Análise da prescrição e dispensação de medicamentos psicotrópicos em dois municípios do Estado de São Paulo

OBJECTIVES: To investigate the prescription and dispensation of psychotropic medications through the analysis of the prescriptions/notices kept at various institutions in two cities in the state of São Paulo. METHODS: The prescriptions kept at drugstores, magistral pharmacies, primary care settings and hospitals were collected and analyzed in collaboration with the Sanitary Vigilance agencies in the year of 1999. The information in the prescriptions/notices were typed and tabulated. RESULTS: A total of 108,215 prescriptions were processed, being 76,954 for benzodiazepines, 26,930 for anorexigenic drugs, 3,540 for opiates and 788 for other drugs. The benzodiazepines most frequently prescribed were: diazepam (31,644), bromazepam (16,911) and clonazepam (7,929). Among the anorexigenic drugs, diethylpropion (14,800) and femproporex (10,942) were the most common. When compared to men, women were given more prescriptions, mainly for anorexigenic drugs: the ratio was 10:1 in the prescriptions for diethylpropion and femproporex. The few magistral pharmacies (n=6) handled even more prescriptions than did the drugstores (n=49). A number of errors and inconsistencies were detected in the prescriptions analyzed. CONCLUSIONS: The results confirm the occurrence of an irrational use of such medications and a series of inadequate practices related to their prescription in Brazil. Therefore, they point out to the need of a comprehensive review of the government's control system of these substances.OBJETIVOS: Analisar a prescrição e dispensação de medicamentos psicotrópicos por meio da análise das receitas/notificações retidas em diferentes estabelecimentos de dois municípios do estado de São Paulo. MÉTODOS: Em parceria com as Vigilâncias Sanitárias dos municípios, foram coletadas e analisadas as prescrições retidas em drogarias, farmácias de manipulação, postos públicos e hospitais no ano de 1999. Os dados contidos nas receitas/notificações foram digitados e tabulados. RESULTADOS: Foram processadas 108.215 prescrições, sendo 76.954 de benzodiazepínicos, 26.930 de anorexígenos, 3.540 de opiáceos e 788 de outros. Os benzodiazepínicos mais freqüentes foram: diazepam (31.644), bromazepam (16.911) e clonazepam (7.929) e, entre os anorexígenos, dietilpropiona (14.800) e femproporex (10.942). As mulheres, em geral, receberam mais prescrições em comparação com os homens, especialmente para os anorexígenos, com uma relação dez vezes maior nas prescrições de dietilpropiona e femproporex. As poucas farmácias de manipulação (n=6) chegaram a movimentar mais prescrições do que as drogarias (n=49). Também foi detectada uma série de erros e incoerências nas prescrições analisadas. CONCLUSÕES: Os resultados confirmam a ocorrência de uso irracional e uma série de práticas inadequadas que envolvem a prescrição desses medicamentos no Brasil e, portanto, indicam a necessidade de uma ampla revisão no atual sistema de controle dessas substâncias no país.Brazilian Information Center on Psychotropic DrugsFederal University of São Paulo Paulista Medical School Department of PsychobiologyUNIFESP, EPM, Department of PsychobiologySciEL

Desordens temporomandibulares e dor orofacial: estudo da qualidade de vida medida pelo Medical Outcomes Study 36 - Item Short Form Health Survey

