Introdução: Portugal é o país da Organização para a Cooperação e Desenvolvimento Económico com maior consumo de ansiolíticos, hipnóticos e sedativos, sendo uma proporção significativa constituída por ...benzodiazepinas ou análogos, associados a efeitos de tolerância e dependência. Por este motivo, em alternativa às benzodiazepinas para tratamento da insónia, algumas publicações identificam outros fármacos com efeito hipnótico, como antidepressivos, anti-histamínicos, antipsicóticos ou anticonvulsivantes. Assim, torna-se necessário compreender a evolução do consumo destes medicamentos, pelo que foi objetivo deste estudo avaliar a evolução da dispensa de benzodiazepinas, outros fármacos ansiolíticos, hipnóticos ou sedativos não benzodiazepínicos, fármacos com potencial uso off-label na insónia e os resultados de indicadores dos Cuidados de Saúde Primários neste âmbito na região de Lisboa e Vale do Tejo.Material e Métodos: Realizou-se um estudo em base de dados, censitário e retrospetivo, no período de 2013 até 2020, avaliando-se a evolução das variáveis total de doses diárias definidas, doses diárias definidas por 1000 habitantes por dia (DHD) e dos indicadores relevantes. Os dados foram extraídos da plataforma SIARS da Administração Regional de Saúde de Lisboa e Vale do Tejo.Resultados: Verificou-se uma diminuição da dispensa de benzodiazepinas (de 57,44 para 51,77 DHD) mas o aumento da dispensa de não benzodiazepinas e de fármacos com potencial uso off-label (de 6,56 para 8,56 DHD e de 14,70 para 25,92 DHD, respetivamente). O zolpidem foi o mais dispensado entre os fármacos não benzodiazepínicos, acompanhando a tendência crescente de dispensa (de 4,86 para 6,96 DHD). Do conjunto de fármacos com potencial para uso off-label verificaram-se aumentos da dispensa para a trazodona (de 3,81 para 7,92 DHD), mirtazapina (de 3,52 para 6,48 DHD), pregabalina (de 3,15 para 4,87 DHD), quetiapina (de 2,68 para 4,59 DHD) e gabapentina (de 1,32 para 1,90 DHD), mas mais significativo ou apenas verificado nas formulações com dosagem mais baixa. A mediana dos resultados do indicador “proporção de idosos sem prescrição de sedativos, ansiolíticos e hipnóticos” em 2015 foi de 81,0, tendo em 2020 aumentado para 84,9. A mediana do indicador “proporção de utentes sem prescrição prolongada de ansiolíticos, sedativos e hipnóticos” em 2019 foi de 93,6 e aumentou para 94,3 em 2020.Conclusão: Globalmente, verificou-se uma redução da dispensa de benzodiazepinas prescritas na Região de Lisboa e Vale do Tejo. Parece existir uma alteração do padrão de prescrição no tratamento da insónia. São necessários estudos mais robustos para confirmar esta observação.
The central role of the Portuguese National Health Service (P-NHS) guarantees virtually free universal coverage. Key policy papers, such as the National Health Plan and the National Plan for Patient ...Safety have implications for pharmacists, including an engagement in medicines reconciliation. These primary health care reform, while not explicitly contemplating a role for pharmacists, offer opportunities for the involvement of primary care pharmacists in medicines management. Primary care pharmacists, who as employees of the P-NHS work closely with an interdisciplinary team, have launched a pilot service to manage polypharmacy in people living with multimorbidities, involving potential referral to community pharmacy. Full integration of community pharmacy into primary health care is challenging due to their nature as private providers, which implies the need for the recognition that public and private health sectors are mutually complementary and may maximize universal health coverage. The scope of practice of community pharmacies has been shifting to service provision, currently supported by law and in some cases, including the needle and syringe exchange program and generic substitution, remunerated. Key changes envisaged for the future of pharmacists and their integration in primary care comprise the development and establishment of clinical pharmacy as a specialization area, peer clinician recognition and better integration in primary care teams, including full access to clinical records. These key changes would enable pharmacists to apply their competence in medicines optimization for improved patient outcomes.
To evaluate the access to comprehensive diagnostics and novel antituberculosis medicines in European countries.
We investigated the access to genotypic and phenotypic Mycobacterium tuberculosis drug ...susceptibility testing and the availability of antituberculosis drugs and calculated the cost of drugs and treatment regimens at major tuberculosis treatment centres in countries of the WHO European region where rates of drug-resistant tuberculosis are the highest among all WHO regions. Results were stratified by middle-income and high-income countries.
