Estudo de base populacional sobre o consumo de medicamentos entre idosos: Projeto Bambuí

Factors associated with adherence to pharmacological treatment in hypertensive patients enrolled in the HIPERDIA program

Objective: To assess adherence to antihypertensive treatment in patients at a Family Health Strategy (FHS) unit. Methods: quantitative, transversal, and observational study with 131 hypertensive patients registered in the HIPERDIA program of an FHS located in the city of Lagarto, Sergipe, Brazil, through the analysis of medical records and the application of structured questionnaires. The assessment of the degree of adherence was carried out through the Brief Medication Questionnaire. Results: Factors related to poor adherence were illiteracy (PR: 0.61; 95%CI: 0.42 - 0.89), per capita family income < 1 minimum wage (PR: 0.51; 95%CI : 0.33 - 0.78) and high pharmacological complexity (PR: 0.66; 95%CI: 0.45 - 0.97), while only regular physical activity (PR: 2.64; 95%CI: 1.28 - 5.46) and a good quality of life (PR: 1.44; 95%CI: 1.02 - 2.04) remained positively associated with adherence. Conclusion: As these are modifiable factors, the simplification of the therapeutic scheme and the regular practice of physical activity are key points for increasing adherence to the treatment of systemic arterial hypertension in Primary Care.

Self-medication in older European adults: Prevalence and predictive factors

BACKGROUND/OBJECTIVES

Self-medication, despite some benefits, carries many risks, especially when practiced by older adults who are polymedicated. Information addressing the prevalence and associated factors of self-medication in older age in a European context is scarce and sometimes contradictory. This paper aims to estimate the prevalence of self-medication among older adults across Europe and to identify its predictive factors.

DESIGN

Cross-sectional study.

SETTING

Micro-data from the European Health Interview Survey (2006-2009) was used.

PARTICIPANTS

The sample comprised 31,672 community-dwelling individuals aged 65 and over living in private households in 14 European countries.

MEASUREMENTS

The analyses explored the use, over the last two weeks, of any medicines, supplements, or vitamins that were not prescribed by a doctor.

RESULTS

The mean self-medication prevalence was 26.3 %, being the highest in Poland (49.4 %) and the lowest in Spain (7.8 %). Greater odds of self-medication were found for women and for participants who were younger, divorced, or presented a higher educational degree. The presence of long-standing illness and physical pain or not using prescribed medication also significantly increased the possibility of self-medication. A wide variation in the odds of self-medication between countries was also observed (up to 8 times more for Poland, compared to Spain).

CONCLUSION

Self-medication is a prevalent problem among older Europeans, and even though some think it is risk-free, dangers tend to be greater with advancing age. This study will help identify the groups most likely to have this behavior so that we can focus on targeted educative and preventive initiatives.

Demographic determinants of self-medication in the population covered by health centers in Tabriz

Background: Self-medication is the choice and use of medications by people to treat a self-diagnosed illness or symptom. The aim of this study was to search the relationship between a number of socio-demographic conditions and self-medication in the population covered by health complexes in Tabriz, Iran. Methods: This study was a cross-sectional descriptive-analytic study and was carried out on the population covered by health complexes in Tabriz. Participants were recruited by a multi-stage sampling method. A total of 1000 participants were included in the study. Data collection was done using a researcher-created questionnaire. Data were analyzed using chi-square test and logistic regression. Results: The incidence of self-medication was 70.9% for participants who reported illness in the last month. The chance of self-medication was higher in young (P=0.007) and middle-aged (P=0.012) groups, and housewives (P=0.048); and was lower among participants who were not literate (P=0.047). There was no significant relationship between gender and self medication (P=0.553). The high cost of visits was mentioned as a reason for self-medication. The most frequently mentioned drugs used in self-medication were analgesics, cold medicines, and antibiotics, respectively. More frequent reasons for self-medication were the previous experience of the disease, the assumption that the ailment was not important, and the high cost of visits, respectively. Conclusion: The prevalence of self-medication in this study was high. Considering the results, education in the community, financial support, and monitoring the delivery of drugs can play an important role in improving the pattern of drug use.

A saúde do idoso na televisão: prescrição de estilo de vida saudável

RESUMO Este artigo apresenta a análise do enquadramento (framing) da saúde do idoso em um programa da série 'Ser Saudável', da TV Brasil, e também em uma edição do programa 'Bem Estar', da TV Globo. Adota-se como caminho teórico-metodológico a ideia de frame como 'pacotes interpretativos' partilhados socialmente, que produzem sentidos, a partir de determinadas perspectivas. Identifica-se a hegemonia dos quadros Técnico-Científico e Comportamento e Responsabilidade Individual na abordagem do tema, tanto numa emissora não comercial quanto na TV comercial, enquanto os quadros Sociocultural e Ambiental e a Política Pública emergem tangencialmente. Dessa forma, reforça-se a ideia de uma velhice bem-sucedida para quem segue as recomendações médicas e faz escolhas saudáveis, sem levar em conta os determinantes sociais e o papel do Estado na promoção da saúde do idoso.

Polypharmacy among the elderly: a population-based study

Objective:

To investigate polypharmacy among the elderly living in the urban area of Florianopolis, in the state of Santa Catarina, Brazil, estimating the prevalence and associated factors.

Methods:

This is a cross-sectional population-based study with a sample of 1,705 individuals aged 60 years old or older, between 2009 and 2010. The dependent variable was polypharmacy (defined as "use of five or more medications"). The following exploratory variables were utilized: sociodemographic data, use of health services and self-rated health status. Prevalence ratios (PR) were estimated by multivariate analysis using the Poisson regression.

Results:

The mean for the medications used by the elderly population was 3.8 (ranging from 0 to 28). The prevalence of polypharmacy was 32%, with 95% confidence interval (95% CI) 29.8 - 34.3. The characteristics presenting a positive association with polypharmacy were: female gender (PR = 1.27; 95%CI 1.03 - 1.57), increasing age (PR = 1.38; 95% CI 1.08 - 1.77), negative self-rated health status (PR = 1.99; 95% CI 1.59 - 2.48) and medical appointments in the 3 months prior to the interview (PR = 1.89; 95% CI 1.53 - 2.32). The groups of medication most utilized by the elderly individuals in polypharmacy were those indicated for the cardiovascular system, digestive tract and metabolism, as well as the nervous system.

Conclusion:

The pattern of medication use among this elderly population is within the national average. The prevalence of polypharmacy and the characteristics associated with it were similar to those found in other regions of Brazil.

Use of medicines by patients of the primary health care of the Brazilian Unified Health System

OBJECTIVE

To characterize the use of medicines by patients of the primary health care of the Brazilian Unified Health System (SUS).

METHODS

This is a cross-sectional, exploratory, and descriptive study, part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). Interviews were carried out with patients present in the services by semi-structured questionnaires. Sociodemographic, clinical, and use of medicines variables were assessed and the use of medicines in the 30 days prior to the interview was also verified. The population was stratified into three age groups: 18 to 44, 45 to 64, and 65 years or more. The differences between the age groups were verified using the Student's t-test for continuous variables and chi-square test for the categorical ones. The complex samples analysis plan was employed. The medicines were classified according to the Anatomical Therapeutic Chemical Classification System.