JUSTIFICATIVA E OBJETIVOS: O conhecimento de indicadores de qualidade de vida (QV) relacionados à saúde bucal é especialmente relevante para a Odontologia considerando o impacto que as condições bucais podem provocar no bem estar psicológico e social. Estudos sobre aspectos psicossociais contribuem para maior integração da conduta clínica e assistencial, preocupação compartilhada com profissionais da saúde. Integrar as áreas de Psicologia e Odontologia quebrando paradigmas interdisciplinares e o interesse em conhecer os aspectos psicológicos dos pacientes, motivou a realização deste estudo. O objetivo deste estudo foi avaliar a QV dos pacientes com disfunção temporomandibular e/ou dor orofacial. MÉTODO: Foi aplicado o Questionário Genérico de Avaliação de Qualidade de Vida - Medical Outcomes Study 36 - Item Short Health Survey (SF-36) a 91 pacientes, que buscaram atendimento por apresentarem sinais e/ou sintomas de disfunção temporomandibular (DTM) e dor orofacial (DOF). O SF-36 avalia 8 domínios: capacidade funcional (CF), aspectos físicos (AF), dor, estado geral de saúde (EGS), saúde mental (SM), aspectos emocionais (AE), aspectos sociais (AS) e vitalidade (V). RESULTADOS: A análise estatística descritiva e inferencial pela Correlação de Pearson (p-valor < 0,05) demonstrou, com exceção da capacidade funcional (73,2), valores médios entre 50 e 64 para os demais domínios: AF - 57,6; Dor - 50; EGS - 54,5; V - 53,4; AS - 63,6; AE - 51,8; SM - 58. Considerando-se que a pontuação varia de 0 a 100, ou seja, do pior para o melhor estado de saúde, os valores médios foram baixos. Verificou-se correlação entre CF e EGS (p-valor 0,01), tendência de significância para dor e EGS (p-valor 0,07). CONCLUSÃO: Os aspectos dor e capacidade funcional interferem no estado geral de saúde; os pacientes com DTM e DOF sofreram impacto negativo na qualidade de vida pelo prejuízo dos aspectos físicos e mentais.BACKGROUND and OBJECTIVES: The understanding of quality of life (QL) indicators related to oral health is especially relevant for Dentistry, considering the impact that oral conditions may have in psychological and social well being. Studies on psychosocial aspects contribute for a better integration of clinical and assistance approach, which is a shared concern with health professionals. Integrating psychology and dentistry breaking interdisciplinary paradigms and the interest in knowing patients' psychological aspects, motivaded this study. This study aimed at evaluating the QL of patients with temporomandibular dysfunction and / or orofacial pain. METHOD: The Generic Questionnaire to Evaluate Quality of Life - Medical Outcomes Study 36 - Item Short Health Survey (SF-36) was applied to 91 patients who looked for assistance due to signs and / or symptoms of temporomandibular dysfunction (DTM) and orofacial pain (OFP). SF-36 evaluates 8 domains: functional capacity (FC), physical aspects (FA), pain, general health status (GHS), mental health (MH), emotional aspects (EA), social aspects (AS) and vitality (V). RESULTS: Descriptive and inferential statistical analysis by Pearson's Correlation (p = 0.05) has shown, with the exception of functional capacity (73.2), mean values between 50 and 64 for remaining domains: PA - 57.6; Pain - 50; HGS - 54.5; V - 53.4; AS - 63.6; EA - 51.8; MH - 58. Considering that grades go from zero to 100, that is, the worst and best health status, mean values were low. There has been correlation between FC and GHS (p = 0.01) and significance trend for Pain and GHS (p = 0.07). CONCLUSION: Pain and functional capacity interfere with general health status; patients with TMD and OFP suffered negative impact in quality of life due to impairment of physical and mental aspects

Instant immunity through chemically programmable vaccination and covalent self-assembly

The ability to instantly create a state of immunity as achieved in the passive transfer of hyperimmune globulin has had a tremendous impact on public health. Unlike passive immunization, active immunization, which is the foundation of vaccinology, is an anticipatory strategy with inherent limitations. Here we show that elements of active and passive immunization can be combined to create an effective chemistry-driven approach to vaccinology. Reactive immunization was used to create a reservoir of covalent polyclonal antibodies in 3 mouse strains that were subsequently engrafted with syngeneic CT26 colon or B16F10 melanoma tumors. Upon administration of designed integrin αvβ3 and αvβ5 adapter ligands, the induced covalent polyclonal antibodies self-assembled with the adapter ligands and the animals mounted an instant, chemically programmed, polyclonal response against the implanted tumors. Significant therapeutic responses were observed without recourse to adjuvant therapy. The chemically programmed immune responses were driven by antibody-dependent cellular cytotoxicity and complement-directed cytotoxicity. We suggest that this type of chemistry-driven approach to vaccinology is underexplored and may provide routes to vaccines to protect against diseases that have proven intractable to biology-driven vaccine approaches