Government Direct-to-Consumer Education to Reduce Prescription Opioid Use: A Cluster Randomized Clinical Trial.

Importance: Direct-to-consumer education reduces chronic sedative use. The effectiveness of this approach for prescription opioids among patients with chronic noncancer pain remains untested. Objectives: To evaluate the effectiveness of a government-led educational information brochure mailed to community-dwelling, long-term opioid consumers to reduce prescription opioid use compared with usual care. Design, Setting, and Participants: This cluster randomized clinical trial was conducted from July 2018 to January 2019 in Manitoba, Canada. All adults with long-term opioid prescriptions were enrolled (n = 4225). Participants were identified via the Manitoba Drug Program Information Network. Individuals receiving palliative care or with a diagnosis of cancer or dementia were excluded. Data were analyzed from July 2019 to March 2020. Intervention: Participants were clustered according to their primary care clinic and randomized to the intervention (a codesigned direct-to-consumer educational brochure sent by mail) or usual care (comparator group). Main Outcomes and Measures: The main outcome was discontinuation of opioid prescriptions at the participant level after 6 months, ascertained by pharmacy drug claims. Secondary outcomes included dose reduction (in morphine milligram equivalents [MME]) and/or therapeutic switch. Reduction in opioid use was assessed using generalized estimating equations to account for clustering, with prespecified subgroup analyses by age and sex. Analysis was intention to treat. Results: Of 4206 participants, 2409 (57.3%) were male; mean (SD) age was 60.0 (14.4) years. Mean (SD) baseline opioid use was comparable between groups (intervention, 157.7 [179.7] MME/d; control, 153.4 [181.8] MME/d). After 6 months, 235 of 2136 participants (11.0%) in 127 clusters in the intervention group no longer filled opioid prescriptions compared with 228 of 2070 (11.0%) in 124 clusters in the comparator group (difference, 0.0%; 95% CI, -1.9% to 1.9%). More participants in the intervention group than in the control group reduced their dose (1410 [66.0%] vs 1307 [63.1%]; difference, 2.8% [95% CI, 0.0%-5.7%]). Receipt of the brochure led to greater dose reductions for participants who were male (difference, 3.9%; 95% CI, 0.1%-7.7%), aged 18 to 64 years (difference, 3.7%; 95% CI, 0.2%-7.2%), or living in urban areas (difference, 5.9%; 95% CI, 1.9%-9.9%) compared with usual care. Conclusions and Relevance: In this cluster randomized clinical trial, no significant difference in the prevalence of opioid cessation was observed after 6 months between the intervention and usual care groups; however, the intervention resulted in more adults reducing their opioid dose compared with usual care. Trial Registration: ClinicalTrials.gov Identifier: NCT03400384.

Phytochemical characterization and toxicological activity attributed to the acetonic extract of South American Vassobia breviflora.

The particular plant species found in southern Brazil, Vassobia breviflora (Solanaceae) has only a few apparent studies examining its biological effect. Thus, the aim of the present study was to determine the activity of the acetone extract fraction derived from V. breviflora. Four compounds were identified by ESI-qTOF-MS: eucalrobusone R, aplanoic acid B, pheophorbide A, and pheophytin A. In addition, 5 compounds were identified by HPLC-PDA-MS/MS: all-trans-lutein, 15-cis-lutein, all-trans-ß-carotene, 5,8-epoxy-ß-carotene, and cis-ß-carotene. Cell lines A549 (lung cancer), A375 (melanoma cancer) and HeLa (cervical cancer) were incubated with different concentrations of each studied extract using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), lactate dehydrogenase (LDH), and 2'-7'dichlorofluorescin diacetate (DCFH-DA) assays. The acetonic extract exhibited cytotoxic activity at a concentration of 0.03 mg/ml in the HeLa strain and 0.1 mg/ml in the others. In addition to increased production of reactive oxygen species (ROS). Antibacterial activity was assessed utilizing minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) in 9 ATCCs strains and 7 clinical isolates, as well as determination of biofilm production. Data demonstrated that MIC and MBC were approximately 256 mg/ml in most of the strains tested and antibiofilm effect at S. aureus, S. epidermidis, A. baumannii, and E. faecalis, concentrations below the MIC. Genotoxic activity on plasmid DNA did not produce significant elevated levels in breaks in the isolated genetic material.

Considerations for Developing a Reassessment Process: Report from the Canadian Real-World Evidence for Value of Cancer Drugs (CanREValue) Collaboration's Reassessment and Uptake Working Group.

