Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2018-05-09T13:39:22Z No. of bitstreams: 1 Andreia Maria da Silva.pdf: 1564506 bytes, checksum: 862f31a0de04bfd10c07aa71fd46034a (MD5) / Made available in DSpace on 2018-05-09T13:39:23Z (GMT). No. of bitstreams: 1 Andreia Maria da Silva.pdf: 1564506 bytes, checksum: 862f31a0de04bfd10c07aa71fd46034a (MD5) Previous issue date: 2018-03-23 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The trajectory of mental health in the Brazilian society is marked by important transformations resulting from the strengthening of the Unified Health System, the anti-asylum Struggle and the Psychiatric Reform. However, the recognition of the demand of the adolescent public with questions related to the use and abuse of drugs is still necessary in order to construct actions based on a logic of care in the perspective of Harm Reduction and Integral Protection. Such demand is complex and suffers directly the impact of the National Drug Policy, where we observe a strengthening of the illegal commerce of these substances and the non-control of the consumption of the population in general. The objective of this research was to characterize the course of care of adolescents with a history of abusive use of alcohol and other drugs that are followed in a CAPS IJ II and a CAPS AD III in the city of São Paulo. The method consisted of a quantitative and qualitative analysis of the medical records of adolescents who used the service for the first time in 2016, a case study and information brought by the researcher, who is a worker in one of the CAPS. The discussions were built based on the theoretical-methodological reference of Socio-Historical Psychology, making possible a critical evaluation of the social reality in which these questions are immersed. Given this scenario, we show that the look at the complexity of actions, permeated by adolescents' uniqueness of life, their emotional care network, the characteristics of the territory and the service, should contribute to overcoming the logic centred on health services. The need to continue investing in creative care constructs, through Harm Reduction and other tools consistent with SUS principles, Psychiatric Reform and Integral Protection to Adolescents, emerges from the analysis as a possibility of psychosocial intervention. Such a perspective aims to extend the care beyond the practices centered in the CAPS, at the same time that bets on the possibilities of this service / A trajetória da saúde mental na sociedade brasileira é marcada por importantes transformações decorrentes do fortalecimento do Sistema Único de Saúde, da Luta Antimanicomial e da Reforma Psiquiátrica. Entretanto, o reconhecimento da demanda do público adolescente com questões relacionadas ao uso e abuso de drogas, ainda se faz necessário no sentido da construção de ações pautadas em uma lógica de cuidado na perspectiva da Redução de Danos e da Proteção Integral. Tal demanda é complexa e sofre diretamente o impacto da Política Nacional de Drogas, onde observamos um fortalecimento do comércio clandestino destas substâncias e o não controle do consumo da população em geral. Inserida neste cenário, esta pesquisa teve como objetivo caracterizar o percurso de atendimento de adolescentes com histórico de uso abusivo de álcool e outras drogas que são acompanhados em um CAPS IJ II e um CAPS AD III no município de São Paulo. O método foi constituído de uma análise quantitativa e qualitativa dos prontuários dos adolescentes que recorreram ao serviço pela primeira vez no ano de 2016, um estudo de caso e informações trazidas pela pesquisadora, que é trabalhadora em um dos CAPS. As discussões foram construídas a partir da referência teórico-metodológica da Psicologia Sócio-Histórica, possibilitando uma avaliação crítica sobre a realidade social na qual estão imersas estas questões. Diante deste cenário, evidenciamos que o olhar para a complexidade das ações, permeada pela singularidade de vida do adolescente, da sua rede afetiva de cuidado, das características do território e do serviço, deve contribuir para superar a lógica centrada nos serviços de saúde. Emerge da análise realizada a necessidade de continuar investindo em construções criativas de cuidado, por intermédio da Redução de Danos e outras ferramentas coerentes com os princípios do SUS, da Reforma Psiquiátrica e da Proteção Integral ao Adolescente, como possibilidade de intervenção psicossocial. Tal perspectiva visa ampliar o cuidado para além das práticas centradas no CAPS, ao mesmo tempo em que aposta nas possibilidades desse serviço

