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2.
Artigo em Inglês | MEDLINE | ID: mdl-31965601

RESUMO

BACKGROUND: Over-the-counter analgesic use during pregnancy, particularly acetaminophen, may be associated with negative developmental outcomes in children. OBJECTIVE: Estimate associations of prenatal and early-life exposure to acetaminophen in early childhood with cognitive, motor, and language skills in two birth cohorts. METHODS: The American Project Viva cohort (1217 mother-child pairs enrolled 1999-2002) assessed cognition at approximately 3 years using the Peabody Picture Vocabulary Test and the Wide Range Achievement of Visual Motor Abilities (WRAVMA). The Brazilian 2015 Pelotas Birth Cohort (3818 mother-child pairs) assessed cognition at 2 years using the INTERGROWTH-21st Neurodevelopment Assessment. We used linear regression to estimate associations of acetaminophen use during pregnancy (Project Viva and Pelotas) and infancy (Project Viva) with children's cognitive scores adjusted for maternal age, pre-pregnancy body mass index, education, parity, race/ethnicity, smoking and alcohol use during pregnancy, depression during pregnancy, antibiotic and ibuprofen use during pregnancy, household income, and child's sex. RESULTS: In Project Viva, exposure to acetaminophen in both the 1st and 2nd trimester of pregnancy was associated with lower WRAVMA drawing scores (ß -1.51, 95% CI -2.92, -0.10). However, in Pelotas, exposure to acetaminophen in both the 1st and 2nd trimester of pregnancy was not associated with INTER-NDA motor scores (ß 0.02; 95% CI -0.05, 0.09) and was associated with higher INTER-NDA total scores (ß 0.08, 95% CI 0.01, 0.16). Other comparisons did not show evidence for any associations. CONCLUSIONS: Inconsistencies and lack of specificity of the findings did not clarify the research question considering that we still have a large variability and uncertainty to define the risk or safety in the use of acetaminophen related to cognition in early childhood. More studies using better exposure assessment and better confounding variables are needed to clarify these associations.

3.
BMC Public Health ; 19(1): 889, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277638

RESUMO

BACKGROUND: Many low- and middle-income countries recommend micronutrient supplements for pregnant women to improve their nutritional status, prevent possible deficiencies and avoid fetal healgth consequences. This study evaluated the influence of socioeconomic status on the use of folic acid, iron salts and other vitamins and minerals among pregnant women in the 2015 Pelotas Birth Cohort. METHODS: This population-based birth cohort study was carried out with 4270 women. Participants were interviewed during pregnancy and at the maternity hospital about the antenatal period; including the use of iron salts, vitamins and other minerals. Descriptive analyses were performed to characterize the sample. The analyses were adjusted according to socioeconomic variables (maternal education, ethnicity, household income). RESULTS: The overall prevalence of the use of folic acid, iron salts or other vitamins and minerals was 91.0% (95% CI: 90.1-91.8). Specifically, 70.9% (95% CI: 69.5-72.3) used folic acid, 72.9% (95% CI: 71.5-74.3) used iron compounds, and 31.8% (95% CI: 30.3-33.2) used other vitamins or minerals. In the adjusted analysis, the use of iron salts was associated with nonwhite mothers, with ≤4 years of education and whose family income was less than or equal to the monthly minimum wage. The use of folic acid and other vitamins and minerals was associated with white mothers who were more highly educated and had a higher family income. CONCLUSION: Although folic acid and other vitamins and minerals were more frequently used in white, richer and more educated mothers, which indicates inequality, iron supplements were more frequently used in the poorer, less educated nonwhite mothers, suggesting the opposite association for this supplement.


Assuntos
Ácido Fólico/administração & dosagem , Ferro na Dieta/administração & dosagem , Gestantes , Vitaminas/administração & dosagem , Adolescente , Adulto , Brasil , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Fatores Socioeconômicos , Adulto Jovem
5.
PLoS One ; 14(3): e0214329, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30897156

