Aqueous Extracts of Fermented Macrofungi Cultivated in Oilseed Cakes as a Carbon Source for Probiotic Bacteria and Potential Antibacterial Activity.

Plant biomass colonized by macrofungi can contain molecules with bioactive properties with applications to human/animal health. This work aimed to verify antibacterial activities from aqueous extracts from oil seed cakes of Jatropha curcas (JSC) and cottonseed (CSC), fermented by macrofungi for probiotic bacteria cultivation. Coriolopsis sp., Tyromyces sp., Panus lecomtei, and Pleurotus pulmonarius were cultivated in solid and submerged media. The aqueous extract of unfermented JSC was more efficient than glucose for the growth of all probiotic bacteria. Extracts from four macrofungi fermented in CSC favored Lactobacillus acidophilus growth. In solid fermentation, macrofungi extracts cultivated in JSC favored Bifidobacterium lactis growth. All fungi extracts showed more significant growth than carbohydrates among the four probiotic bacteria evaluated. Regarding antimicrobial activities, no fungal extract or bacterial supernatant showed a more significant inhibition halo for enteropathogenic bacteria than ampicillin (control). Extracts from P. lecomtei and Coriolopsis sp. in CSC showed inhibition halos for Salmonella enterica. Supernatants from L. acidophilus, B. lactis, and Lactobacillus rhamnosus resulted in more significant inhibition of Staphylococcus aureus than the control, which indicates possible antimicrobial activity. Unfermented JSC supernatant showed better results for bacterial growth, while supernatants and aqueous extracts from CSC fermentation can be used for probiotic bacteria culture.

Professionals' and Patients' Perspectives on Criteria for Referring Hypertensive Patients to Comprehensive Medication Management Services in Public Primary Health Care.

Patient prioritization in comprehensive medication management services allows coordinating care and guiding patients according to their clinical profile and their medication use. The aim of the study is to identify and describe factors that indicate the need for comprehensive medication management services among primary care hypertension patients within a public health system from the perspective of patients, pharmacists, nurses and physicians. A qualitative study was carried out with interviews with nurses, pharmacists and physicians (n = 20), and two focus groups with hypertensive patients (n = 12) at primary health care facilities and a public outdoor fitness area between January and February 2019 in Brazil. All interviews were transcribed and analyzed using the Atlas.ti® software. The data analysis revealed the following factors indicative of the need to refer hypertension patients to a pharmacist: lifestyle habits, comorbidities, health care utilization and medication use. The issues identified and the information obtained from the qualitative research and compared with literature studies reviewed allowed defining dimensions that should be considered as an aid in the selection of uncontrolled hypertensive patients for comprehensive medication management services.

Interprofessional education for shared decision making in drug therapy: a scoping review.

The current complex scenario of medication use calls for the implementation of interprofessional education (IPE) initiatives focused on shared decision making (SDM) in drug therapy. A scoping review was conducted to collate, summarize, and report the evidence available on IPE teaching and learning approaches in this context, involving pre-licensure healthcare students. Searches were conducted in seven electronic databases, with 21 articles meeting the inclusion criteria. This review examines educational strategies employed for interprofessional SDM as well as characteristics of students, teachers, and tutors involved in IPE interventions. The reviewed studies lack detailed description of the students' decision-making process, and none addresses aspects related to patient preferences as a part of learning outcomes. We identified shortcomings in how IPE interventions are assessed and reported. Only a few of the studies explicitly describe the use of competency-based frameworks proposed by national and international organizations, and less than 60% describe learning outcomes. The absence of experiences focused on interprofessional SDM in drug therapy suggests a gap that needs to be addressed with future studies evaluated in a robust way. We argue that such experiences enable students, as a team, to learn to share decisions with the patient as an effective team member.

Avaliação da educação interprofissional para a tomada de decisão compartilhada em farmacoterapia: uma revisão de escopo sobre métodos e instrumentos / Evaluación de la educación interprofesional para la toma de decisionescompartida en farmacoterapia: una revisión del alcance sobre métodos einstrumentos / Evaluation of interprofessional education for shared decision making in drug therapy: a scoping review on methods and instruments

Resumo Este estudo teve como objetivo descrever os métodos de pesquisa e instrumentos utilizados na avaliação de estratégias de educação interprofissional para a tomada de decisão compartilhada em farmacoterapia. Os tipos de avaliação empregados foram categorizados segundo o modelo adaptado de Kirkpatrick. Foi conduzida uma revisão de escopo, seguindo as recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (Prisma-ScR). Entre os 21 estudos selecionados, houve predomínio dos métodos quantitativos na avaliação das experiências educacionais (n=18). Destes, o aspecto mais comum avaliado foi "atitudes e percepções dos estudantes em relação à educação e à prática interprofissional", por meio de instrumentos validados (n=13). Foram identificados dez diferentes instrumentos, que se mostraram em conformidade com as competências colaborativas do Interprofessional Education Collaborative. A variedade de instrumentos sinaliza a crescente produção de conhecimento acerca do assunto, mas aponta o desafio de realizar análises comparativas entre experiências educacionais ao redor do mundo. (AU)

