Pharmacist's contribution to the promotion of access and rational use of essential medicines in SUS

Objective: to describe the pharmaceutical inclusion process in a Basic Health Unit multidisciplinary team and evaluate results related to rational use and promotion of access to essential medicines. Methods: This is a descriptive, cross-sectional study conducted in a primary care health unit in the city of Sao Paulo. Pharmacist's activities were evaluated regarding the service structure and organization and prescribing quality improvement, guidance method creation, and implementation of clinical pharmacy service. Data measured before and after the interventions and between 2010 and 2011 were analyzed using Pearson's chi-square test with a significance level of 5%, and odds ratio. Results: Pharmacist's activities had statistically significant result in drug shortage reductionprescribing quality improvement associated with an increased proportion of prescriptions metdecrease in the total of prescribed drugs among patients receiving pharmacotherapeutic follow-up and, comparing the years 2010 and 2011, changes in the pharmacotherapy recommendations have gained increased acceptance level. Conclusions: Pharmacist's activities may effectively provide rational use and promotion of access to essential medicines.O objetivo deste artigo é descrever o processo da inserção do farmacêutico na equipe de uma Unidade Básica de Saúde e os resultados na promoção do acesso e uso racional de medicamentos. Trata-se de estudo descritivo, transversal, realizado em unidade de atenção primária do município de São Paulo. As atividades do farmacêutico foram avaliadas em relação à estruturação e organização do serviço, melhoria do padrão de prescrição médica, elaboração de método de orientação e implantação de serviços farmacêuticos clínicos. A análise estatística foi realizada empregando o teste Qui-Quadrado de Pearson, com nível de significância de 5%, e o ODDs Ratio, quando comparados os períodos anterior e posterior à intervenções e resultados entre os anos de 2010 e 2011. A atuação do farmacêutico apresentou resultados estatisticamente significativos na redução da falta de medicamentos; melhora da qualidade da prescrição (com aumento do número de prescrições atendidas); redução do número de medicamentos prescritos entre os pacientes em seguimento farmacoterapêutico; e, comparando-se os anos 2010 e 2011, as recomendações de mudanças na farmacoterapia passaram a ter maior nível de aceitação. O farmacêutico contribuiu efetivamente para o acesso e a promoção do uso racional de medicamentos.Univ Fed Sao Paulo, Inst Ciencias Ambientais Quim & Farmaceut, R Prof Arthur Riedel 275, BR-09972270 Diadema, SP, BrazilUniv Fed Mato Grosso do Sul, Ctr Ciencias Biol & Saude, Campo Grande, MS USAInstituto de Ciências Ambientais, Químicas e Farmacêuticas, Universidade Federal de São Paulo. R. Professor Arthur Riedel 275, Eldorado. 09972-270 Diadema SP BrasilWeb of Scienc

Assistance for customers with sexually transmitted diseases at pharmacies in the Federal District, Brazil : an intervention study

Pesquisa para investigar práticas, características dos trabalhadores e avaliar efetividade de intervenção educativa foi desenvolvida em setenta farmácias de Brasília e Taguatinga, Brasil, distribuídas em dois grupos; metade das farmácias participou de treinamento sobre DST. Realizou-se 411 visitas de pesquisadores simulando sintomas de DST, que resultaram em: encaminhamento ao médico em cerca de 30% dos atendimentos; indicação de medicamentos em mais de 70% dos atendimentos, embora nas entrevistas apenas 16,4% afirmaram fazê-lo; nenhum tratamento indicado era adequado segundo abordagem sindrômica; recomendações preventivas e tratamento de parceiros foram pouco freqüentes; farmacêuticos recomendaram ida ao médico mais do que balconistas e estes indicaram medicamentos mais do que farmacêuticos. O conhecimento dos trabalhadores sobre DST foi considerado superficial. Após intervenção educativa nenhum dos indicadores apresentou melhora significativa em ambos os grupos. As constatações apontam a necessidade de regulamentação e de intervenção para divulgação de práticas educativas para controle de doenças como as DST e para o uso racional de medicamentos nas farmácias. ___________________________________________________________________________________________________________________ ABSTRACTA quantitative survey was conducted to analyze the type of assistance provided by pharmacy employees for cases of STDs. Simulated customer visits and interviews were conducted in 70 pharmacies in Brasilia and Taguatinga, Brazil, randomly assigned to two groups, one of which participated in educational activities on STDs. There were 411 simulated client visits to the pharmacies, with the following results: recommendation to seek medical care in 30% of cases, while in 70% of cases the pharmacy employees themselves recommended some drug treatment (although only 16.4% admitted to such practice). None of these suggested treatments was appropriate, based on the syndromic approach. Recommendations for prevention and treatment of partners were rare. Pharmacists recommended consulting a physician more frequently than attendants, and the latter recommended medicines more frequently than the former. Pharmacy workers had only superficial knowledge of STDs. After an educational intervention, none of the indicators showed a significant improvement in either group. The observations point to the need for regulation and intervention to publicize educational practices for the control of diseases like STDs and for the rational use of medicines in pharmacies