A atenção farmacêutica (ATENFAR) é uma nova prática clínica, inerente ao profissional farmacêutico, que tem como principais objetivos a prevenção de doenças, a promoção e a recuperação da saúde de usuários de serviços sanitários, através do fomento ao uso racional de medicamentos. Vários estudos realizados no Brasil e no exterior mostram que a atividade de ATENFAR pode propiciar muitos benefícios aos tratamentos de saúde que fazem uso de farmacoterapia, resultando no aumento da efetividade do tratamento e na melhoria da qualidade de vida dos pacientes. Além disso, alguns estudos mostram que a ATENFAR exerce influência sobre os custos assistenciais, sendo esta informação de grande importância para que se discuta a inserção desta prática em programas de saúde coletiva. Devido à escassez de estudos econômicos sobre serviços de ATENFAR, este trabalho visou, através de pesquisa bibliográfica, levantar informações acerca dos temas Economia da Saúde, Atenção Farmacêutica e Avaliação em Saúde e discutir criticamente a aplicabilidade e adequação dessas informações aos referidos estudos. A análise das publicações encontradas através da revisão bibliográfica realizada permitiu concluir que: o As análises econômicas tipo custo-minimização, tipo custo-efetividade, tipo custo-utilidade e tipo custo-benefício são aplicáveis a serviços de ATENFAR; o Os custos relativos aos salários dos farmacêuticos, dos auxiliares e dos demais membros da equipe de saúde; ao transporte do paciente ou da equipe de saúde; aos materiais de consumo; aos medicamentos; às internações hospita lares; aos atendimentos médicos de urgência; às sensações de dor, de tristeza, de mal estar; aos dias de trabalho perdidos; à necessidade de um cuidador; ao aluguel do espaço desti nado ao serviço; são custos que devem ser levantados em uma avaliação econômica de serviços de ATENFAR; o A melhoria em parâmetros clínicos e na qualidade de vida de pacientes atendidos por serviços de ATENFAR e a economia de recursos financeiros, são possíveis resultados gerados por esses serviços; o As análises econômicas de serviços de ATENFAR podem ser realizadas sob a perspectiva do paciente, da instituição de saúde, do plano de saúde, do sistema de saúde, da sociedade ou de qualquer outro agente que tenha inte resse em realizar uma avaliação econômica de tais serviços; o Os modelos de estudos epidemiológicos mais indicados para serem utilizados em análises econômicas de serviços de ATENFAR são o modelo experimental e o modelo observacional longitudinal tipo coorte prospectivo. / The pharmaceutical care is a new practical clinic, inherent to the pharmaceutical professional, who has as main objectives the prevention of illnesses, the promotion and recovery of health of sanitary services users, through the fomentation of rational drug use. Several studies accomplished in Brazil and the exterior show that the pharmaceutical care activity can propitiate many benefits to the health treatments which use the pharmacotherapy, resulting in the increase of treatment effectiveness and in the improvement of life quality of patients. Moreover, some studies show that the pharmaceutical care exerts influence on the assistance costs, being this information of great importance to discuss the insert of this practical in collective health programs. Due to scarcity of economic studies on pharmaceutical care services, the present work aimed at, through bibliographical research, raise information about the topics Health Economics, Pharmaceutical Care and Health Evaluation and to critically discuss the applicability and adequacy of this information to the related studies. The analysis of publications found by means of bibliographic revision lead to the conclusion that: o The economic analyses type cost-minimization, type cost-effectiveness, type costutility and type cost-benefit are applicable to pharmaceutical care services; o The cost concerning to the wages of the pharmacist, the assistant and others members of the health team; to the patients or health team transport; to the consumption materials; to medicines; to the hospital internments; to the medical attends of urgency; to the sensations of pain, sadness and badly being; to the lost days of work; to the necessity of attendant; to the rent of the space destined to the service; they are costs that must be raised in a economic evaluation of pharmaceutical care services; o The improvement in clinical parameters and the life quality of patients taken care for pharmaceutical care services and the economy of financial resources are possible results from these services; o The system of assumption of costs by absorption or traditional and the system of activity based costs (ABC) are the most indicated to be established in health units that offer pharmaceutical care services; o The economic analyses of pharmaceu tical care services might be carried through under the patient perspective, the health institution, the health plan, the health system, the society or any other agent who has interest in realize an economic evaluation of such services; o The most indicated models of epidemiological studies to be used in economic analyses of pharmaceutical care services are the experimental model and the longitudinal observational model type prospective cohort.