Resumen El objetivo de este estudio es describir los métodos de investigación e instrumentos utilizados en la evaluación de estrategias de educación interprofesional para la toma de decisiones compartida en farmacoterapia. Los tipos de evaluación empleados se caracterizaron según el modelo adaptado de Kirkpatrick. Se realizó una revisión de alcance, siguiendo las recomendaciones del PRISMA-ScR. Entre los 21 estudios seleccionados, predominaron los métodos cuantitativos en la evaluación de las experiencias educativas (n=18). De ellos, el aspecto más común evaluado fue el de "actitudes y percepciones de los alumnos con relación a la educación y a la práctica interprofesional", por medio de instrumentos validados (n=13). Se identificaron diez diferentes instrumentos, que se mostraron en conformidad con las competencias colaborativas del Interprofessional Education Collaborative . La variedad de instrumentos señala la creciente producción de conocimiento sobre el asunto, pero muestra el desafío de realizar análisis comparativos entre experiencias educativas alrededor del mundo. (AU)

Abstract This study aimed to describe the research methods and instruments used in the evaluation of interprofessional education strategies for shared decision making in drug therapy. The types of evaluation employed were categorized according to Kirkpatrick's adapted model. A scoping review was conducted, following the PRISMA-ScR recommendations. Among the 21 selected studies, there was a predominance of quantitative methods in the evaluation of educational experiences (n=18). Of these, the most common aspect evaluated was "students' attitudes and perceptions towards interprofessional education and practice" by means of validated instruments (n=13). Ten different instruments were identified and found to be in line with the Interprofessional Education Collaborative competencies. The variety of instruments signals the growing production of knowledge about this topic, but points to the challenge of conducting comparative analyses between educational experiences around the world. (AU)

As percepções de estudantes de Farmácia e de Medicina sobre o desenvolvimento de competências clínicas / The perceptions of Pharmacy and Medicine students about the development of clinical competencies

Resumo: Introdução: A atuação ativa do profissional médico em conjunto com o farmacêutico pode auxiliar na garantia de uma efetiva, segura e conveniente farmacoterapia. Para que esses profissionais atuem de maneira colaborativa, é necessário que, durante o processo formativo, os estudantes de Farmácia e Medicina desenvolvam competências clínicas para assegurar um serviço clínico de qualidade, com respeito pela atuação e adequada convivência com outros profissionais. Objetivo: Este estudo teve como objetivos descrever a autoavaliação dos discentes de Medicina e Farmácia em relação às suas competências clínicas, compreendendo suas diferenças e similaridades, e avaliar o desenvolvimento destas durante a graduação. Método: Trata-se de um estudo educacional realizado de maneira remota entre agosto de 2020 e agosto de 2021. Os participantes eram discentes de Farmácia e Medicina de uma instituição pública de ensino. Realizaram-se entrevistas individuais, e aplicaram-se instrumentos de autoavaliação de competências clínicas. Resultado: Participaram da pesquisa 39 discentes: 18 (46,2%) de Farmácia e 21 (53,8%) de Medicina. Os estudantes de Farmácia avaliaram-se positivamente quanto às atividades relacionadas às competências clínicas, salvo a implementação de um plano de cuidado e a identificação de pacientes em risco de doenças prevalentes. Quanto ao currículo, o curso avaliado possui três disciplinas que abordam o desenvolvimento de competências clínicas. Dessas, os discentes relataram ter desenvolvido conhecimento científico, atualização do conhecimento científico e comunicação efetiva. Os estudantes de Medicina avaliaram-se positivamente em relação às suas competências clínicas, com exceção daquelas relacionadas ao diagnostico diferencial, à discussão com equipe de saúde e à identificação de falhas no sistema de saúde. O currículo do curso apresenta 11 disciplinas voltadas para o cuidado, e os alunos associaram disciplinas de cunhos sociais ao cuidado centrado na pessoa. As competências desenvolvidas destacadas foram empatia, compaixão, integridade e respeito, comunicação efetiva e anamnese, e obtenção de informações socioculturais. Ademais, os estudantes de ambos os cursos relataram contato escasso com outros profissionais de saúde. Conclusão: Os discentes avaliados apresentam diversas inseguranças, principalmente relacionadas às habilidades clínicas que exigem prática. Apesar disso, os estudantes de Medicina demonstraram maior apreensão de soft skills, o que pode facilitar a criação de vínculos com os pacientes e resultar na qualidade do cuidado.

Abstract: Introduction: The active role of the medical professional together with the pharmacist can help to guarantee an effective, safe, and convenient pharmacotherapy. For these professionals to work collaboratively, it is necessary that, during the training process, Pharmacy and Medicine students develop skills to ensure a quality clinical service, with respect for their performance and adequate coexistence with other professionals. Objective: This study aimed to describe a self-assessment of the Medicine and Pharmacy records in relation to their technical skills, their differences and similarities, as well as to assess their development during a program. Method: Educational study carried out remotely between August 2020 and August 2021. The participants were Pharmacy and Medicine students from a public teaching institution. Individual interviews were carried out and instruments for self-assessment of clinical competences were applied. Result: A total of 39 students participated in the research: 18 (46.2%) from Pharmacy and 21 (53.8%) from Medicine. Pharmacy students evaluated themselves positively regarding activities related to clinical competences, except for the implementation of a care plan and the identification of patients at risk of prevalent diseases. As for the curriculum, the evaluated course has three subjects that address the development of clinical competences. Of these, the students reported having developed scientific knowledge, updated scientific knowledge and effective communication. Medical students evaluated themselves positively in relation to their clinical competences, apart from those related to differential diagnosis, discussion with the health team and identification of failures in the health system. The course curriculum features 11 disciplines focused on care, and the students' associated disciplines of a social nature with person-centered care. The most outstanding skills developed were empathy, compassion, integrity and respect, effective communication and anamnesis and obtaining sociocultural information. In addition, students from both courses reported little contact with other health professionals. Conclusion: The evaluated students have several insecurities, mainly related to clinical skills that require practice. Despite this, medical students showed greater apprehension of soft skills, which can facilitate the creation of bonds with patients and result in the quality of care.