Overall, 43 treatment centres from 43 countries participated in the study. For WHO group A drugs, the frequency of countries with the availability of phenotypic drug susceptibility testing was as follows: (a) 75% (30/40) for levofloxacin, (b) 82% (33/40) for moxifloxacin, (c) 48% (19/40) for bedaquiline, and (d) 72% (29/40) for linezolid. Overall, of the 43 countries, 36 (84%) and 24 (56%) countries had access to bedaquiline and delamanid, respectively, whereas only 6 (14%) countries had access to rifapentine. The treatment of patients with extensively drug-resistant tuberculosis with a regimen including a carbapenem was available only in 17 (40%) of the 43 countries. The median cost of regimens for drug-susceptible tuberculosis, multidrug-resistant/rifampicin-resistant tuberculosis (shorter regimen, including bedaquiline for 6 months), and extensively drug-resistant tuberculosis (including bedaquiline, delamanid, and a carbapenem) were €44 (minimum–maximum, €15–152), €764 (minimum–maximum, €542–15152), and €8709 (minimum–maximum, €7965–11759) in middle-income countries (n = 12) and €280 (minimum–maximum, €78–1084), €29765 (minimum–maximum, €11116–40584), and €217591 (minimum–maximum, €82827–320146) in high-income countries (n = 29), respectively.
In countries of the WHO European region, there is a widespread lack of drug susceptibility testing capacity to new and repurposed antituberculosis drugs, lack of access to essential medications in several countries, and a high cost for the treatment of drug-resistant tuberculosis.
Oil Removing from Emulsions Using Commercial Resins Nattácia Rodrigues de Araujo Felipe Rocha Renyston Lima Ribeiro Nadine Pereira Merlo Moilton Ribeiro Franco Junior
Journal of chemistry and chemical engineering,
04/2016, Letnik:
10, Številka:
4
Journal Article
Odprti dostop
Removal of vegetal oil from wastewater using comercial resins in batch reactors processes is studied in present study. A traditional and patented type of three different surfactants was used for ...stabilizing of the emulsion phase. The results for the emulsion made by the synthesized surfactant showed much better stability and performance in the separation process compared to that by conventionally used Span 80. To determine the optimum operation conditions, the effect of several parameters such as initial oil concentration, amount of resin in the solid phase, adding or not a surfactant, resin type, and stabilizer concentration have been investigated. It was found that under the optimum conditions, more than 98% ofoil can be removed in a single batch process.
Background
In the United States of America, the increased use of opioids is associated with serious risks, such as overdose, opioid use disorder and death. In Portugal, data about the use of these ...drugs are scarce.
Objective
Characterize the prescribing patterns of opioids in the Health Administrative Region of Lisbon and Tagus Valley.
Methods
Observational, retrospective descriptive analysis of the prescription of opioid drugs through the Health Administrative Region database from 2013 to 2017. The outcomes analysed were the defined daily dose (DDD) per year and the defined daily dose per 1000 inhabitants per year (DID).
Results
The prescription of opioid drugs in this region has increased approximately 1.5-fold over a 4 year period (totals of 4.32 million DDD and 3.25 DID in 2013 to totals of 7.21 million DDD and 5.42 DID in 2017). The opioids with the greatest absolute increase in this period were tramadol, tapentadol and codeine.
Conclusion
The prescription of opioid drugs has increased approximately 1.5-fold over a 4 year period in the ambulatory care of one of the main health administrative regions in Portugal. This trend warrants monitoring and suggests the need for highlighting good practices for opioids prescribing.
O sistema ETICS (External Thermal Insulation Composite System) é uma solução para isolar termicamente uma habitação pelo exterior, que apresenta inúmeras vantagens comparativamente a outras soluções ...disponíveis no mercado, nomeadamente por ser um sistema contínuo. Esta solução encontra-se em expansão nos dias de hoje e é cada vez mais utilizada para garantir uma melhor eficiência térmica dos edifícios. A fim de garantir o seu desempenho, funcionalidades e vantagens é necessário conseguir que a sua aplicação se execute de forma rigorosa segundo as normas e documentos de homologação existentes, através de mão de obra especializada na aplicação do sistema. A realização de inspeções periódicas é fundamental para garantir as condições exigidas de aplicação, sendo que um dos objetivos desta dissertação foi criar fichas de verificação que facilitem este processo em obra. Com base nestas fichas, fez-se a aplicação a seis casos de estudo para verificar a sua adequabilidade mas também as condições de execução do sistema ETICS, detetando quais os aspetos que se encontram em conformidade ou não com o exigido. A termografia é uma técnica não destrutiva com inúmeras vantagens. Permite por exemplo, identificar heterogeneidades em elementos construtivos. Considerando esta técnica uma mais-valia, executaram-se também levantamentos termográficos que permitiram verificar a necessidade da aplicação do sistema ETICS, as melhorias que este proporciona e também verificar a existência de pontos sensíveis após a sua aplicação. Os casos de estudo permitiram concluir que, na generalidade, o sistema ETICS é aplicado conforme o exigido. Verificaram-se no entanto, aspetos não conformes, sendo os mais frequentes e relevantes a ausência de perfil de arranque e a ausência do reforço nas zonas do sistema sujeitas a ações de especial agressividade. Quanto ao caso de estudo da termografia, verificou-se uma melhoria na eficiência térmica do edifício depois da intervenção de reabilitação com aplicação de ETICS, revelando os termogramas temperaturas homogéneas nas fachadas. Foi também possível verificar os pontos críticos, responsáveis pela maior troca de calor (ganhos e perdas) entre o interior e exterior. Pode concluir-se que o sistema ETICS é uma solução construtiva excelente e eficiente e que, sendo bem executado, pode oferecer múltiplas vantagens.