RESULTS

Of the 8,803 patients interviewed, 6,511 (76.2%) reported to have used medicines in the 30 days prior to the interview. On average, each patient used 2.32 medicines, without difference between the sexes. Among medicine users, 18.2% were aged 65 years or more. Compared to the other age groups, older adults presented more comorbidities, used more medicines, and self-reported worse health conditions. They were also less educated, reported worse economic situation, and lived alone. The medicines that were mostly used were "other analgesics and antipyretics" (3rd ATC level) and Losartan (5th ATC level).

CONCLUSIONS

Most medicine users had lower education level and presented comorbidities. The most used medicines were the antihypertensive ones. Self-medication was higher among young people. Most patients reported to use generic medicines. The average number of medicines and the prevalence of use increased with age. Due to the characteristics observed and the difficulties in the use of medicines, older adults are in a situation of greater vulnerability.

Avaliação da Assistência Farmacêutica em um município no Sul do Brasil

RESUMO: Introdução: A Assistência Farmacêutica (AF) bem planejada e conduzida é importante para o adequado atendimento às necessidades de saúde da população, facilitando o acesso aos medicamentos essenciais e promovendo seu uso racional. Objetivo: Avaliar a situação da AF no município de Uruguaiana (RS). Métodos: Estudo transversal, com realização de 650 entrevistas, entre junho e setembro de 2013, em 11 Unidades Básicas de Saúde (UBS) e na Farmácia Central. Os indicadores de prescrição, de assistência ao paciente e de serviço foram avaliados de acordo com as recomendações da Organização Mundial da Saúde (OMS). Para avaliar a capacidade gerencial e de planejamento da AF, foi utilizado o Instrumento de Autoavaliação para o Planejamento da Assistência Farmacêutica (IAPAF) do Ministério da Saúde, o qual foi aplicado na Farmácia Central e no almoxarifado de medicamentos. Resultados: O número de medicamentos por prescrição variou de 1 a 10 (média = 1,7). Os percentuais de medicamentos prescritos pelo nome genérico e que constam na Relação Municipal de Medicamentos Essenciais (REMUME) foram de 75,5 e 67,7%, respectivamente; em 9,7% das consultas médicas foram prescritos antibióticos. O tempo médio de consulta médica foi de 6 minutos; 51,4% dos usuários tiveram sua prescrição atendida; apenas 18,9% dos pacientes compreenderam totalmente a prescrição. Dos 24 itens analisados no IAPAF, 12 encontravam-se no estágio 1 (pior avaliação), 12 no estágio 2 e nenhum no estágio 3 (situação considerada ideal). Conclusão: Os resultados encontrados parecem demonstrar a deficiência da AF em Uruguaiana quanto ao planejamento, à gerência e à assistência ao paciente. A ausência de gestão efetiva pode resultar em desperdícios e no uso incorreto de medicamentos.

Evaluation of diet quality of the elderly and associated factors

BACKGROUND

Observational studies suggest healthy dietary patterns are associated with risk reduction and better control of various chronic diseases. However, few Brazilian studies have focused on evaluating the quality of the elderly diet and its relationship with diseases. This study aimed to estimate the association between diet quality and socioeconomic factors, health and nutrition of the elderly.

METHODS

This is a cross-sectional population-based study whose target population were non-institutionalized elderly residents in the city of Viçosa, Brazil. Anthropometric, socioeconomic, health conditions, lifestyle and food consumption variables were obtained from a semi-structured questionnaire. The quality of the diet was assessed by the revised Healthy Eating Index classified into tertiles, considering the first tertile as "Poor diet quality," the second as 'Intermediate diet quality' and the third as "Better diet quality." To identify factors independently associated with diet quality model, the works used multinomial logistic regression.

RESULTS

In the results of the multivariate analysis, the factors independently associated with "better diet quality" included female gender, higher education, history of one to five medical visits in the past year, history of diabetes mellitus, dyslipidemia and the use of polypharmacy.

DISCUSSION

Our results show that most seniors need to improve the quality of their diet and those of male gender with no or little education, and those who do not seek medical services constitute the group that needs attention concerning the measures to improve the quality of their diet.

Polypharmacy and Polymorbidity in Older Adults in Brazil: a public health challenge

OBJECTIVE

To analyze variations in the prevalence of chronic use of medicines by older adults in Brazil according to its possible association with the most prevalent chronic diseases and demographic and health factors, and to identify risk factors for polypharmacy.

METHODS

A study based on data from the National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM), a cross-sectional, population-based survey with probability sampling in Brazilian urban areas. The independent variable was the number of chronic-use medicines taken by older adults, linked to eight chronic diseases investigated. The intervening variables were gender, age group, marital status, level of education, socioeconomic status, Brazilian region, body mass index, smoking, self-perceived health, hospitalization in the previous year and having health insurance, besides the investigated chronic diseases. A multivariable analysis identified risk factors for polypharmacy.

RESULTS

Prevalence of at least one chronic-use medicines among older adults was 93.0%. Of the total number of older adults, 18.0% used at least five medications (polypharmacy). Polypharmacy was higher among the oldest individuals (20.0%), in the South region (25.0%), in those with poor self-perceived health (35.0%), in obese individuals (26.0%), in those with reported health insurance (23.0%) or hospitalization in the previous year (31.0%), and among those who reported any of the investigated diseases, particularly diabetes (36.0%) and heart diseases (43.0%). The variables remaining in the final risk model for polypharmacy were age, region, perceived health, health insurance, hospitalization in the previous year and all investigated diseases except stroke.

CONCLUSIONS

Older adults with specific diseases have risk factors for polypharmacy modifiable by actions aimed at the rational use of medicines. With the current population aging and successful drug access policy, the trend is an increase in drug use by older adults, which should feature as a priority in the planning agenda of the Brazilian Unified Health System (SUS).

OBJETIVO

Analisar as variações da prevalência do uso crônico de medicamentos por idosos no Brasil segundo sua possível associação com as doenças crônicas mais prevalentes, fatores sociodemográficos e de saúde, e identificar fatores de risco para polifarmácia.

MÉTODOS

Estudo com dados da Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos, de caráter transversal e amostra probabilística populacional em municípios brasileiros urbanos. A variável independente foi o número de medicamentos de uso crônico por idosos, vinculados às oito doenças crônicas investigadas. As variáveis intervenientes foram sexo, faixa etária, situação conjugal, escolaridade, nível socioeconômico, região do País, índice de massa corporal, hábito de fumar, percepção da própria saúde, internação no último ano e posse de plano de saúde privado, além das doenças crônicas referidas. Uma análise multivariável identificou os fatores de risco para polifarmácia.

RESULTADOS

A prevalência de pelo menos um medicamento de uso crônico entre idosos foi de 93,0%. Do total de idosos, 18,0% utilizavam pelo menos cinco medicamentos (polifarmácia). A polifarmácia foi maior entre os mais idosos (20,0%), na região Sul (25,0%), nos que avaliaram a própria saúde como ruim (35,0%), nos obesos (26,0%), nos que referiram ter plano de saúde (23,0%) ou internação no último ano (31,0%) e entre os que referiram qualquer uma das doenças investigadas, particularmente diabetes (36,0%) e doenças cardíacas (43,0%). No modelo final de risco para polifarmácia permaneceram idade, região, percepção de saúde, posse de plano de saúde, internação no último ano e todas as doenças investigadas exceto acidente vascular cerebral.

