Automedicação em usuários da Atenção Primária à Saúde: motivadores e fatores associados / Self-medication in users of Primary Health Care: motivators and associated factors

Introdução: a automedicação pode aliviar sintomas e doenças agudas por um menor custo. Entretanto, esse consumo de medicamentos por conta própria e sem orientação adequada pode acarretar prejuízos como terapêuticas inadequadas, intoxicações e dependência. Objetivo: estimar a prevalência, os motivadores e os fatores associados à automedicação em adultos e idosos atendidos na Atenção Primária à Saúde (APS). Métodos: estudo transversal realizado de maio a agosto de 2019. A estatística compreendeu o cálculo da prevalência de automedicação, com período recordatório de 30 dias e seu intervalo de confiança de 95% (IC 95%). Para verificação dos fatores ajustados, foram calculadas as Razões de Prevalência (RP), brutas e ajustadas. Resultados: a amostra foi de 1.365 usuários, com prevalência do desfecho de 55% (IC 95%: 53-58), sendo esta maior em mulheres (RP=1,33; IC 95%: 1,17-1,52), adultos (RP=1,27; IC 95%: 1,14-1,41) e naqueles com 12 anos ou mais de estudo (RP=1,22; IC 95%: 1,09-1,37). Os principais motivadores foram dor (89%), gripe, resfriado e dor de garganta (18,9%) e febre (6,9%). Conclusão: verificou-se prevalência importante de automedicação, especialmente em mulheres, jovens e com maior escolaridade. Considerando os riscos, destaca-se a necessidade de políticas públicas para prevenir o uso indiscriminado de medicamentos.

Introduction: self-medication can relieve symptoms and diseases at a lower cost. However, this can lead to losses such as inappropriate therapies, intoxications and dependence. Objective: to estimate the prevalence, motivators and factors associated with self-medication in adults and the elderly treated in Primary Health Care. Methods: cross-sectional study carried out from May to August 2019. The statistics comprised the calculation of the prevalence of self-medication, with a recall period of 30 days and its 95% confidence interval (95% CI). In order to check the adjusted factors, crude and adjusted Prevalence Ratios (PR) were calculated. Results: the sample consisted of 1,365 users, with an outcome prevalence of 55% (95% CI: 53-58), which was higher in women (PR = 1.33; 95% CI: 1.17-1.52), adults (PR = 1.27; 95% CI: 1.14-1.41) and in those with 12 or more years of study (PR = 1.22; 95% CI: 1.09-1.37). The main motivators were pain (89%), flu, cold and sore throat (18.9%) and fever (6.9%). Conclusion: there was an important prevalence of self-medication, especially in women, young people and those with higher education. Considering the risks, the need for public policies to prevent the indiscriminate use of medicines is highlighted.

Prevalência de sobrecarga em cuidadores de idosos assistidos na Atenção Primária à Saúde / Prevalence of burden in elderly caregivers assisted in Primary Health Care

Objetivo: avaliar a sobrecarga dos cuidadores de idosos assistidos na atenção primária à saúde. Método: trata-se de um estudo transversal realizado com cuidadores de idosos adstritos da Estratégia de Saúde a Família, Marau, Rio Grande do Sul. Para a coleta de dados utilizou-se um questionário sociodemográfico, Escala de Katz e Escala de Zarit Burden Interview. Os dados foram duplamente digitados e posteriormente analisados no software PSPP versão 1.2.0-1. A distribuição do desfecho de acordo com as variáveis independentes foi verificada por meio do teste de Qui-quadrado, usando-se significância estatística de 5%. Resultados: o estudo demonstrou a predominância de cuidadores do sexo feminino (83,8%), adultos e com cônjuge (78,4%). Considerando o grau de parentesco, 64,9% eram filhos e 35,1% eram outros, como, esposo(a), genro, nora, sobrinho(a)s e observou-se que 16,2% utilizavam ansiolíticos e 43,2%, antidepressivos. Os cuidadores que compuseram a amostra atuavam na função há mais de 5 anos (59,5%), trabalhando 10 horas ou mais diariamente (54,1%) e não sobrando tempo para lazer (56,8%). Verificou-se a prevalência de sobrecarga entre os cuidadores equivalente a 56,8%, sendo que 76,2% dos cuidadores que não exerciam nenhuma atividade de lazer, apresentaram sobrecarga (p=0,01). Considerações finais: verificou-se que a maior parte da população apresentou níveis preocupantes de sobrecarga.

