejo da febre são escassas e apontam diferenças clinicamente desprezíveis. O objetivo do estudo foi descrever condutas terapêuticas e uso alternado de antipiréticos em crianças, e avaliar fatores associados ao uso alternado. MÉTODOS: Estudo transversal com 692 crianças de zero a seis anos, residentes no Sul do Brasil. Por meio de amostragem por conglomerados, foram realizadas entrevistas domiciliares com os cuidadores, utilizando questionário estruturado. Foi realizada análise descritiva e avaliada a associação entre o uso alternado de antipiréticos e fatores sociodemográficos. Foram analisados 630 casos (91,0%), correspondendo às crianças com histórico de febre. RESULTADOS: Cerca de 73% dos cuidadores informaram que a primeira medida adotada no último episódio de febre foi administrar medicamentos. A média de temperatura considerada febre foi de 37,4 ºC, e febre alta, 38,7 ºC. A utilização de terapia alternada com antipiréticos foi relatada por 26,7% dos entrevistados, justificada pela ausência de resposta à monoterapia e indicação médica, na maioria dos casos. Os medicamentos mais utilizados foram dipirona e paracetamol. Crianças cujo principal cuidador era um dos pais, com melhores condições socioeconômicas e maior nível educacional, receberam mais medicamentos alternados. Cerca de 70% das doses utilizadas estavam abaixo da dose mínima recomendada para tratamento de febre. CONCLUSÕES: O uso de medicamentos para controlar a febre é uma prática comum, incluindo esquemas alternados de antipiréticos. A maioria dos cuidadores considera como febre temperaturas inferiores às preconizadas, e apontou não resposta à monoterapia e indicação médica como as principais razões para o uso alternado.

OBJECTIVE: The evidence on the effectiveness of alternating antipyretics in fever management is scarce and indicates clinically negligible differences. The present study aimed to describe therapeutic procedures and the use of alternating antipyretics in children, and to evaluate associated factors. METHODS: This was a cross-sectional study with 692 children aged 0 to 6 years, living in Southern Brazil. Household interviews of the children's caregivers were conducted through cluster sampling using a structured questionnaire. A descriptive analysis was carried out, and the association between the use of alternating antipyretics and sociodemographic factors was evaluated. A total of 630 cases were analyzed (91.0%), corresponding to children with a history of fever. RESULTS: Approximately 73% of caregivers reported that the first measure adopted during the last fever episode was the administration of medication. The mean temperature considered as fever by caregivers was 37.4 ºC, and as high fever, 38.7 ºC. The use of alternating antipyretic therapy was reported by 26.7% of respondents, justified by the lack of response to monotherapy and medical indication, in most cases. The drugs most often used were dipyrone and paracetamol. Children whose primary caregiver was a parent with higher socioeconomic status and higher educational level received more alternating medications. Approximately 70% of the doses used were below the minimum recommended dose for the treatment of fever. CONCLUSIONS: The use of medication to control fever is a common practice, including alternating antipyretic regimens. Most caregivers consider as fever temperatures lower than those established and they reported lack of response to monotherapy and medical indication as the main reasons for alternating medication.

The Impact of Psychotropic Drug Costs on the Brazilian Family Budget: An Analysis of the Family Budget Surveys of 2003 and 2009.

OBJECTIVE: To estimate the cost of psychotropic drugs and its impact on the Brazilian family budget in 2003 and 2009 comparatively. METHODS: This study had a cross-sectional design. Data were obtained from the Family Budget Surveys conducted in 2003 and 2009, including interviews in 48,470 and 55,970 homes of all Brazilian regions, respectively. The main measures are prevalence of psychotropic drug acquisition, monetary and nonmonetary expenses with psychotropic drugs, total spending on drugs, spending on health, total household spending, and estimated mean monthly household income. All incomes and expenses from the 2003 survey were adjusted by inflation. RESULTS: There was a reduction in the prevalence of psychotropic drug acquisition by Brazilian households from 13.0% in 2003 to 11.2% in 2009. The mean monthly household spending on psychotropic drugs, however, rose from R $54.38 in 2003 to R $78.73 in 2009. The percentage of spending on psychotropic drugs from the expenses with health increased 27%. CONCLUSIONS: The increase in spending on psychotropic drugs can be due to a rise in their prices, the acquisition of more modern or more expensive drugs, or the increase in the number of drugs used. Proportionally, spending on psychotropic drugs grew more than did spending on health by Brazilian families.

