Factors Associated with Healthcare Services Utilization and Pharmacological Treatment in Individuals with Diabetes Diagnosis: Lessons from a Nationwide Program for Diabetes Mellitus Detection in Brazil

The Brazilian Nationwide Population Screening Program for Diabetes, conducted in 2001, diagnosed 346,168 new cases. Although unexpected, approximately 65,000 previously diabetic individuals participated. We describe their characteristics compared to new cases, based on data obtained by a follow-up study of a subsample of 4991 positively screened from a representative sample of 90,106 individuals. Two groups were analyzed regarding factors associated with adherence to treatment, healthcare services utilization, and compliance to pharmacological treatment: 497 with newly diagnosed diabetes and 257 individuals with previous diabetes diagnosis who were not under treatment at the screening program. For this group, healthcare service utilization was lower when compared with the new cases (OR = 0.06; 95% CI: 0.03–0.12). Diabetes status (OR = 0.23; 95% CI: 0.14–0.37), a healthy behavior score (OR = 0.53, 95% CI: 0.34–0.83), and glucose levels at screening (altered, OR = 5.01; 95% CI: 2.38–10.6 and likely and very likely DM OR = 11.2; 95% CI: 6.85–18.4) were independently associated with pharmacological treatment

Avaliação do uso de trombolíticos, antibióticos e analgésicos em pacientes submetidos à cirurgia bariátrica em hospital público de Porto Alegre / Brasil

Objetivo: Avaliar o uso de trombolíticos, antibióticos e analgésicos e a ocorrência de complicações pós-cirúrgicas em pacientes obesos submetidos à cirurgia bariátrica (CB) no Hospital Nossa Senhora da Conceição/RS. Método: Foi conduzida uma coorte prospectiva, não controlada no período de junho de 2011 a outubro de 2013. Foram realizadas entrevistas com os pacientes durante o período de internação, 15 e 30 dias após a cirurgia. Para avaliação da profilaxia antibiótica os desfechos foram infecção de ferida operatória (IFO) e óbito. Eventos tromboembólicos foram os desfechos estudados para investigação da tromboprofilaxia, sendo também analisados custos associados. Os dados relativos ao paciente, à cirurgia e aos fármacos utilizados foram coletados a partir do prontuário do paciente. A dor foi avaliada nos três primeiros dias pós-cirurgia por dois instrumentos independentes. Resultados: Um total de 149 pacientes fez parte do estudo da profilaxia antibiótica, sendo predominantemente mulheres (89,3%). A idade média foi de 41,6 anos e o índice de massa corporal médio foi de 51,7 kg/m2. Comorbidades como diabetes e hipertensão foram observadas em 40,3% e 59,7% dos pacientes, respectivamente. Todos os pacientes receberam profilaxia antimicrobiana (cefazolina 73,8%, cefoxitina 25,5% e gentamicina 0,67%). IFO foi constatada em 9 (6,04%), 4/110 (3,64%) e 5/38 (13,2%) dos pacientes recebendo cefazolina e cefoxitina, respectivamente (RR=3.62 - 95% IC 1,02-12,8, p=0,049). A vigilância pós-alta detectou 4/9 (44,4%) dos casos de IFO. O estudo da tromboprofilaxia contou com 134 pacientes. Enoxaparina 40 ou 60 mg foi administrada em todos os pacientes, sete tiveram doses flutuantes e seis receberam heparina sódica em adição. Um paciente (0,75%) apresentou evento tromboembólico. O custo total da tromboprofilaxia foi de US$3,346.89. No estudo que avaliou a medicação para dor pós-operatória, foi observado que morfina + dipirona foi o esquema analgésico mais freqüente nos dois primeiros dias (69.9$ 3,346.89. In the evaluation of post surgery pain, we observed that morphine + dipirone was the most frequent analgesic scheme employed in the first two days (69.9% and 61.4%, respectively), while dipirone was predominant in the third day. When the visual analogical scale was used, 54.8% and 41.4% of patients presented moderate or intense pain in the first and second day after surgery, respectively. Also, using this instrument differences were not observed in the average doses for both analgesics for patients presenting light, moderate or severe pain. Having the questionnaire as reference, we observed higher average doses of morphine in patients with higher scores (p<0.01) in the first day. Conclusions: Antibiotic prophylaxis in BS remains controversial and antibiotic choice does not guarantee the prophylaxis; there is also influence of other variables. Our data has shown lack of uniformity on this regard and suggests that cefazolin presented better results over cefoxitin to prevent SSI. Thrombolytic agents were used not accordingly to the hospital guideline, with one related outcome detected. The cost of prophylaxis might, depending on the drug product of heparin used indicating the importance of defining the medication in the guideline of the institution. We did not observe differences in the average dosages for both analgesics. A considerable proportion of patients presented moderate to intense pain during the first two days after surgery, suggesting that the analgesia was inadequate. This study contributes in developing analgesia protocol and points out the importance of pain assessment in these patients. This study contributes to a better use and standardization of antibiotic prophylaxis, thromboprophylaxis, and pain management in patients submitted to BS