CONCLUSÕES

Idosos com doenças específicas têm fatores de risco para polifarmácia modificáveis por ações que visem o uso racional de medicamentos. Com o envelhecimento populacional em curso e a política exitosa de acesso a medicamentos, a tendência é aumentar a utilização de medicamentos por idosos, que deve ser prioridade na agenda de planejamento do Sistema Único de Saúde.

Uso contínuo de medicamentos e condições de trabalho entre motoristas de caminhão

Resumo Os motoristas de caminhão têm sido pouco explorados quanto aos problemas de saúde que os acometem e, principalmente, quanto ao seu perfil de consumo de medicamentos. Este estudo teve o objetivo de determinar o uso contínuo de medicamentos, por motoristas de caminhão, e identificar as características profissionais associadas. Para a sua realização, conduziu-se um estudo transversal com motoristas de caminhão estacionados no Pátio de Triagem do Porto de Paranaguá, Paraná, Brasil. Realizou-se uma entrevista com obtenção de dados socioeconômicos, problemas de saúde, condições de trabalho e uso contínuo de medicamentos. Dos motoristas avaliados (n = 665), 21,1% referiram utilizar algum medicamento continuamente, com destaque para o captopril (10,7%), metformina (10,3%), omeprazol (6,2%) e sinvastatina (6,2%). Motoristas com dezesseis anos ou mais de experiência profissional (RP 1,67; IC 95% 1,11-2,51), proprietários do próprio caminhão (RP 1,38; IC 95% 1,03-1,86) e que não possuíam vínculo empregatício formal (RP 1,49; IC 95% 1,11-2,00) apresentaram maior prevalência de uso contínuo de medicamentos. Observa-se que algumas condições de trabalho têm importante papel do uso contínuo de medicamentos pelos motoristas de caminhão.

Self-medication and its Effective Modifiable Factors among Elderly Referred Health Care Centers in Shahr-e-Kord in 2015

Introduction

Drug overuse is a serious problem for health care, and one of the biggest problems for the socio-economic well-being of different communities. The elderly tend to use more drugs due to changes in their cognitive and physiological factors. One of the best ways to evaluate the health level of elderly people is to evaluate their self-medication. This study was conducted to investigate self-medication among the elderly in Shahr-e-Kord.

Methods

This cross-sectional study was conducted on 350 people older than 65 in Shahr-e-Kord in 2015. Sampling was done in two stages. In the first stage, the city of Shahr-e-Kord was divided into four areas using geographical maps. Eighty-eight people were selected from each area. The research instrument was a questionnaire called the Health Belief Model (HBM). The data were analyzed using SPSS version 20, the chi-squared test, the independent-samples t-test, and the Pearson correlation coefficient.

Results

No significant relationship was observed between the prevalence of self-medication with demographic variables and level of awareness. But there was a significant difference between sensitivity, perceived severity, and perceived barriers and educational level. There also was a significant difference between the perceived benefits and their income level. There also was a significant difference between the level of awareness, sensitivity, severity, benefits, and barriers of people with and without a history of self-medication (p < 0.05).

Conclusion

Due to the adverse effects of self-medication and the high prevalence of this activity among the elderly, it is recommended that a training program be developed and implemented to change the knowledge and beliefs of the elderly about self-medication.

Diabetes em idosos: uso de medicamentos e risco de interação medicamentosa

Resumo Caracterizar o perfil sociodemográfico e de saúde dos idosos segundo diabetes referido, avaliar o conhecimento e a prática quanto às opções de tratamento, bem como descrever o uso de medicamentos e potenciais riscos de interação medicamentosa (IM) neste subgrupo. Estudo transversal com 1.517 idosos de Campinas em 2008. Estimaram-se as prevalências de diabetes e verificaram-se as associações pelo teste de Rao-Scott. As potenciais IM foram avaliadas pela base de dados Micromedex®. A prevalência de diabetes referida pelos idosos foi de 21,7% sem diferença significativa entre os sexos. Verificou-se maior percentual de idosos diabéticos com 70 anos ou mais, com menor escolaridade, renda familiar per capita inferior a 1 salário mínimo e que não realizavam atividade ocupacional. O número médio de medicamentos foi de 3,9 nos 3 dias anteriores. Identificaram-se 413 possíveis interações, sendo que 53,1%, 7,8% e 7,2% dos idosos apresentaram risco de IM moderadas, menores e graves, respectivamente. Ressalta-se a importância da adoção de dieta saudável e prática de atividade física para redução do peso, controle da doença e de complicações. Evidencia-se a necessidade de atenção ao risco potencial das IM e o uso de medicamentos inapropriados ao idoso.

The detection of Trypanosoma cruzi by nested-PCR in elderly patients: relationship to the clinical and epidemiological profile

Chagas disease, which is caused by Trypanosoma cruzi, is transmitted primarily by triatomine bugs, although the incidence of new cases has decreased as a result of vector control. In Brazil, most of those affected have the chronic form of the disease and are generally elderly individuals who require appropriate clinical follow-up. In this work, we undertook a descriptive study in which 85 patients were interviewed and blood samples were collected for molecular analyses based on the amplification of parasite satellite DNA. The cardiac form of the disease was the most prevalent among the patients and hypertension was the most frequent comorbidity; polypharmacy was detected in 34% of the cases. Serological tests were positive in 95% of cases while 36% were positive in nested-polymerase chain reaction. These findings indicate an increased use of medications and a larger number of age-related diseases in elderly patients with Chagas disease, even in patients with low parasitemia. We conclude that elderly patients with Chagas disease require special attention and that further studies should be done with elderly individuals who carry this disease.

[Physical activity, screen time, and use of medicines among adolescents: the 1993 Pelotas (Brazil) birth cohort study]

This study aimed to evaluate cross-sectional and longitudinal associations between physical activity, screen time, and use of medicines among adolescents from the 1993 Pelotas (Brazil) birth cohort study, followed at 11 (N = 4,452), 15 (N = 4,325), and 18 years of age (N = 4,106). The study recorded the use of medicines in the previous 15 days, continuous use of some medication, level of physical activity (by questionnaire and accelerometry), and screen time (TV, computer, and videogame). One-third of adolescents had used at least one medicine in the previous 15 days and approximately 10% were on some continuous medication. In the adjusted analysis, the results showed that higher levels of physical activity at 18 years and less screen time at 15 years in boys were associated with lower overall use of medicines (p < 0.05). For boys, physical activity at 11 and 18 years were inversely related to continuous medication (p < 0.05). More physically active boys and those with less screen time in adolescence showed lower use of medicines at 18 years of age.

Use of the Brazilian People's Pharmacy Program by older adults

OBJECTIVE

To assess the prevalence and factors associated with the use of the expanded Brazilian People's Pharmacy Program among older adults and the reasons for not using it.

