Magister Pharmaceuticae - MPharm / Access to quality healthcare in South Africa is known to be unequal, with those who can afford it, receiving the best quality healthcare services in the private sector, and those who cannot afford it, having to receive healthcare in the public sector. The South African government is implementing the National Health Insurance to remove unequal access to healthcare services. However, the aim of this study is to evaluate the current usage of medicine.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Problemas Relacionados a Medicamentos (PRM) sÃo responsÃveis por causar morbidade e mortalidade em todo o mundo, e tambÃm, afetar resultados clÃnicos esperados e a qualidade de vida (QV) de pacientes. O tratamento etiolÃgico da DoenÃa de Chagas (causada pelo Trypanosoma cruzi) conta apenas com o benzonidazol (BNZ). Este medicamento pode produzir toxicidade (hipersensibilidade, aplasia medular, etc.) e tem eficÃcia parcial. O objetivo deste trabalho foi avaliar os efeitos provocados na saÃde dos pacientes emu so de BNZ, medidos a partir de Ãndices QV e PRM. Dezenove pacientes foram inluÃdos em um estudo observacional, descritivo e de seguimento que ocorreu de novembro de 2006 a outubro de 2007. Estes pacientes, apÃs prescriÃÃo de BNZ e consentimento, foram acompanhados por 6 meses por um farmacÃutico e estagiÃrios treinados. O MÃtodo DÃder foi utilizado, excetuando-se a etapa de intervenÃÃo. Os PRM foram classificados por juÃzes utilizando-se o Segundo Consenso de Granada (2002). As reaÃÃes adversas foram classificadas pelo Centro de FarmacovigilÃncia do Cearà (CEFACE). Utilizou-se o questionÃrio Short-Form Health Survey (SF-36) para avaliar a QV dos pacientes antes e apÃs o seguimento. Realizou-se anÃlise descritiva para os dados. AlÃm disso, os testes de Mcnemar e Wilcoxon foram feitas para anÃlise inerencial, considerando o nÃvel de significÃncia de p<0,05. A maioria dos pacientes era homem (58%), possuÃa escolaridade atà o ensino fundamental (57,9%) e encontrava-se na forma indeterminada da doenÃa de Chagas (74%). Cerca de 42% dos pacientes fizeram uso de dois ou trÃs medicamentos durante o tratamento com BNZ, havendo mÃdia de consumo de 1,3 medicamento por paciente, sendo os anti-hipertensivos e diurÃticos os mais usados durante o tratamento com BNZ (22%). Em relaÃÃo à adesÃo ao BNZ, 47,4% nÃo foram aderentes ao BNZ. Suspenderam o tratamento, 36,8%, a maioria devido à presenÃa de RAM (Coeficiente de CorrelaÃÃo = 0,415, p-valor bicaudal = 0,047). Somou-se um total de 148 PRM nas trÃs etapas de avaliaÃÃo. Destes 41,9% estavam relacionados à necessidade, 33,1% à efetividade e 25% à seguranÃa. Verificou-se que a quantidade de PRM estava associada ao nÃmero de medicamentos usados (Coeficientes de CorrelaÃÃo Kendall = 0,438, p-valor bicaudal = 0,018). Comprovou-se que a quantidade de PRM apÃs o tÃrmino do tratamento (60 dias) foi maior em relaÃÃo ao inÃcio (Teste de Wilcoxon: Z=-3,725, p<0,05). Cerca de 17 pacientes (10 homens e 7 mulheres) afirmaram apresentar alguma RAM, que variou desde prurido a parestesia. A maioria destas foi classificada como provÃvel e leve. Demonstrou-se que os pacientes com RAM leves tÃm um conhecimento maior em relaÃÃo Ãqueles com reaÃÃes moderadas (Coeficiente de CorrelaÃÃo = 0,523; p-valor bicaudal = 0,028). NÃo foi detectada alteraÃÃo da QVRS apÃs o seguimento. Entretanto, mostrou-se que os PRM afetaram a QVRS (Teste de Wilcoxon: Z=-3,724, p<0,05). NÃo houve diferenÃa entre QVRS antes e depois, no entanto houve piora da QVRS em relaÃÃo aos PRM. / Drug Related Problems (DRP) are responsible to cause morbidity and mortality in all world, and can affect expected clinical results and quality of life (QoL) of patient. Etiologic treatment for Chagasâ disease (caused by Trypanosoma cruzi) have only a drug, the benznidazole (BNZ). This medicine may produce toxicity (hipersensibility, bone medular aplasy, etc.) and have partial efficacy. The aim was to estimate the effects in the health of patients in