Prevalence Of Potentially Inappropriate Medication In The Older Adult Population Within Primary Care In Portugal: A Nationwide Cross-Sectional Study

Background: In potentially inappropriate medications harm potentially outweighs benefits. Even appropriately prescribed medications may become inappropriate. They can lead to a high risk of adverse drug reactions, morbidity and mortality. The aim of this study was to determine the prevalence of potentially inappropriate medication in the older adult population attending primary care in Portugal and to identify associated sociodemographic and clinical factors. Methods: We conducted a cross-sectional, analytical study in primary care centres from the five Portuguese healthcare administrative regions and the two autonomous regions. We used a random sample of 757 older patients provided by the information department of the ministry of health (SPMS) and family doctors from the autonomous regions. Data collection occurred March 2018 and we studied sociodemographic characteristics, clinical profile and medication. We used 2015 Beers Criteria to assess potentially inappropriate medications. Logistic regression analyses were performed to determine associations between potentially inappropriate medications’ prescriptions and other variables. Results: Potentially inappropriate medication was present in 68.6% and 46.1% of the sample had two or more. The likelihood of having potentially inappropriate medication increased significantly with being female (OR=1.56 [1.05 to 2.31]), number of chronic health problems (OR=1.06 [1.01 to 1.13]), number of pharmacological subclasses (OR=1.40 [1.30 to 1.51]) and number of prescribers (OR=1.34 [1.09 to 1.65]). Proton-pump inhibitors, nonsteroidal anti-inflammatory drugs and benzodiazepines were the most commonly found ones. Conclusion: Potentially inappropriate medication in older adults was found to be a common occurrence in Portugal. It is important that doctors are aware of this problem, namely in the primary care setting due to the longitudinal care.info:eu-repo/semantics/publishedVersio

Modificações nos padrões de consumo de psicofármacos em localidade do Sul do Brasil

OBJECTIVE: To assess the prevalence and patterns of psychotropic use by population and to compare the results with a study carried out in 1994. METHODS: This is a population-based cross-sectional study carried out in 2003 with 3,542 participants aged 15 or older who lived in an urban area in Southern Brazil. Two-week recall data were collected in household interviews through the same questionnaire used in the 1994 study. The variables studied were age, gender, race, education, family income, marital status, smoking, medical diagnosis of hypertension, and physician visit at last three months. Pearson's Chi-square and linear tendency were used in the bivariate analysis. Four levels of multivariate analysis was performed. RESULTS: The overall prevalence of psychotropic use was 9.9% (CI 95%: 8.9-10.9). There was no significant difference among standardized age groups when compared to the prevalence rates observed in 1994. Higher psychotropic use was associated with being female, older age, medical diagnosis of hypertension, and health service utilization. Of those interviewed, 74% of those drug users were using psychotropic drugs for over three months. CONCLUSIONS: A decade later, prevalence remained high, yet psychotropic drug use did not increase. The association between health service utilization and consumption shows the importance of the appropriate prescription of psychotropic drugs and regular follow-up of those prescribed them by physicians.OBJETIVO: Avaliar a prevalência e padrão de consumo de psicofármacos pela população e comparar esses resultados com outro estudo de 1994. MÉTODOS: Estudo transversal de base populacional, com 3.542 indivíduos de 15 anos ou mais, residentes na zona urbana de Pelotas em 2003. Os dados referentes ao consumo de duas semanas foram coletados em entrevistas domiciliares, utilizando um questionário idêntico ao utilizado em 1994. As variáveis estudadas foram: idade, sexo, cor da pele, situação conjugal, renda familiar, escolaridade, tabagismo, diagnóstico médico de hipertensão e consulta médica nos últimos três meses. Na análise bivariada, utilizou-se teste de qui-quadrado de Pearson e de tendência linear. A análise multivariada foi composta por quatro níveis. RESULTADOS: A prevalência de consumo de psicofármacos foi de 9,9% (IC 95%: 8,9-10,9). Ao comparar as prevalências padronizadas por idade, não houve diferença significativa em relação à prevalência observada em 1994. O maior consumo de psicofármacos associou-se significativamente a: ser do sexo feminino, o aumento da idade, o diagnóstico médico de hipertensão e a utilização de serviços médicos. Dos entrevistados, 74% dos usuários estavam utilizando psicofármacos há mais de três meses. CONCLUSÕES: Após uma década, a prevalência permanece alta, porém o consumo de psicofármacos não aumentou. Os achados sugerem a importância da indicação adequada dos psicofármacos e do acompanhamento médico regular desses usuários, dada a associação encontrada entre as consultas e o consumo