Therapeutic conducts and alternating antipyretics in the management of fever in children.

OBJECTIVES: To describe therapeutic conducts and the alternate use of antipyretics in children, and to evaluate factors associated with this use. METHODS: Cross-sectional study with 692 children from 0 to 6 years, living in southern Brazil. Through cluster sampling, we carried out household interviews with caregivers, using a structured questionnaire. A descriptive analysis was performed and the association between sociodemographic factors and the alternate use of antipyretics was evaluated. We analyzed 630 cases (91.0%), corresponding to children with history of fever. RESULTS: Around 73% of the caregivers answered that their first action with respect to a rising temperature was to medicate the child. The mean temperature considered fever by the caregivers was 37.4 °C and high fever, 38.7 °C. The use of alternate antipyretics was reported by 26.7% of respondents, justified by the lack of response to monotherapy and medical advice, in most cases. The most widely used drugs were dipyrone and paracetamol. Children whose main caregiver was a parent, with better economic conditions and higher educational level were more likely to use alternating therapy. Around 70% of the doses used were below the minimum recommended. CONCLUSIONS: The administration of medication to control fever is a common practice, including alternating antipyretics. Most caregivers consider fever some temperatures below those recommended, and pointed out non-response and medical advice as the main reasons for alternating antipyretics.

Lesser than diabetes hyperglycemia in pregnancy is related to perinatal mortality: a cohort study in Brazil.

BACKGROUND: Gestational diabetes related morbidity increases along the continuum of the glycemic spectrum. Perinatal mortality, as a complication of gestational diabetes, has been little investigated. In early studies, an association was found, but in more recent ones it has not been confirmed. The Brazilian Study of Gestational Diabetes, a cohort of untreated pregnant women enrolled in the early 1990's, offers a unique opportunity to investigate this question. Thus, our objective is to evaluate whether perinatal mortality increases in a continuum across the maternal glycemic spectrum. METHODS: We prospectively enrolled and followed 4401 pregnant women attending general prenatal care clinics in six Brazilian state capitals, without history of diabetes outside of pregnancy, through to birth, and their offspring through the early neonatal period. Women answered a structured questionnaire and underwent a standardized 2-hour 75-g oral glucose tolerance test (OGTT). Obstetric care was maintained according to local protocols. We obtained antenatal, delivery and neonatal data from hospital records. Odds ratios (OR) were estimated using logistic regression. RESULTS: We ascertained 97 perinatal deaths (67 fetal and 31 early neonatal). Odds of dying increased according to glucose levels, statistically significantly so only for women delivering at gestational age ≥34 weeks (p < 0.05 for glycemia-gestational age interaction). ORs for a 1 standard deviation difference in glucose, when analyzed continuously, were for fasting 1.47 (95% CI 1.12, 1.92); 1-h 1.55 (95% CI 1.15, 2.07); and 2-h 1.53 (95% CI 1.15, 2.02). The adjusted OR for IADPSG criteria gestational diabetes was 2.21 (95% CI 1.15, 4.27); and for WHO criteria gestational diabetes, 3.10 (95% CI 1.39, 6.88). CONCLUSIONS: In settings of limited detection and treatment of gestational diabetes mellitus, women across a spectrum of lesser than diabetes hyperglycemia, experienced a continuous rise in perinatal death with increasing levels of glycemia after 34 weeks of pregnancy. Current GDM diagnostic criteria identified this increased risk of mortality.

Association between drug prescribing and quality of life in primary care.