use of BNZ, mensured by QoL and DRP. Nineteen patients included in a observational, descriptive and follow-up study in the period from November of 2006 to October of 2007. These patients, after prescription of BNZ and consent, were followed by 6 months by pharmacist and pharmacist students. Dader Method was utilized except intervention procediment. DRP were classified by judges utilizing the Second Granada Consensus (2002). The adverse reaction were classified by Centro de FarmacovigilÃncia do Cearà (CEFACE). The QoL was mensuread by Short-Form Health Survey (SF-36) questionnaire before and after the follow-up. Were realized by descriptive analysis to study the result. Also, Mcnemar and Wilcoxon tests were made for inferential analysis, considering the significance level p<0,05. The majority of patients were men (58%), had until primary school level (57,9%) and they were in a indeterminate form of Chagas disease (74&#61477;). About 42&#61477; from patients used 2 or 3 medicines with BNZ treatment, with an average from 1,3 medicine per patient. Antihypertension and diuretics were the most utilized in BNZ treatment (22%). In relation to adherence, 47,4% from patients were not adhere to BNZ. The use of BNZ was suspended in 36,8% of patients, the major reason was adverse reaction (Correlation Coefficient = 0,415, p-value = 0,047). In three steps of analysis was founded a total of 148 DRP (41,9% related to necessity, 33,1% to effectiveness and 25% to security). DRP were associated to number of medicines (Kendall Coefficient = 0,438, p-value = 0,018). The number of DRP were high after than the start of treatment with BNZ (Wilcoxon test: Z=-3,725, p<0,05). Seventeen patients (10 men and 7 women) showed adverse reaction, to pruritus until parestesia. These majority reactions were classified as probable and soft. Patients with soft adverse reaction have more knowledge level in relation to patients with moderate adverse reaction (Correlation Coefficient = 0,523; p-value = 0,028). It wasnât detected alterations in QoL after follow-up, but it was showed that DRP affected QoL levels (Wilcoxon test: Z=-3,724, p<0,05). There wasnât difference between QoL before and after, however DRP affected QoL.

Complementary and alternative medicine (CAM) refers to a group of diverse medical and healthcare systems, practices, and products not treated as conventional medicine. The body of literature on stress and stress management among young adults has not addressed the use of CAM modalities for stress management among this population. The theoretical foundation of the study was based upon the transactional model of stress and coping, which describes stress as an interaction between an external stressor and the resources available to eliminate the stressor. The purpose of this quantitative study was to examine whether variables such as exposure to CAM, stress level, dispositional coping style, sociodemographic variables, and social support influence young adults' use of CAM modalities for stress management. This study sought to determine to what extent dispositional coping, exposure to and knowledge of CAM, and sociodemographic variables affect young adults' use of CAM modalities for stress management. This study also sought to answer whether there is a difference in the perceived stress of participants who use CAM modalities and those who do not. A quantitative cross-sectional correlational study was employed, using a survey methodology, to identify whether the factors identified in the study influence young adults' use of CAM modalities. Results showed that knowledge of CAM and dispositional coping style significantly influence the use of CAM modalities; sociodemographic variables do not influence the use of these modalities. Furthermore, the use of CAM modalities was found to have a significant relationship to stress level. The findings of the current study suggest the CAM techniques can be adapted and introduced into college settings so that students can better manage their stress levels

