A percepção de risco teratogênico equivocada pode levar à privação de uso de medicamentos seguros e à relutância ou não adesão ao tratamento farmacológico durante a gestação. Estudos prévios realizados em países desenvolvidos sugerem que a percepção de risco teratogênico ao uso de medicamentos é superestimada por gestantes, não gestantes e profissionais de saúde. Grande parte destes estudos foi realizada em centros de aconselhamento teratogênico e utilizou apenas uma técnica de aferição da percepção de risco (Escalas Visuais Analógicas). Com o objetivo de caracterizar a percepção de risco teratogênico por gestantes e mulheres em idade fértil, conduzimos um estudo que combinou métodos qualitativos e quantitativos de investigação. Participaram da pesquisa usuárias de serviços de saúde da rede básica municipal de Porto Alegre. Em termos qualitativos, foram realizados dois grupos focais com gestantes. Os dados quantitativos resultaram da realização de entrevistas estruturadas com 287 mulheres em idade fértil divididas em dois grupos: gestantes e não gestantes. A percepção de risco de malformações congênitas na população geral e as percepções de risco teratogênico das exposições a paracetamol, metoclopramida, misoprostol e radioterapia na gestação foram aferidas por duas técnicas: Escalas Visuais Analógicas (EVA) e perguntas numéricas. A concordância entre as duas técnicas de aferição foi avaliada pela análise gráfica de Bland-Altman. Não encontramos concordância entre as medidas obtidas por EVA e por pergunta para nenhuma das percepções de risco em estudo. As medianas das percepções de risco teratogênico medidas por EVA foram superiores às obtidas através da pergunta numérica, para todas as variáveis. Para ambas as técnicas de aferição, as medianas das percepções de risco teratogênico ao paracetamol e à metoclopramida foram mais baixas que para o risco de malformações congênitas na população geral. Já as medianas das percepções de risco ao misoprostol e à radioterapia apresentaram os maiores valores. Não foram encontradas diferenças significativas nas percepções de risco entre gestantes e não gestantes. A lógica acionada pelas mulheres na estimação do risco teratogênico é a da classificação dos medicamentos em fortes e fracos. Dentro desta lógica, os medicamentos e as exposições percebidos por elas como fracos não apresentam riscos, enquanto que aqueles percebidos como fortes são vistos como perigosos e devem ser evitados na gestação. Concluímos que o uso de EVA leva à superestimação das percepções de risco teratogênico. Além disso, frente à dificuldade em operar a lógica probabilística na estimação de risco, as mulheres operam uma lógica própria, classificando os medicamentos em fortes ou fracos. / An erroneous perception of teratogenic risk can lead to the non-use of safe medications and reluctance to or abstaining from pharmacological treatment during pregnancy. Previous studies conducted in developed countries suggest that the perception of teratogenic risk in the use of medications is overestimated by pregnant women, non-pregnant women and health professionals. Most of these studies were performed in teratogen counseling centers and only used one technique for measuring risk perception (Visual Analogue Scales). In order to characterize the perception of teratogenic risk by pregnant women and women of childbearing age, we conducted a study that combined qualitative and quantitative research methods. Public health care users from the city of Porto Alegre participated in the research. In qualitative terms, two focus groups were carried out with pregnant women. The quantitative data was derived from structured interviews with 287 women of childbearing age divided into two groups: pregnant and non-pregnant women. The perception of risk of congenital malformations in the general population and the perception of teratogenic risk through exposure to acetaminophen, metoclopramide, misoprostol and radiation therapy during pregnancy were measured via two techniques: Visual Analogue Scales (VAS) and numerical questions. The agreement between the two measurement techniques was evaluated using Bland-Altman graphic analysis. We did not find an agreement between the measurements obtained through VAS and those obtained through questions for any of the risk perceptions in the study. The medians of the perceptions of teratogenic risk measured by VAS were higher than those obtained by numerical questions, for all variables. For both measurement techniques, the medians of the perceptions of teratogenic risk with acetaminophen and metoclopramide were lower than those for the risk of congenital malformations in the general population. However, the medians of the perceptions of risk with misoprostol and radiation therapy presented the highest values. There were no significant differences in risk perceptions among pregnant and non-pregnant women. The logic employed by women in estimating teratogenic risk is the classification of drugs according to strong and weak. According to this logic, the drugs and exposure to them, perceived by these women as weak, do not present risks, while those perceived as strong are seen as hazardous and should be avoided during pregnancy. Our conclusion is that the use of VAS leads to the overestimation of teratogenic risk perceptions. Moreover, given the difficulty to engage in probabilistic logic for estimating risk, women engage in their own logic, classifying medications as strong or weak.