RESUMO

PURPOSE: To estimate the prevalence of use of analgesics in Brazil; and to characterize this use, according to sociodemographic and health-related characteristics. METHODS: A cross-sectional population-based study (National Survey on Access, Use and Promotion of Rational Use of Medicines, PNAUM) was conducted between September 2013 and February 2014. A total of 41,433 people of all ages in Brazilian urban households were interviewed. Occasional use (within the last 15 days) and continuous use of non-opioid analgesics, opioid analgesics and non-steroidal anti-inflammatory drugs were investigated, regardless of whether this use occurred through prescription or self-medication. The main outcome was the use of at least one analgesic. RESULTS: The majority of the individuals were female (52.8%), aged between 20 and 59 years (57.2%), with 1 to 8 years of schooling (45.6%). The overall prevalence of analgesic use was 22.8% [95% CI: 21.4-24.2]. The use of analgesics was significantly higher among women, adults and elderly (20 years or more), highly educated individuals and respondents who referred: diagnosis of one or more chronic diseases, using three or more medications, possession of health insurance and with one or more emergency care admittances or hospitalizations within the last year. Non-opioid analgesics were the agents most used (18.5% of the sample), followed by non-steroidal anti-inflammatory drugs (6.9%) and opioid analgesics (0.5%). The most commonly used drugs were metamizole (37.8% of all analgesics), paracetamol (25.3%) and diclofenac (10.7%). These drugs were used mainly to manage occasional health conditions, particularly pain. CONCLUSION: One in five Brazilians used some analgesic, especially non-opioid analgesics, to manage acute health problems such as painful conditions.


Assuntos
Analgésicos/classificação , Analgésicos/uso terapêutico , Acetaminofen/uso terapêutico , Adulto , Fatores Etários , Brasil , Estudos Transversais , Diclofenaco/uso terapêutico , Dipirona/uso terapêutico , Uso de Medicamentos , Feminino , Promoção da Saúde , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Adulto Jovem
7.
Eur J Hosp Pharm ; 25(5): 262-266, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31157037

RESUMO

Objective: To characterise information requests (IRs) from hospitals received by a drug information center (DIC-RS) according to the resolution of the inquiries. Method: The sample consisted of all requestors and their respective IRs registered in the DIC-RS database from January 2012 to December 2016. Request without information in the consulted literature (RWI) were categorised according to the institution of origin. IRs from hospitals were classified by the information source, topic and subtopic of the questions, and the number of drugs and the pharmacological or therapeutic group. Results: A total of 2,500 IRs were analysed. Of those, 25% did not exhibit conclusive information in the consulted sources. RWI from hospitals represented 51% of all RWI, followed by those from community pharmacies (13%) and health centres (9%). Tertiary literature was the most commonly used source (73%) for IRs from hospitals. The greatest difficulties in finding information were related to off-label drug administration and indication issues (52% of RWI). The most common type of off-label use was related to changes in the original pharmaceutical form of the drug. Furthermore, 61% of RWI were directed at a specific drug, mostly systemic anti-infectives. Conclusion: We found that a quarter of the answers did not exhibit conclusive information in the consulted sources. Answers to IRs from the hospital environment exhibited the greatest extent of limited information, and off-label use was responsible for most cases.

8.
Patient Educ Couns ; 101(4): 672-678, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29203083

RESUMO

OBJECTIVE: The objective of this randomized controlled trial was to evaluate the efficacy of presenting information on the risks of side effects from a medicine, presented in different formats. METHODS: A randomized, parallel-group, single-center controlled trial was conducted among adult users of a training pharmacy. The information was categorized into the following groups: verbal descriptors+percentage range, percentage range and absolute percentage. The main outcomes were gist understanding and verbatim understanding, classified either as adequate or inadequate. The analyses were performed using ANOVA and Pearson's chi-square test. RESULTS: A total of 393 participants were recruited from June to October 2015. Adequate levels of gist understanding and verbatim understanding were respectively 65.6% and 53.9% for the verbal descriptors+percentage range (n=128), 63.4% and 44.3% for percentage range (n=131), and 62.3% and 48.5% for absolute percentage (n=131), with no statistically significant difference between the groups (p=0.852 and p=0.299, respectively). CONCLUSION: The understanding of the information was similar in all three formats, but the percentages of adequate understanding were low. PRACTICAL IMPLICATIONS: The percentage of inadequate understanding demonstrated in this study indicates that alternative formats for reporting adverse reactions need to be evaluated.


