Efficacy of topical drug application to manage in-office bleaching sensitivity: a systematic review and meta-analysis of randomized clinical trials.

OBJECTIVES: To answer whether the topical drug application can reduce in-office tooth bleaching sensitivity without impairing the color change. MATERIALS AND METHODS: This review was registered on PROSPERO (CRD42024524171). Two reviewers screened PubMed, Web of Science, Scopus, Embase, and clinicaltrials.gov in March 2024 independently for randomized clinical trials investigating the efficacy of topical drug application to manage in-office tooth bleaching sensitivity. The risk of bias was assessed using Cochrane's Risk of Bias tool (RoB2). Certainty of the evidence was assessed using the Grading of Recommendations: Assessment, Development, and Evaluation tool (GRADE). The meta-analyses evaluated the bleaching sensitivity and color change with RevMan 5.4 software. RESULTS: 334 articles were retrieved. The final sample was composed of four articles. Tested drugs were Otosporin, Eugenol, Ibuprofen with arginine, and Dipyrone. The meta-analysis evidenced no difference in bleaching sensitivity up to 1 h (MD, -0.39; 95% CI, -0.89, 0.11), 24 h (MD, -0.26, 95% CI, -0.71, 0.18), or 48 h (MD, 0.00, 95% CI, -0.16, 0.16). Meta-analysis for color change evidenced no difference for color change (MD, 0.03; 95% IC, -0.56, 0.61). The risk of bias was low. The certainty of the evidence was rated moderate for bleaching sensitivity and high for color change. CONCLUSIONS: Although topical drug application did not impair color change, it was ineffective in reducing in-office tooth bleaching sensitivity. CLINICAL RELEVANCE: topical drug application on dental enamel is not an effective approach in reducing bleaching sensitivity, but several modifications can be made in future studies to possibly achieve a better outcome.

Avaliação do impacto da orientação farmacêutica aos pacientes sobre os medicamentos prescritos / Evaluation of the impact of pharmaceutical orientation given to patients on prescribed drugs

O uso racional de medicamentos é considerado um dos elementos-chave recomendados pela Organização Mundial de Saúde, cuja ausência pode acarretar consequências como reações adversas, diminuição da eficácia do medicamento, perdas de ordem econômica para o governo e/ou indivíduo, interações medicamentosas e agravo do quadro clínico do paciente. O serviço de orientação farmacêutica que envolve esse contexto foi discutido por poucos estudos, considerando-se interessante a utilização de um instrumento validado para demonstrar o impacto do fornecimento de orientação farmacêutica direcionada a pacientes em uso de medicamentos prescritos, o que constitui o objetivo desse trabalho. A metodologia utilizada foi estudo transversal conduzido em uma Unidade Básica de Saúde de Diamantina/ MG. Foi utilizado um questionário para medir o grau do conhecimento do paciente sobre seus medicamentos nos momentos pré e pós a realização de orientação farmacêutica. Após a orientação farmacêutica, observou-se diminuição do percentual de usuários que não conheciam seus medicamentos (73,2%; 93 para 33,9%; 43) e aumento do nível de conhecimento suficiente (14,2%; 18 para 18,9%; 24) e ótimo (11,0%; 14 para 47,2%; 60). Houve aumento do conhecimento dos usuários em todos os itens que compõem o questionário. A orientação farmacêutica apresentou impacto positivo sobre o conhecimento dos pacientes sobre seus medicamentos e constitui uma prática essencial para o Uso Racional dos Medicamentos.

The rational use of drugs is considered one of the key elements recommended by the World Health Organization, the absence of which can lead to consequences such as adverse reactions, decreased drug efficacy, economic losses for the government and/or individual, drug interactions, and worsening of the patient's clinical condition. The pharmaceutical orientation service that involves this context has been discussed by few studies, and the use of a validated instrument to demonstrate the impact of providing pharmaceutical guidance to patients on prescribed drugs is considered interesting and constitutes the objective of this work. The methodology used was a cross-sectional study conducted in a Primary Care Center in Diamantina, MG. A questionnaire was used to measure the patient's level of knowledge about their medications before and after receiving pharmaceutical guidance. After pharmaceutical orientation, there was a decrease in the percentage of users who did not know about their medications (73.2%; n=93 to 33.9%; n=43) and an increase in the level of sufficient knowledge (14.2%; n=18 to 18.9%; n=24) and excellent knowledge (11.0%; n=14 to 47.2%; n=60). There was an increase in users' knowledge of all the items that make up the questionnaire. Pharmaceutical orientation had a positive impact on patients' knowledge about their medications and constitutes an essential practice for the Rational Use of Medications.