Existem vários métodos para medir tipo e grau de uso de medicamentos. Esse estudo teve como objetivo caracterizar a prescrição médica para idosos, por meio de indicadores, em diferentes ambientes de atendimento à saúde em 4 municípios do Rio Grande do Sul. Buscou-se caracterizar a prescrição em locais de formação e atuação universitária, estabelecendo a prevalência de intervenções nãofarmacológicas e farmacológicas em prescrições para idosos, avaliando diferentes indicadores quanto a sua aplicabilidade em idosos e realizando inferências em relação ao uso racional de medicamentos. Fizeram parte do estudo serviços de atenção básica em saúde, além daqueles de média e alta complexidade, vinculados a ambientes de formação universitária na área da saúde, no sul do Brasil. A amostra foi constituída por prescrições médicas, obtidas diretamente dos pacientes, em nível de atenção primária em saúde e ambientes de média complexidade, ou por meio de prontuários hospitalares, durante o período de um ano. Para caracterização dos idosos, foram considerados aqueles com idade igual ou superior a 65 anos. A coleta de dados foi realizada ao longo de doze meses, em semanas, dias e turnos definidos por meio de sorteio. sorteio. Como resultados, observou-se que, nos ambientes de atenção básica em saúde e nos ambientes de média complexidade estudados, os idosos do Rio Grande do Sul apresentaram maior média de medicamentos prescritos e prevalência considerável de medicamentos inapropriados, em comparação com outros estudos que envolveram dados da população em geral em outros estados do país. Em contrapartida, esses idosos receberam menor percentual de prescrições com antimicrobianos e baixo percentual de prescrições com agentes injetáveis. As classes de medicamentos mais comumente prescritas no ambiente ambulatorial foram aquelas de uso contínuo, provavelmente em função das enfermidades crônicas apresentadas por pacientes desta faixa etária. Destacaram-se os fármacos que agem no sistema cardiovascular, no sistema nervoso e no trato gastrintestinal e metabolismo. Por sua vez, na internação de idosos nos hospitais estudados, independentemente de município, sazonalidade, gênero ou faixa etária mais avançada, identificou-se um perfil elevado de utilização de medicamentos, com polifarmácia (n=345, 85,4%) e prescrição de medicamentos inapropriados (n=325, 80,4%) em número significativo de idosos. Os medicamentos que mais apareceram nas prescrições hospitalares foram aqueles prescritos sob regime de demanda (se necessário). A prescrição inadequada aos idosos é frequentemente atribuída à falta de treinamento de uma equipe especializada em geriatria e gerontologia, além da deficiência da formação universitária. Nesse sentido, considerando-se o contexto demográfico e epidemiológico brasileiro e a caracterização da prescrição para o paciente idoso realizada no estudo, é importante priorizar ações multidisciplinares relacionadas a promoção, prevenção e recuperação de enfermidades e padronizar procedimentos, para evitar erros de prescrição, transcrição e dispensação. A educação continuada dos profissionais da área da saúde, a divulgação e a atualização de listas de medicamentos essenciais e das listas de medicamentos inapropriados para idosos podem ser ferramentas úteis para a qualificação da prescrição e a promoção do uso racional de medicamentos em idosos. A partir dos pontos vulneráveis da prescrição para idosos que foram levantados, podem ser estabelecidas mudanças nos ambientes de formação em saúde estudados, visando a construção de um perfil profissional que paute suas ações pela comunicação efetiva, interdisciplinar e compromisso social. / There are several methods to measure type and degree of drug use. This study aimed to characterize the prescription for the elderly by means of indicators in different environments of health care and 4 cities of Rio Grande do Sul. It was characterized the prescription in academic and training environments, establishing the prevalence of non-pharmacological interventions and pharmacotherapy prescriptions for the elderly, assessing the applicability of different indicators to the elderly prescriptions, and making inferences about the rational use of medicines. Participants of the study were elderly people attended in primary health care services and in medium and high complexity health care services, linked to universities located in the south of Brazil. The sample consisted of prescriptions obtained directly from patients, at the level of primary health care and environments of medium complexity, or through hospital records, during the period of one year. It was considered elderly patients those with age over 65 years. Data collection was conducted over twelve months, in weeks, days and shifts defined by lot. It was observed that in primary health care and medium complexity services the Rio Grande do Sul elderly prescriptions had a higher mean number of medications and a considerable prevalence of inappropriate medications, compared to other studies involving data from the general population. However, these elderly received a lower percentage of prescriptions with antibiotics and injectable drugs. The classes of drugs most commonly prescribed in the outpatient setting were those of continuous use, probably due to the chronic diseases that frequently occurred in the old age. Those classes involved drugs that act on the cardiovascular system, nervous system and gastrointestinal tract and metabolism. In the hospitals studied, independently of the city, seasonality, gender or older age, it was identified high profile drug utilization, with polypharmacy (n = 345, 85.4%) and inappropriate prescription of medications (n = 325, 80.4%) in great number of elderly. The drugs that most appeared in the hospital prescriptions were those prescribed under the demand scheme ("if necessary"). Inappropriate prescribing for the elderly is often attributed to the lack of training in geriatrics and gerontology and disability of university education. Considering the Brazilian epidemiological and demographic context and the prescription pattern for the elderly observed in this study, it is important to prioritize disciplinary actions related to the promotion, prevention and recovery from illness and standardize procedures to avoid errors in prescribing, transcribing, and dispensing. The continuing education of professionals in the health, distribution and update of essential drugs lists and use of lists of inappropriate drugs for elderly may be useful tools for the improvement of the prescription and promotion of rational drug use in the elderly. Based on the vulnerabilities of the prescription for the elderly that have been raised, it is possible to establish changes in the studied healthy education environments, aiming to build a professional profile that bases its actions on effective communication, interdisciplinary and social commitment.