Glyphosate-based herbicide affects biochemical parameters in Rhamdia quelen (Quoy & Gaimard, 1824 and) Leporinus obtusidens (Valenciennes, 1837)

Rhamdia quelen (silver catfish) and Leporinus obtusidens (piava) were exposed to a commercial formulation Roundup(r), a glyphosate-based herbicide at concentrations of 0.2 or 0.4 mg/L for 96 h. The effects of the herbicide were analyzed on the alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities and glucose in plasma, glucose and protein in the mucus layer, nucleotide hydrolysis in the brain, and protein carbonyl in the liver. The parameters were chosen, owing to a lack of information concerning integrated analysis, considering oxidative damage parameters, liver damage, and effects on the mucus layer composition and triphosphate diphosphohydrolase (NTPDase) activities. Plasmatic glucose levels were reduced in both species, whereas the transaminase activities (ALT and AST) increased after exposure to the herbicide. Herbicide exposure increased protein and glucose levels in the mucus layer in both species. There was a reduction in both NTPDase and ecto-5'-nucleotidase activity in the brain of piava, and increased enzyme activity in silver catfish at both concentrations tested. The species showed an increase in protein carbonyl in the liver after exposure to both concentrations of the glyphosate. Our results demonstrated that exposure to Roundup(r) caused liver damage, as evidenced by increased plasma transaminases and liver protein carbonyl in both of the fish species studied. The mucus composition changed and hypoglycemia was detected after Roundup(r) exposure in both species. Brain nucleotide hydrolysis showed a different response for each fish species studied. These parameters indicated some important and potential indicators of glyphosate contamination in aquatic ecosystems.

Rhamdia quelen (jundiá) e Leporinus obtusidens (piava) foram expostos a formulação comercial Roundup(r), um herbicida a base de glifosato nas concentrações de 0,2 e 0,4 mg/L por 96h. Os efeitos do herbicida foram analisados na atividade da alanina aminotransferase (ALT), aspartato aminotransferase (AST) e glicose no plasma, glicose e proteína na camada de muco, hidrólise de nucleotídeos no cérebro e a proteína carbonil no fígado. Os parâmetros foram escolhidos devido à falta de informação com relação a análises integradas, considerando parâmetros oxidativo, danos no fígado, efeitos na composição da camada do muco e atividade da trifosfato difosfoidrolase (NTPDase). Níveis de glicose plasmática foram reduzidos em ambas às espécies, enquanto a atividade das transaminases (ALT e AST) aumentou após exposição ao herbicida. A exposição ao herbicida aumentou a proteína e níveis de glicose na camada de muco em ambas as espécies. Houve uma redução em ambas atividades de NTPDase e ecto-5'-nucleotidase no cérebro de piava, e um aumentou a atividade destas enzimas em jundiás em ambas as concentrações testadas. As espécies mostraram um aumento na proteína carbonil no fígado após exposição a ambas as concentrações de glifosato. Nossos resultados demonstraram que a exposição ao Roundup(r) causou danos no fígado, como evidenciado pelo aumento das transaminases plasmáticas e proteína carbonil no fígado em ambas as espécies de peixes estudadas. A composição do muco alterou e uma hipoglicemia foi detectada após a exposição ao Roundup(r) em ambas espécies. A hidrólise de nucleotídeos em cérebro mostrou diferente resposta para cada espécie estudada. Esses parâmetros indicam alguns importantes e indicadores potenciais da contaminação do glifosato no ecossistema aquático.

Acute exposure to glyphosate herbicide affects oxidative parameters in piava (Leporinus obtusidens).

In recent years, commercial glyphosate herbicide formulations have been widely used in agriculture to control aquatic weeds. These pesticides may result in disruption of ecological balance, causing damage to nontarget organisms including fish. Teleostean fish (Leporinus obtusidens) were exposed to commercial glyphosate herbicide formulation at 0 (control), 3, 6, 10 or 20 mg L(-1) for 96 h. The effects of herbicide on plasmatic metabolic parameters, thiobarbituric acid reactive substances (TBARS), catalase activity, protein carbonyl, and mucus layer parameters were studied. Plasmatic glucose and lactate levels increased but protein levels showed reduction after herbicide exposure. TBARS levels in brain showed a reduction at all tested concentrations. However, liver demonstrated increased TBARS levels at all tested concentrations, whereas in white muscle TBARS production did not change after exposure to herbicide. Fish exposed to all concentrations of glyphosate showed increase in liver catalase activity and protein carbonyl. Herbicide exposure increased protein and carbohydrate levels of the mucus layer at all tested concentrations. The present results showed that, in 96 h, glyphosate changed toxicological parameters analyzed in piava. Parameters measured in this study may be useful in environmental biomonitoring.