Uso irracional de medicamentos na pandemia do Covid-19: revisão integrativa / Irrational use of medicines in the Covid-19 pandemic: integrative review / Uso irracional de medicamentos en la pandemia de Covid-19: revisión integradora

Os medicamentos são uma importante fonte tática de ação em saúde, quando usados para prevenção, alívio, diagnóstico ou cura de algumas enfermidades. Entretanto, apesar dos benefícios de tratar diversas doenças, os medicamentos podem trazer consigo riscos, como efeitos colaterais graves à saúde do usuário, além de possibilitar a resistência microbiana. O consumo excessivo de medicamentos sem prescrição é considerado um grande problema na saúde pública e vem sendo acentuado desde o período pandêmico da COVID-19 disso, partindo do princípio de que os fármacos podem desencadear reações adversas e apresentar danos à saúde, o objetivo deste artigo é discutir o uso irracional de medicamentos e destacar os medicamentos mais utilizados pela população na pandemia da COVID-19. Trata-se de um estudo de revisão integrativa da literatura. Foi realizado um levantamento bibliográfico de 12 artigos científicos do ano de 2020 a 2022. Destaca- se que o uso indevido de medicamentos consiste em uma prática corriqueira na sociedade e a automedicação durante o período da pandemia apresentou-se como um risco à população. Os medicamentos mais citados na pesquisa foram a azitromicina e a ivermectina.

Medications are an important tactical source of health action, when used for prevention, relief, diagnosis or cure of some diseases. However, despite the benefits of treating various diseases, medications can bring with them risks, such as serious side effects to the user's health, as well as enabling microbial resistance. The excessive consumption of non-prescription drugs is considered a major problem in public health and has been accentuated since the pandemic period of COVID-19 of this, assuming that drugs can trigger adverse reactions and present damage to health, the aim of this article is to discuss the irrational use of medicines and highlight the most commonly used drugs by the population in the pandemic of COVID-19. This is an integrative literature review study. A literature survey of 12 scientific articles from the year 2020 to 2022 was conducted. It is noteworthy that the misuse of medicines is a common practice in society and self-medication during the pandemic period presented itself as a risk to the population. The most cited drugs in the survey were azithromycin and ivermectin.

Los medicamentos son una importante fuente táctica de acción sanitaria, cuando se utilizan para prevenir, aliviar, diagnosticar o curar algunas enfermedades. Sin embargo, a pesar de los beneficios en el tratamiento de diversas enfermedades, los medicamentos pueden traer consigo riesgos, como graves efectos secundarios para la salud del usuario, además de posibilitar la resistencia microbiana. El consumo excesivo de medicamentos de venta libre es considerado un gran problema de salud pública y se ha acentuado desde el período de la pandemia de COVID-19 de esto, asumiendo que los medicamentos pueden desencadenar reacciones adversas y presentar daños a la salud, el objetivo de este artículo es discutir el uso irracional de medicamentos y destacar los fármacos más utilizados por la población en la pandemia de COVID-19. Se trata de un estudio de revisión bibliográfica integradora. Se realizó un estudio bibliográfico de 12 artículos científicos del año 2020 al 2022. Se destaca que el uso indebido de medicamentos es una práctica común en la sociedad y la automedicación durante el período pandémico se presentó como un riesgo para la población. Los medicamentos más citados en la encuesta fueron la azitromicina y la ivermectina.

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.

Cardiovascular medications and long-term mortality among stroke survivors in the Brazilian Study of Stroke Mortality and Morbidity (EMMA).

AIM: To investigate the association between medication use and long-term all-cause mortality in a Brazilian stroke cohort. METHODS: Both ischemic and hemorrhagic stroke were evaluated. Medication use was assessed as: never, only pre-stroke, only post-stroke, and continuous use. We evaluated anti-hypertensives, anti-diabetics, lipid-lowering drugs, anti-platelets, and anti-coagulants. Cox regression models were adjusted for sociodemographic and cardiovascular risk factors. RESULTS: Among 1173 incident stroke cases (median age: 68; 86.8% were ischemic, 70% first-ever stroke), medication use was low (overall: 17.5% pre-stroke, 26.4% post-stroke, and 40% were under continuous use). Anti-hypertensives and anti-platelets (aspirin) were the continuous cardiovascular medications used most often, at 83.5% and 72%, respectively, while statins (39.7%) and anti-diabetics (31.3%) were the least used. Medication use (pre-stroke, post-stroke and continuous use) was associated with a reduction in all-cause mortality risk, particularly among those under continuous use (multivariable hazard ratio, 0.52; 95% confidence interval (CI), 0.46-0.66) compared with never-users. Among ischemic stroke patients, this effect was similar (multivariable hazard ratio, 0.52; 95% CI, 0.40-0.68). No significant associations were evident among hemorrhagic stroke patients. CONCLUSIONS: The risk of all-cause mortality was reduced by 48% among those with ischemic stroke under continuous use of medications. Secondary prevention should be emphasized more strongly in clinical practice. Geriatr Gerontol Int 2022; 22: 715-722.

High-risk pregnancy: characterization of medication use profile and association with clinical and sociodemographic factors / Gestação de alto risco: caracterização do perfil de utilização de medicamentos e associação com fatores clínicos e sociodemográficos

Abstract Objectives: describe the profile of medication use and adherence, and the association with clinical and sociodemographic characteristics of high-risk pregnant women attended at a university hospital. Methods: cross-sectional study with data collected through a questionnaire applied on 386 pregnant women. Results: most participants were seen only by the gynecologist (75.1%), started prenatal in the first gestational trimester (86.8%), did not plan the pregnancy (61.9%), and performed an average of 8.2 (SD=4.4) prenatal consultations. The most frequent diagnoses were arterial hypertension (20.5%) and diabetes mellitus (19.7%). Prevalence of medication use was 99.7%, with an average of 5.1 (SD=2.1) medication per woman and 12.7% self-medication. Antianemics (88.9%) and analgesics (63.2%) were the most prevalent classes and 17.9% of the women reported the use of medication with significant gestational risk. Only 36.5% were considered adherent, 32.9% declared they were unaware of the indication of the medication in use and 42% did not receive guidance on the use of the medication during pregnancy. There is no evidence of association between the number of the medication used and clinical and sociodemographic aspects. Conclusions: there is a need to develop strategies to improve the care of this population, with emphasis on strengthening multi-professional care.