Educação permanente para farmacêuticos preceptores que atuam na atenção primária no Sistema Único de Saúde: um estudo qualitativo / Lifelong learning for pharmacist preceptors in primary healthcare in the Brazilian health system: a qualitative study

Resumo O bom exercício da preceptoria exige educação permanente dos profissionais de saúde. Nesse contexto, foi desenvolvido curso para preceptores farmacêuticos em um município do leste de Minas Gerais, visando promover o desenvolvimento de competências clínicas. O objetivo do estudo é descrever a experiência educacional desenvolvida e a perspectiva dos participantes sobre a mesma. Trata-se de estudo qualitativo, com coleta de dados por observação participante, entrevistas semiestruturadas e análise documental. Os dados transcritos foram submetidos a análise temática. O planejamento da atividade educacional, realizado a partir de diagnóstico com os farmacêuticos, resultou em satisfação por parte dos mesmos, que ressaltaram a relevância dos temas abordados para sua prática cotidiana. O curso teórico-prático com estudos de casos que objetivava desenvolver competências clínicas iniciais demonstrou-se satisfatório na perspectiva dos participantes. Problemas na gestão do sistema de saúde local dificultaram a realização da fase de apoio in loco, prevista inicialmente. Além disso, evidenciaram-se fatores que influenciam na possibilidade de aplicação de tais competências no cotidiano profissional. Os conhecimentos gerados podem ser subsidiar outras experiências de integração universidade-serviço de saúde para educação permanente de farmacêuticos, com aproveitamento dos aspectos positivos e desenvolvimento de estratégias de prevenção dos problemas identificados.

Abstract A good preceptorship practice requires lifelong education. In this context, a course was developed for pharmacist preceptors aiming to promote the development of clinical skills. This study aims to describe the educational experience developed and the participants' perspective on it. This is a qualitative study, with data collection through participant observation, semi-structured interviews and document analysis. The transcribed data were submitted to thematic analysis. The planning of the educational activity, carried out based on a diagnosis with the pharmacists, resulted in satisfaction on the part of the pharmacists, who stressed the relevance of the topics addressed for their daily practice. The theoretical-practical course with case studies that aimed to develop initial clinical skills proved to be satisfactory from the perspective of the participants. Problems in the management of the local health system made it difficult to carry out the on-site support phase, initially planned. In addition, factors that influence the possibility of applying such competences in professional daily life were evidenced. The knowledge generated can be used to support other university-health service integration experiences for the lifelong education of pharmacists, taking advantage of the positive aspects and developing strategies to prevent the identified problems.

The Medication Experience of TB/HIV Coinfected Patients: Qualitative Study.

Tuberculosis (TB) and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pharmacotherapy and the stigma related to both diseases are complex. The patients' subjective experiences with diseases and medications are of utmost importance in pharmaceutical care practice. This study aimed to understand the subjective medication experience of TB and HIV/AIDS coinfected patients. The study was based on descriptive research of a qualitative and quantitative nature using data collected during pharmaceutical care appointments and from medical records from September 2015 to December 2016 at a tertiary infectious diseases referral hospital in Southeastern Brazil. Data from 81 patients were analyzed. Regarding patient subjective medication experience, the following responses to the quantitative questionnaire were most frequent: preference for a route of administration (12.4%) and for non-pharmacological therapy (50.6%); concerns about price (11.1%) and adverse effects (18.5%); and association of a worsening of their health status with a change in medication dosage (23.5%). In the thematic analysis, adversity and socially constructed aspects were more prominent. Resolvability, associated with the patient's understanding of relief from signs and symptoms and health recovery, was observed; however, feelings of ambivalence permeated the other aspects, hence leading to treatment abandonment. The evaluation of patient medication experience can be a path to understanding and intervening in the phenomenon of treatment abandonment among TB and HIV/AIDS coinfected individuals.

Bioactives and Extracellular Enzymes Obtained from Fermented Macrofungi Cultivated in Cotton and Jatropha Seed Cakes.

This work focused on obtaining fermented oil cake (cotton or Jatropha) via macrofungi growth with potential characteristics for animal feed formulations, such as the presence of extracellular enzymes, bioactive (ergosterol and antioxidants), and detoxification of antinutritional compounds. The concentration of phorbol esters was reduced by four macrofungi in Jatropha seed cake (JSC) to non-toxic levels. At least two macrofungi efficiently degraded free gossypol in cottonseed cake (CSC). Fermentation with Coriolopsis sp. INPA1646 and Tyromyces sp. INPA1696 resulted in increased ergosterol concentrations, antioxidant activity reduction, and high activity of laccases and proteases. Bromatological analysis indicated high crude protein concentrations, with partial solubilization by fungal proteases. Fermented products from Coriolopsis sp. and Tyromyces sp. in JSC or CSC can be considered important biological inputs for monogastric and polygastric animal feed.

Factors influencing the implementation of pharmaceutical care in outpatient settings: A systematic review applying the Consolidated Framework for Implementation Research.