Estimação de provisões IBNR – incurred but not reported - no mercado de seguros Brasileiro utilizando modelos GAS Estimation of IBNR provisions - incurred but not reported - in the Brazilian insurance market using GAS models

Neste artigo foram feitas aplicações dos modelos GAS, apresentados inicialmente em 2008 pelos pesquisadores Creal, Koopman e Lucas, distintas das até então publicadas na literatura. Utilizamos os modelos GAS com distribuições Gama e Log-normal para modelar as estruturas de dependências entre os dados de seguros e estimamos as reservas IBNR para duas coberturas (Casco e RCFV). Os dados em questão se apresentam em um formato chamado triângulo de run-off, cujos valores estão expostos como uma série temporal em painel. Para avaliar a aderência dos modelos GAS propostos utilizamos o método Chain-ladder (Mack, 1993) como benchmark. Os critérios de avaliação (MAPE, EQM e R2), a dimensão das reservas estimadas e os cocientes de variação apontaram para uma maior aderência dos modelos GAS aos dados de seguros de automóveis

Biomechanical evaluation of orthopaedic cement combined with antibiotic and methylene blue

OBJETIVO: O cimento acrílico é utilizado há anos nas cirurgias ortopédicas, especialmente nas artroplastias do joelho, merecendo atenção também quando utilizado com o acréscimo de antibióticos (para tratamento de infecções) ou corantes (para facilitação de uma possível retirada). Neste estudo procurou-se avaliar diferenças mecânicas entre o cimento ortopédico puro e quando misturado com antibiótico e/ou corante. MÉTODOS: Foram utilizados cimento acrílico ortopédico Surgical Simplex®P Stryker, vancomicina em pó e azul de metileno e as misturas submetidas a testes físicos e mecânicos de acordo com a norma ABNT NBR ISO 5833. Avaliou-se: tempo para a formação de massa, capacidade de intrusão, resistência à compressão, resistência ao dobramento (tensão) e temperatura máxima atingida pelas misturas. RESULTADOS: As misturas avaliadas foram aprovadas quanto ao tempo de preparação da mistura, temperatura máxima alcançada, profundidade da intrusão e resistência à compressão. Somente aquela contendo apenas cimento puro foi aprovada no ensaio de flexão. CONCLUSÃO: O acréscimo de vancomicina e/ou azul de metileno ao cimento ortopédico Surgical Simplex®P Stryker reduz a resistência da mistura à flexão, sendo reprovada pela norma ABNT NBR ISO 5833.OBJECTIVE: Acrylic cement has been used for years on orthopaedic surgeries, especially on knee arthroplasties, deserving special attention when added to antibiotics (for treatment of deep bone infections) or stains (to facilitate its removal). The present study was conducted in order to evaluate potential mechanical differences between the orthopaedic cement itself and when this is added to antibiotic and/or stains. METHODS: Surgical bone cement Simplex®P Stryker, vancomycin and methylene blue were used, and the mixtures were submitted to physical and mechanical tests according the ABNT NBR ISO 5833 rule. The parameters studied here were: time for mass formation, intrusion capability, resistance to compression, resistance to flexion and maximum temperature reached by the mixtures. RESULTS: The evaluated mixtures were approved as to mass formation, maximum temperature, intrusion capability and resistance to compression. Only the one containing pure cement was approved on the flexion essay. CONCLUSION: The addition of vancomycin and/or methylene blue to Surgical Simplex®P Stryker bone cement reduces its resistance to flexion, being unacceptable by the ABNT NBR ISO 5833 rule

Proposição de Métricas para Avaliação da Competitividade em Redes de Negócio: uma Aplicação no Setor Siderúrgico Brasileiro

