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

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

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

Perfil de medicamentos descartados nas farmácias públicas de um município do leste de Minas Gerais / Profile of medicines discarded in the public pharmacies of an eastern municipality of Minas Gerais

O descarte inadequado de medicamentos pode levar a impactos ambientais negativos e deve ser considerado um problema de saúde pública. O presente estudo teve como objetivo levantar dados quantitativos e qualitativos relacionados ao perfil dos medicamentos descartados no município de Governador Valadares - MG. O trabalho foi desenvolvido nas UAPS/ESF que possuíam farmácias, e também na Farmácia Central/Policlínica Municipal. Nesses locais, foi realizada uma análise dos medicamentos descartados no período de julho de 2017 a maio de 2018. Por meio dos dados obtidos nesse período foi possível perceber que as principais classes de medicamentos descartadas foram os inibidores da enzima conversora de angiotensina, antagonistas da angiotensina II, agentes betabloqueadores, diuréticos, hipoglicemiantes, contraceptivos hormonais e agentes modificadores de lipídeos. Além disso, foi realizada uma ação de educação em saúde e aplicado um questionário semiestruturado aos usuários participantes dos grupos operativos. Dos 34 usuários respondentes do questionário, 23 (69,70%) não tinham acesso a informação sobre o local correto de descarte e armazenamento de medicamentos. Após a ação de educação em saúde verificou-se um aumento no quantitativo de medicamentos descartados pelos usuários nas UAPS/ESF Mãe de Deus I e II, Altinópolis III e IV, Santa Rita II, São Pedro I e II e Esperança e Nossa Senhora das Graças. O trabalho desenvolvido permitiu apresentar dados relevantes para a gestão municipal demonstrando a importância do farmacêutico no cuidado em saúde e o caráter epidemiológico local da prevalência das doenças crônico não transmissíveis.

The inadequate disposal of drugs can lead to negative environmental impacts and should be treated as a public health problem. This study aimed at surveying quantitative and qualitative data related to the profile of drugs discarded in the city of Governador Valadares - MG. The work was developed in the UAPS / ESF that had pharmacies, and also in the Central Pharmacy/Municipal Polyclinic. In these locations, an analysis of the drugs discarded between July 2017 and May 2018 was carried out. Through the data obtained in this period, it was possible to notice that the main classes of drugs discarded were angiotensin-converting enzyme inhibitors, angiotensin II antagonists, beta-blocking agents, diuretics, hypoglycemic agents, hormonal contraceptives, and lipid-modifying agents. In addition, a health education action was carried out and a semi-structured questionnaire was applied to users participating in the operating groups. From the 34 users who responded the questionnaire, 23 (69.70%) did not have access to information on the correct place to dispose and store medicines. After the health education action, there was an increase in the amount of drugs discarded by users in the UAPS/ESF Mãe de Deus I and II, Altinópolis III and IV, Santa Rita II, São Pedro I and II, and Esperança and Nossa Senhora das Graças. The work carried out made it possible to present relevant data for municipal management, demonstrating the importance of the pharmacist in health care and the local epidemiological character of the prevalence of chronic non-communicable diseases.

Açai improves non-alcoholic fatty liver disease (NAFLD) induced by fructose.

INTRODUCTION: the excessive consumption of fructose can cause liver damage, characteristic of non-alcoholic fatty liver disease (NAFLD) associated with changes in lipid metabolism and antioxidant defenses. Açai, the fruit of Euterpe oleraceaMart., has demonstrated numerous biological activities, including anti-inflammatory, antioxidant, and lipid metabolism modulating action. OBJECTIVE: we evaluated the benefits of açai supplementation on liver damage caused by replacing starch with fructose in rats. METHODS: thirty male Fischerrats were divided into two groups, the control group (C, 10 animals), which consumed a standard diet (AIN-93M), and the fructose (F, 20 animals) group, which consumed a diet containing 60% of fructose. After eight weeks, 10 animals from the fructose group received 2% of lyophilized açai, and were called the açai fructose group (FA). The animals were fed ad libitumwith these diets for another ten weeks. Serum, hepatic and fecal lipid profile, antioxidant enzymes and carbonylated protein were assessed and histopathological characterization of the liver was performed. RESULTS: açai promoted the reduction of ALT activity in relation to the fructose group (F), reduced alkaline phosphatase to a level similar to that of the control group (C) in relation to the fructose group (F), and reduced catalase activity. The fruit also increased the ratio of total/oxidized glutathione (GSH/GSSG) and reduced the degree of macrovesicular steatosis and the number of inflammatory cells. CONCLUSION: the replacement of starch by fructose during this period was effective in promoting NAFLD. Açai showed attenuating effects on some markers of hepatic steatosis and inflammation.