Among the Organization for Economic Co-operation and Development members, Portugal has the highest reported consumption of anxiolytics, hypnotics, and sedatives, of which a large proportion are ...benzodiazepines or related drugs. These are known to cause tolerance and dependence. Other drugs with hypnotic effect, such as antidepressants, antihistamines, antipsychotics, or anticonvulsants have been identified by some reports as alternatives to benzodiazepines for the treatment of insomnia. In this regard, the aim of this study was to characterize the consumption of benzodiazepines, non-benzodiazepine anxiolytic, hypnotic or sedative effect drugs and other drugs with the potential to be used off-label to treat insomnia, and the results concerning benzodiazepine consumption related indicators in the primary health care setting in the Lisbon and Tagus Valley region.
From 2013 to 2020, a census, descriptive and retrospective study was conducted. The evolution of the variables total defined daily doses, defined daily doses per 1000 inhabitants per day (DHD) and relevant indicators were characterized. Data were extracted from the SIARS platform used in the Lisbon and Tagus Valley regional Health Administration.
There was a decrease in the consumption of benzodiazepines (from 57.44 to 63.11 DHD) and an increase of non-benzodiazepines and of drugs with potential off-label use (from 6.56 to 8.56 DHD and from 14.70 to 25.95 DHD, respectively). Among non-benzodiazepines, zolpidem was the most consumed drug, also showing an increasing trend (from 4.86 to 6.96 DHD). For the group of drugs with off-label use potential, there was an increased consumption of trazodone (from 3.81 to 7.92 DHD), mirtazapine (from 3.52 to 6.48 DHD), pregabalin (from 3.15 to 4.87 DHD), quetiapine (from 2.68 to 4.59 DHD) and gabapentin (from 1.32 to 1.90 DHD), which was only the case (or, at least, more significantly) for the lower dose formulations. The median of results of the Primary Health Care setting indicator "proportion of elderly patients without prescription of sedatives, anxiolytics, and hypnotics", was 81.0 in 2015 and increased to 84.9 in 2020. For the indicator "proportion of patients without prolonged prescription of sedatives, anxiolytics, and hypnotics", the median was 93.6 in 2019 and 94.3 in 2020.
There was, overall, a decreasing trend in the dispensing of benzodiazepines in the Lisbon and Tagus Valley Region. Even though this data suggests a change in the therapeutic pattern for insomnia, more robust studies are needed to confirm this observation.
A study of different nanocomposites based on poly(ε-caprolactone) (PCL) and mesoporous SBA-15 silica that were prepared by melt extrusion was carried out by analyzing the possible effect of this ...filler on the crystalline details of PCL, on its mechanical behavior, and on the eventual observation of the confinement of the polymeric chains within the hollow nanometric silica channels. Thus, simultaneous Small-Angle and Wide-Angle X-ray Scattering (SAXS/WAXS) synchrotron experiments at variable temperature were performed on these PCL nanocomposites with different mesoporous silica contents. The importance of the morphological and structural features was assessed by the changes that were observed during the mechanical response of the final materials, which determined that the presence of mesoporous particles leads to a noticeable reinforcing effect.
Novel human parechovirus from Brazil Drexler, Jan Felix; Grywna, Klaus; Stöcker, Andreas ...
Emerging infectious diseases,
02/2009, Letnik:
15, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Human parechoviruses (HPeVs) were detected by reverse transcription-PCR in 16.1% of 335 stool samples from children <6 years of age with enteritis in Salvador, Brazil. Whole genome sequencing of 1 ...sample showed a novel HPeV that has been designated as HPeV8.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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