Avaliação de indicadores de qualidade de prescrição de medicamentos em uma unidade de atenção primária com diferentes modelos de atenção

Objective: to describe drug prescription indicators in a primary care unit with different models of health care. Methods: this was a descriptive study using secondary data of prescriptions with regard to quality indicators in a health facility that has three health care models: Outpatient Medical Care (OMC), Primary Health Unit (PHU) and Family Health Strategy (FHS) in Vila Nova Jaguar OMC/PHU in Sao Paulo-SP, Brazil, from July to October 2011. Results: 16,720 prescriptions were studied; the proportion of drugs provided through the Municipal Essential Medication List was higher for FHS prescriptions (98.9%), compared to PHU (95.6%) and OMC (95.7%); similarly, both the use of the generic name of the drugs and the proportion of drugs provided was higher among ESF prescriptions (98.9% and 96.1%, respectively), compared with PHU (94.4 % and 92.9%) and OMC (94.0% and 92.7 %). Conclusion: all the prescription indicators show better results for FHS.Univ Fed Sao Paulo, Inst Ciencias Ambientais Quim & Farmaceut, Diadema, SP, BrazilSecretaria Municipal Saude, Prefeitura Municipal Sao Paulo, Sao Paulo, SP, BrazilUniv Fed Mato Grosso do Sul, Ctr Ciencias Biol & Saude, Campo Grande, MS, BrazilUniv Fed Sao Paulo, Inst Ciencias Ambientais Quim & Farmaceut, Diadema, SP, BrazilWeb of Scienc

Desburocratizando o juridiquês: encruzilhadas da educação jurídica popular no enfrentamento ao racismo

This article discusses the relationship between popular education and the fight against racism from an experience of popular university legal assistance. Here we discuss some crossroads of popular legal education based on Freire, experienced in the monitoring of the Forum of Black Artists of Paraíba by the Popular Extension Nucleus Flor de Mandacaru (UFPB). From a methodological point of view, we undertake a systematization of experience based on participant-research. The theoretical framework of the research transits in the field of studies on race relations and the anti-racist critique of law in dialogue with the Freirean contribution expressed in some studies on popular legal adviceO presente artigo aborda relações entre educação popular e enfrentamento ao racismo a partir de uma experiência de assessoria jurídica universitária popular. Problematizamos aqui algumas encruzilhadas da educação jurídica popular de base freireana, vivenciadas no acompanhamento do Fórum de Artistas Pretes da Paraíba por parte do Núcleo de Extensão Popular Flor de Mandacaru (UFPB). Do ponto de vista metodológico, empreendemos uma sistematização de experiência a partir de pesquisa-participante. O marco teórico da pesquisa transita no campo de estudos sobre as relações raciais e a crítica antirracista ao direito em diálogo com o aporte freireano que se expressa em alguns estudos sobre assessoria jurídica popular

