AUTOMEDICAÇÃO COM BASE NAS INFORMAÇÕES NA INTERNET NA PANDEMIA DE COVID-19

This paper studies the population self-medication based on Internet during the COVID-19 pandemic. The research problem is: did the population self-medicated based on internet, during the COVID-19 pandemic? The survey is considered an opinion, according to CONEP Resolution 510/2016. The data were collected from a questionnaire designed to achieve the research objectives and were available on Google Forms, between February and March 2021. 54 participants distributed among 14 men and 40 women from different cities in the country. Among these, 36 claimed to have sought guidance on the Internet about medicines for COVID-19, among which the following stand out: vitamins in general; worms and medications to boost immunity. It was concluded that social distance and reduced contact with similar ones lead to a greater amount of time spent with devices connected to the internet, which can therefore lead to self-medication, even in people with a higher educational level. Keywords: Self-medication in pandemic. Health risks. Digital literacy. Doctor-patient relationship.Estudia-se la automedicación de la población basada en información en Internet durante la pandemia de COVID-19. El problema de investigación es: ¿en qué medida la población se auto medicó a partir de la información transmitida a través de Internet durante la pandemia de COVID-19? El objetivo de este trabajo es identificar y describir cómo la población buscó, en contenidos en internet, diversos medicamentos para auto medicarse durante la pandemia. Se trata de una investigación descriptiva, con un enfoque transversal cuantitativo y cualitativo. La encuesta se considera una opinión, de acuerdo con la Resolución CONEP 510/2016. Los datos fueron recolectados a partir de un cuestionario diseñado para lograr los objetivos de la investigación y fueron puestos a disposición por Google Forms, entre febrero y marzo de 2021. 54 participantes distribuidos entre 14 hombres y 40 mujeres de diferentes ciudades del país. Entre ellos, 36 manifestaron haber buscado orientación en Internet sobre medicamentos para COVID-19, entre los que destacan: vitaminas en general; gusanos y medicamentos para estimular la inmunidad. Se concluyó que la distancia social y la reducción del contacto con otros similares conllevan un mayor tiempo de uso de dispositivos conectados a Internet, lo que puede conducir a la automedicación, incluso en personas con mayor nivel educativo. Descriptores: Auto medicación en la pandemia. Alfabetización digital. Relación medico-paciente.Estuda-se a automedicação da população com base em informações na Internet durante a pandemia da COVID-19.  O problema de pesquisa é: em que medida a população se automedicou com base em informações veiculadas pela internet, durante a pandemia de COVID-19? O objetivo deste trabalho é identificar e descrever como a população buscou, em conteúdos na internet, medicamentos diversos para se automedicar durante a pandemia. Trata-se de pesquisa descritiva, de abordagem quanti-qualitativa de corte transversal.  A pesquisa é considerada de opinião, de acordo com a Resolução 510/2016 da CONEP. Os dados foram coletados a partir de um questionário elaborado para atingir os objetivos da pesquisa e foram disponibilizados pelo Google Forms, entre fevereiro e março de 2021. 54 participantes distribuídos em 14 homens e 40 mulheres de diferentes cidades do país. Entre esses, 36 afirmaram ter buscado orientações na internet sobre medicamentos para a COVID-19, entre os quais destacam-se: vitaminas em geral; vermífugos e medicamentos para aumentar a imunidade. Concluiu-se que o distanciamento social e a redução do contato com outros semelhantes conduzem a um gasto de tempo maior diante de aparelhos conectados à internet, o que por conseguinte pode acarretar a automedicação, mesmo em pessoas com nível educacional mais elevado. Palavras-chave: Automedicação na pandemia. Alfabetização digital. Relação médico-paciente

Therapeutic itineraries for patients with cerebrovascular accident: fragmentation of care in a regionalized health network

Objectives: to analyze the itineraries of patients with cerebrovascular accident (CVA) in the Interstate health region in San Francisco Valley. Methods: this study uses the qualitative approach through the construction of Therapeutic Itineraries (IT). In the IT mapping the observation was prioritized on the different points and forms to access health service in search of care.. Results: sixteen semi-structured interviews with healthcare users were conducted. There were diverse forms to access and provide services at the Rede Interestadual de Atenção à Saúde do Vale do Médio São Francisco–PEBA (Interstate Healthcare Network Region in the San Francisco Valley), which could be characterized by disorganized and uncoordinated care in the analyzed cases, despite the guarantee of hospital care. The Primary Health Care (APS) teams are present at a care point with most of the patients' itineraries, however, little integration to the regionalized network and they were unable to perform their functions and coordinate the care. It is observed pilgrimage assistance, fragmented care and difficulties in receiving care after post hospitalization which is essential for the patients’ rehabilitation. Conclusions: traces of fragments of the regional health system are important warning signs that points out fragility in PEBA and demonstrate persistent gaps in the public health system to fulfil the responsibility and guarantee individuals’ right for health.