Biochemical effects of clomazone herbicide on piava (Leporinus obtusidens).

This study aims to verify the effects of the clomazone concentration used in rice fields on acetylcholinesterase (AChE), thiobarbituric acid reactive substances (TBARS), protein carbonyl and catalase activity in tissues of piava (Leporinus obtusidens). LC(50)-96h was 5.0 mg L(-1) and the fish were exposed to 1/10 of LC(50)-96 h: 0.5 mg L(-1) of clomazone for 96 and 192h. The same parameters were also assayed after a recovery period of 192 h in clean water. AChE activity was reduced only in the brain and heart of fish exposed for 96 h. AChE activity was decreased in the brain, muscle and heart tissues after 192 h of exposure. After 192 h of recovery period, AChE activity remained diminished in brain and muscle and showed a decrease in eye. However, after 192 h of recovery, AChE activity in heart was recovered. Fish showed increased TBARS levels in brain at all experimental periods. TBARS levels decreased in liver and muscle tissues after 192 h of exposure. The increase in muscle TBARS persisted in fish transferred to clean water. Protein carbonyl in the liver was increased in all periods studied including the recovery period. Catalase activity was reduced during all periods. The present study demonstrates the occurrence of disorders in AChE, TBARS, protein carbonyl and catalase activity in piava. The results also show changes in fish after exposure to an environmentally relevant concentration of clomazone. Most effects observed persisted after the recovery period. Thus, these parameters may be used to monitor clomazone toxicity in fish.

The 2,4-D herbicide effects on acetylcholinesterase activity and metabolic parameters of piava freshwater fish (Leporinus obtusidens).

The effects of 2,4-D (1 or 10 mg/L) on acetylcholinesterase (AChE) and metabolic parameters were evaluated in piava (Leporinus obtusidens) after 96 h. AChE activity was significantly reduced in the brain at a concentration of 10 mg/L and in the muscle at both concentrations tested. Muscle glycogen and lactate were significantly reduced for both 2,4-D concentrations but no significant change was observed in liver glycogen. Muscle protein levels were enhanced after exposure at 10 mg/L, but no significant changes were observed in muscle and liver glucose. Liver lactate and protein were significantly reduced after exposure to this herbicide. 2,4-D exposure produced a decrease in blood glucose at both concentrations and enhanced lactate levels at 10mg/L. Plasma protein increased at both concentrations tested. In conclusion, the results obtained indicate that 2,4-D affects brain and muscle AChE activity and some blood and tissue metabolic parameters of L. obtusidens. The stress generated by 2,4-D is the probable cause of alterations observed and measured parameters can be used to monitor 2,4-D fish toxicity.

Acute effects of glyphosate herbicide on metabolic and enzymatic parameters of silver catfish (Rhamdia quelen).

Silver catfish (Rhamdia quelen; Teleostei) were exposed to commercial formulation Roundup, a glyphosate herbicide: 0 (control), 0.2 or 0.4 mg/L for 96 h. Fish exposed to glyphosate showed an increase in hepatic glycogen, but a reduction in muscle glycogen at both concentrations tested. Glucose decreased in liver and increased in muscle of fish at both herbicide concentrations. Glyphosate exposure increased lactate levels in liver and white muscle at both concentrations. Protein levels increased in liver and decreased in white muscle while levels of ammonia in both tissues increased in fish at both glyphosate concentrations. Specific AChE activity was reduced in brain after treatments, no changes were observed in muscle tissue. Catalase activity in liver did not change during of exposure. Fish exposed to glyphosate demonstrated increased TBARS production in muscle tissue at both concentrations tested. For both glyphosate concentrations tested brain showed a reduction of TBARS after 96 h of exposure. The present results showed that in 96 h, glyphosate changed AChE activity, metabolic parameters and TBARS production. The parameters measured can be used as herbicide toxicity indicators considering environmentally relevant concentration.

Effects of four rice herbicides on some metabolic and toxicology parameters of teleost fish (Leporinus obtusidens).

Effects of different herbicides on acetylcholinesterase (AChE), catalase and TBARS formation in teleost fish (Leporinus obtusidens) were studied. Fish were exposed during 30 days at concentrations of herbicides used in rice field. AChE activity in the brain decreased significantly after exposure to the herbicides clomazone and quinclorac. However, AChE activity increased significantly in muscle tissue after exposure to clomazone, propanil and metsulfuron methyl. Fish exposed to quinclorac, propanil and metsulfuron methyl showed TBARS decreased levels in brain and muscle tissues. However, TBARS and catalase activity increased in liver tissue after clomazone and propanil exposure. This study pointed out long-term effects on AChE activity, oxidative stress and antioxidant enzyme catalase in tissues of L. obtusidens after exposure to environmentally relevant concentrations of rice field herbicides. These parameters have been used to monitor fish toxicity in rice field system.

