Learning demands of diabetes self-management: a qualitative study with people who use insulin.

OBJECTIVE: to understand the experiences with diabetes mellitus management of people who use insulin, in order to identify possible factors that may influence adherence to self-care and thus define their learning demands for diabetes self-management. METHOD: this is a qualitative study carried out using individual semi-structured interviews online. The interviews were recorded, transcribed and evaluated using Atlas.ti® software by means of Thematic Content Analysis, using the Health Beliefs Model as a theoretical framework. RESULTS: 11 people living with diabetes and using insulin took part in the study. Four categories were identified: understanding diabetes, how to deal with diabetes, difficulties related to insulin use and emotional adaptation. CONCLUSION: the perception of the severity of the disease, its complications and the benefits of adhering to treatment positively influences adherence to self-care behaviors. Although the study participants have lived with diabetes for many years, they are not exempt from difficulties related to insulin use and disease management, reinforcing the importance of continuing health education. In this sense, the findings of this study guide important educational themes to be worked on by health professionals to promote autonomy in diabetes self-management. BACKGROUND: (1) Perceived severity of diabetes positively influences self-care. (2) Continued health education for people who use insulin is essential. (3) The importance of recognizing the benefits of insulin in adherence to treatment. (4) Emotional aspects in diabetes management should be considered in health education.

Barriers and enablers to deprescribing benzodiazepines in older adults: elaborating an instrument and validating its content / Facilitadores e dificultadores do processo de desprescrição de benzodiazepínicos em idosos: elaboração de um instrumento e validação de seu conteúdo

OBJECTIVE: To elaborate and validate an instrument on barriers and enablers to deprescribing benzodiazepines in the patient's perspective. METHODS: This study was conducted in 3 stages: (1) a methodological stage, (2) a semi-structured pilot interview with 25 older adults undergoing clonazepam deprescribing, and (3) content validation with the Delphi technique. Content validation was performed by 50 specialists with degrees and/or experience with primary health care and/or health care of older adults, such as physicians, pharmacists, and nurses. For evaluating the obtained results, we analyzed the concordance of evaluations with the coefficient of content validity (CCV). We considered values equal to or higher than 0.8 as acceptable levels of concordance. RESULTS: The instrument was considered validated in the first round of evaluation, where all items obtained a CCV of more than 0.8 in the specialists' assessment. Nevertheless, they proposed improvements that were incorporated to the final version of the questionnaire. CONCLUSION: The instrument represents an important tool to be used by health care professionals for optimizing benzodiazepine deprescribing, with suitable levels of clarity and validity.

OBJETIVO: Elaborar e validar um instrumento sobre facilitadores e dificultadores do processo de desprescrição de benzodiazepínicos na perspectiva do paciente. METODOLOGIA: Estudo desenvolvido em três etapas, quais sejam: (1) metodológica, (2) entrevista piloto semiestruturada com 25 idosos em desprescrição de clonazepam e (3) validação de conteúdo por meio da técnica de Delphi. A validação deu-se por 50 especialistas com formação e/ou experiência na área da Atenção Primária à Saúde e/ou Saúde do Idoso, entre eles médicos, farmacêuticos e enfermeiros. Como medidas para avaliar os resultados obtidos, foi analisada a concordância da avaliação por meio do coeficiente de validade de conteúdo (CVC). Considerou-se como nível aceitável de concordância o valor maior ou igual a 0,8. RESULTADOS: O instrumento foi considerado validado na primeira rodada de avaliação, em que todos os itens avaliados obtiveram CVC superior a 0,8 na avaliação dos especialistas. Entretanto, estes propuseram sugestões de melhorias que foram incorporadas na versão final do questionário. CONCLUSÃO: O instrumento apresenta-se como uma importante ferramenta a ser utilizada pelos profissionais de saúde para a otimização do processo de desprescrição de benzodiazepínicos, possuindo índice de clareza e de validade adequados.