BACKGROUND: Pharmaceutical care in outpatient settings is a type of health service that has been shown to contribute to decreasing drug-related morbidity and mortality rates. However, every process of implementing a new service brings about changes and transformations in the work routine, thus posing challenges. OBJECTIVES: This systematic review aims to identify barriers to and facilitators for the implementation of pharmaceutical care in outpatient settings by applying the CFIR method, a framework based on the theory of health services, used to analyze and synthesize research data, which can direct strategies for the service to work as planned. METHODS: A systematic review was conducted exploring the barriers to and facilitators for the implementation of pharmaceutical care in outpatient settings. The MEDLINE, EMBASE, CINAHL, COCHRANE, and LILACS databases were consulted. RESULTS: Eight studies were included: five qualitative ones, two mixed-method ones, and a quantitative one. The most frequent CFIR constructs identified were Patient Needs and Resources (n = 30, 10.75%), Knowledge and Beliefs about the Intervention (n = 31, 11.11%), Networks and Communications (n = 34, 12.19%), and Available Resources (n = 56, 20.07%). The most cited barriers were: insufficient human resources, patients' unawareness of the existence of the pharmaceutical care service, and pharmacists' resistance to changes. Facilitators included: the opportune presentation of the service to the healthcare team; the use of electronic devices for specific guidance; and the assessment of patient satisfaction. CONCLUSIONS: This systematic review allowed detecting key guidelines to improve the implementation process, including (1) defining an implementation method and exploring it extensively during the pre-implementation phase, (2) ensuring human and financial resources, (3) determining how the new service will interact with other existing services. More research is needed to understand how these factors can affect the implementation of clinical services.

Medicalização da vida nas práticas vinculadas à estratégia saúde da família / Medicalization of life in practices linked to the family health strategy / La médicalisation de la vie dans les pratiques liées à la stratégie santé de la famille / Medicalización de la vida en prácticas vinculadas a la estrategia de salud de la familia

A inclusão dos cuidados em Saúde Mental na Atenção Primária tem ocorrido em diversos países, incluindo o Brasil, para suprir a existência de uma lacuna assistencial. A integração dos serviços é apontada como necessária, mas ao mesmo tempo um grande desafio. O objetivo deste estudo foi realizar a análise exploratória das práticas discursivas sobre o uso dos medicamentos psicotrópicos e das abordagens não farmacológicas para superação de eventos negativos da vida. As entrevistas realizadas com médicos que trabalham na saúde da família, sobre a prática clínica nos cuidados primários em saúde mental, compuseram o corpus da pesquisa. Os dados foram tratados a partir dos pressupostos da análise do discurso. As descrições analíticas foram construídas a partir dos enunciados identificados na formação discursiva da medicalização da vida. Os resultados da análise evidenciaram o pluralismo terapêutico dos psicotrópicos e seus efeitos, com o uso menos frequente das abordagens não farmacológicas; a prescrição exclui tramas sociais mais amplas, captura a potência da vida modulando os comportamentos individuais e coletivos, para que a convivência seja assegurada e legitimada, para garantir o pretenso bem comum.

Inclusion of mental health care into primary care has occurred in several countries, including Brazil, to tackle the lack of assistance. The integration of services is seen as necessary, but at the same time a major challenge. The aim of this study was to conduct an exploratory analysis of discursive practices on the use of psychotropic drugs and non-pharmacological approaches to overcome negative life events. Interviews conducted with physicians working in family health on the clinical practice of primary mental health care made up our research corpus. Data were analyzed based on the assumptions of discourse analysis. The analytical descriptions were built based on the statements identified in the discursive formation of the medicalization of life. The results of the analysis showed the therapeutic pluralism of psychotropics and their effects, less frequently using non-pharmacological approaches. Prescription excludes broader social plots, captures the power of life by modulating individual and collective behavior, so that social life is assured and legitimized, thus ensuring the alleged common good.

L'inclusion des soins de santé mentale dans l'attention primaire se développe dans divers pays, y compris au Brésil, pour combler l'existence d'une lacune assistancielle. L'intégration des services est considérée comme nécessaire, mais également comme un défi. L'objectif de cette étude a été de réaliser l'analyse exploratoire des pratiques discursives sur l'usage des médicaments psychotropes et des approches non pharmacologiques pour surmonter les événements négatifs de la vie. Les entretiens réalisés avec les médecins travaillant en santé familiale à propos de la pratique clinique dans les soins primaires de santé mentale ont composé le corpus de la recherche. Les résultats de l'analyse ont mis en évidence le pluralisme thérapeutique des psychotropes et leurs effets, avec l'usage moins fréquent des approches non pharmacologiques. La prescription exclut des trames sociales plus amples, capture la puissance de la vie en modulant les comportements individuels et collectifs pour que la vie sociale soit assurée et légitimée, pour garantir le prétendu bien commun.

La inclusión de la atención en salud mental en el ámbito de la atención primaria se ha dado en varios países, entre ellos Brasil, para suplir la existencia de un vacío asistencial. La integración de los servicios se considera como necesaria y, al mismo tiempo, como un gran desafío. El objetivo de este estudio fue realizar un análisis exploratorio de las prácticas discursivas sobre el uso de medicamentos psicotrópicos y sobre los abordajes no farmacológicos para superar los eventos negativos de la vida. Las entrevistas a médicos, que trabajan en salud familiar, sobre la práctica clínica en salud mental dentro de la atención primaria, constituyeron el corpus de la investigación. Los datos fueron tratados a partir de los postulados del análisis del discurso. Las descripciones analíticas se construyeron a partir de las declaraciones identificadas en la formación discursiva de la medicalización de la vida. Los resultados del análisis mostraron el pluralismo terapéutico de los psicotrópicos y sus efectos, con un uso menos frecuente de abordajes no farmacológicos, la prescripción excluye tramas sociales más amplias, capta la potencia de la vida modulando os comportamientos individuales y colectivos, para garantizar y legitimar la coexistencia y garantizar el supuesto bien común.