Resumo Objetivos: descrever o perfil de utilização de medicamentos e de adesão, e a associação com as características clínicas e sociodemográficas de gestantes de alto risco atendidas em um hospital universitário. Métodos: trata-se de um estudo transversal com dados coletados mediante um questionário estruturado aplicado à 386 gestantes. Resultados: a maior parte das participantes era acompanhada apenas pelo ginecologista (75,1%), iniciou o pré-natal no primeiro trimestre gestacional (86,8%), não planejou a gravidez (61,9%) e realizou em média 8,2 (DP=4,4) consultas de pré-natal. Os diagnósticos mais frequentes foram hipertensão arterial (20,5%) e diabetes mellitus (19,7%). A prevalência de uso de medicamentos foi 99,7%, com média de 5,1 (DP=2,1) medicamentos por mulher e 12,7% de automedicação. Os antianêmicos (88,9%) e analgésicos (63,2%) foram as classes farmacológicas mais prevalentes e 17,9% das gestantes referiram uso de fármacos com risco gestacional relevante. Apenas 36,5% das gestantes foram consideradas aderentes ao tratamento, 32,9% declararam desconhecer a indicação dos medicamentos em uso e 42% não receberam orientações sobre o uso de medicamentos durante a gestação. Não há evidências de associação entre o número de medicamentos utilizados e os aspectos clínicos e sociodemográficos. Conclusão: é necessário desenvolver estratégias para melhorar o atendimento desta população e o uso racional de medicamentos, com ênfase no fortalecimento do cuidado multiprofssional.

Descripción de la disponibilidad y normas para el uso de las benzodiacepinas en algunos países de América Latina, 2022 / Description of benzodiazepines availability and regulation in several countries of Latin America, 2022 / Descrição da disponibilidade e regulamentação para o uso de benzodiazepínicos em alguns países da América Latina, 2022

Resumen: Introducción: las benzodiacepinas constituyen un grupo farmacológico de amplia prescripción a nivel mundial desde su aparición en la década de 1960. El objetivo del presente estudio fue identificar la disponibilidad, las modalidades de prescripción y dispensación de benzodiacepinas en diferentes países de América Latina, según reglamentación vigente en cada país participante del estudio. Materiales y métodos: estudio observacional, descriptivo y transversal, realizado con los datos disponibles al año 2022 de todos los países miembros de la Red de Centros de Información de Medicamentos de LatinoAmérica y el Caribe (Red CIMLAC) que fueron parte del estudio. Se utilizaron las bases de datos de las agencias regulatorias, la reglamentación vigente y otros documentos necesarios para obtener la información sobre la dispensación y prescripción en cada país. Resultados: doce de los 20 países de la Red CIMLAC completaron el estudio. El total de benzodiacepinas disponible en cada país varió entre 6 y 12 (media: 9). De ellas, en promedio 5 estaban incluidas en listados de medicamentos esenciales nacionales. La mayoría de los países cuentan con combinaciones a dosis fijas con benzodiacepinas. En todos los países se realiza la prescripción por receta especial. Más de la mitad de los países cuentan con recomendaciones nacionales. Conclusiones: la amplia disponibilidad de benzodiacepinas comercializadas, la existencia de combinaciones a dosis fijas y la falta de recomendaciones nacionales pueden ser factores que contribuyan al uso irracional de este grupo terapéutico.

Summary: Introduction: benzodiazepines constitute a widely prescribed group of drugs around the world, since they appeared in the sixties. This study aims to identify the availability, prescription modalities and dispensing of benzodiazepines in different countries around Latin America, as per the legal provisions in force in each of the countries participating in the study. Method: observational, descriptive, transversal study based on the information available in 2022 about all the member countries of the Network Medicines Information Centers of Latin America and the Caribbean (CIMLAC Network) that were part of the study. The databases of regulatory authorities were used and the legal provisions in force and relevant documents were consulted in order to obtain information on benzodiazepines dispensing and prescription in each country. Results: twelve out of the 20 CIMLAC Network member countries completed the study. The total number of benzodiazepines available in the study ranged from 6 to 12 (mean was 9), and 5 of them on average were included in the national essential medications lists. Most countries have benzodiazepines fixed dose combinations and in all countries a special medical prescription is needed. More than half of the countries have national recommendations. Conclusions: the wide availability of benzodiazepines in the market, the existence of fixed-dose combinations and the lack of national recommendations may constitute factors that contribute to the irrational use of this group of drugs.