Clinical outcomes of medication therapy management services in primary health care

This study evaluates whether the integration of pharmacists into health-care teams through the delivery of pharmaceutical care-based medication therapy management (MTM) services can improve the clinical outcomes of patients with chronic health conditions in the primary health-care setting. A retrospective descriptive study of 92 outpatients assisted by MTM pharmacists in primary health-care units was carried out over 28 months (median follow-up: 05 months). Patients were followed up by MTM pharmacists, with a total of 359 encounters and a ratio of 3.9 encounters per patient. The prevalence of hypertension, diabetes mellitus and dyslipidaemia was 29.5%, 22.0% and 19.4%, respectively. There was a high prevalence of drug-related problems with a ratio of 3.4 per patient. Pharmacists performed a total of 307 interventions to prevent or resolve drug-related problems. With regard to control of the most prevalent chronic medical conditions, a high percentage of patients reached their therapy goals by the last encounter with the pharmacist: 90.0% for hypertension, 72.3% for diabetes mellitus and 90.3% for dyslipidaemia. MTM services provided by pharmacists resolved drug therapy problems and improved patients' clinical outcomes. This study provides evidence for health-care managers of the need to expand the clinical role of pharmacists within the Brazilian public health-care system

Studies of the mass composition of cosmic rays and proton-proton interaction cross-sections at ultra-high energies with the Pierre Auger Observatory

In this work, we present an estimate of the cosmic-ray mass composition from the distributions of the depth of the shower maximum (Xmax) measured by the fluorescence detector of the Pierre Auger Observatory. We discuss the sensitivity of the mass composition measurements to the uncertainties in the properties of the hadronic interactions, particularly in the predictions of the particle interaction cross-sections. For this purpose, we adjust the fractions of cosmic-ray mass groups to fit the data with Xmax distributions from air shower simulations. We modify the proton-proton cross-sections at ultra-high energies, and the corresponding air shower simulations with rescaled nucleus-air cross-sections are obtained via Glauber theory. We compare the energy-dependent composition of ultra-high-energy cosmic rays obtained for the different extrapolations of the proton-proton cross-sections from low-energy accelerator data

Study of downward Terrestrial Gamma-ray Flashes with the surface detector of the Pierre Auger Observatory

The surface detector (SD) of the Pierre Auger Observatory, consisting of 1660 water-Cherenkov detectors (WCDs), covers 3000 km2 in the Argentinian pampa. Thanks to the high efficiency of WCDs in detecting gamma rays, it represents a unique instrument for studying downward Terrestrial Gamma-ray Flashes (TGFs) over a large area. Peculiar events, likely related to downward TGFs, were detected at the Auger Observatory. Their experimental signature and time evolution are very different from those of a shower produced by an ultrahigh-energy cosmic ray. They happen in coincidence with low thunderclouds and lightning, and their large deposited energy at the ground is compatible with that of a standard downward TGF with the source a few kilometers above the ground. A new trigger algorithm to increase the TGF-like event statistics was installed in the whole array. The study of the performance of the new trigger system during the lightning season is ongoing and will provide a handle to develop improved algorithms to implement in the Auger upgraded electronic boards. The available data sample, even if small, can give important clues about the TGF production models, in particular, the shape of WCD signals. Moreover, the SD allows us to observe more than one point in the TGF beam, providing information on the emission angle

Combined fit to the spectrum and composition data measured by the Pierre Auger Observatory including magnetic horizon effects

The measurements by the Pierre Auger Observatory of the energy spectrum and mass composition of cosmic rays can be interpreted assuming the presence of two extragalactic source populations, one dominating the flux at energies above a few EeV and the other below. To fit the data ignoring magnetic field effects, the high-energy population needs to accelerate a mixture of nuclei with very hard spectra, at odds with the approximate E$^{-2}$ shape expected from diffusive shock acceleration. The presence of turbulent extragalactic magnetic fields in the region between the closest sources and the Earth can significantly modify the observed CR spectrum with respect to that emitted by the sources, reducing the flux of low-rigidity particles that reach the Earth. We here take into account this magnetic horizon effect in the combined fit of the spectrum and shower depth distributions, exploring the possibility that a spectrum for the high-energy population sources with a shape closer to E$^{-2}$ be able to explain the observations

The dynamic range of the upgraded surface-detector stations of AugerPrime

The detection of ultra-high-energy cosmic rays by means of giant detector arrays is often limited by the saturation of the recorded signals near the impact point of the shower core at the ground, where the particle density dramatically increases. The saturation affects in particular the highest energy events, worsening the systematic uncertainties in the reconstruction of the shower characteristics. The upgrade of the Pierre Auger Observatory, called AugerPrime, includes the installation of an 1-inch Small PhotoMultiplier Tube (SPMT) inside each water-Cherenkov station (WCD) of the surface detector array. The SPMT allows an unambiguous measurement of signals down to about 250m from the shower core, thus reducing the number of events featuring a saturated station to a negligible level. In addition, a 3.8m2 plastic scintillator (Scintillator Surface Detector, SSD) is installed on top of each WCD. The SSD is designed to match the WCD (with SPMT) dynamic range, providing a complementary measurement of the shower components up to the highest energies. In this work, the design and performances of the upgraded AugerPrime surface-detector stations in the extended dynamic range are described, highlighting the accuracy of the measurements. A first analysis employing the unsaturated signals in the event reconstruction is also presented

Investigating multiple elves and halos above strong lightning with the fluorescence detectors of the Pierre Auger Observatory

ELVES are being studied since 2013 with the twenty-four FD Telescopes of the Pierre Auger Observatory, in the province of Mendoza (Argentina), the world’s largest facility for the study of ultra-high energy cosmic rays. This study exploits a dedicated trigger and extended readout. Since December 2020, this trigger has been extended to the three High levation Auger Telescopes (HEAT), which observe the night sky at elevation angles between 30 and 60 degrees, allowing a study of ELVES from closer lightning. The high time resolution of the Auger telescopes allows us to upgrade reconstruction algorithms and to do detailed studies on multiple ELVES. The origin of multiple elves can be studied by analyzing the time difference and the amplitude ratio between flashes and comparing them with the properties of radio signals detected by the ENTLN lightning network since 2018. A fraction of multi-ELVES can also be interpreted as halos following ELVES. Halos are disc-shaped light transients emitted at 70-80 km altitudes, appearing at the center of the ELVES rings, due to the rearrangement of electric charges at the base of the ionosphere after a strong lightning event