+ Literacia, melhor saúde: projeto de intervenção na Universidade Sénior de Sousel / + More literacy, better health: intervention project at the Sousel Senior University

A Literacia em Saúde [LS] abrange o conhecimento, a motivação e as competências das pessoas, para aceder, compreender, avaliar e aplicar informações sobre saúde levando a toma-das de decisão acerca dos cuidados de saúde, prevenção de doença e promoção da saúde, de forma a manter ou melhorar a sua qualidade de vida ao longo do ciclo de vida. Podemos considerar a LS como um desafio, mas também uma oportunidade, sendo a população idosa um grupo etário vul-nerável. Objetivo: Aumentar o nível de Literacia em Saúde dos alunos da Universidade Sénior de Sousel. Métodos: Foi realizado um projeto de intervenção "+ Literacia, Melhor Saúde", iniciado com a aplicação de questionário para avaliar o nível de LS, seguindo de intervenções com base na metodologia do planeamento em saúde, sendo a população os alunos da Universidade Sénior de Sousel [USS]. Resultados: Verificou-se uma elevada percentagem de nível de LS problemática e inadequada (76%). O projeto de intervenção teve boa adesão, e as metas e indicadores propostos foram atingidos. Conclusões: O projeto de intervenção pareceu demonstrar aumento dos níveis de literacia em saúde dos alunos da USS.

Health Literacy [HL] encompasses people`s knowledge, motivation and skills to access, understand, evaluate and apply health information leading to decision-making about health care, disease prevention and health promotion, in order to maintain or improve your quality of life throughout the life cicle. We can consider HL as a challenge, but also na opportunity, with the elderly population being a vulnerable age group. Objective: Increase the level of Health Literacy for students at the Sousel Senior University. Methods: An intervention project "+ Literacia, Melhor Saúde" was carried aut, started with the application of a questionnaire to assess the level of HL, followed by interventions based on the health planning methodology, with the population being students of the Sousel Senior University. Results: There was a higt percentage of problematic and inadequate HL level (76%). The intervention project had good adherence, and the proposed goals and indicators were achieved. Conclusions: The intervention project seemed to reveal an increasement in health literacy levels of students at the Senior University of Sousel.

Use of drugs for gastrointestinal disorders: evidence from National Survey on Access, Use and Promotion of Rational Use of Medicines.

Objective To estimate the prevalence of use of drugs to treat gastrointestinal disorders, according to demographic, socioeconomic, and health characteristics of the Brazilian population. Methods This is a population-based survey that interviewed individuals residing in cities of the five regions in Brazil. The study sample was composed of 32,348 individuals aged 20 or more years. The profile of use of drugs for gastrointestinal disorders was evaluated considering the variables sex, age, healthcare plan, region, and number of chronic diseases. We also analyzed the frequency of individuals who declared using other drugs, besides those already employed for treatment of gastrointestinal disorders. Additionally, the estimated frequencies of the drug classes used were determined. Results The prevalence of use of drugs for gastrointestinal disorders in Brazil was 6.9% (95% confidence interval - 6.4-7.6), higher in females, among persons aged over 60 years, in those who had a private healthcare insurance, and presented with two or more chronic diseases. It was noted that 42.9% of the aged who used drugs for gastrointestinal disorders were also on polypharmacy. As to the classes of drugs, 82% corresponded to drugs for the food tract and metabolism, particularly proton pumps inhibitors. Conclusion The use of drugs for treatment of gastrointestinal disorders was significant among women and elderly. In this age group, consumption may be linked to gastric protection due to polypharmacy. This study is an unprecedented opportunity to observe the self-reported consumption profile of these drugs in Brazil and, therefore, could subsidize strategies to promote their rational use.

Development and validation of an instrument to measure the professional's knowledge of dispensing medication (CDM-51) in community pharmacies.