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Os medicamentos sÃo a principal ferramenta terapÃutica para a recuperaÃÃo ou manutenÃÃo das condiÃÃes de saÃde da populaÃÃo. Dentre os problemas mais comuns relacionados aos mesmos estÃo a ReaÃÃo Adversa a Medicamentos (RAM) e Queixas TÃcnicas (QT), sendo necessÃria sua vigilÃncia atravÃs do gerenciamento, direcionamento e desenvolvimento de atividades de farmacovigilÃncia mediante a formaÃÃo de centros colaboradores/notificadores. Avaliar as notificaÃÃes de RAM e QT enviadas e analisadas pelo Centro de FarmacovigilÃncia do Cearà (CEFACE) durante os seus nove anos de funcionamento voltados para o contexto da saÃde pÃblica e do uso racional de medicamentos. Foram coletadas todas as notificaÃÃes de RAM e QT do banco de dados do CEFACE, durante o perÃodo de janeiro/97 a dezembro/05, sendo as seguintes variÃveis analisadas: sexo e idade, origem da notificaÃÃo, notificador, medicamento envolvido, RAM referida, e classificaÃÃo desta quanto à causalidade e severidade e tipo de RAM segundo Rawlins e Thompson. Quanto à QT, as variÃveis foram: origem da notificaÃÃo, tipo de QT, notificador e medicamento ou material mÃdico envolvido. Foi tambÃm realizado um levantamento para identificaÃÃo na literatura da possibilidade dos excipientes farmacÃuticos serem fatores de risco para RAM, utilizando-se como base inicial os 11 medicamentos mais vendidos no mercado brasileiro, no perÃodo de novembro/02 a novembro/03 e suas respectivas formulaÃÃes. Posteriormente foi feita a retirada de casos com envolvimento desses excipientes em estudos de casos clÃnicos suspeitos. No perÃodo de janeiro/97 a dezembro/05, o CEFACE registrou 1.293 notificaÃÃes. Destas, 1.172 (90,6%) foram casos de RAM e 121 (9,4%) de QT. Houve uma reduÃÃo significante do envio dessas notificaÃÃes durante os anos. A maioria das RAM foi referente ao sexo feminino (62,7%) e a faixa etÃria de 21-30 anos (17,7%). A busca ativa foi o mÃtodo de notificaÃÃo com maior percentual (59,3%). 85,6% (RAM) foram de origem hospitalar com percentual de pÃblicos de 81,6%. O grupo terapÃutico com maior envolvimento foi o dos antiinfecciosos de uso sistÃmico (40%). O sistema da pele (48,5%) destacou-se dentro das RAM referidas. Quanto à causalidade, o maior nÃmero de RAM foi do tipo provÃvel (44,1%) e para a severidade destacaram-se as moderadas (52,2%). A maioria foi RAM do tipo A. As RAM graves e fatais tambÃm ocorreram. As QT foram de origem hospitalar (n=120), com Ãnfase para a mudanÃa de coloraÃÃo (47,1%) e falta de eficÃcia (22,3%). Foram identificados na literatura 10 excipientes farmacÃuticos de risco, sendo 03 responsÃveis por RAM coletadas no banco de dados do CEFACE. O estudo de RAM e QT, bem como o estabelecimento de seus fatores condicionantes por um centro de farmacovigilÃncia tÃm grande importÃncia no contexto da saÃde pÃblica e do uso racional de medicamentos. Tanto o profissional notificador, como a populaÃÃo em geral, deve ser incentivado a notificar toda suspeita de RAM e QT aos ÃrgÃos responsÃveis para que sejam estabelecidas medidas administrativas, dentre elas: a) Retirada de produtos inadequados do mercado; b) MudanÃas nas suas bulas e c) RestriÃÃo de uso na populaÃÃo. O levantamento na literatura cientÃfica demonstra de forma clara que, o envolvimento dos excipientes à um fator de risco para a ocorrÃncia de RAM, possibilitando sua inserÃÃo no estudo de causalidade de casos suspeitos. / Drugs are the mainly therapeutical tool to the recoverying or maintenance of the population health condiction. Among the most common problems related for it are Adverse Drug Reactions (ADR) and Technical Complains (TC), being need this survey through the management, and development of activities of pharmacovigillance with the creation of helperâs and notifiers centers. Evaluate the ADR and TC sended to and analized by the pharmacovigillance center of ceara during its nine years of function toward to public health and rational use of drugs. Were collected All