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

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

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

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

Itinerant vending of medicines inside buses in Nigeria: vending strategies, dominant themes and medicine-related information provided / Venta itinerante de medicamentos en autobuses en Nigeria: estrategias de venta, temas dominantes e información sobre medicamentos proporcionada

Objective: To determine vending strategies and marketing themes employed by itinerant bus vendors, and assess the accuracy and completeness of information provided on medicines being sold in an urban setting in Nigeria Methods: Cross-sectional study and content analysis of itinerant vending of medicines inside buses recorded with a mobile telephone on purposively selected routes in a mega city with an estimated 18 million residents in southwestern Nigeria over a 2-month period. Two coders independently assessed 192 vending episodes by 56 vendors for 147 OTC and prescription medicines. Inter-rater reliability (Gwet AC1 =0.924; p<0.0001). Results: Fourteen thousands and four hundred potential consumers encountered 192 recorded episodes of vending of medicines inside 192 buses within the study periods. Forty-four (78•5%) of the 56 vendors were females in the 30-45 years age bracket, were mostly (75%) attired in the local ‘Iro and Buba’ Ankara fabric and showed laminated identity cards (97.5%) issued by the local association for ‘marketers’ of medicines inside buses, markets, and motor parks. Of the 14400 consumers encountered inside buses during the study period, between 6.7% and 48.3% purchased the medicines promoted. Prayers against death from road traffic accidents and diseases of physical and / or meta-physical origins were the most frequently used (76•8%) ice-breaking opening statement / strategy to gain consumers’ attention. Hematinics, multi-vitamins, simple analgesic, NSAIDs and corticosteroids were the most frequently vended medicines. Consumers’ enquiries were related to dosing for children (51.8%), elderly (28.6%), and pregnancy (52.7%); and contraindications during pregnancy (8.9%). Factual medicines information such as dose, frequency, potential side effects and contra-indications were not provided in majority of vending episodes. Conclusion: Itinerant vending of medicines and the use of misleading and melodramatic themes to secure high consumer patronage appear considerable in Nigeria. Majority of the vendors did not correctly respond to consumers medicine- related enquiries, or provide detailed factual medicines information to guide appropriate use. These misleading promotional activities could potentially encourage inappropriate purchase and probable self-medication by consumers (AU)

Objetivo: Determinar las estrategias de venta y los temas de marketing empleados por los vendedores en autobuses itinerantes y evaluar la precisión y compleción de la información sobre medicamentos proporcionada durante la venta en un área urbana de Nigeria. Métodos: Estudio transversal y análisis de contenido de la venta itinerante de medicamentos en autobuses grabadas con un teléfono móvil en rutas seleccionadas a propósito en una mega-ciudad de 18 millones de habitantes en el suroeste de Nigeria durante un periodo de dos meses. Dos codificadores evaluaron independientemente 192 episodios de venta de 56 vendedores para 147 medicamentos OTC y de prescripción. Fiabilidad inter-evaluador (K de Cohen)=0.89 [IC95% 0.76- 0.92]. Resultados: 14.400 potenciales consumidores visitaron los 192 episodios grabados de venta de medicamentos en el interior de 192 autobuses en el periodo de estudio. 44 (78.5%) de los 56 vendedores eran mujeres entre los 30-45 años, estaban mayoritariamente (75%) con tejidos tradicionales ‘Iro and Buba’ Ankara y mostraban tarjetas identificativas plastificadas (97.5%) emitidas por las autoridades locales para ‘vendedores’ de medicamentos en autobuses, mercados y aparcamientos. De los 14.400 consumidores que visitaron el interior de los buses durante el periodo de estudio, el 6.7% y el 48.3% compró los medicamentos promocionados. Oraciones contra la muerte en accidentes de tráfico y enfermedades de orígenes físicos o metafísicos eran los mensajes para romper el hielo / estrategias para ganar la atención de los clientes más frecuentemente utilizados (76.8%). Los medicamentos más frecuentemente vendidos eran los hematínicos, multivitamínicos, analgésicos simples, AINE y corticoides. Las preguntas de los consumidores estaban relacionadas con las dosis para niños (51.8%), ancianos (28.6%) y embarazo (52.7%); y contraindicaciones durante el embarazo (8.9%). En la mayoría de los episodios de venta no se proporcionaba informaciones objetivas sobre los medicamentos, como dosis, frecuencia, efectos adversos potenciales y contraindicaciones. Conclusión: La venta itinerante de medicamentos y el uso de temas engañosos y melodramáticos para asegurar el elevado consumo aparecen frecuentemente en Nigeria. La mayoría de los vendedores no respondió correctamente a las preguntas sobre medicamentos de los consumidores, ni proporcionó información objetiva detallada para guiar en el uso adecuado. Estas actividades promocionales engañosas probablemente podrían animar a la compra y a la automedicación de los consumidores (AU)

Medication storage and self-medication behaviour amongst female students in Malaysia / Almacenamiento de medicación y comportamientos en auto-medicación entre mujeres estudiantes en Malasia