nÃo hà / INTRODUÃÃO: A automedicaÃÃo se constitui numa prÃtica comum e por isso preocupante entre os brasileiros. Causa conseqÃÃncias diversas tais como reaÃÃes adversas, intoxicaÃÃes, atraso e morosidade para diagnÃsticos e tratamentos, alÃm do temido aumento da resistÃncia bacteriana aos antimicrobianos. OBJETIVOS: Analisar a prÃtica da automedicaÃÃo em duas amostras da populaÃÃo de Teresina que possuem caracterÃsticas demogrÃficas e socioeconÃmicas distintas,abordando aspectos de farmacoepidemiologia e de Estudo da UtilizaÃÃo de Medicamentos. METODOLOGIA:Estudo transversal de base populacional que avaliou a automedicaÃÃo em duas Ãreas de Teresina,divididas em:Grupo 01 com entrevistados residentes no bairro Planalto Uruguai â predomÃnio das classes sociais C e D.Grupo 02 entrevistados residentes no bairro JÃquei Clube â predomÃnio das classes sociais A e B.Utilizou-se perÃodo recordatÃrio de 15 dias para o uso de medicamentos.A amostra foi obtida atravÃs de sorteio das ruas em cada bairro e de casas em cada rua.Nos domicÃlios sorteados foram entrevistados todos os moradores que aceitaram participar do estudo.RESULTADOS:Verificou-se que o consumo geral de medicamentos,em ambos os grupos à mais freqÃente entre as mulheres (67,8 % grupo 01 e 55,8% grupo 02).Quanto a faixa etÃria e automedicaÃÃo este trabalho esta de acordo com literatura nacional que demonstra ser a faixa entre 20 e 50 anos a maior praticante de automedicaÃÃo no Brasil,independente do gÃnero.Dentre os que se automedicaram ,no grupo 01,26,2% possuem plano de saÃde e para o grupo 02, 65,2%.O aumento da escolaridade do entrevistado ,em ambos os grupos,contribui para acrÃscimo na automedicaÃÃo.A renda per capita no grupo 01 com predomÃnio de automedicaÃÃo à de atà 0,5 salÃrio mÃnimo (52,4%) e para o grupo 02 à de 1,6 a mais salÃrios mÃnimos (64,1%).A automedicaÃÃo se faz em sua maioria atravÃs de 1 especialidade farmacÃutica ,em ambos os grupos. A classe farmacolÃgica mais freqÃente, em ambos os grupos, à a dos analgÃsicos, seguindo-se os antiinflamatÃrios e a principal motivaÃÃo sÃo as queixas Ãlgicas. CONCLUSÃO: Essa pesquisa demonstrou interessantes nuances da automedicaÃÃo. Algumas destas sofrem influencias sociodemogrÃficas, enquanto outras sÃo independentes destes fatores. Em linhas gerais foi possÃvel observar o quÃo comum e banal à o ato de se automedicar na populaÃÃo, seguindo aspectos e padrÃes culturais e sutilmente influenciado pelas condiÃÃes sociodemogrÃficas. / INTRODUCTION: The selfmedication refers to a common practice, and therefore concerning, among the Brazilians. It causes several consequences such as side effects, intoxications, delay and slowness for the diagnoses and treatments, besides the feared increase of bacterial resistance to the antimicrobial agents. OBJECTIVES:To analyze the practice of selfmedication in two samples of the population of Teresina that possesses distinct demographic and socioeconomic characteristics. Furthermore, to approach aspects of the pharmacoepidemiology and of the study in medicationâs use. METHODOLOGY: Transverse study of population base that evaluated the self medication in two areas of Teresina, divided in: Group 01 with residents interviewed in Planalto Uruguai neighborhood â predomination of social classes C and D. Group 02 residents interviewed in JÃquei Clube neighborhood â predomination of social classes A and B. It was used a reminding period of 15 days for the medicationâs use. The sample was acquired through a lottery of streets in each neighborhood and houses in each street. In the residencies assorted, were interviewed all the inhabitants that accepted to participate in the study. RESULTS: It was verified that the general consumption of medications, in both groups, is more frequent between women (67,8% group 01 and 55,8% group 02). As the ageism trate and auto medication, this study is according to the national literature that shows the gap between 20 and 50 years of age being the most practicing in auto medication in Brasil, independently of the gender. Among those that practiced auto medication, in group 01, 26,2% possess health insurance and in group 02, 65,2%. The increase of schooling, of the intervieweds, in both groups, contributes to the rise of selfmedication. The per capita income in group 01 with predominance of auto medication is until 0,5 minimum wage (52,4%) and for group 02 is from 1.6 minimum wage (64,1%). The selfmedication occurs, in majority, between one pharmaceuticsâ specialty, in both groups. In both groups, the most frequent pharmacologic class is of the analgesics, followed by the anti-inflammatories( both groups) and the main motivation is pain complaints. CONCLUSION: This research showed interesting nuances of the selfmedication. Some suffers socio-demographic influences and others are independent of these factors. In general lines, it was possible to observe how common and trivial is the act of auto medication diffused in the population, following cultural patterns and aspects subtly influenced by socio-demographic conditions.