the ADR and TC notifications in the database of CEFACE, during the period of January 1997 to December 2005, being analized the following variables: gender and age, origin of the notification, notifier, drug involved, ADR, causality and severity classification of these ones and the kind of ADR according to Rawlins and Thompson. About the TC, the variables being: origin of notification, kind of TC, notifier, and drug or medical material involved. Also A research was made to identify in literature the possibility of pharmaceutical excipients being risks factors to cause ADR, using as initial data the 11 drugs most sold in the brazilian market in the period of November/02 to November/03 and their respective compositions. Lately was made the retrieve of cases with the involvement of these excipients in studies of suspects clinical cases. In the analized period, January 1997 to December 2005, the CEFACE registered 1.293 notifications. Of these ones, 1.172 (90,6%) ADR cases and 121 (9,4%) TC. There was a significant reduction of the number of notification during the years. Most of the ADR were registered in females (62,7%) and age of 21-30 anos (17,7%). Active search was the greatest notification method (59,3%). 85,6% (ADR) came from in hospitals with a percentual of publics in 81,6%. The therapeutical group with greatest involvement most was antibiotics for systemic use (40,0%). %). The skin system (48,5%) to be detached inside of the reported ADR. For causality, the higher number of ADR were classified as probably (44,1%) and for severity the highest percentual were considered as moderate (52,2%). Most were ADR A type. The severe and fatal ADR also occurred. The TC came from in hospitals (n=120), with emphasis to changing of color (47,1%) and lack of effectiveness (22,3%). In the literature were identified 10 risk pharmaceutical excipients, being 03 responsible for ADR collected in CEFACE database. The study of ADR and TC, as well as the establishment of their conditioners factors by a pharmacovigillance center, has large importance in public health and rational use of drugs context. Both the professional notifier and the population must be encouraged to notify all the suspects of ADR and TC to the responsable groups to be taken administrative measures among them: a) retrieve of inapropriated products from market; b) change in the labels and c) restriction in the use by population. The research in scientific literature shows in a clear way that, the involvment of excipients is a risk factor to ADR occurrence, enabling your insertion in the causality study of suspects cases.

>Magister Scientiae - MSc / Type 2 diabetes mellitus is a progressive disease characterised by defects in insulin secretion, insulin action or both. Proper management of diabetes with appropriate drug and lifestyle interventions, guided by proper glycaemic monitoring has shown improved glycaemic control and a substantial decrease in morbidity associated with complications and mortality. Evidence-based guidelines for the appropriate management of diabetes, suggests the use of glycated haemoglobin (HbA1c) and fasting plasma glucose (FPG) as monitoring indicators and have set targets levels that indicate appropriate glucose control. In the event of suboptimal control, actions steps to adjust pharmacotherapeutic treatment has been set out. Of the two aforementioned glycaemic monitoring indicators, HbA1c is termed the 'gold standard' as it provides the most comprehensive data i.e. it reflects both fasting and postprandial glucose concentrations over a 3 months period as compared to FPG which only show glucose levels for a few hours. The aim of this study was to describe the use of glycaemic monitoring indicators in patients with type 2 diabetes mellitus, classified as stable, treated at primary health care facilities in the Cape Town Metropolitan Region in South Africa. The study was a descriptive, retrospective and quantitative in design. Data were collected from patient medical records