OBJECTIVE: To evaluate quality of life among patients of Family Health Strategy Units and how it relates to the prescribing complexity and to the number of psychotropic medications prescribed, including adjustments for sociodemographic characteristics. SETTING: Family Health Strategy Units in a municipality in the Brazilian state of Rio Grande do Sul. METHOD: Cross-sectional study using face-to-face interviews and prescribing analysis among users of Family Health Strategy Units. Patients were recruited by consecutive sampling. Multiple linear regression models were fitted to the different domains of quality of life in the WHOQOL-Bref questionnaire. The response rate for the patients who completed the interview was 97%. The prescribed medication data and sociodemographic characteristics of the sample were included as covariates. Prescribing complexity was analyzed by means of the Medication Regimen Complexity Index. The assumptions in the estimated models were tested and the models were validated. MAIN OUTCOME MEASURE: Quality of life among patients of Family Health Strategy Units. RESULTS: At total, 336 patients answered the questionnaire. Through multiple linear regression, it was observed that higher prescribing complexity was associated with significantly low scores in the physical (-2.01, 95% CI = -2.89 to -1.35) and overall (-1.93, 95% CI = -2.81 to -0.99) quality of life domains. Greater amounts of psychotropic medications prescribed were associated with significantly low scores in the physical (-1.02, 95% CI = -1.29 to -0.56), psychological (-2.52, 95% CI = -3.15 to -1.65) and overall (-0.97, 95% CI = -2.06 to -0.33) domains of the interviewees' quality of life. The estimated models were adjusted for the sociodemographic characteristics of the sample and presented good predictive capacity. CONCLUSIONS: The evaluated aspects of the prescribed medication (complexity and presence of psychotropic medications) were associated with low scores in the physical, psychological and overall quality of life domains. This may be an intrinsic characteristic of the interviewed patients, like having the quality of life at such a low level before starting the treatment, that the medication could not improve it to normal levels. Also, it can be a demonstration of the ineffectiveness of these treatments within primary health care.

Initial impact and cost of a nationwide population screening campaign for diabetes in Brazil: a follow up study.

BACKGROUND: In 2001 Brazilian citizens aged 40 or older were invited to participate in a nationwide population screening program for diabetes. Capillary glucose screening tests and procedures for diagnostic confirmation were offered through the national healthcare system, diagnostic priority being given according to the severity of screening results. The objective of this study is to evaluate the initial impact of the program. METHODS: Positive testing was defined by a fasting capillary glucose >or= 100 mg/dL or casual glucose >or= 140 mg/dL. All test results were tabulated locally and aggregate data by gender and clinical categories were sent to the Ministry of Health. To analyze individual characteristics of screening tests performed, a stratified random sample of 90,106 tests was drawn. To describe the actions taken for positive screenees, a random sub-sample of 4,906 positive screenees was actively followed up through home interviews. Main outcome measures considered were the number of diabetes cases diagnosed and cost per case detected and incorporated into healthcare. RESULTS: Of 22,069,905 screening tests performed, we estimate that 3,417,106 (95% CI 3.1 - 3.7 million) were positive and that 346,168 (290,454 - 401,852) new cases were diagnosed (10.1% of positives), 319,157 (92.2%) of these being incorporated into healthcare. The number of screening tests needed to detect one case of diabetes was 64. As many cases of untreated but previously known diabetes were also linked to healthcare providers during the Campaign, the estimated number needed screen to incorporate one case into the healthcare system was 58. Total screening and diagnostic costs were US$ 26.19 million, the cost per diabetes case diagnosed being US$ 76. Results were especially sensitive to proportion of individuals returning for diagnostic confirmation. CONCLUSION: This nationwide population-based screening program, conducted through primary healthcare services, demonstrates the feasibility, within the context of an organized national healthcare system, of screening campaigns for chronic diseases. Although overall costs were significant, cost per new case diagnosed was lower than previously reported. However, cost-effectiveness analysis based on more clinically significant outcomes needs to be conducted before this screening approach can be recommended in other settings.

Prenatal weight gain following smoking cessation.

OBJECTIVE: To evaluate the association of changes in smoking habit with maternal weight gain. STUDY DESIGN: We questioned 4000 pregnant women > or =20 years about previous and current smoking habits during a second trimester visit to general prenatal clinics in 6 Brazilian cities, from 1991 to 1995, and followed their weight, through chart review, to term. RESULTS: Of women who reported stopping smoking (915, 23% of the total), 240 (26.2%) stopped during pregnancy. The median number of cigarettes smoked/day among those who reported continued smoking (717, 18%) decreased from 10 to 5 with pregnancy. In linear regression models adjusting for age, educational attainment, ethnicity, prepregnancy body mass index, parity and clinical center, ex-smokers gained 1.03 kg (95%CI 0.59-1.46) more than those reporting never smoking, this difference being greater: 1.54 kg (95%CI 0.78-2.30) in those who reported quitting while pregnant. The size of weight gain in both continuing smokers and ex-smokers was proportional to the reduction in daily number of cigarettes smoked during pregnancy, being 0.38 kg (95%CI 0.07-0.68) greater for each 10 cigarettes reduced (p=0.007). CONCLUSION: Decreasing the quantity of cigarettes smoked in pregnancy, although important for maternal and child health, is associated with maternal weight gain.