Effect of clomazone herbicide on biochemical and histological aspects of silver catfish (Rhamdia quelen) and recovery pattern.

The effects of the herbicide, clomazone, on acetylcholinesterase (AChE), catalase and TBARS formation in teleost fish (Rhamdia quelen) were studied. The fish were exposed to 0.5 or 1.0 mg L(-1) of clomazone for 12, 24, 48, 96 and 192 h. After 192 h of exposure period, fish were transferred to clean water and kept in the same for 192 h to study the recovery response. Same parameters as that of exposure period were assayed after 96 and 192 h of recovery period. Specific AChE activity was reduced in the brain and muscle after treatments, reaching a maximum inhibition of 47% in the brain and 45% in the muscle after 12h of exposure. Fish exposed to clomazone increased TBARS production in the liver for all exposure periods. The brain presented elevated TBARS levels after 12, 24 and 48 h, but after 96 and 192 h, these levels decreased. The decrease of TBARS levels persisted in brain tissue after 96 h of recovery and returned to the control value after 192 h in clean water. Catalase activity was reduced for all periods of exposure. Histological analysis showed vacuolation in the liver after herbicide exposure. Some of the alterations observed were completely restored after recovery period.

Effect of glyphosate herbicide on acetylcholinesterase activity and metabolic and hematological parameters in piava (Leporinus obtusidens).

In this study, teleostean fish Leporinus obtusidens (piava) were exposed to different concentrations of Roundup, a glyphosate (acid equivalent) herbicide: 0 (control), 3, 6, 10, and 20 mg/L for 96 h (short-term). Acetylcholinesterase (AChE) activity was verified in brain and muscle tissues. Metabolic parameters in the liver and muscle (lactate, glycogen, glucose, protein, and ammonia), as well as some hematological parameters, were determined. Unexposed fish exhibited significantly higher brain AChE activity when compared to that of the muscle (P<0.05) (13.8+/-0.76 and 6.1+/-1.31 micromol/min/g protein, respectively). Results indicated that AChE activity significantly decreased in the brain of fish exposed to all glyphosate concentrations tested, but in the muscle this parameter was not altered. In addition, fish exposed to all glyphosate concentrations showed a significant increase in hepatic glycogen and glucose, but a significant reduction in muscle glycogen and glucose. Lactate and protein of fish exposed to all glyphosate concentrations presented a significant decrease in the liver, but did not change significantly in the muscle. Levels of ammonia in both tissues increase in fish at all glyphosate concentrations. Exposure to this herbicide produced a decrease in all hematological parameters tested. These results indicate that AChE activity as well as metabolic and hematological parameters may be good early indicators of herbicide contamination in L. obtusidens.

Effects of clomazone herbicide on hematological and some parameters of protein and carbohydrate metabolism of silver catfish Rhamdia quelen.

The effects of clomazone (0.5 and 1.0 mg/L) according to nominal concentrations used in paddy rice fields (0.4-0.7 mg/L) on protein and carbohydrate metabolism and haematological parameters were evaluated in silver catfish (Rhamdia quelen) after 12, 24, 48, 96 and 192 h of exposure with a recovery period of 96 and 192 h. Liver glycogen increased significantly (P<0.05) in all periods and concentrations tested. The maximum glycogen increase reaches 250% after 12h of exposure. Muscle glycogen reduced significantly after 24, 48, 96 and 192 h for both clomazone concentrations (P<0.05). Significantly elevated plasma glucose values (P<0.05) and variation in glucose in the liver and muscle of exposed fish were observed. Muscle lactate levels increased after 12, 24 and 48 h of clomazone exposure (22-67%), but reduced in the liver (P<0.05). Protein levels were enhanced in the liver and white muscle, except at 96 and 192 h of exposure, whereas it increased in the plasma in the period from 48 to 96 h (P<0.05). Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities were significantly elevated in the plasma (P<0.05). In the liver, ALT increased after 24 h, while AST activity was enhanced only after 12 h of exposure. Hematocrit contents were reduced after 96 and 192 h of exposure. Most of the metabolic disorders observed did not persist after the recovery period, except for the liver AST and ALT activity. Clomazone concentrations used in this study appear safe to fish, Rhamdia quelen, because overall parameters can be recovered after 96 and 192 h in clean water. ALT and AST activity may be an early biomarker of clomazone toxicity.