Este estudo teve por objetivo investigar a associação transtornos de ansiedade e depressão e do uso de medicamentos com o líquen plano oral (LPO). O grupo de estudo compreendeu pacientes com diagnóstico clínico e histopatológico de LPO, segundo critérios da Organização Mundial de Saúde (WHO, 1978), com ou sem envolvimento cutâneo ou de outras mucosas. Um grupo controle composto por indivíduos sem lesão de líquen plano cutâneo e/ou mucoso, com perfil semelhante ao dos pacientes com LPO em relação ao sexo, idade e cor, foi incluído. Para avaliação de transtornos de ansiedade e depressão foram aplicadas duas escalas de auto-avaliação, respectivamente, o Inventário de Ansiedade Traço-Estado (IDATE-T) e a Escala de Rastreamento Populacional para Depressão - Center for Epidemiologic Studies Depression Scale (CES-D), ambas as escalas validadas internacionalmente. O uso diário de medicamentos foi analisado de acordo com os seguintes critérios: (1) classificação de medicamentos de acordo com o código ATC (Anatomical Therapeutic Chemical - classificação pela OMS, versão 2007), (2) quantidade de medicamentos utilizados - monofarmacia: 1 medicamento, polifarmacia menor: 2 a 4 medicamentos, e polifarmacia maior: 5 ou mais medicamentos, e (3) uso de medicamentos com potencial de induzir reação liquenóide a drogas. Sessenta e três pacientes LPO (média de idade = 54,2 anos, relação mulher/homem 6:1) e 35 do grupo controle (média de idade = 53,3 anos, relação mulher/homem 4:1) compuseram a casuística de pacientes avaliados. Os resultados demonstraram que não houve diferenças estatisticamente significantes (P > 0,05) entre o grupo LPO e o grupo controle com relação aos transtornos de ansiedade e depressão e o uso de medicamentos. Em conclusão, transtornos de ansiedade e depressão e o uso de medicamentos parecem não constituir fatores diretos na etiopatogenia do LPO. Todavia, esses fatores devem ser considerados na avaliação geral do paciente LPO, principalmente em termos de tratamento da lesão oral. / This study was aimed at investigating the possible association of the anxiety and depression disorders and the use of drugs with the oral lichen planus (OLP). The study group included patients with clinical and histopathologic diagnosis of OLP, according World Health Organization criteria (WHO, 1978), with or without skin and others mucosal involvement. A control group composed of individuals without skin and/or mucosal lichen planus, with similar characteristics to the OLP patients in respect to the sex, age and skin color, was included. For evaluation of anxiety and depression disorders a two self-administered scale the State-Trait Anxiety Inventory (STAI-T) and the Center for Epidemiologic Studies Depression Scale (CES-D) scales were applied, both internationally validated scales. The daily drug intake was analyzed according to the following criteria: (1) classification of drugs according the ATC code (Anatomical Therapeutic Chemical - classification by OMS, 2007 version), (2) amount of drugs used - monopharmacy: 1 drug, minor polipharmacy: 2 a 4 drugs, e major polipharmacy: 5 or more drugs, and (3) use of drugs with potential to induce a lichenoid drug reaction. Sixty-three patients (mean age = 54.4 years, ratio female/male = 6:1) and 35 individuals of control group (mean age = 53.3 years, ratio female/male = 4:1) composed the sample of patients evaluated. The results showed that there were no statistically significant differences (P> 0.05) between the OLP group and the control group with respect to anxiety and depression and the use of drugs. In conclusion, anxiety and depression disorders and the use of drugs seem to play no direct role in the etiopathogenesis of OLP. However, these factors should be considered for general evaluation of OLP patients, mainly for therapeutic purposes.