Business Networks (BN) are systems formed by companies that interact in specific way, and the result of these interactions is a remarkable ability to compete. The object of this research is the analysis of the competitiveness in BN, and the objective is to develop metrics for analysis of the competitiveness in BN. This is a qualitative descriptive research, and uses primary sources (questionnaires and semi-structured interviews) and secondary sources of information (articles and other publications in the area). From the model of analysis of competitiveness proposed by Zaccarelli et al. (2008), procedures were performed to analyze the feasibility of applying the original metric of the model and new metrics were developed when necessary. The evaluation of metrics was possible after the empirical analysis, which consisted of the application of the model in two steel makings BN, the ArcelorMittal BN and Votorantim Steel BN. It was found that the metrics of six of ten fundamentals of the model of Zaccarelli et al. (2008) had impracticable metrics, subsequently, new metrics were developed and tested. The main contribution of this study was the improvement of the model, which will enable advances in the analysis of competitiveness business network.Redes de Negócios (RN) são sistemas formados por empresas que interagem entre si de forma específica, e o resultado dessas interações é uma notável capacidade de competir. Diante disso, o objeto de estudo desta pesquisa é a análise da competitividade em RN, e o objetivo consiste em desenvolver métricas para análise da competitividade em RN. Esta é uma pesquisa de caráter descritivo e qualitativo e que utiliza fontes primárias (questionários e entrevistas semiestruturadas) e secundárias de informação (artigos e outras publicações na área). A partir do modelo de análise da competitividade proposto por Zaccarelli et al. (2008), realizaram-se procedimentos de análise da viabilidade de aplicação das métricas originais, bem como o desenvolvimento de novas métricas quando necessário. A avaliação das métricas foi possível após a análise empírica, que consistiu na aplicação do modelo em duas RN de siderurgia, a RN da ArcelorMittal e a RN da Votorantim Siderurgia. Constatou-se que, dentre os dez fundamentos do modelo de Zaccarelli et al. (2008), seis possuíam métricas inviáveis, motivo pelo qual novas métricas foram desenvolvidas e testadas. A principal contribuição deste estudo foi, assim, o aperfeiçoamento do modelo, o que possibilitará avanços nas análises de competitividade de redes de negócios

Toxocara Seropositivity, Atopy and Wheezing in Children Living in Poor Neighbourhoods in Urban Latin American

Background Toxocara canis and T. cati are parasites of dogs and cats, respectively, that infect humans and cause human toxocariasis. Infection may cause asthma-like symptoms but is often asymptomatic and is associated with a marked eosinophilia. Previous epidemiological studies indicate that T. canis infection may be associated with the development of atopy and asthma. Objectives To investigate possible associations between Toxocara spp. seropositivity and atopy and childhood wheezing in a population of children living in non-affluent areas of a large Latin American city. Methods The study was conducted in the city of Salvador, Brazil. Data on wheezing symptoms were collected by questionnaire, and atopy was measured by the presence of aeroallergen-specific IgE (sIgE). Skin prick test (SPT), total IgE and peripheral eosinophilia were measured. Toxocara seropositivity was determined by the presence of anti-Toxocara IgG antibodies, and intestinal helminth infections were determined by stool microscopy. Findings Children aged 4 to 11 years were studied, of whom 47% were seropositive for anti-Toxocara IgG; eosinophilia >4% occurred in 74.2% and >10% in 25.4%; 59.6% had elevated levels of total IgE; 36.8% had sIgE≥0.70 kU/L and 30.4% had SPT for at least one aeroallergen; 22.4% had current wheezing symptoms. Anti-Toxocara IgG was positively associated with elevated eosinophils counts, total IgE and the presence of specific IgE to aeroallergens but was inversely associated with skin prick test reactivity. Conclusion The prevalence of Toxocara seropositivity was high in the studied population of children living in conditions of poverty in urban Brazil. Toxocara infection, although associated with total IgE, sIgE and eosinophilia, may prevent the development of skin hypersensitivity to aeroallergens, possibly through increased polyclonal IgE and the induction of a modified Th2 immune reaction

Correlation between peripheral levels of brain-derived neurotrophic factor and hippocampal volume in children and adolescents with bipolar disorder

Pediatric bipolar disorder (PBD) is a serious mental disorder that affects the development and emotional growth of affected patients. The brain derived neurotrophic factor (BDNF) is recognized as one of the possible markers of the framework and its evolution. Abnormalities in BDNF signaling in the hippocampus could explain the cognitive decline seen in patients with TB. Our aim with this study was to evaluate possible changes in hippocampal volume in children and adolescents with BD and associate them to serum BDNF. Subjects included 30 patients aged seven to seventeen years from the ProCAB (Program for Children and Adolescents with Bipolar Disorder). We observed mean right and left hippocampal volumes of 41910.55 and 41747.96 mm3 , respectively. No statistically significant correlations between peripheral BDNF levels and hippocampal volumes were found. We believe that the lack of correlation observed in this study is due to the short time of evolution of BD in children and adolescents. Besides studies with larger sample sizes to confirm the present findings and longitudinal assessments, addressing brain development versus a control group and including drug-naive patients in different mood states may help clarify the role of BDNF in the brain changes consequent upon BD