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No. of bitstreams: 2 Dissertação - Thayrene Vieira Ferreira - 2016.pdf: 3610910 bytes, checksum: dce67917d30ef353a7e7184e8631a00a (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-12-20 / The teaching profession is considered by the International Labor Organization (ILO) as one of the most stressful. Research indicates that there is precariousness in the organization, conditions and professional relationships and link this precarization to the illness that affects these professionals. In view of this, this study sought to analyze the use of medications by teachers of the state education network of Rio Verde / GO and associate it with determining factors. This is a cross-sectional descriptive and analytical study with a qualitative-quantitative approach, which had 289 teachers. The data were analyzed with the support of the software SPSS® 23.0, in order to verify if any variables were associated with the use of medicines, the Chi-square test or the Student t-test was performed. The prevalence of medication use among teachers in the 15-day recall period was 79.2%. 155 active ingredients were used in a total of 538 pharmaceutical specialties. The mean use was 1.86 medication per person (SD 1.87). Of the teachers surveyed, 88.9% of them reported self-medication. The most commonly used drug was dipyrone (8.55%). The most used drugs were nervous system (29.6%), musculoskeletal system (19.5%) and digestive system and metabolism (17.3%). The female gender was associated with the use of drugs, the perception that the medicine poses a risk to health, self-medication, chronic diseases, not interruption of activities due to health problems, medical consultations in the last three months; no other paid activity, excessive workload and consider that work affects health. The precariousness of teachers' work was revealed in this research by the devaluation of the class, by bad remuneration, by the intensification of teaching activity, by violence in schools and by strenuous journeys. Teachers inserted in this context and in the logic of medication, use medicines as a way to alleviate the suffering that the teaching practice has brought to their health. There are many challenges to be overcome in reaching teachers' health, and they involve intervening in the various stressors related to teaching work, and involve better salaries, valorization, social recognition, improvement in the school infrastructure, support of parents, students, School management, and thus in fact, do not allow medicines to occupy the undue place of health symbols, but that really teachers have decent working conditions and quality of life. / A profissão docente é considerada pela Organização Internacional do Trabalho (OIT) como uma das mais estressantes. Pesquisas apontam que há precariedade na organização, nas condições e nas relações profissionais e vinculam essa precarização ao adoecimento que acomete tais profissionais. Diante disso, este estudo buscou analisar o uso de medicamentos por professores da rede estadual de educação de Rio Verde/GO e associá-lo a fatores determinantes. Trata-se de um estudo transversal descritivo e analítico com abordagem qualiquantitativa, que teve como amostra 289 professores. Os dados foram analisados com apoio do software SPSS® 23.0. Para verificar se alguma variável apresentou associação com o uso de medicamentos, foi realizado o teste Qui Quadrado ou o teste t Student. A prevalência de uso de medicamentos entre professores no período recordatório de quinze dias foi de 79,2%. Foram utilizados 155 princípios ativos num total de 538 especialidades farmacêuticas. A média do uso foi de 1,86 medicamento por pessoa (DP 1,87). Dos professores pesquisados, 88,9% deles relataram realizar automedicação. O medicamento mais utilizado foi a dipirona (8,55%). Os medicamentos mais utilizados atuaram no: sistema nervoso (29,6%), no sistema músculoesquelético (19,5%) e no aparelho digestivo e metabolismo (17,3%). Estiveram associados ao uso de medicamentos o gênero feminino, a percepção de que o medicamento oferece risco à saúde, a realização de automedicação, as doenças crônicas, a não interrupção de atividades por problemas de saúde, as consultas médicas nos últimos três meses, o fato de não possuir outra atividade remunerada, a carga de trabalho excessiva e o trabalho afeta a saúde. A precarização do trabalho dos docentes revelou-se nesta pesquisa pela desvalorização da classe, má remuneração, intensificação da atividade docente, violência nas escolas e jornadas extenuantes. Os professores inseridos nesse contexto recorrem aos medicamentos como forma de atenuar o sofrimento que a prática docente vem gerando à saúde desses trabalhadores. São muitos os desafios a serem superados para o alcance da saúde do professor, que consistem em intervir nos diversos estressores relacionados ao trabalho docente e envolvem melhores salários, valorização, reconhecimento social, melhoria na infraestrutura das escolas, apoio dos pais, dos alunos e da gestão escolar. Para que assim, de fato, os medicamentos possam deixar de ser entendidos como sinônimo de saúde e os professores possam ter condições de trabalho dignas e qualidade de vida.