Made available in DSpace on 2016-04-25T16:45:23Z (GMT). No. of bitstreams: 1 Jorge Andre Rocha de Sousa.pdf: 669685 bytes, checksum: d6fc5f5849baf4ff79a6de19dcb5a142 (MD5) Previous issue date: 2009-10-27 / The main objective of this present job is to discuss the Pharmacy benefit management and its analyses resulting from medicines consuming information, in special on the consuming of antihypertensive drugs. The research theme is based on the preventive actions necessity targeted to users with chronic conditions. The patients with hypertension or high blood pressure was chosen for analyses based on the fact that the diseases of the cardiovascular system presents the biggest rate of mortality with 32% of the incidents, (chapter 1) also being, at the range over the age of 50 years old, and its responsible for 27,5% of the admissions recorded (CIS-MS-2007). The changes in the health sector, through the regulate agency, ANS, accordingly approached on the 2nd chapter indicates a tendency towards preventive actions. The companies that compound the health supplementary sector passed by process standard of the products and the procedures roll, generating one new dynamic in the sector, doing that the level of the risk index assumed both strong performance and financial indicator. In this scenario arise the PBMS (the Pharmacy Benefit Management), with the proposal to play the role of administer the drugs for what the components of the health management, information management. This approach, discussed in the chapter 3 and 4, tried to understand the movement in the sector provoked by the proposals of the health management on the pharmaceutical retail behaving. The study was conducted analyzing the antihypertensive drugs among 42.145 users of three companies localized of São Paulo and Paraná, with the policies of subsidy on drugs that varied of 35% to 90% of the price of sales. The methodology utilized was the data base direct investigation of the all registers of sales of the year 2008, comparing the results of the numbers identified consuming the products for hypertensive with estimative on the index of the prevalence of the high blood pressure and the incidence of the adverse events. It seems that is clear the users with major level of subsidy tends to follow more correctly the therapeutic prescriptions and, potentially reduces the index of risks to aggravate of the health state. The return of subsidy investment reached the range of the 20,2% through 80,6%, respectively the subsidy ranges between 35% and 90% / O presente trabalho tem como objetivo discutir o gerenciamento do benefício farmácia e as análises decorrentes das informações de consumo de medicamentos, em especial do consumo de anti-hipertensivos. A pesquisa do tema se baseia na necessidade de ações preventivas direcionadas aos usuários portadores de patologias crônicas. A escolha da análise de pacientes com tendência terapêutica para hipertensão arterial sistêmica (HAS) baseia-se no fato de que entre as doenças do aparelho cardiovascular, esta apresenta a maior taxa de mortalidade com 32% das ocorrências, (capítulo 1) sendo também, na faixa acima dos 50 anos, responsável por 27,5% das internações registradas (CIS-MS- 2007). As mudanças no setor de saúde, através da agência reguladora, ANS, conforme abordado no 2º capítulo indicam uma tendência a ações preventivas. As empresas que compõem a saúde suplementar passaram por um processo de padronização de produtos e rol de procedimentos, gerando uma nova dinâmica ao setor, fazendo com que os níveis de sinistralidade se transformassem em forte indicador de performance e da saúde financeira deste mercado. Neste cenário surgem as administradoras dos programas de benefícios em medicamentos ou PBMs, com a proposta de administrar o papel dos medicamentos como componentes da gestão da saúde, com ênfase na gestão da informação. Esta abordagem, tratada no capítulo 3 e 4, busca entender o movimento deste setor e os impactos provocados pelas propostas de gerenciamento de saúde no comportamento do varejo farmacêutico. O estudo foi conduzido analisando o consumo de anti-hipertensivos entre 42.145 usuários de três empresas localizadas nos estados de São Paulo e Paraná, com políticas de subsídios em medicamentos que variaram de 35% a 90% do preço de venda. A metodologia utilizada foi a investigação direta do banco de dados de todos os registros de vendas do ano de 2008, comparando os resultados do número de usuários identificados consumindo os produtos para hipertensão com as estimativas sobre os índices da prevalência de hipertensão arterial e a incidência de eventos adversos. Parece ficar claro que usuários com maior nível de subsídio tendem a seguir mais corretamente as prescrições terapêuticas e, potencialmente, reduzem o risco de sinistralidade a partir da diminuição potencial da exposição a riscos de agravamento do estado de saúde. Foi observada a faixa de 20,2% até 80,6% de retorno sobre o investimento em subsídios, respectivamente as faixas de subsídios entre 35% e 90%