Farmacêutico na farmácia básica: garantia de qualidade na assistência farmacêutica? / Pharmacist in Primary Health Care: quality assurance in Pharmaceutical Services?

A Assistência Farmacêutica se volta à promoção, proteção e recuperação da saúde por meio de atividades técnico-gerenciais e clínico-assistenciais. A atuação do farmacêutico nas unidades básicas de saúde parece favorecer esse processo, embora alguns municípios optem por não o incluir no quadro de recursos humanos das farmácias na atenção primária à saúde. Nesse contexto, ao realizar uma pesquisa para avaliar o acesso e o uso dos medicamentos em municípios de Minas Gerais, nosso grupo de pesquisa verificou que a presença do farmacêutico nas farmácias básicas tem influenciado sobre a qualidade dos produtos e serviços oferecidos nesses estabelecimentos. Um instrumento padronizado foi utilizado na coleta de dados e indicadores foram selecionados para avaliar qualidade no âmbito técnico-gerencial e clínico-assistencial. Como resultado, observou-se que a presença do farmacêutico nesses estabelecimentos não influenciou sobre a qualidade da Assistência Farmacêutica. Lacunas na formação desses profissionais podem estar comprometendo a atuação do farmacêutico em consonância com as necessidades do Sistema Único de Saúde.

Pharmaceutical Assistance is focused on health promotion, health protection and recovery through technical-managerial, and clinical-care activities. The role of pharmacists in basic health units seems to favor this process, although some municipalities choose not to include them in the human resources framework of pharmacies in primary health care. When conducting a survey to assess the access and use of medicines in municipalities of Minas Gerais, our research group verified that the presence of pharmacists in basic pharmacies has influenced the quality of products and services offered in these establishments. A standardized instrument was used for data collection and indicators were selected to assess quality in the technical-managerial and clinical-care areas. As a result, it was observed that the presence of the pharmacist in these establishments did not influence the quality of Pharmaceutical Services. Gaps in the training of these professionals may be compromising the pharmacist's performance in line with the needs of the Unified Health System.

Caracterização do acesso a medicamentos em um município de médio porte no leste do estado de Minas Gerais, Brasil / Characterization of access to medicines in a medium-sized municipality in the east of Minas Gerais, Brazil

Apesar das dificuldades políticas e estruturais das décadas de 1980 e 1990, avanços significativos como a criação e a implementação do Sistema Único de Saúde e a publicação da Política Nacional de Medicamentos favoreceram o acesso a medicamentos no Brasil. Buscando compreender melhor este fenômeno, o presente estudo teve como objetivo caracterizar o acesso a medicamentos em um município de médio porte do leste do estado de Minas Gerais. Trata-se de um estudo transversal desenvolvido sob o modelo da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil - Componente Avaliação do Serviço de Assistência Farmacêutica Básica. Foram entrevistados os usuários do Sistema Único de Saúde, os responsáveis pela dispensação de medicamentos nas unidades públicas de saúde na Atenção Primária, médicos da rede pública, o responsável pela assistência farmacêutica do município e o representante do secretário municipal de Saúde. Os resultados evidenciaram que houve períodos de desabastecimento de medicamentos e insumos nos últimos 12 meses, provavelmente relacionados à ausência de uma Relação Municipal de Medicamentos Essenciais e Comissão de Farmácia Terapêutica, prescrição de medicamentos pelos nomes comerciais, redirecionamento dos recursos do Componente Básico da Assistência Farmacêutica, ausência de auxiliares para os responsáveis pela dispensação de medicamentos e aos dispendiosos recursos empregados na aquisição de medicamentos para atender demandas judiciais. Ações em gestão direcionadas para a correção das falhas apontadas devem ser realizadas para otimizar o empenho de recursos do município e, consequentemente, melhorar o acesso a medicamentos na atenção básica.

Despite the structural difficulties in public health in the 80's and 90's, there were significant advances in the Brazilian health system back then, like the creation of the Unified Health System and the National Medicine Policy. They seem to have favored access to medicines in Brazil. The present study aimed to characterize the access to medicines in a medium-sized municipality in the eastern state of Minas Gerais. This study is based on the evaluation component of the National Research on Access, Use and Promotion of the Rational Use of Medicines - Component Evaluation of the Basic Pharmaceutical Assistance Service. The users of the Unified Health System, those responsible for dispensing medications in public health units in Primary Care, public doctors, the person responsible for pharmaceutical assistance in the municipality, and the representative of the municipal health secretary were interviewed. The results showed that there were shortages of medicines and supplies in the last 12 months and probably they are related to: absence of a Municipal Drug List and Therapeutic Pharmacy Commission, prescription of medicines by trade names, redirection of the Basic Assistance Component Pharmaceutical funds, lack of auxiliaries for those responsible for dispensing drugs, and the excessive financial resources used in legal demands. Management actions that aim to correct the mentioned flaws, can help in the improvement of the health field, with the optimized commitment of resources and consequent complete attention to the needs of the users of the health system.

Pigment production by Fusarium solani BRM054066 and determination of antioxidant and anti-inflammatory properties.