Açai improves non-alcoholic fatty liver disease (NAFLD) induced by fructose / El açai mejora la enfermedad de hígado graso no alcohólico (NAFLD) inducida por la fructosa

Introduction: the excessive consumption of fructose can cause liver damage, characteristic of non-alcoholic fatty liver disease (NAFLD) associated with changes in lipid metabolism and antioxidant defenses. Açai, the fruit of Euterpe oleracea Mart., has demonstrated numerous biological activities, including anti-inflammatory, antioxidant, and lipid metabolism modulating action. Objective: we evaluated the benefits of açai supplementation on liver damage caused by replacing starch with fructose in rats. Methods: thirty male Fischer rats were divided into two groups, the control group (C, 10 animals), which consumed a standard diet (AIN-93M), and the fructose (F, 20 animals) group, which consumed a diet containing 60% of fructose. After eight weeks, 10 animals from the fructose group received 2% of lyophilized açai, and were called the açai fructose group (FA). The animals were fed ad libitum with these diets for another ten weeks. Serum, hepatic and fecal lipid profile, antioxidant enzymes and carbonylated protein were assessed and histopathological characterization of the liver was performed. Results: açai promoted the reduction of ALT activity in relation to the fructose group (F), reduced alkaline phosphatase to a level similar to that of the control group (C) in relation to the fructose group (F), and reduced catalase activity. The fruit also increased the ratio of total/oxidized glutathione (GSH/GSSG) and reduced the degree of macrovesicular steatosis and the number of inflammatory cells. Conclusion: the replacement of starch by fructose during this period was effective in promoting NAFLD. Açai showed attenuating effects on some markers of hepatic steatosis and inflammation

Introducción: el consumo excesivo de fructosa puede causar daño hepático, característico de la enfermedad hepática grasa no alcohólica (EHGNA), asociada con cambios en el metabolismo de los lípidos y defensas antioxidantes. El açai, fruto del Euterpe oleracea Mart., ha demostrado desempeñar numerosas actividades biológicas, incluidas acciones antiinflamatorias, antioxidantes y moduladoras del metabolismo lipídico. Objetivo: se evaluaron los beneficios de la suplementación con açai en el daño hepático causado por la sustitución del almidón por fructosa en ratas. Métodos: se distribuyeron 30 ratas Fischer macho en dos grupos: 10 ratas en el grupo control (C), que consumía una dieta estándar (AIN-93M), y 20 ratas en el grupo fructosa (F), que consumía una dieta que contenía un 60% de fructosa. Después de ocho semanas, diez animales del grupo fructosa recibieron un 2% de açai liofilizado, por lo que pasaron a integrar el grupo açai fructosa (FA). Los animales fueron alimentados ad libitum con estas dietas durante otras diez semanas. Se analizaron el perfil lipídico hepático y fecal, las enzimas antioxidantes y la proteína carbonilada, y se realizó la caracterización histopatológica del hígado. Resultados: el açai promovió la reducción de la actividad de ALT en relación al grupo de fructosa (F) y la reducción de la fosfatasa alcalina a niveles similares a los hallados en el grupo control (C) en relación con el grupo de fructosa (F). El fruto también aumentó la proporción de glutatión total/oxidado (GSH/GSSG) y redujo el grado de esteatosis macrovesicular y el número de células inflamatorias. Conclusión: la sustitución de almidón por fructosa durante este periodo fue eficaz en la promoción de NAFLD. El açai mostró efectos atenuantes en algunos marcadores de esteatosis hepática y de inflamación

Carqueja (Baccharis trimera) Protects against Oxidative Stress and ß-Amyloid-Induced Toxicity in Caenorhabditis elegans.