Objectives: The aims of this study are to determine the prevalence, attitudes and behaviours of medication storage and self-medication amongst female students at Universiti Sains Malaysia (USM). Methods: A cross-sectional survey was conducted and cluster random sampling technique was used for respondent selection. A pre-piloted questionnaire was administered to female respondents so as to collect the data. Data was analyzed using SPSS version 12 and analysis was conducted using descriptive analysis procedures. Results: Of the 481 participants (mean age; SD was 22.1; 3.3), 93.1% (n=448) students stated that they stored medicine in their rooms, while 70.7% (n=340) stated that they stopped taking a prescribed medicine without consulting a doctor. The prevalence of self-medication was 80.9% (n=389). The most common reasons for self-medication were related to their knowledge of their ailment and its treatment (58.0%), 14.4% thought it saved time and 8.5% mentioned that medication given by provider was not effective. The most common symptoms were otorhinolaryngology problems (22.5%), followed by respiratory disease (19.6%), Gastro Intestinal Tract (GIT) disease (18.1%) and headache/fever (16.8%). Commonly used medicines were analgesics & antipyretics (30.2%), ear, nose & throat drugs (10.8%), vitamins & minerals (10.8%), GIT drugs (8.5%), anti-infections (7.3%) and herbal medicines (3.5%). Prevalence of medicine storage and self-medication practice is high among educated female students in USM. Conclusions: There is a need to educate the students to ensure safe practice by increasing their awareness. Strict policies need to be implemented on the unrestricted availability of medicines so as to prevent the wastage of medicines (AU)

Objetivos: Los objetivos de este estudio son determinar la prevalencia, actitudes y comportamiento en el almacenamiento de medicamentos y la auto-medicación entre mujeres jóvenes estudiantes en la Universiti Sains Malaysia (USM). Métodos: Se realizó un estudio transversal y se utilizó una técnica de muestreo por cluster para la selección de respondentes. Para recoger los datos, se administró un cuestionario pre-pilotado a las mujeres que respondieron. Los datos fueron analizados utilizando el SPSS versión 12 y el análisis se realizó utilizando procedimientos descriptivos. Resultados: De los 481 participantes (edad media; DE era 22,1; 3,3), el 93,1% (n=448) afirmaron que almacenaban medicamentos en sus habitaciones, mientras que el 70,7% (n=340) afirmó que pararon de tomar un medicamento prescrito sin consultar al médico. La prevalencia de auto-medicación era del 80,9% (n=389). Entre las razones más frecuentes para auto-medicación estaban relacionadas con sus conocimientos de su enfermedad y su tratamiento (58,0%), el 14,4% pensaba que ahorraba tiempo y el 8,5% mencionó que la medicación proporcionada no era efectiva. Los síntomas más frecuentes fueron problemas otorrinolaringológicos (22,5%), seguidos de enfermedades respiratorias (19,6%), del tracto gastrointestinal (TGI) (18,1% y dolor de cabeza/fiebre (16,8%). Los medicamentos frecuentemente utilizados eran analgésicos y antipiréticos (30,2%), medicamentos para nariz, garganta y oídos (10,8%), vitaminas y minerales (10,8%) y plantas medicinales (3,5%). La prevalencia del hábito de almacenar medicamentos y de auto-medicación es alta entre las mujeres estudiantes de la USM. Conclusiones: Existe la necesidad de educar a los estudiantes para garantizar la práctica segura aumentando sus conocimientos. Se necesita implantar políticas estrictas sobre la disponibilidad irrestricta de medicamentos así como para prevenir el desperdicio de medicamentos (AU)

Self medication among hospitalized patients in selected secondary health facilities in South Western Nigeria / Auto-medicación entre pacientes hospitalizados en establecimientos secundarios selectos en el sur oeste de Nigeria

Practice of self-medication has not been evaluated in hospitalized patients especially in Nigerian hospitals. Objectives: To evaluate the practice of self-medication among hospitalized patients with an aim to unearth some of the reasons for, and perceptions of benefits of this type of behaviour in secondary health care facilities. Methods: This study was carried out among 197 in-patients admitted in three secondary health facilities in southwestern Nigeria using structured questionnaire. Effects of variables such as age, gender and marital status on the practice of self medication were also evaluated using the Fisher's Exact test at p<0.05 as level of significance. Results: Response rate of the study was 93.8% with 174 respondents (88.3%) perceived that the medications prescribed for them were efficacious. Almost 38% of the respondents were self-medicating, with herbal medicines (29.2%) and western medicines (37%) partly due to side effects of the prescribed medicines. Thirty one (15.7%) respondents obtained medicines for self medication through relatives and friends. Prescription medicines used for self medication constituted 7.5%. Major reasons given for self medication included habit, availability and necessity. Ninety respondents (35.7%) had been informed by health care personnel about possible side effects of the medications. Ninety six respondents (48.7%) experienced side effects with the prescribed medications and was a major reason for self medication. Seventy six respondents (79.2%) who had side effects or other secondary symptoms informed healthcare personnel in the hospital while 16 (16.7%) informed relatives and friends. There was statistically significant association between age and the action taken on whom was informed (p=0.001). Conclusions: There is need for extra vigilance from health personnel directly responsible for care of hospitalized patients to look for incidences of self-medication and patient education on the negative aspects of administering undisclosed medicines to their health care givers especially while they are hospitalized (AU)