MACERATION-VORTEX-TECHNIQUE (MVT), A RAPID AND NEW EXTRACTION METHOD IN PHYTO-PHARMACOLOGICAL SCREENING

Extraction is a process of preparation of extracts from biological materials (plant/animal/microorganism) in the essence of drug discovery and development scienticism. This writing is aimed at proposing a new, rapid, economical and easy extraction method, Maceration-Vortex-Technique (MVT). For this 2-5 g of powdered materials is sucked into 5-10 ml of solvent recommended for extraction. A cleaned, small amber-colored glass bottle of 20-25 ml capacity is needed for this purpose. Powdered materials are mixed with the solvent, then followed by shaking vigorously; shaken for 1.5-2 h and vortexed for 5 min. The extract is collected by immediate filtration through filter paper (Whatmann no. 1) and allowed for concentration and/or solvent partitioning. The MVT allows a 3 h extraction of plant materials. A small amount of extraction material is needed along with a small quantity of solvent which is a marker for the economy of this extraction process. In conclusion, rapidity in the extraction process is the rapidity in the screening process of biological materials. The MVT may be one of the speediest and most economical extraction processes.Keywords: Extraction, Maceration-Vortex-Technique, New method, Phyto-pharmacological screenin

GROWTH OF Manilkara huberi AND Manilkara paraensis AFTER LOGGING AND SILVICULTURAL TREATMENTS IN THE MUNICIPALITY OF PARAGOMINAS, PARÁ, BRAZIL

AbstractThe effects of silvicultural treatments and logging on the growth rates of Manilkara huberi and Manilkara paraensis in a terra firme natural forest were evaluated. The study was performed in a Forest Management Unit (FMU) located in the municipality of Paragominas, PA. The experimental area covered 500 ha, where five treatments (100 ha each), with four replications per treatment (25 ha each), were established. The replications were randomly distributed in the 500 ha sample area of the FMU. The growth rate of trees was evaluated in the following treatments: T1 – Reduced Impact Logging (RIL) + classic liberation thinning and climber cutting; T2 – RIL + modified liberation thinning and climber cutting; T3 – RIL + climber cutting; T6 - only RIL; T7 - unlogged forest (control). Manilkara huberi and Manilkara paraensis showed good responses on diameter growth rate to the post-harvesting silvicultural treatments applied. However, considering the growth rate differences between the evaluated periods, one can say that the short time elapsed from the application of silvicultural treatments (four years) to the end of the study period does not allow to make accurate statements about the most appropriate treatment for the species, or about the intensity of the interventions to be applied.Keywords: Diameter increment; post-harvesting silviculture; tree girdling; climber cutting. ResumoCrescimento de Manilkara huberi e Manilkara paraensis após a colheita de madeira e tratamentos silviculturais, paragominas, Pará, Brasil. Foram avaliados os efeitos de tratamentos silviculturais e da colheita de madeira sobre o crescimento diamétrico das espécies Manilkara huberi e Manilkara paraensis em uma floresta natural de terra firme. A pesquisa foi conduzida em uma Unidade de Manejo Florestal (UMF), município de Paragominas, PA. A área experimental correspondeu a 500 ha, onde foram estabelecidos cinco tratamentos (100 ha cada) com quatro repetições (25 ha cada). As repetições foram distribuídas aleatoriamente na amostra de 500 ha na UMF. O crescimento das árvores foi avaliado nos seguintes tratamentos: T1 – exploração de impacto reduzido (EIR) + desbaste de liberação clássico e corte de cipós; T2 – EIR + desbaste de liberação modificado e corte de cipós; T3 – EIR + corte de cipós; T6 – apenas EIR; T7 - floresta não-explorada. Manilkara huberi e Manilkara paraensis mostraram respostas favoráveis, em termos de crescimento em diâmetro, às intervenções silviculturais pós-exploratórias aplicadas. Contudo, considerando as diferenças no incremento das árvores entre os períodos avaliados, pode-se dizer que o curto espaço de tempo decorrido da aplicação dos tratamentos silviculturais (quatro anos) ainda não permite fazer projeções precisas acerca do tratamento mais adequado às espécies, ou mesmo, da intensidade das intervenções a serem aplicadas.Palavras-chave: Incremento diamétrico; silvicultura pós-colheita; anelagem de árvores, corte de cipós.AbstractThe effects of silvicultural treatments and logging on the growth rates of Manilkara huberi and Manilkara paraensis in a terra firme natural forest were evaluated. The study was performed in a Forest Management Unit (FMU) located in the municipality of Paragominas, PA. The experimental area covered 500 ha, where five treatments (100 ha each), with four replications per treatment (25 ha each), were established. The replications were randomly distributed in the 500 ha sample area of the FMU. The growth rate of trees was evaluated in the following treatments: T1 – Reduced Impact Logging (RIL) + classic liberation thinning and climber cutting; T2 – RIL + modified liberation thinning and climber cutting; T3 – RIL + climber cutting; T6 - only RIL; T7 - unlogged forest (control). Manilkara huberi and Manilkara paraensis showed good responses on diameter growth rate to the post-harvesting silvicultural treatments applied. However, considering the growth rate differences between the evaluated periods, one can say that the short time elapsed from the application of silvicultural treatments (four years) to the end of the study period does not allow to make accurate statements about the most appropriate treatment for the species, or about the intensity of the interventions to be applied.Keywords: Diameter increment; post-harvesting silviculture; tree girdling; climber cutting. ResumoCrescimento de Manilkara huberi e Manilkara paraensis após a colheita de madeira e tratamentos silviculturais, paragominas, Pará, Brasil. Foram avaliados os efeitos de tratamentos silviculturais e da colheita de madeira sobre o crescimento diamétrico das espécies Manilkara huberi e Manilkara paraensis em uma floresta natural de terra firme. A pesquisa foi conduzida em uma Unidade de Manejo Florestal (UMF), município de Paragominas, PA. A área experimental correspondeu a 500 ha, onde foram estabelecidos cinco tratamentos (100 ha cada) com quatro repetições (25 ha cada). As repetições foram distribuídas aleatoriamente na amostra de 500 ha na UMF. O crescimento das árvores foi avaliado nos seguintes tratamentos: T1 – exploração de impacto reduzido (EIR) + desbaste de liberação clássico e corte de cipós; T2 – EIR + desbaste de liberação modificado e corte de cipós; T3 – EIR + corte de cipós; T6 – apenas EIR; T7 - floresta não-explorada. Manilkara huberi e Manilkara paraensis mostraram respostas favoráveis, em termos de crescimento em diâmetro, às intervenções silviculturais pós-exploratórias aplicadas. Contudo, considerando as diferenças no incremento das árvores entre os períodos avaliados, pode-se dizer que o curto espaço de tempo decorrido da aplicação dos tratamentos silviculturais (quatro anos) ainda não permite fazer projeções precisas acerca do tratamento mais adequado às espécies, ou mesmo, da intensidade das intervenções a serem aplicadas.Palavras-chave: Incremento diamétrico; silvicultura pós-colheita; anelagem de árvores, corte de cipós