University attendance includes various activities and experiences that can have a unique impact on psychosocial development and adult health behaviors, and can influence life course outcomes such as short- and long-term health and quality of life. College attendance and health are cyclical and reinforcing factors. Healthier students do better while at college, which allows them to effectively progress through university. College graduation is closely associated with improved health status in later life. In addition, students' personal development as part of their transition to adulthood during college, which includes psychosocial and interpersonal growth, is associated with greater gains in health and personal success in later life. Identifying the factors associated with enhanced health status while in college would ensure that a greater number of the overall population has access to the potential health benefits of progressing through and graduating from an institution of higher education. Because health behaviors can have a significant impact on how well a student progresses through college, as well as future quality of life, colleges and universities should recognize the role health is playing in the student experience. This study explored the connection of how factors such as student sub-group participation, health behaviors, and particular negative experiences affect the health status of college students attending a large, urban, top-tier university. It investigated which students were at an increased risk for negative mental health symptoms and overall lower general health and how students' participation in various groups (student athletes, students who are members of sororities and fraternities, and students who volunteer) is associated with health behavior (alcohol and other drug use, sexual behavior, and sleep), negative experiences (bias/discrimination and interpersonal violence), and health outcomes. In addition, the study analyzed how personal development at college mediates those relationships. This study is based on non-experimental cross-sectional survey data from the National College Health Assessment that was collected in collaboration with the American College Health Association at Columbia University (CU). All enrolled undergraduate students at CU in Columbia College or the School of Engineering and Applied Sciences in the spring semester of 2009 (n=5708) were invited to participate in the survey, and 31.8% of the sample responded. This research used the Baron and Kenny model to examine the mediation effects of personal development on general health and mental health via a series of bivariate and regression analyses. While the overall general and mental health of respondents was good, particular groups were less likely to report overall excellent or very good general health and more likely to report mental health symptoms. Negative experiences and health behaviors varied significantly between student sub-groups. Health behaviors and negative experiences were predictive of overall general health and mental health symptoms. Sleep, drug use, and experiences of bias/discrimination and interpersonal violence (IPV) were most predictive of health. Personal development was found to partially mediate the relationship between IPV, sleep and overall general health. In addition, personal development was found to partially mediate the relationship between IPV, drug use other than or in addition to marijuana, and sleep and mental health symptoms. The findings from this study suggest that college and university administrators should consider directing resources into targeting particular groups of students for focused health promotion interventions related to specific topics as a method for improving overall general health and reducing mental health symptoms of students. College and university administrators are encouraged to consider the role of personal development as a unique factor in improving student health.

A atenção farmacêutica (ATENFAR) é uma nova prática clínica, inerente ao profissional farmacêutico, que tem como principais objetivos a prevenção de doenças, a promoção e a recuperação da saúde de usuários de serviços sanitários, através do fomento ao uso racional de medicamentos. Vários estudos realizados no Brasil e no exterior mostram que a atividade de ATENFAR pode propiciar muitos benefícios aos tratamentos de saúde que fazem uso de farmacoterapia, resultando no aumento da efetividade do tratamento e na melhoria da qualidade de vida dos pacientes. Além disso, alguns estudos mostram que a ATENFAR exerce influência sobre os custos assistenciais, sendo esta informação de grande importância para que se discuta a inserção desta prática em programas de saúde coletiva. Devido à escassez de estudos econômicos sobre serviços de ATENFAR, este trabalho visou, através de pesquisa bibliográfica, levantar informações acerca dos temas Economia da Saúde, Atenção Farmacêutica e Avaliação em Saúde e discutir criticamente a aplicabilidade e adequação dessas informações aos referidos estudos. A análise das publicações encontradas através da revisão bibliográfica realizada permitiu concluir que: o As análises econômicas tipo custo-minimização, tipo custo-efetividade, tipo custo-utilidade e tipo custo-benefício são aplicáveis a serviços de ATENFAR; o Os custos