The fungal kingdom has been widely studied as a source of bioactive compounds of interest to the pharmaceutical and food industry. This paper studies the production of natural red pigments by Fusarium solani BRM054066 in the submerged fermentation system, using Doehlert experimental design to determine optimal cultivation conditions. The chemical composition of the red pigment was determined by Nuclear Magnetic Resonance spectroscopy (NMR) and Ultra-Performance Liquid Chromatography coupled to Mass Spectrometry (UPLC-MS). Antioxidant activity was assessed by the ability to sequester of free radical DPPH. In the analysis of anti-inflammatory activity, murine peritoneal macrophages activated by LPS were used, and the gene expression of TNF-α, IL-1ß, IL-6, IL-10 and IL-17 was determined using qPCR. As a result, it was found that agitation at 200 rpm and glucose concentration ≥ 20 g/L promote the best results in the production of red pigment. The chemical compounds identified were two naphthoquinones, fusarubin and dihydrofusarubin, and an anthraquinone, a bostrycoidin, being fusarubin the majority compound. The red pigment showed antioxidant activity by scavenge 50% of the DPPH radical, in a concentration of 24 µg/mL. The pigment also showed an effective anti-inflammatory capacity by reducing the overexpression of the pro-inflammatory cytokines TNF-α, IL-1ß and IL-6 and promoting the production of anti-inflammatory IL-10 and IL-17, in murine macrophages activated by LPS (p < 0.05). According to the results, the fungus F. solani BRM054066, under optimized conditions of cultivation, proved to be a promising source of biologically active natural pigments with wide industrial applicability.

Chemical features and antioxidant profile by Schizophyllum commune produced on different agroindustrial wastes and byproducts of biodiesel production.

Schizophyllum commune VE_07 was produced in different culture media containing pine sawdust (PS), grape residue (GR), cotton cake (CC) and jatropha seed cake (JC). The content of phenolics and antioxidant activity were determined for the substrates and mushrooms produced. The content of ß-glucans and the composition of S. commune were also evaluated. The medium formulated with 94% grape residue enabled the highest values of yield, biological efficiency, and productivity. Mushrooms grown in this condition showed the highest value (13.14%) of ß-glucans. The contents of proteins and dietary fibre were 16.59% and 59.61%, respectively. Mushrooms grown in cotton cake showed the highest phenolic content (291.51 ± 1.83 mg GAE/ 100 g mushroom) and antioxidant activity (58.15 ± 0.86 DPPH % scavenging). The results obtained indicate that substrate composition affected the production of S. commune and its chemical composition.

Experiential education in the pharmacy undergraduate curricula in Brazil.

OBJECTIVE: Considering the curriculum reform process taking place in pharmacy undergraduate programs in Brazil and the importance of practical experience to students throughout their learning process in university, this study aims to provide an overview of pharmacy undergraduate programs in Brazil and their respective internships. METHODS: An observational, descriptive, cross-sectional study. A documentary analysis of pharmacy undergraduate programs in the face-to-face modality was carried out, with data obtained from the Political Pedagogical Projects of the programs, the curricula, and course descriptions containing information on internships, all provided by the Brazilian Ministry of Education. The data collected concerned higher education institutions (HEIs), pharmacy programs and internships. RESULTS: Pharmacy undergraduate programs in Brazil have a median duration of 10 semesters, requiring from students a median of 6 internships, from the 6th semester on, totalizing 826 hours. The programs lack uniformity among their internships, mainly regarding total hours and the semester in which internships start. The pharmacy internships cover, in greater number, the areas of outpatient and community pharmacy, clinical analysis, and pharmaceutical technology, respectively, being clinical analysis the area with more hours. Public and private HEIs have different internship proceedings in their curricula, hence no homogeneity among them in the different regions of Brazil. CONCLUSIONS: This study demonstrates the diversity of pharmacy programs in Brazil in the context of internships, reflecting on the training and the activity of pharmacists in recent decades. Further studies are needed to deepen the understanding of this theme.

Tools to prioritize outpatients for pharmaceutical service: A scoping review.

BACKGROUND: The performance of pharmacists in clinical services contributes to improving outcomes in patient drug therapy. In the context of streamlined resources and high health services' demand, the use of patient selection tools can screen those who would benefit more from a pharmaceutical service. OBJECTIVE: This review aims to map and describe tools developed for patient selection for pharmaceutical services delivered in primary health care and outpatient settings. METHODS: The search was conducted in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and the Latin American and Caribbean Health Sciences. The search strategy included terms relating to patient selection and outpatient pharmaceutical service. We included papers on outpatient settings, and which described the tool developed for the selection of a patient for pharmaceutical service. Two reviewers extracted data of each study concerning the types and items making up the tool. The items composing the tools were grouped into categories. RESULTS: Twelve studies were included in the literature. Most of the studies were developed in the United States (53.8%), followed by Canada (30.8%). Approximately half of the studies developed tools for selecting patients for a medication review (46.2%), and only 15.4% for drug therapy management. Identification of patients at risk of drug-related problems, the need for pharmaceutical service follow-up, and patients at risk of hospital readmission were the main objective to develop the tools. In total, 92.3% of the developed tools had items related to drug therapy complexity, 76.9% to comorbidities and 61.5% to adherence/subjective aspects. Statistical methods were employed to evaluate the validation parameters, such as the ROC curve and internal consistency. CONCLUSIONS: Few studies that developed tools to select outpatients for pharmaceutical services were found. However, many tools showed unsatisfactory validation parameters. Thus, it is necessary to improve the development of instruments that can identify patients who would benefit from the pharmaceutical service accurately.