INTRODUÇÃO: O tema segurança do paciente ganhou importância a partir da publicação dos Estudos Harvard I e II, e dimensão pública a partir do livro To Error is Human pelo Institute of Medicine em 1999, onde são apresentados números alarmantes sobre erros durante o processo do cuidado em saúde. Esses estudos demonstram que os erros com medicamentos são a causa mais frequente de incidentes em pacientes internados. O Institute for Safe Medication Practices (ISMP), uma organização que se dedica à prevenção de erros de medicação e ao uso seguro dos medicamentos publicou em 1989 a primeira lista de medicamentos reconhecidos como perigosos. Em 1995, o ISMP avaliou os erros notificados com medicamentos quanto à gravidade e os danos causados no Medication Error Reporting and Prevention (MERP). Após este estudo, o termo \"High Alert Medication\" foi adotado para designar um grupo de medicamentos mais relacionados a danos graves ou fatais quando ocorre alguma falha no seu processo de utilização. No Brasil estes medicamentos são conhecidos como Medicamentos de Alto Risco, Medicamentos de Alta Vigilância (MAV) ou Medicamentos Potencialmente Perigosos (MPP). OBJETIVOS: Avaliar a ocorrência de incidentes com medicamentos de acordo com a classificação MPP e suas variáveis no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP - USP), nos anos de 2013 e 2015. MÉTODOS: Estudo transversal descritivo retrospectivo com abordagem quantitativa dos incidentes notificados ao Núcleo de Segurança do Paciente relacionados aos MPP. RESULTADOS: Durante o ano de 2013, foram notificados 28% de incidentes envolvendo MPP na unidade Campus e 37,5% na Unidade de Emergência (UE). Os medicamentos quimioterápicos foram os mais notificados e com as maiores Taxas de Incidência (TI) na unidade Campus; o cloreto de potássio foi o mais notificado e com a maior TI na UE. A etapa de prescrição foi a mais notificada nas duas unidades. Utilizando a classificação ATC, os subgrupos terapêuticos que mais atingiram o paciente foram Análogos da Purina, Análogos do Ácido Fólico e Nutrição Parenteral (Campus); Insulina e Análogos Injetáveis, Outras Preparações Cardíacas foram os mais notificados na UE. Em 2015, os percentuais de notificações com MPP foram 8,8% (Campus) e 31,7% (UE). Nesse ano, os medicamentos mais notificados foram o cloridrato de tramadol e a enoxaparina nas duas unidades. Na unidade Campus a etapa de dispensação foi a mais notificada, e etapa de administração na UE. Os subgrupos com maiores TI foram Agentes Alquilantes, Anti Histamínico para Uso Sistêmico e Agente com Ação no Músculo Liso Arteriolar (Campus); na UE, Antiarrítmico, Classe III e Analgésico Opióide. CONCLUSÃO: A classificação MPP pode padronizar a atuação do farmacêutico clínico, além de prover indicadores clínico-gerenciais que auxiliem no desenho de processos proativos de prevenção de erros de medicação. / INTRODUCTION: The patient safety issue gained importance from the publication of Harvard Studies I and II, and public dimension from the book To Error is Human by the Institute of Medicine in 1999, which presents the alarming dates about errors during the process of healthcare. These studies demonstrate that the errors with medications are the most common cause of incidents in hospitalized patients. The Institute for Safe Medication Practices (ISMP), an organization dedicated to the prevention of medication errors and the safe use of medication published in 1989 the first list of recognized dangerous drugs. In 1995, the ISMP evaluated the reports of drugs errors according the severity and damage to the Medication Error Reporting and Prevention (MERP). After this study, the term \"High Alert Medication\" was adopted to designate a group of drugs more related to serious injury or death occurs when a fault in its usage. In Brazil, these drugs are known as high-risk drugs, high alert medications or potentially dangerous drugs. OBJECTIVES: Analyze the occurrence of reported incidents involving the high alert medication and its variables at the Hospital of Ribeirão Preto Medical School, University of São Paulo (HCFMRP - USP) in the years 2013 and 2015. METHODS: Retrospective descriptive cross-sectional study with a quantitative approach of the reported incidents to the Patient Safety Center related to high alert medication. RESULTS: During the year 2013 it was reported 28% of incidents involving high alert medication in the Campus Unit (CU) and 37.5% at the Emergency Unit (EU). Chemotherapeutic drugs were the most reported and with the highest