Real-World Impact of Transferring the Dispensing of Hospital-Only Medicines to Community Pharmacies During the COVID-19 Pandemic.

OBJECTIVES: In Portugal, the dispensing of most outpatient specialty medicines is performed exclusively through hospital pharmacies and totally financed by the National Health Service. During the COVID-19 first wave, the government allowed the transfer of the dispensing of hospital-only medicines (HOMs) to community pharmacies (CPs). This study aimed to measure the value generated by the intervention of CP in the dispensing of HOM. METHODS: A single-arm, before-and-after study with 3-month follow-up was conducted enrolling a randomly selected sample of patients or caregivers with at least 1 dispensation of HOM through CP. Data were collected by telephone interview. Main outcomes were patients' self-reported adherence (Measure Treatment Adherence), health-related quality of life (EQ-5D 3-Level), satisfaction with the service, and costs related to HOM access. RESULTS: Overall 603 subjects were recruited to participate in the study (males 50.6%) with mean 55 years old (SD = 16). The already high mean adherence score to therapy improved significantly (P < .0001), and no statistically significant change (P > .5757) was found in the mean EQ-5D score between baseline (0.7 ± 0.3) and 3-month follow-up (0.8 ± 0.3). Annual savings account for €262.1/person, arising from travel expenses and absenteeism reduction. Participants reported a significant increase in satisfaction levels in all evaluated domains-pharmacist's availability, opening hours, waiting time, privacy conditions, and overall experience. CONCLUSIONS: Changing the dispense setting to CP may promote better access and satisfaction. Moreover, it ensures the persistence of treatments, promotes savings for citizens, and reduces the burden of healthcare services, representing a crucial public health measure.

Fine structure and molecular content of human chondrocytes encapsulated in alginate beads.

Preservation of the chondrocytic phenotype in vitro requires a 3D (three-dimensional) culture model. Diverse biomaterials have been tested as scaffolds for culture of animal chondrocytes; however, to date, none is considered a gold standard in regenerative medicine. Here, we studied the fine structure and the GAGs (glycosaminoglycans) content of human chondrocytes encapsulated in alginate beads by using electron microscopy and radioactive sulfate [35S] incorporation, respectively. Cells were obtained from human cartilage, encapsulated in alginate beads and cultured for 28 days. [35S]Na2SO4 was added to the culture media and later isolated for quantification of the sulfated GAGs found in three compartments: IC (intracellular), IB (intra-bead) and EB (extra-bead). Round cells were seen isolated or forming small groups throughout the alginate. Human chondrocytes presented the features of active cells such as euchromatic nuclei, abundant RER (rough endoplasmic reticulum) and many transport vesicles. We observed an extracellular matrix rich in collagen fibres and electrondense material adjacent to the cells. Most of the GAGs produced (74%) were found in the culture medium (EB), indicating that alginate has a limited capacity to retain the GAGs. CS (chondroitin sulfate), the major component of aggrecan, was the most prominent GAG produced by the encapsulated cells. Human chondrocytes cultured in alginate can sustain their phenotype, confirming the potential application of this biomaterial for cartilage engineering.

Assistência pré-natal ambulatorial da Fundação Santa Casa de Misericórdia do Pará / Prenatal attendance ambulatorial of Fundação Santa Casa de Misericórdia do Pará

Introdução: A assistência pré-natal da Fundação Santa Casa de Misericórdia do Pará, está vinculada ao ensino médico da Universidade Federal do Pará, com orientação docente aos alunos do 5°(quinto) ano e do internato do curso, onde as mulheres recebem ainda atendimento de outros profissionais da área da saúde. Objetivo: estudar os diversos aspectos da assistência pré-natal entre as usuárias da Fundação Santa Casa de Misericórdia do Pará - Universidade Federal da Pará. Métodos: estudo transversal de 110 gestações cujaresolução ocorreu no período de fevereiro à junho de 2003, com base nos critérios do Programa Nacional de Humanização do Pré-natal e Nascimento do Ministério da Saúde (PNHPN, 2000). Resultados: a média de consultas observada foi de 6,2. Em 50por cento dos casos, o acompanhamento pré-natal iniciou no segundo trimestre de gravidez, sendo que 95,45por cento das pacientes submeteram-se a todos os exames complementares preconizados. A atenção pré-natal foi considerada inadequada em 70,5por cento e adequada em 29,5por cento dos casos. A escolaridade materna e a paridade mostraram associação significativa com a qualidade da atenção pré-natal. Quanto maior a escolaridade, melhor a qualidade da atenção pré-natal (p<0,05 -c2 ). Em relação à paridade, quanto maior o número de filhos, mais tardiamente a gestante iniciou o acompanhamento pré-natal e menor o número de consultas observado (p<0,05 -c2 ). Conclusão: a assistência pré-natal disponível por meio da Fundação Santa Casa de Misericórdia do Pará, deve ser revista do ponto de vista qualitativo. Especial atenção deve ser dada à educação em saúde durante a assistência pré-natal