FITOSSOCIOLOGIA E POTENCIAL MADEIREIRO NO SUDESTE DA FLORESTA NACIONAL DO TAPAJÓS, ESTADO DO PARÁ

The objective of this study was to evaluate the phytosociology and timber potential in the southeast of Flona Tapajós, state of Pará. The cluster sampling process was adopted with 36 primary units systematically distributed. These units were composed of four secondary units measuring 20 x 250 m. All trees with DBH > 10 cm were measured, but different size classes and subsamplings were considered. The phytosociological parameters were calculated and the monetary valuation of the forest was carried out following the normative instructions of environmental agencies. The cubic meter of the log placed in the yard was valued considering the price of R$380.0 m3. However, 60$ 152.00 m3. The most important species was Pouteria cladantha, but Apuleia leiocarpa, Virola melinonii, Protium paraense, Alexa grandiflora and Manilkara huberi also stood out, mainly due to their tree stock, excellent use in the timber industry and good commercialization. The area presented 126 m3 ha-1 and 13.61 m2 ha-1, of which 54.8 and 41.8%, respectively, were above the minimum harvest diameter. The estimated net profit was R$4,047.27 ha-1, demonstrating that the area is suitable for timber forest management.O objetivo desse estudo foi avaliar a fitossociologia e o potencial madeireiro no sudeste da Flona Tapajós, estado do Pará. Adotou-se o processo de amostragem em conglomerado com 36 unidades primárias distribuídas sistematicamente. Essas unidades foram compostas por quatro unidades secundárias de 20 x 250 m. Todas as árvores com DAP ≥ 10 cm foram medidas, considerando diferentes classes de tamanho e subamostragens. Foram calculados os parâmetros fitossociológicos e realizada a valoração monetária da floresta, acatando as instruções normativas dos órgãos ambientais. O metro cúbico da tora posta no pátio foi valorado tendo em vista o preço de R$ 380,0 m3, sendo descontados desse valor 60% referente aos custos de operação, produzindo um preço líquido de R$152,00 m3. A espécie mais importante foi Pouteria cladantha, mas Apuleia leiocarpa, Virola melinonii, Protium paraense, Alexa grandiflora e Manilkara huberi também se destacaram, principalmente pelo estoque de árvores, ótimo aproveitamento na indústria madeireira e boa comercialização. A área apresentou 126 m3 ha-1 e 13,61 m2 ha-1, dos quais 54,8 e 41,8$ 4.047,27 ha-1, demonstrando que a área apresenta aptidão para o manejo florestal madeireiro. Palavras-chave: Amazônia; valoração de florestas; manejo florestal madeireiro.   Phytosociology and timber potential in the Southeast of the Tapajós National Forest, Pará state   ABSTRACT: The objective of this study was to evaluate the phytosociology and timber potential in the southeast of Flona Tapajós, state of Pará. The cluster sampling process was adopted with 36 primary units systematically distributed. These units were composed of four secondary units measuring 20 x 250 m. All trees with DBH ≥ 10 cm were measured, considering different size classes and subsamplings. The phytosociological parameters were calculated and the monetary valuation of the forest was carried out, following the normative instructions of Organs environmental agencies. The cubic meter of the log placed in the yard was valued considering the price of R$380.0 m3, with 60$ 152.00 m3. The most important species was Pouteria cladantha, but Apuleia leiocarpa, Virola melinonii, Protium paraense, Alexa grandiflora and Manilkara huberi also stood out, mainly due to their tree stock, excellent use in the timber industry and good commercialization. The area presented 126 m3 ha-1 and 13.61 m2 ha-1, of which 54.8 and 41.8%, respectively, were above the minimum harvest diameter. The estimated net profit was R$ 4,047.27 ha-1, demonstrating that the area is suitable for timber forest management. Keywords: Amazon; forest valuation; timber forest management

EFEITO DA SILVICULTURA PÓS-COLHEITA NA POPULAÇÃO DE Lecythis lurida (Miers) Mori EM UMA FLORESTA DE TERRA FIRME NA AMAZÔNIA BRASILEIRA

http://dx.doi.org/10.5902/1980509816601The growth rate of trees dbh > 35cm of a Lecythis lurida (Miers) Mori (jarana) population was evaluated in a 700ha area of natural forest after logging and applying silvicultural treatments in the municipality of Paragominas, in Pará state. Seven treatments were established: in three of them climbers were cut and competitor trees were girdled after logging; in two of them only climber cutting was performed; in one of them the forest was logged; and one of them remained with no silvicultural intervention.  The yearly diameter increment of the species was calculated from 2005 to 2009, considering also the crown shape of trees and the intensity of light on tree crown. Growth rate of Lecythis lurida was higher in T3 (only climber cutting)’differing statistically from the T7 (unlogged forest). In the treatments T1, T2 and T3 where climber were cut and competitors-trees were girdled, diameter increment of the species was similar to the forest that was logged but not treated, although the trees with good shape and complete crowns receiving full light had high increment in those treatments. Therefore, one can infer that five years were not enough to conclude on the effects of the silvicultural treatments over the species growth rate.http://dx.doi.org/10.5902/1980509816601Avaliou-se o crescimento de uma população de Lecythis lurida (Miers) Mori (jarana), considerando árvores com diâmetro igual ou superior a 35 cm, em 700 ha de floresta natural de terra firme, submetida à exploração de impacto reduzido e a tratamentos silviculturais, no município de Paragominas - PA. Foram estabelecidos sete tratamentos: em três deles foi feita a colheita da madeira, o corte de cipós e a anelagem de árvores competidoras; em dois foi feita a colheita da madeira e o corte de cipós; em um deles houve apenas a colheita da madeira; e um permaneceu como testemunha, sem intervenções. Calculou-se o incremento periódico anual em diâmetro da espécie, no período de 2005 a 2009, considerando também as formas das copas das árvores e a intensidade de luz recebida pelas copas. A taxa de crescimento de Lecythis lurida foi maior no T3 (somente corte de cipós), inclusive com diferença significativa da testemunha (floresta não explorada). Nos tratamentos T1, T2 e T3, onde houve corte de cipós e anelagem de árvores competidoras, o incremento diamétrico da espécie manteve-se semelhante ao da floresta apenas explorada (sem tratamento), embora as árvores com copas bem formadas, bem distribuídas e completamente expostas à luz tenham tido altos incrementos nesses tratamentos. Portanto, pode-se inferir que o período de tempo estudado (5 anos) não foi suficiente para se concluir em relação ao efeito dos tratamentos silviculturais sobre o crescimento da espécie