Medication dispensing performed without the necessary information on proper use can result in harmful effects to the individual, and therefore providing this service with quality for the users is necessary to promote the rational use of medication; however, in a developing country this activity is performed largely by unqualified people and in an inappropriate way. This study aims to develop and validate a study instrument that measures the knowledge of medication dispensing for the professionals involved in this practice (pharmacist, pharmacy technician in the pharmacy, and clerk/assistant). The study has methodological design and is characterized by the development and validation of an instrument to measure the knowledge of dispensation. A questionnaire denominated CDM-51 was elaborated and divided in two parts: the first collects the socio-demographic characteristics of the participants, and the second has 51 questions to assess the knowledge construct regarding dispensation. The validity of content was realized through the evaluation by seven experts regarding the relevance and clarity of the items. A pretest and main validation study with 30 and 79 pharmacy professionals respectively, from the city of Ribeirão Preto in the Brazilian state of São Paulo were carried out, and questions presented to the respondents were corrected. The analysis of the internal consistency of the KR-20 (Kuder-Richardson) was 0.837, and validity construct evidence was found (p value: 0.001) that participants with formal education have greater knowledge of medication dispensing. This work contributes to increasing the quality of services provided by dispensing pharmacies and points out the importance of training for formal education to perform this service, thus promoting the rational use of medication.

INSAF-HAS: a tool to select patients with hypertension for pharmaceutical care.

OBJECTIVE: To develop and validate the content of a tool aimed to select patients with hypertension for pharmaceutical care, based on identification of individuals in greater need of attention. METHODS: The tool was developed and assessed for face and content validity, which was carried out in three stages. Phase I consisted of comprehensive literature review, which prompted the development of the first version of the tool. Phase II consisted of validation by an expert panel. Phase III consisted of a pilot study with hypertensive patients and preparation of the final version of the instrument. RESULTS: Literature review yielded 30 studies, out of which 13 factors associated with hypertension and cardiovascular disease control and complications were selected. Once the initial version of the tool named INSAF-HAS was obtained, four expert meetings were held, each leading to instrument improvement until a final consensus was reached. In the pilot study, INSAF-HAS was applied to 30 patients with a diagnosis of hypertension for applicability pretest; adjustments were made and the final version of INSAF-HAS obtained. CONCLUSION: The INSAF-HAS tool developed in this study has face and content validity, and may contribute to the selection of patients with hypertension in greater need of pharmaceutical care services.

INSAF-HAS: a tool to select patients with hypertension for pharmaceutical care / INSAF-HAS: ferramenta para seleção de pacientes com hipertensão arterial sistêmica e inserção em serviços de cuidado farmacêutico

ABSTRACT Objective To develop and validate the content of a tool aimed to select patients with hypertension for pharmaceutical care, based on identification of individuals in greater need of attention. Methods The tool was developed and assessed for face and content validity, which was carried out in three stages. Phase I consisted of comprehensive literature review, which prompted the development of the first version of the tool. Phase II consisted of validation by an expert panel. Phase III consisted of a pilot study with hypertensive patients and preparation of the final version of the instrument. Results Literature review yielded 30 studies, out of which 13 factors associated with hypertension and cardiovascular disease control and complications were selected. Once the initial version of the tool named INSAF-HAS was obtained, four expert meetings were held, each leading to instrument improvement until a final consensus was reached. In the pilot study, INSAF-HAS was applied to 30 patients with a diagnosis of hypertension for applicability pretest; adjustments were made and the final version of INSAF-HAS obtained. Conclusion The INSAF-HAS tool developed in this study has face and content validity, and may contribute to the selection of patients with hypertension in greater need of pharmaceutical care services.