Satisfacão com a prótese auditiva na vida diária em usuários do Sistema de Saúde do Exército / Satisfaction level with hearing aid in the daily life of Army Healthcare System users

O objetivo deste estudo foi investigar o nível de satisfacão com a prótese auditiva na vida diária em usuários do Sistema de Saúde do Exército e fatores associados. Foram selecionados adultos e idosos, usuários do convênio de saúde da 3ª Região Militar, que adquiriram prótese auditiva entre os anos de 1998 e 2003, para responderem ao questionário SADL (Satisfaction with Amplification in Daily Life). Foram excluídos do estudo indivíduos com idade inferior a 18 anos; que adquiriram a prótese auditiva há menos de 6 semanas; com grave limitacão da capacidade de compreensão e expressão; e que não concordaram em participar da pesquisa. Os resultados mostraram que os pacientes estavam consideravelmente satisfeitos com o uso da prótese auditiva. Houve menor satisfacão na subescala fatores negativos do SADL, especialmente em relacão ao uso do telefone. Tiveram associacão com a satisfacão fatores ligados à pessoa e, principalmente, à reabilitacão auditiva. Os dados mostraram que, além da selecão da prótese tecnicamente mais adequada, tem fundamental importância a implantacão de programas de reabilitacão auditiva, com experiência domiciliar, orientacões e aconselhamento, buscando que o paciente tenha expectativas realistas.

Satisfaction level with hearing aid in the daily life of Army Healthcare System users.

The objective of the present study was to investigate satisfaction levels with hearing aids in daily life of Army Health System users, in addition to associated factors. Adults and seniors from 3rd Military Area that had purchased hearing aids within the years 1998 and 2003 were selected to answer SADL (Satisfaction with Amplification in Daily Life) questionnaire. We excluded patients aged less than 18 years; those that had acquired hearing aid for less than 6 weeks, and patients with severe comprehension and expression limitation. The results showed that patients were considerably satisfied with the use of aids. There was lower satisfaction level with the negative factor subscale of SADL (Satisfaction with Amplification in Daily Life), especially in relation to telephone using. The factors that were associated with satisfaction were linked to the person and, mainly, to auditory rehabilitation. The data showed that, beyond the selection of the most technically appropriate hearing aid, it is highly important to follow auditory rehabilitation programs including home trials, guidance and counseling so that patients can have realistic expectations.

[Level of knowledge of the compositions of analgesic medication containing aspirin]. / Nível de conhecimento sobre a composição de analgésicos com ácido acetilsalicílico.

OBJECTIVE: To evaluate the knowledge of the generic designation, use and composition of analgesic medications containing aspirin. METHODS: A total of 124 interviews were carried out between December 1999 and January 2000, in two neighborhoods of the city of Porto Alegre, southern Brazil. The interview was held with the person who came to answer the door at each of the homes that was drawn. The data collection instruments comprised a set of five different pharmaceutical specialties containing acetylsalicylic acid, and an interview consisting of two open questions concerning the differences and similarities between the products. RESULTS: Three major knowledge-level groups were characterized on the basis of the information that the interviewees were able to provide. The group that was knowledgeable about the matter comprised 14 individuals (11%). The group with limited knowledge contained 61 people (49)%. Those who had no knowledge of the matter at all formed a group of 49 people (40%). CONCLUSIONS: Taking the results as a whole, they indicate that most people (about 90% of the sample investigated) are simply not aware of what the active substance is, even in pharmaceutical specialties that they use frequently.

Nível de conhecimento sobre a composição de analgésicos com ácido acetilsalicílico / Level of knowledge of the compositions of analgesic medication containing aspirin

OBJETIVO: Avaliar o conhecimento sobre a designação genérica, uso e composição de medicamentos analgésicos contendo ácido acetilsalicílico. MÉTODOS: Foram realizadas 124 entrevistas entre dezembro de 1999 e janeiro de 2000, em dois bairros da cidade de Porto Alegre, RS. As entrevistas foram respondidas pela pessoa que atendeu o entrevistador em cada um dos domicílios sorteados. Os instrumentos de coleta de dados foram uma cartela com cinco especialidades farmacêuticas de analgésicos contendo ácido acetilsalicílico e uma entrevista com duas perguntas abertas sobre diferenças e semelhanças entre os produtos. RESULTADOS: A partir do nível de informação demonstrado pelos entrevistados, foram caracterizados três grandes grupos de conhecimento. O grupo das pessoas que demonstraram domínio sobre o assunto foi de 14 indivíduos (11 por cento); os que demonstraram domínio limitado foi de 61 pessoas (49 por cento); e os que não demonstraram domínio sobre o assunto formaram um grupo de 49 pessoas (40 por cento). CONCLUSÕES: Considerando o conjunto de resultados, verificou-se que a maioria das pessoas (cerca de 90 por cento na amostra avaliada) simplesmente desconhece qual a substância ativa presente em uma especialidade farmacêutica de seu uso freqüente.