Resumo: Introdução: os benzodiazepínicos constituem um grupo farmacológico amplamente prescrito em todo o mundo desde seu surgimento na década de 1960. O objetivo deste estudo foi identificar a disponibilidade, prescrição e modalidades de dispensação de benzodiazepínicos em diferentes países da América Latina, de acordo com as regulamentações vigentes em cada país participante do estudo. Materiais e métodos: estudo observacional, descritivo e transversal, realizado com os dados disponíveis até o ano de 2022 dos países membros da Rede de Centros de Informação sobre Medicamentos da América Latina e do Caribe (Red CIMLAC) que faziam parte do estudo. As bases de dados das agências reguladoras, normas vigentes e outros documentos necessários foram utilizados para obter informações sobre dispensação e prescrição em cada país. Resultados: doze dos 20 países da Rede CIMLAC completaram o estudo. O número total de benzodiazepínicos disponíveis em cada país variou entre 6 e 12 (média: 9). Destes, uma média de 5 foram incluídos nas listas nacionais de medicamentos essenciais. A maioria dos países tem combinações de dose fixa com benzodiazepínicos. Em todos os países é necessário prescrição especial. Mais da metade dos países têm recomendações nacionais. Conclusões: a ampla disponibilidade de benzodiazepínicos comercializados, a existência de combinações em doses fixas e a falta de recomendações nacionais podem ser fatores que contribuem para o uso irracional desse grupo terapêutico.

Prevalence of chronic respiratory diseases and medication use among children and adolescents in Brazil - a population based cross-sectional study / Prevalência de doenças respiratórias crônicas e uso de medicamentos entre crianças e adolescentes no Brasil - um estudo transversal de base populacional

Abstract Objectives: to describe the prevalence of chronic respiratory diseases and their pharmacological management in children and adolescents in Brazil. Methods: data from the Pesquisa Nacional de Acesso, Uso e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM)(National Access Survey, Use and Promotion of Rational Use of Medicines in Brazil),a population-based cross-sectional study, were analyzed. Household surveys were conducted between September 2013 and February 2014. We included the population under 20 years of age with chronic respiratory diseases. Prevalence of disease, indication of pharmacological treatment, and their use were assessed. Results: the prevalence of chronic respiratory diseases in children aged less than 6 years old was 6.1% (CI95%= 5.0-7.4), 4.7% (CI95%= 3.4-6.4) in those 6-12 years, and 3.9% (CI95%= 2.8-5.4) in children 13 years and older. Children under 6 showed a higher prevalence of pharmacological treatment indication (74.6%; CI95%= 66.0-81.7), as well as medication use (72.6%; CI95%= 62.8-80.7). Of those using inhalers, 56.6% reported using it with a spacer. The most frequent pharmacologic classes reported were short-acting β2 agonists (19.0%), followed by antihistamines (17.2%). Conclusion: children and adolescents who report chronic respiratory diseases living in urban areas in Brazil seem to be undertreated for their chronic conditions. Pharmacological treatment, even if indicated, was not used, an important finding for decision-making in this population.

Resumo Objetivos: descrever a prevalência de doenças respiratórias crônicas e seu manejo farmacológico em crianças e adolescentes no Brasil. Métodos: foram analisados os dados da Pesquisa Nacional de Acesso, Uso e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM), um estudo transversal de base populacional. As pesquisas domiciliares foram realizadas entre setembro de 2013 e fevereiro de 2014. Incluímos a população com menos de 20 anos de idade com doenças respiratórias crônicas. Foi avaliada a prevalência de doença, indicação de tratamento farmacológico e seu uso. Resultados: a prevalência de doenças respiratórias crônicas em menores de 6 anos foi de 6,1% (IC95%= 5,0-7,4), 4,7% (IC95%= 3,4-6,4) naqueles 6-12 anos e 3,9% (IC95%= 2,8-5,4) em crianças com 13 anos ou mais. Crianças menores de 6 anos apresentaram uma maior prevalência de indicação de tratamento farmacológico (74,6%; IC95%= 66,0-81,7), assim como uso de medicamentos (72,6%; IC95%= 62,8-80,7). Dos usuários de inaladores, 56,6% relataram o uso com espaçador. As classes farmacológicas mais frequentemente relatadas foram β2 agonistas de curta ação (19,0%), seguidos por anti-histamínicos (17,2%). Conclusão: crianças e adolescentes que relatam doenças respiratórias crônicas residentes em áreas urbanas no Brasil parecem ser subtratados para suas condições crônicas. O tratamento farmacológico, mesmo quando indicado, não foi utilizado em sua totalidade, um achado importante para a tomada de decisão nessa população.

Potentially inappropriate medications based on TIME criteria and risk of in-hospital mortality in COVID-19 patients

SUMMARY OBJECTIVE: This study aimed to evaluate the relationship between hospital admission potentially inappropriate medications use (PIM) and in-hospital mortality of COVID-19, considering other possible factors related to mortality. METHODS: The Turkish inappropriate medication use in the elderly (TIME) criteria were used to define PIM. The primary outcome of this study was in-hospital mortality. RESULTS: We included 201 older adults (mean age 73.1±9.4, 48.9% females). The in-hospital mortality rate and prevalence of PIM were 18.9% (n=38) and 96% (n=193), respectively. The most common PIM according to TIME to START was insufficient vitamin D and/or calcium intake per day. Proton-pump inhibitor use for multiple drug indications was the most prevalent PIM based on TIME to STOP findings. Mortality was related to PIM in univariate analysis (p=0.005) but not in multivariate analysis (p=0.599). Older age (hazards ratio (HR): 1.08; 95% confidence interval (CI): 1.02-1.13; p=0.005) and higher Nutritional Risk Screening 2002 (NRS-2002) scores were correlated with in-hospital mortality (HR: 1.29; 95%CI 1.00-1.65; p=0.042). CONCLUSION: Mortality was not associated with PIM. Older age and malnutrition were related to in-hospital mortality in COVID-19.