METHODS

In this population-based cross-sectional study conducted in the urban area of Pelotas, RS, Southern Brazil, we evaluated 1,305 older adults (aged 60 years or over) who had used medication in the last 15 days. Independent variables were socioeconomic factors, economic status, household income in minimum wages, educational attainment in years of schooling and occupational status. Demographic variables were sex, age, marital status, and self-reported skin color/race. Poisson regression was employed to analyze the factors associated with the use of the program.

RESULTS

The prevalence of use was 57.0% whilst the prevalence of knowledge of the program was 87.0%. In individuals aged 80 years or over, use of the program was 41.0%. As to the origin of the prescriptions used by older adults, 46.0% were from the Brazilian Unified Health System. The main reasons for not using the program were: difficulty in getting prescriptions, medication shortage, and ignorance about the medications offered and about the program. Higher age, lower income, presence of chronic diseases, and use of four or more medications were associated with use of the program.

CONCLUSIONS

It is necessary to expand the knowledge and use of the Brazilian People's Pharmacy Program, especially among older adults, and to improve the dissemination of its list of medications to users and physicians. Thus it will be possible to reduce spending on long-term medications, which are especially important for this population.

Prevalence of self-medication among the elderly in Kermanshah-Iran

INTRODUCTION

Self-medication is consumption of one or several medications without the physician's prescription. Given the risks of self-medication, this study was carried out to assess the prevalence of self-medication and its related factors among the elderly in Kermanshah-Iran

METHOD

In this descriptive cross-sectional study, 272 elderly visiting the private offices in Kermanshah were selected through convenience sampling method. The instrument for data collection was a researcher made self-medication questionnaire. Data were analyzed using descriptive and analytic statistical methods (Chi-Square and Fisher exact test).

RESULTS

The prevalence of self-medication was 83%. The most common reasons for self-medication were certainty of its safety (93%), prior consumption of the drug (87.6%), busy offices of physicians (82%), non-seriousness of the illness (77.8%) and prior experience of the disease (73%).The most common drugs used for self-medication were analgesics (92%), cold drugs (74%), vitamins (61%), digestive drugs (54%) and antibiotics (43%). There was a significant correlation between self-medication and gender (p=0.001), education level (p=008), drug information (p=0.01), marital status (p=0.002), and medical insurance (p=0.001) variables.

CONCLUSION

considering the relatively high rates of self-medication among the elderly as well as its side effects, designing and performing educational programs are suggested for the elderly people.

Use of self-medication among adolescents: a systematic review and meta-analysis

BACKGROUND

We performed a systematic review and proportion meta-analysis in order to investigate the prevalence and the adverse effects of the self-medication among the teenagers.

METHODS

We selected observational studies published from January 1990 until January 2014 that examined the use of self-medication in the adolescents (aged from 13 to 18 years). Keywords used on PubMed, ISI Web of Knowledge and Scopus were 'self medication', 'adolescent*', 'self prescription', 'over the counter preparations' and 'self administration'.

RESULTS

Finally, 15 articles met the inclusion criteria, for a total of 143 213 subjects involved. Overall, 50% of adolescents use to take drugs without consulting a physician. Further analyses stratified by number of drugs used demonstrated that in the studies reporting that adolescents use more than one type of drug the prevalence rises up to 63%. Only one study reported the possible adverse effects related to the inappropriate use of drugs, which were experienced by 31.1% of the females and 19.6% of the males.

CONCLUSIONS

Self-medication use among adolescents is a widespread phenomenon. It would be advisable to give more attention on this public health concern and to promote initiatives, such as mass media campaigns and governmental actions, in order to make the citizens more aware to the risks related to the consumption of drugs without medical consultation. Further studies on adverse effects are urgently needed.

Polypharmacy, chronic diseases and nutritional markers in community-dwelling older

Polypharmacy is a common practice among the elderly, but few studies have evaluated its association with nutritional markers. The aim of this study was to estimate the prevalence of polypharmacy and its association with nutritional markers, chronic diseases, sociodemographic and health variables. This research is part of the Study Elderly/Goiânia, which evaluated 418 elderly community in a cross-sectional design. Polypharmacy was defined as the use of five or more concomitant medications. The following nutritional markers were investigated: BMI, waist circumference, percentage body fat, weight gain and loss, use of diet, daily consumption of fruits, vegetables, skimmed and whole milk. Multivariate analysis was performed using hierarchical Poisson regression, with significance level set at 5%. The prevalence of polypharmacy was 28% (95%CI 23.1 - 32.5), with a significant association with feminine gender, age range 75 - 79 years, eutrophic nutritional status and obesity, use of diet, poor self-rated health and presence of two, three or more chronic diseases. The high prevalence of polypharmacy and its association with nutritional markers and chronic diseases call the attention for the need of nutritional surveillance and monitoring in the elderly.

Clinical and epidemiological analysis of hospitalizations of elderly due to poisoning and adverse effects of medications, Brazil from 2004 to 2008

The elderly are more susceptible to adverse drugs effects due to a variety of factors, such as excessive and concomitant use of several drugs, administration errors, physiological changes in the body that alter the pharmacodynamics and pharmacokinetics. In order to determine the main therapeutic classes involved in hospital admissions of elderly people due to intoxication and adverse drug effects, as well as major health problems related to these events, 9,793 hospitalizations of people aged 60 or over registered in the Hospital Information System of the Unified Health System (SIH-SUS) in the period of 2004 to 2008 were analyzed. Unspecified drugs, systemic antibiotics, psychotropics, psychoactives, antiepileptics, sedatives, hypnotics and antiparkinsonians accounted for 57% of the total of admissions analyzed. Injuries and falls were the main health problems related to intoxication and adverse drug effects. Hospitalizations due to injuries were associated with analgesic, antipyretic and antirheumatic non-opioid. Falls were associated with systemic antibiotics, contradicting studies which point out psychotropic drugs as the main drug involved in these events. The results reflect the growing trend of problems associated with drug use by elderly people. It was verified that the consumption profile alone is not sufficient to explain the concentration of cases of the major therapeutic classes. We suggest the adoption of more effective programs of pharmacovigilance, capable of intervening at different stages of drug use: prescribing, dispensing, marketing, administration and compliance.

Potentially inappropriate medication use among institutionalized elderly individuals in southeastern Brazil

In recent decades, the elderly population in Brazil has grown rapidly, as has concern for the health of this population. Institutionalization in nursing homes has appeared as an alternative form of health care for frail elderly that live alone. The present study evaluated the pharmacotherapy and inappropriate drug prescriptions for institutionalized elderly patients living in long-term institutions in southeastern Brazil. This research was conducted at five institutions with a total sample of 151 individuals aged at least 60 years. Databases were used to identify drug interactions, defined daily dose and inappropriate prescriptions. The prevalence of drug intake among the elderly was 95.36%, and there were an average of 3.31 ± 1.80 drug prescriptions per individual. Based on Beers criteria, the prevalence of inappropriate prescriptions was 25.83%. In addition, 70.2% of prescriptions were prescribed at a higher dosage than the defined daily dose (ATC/WHO). Potential drug interactions were identified for 54.11% of prescriptions; 81.42% of these were of moderate severity. The main inappropriate drugs were prescribed for cardiovascular and nervous system problems. Institutionalized elderly individuals presented a high consumption and misuse of medications, requiring professional intervention to monitor prescriptions and improve the quality of service for this population.