RESUMO Objetivo Desenvolver e realizar a validação de conteúdo de uma ferramenta para seleção de pacientes com hipertensão arterial sistêmica a serem atendidos em serviços de cuidado farmacêutico, com base na identificação daqueles com maior necessidade dessa assistência. Métodos O instrumento foi desenvolvido e avaliado por validação de face e conteúdo, subdividida em três fases. A fase I abordou ampla revisão bibliográfica, que originou a versão inicial da ferramenta. Na fase II, realizou-se a validação com a análise de um painel de experts . A fase III foi composta por estudo piloto realizado com pacientes com hipertensão, tendo sido definida a versão final do instrumento. Resultados A partir da revisão bibliográfica, 30 estudos foram consultados, e foram selecionados 13 fatores associados ao controle e à ocorrência de complicações, relacionados à hipertensão arterial sistêmica e a doenças cardiovasculares. Por conseguinte, mediante a versão inicial da ferramenta intitulada INSAF-HAS, realizaram-se quatro reuniões com especialistas, para obtenção de consenso final. A cada encontro, o instrumento foi aprimorado. No estudo piloto, 30 pacientes com diagnóstico de hipertensão arterial sistêmica foram abordados para o pré-teste de avaliação da aplicabilidade e, após as adequações, obteve-se a versão final do INSAF-HAS. Conclusão A ferramenta elaborada INSAF-HAS apresenta validade de face e conteúdo. Ela deve contribuir para a seleção de pacientes portadores de hipertensão arterial sistêmica e com maior necessidade de participação em serviços de cuidado farmacêutico.

Use of drugs for gastrointestinal disorders: evidence from National Survey on Access, Use and Promotion of Rational Use of Medicines / Utilização de medicamentos para distúrbios gastrintestinais: evidências da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos

ABSTRACT Objective To estimate the prevalence of use of drugs to treat gastrointestinal disorders, according to demographic, socioeconomic, and health characteristics of the Brazilian population. Methods This is a population-based survey that interviewed individuals residing in cities of the five regions in Brazil. The study sample was composed of 32,348 individuals aged 20 or more years. The profile of use of drugs for gastrointestinal disorders was evaluated considering the variables sex, age, healthcare plan, region, and number of chronic diseases. We also analyzed the frequency of individuals who declared using other drugs, besides those already employed for treatment of gastrointestinal disorders. Additionally, the estimated frequencies of the drug classes used were determined. Results The prevalence of use of drugs for gastrointestinal disorders in Brazil was 6.9% (95% confidence interval − 6.4-7.6), higher in females, among persons aged over 60 years, in those who had a private healthcare insurance, and presented with two or more chronic diseases. It was noted that 42.9% of the aged who used drugs for gastrointestinal disorders were also on polypharmacy. As to the classes of drugs, 82% corresponded to drugs for the food tract and metabolism, particularly proton pumps inhibitors. Conclusion The use of drugs for treatment of gastrointestinal disorders was significant among women and elderly. In this age group, consumption may be linked to gastric protection due to polypharmacy. This study is an unprecedented opportunity to observe the self-reported consumption profile of these drugs in Brazil and, therefore, could subsidize strategies to promote their rational use.

RESUMO Objetivo Estimar a prevalência de utilização de medicamentos para o tratamento de distúrbios gastrintestinais, segundo características demográficas, socioeconômicas e de saúde da população brasileira. Métodos Trata-se de inquérito de base populacional, que entrevistou indivíduos residentes em municípios das cinco regiões do Brasil. A amostra deste estudo foi composta por 32.348 indivíduos de 20 anos ou mais de idade. Foi avaliado o perfil de utilização de medicamentos para distúrbios gastrintestinais entre as variáveis sexo, idade, plano de saúde, região e número de doenças crônicas. Analisou-se a frequência de indivíduos que declararam utilizar outros medicamentos, além daqueles já utilizados para tratamento de distúrbios gastrintestinais. Além disso, foram estimadas as frequências das classes medicamentosas utilizadas. Resultados A prevalência de utilização de medicamentos para distúrbios gastrintestinais no Brasil foi de 6,9% (intervalo de confiança de 95% − 6,4-7,6), sendo maior no sexo feminino, entre pessoas acima de 60 anos de idade, naqueles que possuíam plano privado de saúde e tinham duas ou mais doenças crônicas. Observou-se que 42,9% dos idosos que utilizaram medicamentos para distúrbios gastrintestinais também eram polimedicados. Em relação às classes medicamentosas, 82% correspondiam a medicamentos para o trato alimentar e metabolismo, destacando os inibidores da bomba de prótons. Conclusão A utilização de medicamentos para tratamento de distúrbios gastrintestinais foi significativa entre mulheres e idosos. Nesta faixa etária, o consumo pode estar vinculado à proteção gástrica causada por polimedicação. Este estudo representa oportunidade inédita para observar o perfil de consumo autorreferido desses medicamentos no Brasil e pode, portanto, subsidiar estratégias para promoção de seu uso racional.

