Socioeconomic factors influencing access to drugs from the Specialized Component of Pharmaceutical Services in Paraná-Brazil: An observational, cross-sectional retrospective study

The Specialized Component of Pharmaceutical Services (CEAF) is a crucial strategy for accessing medicines through the Brazilian Public Health System, holding the highest budgetary impact on outpatient pharmaceutical care. This study aimed to assess the association of socioeconomic factors with access to CEAF drugs in municipalities throughout Paran & aacute; from 2010 to 2019. It utilized a retrospective, observational, cross-sectional approach, evaluating dispensed medication units, medication expenditure, and average unit cost. Analyses were performed to identify a correlation between the use of CEAF drugs and socioeconomic indicators. In these 10 years, the number of dispensed units practically quadrupled, and the expenditure on these drugs doubled, from BRL 214 million to BRL 476 million. The Index of Paran & aacute; Institute for Economic and Social Development of Municipal Performance (IPDM) showed a greater association with the use of CEAF drugs, and no correlation was observed between gross domestic product (GDP) per capita and the municipal population. Overall, the IPDM index that includes income, education, and health are socioeconomic factors that influence the utilization of CEAF drugs. These findings emphasize the need for health education among users and adjustment of public policies to mitigate inequalities in the CEAF drug access for the citizens of Paran & aacute;

Pharmacists' interventions on clinical asthma outcomes: A systematic review

Copyright © ERS 2016. The objective of this systematic review was to evaluate the impact of pharmacists' interventions on clinical asthma outcomes on adult patients and to identify the outcome indicators used. PubMed, Scopus, Web of Science and Scielo were searched. Studies addressing pharmacists' interventions on adult asthma patients reporting clinical asthma outcomes were incorporated. 11 clinical outcomes were identified in 21 studies. 10 studies measured the impact of the intervention on asthma control. Randomised controlled trials (RCT) and non-RCTs found positive results in percentages of controlled patients and Asthma Control Questionnaire (ACQ) scores. Discordant results were found for Asthma Control Test results. Asthma severity was assessed in four studies. One RCT found a significant decrease in the percentage of severe patients; two non-RCTs found significant improvements in severity scores. 11 studies reported pulmonary function indicators, showing inconsistent results. Eight studies measured asthma symptoms; three RCTs and four non-RCTs showed significant improvements. RCTs and non-RCTs generated similar results for most outcomes. Based on the evidence generated by RCTs, pharmacists' have a positive impact on the percentage of controlled patients, ACQ scores, severity and symptoms. Future research should report using the core outcome set of indicators established for asthma (PROSPERO CRD42014007019)

Characterization of pharmacists’ interventions in asthma management: A systematic review

© 2018 American Pharmacists Association® Objective: Pharmacists have adopted an active role in asthma management. This review aimed to analyze the intervention dose, understood as the “amount of program delivered,” and core components of the intervention provided by pharmacists in asthma management. Data sources: A literature search was conducted in December 2016 using PubMed. Study selection: A 2-stage approach was used. At the first stage, systematic reviews of pharmacists’ interventions in asthma management were identified. At the second stage, primary studies included in the systematic reviews were selected. Data extraction: The DEPICT-2 (Descriptive Elements of Pharmacist Intervention Characterization Tool) was used for data extraction. In addition GINA (Global Initiative for Asthma) guidelines were used as a reference to classify the interventions’ core components. Results: Thirty-one studies were included. In most of the studies, the pharmacist–patient intervention occurred at the community pharmacy setting (n = 22). The most common core components used in pharmacists’ interventions were the provision of drug information and patient counseling (n = 27). Pharmacists’ interventions frequently were targeted at assessing and improving the use of patient's inhaler technique (n = 27). Educational materials and written action plans were the materials most commonly used in the interventions (n = 20). The duration (n = 13) and the frequency (n = 16) of the intervention were the most frequent information about the intervention dose measure reported. Conclusion: Pharmacists’ interventions in asthma management are complex. Structured educational programs and patient counseling appear to be the most frequent core components of pharmacists’ interventions. Interventions were focused on providing information about the condition and on inhaler technique assessment and training. However, most studies failed to report the intervention dose sufficiently to be reproduced. The reporting of this indicator is crucial to ensure the reproducibility of the interventions assessed and their implementation in practice. (Registration number CRD42016029181.

Tipos de Serviços Farmacêuticos Clínicos: O que dizem as Revisões Sistemáticas?