Utilização de medicamentos pela população quilombola: inquérito no Sudoeste da Bahia

OBJETIVO Analisar o uso de medicamentos pela população quilombola. MÉTODOS Estudo transversal de base populacional com 797 quilombolas adultos de Vitória da Conquista, BA, em 2011. Utilizou-se análise de variância para comparar as médias de medicamentos por indivíduo segundo variáveis demográficas, socioeconômicas e de comportamentos relacionados à saúde. Foram estimadas as prevalências, razões de prevalência e os respectivos intervalos de confiança de 95%. Análise múltipla foi conduzida por meio de regressão de Poisson com variância robusta. RESULTADOS Os medicamentos mais consumidos pela população foram aqueles que atuam nos sistemas cardiovascular e nervoso. A prevalência de uso de medicamentos foi de 41,9%, significativamente maior nas mulheres (50,3%) do que nos homens (31,9%). Após análise ajustada, o uso de fármacos foi associado a sexo feminino, idade de 60 anos e mais, nível econômico mais alto, pior avaliação da saúde, maior número de morbidades autorreferidas e de consultas médicas. CONCLUSÕES Mulheres e idosos deverão ser os grupos de preferência para o desenvolvimento de estratégias específicas que garantam o uso racional dos medicamentos. É necessária a promoção de prescrição racional no cotidiano dos serviços de saúde.

[Use of medicines by individuals with hypertension and diabetes in municipalities covered by the Pharmacy Network in Minas Gerais State, Brazil]

This article analyzes the use of medicines by individuals with hypertension and/or diabetes mellitus who received their medication through a public network of pharmacies, with a particular emphasis on gender differences. During the first two months of 2010, individuals with hypertension and/or diabetes were interviewed in half of the 64 municipalities (counties) participating in the Minas Gerais Pharmacy Network. Mean age of the 4,777 interviewees was 60.9 years, which may have contributed to the high mean number of medicines used (4.0 among women and 3.5 among men). The most frequently used drugs were those acting on the cardiovascular system (56.3%), alimentary tract and metabolism (14.9%), and nervous system (13.8%), consistent with the sample's epidemiological profile. Women and more elderly individuals tended to use more medicines. The findings show high expenditures on medicines by the interviewees and suggest the design of educational activities targeting rational use of medication.

[Falls in elderly Brazilians and the relationship to medication: a systematic review]

Falls in the elderly, often classified as accidental, are frequently related to medication, generally involving poor prognosis and thus becoming a public health issue. The purpose of this systematic review was to identify published Brazilian studies on medication as a risk factor for falls or fall-related fractures in the elderly. The search covered the LILACS, PubMed, and SciELO indexes using the descriptors falls, elderly, and pharmaceutical preparations/medications/medicines/drugs or specific drug classes. A total of 340 articles presented data on prevalence, incidence, and risk factors associated with medication and falls or fall-related fractures, but only 6 pharmacoepidemiological studies were examined because they were conducted specifically in Brazilian samples. The main drug classes associated with increased risk of falls: antidepressants, sedatives, anxiolytics, and diuretics. The promotion of rational drug use in geriatrics requires well-designed studies to produce robust scientific data.

[Self-medication in the elderly population of Campinas, São Paulo State, Brazil: prevalence and associated factors]

The aim of this study was to evaluate the prevalence and causative factors associated with self-medication in the elderly and identify the main drugs consumed without prescription. A cross-sectional population-based study with stratified clustered two-stage sampling was performed in Campinas, São Paulo, Brazil in 2008 and 2009. Of the 1,515 elderly studied, 80.4% reported using at least one drug during the three days preceding the survey. Of these, 91.1% reported the use of prescription drugs only and the remainder (8.9%) reported simultaneous use of prescribed and non prescribed drugs. After adjustment, a negative association between age ≥ 80 years, hypertension, chronic diseases, use of health services, dental consultations and adherence to a medical plan,and self-medication was found, whereas a positive association was found with per capita income. Dipyrone, acetylsalicylic acid, diclofenac, Ginkgo biloba, paracetamol and homeopathic medicines were among the most used non-prescribed drugs. Pharmaceutical assistance should be provided as a priority to the elderly, to avoid the misuse of medicines and ensure access to the correct drugs.

[Use of medication by the elderly in urban and rural areas in southern Brazil: a population-based study]

The study aimed to measure use of medication and polypharmacy among the elderly in Carlos Barbosa, Rio Grande do Sul State, Brazil, and to compare socio-demographic, economic, and health characteristics in relation to area of residence (urban versus rural) in a random sample of 811 persons 60 year of age or older. Interviews were used to collect data on socio-demographic characteristics, chronic illnesses, and self-reported use of medications. The association between area of residence and medication or polypharmacy was adjusted for confounders using Poisson regression with robust variance. Prevalence rates for use of medication and polypharmacy were higher among older persons living in the urban area. Living in the urban area was positively and independently associated with use of medication (PR = 1.10; 95%CI: 1.02-1.20) and polypharmacy (PR = 1.83; 95%CI: 1.27-2.65) in this group of elderly in southern Brazil.

Utilização de medicamentos por idosos brasileiros, de acordo com a faixa etária: um inquérito postal

O objetivo deste estudo foi avaliar fatores associados ao uso de medicamentos por idosos. Foi realizado um inquérito postal nacional, com 3 mil idosos, selecionados com base no cadastro do Instituto Nacional do Seguro Social. Foram estimadas a prevalência e a média de medicamentos utilizados nos 15 dias anteriores à pesquisa, segundo faixas etárias. A prevalência de uso de medicamentos foi de 83%, sendo de 87,3% no grupo de 70 anos ou mais, e de 78,8% no de 60-69 anos (p < 0,05). Os idosos com 70 anos ou mais usaram em média 4,4 medicamentos, os mais jovens 3,3. Os medicamentos mais utilizados pertenciam ao sistema cardiovascular. Idade de 70 ou mais anos, sexo feminino, pior percepção de saúde, interrupção de atividades habituais, mais de 6 consultas médicas no último ano, filiação a plano de saúde e relato de 4 ou mais doenças estavam associados ao uso de medicamentos (p < 0,05) entre os participantes. Os resultados ampliam o conhecimento a respeito da utilização de medicamentos pelos idosos brasileiros, evidenciando a necessidade de aprimoramento da assistência farmacêutica voltada para esse subgrupo da população.