Impediments to deprescription in Brazil: overview from a panel of geriatrics experts / Os condicionantes à desprescrição no Brasil: o panorama de um painel de especialistas em geriatria

Objectives: To identify impediments to deprescription among older adults from the perspective of a panel of Brazilian geriatricians. Methods: The Delphi method was used to obtain a consensus among Brazilian geriatricians about the factors that influence the lack of deprescription for older adults in clinical practice. The study was developed in two stages: (i) a survey and description of potential factors involved in deprescription; and (ii) applying the results of the survey to a panel of experts to obtain a consensus. Results: The deprescription process is influenced by the interaction of three pillars of older adult health care: the prescriber, the patient-family, and the health care system. In the professional and health care systems, professional training and communication skills, prolonged clinical follow-up, access to the multidisciplinary team, medical consultations of an adequate time, and unified electronic health records were identified as facilitators of deprescription. In the patient-family pillar, clear facilitators included health literacy, no sensory or cognitive deficits, and a clinical situation of transitional or palliative care. Conclusions: Deprescription is a complex, multifactorial process that requires attention, time, and specific skills and competencies from the attending physician, but it also requires shared decision-making and a health system compatible with a culture of deprescription.

Objetivos: Identificar os fatores condicionantes para a desprescrição em idosos na perspectiva consensual de um grupo de geriatras brasileiros. Metodologia: Foi utilizado o método Delphi para a obtenção de um consenso entre médicos geriatras brasileiros sobre os fatores que condicionam a desprescrição na assistência à saúde do idoso, na prática clínica. O estudo desenvolveu-se em duas etapas: (i) levantamento e descrição dos potenciais fatores envolvidos na prática da desprescrição; e (ii) submissão do levantamento realizado na etapa anterior a um painel de especialistas para a obtenção do consenso. Resultados: O processo de desprescrição é influenciado pela interação de três pilares da assistência à saúde do idoso: o prescritor, o paciente-família e o sistema de saúde. Como elementos de destaque, verificou-se que tanto a capacitação profissional, a habilidade em comunicação e o acompanhamento clínico prolongado do paciente quanto o acesso à equipe multidisciplinar, o tempo adequado para a consulta médica e o registro eletrônico único em saúde foram apontados como facilitadores à desprescrição, conforme os pilares do profissional e do sistema de saúde. Sob o pilar do paciente- família, os facilitadores evidenciados foram a literacia em saúde, a ausência de déficits sensoriais ou cognitivos, a situação clínica de cuidados de transição ou cuidados paliativos. Conclusões: A desprescrição é um processo complexo, multifatorial, que exige atenção, tempo, habilidades e competências específicas do médico assistente, mas requer decisão compartilhada e um sistema de saúde coadunável com a cultura de desprescrever

Corrigendum: Self-Medication Among Pregnant Women: Prevalence and Associated Factors.

[This corrects the article DOI: 10.3389/fphar.2021.659503.].

Self-Medication Among Pregnant Women: Prevalence and Associated Factors.

Objectives: The pregnancy period, with its peculiarities and specific symptoms that may or may not be physiological, can lead to medication use through prescription or even self-medication. This study aimed to assess self-medication practices among pregnant women, the most used medications, symptoms reported, and factors associated with this practice. Methods: This was a cross-sectional study conducted with pregnant women with an antenatal care (ANC) appointment in a tertiary teaching hospital referral in women's health. From April 2019 to February 2020, 297 pregnant women were interviewed. Self-medication was considered as the use of any medicine (including medicinal plants (MPs), herbal products, and vitamins) without a medical or dental prescription. The period considered to assess self-medication practice was the last 60 days prior to the study interview. Results: Among the 297 women interviewed, 107 (36.0%) had practiced self-medication in the previous 60 days. Acetaminophen was the most used medication, and headache was the most frequent symptom reported by self-medicated pregnant women. Pregnant women with high-school (73 (68.2%) (OR = 2.52; 95% CI 1.17-5.43; p = 0.018)) or university-level (23 (21.5%) (OR = 2.82; 95% CI 1.15-6.94; p = 0.024)) education had a higher risk of practicing self-medication when compared to women with lower education. Women in the first gestational trimester (35 (32.7%) (OR = 3.61; 95% CI 1.64-7.96; p = 0.002)) and with two or more pregnancies (87 (81.2%) (OR = 1.96; 95% CI 1.07-3.60; p = 0.029)) were more likely to practice self-medication than pregnant women in the second or third gestational trimester and in the first pregnancy, respectively. Conclusion: Self-medication was practiced by a considerable proportion of our sample, with the majority being OTC drugs. The factors associated with self-medication can help to improve prevention strategies regarding self-medication during pregnancy.