and included glycaemic monitoring tests and results as well as prescribing records for a maximum period of 18 months. The study comprised of 575 participants from five primary health care facilities in the Western Cape Metropole region. All participants had FPG results, while HbA1c results were recorded for 86% of participants at least once. More than 70% of participants with either a FPG or HbA1c result showed suboptimal glucose control i.e. were outside of the target range. In 181 opportunities for intervention in participants with HbA1c results outside target, 113 (62.4%) did not have any therapy adjustments, 19 (10.5%) had the total daily dose increased, 6 (3.3%) had total daily dose decreased, 9 (5.0%) had a step-up in regimen, 5 (2.8%) had a step down in regimen and 29 (16.0%) had a lateral regimen change. In 852 opportunities for intervention in participants with FPG results outside target, 609 (71.5%) did not have any therapy adjustments, 47 (5.5%) had the total daily dose increased, 18 (2.1%) had the total daily dose decreased, 16 (1.9%) had a step-up in regimen, 15 (1.8%) had a step down in regimen and 147 (17.3%) had a lateral change in regimen. This study has demonstrated that in the primary healthcare facilities investigated, FPG was the most often used gycaemic monitoring indicator, glycaemic monitoring of patients mostly show suboptimal glucose control and that opportunities to optimise pharmacotherapy in diabetes management are mostly missed.

Philosophiae Doctor - PhD / Studies on rational medicine use (RMU) have mainly focused on identifying, quantifying, and addressing irrational use without exploring reasons behind this irrational use. In addition, minimal work has been conducted on irrational use of medicines in the context of the growing burden of non-communicable diseases (NCDs). This PhD research examined medicine use in Eswatini, (previously Swaziland) between April 2017 and March 2019, with a focus on prescribing practices linked to specific diagnoses. It further explored factors influencing RMU, which included testing the effects of a short intervention - prescription audit and feedback coupled with small group education - on prescribing practices in health facilities.

There are widespread concerns about the increasing use of multiple medicines. The aims of this thesis were to identify older patients' and general practitioners' (GPs) attitudes to and experiences of multiple medicine use, as well as to describe patterns of multiple medicine use in different age groups in association with patient-related factors. An additional aim was to contribute to scientific methodological development by providing an empirical example of the application of the Lehoux, Poland, &amp; Daudelin template for the analysis of interaction in focus groups. Data were collected via qualitative focus group discussions and from a cross-sectional community-based population survey conducted during 2001-2005. The patients revealed co-existing accounts of both immediate gratitude that medicines exist and problems with using multiple medicines such as worrying whether multiple medicine use is 'good' for the body. The patient-doctor relationship coloured their attitudes towards their treatment and care. The GPs at times felt insecure, though surrounded by treatment guidelines. Lack of communication with hospital specialists was perceived to reduce treatment quality, while influence of patient pressure was thought to contribute to the development of multiple medicine use. An interaction analysis helped in appreciating and clarifying the contexts in which results from the content analysis were created. Further discussion is needed on how to best report these results. Different cut-offs are useful in defining multiple medicine use in different age groups. Vast majorities of users of multiple medicines were found to have unique medicine combinations. Multiple medicine use was found to be associated with morbidity and poor self-rated health across all age groups.