Analysis of clinical pharmacist interventions in the neurology unit of a Brazilian tertiary teaching hospital.

It is estimated that around five to 10.0% of hospital admissions occur due to clinical conditions resulting from pharmacotherapy. Clinical pharmacist's activity can enhance drug therapy's effectiveness and safety through pharmacotherapy interventions (PIs), thus minimizing drug-related problems (DRPs) and optimizing the allocation of financial resources associated with health care. This study aimed to estimate the DRPs prevalence, evaluate PI which were performed by clinical pharmacists in the Neurology Unit of a Brazilian tertiary teaching hospital and to identify factors associated with the occurrence of PI-related DRP. A single-arm trial included adults admitted in the referred Unit from 2012 July to 2015 June. Patients were evaluated during their hospitalization period and PIs were performed based on trigger DRPs that were detected in medication reconciliation (admission or discharge) or during inpatient follow-up. Student's t-test, Chi-square test, Pearson and Multiple logistic regression models to analise the association among age, number of drugs, hospitalization period, and number of diagnoses with occurrence of DRPs. Analyses level of significance was 5%. In total 409 inpatients were followed up [51.1% male, mean age of 49.1 (SD 16.5)]. Patients received, on average, 11.9 (SD 5.8) drugs, ranging from two to 38 drugs per patient, and 54.3% of the sample presented at least one DRP whose most frequent description was "untreated condition". From all 516 performed PIs that resulted from DRPs, 82.8% were accepted and the majority referred to "drug introduction" (27.5%). Multiple logistic regression showed that age, length of hospital stay, number of drugs used, diagnosis of epilepsy, multiple sclerosis and myasthenia gravis would be clinical variables associated with DRP (p < 0,05). Monitoring the use of drugs allowed the clinical pharmacist to detect DRPs and to suggest interventions that promote rational pharmacotherapy.

Deinococcus radiodurans DR2231 is a two-metal-ion mechanism hydrolase with exclusive activity on dUTP.

DR2231 from Deinococcus radiodurans was previously functionally and structurally characterized as an all-α NTP pyrophosphohydrolase with specific dUTPase activity. dUTPases have a central role in the regulation of dUTP intracellular levels and dTTP nucleotide metabolism. DR2231 presents a conserved dimetal catalytic site, similar to all-α dimeric dUTPases, but contrary to these enzymes, it is unable to process dUDP. In this article, we present functional and structural evidence of single-point mutations that affect directly or indirectly the enzyme catalysis and provide a complete description of the all-α NTP pyrophosphohydrolase mechanism. Activity assays, isothermal titration calorimetry and the crystal structures of these mutants obtained in complex with dUMP or a dUTP analogue aid in probing the reaction mechanism. Our results demonstrate that the two metals are necessary for enzyme processing and also important to modulate the substrate binding affinity. Single-point mutations located in a structurally mobile lid-like loop show that the interactions with the nucleoside monophosphate are essential for induction of the closed conformation and ultimately for substrate processing. ß- and γ-phosphates are held in place through coordination with the second metal, which is responsible for the substrate 'gauche' orientation in the catalytic position. The lack of sufficient contacts to orient the dUDP ß-phosphate for hydrolysis explains DR2231 preference towards dUTP. Sequence and structural similarities with MazG proteins suggest that a similar mechanism might be conserved within the protein family. DATABASE: Structural data are available in the PDB under the accession numbers 5HVA, 5HWU, 5HX1, 5HYL, 5I0J, 5HZZ, 5I0M.

The crystal structure of Pseudomonas putida azoreductase - the active site revisited.