The Canadian Real-world Evidence for Value in Cancer Drugs (CanREValue) Collaboration was established to develop a framework for generating and using real-world evidence (RWE) to inform the reassessment of cancer drugs following initial health technology assessment (HTA). The Reassessment and Uptake Working Group (RWG) is one of the five established CanREValue Working Groups. The RWG aims to develop considerations for incorporating RWE for HTA reassessment and strategies for using RWE to reassess drug funding decisions. Between February 2018 and December 2019, the RWG attended four teleconferences (with follow-up surveys) and two in-person meetings to discuss recommendations for the development of a reassessment process and potential barriers and facilitators. Modified Delphi methods were used to gather input. A draft report of recommendations (to December 2018) was shared for public consultation (December 2019 to January 2020). Initial considerations for developing a reassessment process were proposed. Specifically, reassessment can be initiated by diverse stakeholders, including decision makers from public drug plans or industry stakeholders. The reassessment process should be modelled after existing deliberation and recommendation frameworks used by HTA agencies. Proposed reassessment outcome categories include maintaining status quo, revisiting funding criteria, renegotiating price, or disinvesting. Overall, these initial considerations will serve as the basis for future advancements by the Collaboration.

Relação entre habilidades sociais, estresse, idade, sexo, escola e série em adolescentes / Relationship between social skills, stress, age, sex, school type and school grade in adolescents

Várias mudanças ocorrem no período da adolescência. O adolescente tem que desenvolver habilidades sociais, que são comportamentos que compõem o repertório do indivíduo para responder às demandas sociais adequadamente. Ele também enfrenta situações que podem desencadear estresse, que é a reação do organismo para reestabelecer seu equilíbrio após passar por situação estressora. O objetivo deste estudo foi verificar a relação de habilidades sociais e estresse com as variáveis: sexo, idade, tipo de escola e série. Foram utilizados os testes psicológicos ESA (Escala de Stress para Adolescentes) e IHSA-Del-Prette (Inventário de Habilidades Sociais para Adolescentes). Conforme os resultados encontrados no presente estudo, pode-se concluir que há correlação entre estresse e as variáveis sexo, idade e tipo de escola frequentada, assim como também entre a emissão de habilidades sociais e o tipo de escola frequentada. A hipótese de que as alunas teriam mais habilidades sociais que os alunos não foi confirmada, assim como também não se confirmou que os homens têm mais dificuldades na emissão das respostas do que as mulheres.(AU)

During adolescence many changes occur in adolescent life. They have to develop social skills, behaviors that composes the repertoire of an individual to respond the social demands adequately. They face some situations that can cause stress, which is the reaction of the body to restore its balance after going through stressor situation. The present study aimed to investigate the correlation of social skills and stress variables: sex, age, type of school attended and grade. For this was used Psychological tests ESA (Stress Scale for Adolescents) and IHSA-Del-Prette(Inventory of Social Skills for Adolescents). The obtained results permit to conclude that there is a correlation between stress and the variables gender, age and type of school attended, as well as between the emission of social skills and the type of school attended. The hypothesis that the female students had more social skills than the students was not confirmed, nor it was confirmed that men have more difficulties in issuing the answers than women.(AU)

Pistas somáticas para um estudo da corporeidade: uma aprendizagem das sensações / Somatic clues for a study of the corporeity: a learning of sensations

Resumo Este texto pretende apresentar algumas pistas para um estudo da corporeidade a partir da metodologia de aprendizagem somática evidenciando-a como uma aprendizagem do/pelo corpo vivido e experimentado através da habitação de sua dimensão material intensiva e heterogênea, produtora de alteridades espaço-temporais. Para tanto, nos aproximaremos da abordagem somática Body Mind Centering. Serão apresentados relatos de experiências registrados em um diário de bordo e em entrevistas que procurarão evidenciar a natureza estético-sensível do corpo como impulsionadora de um aprendizado pela via das sensações. Os relatos compõem um campo investigativo no qual o corpo, em experimentação de si, se faz bússola de um processo errante de buscas pela legitimação do corpo enquanto realidade plena, potente e vital.(AU)

Abstract This text intends to present some clues for a study of the corporeity from the methodology of somatic learning evidencing it as a learning of / by the lived and experienced body through the habitation of its intensive and heterogeneous material dimension, producer of space-time othernesses. To do so, we will get closer to the somatic approach developed by Body Mind Centering. We will present accounts of experiences recorded in a logbook and in interviews that will search to highlight the aesthetic-sensitive nature of the body as a propellor of learning through sensations. The accounts set out an investigative field in which the body, in self-experimentation, become the compass of an errant process of searching for the legitimation of the body as a full, potent and vital reality.(AU)