Carqueja (Baccharis trimera) is a native plant found throughout South America. Several studies have shown that Carqueja has antioxidant activity in vitro, as well as anti-inflammatory, antidiabetic, analgesic, antihepatotoxic, and antimutagenic properties. However, studies regarding its antioxidant potential in vivo are limited. In this study, we used Caenorhabditis elegans as a model to examine the antioxidant effects of a Carqueja hydroalcoholic extract (CHE) on stress resistance and lifespan and to investigate whether CHE has a protective effect in a C. elegans model for Alzheimer's disease. Here, we show for the first time, using in vivo assays, that CHE treatment improved oxidative stress resistance by increasing survival rate and by reducing ROS levels under oxidative stress conditions independently of the stress-related signaling pathways (p38, JNK, and ERK) and transcription factors (SKN-1/Nrf and DAF-16/Foxo) tested here. CHE treatment also increased the defenses against ß-amyloid toxicity in C. elegans, in part by increasing proteasome activity and the expression of two heat shock protein genes. Our findings suggest a potential neuroprotective use for Carqueja, supporting the idea that dietary antioxidants are a promising approach to boost the defensive systems against stress and neurodegeneration.

Açaí (Euterpe oleracea Mart.) modulates oxidative stress resistance in Caenorhabditis elegans by direct and indirect mechanisms.

Açaí (Euterpe oleracea Mart.) has recently emerged as a promising source of natural antioxidants. Despite its claimed pharmacological and nutraceutical value, studies regarding the effects of açaí in vivo are limited. In this study, we use the Caenorhabditis elegans model to evaluate the in vivo antioxidant properties of açaí on an organismal level and to examine its mechanism of action. Supplementation with açaí aqueous extract (AAE) increased both oxidative and osmotic stress resistance independently of any effect on reproduction and development. AAE suppressed bacterial growth, but this antimicrobial property did not influence stress resistance. AAE-increased stress resistance was correlated with reduced ROS production, the prevention of sulfhydryl (SH) level reduction and gcs-1 activation under oxidative stress conditions. Our mechanistic studies indicated that AAE promotes oxidative stress resistance by acting through DAF-16 and the osmotic stress response pathway OSR-1/UNC-43/SEK-1. Finally, AAE increased polyglutamine protein aggregation and decreased proteasome activity. Our findings suggest that natural compounds available in AAE can improve the antioxidant status of a whole organism under certain conditions by direct and indirect mechanisms.

Iron overload potentiates diet-induced hypercholesterolemia and reduces liver PPAR-α expression in hamsters.

Iron stores and lipids are related to the development of cardiovascular disease. Given that peroxisome proliferator-activated receptor alpha (PPAR-α) regulates important physiological processes that impact lipid and glucose homeostasis, we decided to investigate the effects of iron overload on serum lipids and the liver expression of PPAR-α, 3-hydroxy-3-methylglutaryl coenzyme A reductase, and cholesterol 7α-hydroxylase. Hamsters were divided into four groups. The standard group (S) was fed the AIN-93M diet, the SI group was fed the diet and iron injections, the hypercholesterolemic group (H) was fed a standard diet containing cholesterol, and the HI group was fed a high-cholesterol diet and iron injections. Serum cholesterol in the HI group was higher than in the H group. Gene expression analysis of PPAR-α showed that the HI group had a lower PPAR-α expression than H. These data show that iron, when associated with a high-fat diet, can cause increased serum cholesterol levels, possibly due to a reduction in PPAR-α expression.

Effects of the interaction of diabetes and iron supplementation on hepatic and pancreatic tissues, oxidative stress markers, and liver peroxisome proliferator-activated receptor-α expression.

This study evaluated the effects of the interaction of diabetes and a carbonyl iron supplemented on hepatic and pancreatic tissues, oxidative stress markers and liver peroxisome proliferator-activated receptor-α expressions. Hamsters were divided: Control which received a standard AIN 93 diet; Control Iron, composed of control animals that received a diet with 0.83% carbonyl iron; Diabetic, composed of animals that received a injection of streptozotocin (50 mg/kg, intraperitoneal) on day 35; and Diabetic Iron composed of streptozotocin treated animals that received a diet supplemented with carbonyl iron. Diabetes increased the glucose level and reduced triglycerides. Diabetic Iron group showed higher levels of glucose and serum triglycerides as compared to the Diabetic group. Diabetes decreased mRNA levels of peroxisome proliferator-activated receptor-α. Iron attenuated the diabetes induced down regulation of peroxisome proliferator-activated receptor-α mRNA. Moreover, diabetes increased carbonyl protein and decreased glutathione levels and catalase activity, while iron attenuated the increase in levels of carbonyl protein and attenuated the decrease in those of glutathione level and catalase activity. Histological analysis shows that supplementation iron caused an increase in the size of the islets in Control Iron. The results show that iron does not aggravated liver oxidant/antioxidant status and peroxisome proliferator-activated receptor-α expression in diabetic hamsters.