Diagnosis of the availability and use of drug information sources in drugstores and pharmacies in southern Brazil

This research has aimed to estimate the use of drug information sources by pharmacists in drugstores and pharmacies in southern Brazil. It consisted of sending a questionnaire through regular mail, contacting the pharmacist via phone and visiting the drugstores. Four hundred and eight (68.6%) of the 595 enrolled establishments answered the questionnaire. The information at pharmacies and drugstores is searched mainly to orient the patient. At drugstores the professionals have an average of 2.3 books, whereas at pharmacies they rely on 6.1. In a pharmacy, the chance to find more than five books is 27 times higher than in a drugstore. The more often available books are pharmaceutical specialties compendiums. There is access to Internet in 87.5% of pharmacies and 59% of drugstores. The National Agency of Health Surveillance webpage is the most accessed website, and the call centers of Pharmaceutical Companies are the most searched information service. Lack of time is the main alleged difficulty for searching information. The pharmacists working in the studied establishments miss appropriate drug information sources. Taking into consideration how important information is in the pharmaceutical practice, there is a need to emphasize this subject through an educative process, during undergraduate studies and continued education.A pesquisa teve como objetivo descrever a utilização de fontes de informação em drogarias e farmácias no sul do Brasil. A mesma consistiu do envio do questionário pelo correio, contato com farmacêuticos por telefone e visita aos estabelecimentos. A resposta foi obtida em 408 (68,6%) dos 595 estabelecimentos amostrados. A informação nas farmácias e drogarias é buscada, principalmente, para orientar o paciente. O profissional tem, em média, 2,3 livros nas drogarias e 6,1 nas farmácias. Em uma farmácia, a chance de se encontrar mais de cinco livros corresponde a 27 vezes aquela em uma drogaria. Os bulários são os livros mais freqüentemente disponíveis. Há acesso à Internet em 87,5% das farmácias e em 59% das drogarias, sendo a chance de uma farmácia ter este recurso, cinco vezes maior que aquela em uma drogaria. A página da Agência Nacional de Vigilância Sanitária é a mais acessada e o Serviço de Atendimento ao Consumidor das Companhias Farmacêuticas, o serviço de informação mais consultado. A falta de tempo é a principal limitação da busca de informação. O farmacêutico nos estabelecimentos pesquisados é carente de fontes adequadas de informação. Considerando a importância da informação na prática farmacêutica, é necessário enfatizar o tema utilizando um processo educativo no período de formação e em atividades de atualização

Comparison of two combinations of opioid and non-opioid analgesics for acute periradicular abscess: a randomized clinical trial

Acute periradicular abscess is a condition characterized by the formation and propagation of pus in the periapical tissues and generally associated with debilitating pain. Objective: The aim of this study was to compare the overall analgesic effectiveness of two combinations of opioid and non-opioid analgesics for acute periradicular abscess. Material and Methods: This study included 26 patients who sought emergency care in a Brazilian dental school. The patients were randomly divided into two groups: Co/Ac - oral prescription of codeine (30 mg) plus acetaminophen (500 mg), every 4 h, for 3 days or Tr/Ac - oral prescription of tramadol hydrochloride (37.5 mg) plus acetaminophen (500 mg) on the same schedule. Two factors were evaluated: (1) pain scores recorded by the patients in a pain diary 6, 12, 24, 48, and 72 h after treatment, using the Visual Analogue Scale; and (2) the occurrence of adverse effects. Results: In both groups, there was a reduction in pain scores over time. For the Co/Ac group, there was a significant reduction in the scores 12, 24, 48, and 72 hours after treatment (

Comparison of two combinations of opioid and non-opioid analgesics for acute periradicular abscess : a randomized clinical trial

Acute periradicular abscess is a condition characterized by the formation and propagation of pus in the periapical tissues and generally associated with debilitating pain. Objective: The aim of this study was to compare the overall analgesic effectiveness of two combinations of opioid and non-opioid analgesics for acute periradicular abscess. Material and Methods: This study included 26 patients who sought emergency care in a Brazilian dental school. The patients were randomly divided into two groups: Co/Ac - oral prescription of codeine (30 mg) plus acetaminophen (500 mg), every 4h, for 3 days or Tr/Ac - oral prescription of tramadol hydrochloride (37.5 mg) plus acetaminophen (500 mg) on the same schedule. Two factors were evaluated: (1) pain scores recorded by the patients in a pain diary 6, 12, 24, 48, and 72 h after treatment, using the Visual Analogue Scale; and (2) the occurrence of adverse effects. Results: In both groups, there was a reduction in pain scores over time. For the Co/Ac group, there was a significant reduction in the scores 12, 24,48, and 72 hours after treatment (P0.05), i.e.,both treatments were effective in controlling pain caused by APA; however, the combination of Tr/Ac caused more adverse reactions as two patients had to stop using the medication. Conclusion: This study suggests that, considering both analgesic efficacy and safety, the combination of codeine and acetaminophen is more effective to control moderate to severe pain from acute periradicular abscesses