Uso de medicamentos contínuos e fatores associados em idosos de Quixadá, Ceará

OBJETIVO: Analisar a polifarmácia (uso diário de dois ou mais) de medicamentos contínuos e seus fatores associados em idosos. MÉTODOS: Estudo seccional realizado com idosos residentes em área urbana do município de Quixadá-CE, no período de maio a dezembro de 2009. A amostra compôs-se de 384 indivíduos, com 60 anos ou mais, usuários de medicamentos contínuos. As variáveis estudadas foram as sociodemográficas, econômicas e das características de saúde e referentes ao uso de medicamentos. Para a análise da associação entre a variável dependente polifarmácia de medicamentos contínuos e as variáveis independentes foi elaborado um modelo de regressão logística. RESULTADOS: Os resultados mostram predominância de idosos do sexo feminino, faixa etária entre 60 e 69 anos, casados, ensino fundamental incompleto, sem exercer atividade remunerada, renda familiar de até um salário mínimo, habitando em moradia própria, residindo com até três pessoas. Constatou-se uma prevalência de 70,6% de polifarmácia em idosos, sendo mais elevada no sexo feminino (66,4%). Os fatores associados positivamente ao uso de dois ou mais medicamentos contínuos foram: renda familiar acima de um salário mínimo (OR 2,83; IC95% = 1,54-5,32); duas ou mais condições crônicas autorreferidas (OR 17,71; IC95% = 9,80-31,990) e autopercepção da qualidade de vida regular e ruim (OR 2,85; IC95% = 1,60-5,07). CONCLUSÕES: Constatou-se uma prática de polifarmácia de medicamentos contínuos em idosos com renda familiar superior a um salário mínimo, que apresenta duas ou mais condições crônicas e autopercepção da sua qualidade de vida entre regular e ruim. Situação que remete a questões relativas aos aspectos social, cultural, econômico e de saúde.

[Use of medication among hospital workers]

Although medication is acknowledged as a key element in treating health problems, there is little information available on the use of medication by hospital workers. To estimate the prevalence and describe the patterns of medication consumption by hospital workers and to identify the factors associated with such consumption in this population, data from the "PROSEC" baseline cohort were analyzed (n=417). The prevalence of overall medication consumption was 72.4%, most of which was for nervous complaints (25.4%), especially analgesics (17.8%). Use of any amount of medication was independently associated with gender, number of medically diagnosed conditions and health problem in the two weeks prior to the interview. Use of a drug was significantly associated with income whereas self-diagnosed health problems were independently related with the use of two or more pharmaceutical products. The high prevalence of medication usage in this population, with analgesics being the most consumed medication, should be seen as a cause for concern, since many consumers are unaware that these products are not exempt from risk. Women and individuals in poor health are the main candidates for intervention programs in order to promote adequate and proper use of these pharmaceutical products.

Medicamentos prescritos aos idosos em uma capital do Sul do Brasil e a Relação Municipal de Medicamentos

O objetivo deste trabalho foi descrever os medicamentos prescritos aos idosos residentes na zona urbana do Município de Florianópolis, Santa Catarina, Brasil, nos 30 dias anteriores à entrevista e, a partir disto, comparar com a Relação Municipal de Medicamentos (REMUME). Foi realizado um estudo transversal populacional de base domiciliar, no qual os 1.705 idosos entrevistados relataram ter utilizado o total de 5.458 medicamentos prescritos e dentro dos critérios da pesquisa, que corresponderam a 374 princípios ativos diferentes. Os medicamentos mais utilizados foram os indicados para o sistema cardiovascular, sendo a classe farmacológica dos redutores de colesterol e triglicerídeos os mais prevalentes, apesar de não haver nenhum exemplar desta classe de medicamentos selecionado na REMUME. Embora haja algumas faltas, a REMUME coincide com a maior proporção dos medicamentos prescritos no Município de Florianópolis. A principal diferença entre as prescrições é que as oriundas do SUS estão em maior conformidade com a REMUME.

Birth cohort differences in the use of medications in a Brazilian population of older elderly: the Bambuí Cohort Study of Aging (1997 and 2008)

This study examined differences in the use of medications in two birth cohorts (born from 1916 to 1926 and from 1927 to 1937) among older elderly in the population-based cohort study in Bambuí, Minas Gerais State, Brazil. The study used data on participants who were 71-81 years of age in the baseline survey in 1997 (n = 492) and in the 11th wave, in 2008 (n = 620). The number of medications currently consumed (mean = 4.6 and 3.4, respectively) and prevalence of polypharmacy (46.6% and 29.1%, respectively) were higher in the more recent cohort as compared to the earlier one. These differences were independent of gender, age, schooling, number of medical visits in the previous 12 months, and number of chronic conditions. The more recent cohort showed significant differences in the use of psychoactive drugs, lipid modifying agents, drugs for diabetes, and antithrombotic agents, as well as changes in drugs used for arterial hypertension. In general, these changes are consistent with those observed in elderly populations in high-income countries.

Prevalência e fatores associados ao acesso a medicamentos pela população idosa em uma capital do sul do Brasil: um estudo de base populacional

O presente estudo tem por objetivo descrever a prevalência, fatores associados e a forma de acesso aos medicamentos prescritos aos idosos residentes na área urbana do Município de Florianópolis, Santa Catarina, Brasil. Foi realizado estudo transversal populacional de base domiciliar em amostra de 1.469 indivíduos (taxa não-resposta 10,8%). Os dados foram analisados, por meio de regressão de Poisson, sob duas perspectivas: do acesso a medicamentos em geral e do acesso a medicamentos pelo SUS. Os resultados foram, respectivamente, 95,8% (IC95%: 94,7-96,8) e 50,3% (IC95%: 47,7-52,8). Observou-se que ocorre menor acesso a medicamentos quanto maior a dependência funcional, maior o número de doenças crônicas e quando há realização de consulta médica. Acessam mais medicamentos pelo SUS indivíduos de cor da pele parda ou negra, menor idade, pior escolaridade, pior renda, maior número de doenças crônicas, ausência de plano de saúde privado e consulta médica nos últimos três meses. Estes resultados mostram que o SUS vem cumprindo seu papel na universalização do acesso aos medicamentos em Florianópolis.

[Family health strategy in the treatment of chronic-degenerative diseases: achievements and challenges]

This retrospective, exploratory, quantitative study was carried in a team of heath care unit (ESF) in the municipalitie of Maringá, Paraná, Brasil, to evaluate the effectiveness of ESF in the treatment of chronic diseases. Data were collected between May, 2006 and September, 2009, among 94 patients with hypertension and/or diabetes, through the analysis of the records of registration of the monitoring system of hypertensive and diabetics and charts. Despite changes in the pharmacotherapy of patients and home care, it was found a slight increase in the number of individual with blood pressure (p = 0.773) and fasting glucose levels (p = 0.745) considered appropriate, in the reporting period. It was concluded that changes in the pharmacotherapy prescribed are insufficient for an adequate control of these diseases, being necessary the development of interventions of the health team that promote the practice of self-care in individuals and their families.

Intervenção interdisciplinar enquanto estratégia para o Uso Racional de Medicamentos em idosos

A presente pesquisa avaliou a efetividade de intervenções interdisciplinares, envolvendo médicos, farmacêuticos e nutricionistas, destinadas à promoção do Uso Racional dos Medicamentos. Trata-se de um estudo de caráter prospectivo e analítico, com uma população de mulheres idosas, onde a efetividade da intervenção foi avaliada de acordo com indicadores de Uso Racional dos Medicamentos preconizados pela Organização Mundial de Saúde. As análises estatísticas foram realizadas utilizando-se do teste t ou one-way ANOVA para variáveis discretas, e o teste de qui-quadrado para avaliação categórica das variáveis. Após a intervenção, houve uma redução média no consumo de medicamentos em relação às consultas da pré-intervenção (p=0,001). Os medicamentos utilizados na terapêutica cardiovascular foram os mais consumidos, o que se encontra em consonância com as doenças autoreferidas pelas idosas. Foi possível verificar que a intervenção interdisciplinar em idosas pôde contribuir para melhoria dos indicadores de Uso Racional dos Medicamentos, em especial os de prescrição.