La práctica de la auto-medicación no ha sido evaluada en los pacientes hospitalizados, especialmente en Nigeria. Objetivos: Evaluar la práctica de auto-medicación entre pacientes hospitalizados con el objetivo de desenterrar algunos motivos y percepciones del beneficio de este comportamiento en establecimientos de cuidados secundarios. Métodos: Este estudio fue realizado entre 197 pacientes hospitalizados en tres establecimientos de cuidados secundarios en el suroeste de Nigeria utilizando un cuestionario estructurado. También se evaluó, utilizando la prueba exacta de Fischer con p<0,05 como nivel de significación, el efecto sobre la práctica de auto-medicación de variables como edad, género, estado civil. Resultados: La tasa de respuesta del estudio fue del 93,8% con 174 respondentes (88,3%) que percibían que los medicamentos prescritos eran eficaces para ellos. Casi el 38% de los respondentes se auto-medicaban, el 29,2% con plantas medicinales y el 37% con medicinas occidentales, en parte debido a los efectos secundarios de los medicamentos prescritos. 31 (15,7%) de los respondentes obtenía los medicamentos para auto-medicación de sus parientes y amigos. De los medicamentos de auto-medicación, el 7,5% eran medicamentos de prescripción. Las principales razones aportadas para la auto-medicación incluían la costumbre, la disponibilidad y la necesidad. 90 respondentes (35,7%) habían sido alertados por el personal sanitario de los posibles efectos secundarios de los medicamentos. 96 (48,7%) experimentó efectos secundarios de la medicación prescrita y esta fue la principal razón para la auto-medicación. 76 (79,2%) de los que habían tenido efectos secundarios informaron al personal sanitario del hospital, mientras que 16 (16,7%) que tuvo efectos secundarios u otros síntomas secundarios informó a sus parientes y amigos. Hubo una asociación estadística entre la edad y la acción tomada sobre quien era informado (p=0,001). Concusiones: Existe una necesidad de una vigilancia extra del personal sanitario directamente responsable de los cuidados de los pacientes hospitalizados para localizar la aparición de auto-medicación y de la educación de los aspectos negativos de la administración de medicamentos no declarada a sus profesionales de la salud, especialmente mientras están hospitalizados (AU)

Essential veterinary education on the development of antimicrobial and antiparasitic resistance: consequences for animal health and food safety and the need for vigilance.

The role played by the veterinary profession in protecting animal and public health, along with food safety, is unique. Thus, it is important that veterinarians have the necessary knowledge to be pro-active in responding to the emergence of antimicrobial resistance. Many current veterinary educational programmes do not attempt to enhance the understanding of undergraduate students of this complex situation. As a first step, a modern veterinary education programme should provide students with a holistic view of the ecology of resistance and clearly describe how antimicrobial resistance emerges. Understanding the relationships between drug use, natural selection and antimicrobial-resistant organisms, as well as gene mobilisation and recombination, and how these contribute to the emergence of resistant organisms are important facets of a modern veterinary education.

La responsabilidad del oftalmólogo al emplear medicamentos no rentables a los laboratorios / The responsability of the ofhthalmologist when using drugs which are uneconomic from the perspective of the pharmaceutical industry

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Problemas éticos en la prescripción de fármacos de eficacia clínica poco significativa / Ethical problems in prescribing drugs of not very significant clinical effectiveness

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Moral hazard and prescription medicine use in Australia--the patient perspective.

All Australian citizens are provided affordable access to prescription medicines through the nation's system of universal pharmaceutical subsidies--the pharmaceutical benefits scheme. The rapid increase in pharmaceutical related expenditure has generated the concern that Australians are taking advantage of prescription subsidies and are using more medicines than are necessary, thereby creating a 'moral hazard'. This concern is predicated on a number of assumptions about patient behaviour rather than on empirical observation. These assumptions amount to a view that patients are consumers who treat prescription medicines as common goods subject to informed and rational calculation of the cost and benefits of their use. This paper reports the findings of an in-depth interview study undertaken to explore how prescription cost influences Australians' medicine use. Qualitative data were analysed to compare medicine users' descriptions of the role of prescription cost in medicine use against the assumptions that underlie the belief in moral hazard. Moral hazard did not appear to be significantly operating in the accounts of medicine use collected for this study. Interviewees' accounts of medicine use revealed an act characterised by ambivalence, a mix of desire and antipathy, faith and suspicion. Medicines appeared in interviewees' accounts as both pharmacologically and symbolically potent substances, which despite their familiarity as objects, are often mysterious to non-expert patients. Cost appeared as a secondary factor in patients' decision to access a prescription medicine. Using a prescription was predicated on the medicine being necessary, with necessity typically established by an expert doctor prescribing the medicine. Prescription medicines did not appear as 'common goods' where subsidised access motivates a 'consumer' to demand more or make the prospect of prescription use more attractive or necessary.