The Subjective Experience of Using Medications: What We Know and the Paths Forward.

Medications can cause bodily changes, where the associated benefits and risks are carefully assessed based on the changes experienced in the phenomenal body. For this reason, the phenomenology of Merleau-Ponty is an important theoretical framework for the study of experience related to the daily use of medications. The aim of this study was to discuss the contribution of a recently developed framework of the general ways people can experience the daily use of medications-resolution, adversity, ambiguity, and irrelevance-and present reflections about the little-understood aspects of this experience. However, some issues raised throughout this article remain open and invite us to further exploration, such as (1) the coexistence of multiple ways of experiencing the use of medications, by the same individual, in a given historical time; (2) the cyclical structure of this experience; (3) the impact of habit and routine on the ways of experiencing the daily use of medications; and (4) the contribution of the concept of existential feelings to this experience and its impact on patients' decision-making. Therefore, the experience with the daily use of medications is a complex and multifaceted phenomenon that directs the decision-making process of patients, impacting health outcomes.

Acculturation Associated with Sleep Duration, Sleep Quality, and Sleep Disorders at the US-Mexico Border.

Sleep disparities exist among Hispanics/Latinos, although little work has characterized individuals at the United States (US)-Mexico border, particularly as it relates to acculturation. This study examined the association of Anglo and Mexican acculturation to various facets of sleep health among those of Mexican descent at the US-Mexico border. Data were collected from N = 100 adults of Mexican descent in the city of Nogales, Arizona (AZ). Surveys were presented in English or Spanish. Acculturation was assessed with the Acculturation Scale for Mexican-Americans (ARSMA-II). Insomnia was assessed with the Insomnia Severity Index (ISI), sleepiness was assessed with the Epworth Sleepiness Scale (ESS), sleep apnea risk was assessed with the Multivariable Apnea Prediction (MAP) index, weekday and weekend sleep duration and efficiency were assessed with the Sleep Timing Questionnaire, sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI), and sleep duration and sleep medication use were assessed with PSQI items. No associations were found between Mexican acculturation and any sleep outcomes in adjusted analyses. Anglo acculturation was associated with less weekend sleep duration and efficiency, worse insomnia severity and sleep quality, and more sleep apnea risk and sleep medication use. These results support the idea that sleep disparities may depend on the degree of acculturation, which should be considered in risk screening and interventions.

[Pharmaceutical care for older adults. Application of STOPP-START criteria]. / Atención farmacéutica de adultos mayores. Aplicación de los criterios STOPP-START.

INTRODUCTION: Drug-related problems can be caused by potentially inappropriate prescribing (PIP), one of the most used tools for its identification are the STOPP (Older Persons' potentially inappropriate Prescriptions) - START (Screening Tool to Alert doctors to Right Treatment) criteria. The objective of this study is to determine PIP in older adults who receive pharmaceutical care in the Pharmacotherapy Optimization Unit (POU)-Rosario. MATERIALS AND METHODS: Pharmacoepidemiological observational study, which evaluates the quality of medication use. Workplace: POU-Rosario. Population under study: adults over 60 years of age, who received pharmacotherapy follow-up during the period March 2017 to February 2018. PIPs were identified using the STOPP-START criteria, 2014 version; selecting the most appropriate criteria to assess outpatient pharmacotherapy. Prevalence of PIP and amount of PIP per active principle were estimated. RESULTS: 50 patients older than 60 years received pharmacotherapy follow-up in the POU; 47 patients (94.0%) had at least one PIP corresponding to a STOPP criterion; 17 STOPP criteria were found among the 41 initially selected, leading to 145 PIPs identified. And 7 START criteria among the 11 initially selected, leading to 50 PIPs identified. Medications with a higher amount of PIPs: benzodiazepines and proton pump inhibitors. CONCLUSIONS: This study allowed the identification of a high prevalence of PIP. The data obtained show the usefulness of these criteria. The STOPP-START criteria have been included to support decision making during pharmacotherapy follow-up to propose pharmaceutical interventions, in order to enhance pharmacotherapy. These activities contribute to patient safety, a dimension of health quality.

Medication use by adults in greater Manaus: a population-based cross-sectional study, 2015

The use of medicines can be an indicator of healthcare access. Our aim was to evaluate the consumption of medicine and associated factors among adults in Manaus Metropolitan Region, located in the north of Brazil. A cross-sectional population-based study was conducted with adults, ≥18 years old, selected by probabilistic sampling. The outcome was the use of medicine in the previous 15 days. Poisson regression with robust variance was used to calculate the prevalence ratio (PR) of medicine consumption, with 95% confidence interval (CI). Use of medicines was reported by 29% (95% CI: 28-31%) of the participants. People with good (PR: 0.82, 95% CI: 0.72-0.94) and fair (PR: 0.77, 95% CI: 0.65-0.90) health status were shown to use less medication than those with very good health. People with partners (PR: 1.19, 95% CI: 1.08-1.31), and people who had sought healthcare service in the fortnight (PR: 2.16, 95% CI: 1.97-2.37) showed higher medicine consumption. Medical prescription (80.1%) was the main inductor of consumption; purchasing at a drug store (46.4%), and acquiring through the Brazilian Unified Health System (39.6%) were the main ways to obtain medicines. About one-third of adults in the Metropolitan Region of Manaus used medicines regularly, mainly people with very good health, living with partners, and with recent use of a health service.