Methodologic quality and risk-of-bias in systematic reviews of healthcare interventions: a review of methods

OBJECTIVE: To compare the characteristics of systematic reviews of healthcare interventions that assessed or did not methodologic quality/risk-of-bias of included studies. Additionally, to analyze methodologic features of those assessing the methodologic quality/risk-of-bias. METHODS: PubMed database was searched. From 25,571 systematic reviews retrieved, a random sample of 1,025 was screened. Frequencies were used to describe outcomes. Unadjusted and adjusted logistic regressions were performed to test the associations with methodologic quality/risk-of-bias results assessment. In a second analysis, systematic reviews that assessed methodologic quality/risk of bias were dichotomized according to the design of included studies (randomized clinical trials-only versus non-randomized studies of intervention or a combination of both). RESULTS: 303 systematic reviews were fully analyzed. Methodologic quality/risk of bias was assessed by 278 (92%). Methodologic quality/risk-of-bias assessment was associated with a higher number of databases searched (>4, P= 0.008), the presence of meta-analysis (P= 0.005), and the design of included studies (randomized clinical trials-only, P= 0.042). The chance of using a suitable tool and a tool designed for risk-of-bias assessment rather than methodologic quality was higher for randomized clinical trials-only systematic reviews (P4). The most used tool was Cochrane’s RoB Tool, with no clearly defined rating system. Methodologic quality/risk-of-bias assessment methods description, results, and impacts on meta-analysis, the certainty of evidence, and systematic reviews’ results are still to be consistently addressed.

Effect of low temperature and room temperature on the depth of cure of bulk-fill composite resins

The study analyzed the influence of temperature on the depth of cure of bulk-fill composite resins. Three discs (ISO 4049/2000) from each group were made, and four restorative materials were investigated: Opus Bulk-Fill Flow, Opus Bulk-Fill APS, Filtek™ One Bulk-Fill, and Filtek™ Bulk-Fill Flow. They were light-cured (Gnatus ± 1,200 mW/cm2) for 20 seconds, varying the temperature (23°C and 5°C) and simulating the use of the product both at room temperature and under refrigeration. The materials were inserted in aluminum matrices with 10 mm in depth and 4 mm in diameter. A clear film strip and a glass microscope slide were positioned at the top and bottom surfaces. The material was condensed and light-cured with the tip of the light source in close contact, for 20 seconds on the top surface. Immediately after irradiation, the samples were removed from the mold, and the uncured part was removed with a plastic spatula. The measurement was performed with a micrometer ± 0.1 mm, and the value was divided by 2. The data were analyzed with two-way ANOVA at a significance of 0.05. There was a statistical difference in the temperature between the results obtained in Opus Bulk-Fill APS (p <0.001) and Filtek™ Bulk-Fill Flow (p = 0.018) resins. For the temperature of 5°C, Filtek™ Bulk-Fill Flow showed a statistical difference compared to the other resins, while Opus Bulk-Fill Flow and Opus Bulk-Fill APS did not. For the temperature of 23°C, Filtek™ Bulk-Fill Flow maintained the statistical difference from the others, but Filtek™ One Bulk-Fill and Opus Bulk-Fill APS did not present statistical differences. Storing the Filtek™ Bulk-Fill Flow composite resin in the refrigerator caused a greater depth of cure than the other resins, and the depth of cure decreased at room temperature. As for Opus Bulk-Fill APS, the depth of cure decreased proportionally to the temperature decrease. The temperature may affect the depth of cure of some composite resins