Total sialic acid and associated elements of the metabolic syndrome in women with and without previous gestational diabetes.

OBJECTIVE: Inflammatory markers predict type 2 diabetes and relate to the metabolic syndrome. Gestational diabetes mellitus (GDM) predicts type 2 diabetes and may be part of this syndrome. To examine the association of inflammatory markers with GDM, we investigated total sialic acid (TSA) in women with and without previous GDM. RESEARCH DESIGN AND METHODS: All women with GDM and a random sample of women from one center of the Brazilian Study of Gestational Diabetes were invited to return 7 years after their index pregnancy. After an interview, an oral glucose tolerance test and anthropometry were performed. A total of 46 women with and 50 women without previous GDM completed the protocol. RESULTS: Mean TSA was significantly higher in women with (71.8 +/- 11.1 mg/dl) than without (67.5 +/- 9.8 mg/dl) previous GDM (P < 0.05). In a linear regression model, TSA was 4 mg/dl (P < 0.05) higher in women with previous GDM, after adjustment for BMI, fasting insulin sensitivity, and number of years spent in school. In a similar model, current 2-h plasma glucose levels were associated with higher TSA levels after adjustment for waist-to-hip ratio and the log of triglycerides. TSA was strongly correlated with individual components and aggregates (r = 0.55, P < 0.001) of the metabolic syndrome. CONCLUSIONS: Increased TSA levels are associated with previous GDM and are strongly linked to the metabolic syndrome. These findings in young women suggest that a chronic mild systemic inflammatory response is an early feature of the metabolic syndrome and that GDM may be a window for its investigation.

Uso de medicamentos por gestantes em seis cidades brasileiras / Drug use by pregnant women in six Brazilian cities

OBJETIVO: Descrever os medicamentos utilizados por gestantes que fizeram o pré-natal em serviços do SUS (Sistema Unico de Saúde) em cidades brasileiras. MÉTODOS: Utilizando-se um questionário estruturado, foram entrevistadas 5.564 gestantes entre a 21a e a 28a semanas de gravidez, que se apresentaram para consulta em serviço de pré-natal do SUS em seis grandes cidades brasileiras. As perguntas foram agrupadas em "uso orientado" para dor, cólica, enjôo, tosse e outros e em "medicamento orientado" para vitamina, ferro e flúor. Foi adotada a classificaçäo de risco do FDA (Food and Drug Administration), entre 1991 e 1995. RESULTADOS: Do total de 5.564, 4.614 (83,8 por cento) das gestantes usaram pelo menos um medicamento durante a gestaçäo, somando 9.556 medicamentos. Os medicamentos mais utilizados foram as vitaminas associadas a antianêmicos (33,5 por cento), os medicamentos que atuam sobre o aparelho digestivo (31,3 por cento), os analgésicos/antiinflamatórios (22,2 por cento), os antianêmicos (19,8 por cento) e os antimicrobianos (11,1por cento). Quanto à classificaçäo de risco para a gestaçäo, 3.243 (34,0por cento) foram incluídos na categoria A, 1.923 (22,6por cento) na categoria B, 3.798 (39,7 por cento) na categoria C, 289 (3,0 por cento) na categoria D e 55 (0,6 por cento) na categoria X. CONCLUSOES: Foram observadas grandes variaçöes quanto ao uso de medicamentos, principalmente antianêmicos e vitaminas associadas a antianêmicos, entre as várias cidades estudadas, mostrando a ausência de um padräo nacional quanto ao uso desses medicamentos na gestaçäo. Para uma proporçäo de 12,9por cento dos medicamentos utilizados, näo foi localizada qualquer informaçäo na literatura sobre a segurança para o uso durante a gestaçäo. Essa proporçäo, somada aos 26,9por cento dos medicamentos classificados no grupo "C", mostra que 40por cento do uso de medicamentos na gestaçäo säo feitos sem bases definidas de segurança. Entretanto, medicamentos claramente contra-indicados durante a gestaçäo corresponderam a apenas 3por cento dos 9.956 medicamentos utilizados