The enzymatic degradation of azo dyes begins with the reduction of the azo bond. In this article, we report the crystal structures of the native azoreductase from Pseudomonas putida MET94 (PpAzoR) (1.60 Å), of PpAzoR in complex with anthraquinone-2-sulfonate (1.50 Å), and of PpAzoR in complex with Reactive Black 5 dye (1.90 Å). These structures reveal the residues and subtle changes that accompany substrate binding and release. Such changes highlight the fine control of access to the catalytic site that is required by the ping-pong mechanism, and in turn the specificity offered by the enzyme towards different substrates. The topology surrounding the active site shows novel features of substrate recognition and binding that help to explain and differentiate the substrate specificity observed among different bacterial azoreductases.

Endo-ß-D-1,4-mannanase from Chrysonilia sitophila displays a novel loop arrangement for substrate selectivity.

The crystal structure of wild-type endo-ß-D-1,4-mannanase (EC 3.2.1.78) from the ascomycete Chrysonilia sitophila (CsMan5) has been solved at 1.40 Å resolution. The enzyme isolated directly from the source shows mixed activity as both an endo-glucanase and an endo-mannanase. CsMan5 adopts the (ß/α)(8)-barrel fold that is well conserved within the GH5 family and has highest sequence and structural homology to the GH5 endo-mannanases. Superimposition with proteins of this family shows a unique structural arrangement of three surface loops of CsMan5 that stretch over the active centre, promoting an altered topography of the binding cleft. The most relevant feature results from the repositioning of a long loop at the extremity of the binding cleft, resulting in a shortened glycone-binding region with two subsites. The other two extended loops flanking the binding groove produce a narrower cleft compared with the wide architecture observed in GH5 homologues. Two aglycone subsites (+1 and +2) are identified and a nonconserved tryptophan (Trp271) at the +1 subsite may offer steric hindrance. Taken together, these findings suggest that the discrimination of mannan substrates is achieved through modified loop length and structure.

Structural and functional insights into DR2231 protein, the MazG-like nucleoside triphosphate pyrophosphohydrolase from Deinococcus radiodurans.

Deinococcus radiodurans is among the very few bacterial species extremely resistant to ionizing radiation, UV light, oxidizing agents, and cycles of prolonged desiccation. The proteome of D. radiodurans reflects the evolutionary pressure exerted by chronic exposure to (nonradioactive) forms of DNA and protein damage. A clear example of this adaptation is the overrepresentation of protein families involved in the removal of non-canonical nucleoside triphosphates (NTPs) whose incorporation into nascent DNA would promote mutagenesis and DNA damage. The three-dimensional structure of the DR2231 protein has been solved at 1.80 Å resolution. This protein had been classified as an all-α-helical MazG-like protein. The present study confirms that it holds the basic structural module characteristic of the MazG superfamily; two helices form a rigid domain, and two helices form a mobile domain and connecting loops. Contrary to what is known of MazG proteins, DR2231 protein shows a functional affinity with dUTPases. Enzymatic and isothermal calorimetry assays have demonstrated high specificity toward dUTP but an inability to hydrolyze dTTP, a typical feature of dUTPases. Co-crystallization with the product of hydrolysis, dUMP, in the presence of magnesium or manganese cations, suggests similarities with the dUTP/dUDP hydrolysis mechanism reported for dimeric dUTPases. The genome of D. radiodurans encodes for all enzymes required for dTTP synthesis from dCMP, thus bypassing the need of a dUTPase. We postulate that DR2231 protein is not essential to D. radiodurans and rather performs "house-cleaning" functions within the framework of oxidative stress response. We further propose DR2231 protein as an evolutionary precursor of dimeric dUTPases.

Perfil diagnóstico de enfermagem admissional de pacientes com síndrome coronariana aguda / Diagnostic profile of admissional nursing of acute coronary syndrome patients

Durante décadas, a Enfermagem teve uma orientação dirigida para o imediatismo, embasando-se em ações práticas, de modo não sistematizado. As transformaões sócio-econômicas, políticas e educacionais, bem como os avanços do conhecimento científico e as descobertas médicas foram os fatores que contribuíram para que alterações nesta prática ocorressem, visando a autonomia e independência dos profissionais...