Conduta do enfermeiro frente aos conflitos éticos e bioéticos em área vulnerável na ESF / Nurse´s behavior in the wake of ethical and bioethical conflicts in the Family Heath Strategy

Este estudo tem como objetivo identificar a conduta do enfermeiro frente aos conflitos éticos e bioéticos no atendimento de famílias em situação de vulnerabilidade social na Estratégia Saúde da Família (ESF). Pesquisa de abordagem qualitativa, descritiva, exploratória e de campo. Realizou-se uma entrevista semiestruturada com seis enfermeiros atuantes na ESF de áreas consideradas vulneráveis, em um município do extremo Sul de Santa Catarina. A análise dos dados foi realizada a partir da análise de conteúdo. A conduta dos enfermeiros para a resolução dos conflitos éticos e bioéticos envolve a linguagem clara e acessível com discussão de caso com a equipe multidisciplinar; o trabalho em rede; vínculo do agente comunitário de saúde (ACS) com a comunidade; e a conduta ética dos profissionais. Considera-se fundamental que os profissionais promovam discussões sobre os dilemas e conflitos éticos e bioéticos enfrentados, buscando a qualificação e a humanização do cuidado, com resolutividade da rede de serviços.

Current qualitative, descriptive, field and exploratory study identifies the nurse´s behavior in the wake of ethical and bioethical conflicts in the attendance of socially vulnerable families within the context of Family Health Strategy. A half-structured interview was conducted with six nurses in Family Health Strategy in a municipality in the south of the state of Santa Catarina, Brazil. Data were analyzed according to contents. Nurses´ behavior for the solution of ethical and bioethical conflicts involved clear and accessible language with case discussion with a multidisciplinary team; network; the health agent´s bond with the community and the ethical behavior of the professionals. It is important that professionals discuss their dilemmas and ethical and bioethics conflicts towards more qualified and humanized care, coupled to solutions of service networks.

Rising prevalence of vascular comorbidities in multiple sclerosis: validation of administrative definitions for diabetes, hypertension, and hyperlipidemia.

BACKGROUND: Despite the importance of comorbidity in multiple sclerosis (MS), methods for comorbidity assessment in MS are poorly developed. OBJECTIVE: We validated and applied administrative case definitions for diabetes, hypertension, and hyperlipidemia in MS. METHODS: Using provincial administrative data we identified persons with MS and a matched general population cohort. Case definitions for diabetes, hypertension, and hyperlipidemia were derived using hospital, physician, and prescription claims, and validated in 430 persons with MS. We examined temporal trends in the age-adjusted prevalence of these conditions from 1984-2006. RESULTS: Agreement between various case definitions and medical records ranged from kappa (κ) =0.51-0.69 for diabetes, κ =0.21-0.71 for hyperlipidemia, and κ =0.52-0.75 for hypertension. The 2005 age-adjusted prevalence of diabetes was similar in the MS (7.62%) and general populations (8.31%; prevalence ratio [PR] 0.91; 0.81-1.03). The age-adjusted prevalence did not differ for hypertension (MS: 20.8% versus general: 22.5% [PR 0.91; 0.78-1.06]), or hyperlipidemia (MS: 13.8% versus general: 15.2% [PR 0.90; 0.67-1.22]). The prevalence of all conditions rose in both populations over the study period. CONCLUSION: Administrative data are a valid means of tracking diabetes, hypertension, and hyperlipidemia in MS. The prevalence of these comorbidities is similar in the MS and general populations.

Análise profissiográfica e mapeamento de competências nas instituições de segurança pública / Análisis profisiográfico y mapeo en la seguridad pública

A profissionalização contínua da qualidade dos serviços prestados à comunidade pelas instituições de segurança pública vem sendo impulsionada pela aplicação de princípios e práticas de recursos humanos e de gestão de pessoas no trabalho. Tais práticas dizem respeito à definição das atribuições e responsabilidades de um cargo em consonância com o perfil de competências exigido para o desempenho do mesmo. Importantes fontes de insumo a essas práticas dizem respeito à aplicação da profissiografia e do mapeamento de competências à realidade das instituições de segurança pública, importantes para o planejamento de ações voltadas para o desenvolvimento das pessoas e para a busca pelo desempenho competente. Este trabalho objetiva discutir questões de natureza metodológica e implicações práticas decorrentes da aplicação dessas ferramentas, análise profissiográfica e mapeamento de competências em instituições policiais, apontando limites e possibilidades no contexto da segurança pública. Efetuou-se um levantamento bibliográfico nos principais periódicos nacionais de administração e de Psicologia, visando, a partir de análise das publicações sobre o tema, a propor um método destinado ao mapeamento profissiográfico e de competências e à sua análise crítica em termos de aplicabilidade no contexto das organizações. Apresentam-se, aqui, possibilidades de atuação na área da segurança pública, integrando-se as técnicas de mapeamento de profissiografia...