Estimating hidden prevalence in Hansen´s disease through diagnosis delay and grade of disability at time of diagnosis

The objective of the present study was to propose a new method for the calculation of estimated hidden prevalence (EHP) in Hansen's disease (HD). We analyzed the records of 4142 HD patients diagnosed in the state of Rio Grande do Sul, Brazil, between 1970 and 1991. Out of these 4142 cases, 3291 patients had their grade of disability (GD) evaluated at the time of diagnosis and provided information about the time elapsed between the appearance of the symptoms and the moment when HD was identified by a physician (diagnosis delay, DD). Mean DD for the sample (in years) was 1.51 for disability grade 0, 2.14 for grade 1, 4.46 for grade 2, and 9.64 for grade 2. EHP was calculated taking into account only two strata of GD using the formula HP = [(NC-GD 0/1) x 2.0 + (CN-GD 2/3) x 5.0]/(CGE x PCP), where: NC-GD 0/1 = mean annual number of newly detected grades 0 or 1 cases; CN-GD 2/3 = mean annual number of newly detected grades 2 or 3 cases; CGE = proportion of newly detected cases with GD evaluated; PCP = proportion of the population covered by the state HD control program; 2.0 and 5.0 correspond to an approximation of the mean time in years of DD in each respective stratum of GD. Applying this model, we found an EHP of 529 cases which translates to an excess of 0.58 cases/10,000 population. We also conducted a multivariate analysis using a logistic regression model. This analysis revealed that, in addition to DD, other variables such as clinical form, age group, sex and mode of detection were independent risk factors for the presence of disabilities. We also found two significant effect modification factors: DD versus clinical form and DD versus age group. Taking these findings into consideration, a more complex model was used to calculate the EHP with 16 strata (defined by clinical form of the disease, age group, and GD from 0 to 3). An EHP of 502 cases (excess of 0.55/10,000) was obtained with this more complex model. This result differs only 5% from that of the simplified model. Therefore, we conclude that the simplified model is indicated to estimate hidden prevalence of HD in the field.

Bulas de medicamentos e a informaçäo adequada ao paciente / Drug package inserts and the adequacy of patient's drug information

Objetivo: Avaliar a adequação da forma e conteúdo da seção de "informações ao paciente" das bulas de medicamentos, freqüentemente prescritos no ambulatório de medicina interna de um hospital universitário. Métodos: Foram selecionadas 48 bulas disponíveis em três redes de farmácia e três farmácias de pequeno porte de Porto Alegre, em junho de 1998. Por meio de um formulário, foi verificada a presença de frases de formato padronizado e outras informações exigidas pela Portaria 110, que regulamenta o conteúdo das bulas de medicamentos. Resultados: Em nenhuma das bulas analisadas foi verificada a presença de todas as frases e demais infomrções exigidas pela legislação. Cuidados com o armazenamento e com o prazo de validade dos medicamentos foram as infomações mais freqüentemente apresentadas nas bulas analisadas. Conclusões: Ausência de informações importantes para o usuário, sobre o medicamento nas bulas, reduz o seu valor enquanto material educativo para o paciente

Composiçäo da demanda de uma unidade sanitária em área rural, Viamäo, Brasil, 1987 / Composition of the demand in a rural state primary health care clinic, Viamäo, Brazil, 1987

O trabalho analisa a composiçäo da demanda que procurou uma unidade de assistência primária a saúde em área rural durante 1987. Os cinco motivos de consulta mais freqüentes foram: exame médico e avaliaçäo de saúde, febre, tosse, dor de cabeça e grupe (classificados segundo a Internacional Classification of Primary Care). Os cinco problemas de saúde mais comuns foram: infecçäo de vias aéreas superiores, transtorno e estado de ansiedade, hipertensäo näo complicada (primária e secundária), enterobíase e todas outras helmintíases e cistite e infecçäo urinária (classificados segundo a International Classification of Health Problems in Primary Care - ICHPPC 2). Pacientes do sexo feminino foram responsáveis por 64,3% dos motivos de consulta e 61,8% dos problemas de sáude diagnosticados