Experiential education in the pharmacy undergraduate curricula in Brazil

OBJECTIVE: Considering the curriculum reform process taking place in pharmacy undergraduate programs in Brazil and the importance of practical experience to students throughout their learning process in university, this study aims to provide an overview of pharmacy undergraduate programs in Brazil and their respective internships. METHODS: An observational, descriptive, cross-sectional study. A documentary analysis of pharmacy undergraduate programs in the face-to-face modality was carried out, with data obtained from the Political Pedagogical Projects of the programs, the curricula, and course descriptions containing information on internships, all provided by the Brazilian Ministry of Education. The data collected concerned higher education institutions (HEIs), pharmacy programs and internships. RESULTS: Pharmacy undergraduate programs in Brazil have a median duration of 10 semesters, requiring from students a median of 6 internships, from the 6thsemester on, totalizing 826 hours. The programs lack uniformity among their internships, mainly regarding total hours and the semester in which internships start. The pharmacy internships cover, in greater number, the areas of outpatient and community pharmacy, clinical analysis, and pharmaceutical technology, respectively, being clinical analysis the area with more hours. Public and private HEIs have different internship proceedings in their curricula, hence no homogeneity among them in the different regions of Brazil. CONCLUSIONS: This study demonstrates the diversity of pharmacy programs in Brazil in the context of internships, reflecting on the training and the activity of pharmacists in recent decades. Further studies are needed to deepen the understanding of this theme

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The use of psychotropic medications and non-pharmacological approaches in everyday life: a qualitative study of the lived experience / O uso de medicamentos psicotrópicos e abordagens não farmacológicas na vida cotidiana: um estudo qualitativo da experiência vivida / L'usage de médicaments psychotropes et approches non pharmacologiques dans la vie quotidienne: une étude qualitative de l'experience vécue / El uso de medicamentos psicotrópicos y abordajes no farmacológicos en la vida cotidiana: um estudio cualitativo de la expericncia vivida

Increased consumption of psychotropic drugs has been noted in Brazil and other Western countries in the last few decades for different reasons. The objective of this study was to understand the lived experience of individuals who used psychotropic drugs to cope with the problems faced in daily life. A qualitative study guided by hermeneutic phenomenology was carried out. In-depth interviews were conducted. The experience was grouped into two themes: experience of using psychotropic and the search for non-pharmacological approaches. Psychotropics were considered necessary for regaining a point of equilibrium when the problems faced were recognized as having a high degree of difficulty. In some cases, the drugs were perceived as insufficient for solving the problem, leading or not to the search for alternatives to deal with the difficulty.

O aumento do consumo de psicotrópicos tem sido observado no Brasil e em outros países ocidentais nas últimas décadas, por diferentes razões. O objetivo deste estudo foi compreender a vivência de indivíduos que utilizaram psicotrópicos para lidar com os problemas enfrentados no cotidiano. Um estudo qualitativo guiado pela fenomenologia hermenêutica foi realizado, agrupando-se o resultado em dois temas: experiência com o uso dos psicotrópicos e busca por abordagens não farmacológicas. Os psicotrópicos foram considerados necessários para recuperar um ponto de equilíbrio quando se reconheceram os problemas enfrentados como tendo alto grau de dificuldade. Em alguns casos, os fármacos foram percebidos como insuficientes para solucionar o problema, levando ou não à busca de alternativas para lidar com as dificuldades.

Au cours des dernières décennies, on a observé l'augmentation de la consommation de médicaments psychotropes au Brésil et dans d'autres pays occidentaux pour différentes raisons. L'objectif de cette étude est de comprendre le vécu d'individus qui ont utilisé les psychotropes pour faire face aux problèmes de la vie quotidienne. Une étude qualitative, guidée par la phénoménologie herméneutique, a été réalisée. Le résultat a été divisé en deux thèmes: l'expérience découlant de l'usage de psychotropes et la recherche d'approches non pharmacologiques. Les psychotropes ont été considérés nécessaires pour récupérer un point d'équilibre lorsque les problèmes vécus ont été reconnus comme ayant un degré élevé de difficulté. Dans certains cas, les médicaments se sont révélés insuffisants pour résoudre le problème, entraînant ou pas la recherche d'alternatives pour faire face aux difficultés.

En las últimas décadas y por diferentes razones, se ha observado en Brasil y en otros países occidentales un aumento en el consumo de psicotrópicos. El objetivo de este estudio fue comprender la vivencia de individuos que utilizaron psicotrópicos para enfrentar los problemas del día a día. Se realizó un estudio cualitativo dirigido por la fenomenología hermenéutica. El resultado fue agrupado en dos temas: experiencia con el uso de los psicotrópicos y la búsqueda de enfoques no farmacológicos. Los psicotrópicos fueron considerados necesarios para recuperar un punto de equilibrio cuando los problemas enfrentados fueron reconocidos como problemas de alto grado de dificultad. En algunos casos, los fármacos fueron percibidos como insuficientes para solucionar el problema, llevando o no a la búsqueda de alternativas para enfrentar las dificultades.

In den letzten Jahrzehnten wird ein steigender Konsum von Psychotropika in Brasilien und in anderen westlichen Ländern festgestellt, der auf verschiedenen Faktoren beruht. Ziel dieser Untersuchung war es, die Lebensweise von Personen zu verstehen, die psychotropische Medikamente benutzen, um Alltagsprobleme zu meistern. Basierend auf der hermeneutischen Phänomenologie wurde dazu eine qualitative Untersuchung durchgeführt. Das Ergebnis wurde in zwei Themen eingeteilt: Erfahrungen mit der Benutzung von Psychotropika und die Suche nach nicht-pharmakologischen Ansätzen. Die Psychotropika wurden als notwendig betrachtet, um ein Gleichgewicht wiederherzustellen, wenn Probleme mit hohem Schwierigkeitsgrad zu meistern waren. In einigen Fällen wurden diese als unzureichend empfunden, was zur Suche nach Alternativen führte, um mit diesen Problemen umzugehen.