relativos aos salários dos farmacêuticos, dos auxiliares e dos demais membros da equipe de saúde; ao transporte do paciente ou da equipe de saúde; aos materiais de consumo; aos medicamentos; às internações hospita lares; aos atendimentos médicos de urgência; às sensações de dor, de tristeza, de mal estar; aos dias de trabalho perdidos; à necessidade de um cuidador; ao aluguel do espaço desti nado ao serviço; são custos que devem ser levantados em uma avaliação econômica de serviços de ATENFAR; o A melhoria em parâmetros clínicos e na qualidade de vida de pacientes atendidos por serviços de ATENFAR e a economia de recursos financeiros, são possíveis resultados gerados por esses serviços; o As análises econômicas de serviços de ATENFAR podem ser realizadas sob a perspectiva do paciente, da instituição de saúde, do plano de saúde, do sistema de saúde, da sociedade ou de qualquer outro agente que tenha inte resse em realizar uma avaliação econômica de tais serviços; o Os modelos de estudos epidemiológicos mais indicados para serem utilizados em análises econômicas de serviços de ATENFAR são o modelo experimental e o modelo observacional longitudinal tipo coorte prospectivo. / The pharmaceutical care is a new practical clinic, inherent to the pharmaceutical professional, who has as main objectives the prevention of illnesses, the promotion and recovery of health of sanitary services users, through the fomentation of rational drug use. Several studies accomplished in Brazil and the exterior show that the pharmaceutical care activity can propitiate many benefits to the health treatments which use the pharmacotherapy, resulting in the increase of treatment effectiveness and in the improvement of life quality of patients. Moreover, some studies show that the pharmaceutical care exerts influence on the assistance costs, being this information of great importance to discuss the insert of this practical in collective health programs. Due to scarcity of economic studies on pharmaceutical care services, the present work aimed at, through bibliographical research, raise information about the topics Health Economics, Pharmaceutical Care and Health Evaluation and to critically discuss the applicability and adequacy of this information to the related studies. The analysis of publications found by means of bibliographic revision lead to the conclusion that: o The economic analyses type cost-minimization, type cost-effectiveness, type costutility and type cost-benefit are applicable to pharmaceutical care services; o The cost concerning to the wages of the pharmacist, the assistant and others members of the health team; to the patients or health team transport; to the consumption materials; to medicines; to the hospital internments; to the medical attends of urgency; to the sensations of pain, sadness and badly being; to the lost days of work; to the necessity of attendant; to the rent of the space destined to the service; they are costs that must be raised in a economic evaluation of pharmaceutical care services; o The improvement in clinical parameters and the life quality of patients taken care for pharmaceutical care services and the economy of financial resources are possible results from these services; o The system of assumption of costs by absorption or traditional and the system of activity based costs (ABC) are the most indicated to be established in health units that offer pharmaceutical care services; o The economic analyses of pharmaceu tical care services might be carried through under the patient perspective, the health institution, the health plan, the health system, the society or any other agent who has interest in realize an economic evaluation of such services; o The most indicated models of epidemiological studies to be used in economic analyses of pharmaceutical care services are the experimental model and the longitudinal observational model type prospective cohort.

Introdução: As doenças cardiovasculares são atualmente a principal causa de mortalidade no país e também o conjunto de doenças que provoca o maior gasto no sistema de saúde. Dentre elas, há uma que merece especial atenção por estar vinculada a diversas origens e ser fator de agravamento para outras patologias: a hipertensão arterial. O modelo assistencial vigente caracteriza-se por ações curativas, pelo atendimento ao paciente com patologia já instalada e visão extremamente limitada em especificidades dos problemas. O Programa de Saúde da Família propõe um modo diferente de atendimento, estruturada no atendimento ambulatorial contínuo e integral, se valendo da interação com a comunidade o que permite ações mais efetivas na promoção da saúde. A presença de um programa de atenção farmacêutica no PSF promove um maior trânsito, riqueza e percepção de informações a respeito de medicamentos, fazendo com que a terapia medicamentosa seja mais efetiva, com a promoção do uso correto. Objetivos: Desenvolver uma metodologia que permita identificar e analisar práticas terapêuticas medicamentosas anti-hipertensivas (Momento terapêutico ? MT). Estimar resultados e tendências na evolução da pressão arterial dos pacientes hipertensos acompanhados pelo NSF-III. Estimar o nível de adesão ao tratamento anti-hipertensivo e a influência desse fator no resultado terapêutico dos pacientes. Casuística e Métodos: População - Indivíduos cadastrados no Núcleo de Saúde da Família III (NSF-III) do PSF de Ribeirão Preto, com diagnóstico de hipertensão arterial e acompanhamento da patologia realizado no referido núcleo. Amostra: prontuários de 73 pacientes. Métodos - Foram coletados dados retrospectivos dos prontuários dos indivíduos, relativos ao período de 1.