Continuous professionalization of the quality of the services provided to the community by the public security institutions has been propelled by the application of practices and principles from human resources and management of people at work. Such practices refer to the definition of duties and responsibilities of a post in accord with the competency profile required for the performance of the post. Important sources of input to the referred practices regard the application of professional profiling and of competency mapping to the reality of the public security institutions, vital to the planning of personnel development actions and to the quest for competent performance. The present work aims at discussing issues of methodological nature and the practical implications deriving from the application of these tools, namely, professional profiling and competency mapping, in law enforcement institutions, indicating the limits and the possibilities in the context of public security. The bibliographic study of the main national administration and psychology periodicals was conducted with the view of proposing a method for competency and professional profile mapping and its critical analysis in terms of applicability within the reality of the organizations, based on the analysis of the publications on the theme. Possibilities are presented herein for the acting in the context of public security, integrating the techniques of professional profile mapping...

La profesionalización continuada de la calidad de los servicios rendidos a la comunidad por las instituciones de seguridad pública ha sido impulsada por la aplicación de principios y prácticas de recursos humanos y de gestión de personas en el trabajo. Dichas prácticas dicen respecto a la definición de las atribuciones y responsabilidades de un cargo en consonancia con el perfil de competencias exigido para el desempeño de ese cargo. Importantes fuentes de insumo a esas prácticas dicen respecto a la aplicación de la profisiografía y del mapeo de competencias a la realidad de las instituciones de seguridad pública, importantes para la planeación de acciones destinadas al desarrollo de las personas y a la búsqueda por el desempeño competente. Este trabajo tiene como objetivo discutir cuestiones de naturaleza metodológica e implicaciones prácticas decurrentes de la aplicación de esas herramientas, análisis profisiográfico y mapeo de competencias en instituciones policíacas, señalando límites y posibilidades en el contexto de la seguridad pública. Se ha efectuado un levantamiento bibliográfico en los principales periódicos nacionales de administración y de Psicología, objetivando, a partir de un análisis de las publicaciones acerca del tema, proponer un método destinado al mapeo profisiográfico y de competencias y a su análisis crítico en términos de aplicabilidad en el contexto de las organizaciones. Se presentan, aquí, posibilidades de actuación en el área de seguridad pública, integrándose las técnicas de mapeo de profisiografía...

Antidepressant utilization in British Columbia from 1996 to 2004: increasing prevalence but not incidence.

OBJECTIVES: Expenditures on antidepressants in Canada are rapidly increasing; yet few studies have analyzed the characteristics of antidepressant users. This study investigated the prevalence and incidence of antidepressant use in British Columbia over eight years. METHODS: Antidepressant utilization and demographic data were assessed for the population of British Columbia from 1996 to 2004. Prescription claims were identified within the PharmaNet database for serotonin reuptake inhibitors (SSRI), tricyclics, monoamine oxidase inhibitors, bupropion (categorized separately for smoking cessation), and "novel" antidepressants, such as venlafaxine. Incident utilization (dispensed "first" antidepressant after two years without an antidepressant claim) and prevalent utilization were analyzed. All cohort members were required to have continuous registration with British Columbia medical services for at least two years before the first antidepressant claim. RESULTS: Prevalence of antidepressant use doubled, from 34 to 72 users per 1,000 population, between 1996 and 2004. The prevalence of particular classes of antidepressants also changed over time. Prevalence of novel antidepressants and SSRIs increased, although incidence of SSRIs decreased. Prevalent and incident use of bupropion for smoking cessation peaked in 1999 but then declined. Quarterly incident antidepressant use increased in 1998 and 1999 (6.5 and 11.3 users per 1,000) but decreased through 2004 (4.2 users per 1,000). Those aged 20 to 44 years and those aged 45 to 64 years showed the greatest peak in incident antidepressant use. A socioeconomic gradient in prescribing was observed. CONCLUSIONS: Prevalent antidepressant use has increased dramatically since 1996. By contrast, incident use increased from 1998 to 1999 but then decreased through 2004. Many complex factors likely contribute to antidepressant prescribing patterns.