Chemical features and bioactivity of grain flours colonized by macrofungi as a strategy for nutritional enrichment.

Agaricus blazei, Auricularia fuscosuccinea and Pleurotus albidus mycelia were obtained in solid-state cultivation (SSC), using grains (brown rice, canjica corn and wheat) as raw material. Colonized grain flours were analysed for their nutritional, physical and physico-chemical characteristics and biological activity in vitro. Wheat flour with P. albidus showed higher values for protein (18.34 g/100 g), ergosterol (0.60 mg/g), mycelial biomass (183 mg/g) and total amino acids (58.34 mg/g). Corn flour with A. fuscosuccinea showed the highest total phenolic content (2.38 mg GAE/g), antioxidant activity in the 1,1-diphenyl-2-picrylhydrazyl (DPPH) (8.90 µmol TEAC/g) and 2,2'-Azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) (16.52 µmol TEAC/g) assay. Wheat flour with P. albidus were more effective at inhibiting of pancreatic lipase (74.5%) and of α-glucosidase (98.2%). In conclusion, grains colonized by macrofungi mycelia through SSC can enrich the nutritional value and the biological activity of the flours, which presents a potential for functional foods.

Complexidades do trabalho do agente comunitário de saúde com pacientes em uso de medicamentos / Community health agents and the complexities of the working with patients using medicines / Complejidad del trabajo del agente comunitário de salud con pacientes en uso de medicamentos

Resumo Os agentes comunitários de saúde representam importante elemento na gestão de informações sobre o uso de medicamentos na atenção primária, melhorando a interação da equipe de saúde com a comunidade. O objetivo do estudo foi revelar como o uso de medicamentos está presente na rotina deles e compreender as relações que se estabelecem entre agentes, usuários e equipe. Tratou-se de um estudo qualiquantitativo, com utilização de observação participante, entrevista semiestruturada e grupo focal. Foi desenvolvido em três unidades básicas de saúde em um município de Minas Gerais no período de março de 2013 a fevereiro de 2015. Os resultados revelaram que os agentes se relacionam constantemente com usuários que vivenciam problemas com o uso de medicamentos e apresentam dúvidas sobre suas indicações, efeitos esperados, reações adversas, entre outras. Eles realizam algumas intervenções diretamente com o usuário, porém preferem encaminhar os casos à equipe de saúde. Alguns agentes referiram-se ao farmacêutico como profissional de referência no tocante ao uso de medicamentos, mas a procura por esse profissional mostrou-se baixa pelos sujeitos do estudo. Ressalta-se a importância da formação do agente sobre utilização de medicamentos para instrumentalizá-los no reconhecimento de situações inadequadas, no desenvolvimento de intervenções com a equipe de saúde e no acompanhamento dos usuários.

Abstract The community health agents are an important element in the management of medication information in primary healthcare setting, improving healthcare team interaction with the community. The aim of this study was to reveal how the use of medicines is present in the routine of agentes and understand the relationships established between agents, users and healthcare team. This is a quantitative and qualitative study, using participant observation, semi-structured interview and focus group. This study was conducted at three basic health units in a municipality of Minas Gerais, Brazil, between March, 2013 and February, 2015. The results show that agents constantly relate with patients who experience drug therapy problems and have doubts about the indication, effects, adverse drug reactions, among other. They perform some interventions directly with the patient, but usually they prefer to refer cases to the healthcare team. Some agents said recognizing the pharmacist as a reference on medicines, but the demand for this professional was low by the subjects of this study. We emphasize the importance of the agents training on medication use to instrumentalize them to recognize problematic situations, to develop interventions with the support of the healthcare team and to follow up patients using medicines.

Resumen El agente comunitario de salud representa um elemento importante en la gestión de la información sobre el uso de medicamentos en la atención primaria, mejorando la interacción del equipo de salud con la comunidad. El objetivo de este estudio fue revelar cómo el uso de medicamentos está presente en la rutina de los agentes y entender las relaciones que se establecen entre agentes, usuarios y equipo de salud. Se trata de un estudio cuantitativo y cualitativo, utilizando la observación participante, entrevista semi-estructurada y grupos focales. Lo studio fue desenvolvido en tres unidades básicas de salud en um municipio de Minas Gerais, Brasil, en el período de marzo de 2013 a febrero de 2015. Los resultados muestran que los agentes se relacionan constantemente con usuarios que experimentan problemas con el uso de medicamentos y que tienen dudas acerca de la indicación de medicamentos, los efectos esperados, las reacciones adversas, entre otros. Los agentes realizan algunas intervenciones directamente con el usuario, no obstante prefieren referir los casos para el equipo de salud. Algunos agentes se refieren al farmacéutico como profesional de referencia con respecto al uso de medicamentos, sin embargo, la demanda de estos profesionales por los sujetos de este estudio fue baja. Se resalta la importancia de la formación de los agentes sobre el uso de medicamentos, para darles instrumentos en el reconocimiento de situaciones inadecuadas, el desarrollo de intervenciones con el equipo de salud y el seguimiento de los usuarios.