O presente estudo avalia a produção pública de medicamentos no Brasil, abordando as possibilidades de avanços no acesso aos medicamentos essenciais. Fundamentou-se na análise bibliográfica e documental. Esta última análise focou os documentos oficiais, originários dos diversos agentes institucionais vinculados à política de medicamentos do país. A Política Nacional de Medicamentos concentrou-se na provisão da assistência farmacêutica e, em especial, no acesso racional aos medicamentos essenciais. A pesquisa, de caráter histórico, destacou analiticamente o desenvolvimento dessa política desde 2003 até o presente. Nesse contexto, privilegiam-se as características universais do atual sistema de saúde no Brasil e o compromisso do Estado nacional em garantir o acesso a esse direito fundamental. Foram também objeto de destaque nesta pesquisa as alternativas de oferta de medicamentos por intermédio da indústria farmacêutica internacional e nacional. O núcleo deste estudo é a análise da produção dos medicamentos pelos laboratórios oficiais, bem como das dificuldades que esses laboratórios enfrentam em função da descontinuidade histórica de políticas voltadas para o fortalecimento de suas atividades. Assim, permite-se afirmar que a produção dos medicamentos essenciais poderia contribuir de forma decisiva para a inclusão da população historicamente excluída das políticas de saúde a partir de estratégias para o seu fortalecimento continuado, definidas pelo Estado brasileiro. / The present thesis has evaluated the medicine production by the State, addressing its possibilities in improving the access to essential medicines. This study has relied on both bibliographical and documental analysis. The latter was focused on official documents from several institutional agencies linked to the countrys pharmaceutical policy. The National Pharmaceutical Policy has been concentrated on the provision of pharmaceutical assistance, especially on the rational access to essential medicines. From an analytical and historical perspective, this research has highlighted the development of such policy from 2003 to the present day. Within this context, the current universal features of the Brazilian National Health System and the responsibility undertaken by the State to provide access to medicines were emphasized. The alternative offers of medicines by both the national and international pharmaceutical industries were also highlighted. The main goal of this thesis was the analysis of pharmaceutical production by the official laboratories as well as the difficulties faced by these laboratories resulting from a lack of continuity in the policies geared at strengthening its activities. Thus, the present work aims to show that essential medicine production might significantly contribute to the inclusion of those historically excluded from the health policies through continued strengthening policies as defined by the State.

O presente estudo avalia a produção pública de medicamentos no Brasil, abordando as possibilidades de avanços no acesso aos medicamentos essenciais. Fundamentou-se na análise bibliográfica e documental. Esta última análise focou os documentos oficiais, originários dos diversos agentes institucionais vinculados à política de medicamentos do país. A Política Nacional de Medicamentos concentrou-se na provisão da assistência farmacêutica e, em especial, no acesso racional aos medicamentos essenciais. A pesquisa, de caráter histórico, destacou analiticamente o desenvolvimento dessa política desde 2003 até o presente. Nesse contexto, privilegiam-se as características universais do atual sistema de saúde no Brasil e o compromisso do Estado nacional em garantir o acesso a esse direito fundamental. Foram também objeto de destaque nesta pesquisa as alternativas de oferta de medicamentos por intermédio da indústria farmacêutica internacional e nacional. O núcleo deste estudo é a análise da produção dos medicamentos pelos laboratórios oficiais, bem como das dificuldades que esses laboratórios enfrentam em função da descontinuidade histórica de políticas voltadas para o fortalecimento de suas atividades. Assim, permite-se afirmar que a produção dos medicamentos essenciais poderia contribuir de forma decisiva para a inclusão da população historicamente excluída das políticas de saúde a partir de estratégias para o seu fortalecimento continuado, definidas pelo Estado brasileiro. / The present thesis has evaluated the medicine production by the State, addressing its possibilities in improving the access to essential medicines. This study has relied on both bibliographical and documental analysis. The latter was focused on official documents from several institutional agencies linked to the countrys pharmaceutical policy. The National Pharmaceutical Policy has been concentrated on the provision of pharmaceutical assistance, especially on the rational access to essential medicines. From an analytical and historical perspective, this research has highlighted the development of such policy from 2003 to the present day. Within this context, the current universal features of the Brazilian National Health System and the responsibility undertaken by the State to provide access to medicines were emphasized. The alternative offers of medicines by both the national and international pharmaceutical industries were also highlighted. The main goal of this thesis was the analysis of pharmaceutical production by the official laboratories as well as the difficulties faced by these laboratories resulting from a lack of continuity in the policies geared at strengthening its activities. Thus, the present work aims to show that essential medicine production might significantly contribute to the inclusion of those historically excluded from the health policies through continued strengthening policies as defined by the State.