º de julho de 2001 a 30 de junho de 2005. Foram avaliados ?Conduta Diagnóstica? e os valores de pressão arterial. Resultados: Observou-se a redução de MT nos quais nenhum anti-hipertensivos (AH) foi utilizado, redução no uso de um AH isoladamente e aumento no número médio de AH por MT anos após ano (1,35 no Ano 1 até 1,89 no Ano 4). Analisando-se o percentual de MT de acordo com a classe de AH envolvida, verificou-se a predominância de prescrição da classe dos IECA (58,8%), seguida pelos diuréticos (54,4%) e BBloq e BloqCa em proporções próximas (19% e 18,2%, respectivamente). Foram encontradas indicações de uso irregular da medicação nos prontuários de 35 (48%) pacientes. O percentual médio de pacientes com controle de PA adequado foi de 34,2% no geral, 42.1% nos pacientes Aderentes e 25,7% nos Não Aderentes. Conclusões: A metodologia dos momentos terapêuticos se mostrou adequada na caracterização do padrão de prescrição do NSF-III, que segue as recomendações de tratamento de hipertensão baseada nos consensos, ou seja, a terapêutica medicamentosa praticada tende a ser racional. A maioria dos pacientes do PSF que faz acompanhamento em hipertensão arterial apresenta valores de pressão arterial fora dos limites internacionalmente estabelecidos. O presente trabalho também permitiu demonstrar que o problema de adesão ao tratamento no NSF-III é similar ao que já foi descrito na literatura mas a tendência a indiferenciação entre os grupos de pacientes aderentes e não aderentes indica que abordagem do programa tem conseguido resultados positivos / Introduction: Cardiovascular diseases are the currently leading cause of mortality in Brazil and also the set of illnesses that is the largest expense in health system. Amongst them, there is one that deserves special attention for being tied the diverse origins and to be factor of aggravation for other pathologies: hypertension. The actual model of care is characterized for curative actions and vision extremely limited in specificities of the problems. The Family Health Care Program (FHCP) considers a different way of care, structured in continuous and integral ambulatory care, considering the interaction with community as crucial for more effective actions on health promotion. The presence of a pharmaceutical care program in the FHCP promotes a better flow, quality, and perception of information regarding medicines, making drug therapy more effective with the promotion of the correct use. Objectives: To develop a methodology that allows to identify and analyze therapeutical pratices of antihypertensive drugs (Therapeutic Moment - TM). Esteem results and trends in the evolution of the blood pressure (BP) of the hypertensive patients followed by the NFHCIII. Esteem the level of adherence to the hypertension treatment and the influence of this factor in the therapeutic result of the patients. Casuistry and Methods: Population - Individuals registered in the Nucleus of Family Health Care III (NFHC-III) of the FHCP of Ribeirão Preto, with diagnosis of hypertension and accompaniment of the pathology. Sample: medical records of 73 patients. Methods - Data had been retrospectively collected relative to the period of 1.º of July of 2001 to 30 of June of 2005. Results: It was observed TM reduction in which no antihypertensives (AH) were used, reduction in the use of one single AH and increase in the average number of AH for TM (1,35 in Year 1 up to 1,89 in Year 4). Analyzing the percentage of TM in accordance with the class of AH involved, verified it predominance of prescriptions on the class of ACE (58.8%), followed for diuretics (54.4%), with betablockers and calcium channel blockers in next (19% and 18.2%, respectively). Indications of irregular use of medication in medical records of 35 (48%) patient had been found. Average percentage of the 73 patients with adequate control of BP was of 34,2%, 42,1% in the Adherent group of patients and 25.7% in Not Adherent. Conclusions: The methodology of therapeutic moments showed adequate results in the characterization of the practices of AH prescribing in the NFHC-III. This health care facility follows the recommendations of treatment of hypertension based on the Brazilian guidelines, suggesting that the drug practices tends to be rational. The majority of the patients of the NFHC-III that makes accompaniment in hypertension present values of blood pressure above of the limits internationally established. The present work also demonstrate that the problem of adherence to the treatment in the NFHC-III is similar of the already described in literature but trends of BP reduction values between the groups of adherent and not adherent patients indicates the approach of the program has obtained positive results