Incidence Rates (IR) (CU) and 19.1% potassium chloride was the most commonly reported and the largest IR in the EU. Prescription stage was the most reported in both units. Using the ATC classification, therapeutic subgroups most reached the patient were Purine Analogues, Folic Acid Analogues and Parenteral Nutrition (CU), Insulin and Analogs for Injections and Other Cardiac Preparations (EU). In 2015, the percentage of notifications with high alert medication was 8.8% (CU) and 31.7% (EU). The most reported drugs were tramadol hydrochloride and enoxaparin in both units. On CU dispensing stage was the most notified and administration stage in the EU. Subgroups with higher IR were Alkylating Agents, Antihistamine for Systemic Use and Arteriolar Smooth Muscle, Agent Action On (CU) and Antiarrhythmic, Class III and Analgesic Opioid (EU). CONCLUSION: The MPP classification can standardize the performance of the clinical pharmacist, and provide clinical and management indicators to assist in the proactive process design to prevent medication errors.

abstract: ABSTRACT The cold and the flu are two of the most prevalent diseases in the world. Many over the counter (OTC) medications have been created to combat the symptoms of these illnesses. Some medications take a holistic approach by claiming to alleviate a wide range of symptoms, while others target a specific symptom. As these medications become more ubiquitous within the United State of America (USA), consumers form associations and mental models about the cold/flu field. The goal of Study 1 was to build a Pathfinder network based on the associations consumers make between cold/flu symptoms and medications. 100 participants, 18 years or older, fluent in English, and residing in the USA, completed a survey about the relatedness of cold/flu symptoms to OTC medications. They rated the relatedness on a scale of 1 (highly unrelated) to 7 (highly related) and those rankings were used to build a Pathfinder network that represented the average of those associations. Study 2 was conducted to validate the Pathfinder network. A different set of 90 participants with the same restrictions as those in Study 1 completed a matching associations test. They were prompted to match symptoms and medications they associated closely with each other. Results showered a significant negative correlation between the geodetic distance (the number of links between objects in the Pathfinder network) separating symptoms and medications and frequency of pairing symptoms with medication. This provides evidence of the validity of the Pathfinder network. It was also seen that, higher the relatedness rating between symptoms and medications in Study 1, higher the frequency of pairing symptom to medication in Study 2, and the more directly linked those symptoms and medications were in the Pathfinder network. This network can inform pharmaceutical companies about which symptoms they most closely associate with, who their competitors are, what symptoms they can dominate, and how to market their medications more effectively. / Dissertation/Thesis / Masters Thesis Engineering 2020

Orientador: Paulo José Fortes Villas Boas / Resumo: Introdução: A prescrição de Medicamentos Potencialmente Inapropriados (MPIs) é altamente prevalente em idosos e estes frequentemente estão associados à maior risco de interações medicamentosas, aumento das admissões hospitalares e Reações Adversas à Medicamentos (RAM), podendo ser prejudiciais à saúde do idoso. Objetivo: Analisar a prevalência de MPI em idosos em uma unidade de internação de hospital terciário e associação com a ocorrência de RAM durante a hospitalização. Material e Métodos: Trata-se de um estudo longitudinal, do tipo coorte, realizado em 2015 na Enfermaria da Clínica do HCFMB – UNESP com acompanhamento de 155 pacientes. Foram incluídos pacientes com 60 anos ou mais internados por condição clínica de ambos os sexos, e excluídos pacientes hospitalizados por um período inferior a 72 horas, e com internação prévia há menos de 30 dias. Foi utilizado como instrumento para identificar a associação entre o medicamento e a RAM o algorítimo de Naranjo, e utilizado os Critérios de Beers (2015) para categorizar os medicamentos como MPI. Resultados: Faziam uso contínuo de MPI antes da internação 113 (73,3%) idosos e receberam MPI durante a internação 139 (89,7%). Na análise multivariável observou-se associação de MPI na internação com uso de MPI antes da internação (RR=1,09; IC 95% = 0,00 – 0,57), Doença Arterial Coronariana (DAC) (RR = 1,39; IC 95% = 1,18 – 69,41) com p < 0,05. Identificou-se que 49 (36,1%) apresentam RAM, sendo no total 71 reações. Os principais medica... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Prescription of Potentially Inappropriate Medications (PIMs) is highly prevalent in the elderly, and these are often associated with increased risk of drug interactions, increased hospital admissions, and Adverse Drug Reactions (ADRs), which may be detrimental to the health of the elderly. Objective: To analyze the prevalence of PIM in the elderly in a tertiary hospital admission unit and association with the occurrence of ADR during hospitalization. Material and methods: This is a longitudinal study, cohort type, carried out in 2015 at the HCFMB Clinic Infirmary - UNESP, with follow-up of 155 patients. Patients with 60 years or more hospitalized due to clinical condition of both sexes, excluding patients hospitalized for less than 72 hours, and hospitalized for less than 30 days were included. The Naranjo algorithm was used as an instrument to identify the association between the drug and ADR and the criteria of Beers (2015) were used to categorize the drugs as PIM. Results: PIM were continuously used before hospitalization (73.3%), and received PIM during hospitalization (89.7%). In the multivariate analysis, the association of PIM was observed in the interment with PIM before admission (RR = 1.09, 95% CI = 0.00 - 0.57), Coronary Artery Disease (CAD) (RR = 1.39; 95% CI = 1.18 - 69.41) with p <0.05. It was identified that 49 (36.1%) presented ADR, being in total 71 reactions. The main drugs involved in ADR were furosemide (10), enoxoparin (5) and haloperidol (4... (Complete abstract click electronic access below) / Doutor

Background: Emerging adulthood (18 to 29 years old) is a critical age group in relation to the Human Immunodeficiency Virus (HIV) epidemic and to mental health. A major public health concern globally, in management of HIV, is that emerging adults have suboptimal antiretroviral therapy (ART) adherence, yet they are the largest group initiating ART. In addition, common mental disorders (CMDs), including depression and anxiety have their peak incidence during this period and they have been found to increase risk of non-adherence to ART. Those with CMDs may have different types of barriers than those without CMDs. Furthermore, those with CMDs might be more likely to have a greater number of barriers to adherence than those without because of the way symptoms of CMDs impact on memory, problem solving skills and concentration. Aims: The main aim of this study was to describe barriers to adherence to ART in emerging adults living with HIV with probable CMDs (i.e. depression and/or anxiety) and accessing HIV treatment at a government clinic in Harare, Zimbabwe, compared to emerging adults living with HIV without probable CMDs. The specific objectives were: a. to determine the prevalence of probable CMDs among emerging adults living with HIV, b. to describe the prevalence, severity and common barriers to ART adherence, measured using the 22-item Barriers to Adherence (BARTA scale) in emerging adults living with HIV with probable CMDs and to compare this with those without probable CMDs. Methods: A representative sample of 223 emerging adults aged 18 to 29 years were recruited in a crosssectional study using the random sampling technique. The Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) and Barriers to Adherence Scale (BARTA scale) were used to assess probable depression, probable anxiety and barriers to adherence respectively. Data Analysis: Univariate Descriptive statistics were used to describe the socio-demographic, prevalence of probable CMDs, prevalence of barriers to adherence, overall median of total BARTA score (severity of barriers to ART adherence) for the whole sample and overall median number of barriers to ART adherence for the whole sample. Chi-square analyses were used to compare the prevalence of barriers (no barrier vs. at least one) between participants with and without probable CMDs. Non-parametric Wilcoxon rank-sum tests and Kruskal Wallis tests (for variables with more than two categories) were used to I. Compare the number of barriers to ART adherence between participants with and without a probable CMDs; II. Compare the severity of barriers to ART adherence between participants with and without probable CMDs, using overall scores on the BARTA scale III. Assess the relationship between demographic variables, HIV related variables, Substance Use Disorders (SUD) and total BARTA scores. Variables which were significantly associated with BARTA scores were entered into a negative binomial regression model, to assess the relationship between CMDs and severity of barriers to ART adherence, this time controlling for possible demographic confounding factors. Results: The prevalence of probable CMDs (i.e. probable depression and/or probable anxiety) was 33.2%. Specifically, 31.8% had probable depression and 16.1% had probable anxiety. Results: showed that 76.2 % of the sample experienced at least one barrier to ART adherence and that 94.5% of those with CMDs experienced at least one barrier to adherence compared to 67.1% of those without CMDs (p>0.001). We found a significant difference (U=-7.209, p<0.001) between the number of barriers