Vigilância em saúde na enfermagem: o caso das medicações sem prescrição em crianças

A automedicação é um hábito comum em nosso país e sempre foi um assunto muito discutido e controverso. Muitas mães recorrem à prática de medicar por conta própria suas crianças quando estas apresentam algum sintoma decorrente ou não de alguma patologia. Esta pesquisa teve como objetivo descrever os motivos que levaram as mães a administrarem medicações sem prescrição profissional a seus filhos. Foram entrevistadas 20 mães de crianças menores de 10 anos cadastradas no programa de Crescimento e Desenvolvimento da Unidade de Saúde da Família do município de Passagem, interior do Rio Grande do Norte. Entre as 20 mães entrevistadas, 30% automedicaram seus filhos com antipirético, 50% automedicaram devido à febre, 43% foram motivadas pela experiência anterior e 90% não relataram efeitos adversos. A automedicação na população infantil reforça a necessidade de um melhor esclarecimento às mães sobre os riscos da automedicação.

[The influence of the advertising in the medication use in a group of elderly attended in a primary health care unit in Aracaju (Sergipe, Brasil)]

The growth of the Brazilian elderly people has led to a trend to an increase in the medication use. The inadequate use of drugs can be induced by some factors, like advertisement, with the risk of damaging the user's health. The objective of the study was to evaluate the advertisement influence in medication use in a group of elderly patients in a primary health care unit in Aracaju, Sergipe, Brazil. 230 elderly aging over 60 years with both genders had been interviewed from April to June of 2007. The majority of the interviewees (73%) has at least a chronic health condition and 73.9% consumed regularly at least one medication. 17.8% of the sample informed to use medication motivated by publicity influence; 2.2% had considered that the medication never cause damages and 6.5% believed that always it makes well. In this study, correlations have been made and demonstrated that those who presented a higher level of consumption influenced by advertising also think that drugs used are always beneficial and vice versa (p= 0.04). The data showed that part of elderly suffered influence of advertisement to medication use, and are not conscious of risks involved.

Automedicação em adultos de baixa renda no município de São Paulo

OBJETIVO: Estimar a proporção de automedicação em adultos de baixa renda e identificar fatores associados. MÉTODOS: Foram utilizados dados de inquérito populacional realizado no município de São Paulo em 2005, cujo plano amostral incluiu dois domínios, favela e não favela, com amostragem por conglomerados em dois estágios, totalizando 3.226 indivíduos elegíveis. Além de características sociodemográficas e econômicas, foram analisados: uso de medicamentos nos 15 dias anteriores à entrevista, tipo de acesso (gratuito, comprado ou outra) aos medicamentos e os tipos de morbidades (crônicas ou agudas) tratadas, em análise de regressão logística múltipla. RESULTADOS: A proporção de automedicação foi de 27% a 32%. Automedicação esteve fortemente associada à morbidade aguda, ao acesso ao medicamento por compra, à idade menor que 47 anos e medicamentos do grupo terapêutico que atuam no sistema nervoso central. O grupo que atua no sistema nervoso central foi o mais utilizado na automedicação. CONCLUSÕES: O acesso gratuito aos medicamentos mostrou-se fator de proteção para a automedicação. A distribuição de medicamentos e o atendimento adequado devem ser considerados para orientação e redução dos riscos que o uso irracional de medicamentos pode gerar à saúde.

Adesão medicamentosa em idosos em seguimento ambulatorial

Este estudo objetivou avaliar a adesão ao tratamento medicamentoso em idosos em seguimento ambulatorial e identificar os fatores relacionados a esta adesão. Foram entrevistados 165 idosos em seguimento ambulatorial no Hospital das Clínicas da Universidade Estadual de Campinas (Unicamp), São Paulo. Utilizou-se instrumento próprio, com informações relativas à identificação dos sujeitos, dados de saúde autorreferidos e relativos à terapêutica medicamentosa. Os dados foram submetidos às análises descritiva e de comparação. A maioria dos idosos revelou adesão ao tratamento (88,5%), dentre os quais 91,1% moravam acompanhados. Os idosos que moravam sozinhos apresentaram três vezes mais chances de não aderência ao tratamento (OR: 3,655). Os efeitos colaterais dos medicamentos mostraram sete vezes mais chances de não aderência (OR: 7,092). Os fatores combinados que apresentaram maior chance de predizer a não adesão à terapêutica foram "mora sozinho" (OR: 4,346) e "efeitos colaterais" (OR: 8,219).

Fatores associados à polifarmácia em idosos institucionalizados

INTRODUÇÃO: A polifarmácia é um problema importante no atendimento do idoso, sendo os pacientes em instituições de longa permanência (ILPs) aqueles com riscos aumentados, por apresentarem muitas doenças limitantes, fragilidade e baixa funcionalidade. Objetiva-se então, com o presente estudo, avaliar os fatores associados à presença de polifarmácia em pacientes idosos internados em instituição de longa permanência. METODOLOGIA: Realizado estudo transversal, retrospectivo, por meio de análise de prontuários de todos os pacientes acima de 60 anos institucionalizados em ILP pública de grande porte. Elaborou-se protocolo constituído de dados sócio-demográficos, número e tipos de doenças, número de medicamentos, grupos de fármacos, dependência funcional e tempo de institucionalização. Na análise estatística, esses fatores foram relacionados com a presença ou não de polifarmácia. RESULTADOS: A casuística final constituiu-se de 209 pacientes; 73,2% mulheres, idade média de 75,9 anos e tempo de institucionalização médio de 95,3 meses. Principais doenças encontradas: hipertensão arterial sistêmica (HAS) em 67,9% do total, síndromes demenciais em 36,8% e sequelas de trauma crânio-encefálico ou acidente vascular cerebral (TCE ou AVC) em 33,9%. No presente estudo, os fatores relacionados à polifarmácia em institucionalizados foram: ausência de déficit cognitivo (OR=3,61 - IC: 1,96-6,65); consumo de medicamentos cardiovasculares (OR=0,22 - IC: 0,11-0,44), uso de medicamentos gastrointestinais e metabolismo (OR=0,38 - IC: 0,21-0,67); número de diagnósticos acima de 5 (OR=1,90 - IC: 1,08-3,33); tempo de institucionalização entre 12 e 23 meses (OR:0,32 - IC: 0,11-0,91) e maior dependência funcional pela escala de Katz (OR: 1,90 - IC:1,07-3,22). Não houve relação com idade, sexo, uso de medicamentos psiquiátricos e diagnóstico de sequela de AVC ou TCE. CONCLUSÃO: Conclui-se que institucionalizados possuem aspectos diferentes de idosos ambulatoriais ou de comunidade, havendo maior importância de fatores relacionados à funcionalidade e ao tempo de institucionalização do que com idade e sexo.