Adolescent substance use research has yet to consider victimization as a potential risk factor contributing to alcohol and marijuana use among American Indian youth living on or near reservations, despite the presence of traumatic experiences, childhood adverse events, racism, and discrimination. Contribution to this lack of attention may be due to little being known about American Indian youth victimization. Even less is known about its association with alcohol and marijuana use in general and for those youth living on or near reservations in particular. This study utilizes mixed methods with a nationally representative sample of American Indian youth living on or near reservations in the first phase. A qualitative study in the second phase followed up with a group of practitioners serving American Indian youth living on or near a reservation to explore the association between victimization and alcohol and marijuana use. Understanding the perceptions of practitioners presents an opportunity for collaborative knowledge creation on the conceptualization of victimization and its relationship to alcohol and marijuana use. A secondary data analysis utilizing ordinary least squares regression yielded several significant contributions to alcohol and marijuana user levels when the models were run with the sample intact and when run by gender and compared side-by-side. Extending these findings to a qualitative follow-up produced themes that illustrated practitioner conceptualizations of victimization and perceptions about the influence of these experiences on alcohol and marijuana use among the American Indian youth they serve. Study findings inform or enhance substance use treatment design, delivery, and policy, and to advocate for tribal sovereignty and self-determination.

Marijuana is the most common illicit drug that is abused by pregnant women, and recently many states have adopted various levels of relaxed marijuana policies. The purpose of this study was to evaluate a potential association between residing in a state that allows medical marijuana use and maternal marijuana usage. Grounded in the theory of planned behavior, this study evaluated the prevalence and extent of maternal marijuana use in states that allow and states that do not allow medical marijuana use using the National Survey of Drug Use and Health (NSDUH). It was anticipated that more lenient subjective norms toward marijuana use and increased availability would support an increase of maternal marijuana use. The 2014 NSDUH was queried and analyzed using chi-square and logistic regression. The study revealed an increase of maternal marijuana use in states where medical marijuana was allowed, but the increase was not statistically significant. An increase of heavy users was observed in states where medical marijuana was allowed (54% versus 37%). Consistent with other research findings, this study revealed that young (OR = 3.56; 95% CI: 1.379, 9.213; p = 0.009) and unmarried (OR = 6.81; 95% CI: 2.485, 18.661; p < 0.001) pregnant woman were at higher risk for past month maternal marijuana use and had similar results for past year use. The unintended consequences of increased in utero marijuana exposure and its subsequent negative public health effects have been missing from the discussion of the relaxation of statewide marijuana policies. This study will provide policy makers responsible for changing marijuana policy with useful evidence on the unintended consequences of increased maternal marijuana use in areas where medical marijuana is allowed.

Abuse of painkiller drugs and non-medical use of drugs among young adults continues to be a public health crisis in the United States. Living arrangements and source of treatment referral were considered as the social context that could contribute to increased admissions to treatment for drug abuse. The purpose of this study was to examine the relationship between, independent living arrangement, the principal source of referral, and abuse of opioid, heroin, and cocaine. Steered by the conceptual framework of the biopsychosocial model, this study used the data from the 2015 Treatment Episode Data Set: Admissions managed by the Substance Abuse and Mental Health Services Administration. Multiple logistic regression analyses were performed to test the hypotheses regarding a predictive relationship between independent living arrangement, the principal source of treatment referral, and admissions to treatment for abuse of opioid, heroin, and cocaine. The results showed a significant association between the source of treatment referrals and independent living arrangement, and the increased odds of admissions for prescription opioids use disorder, heroin use disorder, and cocaine use disorder among adults aged 18-34 living in the United States. The implication for positive social change included a need for a targeted treatment and other intervention programs for young adults' users with associated higher-risk treatment referral categories and exposed to neighborhoods factors and health-risk behaviors in reducing the crisis of drug abuse in the United States.