Assuntos
Comunicação , Compreensão , Informação de Saúde ao Consumidor/métodos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Educação de Pacientes como Assunto/métodos , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
9.
J Pregnancy ; 2012: 257597, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23346403

RESUMO

BACKGROUND: To estimate the exposure to medicines with unknown fetal risk during pregnancy and to analyze the maternal characteristics associated with it. METHODS: A questionnaire was administered to 4,189 mothers of children belonging to the 2004 Pelotas (Brazil) birth cohort study about use of any medicine during gestation. We evaluated the associations between use of medicines with unknown fetal risk and the independent variables through logistic regression models. Unknown fetal risk was defined as medicines in which studies in animals have revealed adverse effects on the fetus, and no controlled studies in women, or studies in women and animals, are available. RESULTS: Out of the 4,189 women, 52.5% used at least one medicine from unknown fetal risk. Use of these medicines was associated with white skin color, high schooling, high income, six or more antenatal care consultations, hospital admission during pregnancy, and morbidity during gestation. CONCLUSION: The use of unknown fetal risk medicines is high, suggesting that their use must be addressed with caution with the aim of restricting their use to cases in which the benefits are greater than the potential risks.


Assuntos
Uso de Medicamentos/estatística & dados numéricos , Gravidez/estatística & dados numéricos , Adulto , Brasil , Estudos de Coortes , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Risco , Fatores Socioeconômicos , Inquéritos e Questionários
10.
Arch Gynecol Obstet ; 279(3): 293-7, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18568358

RESUMO

OBJECTIVE: To evaluate the risk of adverse perinatal events among newborns exposed to dipyrone during gestation. DESIGN AND SETTING: The present study is a secondary analysis of Brazilian study of gestational diabetes (EBDG), a cohort of women attended at healthcare units of the Brazilian national health system (SUS) located in six Brazilian state capitals, between February 1991 and June 1995. SAMPLE: A total number of 5,564 women aged 20 years and over who were between their 21st and 28th week of pregnancy were followed up. METHODS: A structured questionnaire was used to obtain data on the pregnant women, their pregnancies, and their use of medications. Other data and the outcomes congenital abnormalities, intrauterine death, preterm birth, or low birth weight were obtained from the medical records. To estimate the odds ratios after adjustment for the potential confounding factors, logistic regression modeling was developed. MAIN OUTCOME MEASURES: Congenital abnormalities, intrauterine death, preterm birth, and low birth weight. RESULTS: Dipyrone use was reported by 555 pregnant women (11.5%). Their exposure to this medication did not present any association with the outcomes of congenital abnormalities (OR 1.11; 95% CI, 0.58-2.10), intrauterine death (OR 0.69; 95% CI, 0.33-1.43), preterm birth (OR 0.94; 95% CI, 0.73-1.20), or low birth weight (OR 0.88; 95% CI, 0.64-1.22), in the crude analysis. This absence of associations was maintained after performing logistic regression analysis. CONCLUSIONS: The data suggest that the exposure to dipyrone during pregnancy does not increase the risk of congenital abnormalities and other adverse events as outcomes from pregnancy.


Assuntos
Anormalidades Induzidas por Medicamentos/etiologia , Anti-Inflamatórios não Esteroides/efeitos adversos , Dipirona/efeitos adversos , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Estudos de Coortes , Dipirona/uso terapêutico , Feminino , Humanos , Recém-Nascido , Análise Multivariada , Gravidez , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
11.
Reprod Toxicol ; 22(4): 666-71, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16750609

RESUMO

The present systematic review was proposed with the objective of estimating the risk of congenital anomalies and other adverse events in children exposed to misoprostol during fetal life. The data source consisted of case-control studies that analyzed the effect of prenatal exposure to misoprostol on the pregnancy outcome, which were located in electronic databases and published up to June 2005. The outcomes of interest included congenital anomalies, fetal death, low birth weight and prematurity. The odds ratios (OR) for the individual studies were pooled by meta-analysis. Sensitivity tests and heterogeneity analysis were performed. Four studies involving 4899 cases of congenital anomalies and 5742 controls were included in accordance with the selection criteria. None of the studies analyzed other adverse effects from misoprostol on the outcome from gestation. Increased risks of congenital anomalies related to misoprostol use were found for any congenital defect (OR=3.56; 95% CI: 0.98-12.98), Möbius sequence (OR=25.31; 95% CI: 11.11-57.66) and terminal transverse limb defects (OR=11.86; 95% CI: 4.86-28.90). In conclusion, prenatal exposure to misoprostol is associated with an increased risk of Möbius sequence and terminal transverse limb defects.


Assuntos
Anormalidades Congênitas/etiologia , Misoprostol/efeitos adversos , Antiulcerosos/administração & dosagem , Antiulcerosos/efeitos adversos , Estudos de Casos e Controles , Relação Dose-Resposta a Droga , Feminino , Humanos , Deformidades Congênitas dos Membros/etiologia , Misoprostol/administração & dosagem , Síndrome de Möbius/embriologia , Síndrome de Möbius/etiologia , Gravidez
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