Self-medication among nursing workers from public hospitals

This study describes the prevalence of self-medication and associated factors among nursing workers. This epidemiological sectional study included 1,509 working nurses from two public hospitals in Rio de Janeiro, Brazil. The medications were identified and classified according to the Anatomical Therapeutic Chemical Index. The self-medication prevalence was 24.2% and the most reported anatomical group treated was the nervous system, while the therapeutic group included analgesics. Self-medication was more prevalent among young people, individuals with minor psychiatric disturbances, non-hypertensive individuals, those who did not exercise, those who reported a disease or injury in the last 15 days, with the highest number of self-diagnosed diseases, nurses, professionals with temporary work contracts and those highly involved with their work. Self-medication is a frequent practice among the nursing team members and is associated with factors that should be taken into account when planning strategies aimed at improving workers' health conditions.

Dor crônica em idosos e sua influência nas atividades da vida diária e convivência social

RESUMO Estudo transversal que objetivou caracterizar a dor crônica em idosos residentes na cidade de Cruzaltense/RS, a fim de evidenciar a influência desta na vida diária e na convivência social. A amostra abrangeu 48 idosos. A coleta de dados ocorreu através da aplicação de um questionário com questões fechadas. Os dados foram analisados através da estatística descritiva. Dos 48 pesquisados, 56,25% referiram dor crônica: 16 do sexo feminino e 11, do masculino. Os idosos apresentavam idade entre 60 e 83 anos, com média de 71,5, sendo que 81,5% apresentam alguma patologia com diagnóstico médico. Predominam os idosos casados (55,5%), embora seja significativo o percentual de viúvos (40,7%). Quanto à ocupação pregressa, 92,6% eram agricultores. Os lugares mais prevalentes de dor crônica foram: coluna lombar e cervical, pernas, articulação do joelho e membros superiores. A intensidade da dor, segundo a escala numérica visual (VAS), variou de 1 a 10. Em relação ao tipo de dor, destacaram: sensação de dolorimento, queimação, latejante, lacerante e aguda podendo ocorrer diariamente, eventualmente e associada a esforços. A dor está entre os principais fatores que limitam a possibilidade do idoso em manter seu cotidiano de maneira normal, impactando negativamente sua qualidade de vida, prejudicando, de algum modo a realização das atividades de vida diária, bem como restringindo a convivência social, o que pode conduzir ao isolamento.

[Prevalence of non-utilization of mammography and associated factors in elderly women]

This study analyzes the prevalence of non-utilization of mammography among older women, according to socio-demographic variables, health status, and use of preventive health services. This was a cross-sectional study including women 60 years or older. We interviewed 4,621 women 60 to 106 years of age; the majority were widows (51.8%) and had little or no schooling (53.8%). Most (89%) reported health problems, and 66.4% used private medical care. Prevalence of self-reported mammography was 72.1%. Gynecological visits (PR = 2.39; 95%CI: 2.04-2.80), Pap smear (PR = 3.24; 95%CI: 2.89-3.63), years of schooling (PR = 1.07; 95%CI: 1.02-1.12), health care insurance (PR = 1.16; 95%CI: 1.11-1.20), physician visits (PR = 1.23; 95%CI: 1.11-1.37), age (PR = 1.12; 95%CI: 1.08-1.17), marital status (PR = 1.05; 95%CI: 1.00-1.09), and barriers to health services (PR = 0.94; 95%CI: 0.89-0.98) were also associated with non-utilization of mammography. These associations may be partially explained by lack of knowledge, poor access to public health services, and cultural factors related to the aging process and reproductive incapacity.

[Use of medicines by the elderly in a Family Health Program unit in Brazil]

The use of multiple medicines is frequent among the elderly. Although such practice is usually necessary, it predisposes to risks of adverse events and drug interaction. The present study was intended to verify the characteristics of medication among the elderly in relation to socio-demographic profile, the most commonly used drug classes, and treatment adherence. This was a descriptive study that included 301 elderly in the coverage area of a Family Health Program, using a previously structure home interview. The sample was predominantly female, with a high illiteracy rate and alterations in cognitive status and various forms of dependency. The subjects showed an average of 2.5 diagnoses and used 2.9 drugs per individual. Some of the drugs are classified as high-risk for the age bracket. Treatment adherence data showed dependence on others for administration, self-medication, forgetfulness in relation to medication, and insufficient knowledge of the drugs taken. Systematic follow-up is needed for elderly persons using multiple medicines, in addition to encouragement for non-pharmaceutical measures and an emphasis on educational measures for lifestyle change, backed by a multidisciplinary team.

Estudo de base populacional da subutilização de medicamentos por motivos financeiros entre idosos na Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil

O objetivo deste trabalho foi estimar a prevalência e avaliar os fatores associados à subutilização de medicamentos por motivos financeiros em amostra representativa de 1.134 idosos, residentes na Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil. A prevalência da subutilização foi de 12,9%, estando independentemente associada à renda pessoal mensal inferior a dois salários mínimos (RP = 0,57; IC95%: 0,34-0,97), à filiação a plano privado de saúde (RP = 0,68; IC95%: 0,46-0,99), à freqüência com que o profissional de saúde esclareceu sobre a saúde/tratamento (raramente/nunca, RP = 1,79; IC95%: 1,10-2,90), à auto-avaliação de saúde (razoável, RP = 1,66; IC95%: 0,95-2,90 e ruim/muito ruim, RP = 2,49; IC95%: 1,38-4,48) e ao número de condições crônicas (uma, RP = 2,51; IC95%: 0,99-6,35; duas, RP = 3,51; IC95%: 1,40-8,72 e três ou mais, RP = 4,52; IC95%: 1,79-11,41). Os resultados confirmam a importância dos aspectos sócio-econômicos para a subutilização, mas indicam que sua determinação também está ligada à qualidade da comunicação médico-paciente. Evidencia-se ainda uma situação de risco para idosos em piores condições de saúde.

Frequency of potential interactions between drugs in medical prescriptions in a city in southern Brazil

CONTEXT AND OBJECTIVE

Drug interactions form part of current clinical practice and they affect between 3 and 5% of polypharmacy patients. The aim of this study was to identify the frequency of potential drug-drug interactions in prescriptions for adult and elderly patients. TYPE OF STUDY AND SETTING: Cross-sectional pharmacoepidemiological survey in the Parque Verde housing project, municipality of Cascavel, Paraná, Brazil, between December 2006 and February 2007.

METHODS

Stratified cluster sampling, proportional to the total number of homes in the housing project, was used. The sample consisted of 95 homes and 96 male or female patients aged 19 or over, with medical prescriptions for at least two pharmaceutical drugs. Interactions were identified using DrugDigest, Medscape and Micromedex softwares.

RESULTS

Most of the patients were female (69.8%), married (59.4%) and in the age group of 60 years or over (56.3%), with an income less than or equal to three minimum monthly salaries (81.3%) and less than eight years of schooling (69.8%); 90.6% of the patients were living with another person. The total number of pharmaceutical drugs was 406 (average of 4.2 medications per patient). The drugs most prescribed were antihypertensives (47.5%). The frequency of drug interactions was 66.6%. Among the 154 potential drug interactions, 4.6% were classified as major, 65.6% as moderate and 20.1% as minor.

CONCLUSION

The high frequency of drug prescriptions with a potential for differentiated interactions indicates a situation that has so far been little explored, albeit a reality in household surveys.