Aumento da utilização de benzodiazepínicos entre idosos mais velhos: Projeto Bambuí / Increased use of benzodiazepines among older adults: Bambuí Project

RESUMO: Introdução: Os benzodiazepínicos são os psicofármacos mais utilizados globalmente, apesar dos riscos associados ao seu uso prolongado, especialmente entre os idosos. Objetivo: O estudo teve como objetivo investigar a tendência do uso de benzodiazepínicos entre idosos mais velhos (75 anos ou mais) residentes em comunidade. Métodos: Trata-se de um estudo realizado com idosos com idades entre 75 e 89 anos, integrantes da linha base (em 1997) e sobreviventes (em 2012) da coorte idosa do Projeto Bambuí. A prevalência do uso de benzodiazepínicos foi estimada separadamente para cada ano, e a comparação entre elas foi realizada por meio de regressão de Poisson com variância robusta. Resultados: A prevalência do uso de benzodiazepínicos foi maior em 2012 (33,9%) em comparação a 1997 (24,9%). Após o ajuste múltiplo, a diferença de prevalências não permaneceu significativa na população total de estudo (razão de prevalência (RP) = 1,25; intervalo de confiança de 95% (IC95%) 0,99 - 1,60), diferentemente do observado no estrato feminino (RP = 1,38; IC95% 1,04 - 1,84). O clonazepam foi o medicamento que apresentou o mais forte crescimento (RP = 4,94; IC95% 2,54 - 9,62) entre os dois anos. Conclusão: O presente estudo evidenciou um importante aumento no uso de benzodiazepínicos em uma população idosa mais velha. Esses resultados preocupam, pois são medicamentos contraindicados para idosos, especialmente se utilizados cronicamente, e estão disponíveis na relação nacional de medicamentos essenciais. Os profissionais de saúde devem estar atentos para os riscos envolvidos no seu uso por essa população.

ABSTRACT: Background: Benzodiazepines are the most widely used psychoactive drugs, despite the risks associated with their prolonged use, especially among older adults. Objective: To investigate the use of benzodiazepines among community-dwelling people aged ≥ 75 years. Methods: The study was conducted among members of the baseline (in 1997) and survivors (in 2012) of the Bambuí Project cohort. The prevalence of benzodiazepine use was estimated separately for each year, and the comparison between them was performed using the Poisson regression model with robust variance. Results: The prevalence of benzodiazepine use was higher in 2012 (33.9%) compared to 1997 (24.9%). After multiple adjustments, the difference in prevalence did not remain significant in study population (PR = 1.25; 95%CI 0.99 - 1.60), unlike that observed in the female stratum (PR = 1.38; 95%CI 1.04 - 1.84). Clonazepam was the strongest-growing drug between the two years (PR = 4.94; 95%CI 2.54 - 9.62). Conclusion: This study showed an important increase in benzodiazepine use in an older adult population. These results are concerning as these drugs are contraindicated for use in older adults, mainly if used chronically, and are available in the national list of essential medicines. Health professionals should be aware of the risks involved in its use regarding this population.

Effect of Dual Use of Veterans Affairs and Medicare Part D Drug Benefits on Antihypertensive Medication Supply in a National Cohort of Veterans with Dementia.

OBJECTIVE: To evaluate the effect of dual use of VA/Medicare Part D drug benefits on antihypertensive medication supply in older Veterans with dementia. DATA SOURCES/STUDY SETTING: National, linked 2007-2010 Veterans Affairs (VA) and Medicare utilization and prescription records for 50,763 dementia patients with hypertension. STUDY DESIGN: We used inverse probability of treatment (IPT)-weighted multinomial logistic regression to examine the association of dual prescription use with undersupply and oversupply of antihypertensives. DATA COLLECTION/EXTRACTION METHODS: Veterans Affairs and Part D prescription records were used to classify patients as VA-only, Part D-only, or dual VA/Part D users of antihypertensives and summarize their antihypertensive medication supply in 2010: (1) appropriate supply of all prescribed antihypertensive classes, (2) undersupply of ≥1 class with no oversupply of another class, (3) oversupply of ≥1 class with no undersupply, or (4) both undersupply and oversupply. PRINCIPAL FINDINGS: Dual prescription users were more likely than VA-only users to have undersupply only (aOR = 1.28; 95 percent CI = 1.18-1.39), oversupply only (aOR = 2.38; 95 percent CI = 2.15-2.64), and concurrent under- and oversupply (aOR = 2.89; 95 percent CI = 2.53-3.29), versus appropriate supply of all classes. CONCLUSIONS: Obtaining antihypertensives through both VA and Part D was associated with increased antihypertensive under- and oversupply. Efforts to understand how best to coordinate dual-system prescription use are critically needed.