experienced by participants with and without CMDs: participants with a CMD reported a greater number of barriers (median (md) =5, IQR=3-7) compared to those without CMDs (md= 1, IQR=0-4). A statistically significant difference was also found in total BARTA scores between participants with and without CMDs: participants with a CMD reported a greater BARTA score (md=7, IQR=4-12) compared to those without a CMD (md= 2, IQR=0-4; U=-7.415, p<0.001). The most frequent barriers reported by emerging adults living with HIV with probable CMDs were 'forgetting' (68.0%), 'thinking too much' (49.0%), 'having to take ART in front of others' (41.0%) and 'not having a reminder' (39.0%). The most frequent barriers for emerging adults living with HIV without probable CMDs were 'forgetting' (30%), 'not having medications with them' (21%), 'not wanting others to know their status' (20%) and 'not having a reminder' (19%). Although 'forgetting' and 'not having a reminder' were among the top barriers in both groups, those with probable CMDs reported them more frequently. Conclusion: This study has shown that firstly, CMDs and barriers to ART adherence are prevalent among emerging adults living with HIV. Secondly, emerging adults living with HIV with probable CMDs experience a high number of barriers to ART adherence and more severely than those without probable CMDs. Finally, emerging adults with CMDs reported barriers such as forgetting and not having a reminder more frequently than those without CMDs. This calls for routine screening for probable CMDs and barriers to ART adherence in HIV clinics. Furthermore, there is need to come up with tailored psychological interventions that can simultaneously treat CMDs and reduce barriers to ART adherence among emerging adults living with HIV.

Background and purpose: Celebrity endorsements have a profound impact on consumers’ purchases and lifestyles. Pharmacists and student pharmacists must be aware of celebrity endorsements of over-the-counter (OTC) medications and dietary supplements to properly advise patients regarding safety and effectiveness, or lack thereof, of endorsed products. Educational activity and setting: An application-based activity was utilized in a self-care course to apply OTC medication and dietary supplement regulations to celebrity endorsements of these products. Students were asked to identify a celebrity endorsement of a product, providing: (1) the product endorsed, (2) celebrity endorser, (3) location of the endorsement, (4) summary of the endorsement and the endorsement itself, (5) assess if the endorsement violated any regulations, and (6) assess if the endorsement was in disagreement with evidence-based resources. Findings: Student pharmacists concluded that 30% of celebrity endorsements violated laws and regulations while 35% concluded the claims made were not supported by evidence-based literature. Interestingly, student pharmacists who selected the same endorsements did not always arrive at the same conclusions. Studied endorsements were frequently found to be in violation of laws and regulations governing OTC medications and dietary supplements and frequently were not supported by evidence-based literature. The activity described provides an innovative active-learning strategy to teach laws and regulations affecting OTC medications and dietary supplements.

Background: The pervasiveness of hypertension (HTN), morbidity, and mortality in Haitians immigrants are frightening. Nonadherence with hypertensive medications, disease management, lifestyle modifications, and cultural and spiritual beliefs, including prayer; faith healing; use of herbal teas; and a diet that is deficient in potassium, rich in sodium, high in fat, cholesterol, and carbohydrates result in increased prevalence of HTN and disability in the Haitian community. Purpose: The purpose of this quality improvement project was to examine the existing system for adherence to hypertensive medications, standardized clinical practice guidelines, identify patients at risk for nonadherence to hypertensive medications, disease management, medical follow-up, and incorporate standardized clinical guidelines into existing medical practice at a primary care office. Theoretical Framework: Theory of transnationalism was used. The transnationalism theoretical framework presents the impact of migration and transnational activities on the health of immigrants. Methods: The mixed model research with exploratory design was used. Results: The implementation of the resource guide was effective as evidenced by improved blood pressure readings and increase adherence to hypertensive medications as well as follow-up appointments. Conclusion: The prevalence of HTN in Haitian immigrants necessitate a different approach to health care delivery. Health care providers need to be aware of Haitian culture to deliver culturally competent care to improve health outcomes in Haitian immigrants.