Muito vem sendo publicado nos últimos anos em termos de desenhos de novos serviços farmacêuticos clínicos. Predomina hoje incerteza sobre que serviços farmacêuticos apresentam melhores resultados ou são promissores em termos de implementação e adoção pelos profissionais. Além disso, a diversidade de denominações dificulta a padronização de práticas entre farmacêuticos e organizações. O objetivo deste trabalho foi descrever os serviços farmacêuticos clínicos avaliados em revisões sistemáticas publicadas e identificar de forma qualitativa os seus componentes principais. Foi realizada uma busca sistemática de revisões sistemáticas, seguindo as recomendações da colaboração Cochrane, na base de dados Medline via Pubmed no período compreendido entre 2000 e 2010. Foram encontrados 343 artigos potencialmente relevantes, dos quais 49 foram incluídos após o processo de seleção. Foram identificadas oito categorias de serviços clínicos, agrupadas segundo o seu objetivo principal: aconselhamento do doente, controlo de fatores de risco, adesão ao tratamento, revisão da farmacoterapia, acompanhamento farmacoterapêutico, elaboração ou aprimoramento da história farmacoterapêutica, informações ao médico e equipa de saúde e prescrição de novos tratamentos. De um modo geral, estes serviços têm como foco a melhoria da qualidade do uso dos medicamentos e dos resultados terapêuticos sob o ponto de vista clínico, humanístico e económico. In the last years, much has been published on the development of new clinical pharmacist services. However, uncertainty persists as to which services show better results or can be successfully implemented by pharmacists. Furthermore, the diversity of designations available hinders practice standardization among practitioners and professional organizations. The aim of this study was to describe clinical pharmacist services assessed by systematic reviews and to qualitatively identify the main categories of the pharmacist intervention. We searched Medline for systematic reviews compiling evidence of the impact of clinical services on patient health outcomes published between 2000 and 2010, following the recommendations of the Cochrane collaboration. The search returned a total of 343 potentially relevant citations, of which 49 studies were included after the selection process. We identified eight categories of clinical services, which were grouped according to their main goals: patient counselling, risk factors prevention and control, adherence/compliance, medication review, pharmacotherapy follow-up, medication reconciliation, information to physicians or the health care team and prescription of new treatments. In general, all services focus on the improvement of the process of use of medicines as well as clinical, humanistic and economic outcomes.

Searching for network modules

When analyzing complex networks a key target is to uncover their modular structure, which means searching for a family of modules, namely node subsets spanning each a subnetwork more densely connected than the average. This work proposes a novel type of objective function for graph clustering, in the form of a multilinear polynomial whose coefficients are determined by network topology. It may be thought of as a potential function, to be maximized, taking its values on fuzzy clusterings or families of fuzzy subsets of nodes over which every node distributes a unit membership. When suitably parametrized, this potential is shown to attain its maximum when every node concentrates its all unit membership on some module. The output thus is a partition, while the original discrete optimization problem is turned into a continuous version allowing to conceive alternative search strategies. The instance of the problem being a pseudo-Boolean function assigning real-valued cluster scores to node subsets, modularity maximization is employed to exemplify a so-called quadratic form, in that the scores of singletons and pairs also fully determine the scores of larger clusters, while the resulting multilinear polynomial potential function has degree 2. After considering further quadratic instances, different from modularity and obtained by interpreting network topology in alternative manners, a greedy local-search strategy for the continuous framework is analytically compared with an existing greedy agglomerative procedure for the discrete case. Overlapping is finally discussed in terms of multiple runs, i.e. several local searches with different initializations.Comment: 10 page

Effects of vessel traffic on relative abundance and behaviour of cetaceans : the case of the bottlenose dolphins in the Archipelago de La Maddalena, north-western Mediterranean sea

Acknowledgements This study was part of the Tursiops Project of the Dolphin Research Centre of Caprera, La Maddalena. Financial and logistical support was provided by the Centro Turistico Studentesco (CTS) and by the National Park of the Archipelago de La Maddalena. We thank the Natural Reserve of Bocche di Bonifacio for the support provided during data collection. The authors thank the numerous volunteers of the Caprera Dolphin Research Centre and especially Marco Ferraro, Mirko Ugo, Angela Pira and Maurizio Piras whose assistance during field observation and skills as a boat driver were invaluable.Peer reviewedPostprin

Energy- and flux-budget (EFB) turbulence closure model for the stably stratified flows. Part I: Steady-state, homogeneous regimes

We propose a new turbulence closure model based on the budget equations for the key second moments: turbulent kinetic and potential energies: TKE and TPE (comprising the turbulent total energy: TTE = TKE + TPE) and vertical turbulent fluxes of momentum and buoyancy (proportional to potential temperature). Besides the concept of TTE, we take into account the non-gradient correction to the traditional buoyancy flux formulation. The proposed model grants the existence of turbulence at any gradient Richardson number, Ri. Instead of its critical value separating - as usually assumed - the turbulent and the laminar regimes, it reveals a transition interval, 0.1< Ri <1, which separates two regimes of essentially different nature but both turbulent: strong turbulence at Ri<<1; and weak turbulence, capable of transporting momentum but much less efficient in transporting heat, at Ri>1. Predictions from this model are consistent with available data from atmospheric and lab experiments, direct numerical simulation (DNS) and large-eddy simulation (LES).Comment: 40 pages, 6 figures, Boundary-layer Meteorology, resubmitted, revised versio

Potential application of mesh-free SPH method in turbulent river flows

A comprehensive review has been completed on the simulation of turbulent flow over rough beds using mesh-free particle models. Based on the outcomes of this review, an improved Smoothed Particle Hydrodynamics (SPH) method has been developed for open channel flows over a rough bed, in which a mixing length model is used for modeling the 2D turbulence and a drag force equation is proposed for treating the boundary shear. The proposed model was applied to simulate a depth-limited open channel flow over a rough bed surface. The results of the velocity profile and shear stress distribution show a good agreement with the experimental data and existing analytical solutions. This work reveals that in order to correctly model turbulent open channel flow over a rough bed, the treatment of both flow turbulence and bed roughness effect is equally important