Religiousness, social support and the use of antidepressants among the elderly: a population-based study / Religiosidade, suporte social e uso de antidepressivos entre idosos residentes em comunidade: um estudo de base populacional

Abstract The purpose of the study was to investigate whether religiousness and social support were associated with the use of antidepressants among community-dwelling elders. The research involved 1,606 older adults who make up the cohort of Bambuí Project, a study on ageing and health. The dependent variable was the use of antidepressants in the last 90 days, and the exposures of interest were social support and religiousness. Logistic regression was used to test the associations and to estimate crude and adjusted Odds Ratio and their 95% confidence intervals. The chances of use of antidepressants were significantly lower among older people with higher level of religiosity (OR = 0.45; 95% CI: 0.29 to 0.70), but none of the descriptors social support was associated with the event. In this population, it is possible that religion occupies a prominent role in the arsenal of health problems coping strategies, especially mental. Health professionals attending this particular segment of the population (elderly people with depressive disorders) should consider religiousness of patients when the proposed guidelines and treatment in coping with their mental suffering.

Resumo O propósito do estudo foi investigar se a religiosidade e o suporte social estariam associados ao uso de antidepressivos entre idosos residentes em comunidade. A investigação envolveu 1.606 integrantes da coorte idosa do Projeto Bambuí, um estudo longitudinal sobre envelhecimento e saúde. A variável dependente foi o uso de antidepressivos nos últimos 90 dias, e as exposições de interesse foram suporte social e religiosidade. As hipóteses de associação foram testadas por meio de regressão logística multivariada, que incluiu características sociodemográficas, condições de saúde e uso de serviços de saúde como potenciais fatores de confusão. As chances de utilização de antidepressivos foram significativamente menores entre os idosos com nível mais elevado de religiosidade (OR = 0,45; IC95%: 0,29-0,7), mas nenhum dos descritores de suporte social mostrou-se associado ao evento. É possível que, nessa população, a religiosidade ocupe um lugar de destaque no arsenal de estratégias de enfrentamento de problemas de saúde, especialmente os mentais. Profissionais de saúde que atendem este segmento específico da população (idosos com transtornos depressivos) devem considerar a religiosidade dos pacientes quando das orientações e tratamento propostos no enfrentamento do seu sofrimento mental.

Polifarmácia em idosos: um estudo de base populacional / Polypharmacy among the elderly: a population-based study

RESUMO: Objetivo: Investigar a polifarmácia em idosos residentes na área urbana de Florianópolis, Santa Catarina, Brasil, estimando a prevalência e os fatores a ela associados. Métodos: Foi realizado um estudo transversal de base populacional em uma amostra de 1.705 idosos, entre 2009 e 2010. A variável dependente foi polifarmácia (definida como "uso de cinco ou mais medicamentos"). Utilizaram-se variáveis sociodemográficas, uso de serviços de saúde e autoavaliação de saúde como exploratórias. Foram estimadas razões de prevalência (RP) por meio de análise multivariada utilizando-se da regressão de Poisson. Resultados: A média do uso de medicamentos por idosos foi de 3,8 (variando entre 0 e 28). A prevalência de polifarmácia foi de 32%, com intervalo de confiança de 95% (IC95%) 29,8 - 34,3. As características que apresentaram associação positiva com polifarmácia foram: sexo feminino (RP = 1,27; IC95% 1,03 - 1,57), aumento da idade (RP = 1,38; IC95% 1,08 - 1,77), autoavaliação de saúde negativa (RP = 1,99; IC95% 1,59 - 2,48) e realização de consulta médica nos últimos 3 meses anteriores à entrevista (RP = 1,89; IC95% 1,53 - 2,32). Os grupos de medicamentos mais utilizados pelos idosos na polifarmácia foram os indicados para o sistema cardiovascular, trato alimentar e metabolismo e sistema nervoso. Conclusão: O padrão de uso de medicamentos por idosos está dentro da média nacional. A prevalência de polifarmácia e as características a ela associadas foram semelhantes aos achados em outras regiões do Brasil.

ABSTRACT: Objective: To investigate polypharmacy among the elderly living in the urban area of Florianopolis, in the state of Santa Catarina, Brazil, estimating the prevalence and associated factors. Methods: This is a cross-sectional population-based study with a sample of 1,705 individuals aged 60 years old or older, between 2009 and 2010. The dependent variable was polypharmacy (defined as "use of five or more medications"). The following exploratory variables were utilized: sociodemographic data, use of health services and self-rated health status. Prevalence ratios (PR) were estimated by multivariate analysis using the Poisson regression. Results: The mean for the medications used by the elderly population was 3.8 (ranging from 0 to 28). The prevalence of polypharmacy was 32%, with 95% confidence interval (95% CI) 29.8 - 34.3. The characteristics presenting a positive association with polypharmacy were: female gender (PR = 1.27; 95%CI 1.03 - 1.57), increasing age (PR = 1.38; 95% CI 1.08 - 1.77), negative self-rated health status (PR = 1.99; 95% CI 1.59 - 2.48) and medical appointments in the 3 months prior to the interview (PR = 1.89; 95% CI 1.53 - 2.32). The groups of medication most utilized by the elderly individuals in polypharmacy were those indicated for the cardiovascular system, digestive tract and metabolism, as well as the nervous system. Conclusion: The pattern of medication use among this elderly population is within the national average. The prevalence of polypharmacy and the characteristics associated with it were similar to those found in other regions of Brazil.