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To evaluate the utilization of benzodiazepines (BZD) in Brazilian older adults, based on the Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - National Survey of Access, Use and Promotion of Rational Use of Medicines).The PNAUM is a cross-sectional study conducted between 2013 and 2014, representing the Brazilian urban population. In the present study, we included 60 years or older (n = 9,019) individuals. We calculated the prevalence of BZD utilization in the 15 days prior to survey data collection according to independent variables, using a hierarchical Poisson regression model. A semistructured interview performed empirical data collection (household interview).The prevalence of BZD utilization in the older adults was 9.3% (95%CI: 8.3-10.4). After adjustments, BZD utilization was associated with female sex (PR = 1.88; 95%CI: 1.52-2.32), depression (PR = 5.31; 95%CI: 4.41-6, 38), multimorbidity (PR = 1.44; 95%CI: 1.20-1.73), emergency room visit or hospitalization in the last 12 months (PR = 1.42; 95%CI: 1.18-1.70 ), polypharmacy (PR = 1.26; 95%CI: 1.01-1.57) and poor or very poor self-rated health (PR = 4.16; 95%CI: 2.10-8.22). Utilization was lower in the North region (PR = 0.18; 95%CI: 0.13-0.27) and in individuals who reported abusive alcohol consumption in the last month (PR = 0.42; 95%CI: 0.19-0.94).Despite contraindications, results showed a high prevalence of BZD utilization in older adults, particularly in those with depression, and wide regional and sex differences.

Hypertensive disorders of pregnancy account for approximately 22% of all maternal deaths in Latin America and the Caribbean. Pharmacotherapies play an important role in preventing and reducing the occurrence of adverse outcomes. However, the patterns of medications used for treating women with hypertensive disorders of pregnancy (HDP) living in this country is unclear. A population-based birth cohort study including 4262 women was conducted to describe the pattern of use of cardiovascular agents and acetylsalicylic acid between women with and without HDP in the 2015 Pelotas (Brazil) Birth Cohort. The prevalence of maternal and perinatal outcomes in this population was also assessed. HDP were classified according to Ministry of Health recommendations. Medications were defined using the Anatomical Therapeutic Chemical Classification System and the substance name. In this cohort, 1336 (31.3%) of women had HDP. Gestational hypertension was present in 636 (47.6%) women, 409 (30.6%) had chronic hypertension, 191 (14.3%) pre-eclampsia, and 89 (6.7%) pre-eclampsia superimposed on chronic hypertension. Approximately 70% of women with HDP reported not using any cardiovascular medications. Methyldopa in monotherapy was the most frequent treatment (16%), regardless of the type of HDP. Omega-3 was the medication most frequently reported by women without HDP. Preterm delivery, caesarean section, low birth weight, and neonatal intensive care admissions were more prevalent in women with HDP. Patterns of use of methyldopa were in-line with the Brazilian guidelines as the first-line therapy for HDP. However, the large number of women with HDP not using medications to manage HDP requires further investigation.

Objective To estimate the prevalence of use of drugs to treat gastrointestinal disorders, according to demographic, socioeconomic, and health characteristics of the Brazilian population. Methods This is a population-based survey that interviewed individuals residing in cities of the five regions in Brazil. The study sample was composed of 32,348 individuals aged 20 or more years. The profile of use of drugs for gastrointestinal disorders was evaluated considering the variables sex, age, healthcare plan, region, and number of chronic diseases. We also analyzed the frequency of individuals who declared using other drugs, besides those already employed for treatment of gastrointestinal disorders. Additionally, the estimated frequencies of the drug classes used were determined. Results The prevalence of use of drugs for gastrointestinal disorders in Brazil was 6.9% (95% confidence interval − 6.4-7.6), higher in females, among persons aged over 60 years, in those who had a private healthcare insurance, and presented with two or more chronic diseases. It was noted that 42.9% of the aged who used drugs for gastrointestinal disorders were also on polypharmacy. As to the classes of drugs, 82% corresponded to drugs for the food tract and metabolism, particularly proton pumps inhibitors. Conclusion The use of drugs for treatment of gastrointestinal disorders was significant among women and elderly. In this age group, consumption may be linked to gastric protection due to polypharmacy. This study is an unprecedented opportunity to observe the self-reported consumption profile of these drugs in Brazil and, therefore, could subsidize strategies to promote their rational use. RESUMO Objetivo Estimar a prevalência de utilização de medicamentos para o tratamento de distúrbios gastrintestinais, segundo características demográficas, socioeconômicas e de saúde da população brasileira. Métodos Trata-se de inquérito de base populacional, que entrevistou indivíduos residentes em municípios das cinco regiões do Brasil. A amostra deste estudo foi composta por 32.348 indivíduos de 20 anos ou mais de idade. Foi avaliado o perfil de utilização de medicamentos para distúrbios gastrintestinais entre as variáveis sexo, idade, plano de saúde, região e número de doenças crônicas. Analisou-se a frequência de indivíduos que declararam utilizar outros medicamentos, além daqueles já utilizados para tratamento de distúrbios gastrintestinais. Além disso, foram estimadas as frequências das classes medicamentosas utilizadas. Resultados A prevalência de utilização de medicamentos para distúrbios gastrintestinais no Brasil foi de 6,9% (intervalo de confiança de 95% − 6,4-7,6), sendo maior no sexo feminino, entre pessoas acima de 60 anos de idade, naqueles que possuíam plano privado de saúde e tinham duas ou mais doenças crônicas. Observou-se que 42,9% dos idosos que utilizaram medicamentos para distúrbios gastrintestinais também eram polimedicados. Em relação às classes medicamentosas, 82% correspondiam a medicamentos para o trato alimentar e metabolismo, destacando os inibidores da bomba de prótons. Conclusão A utilização de medicamentos para tratamento de distúrbios gastrintestinais foi significativa entre mulheres e idosos. Nesta faixa etária, o consumo pode estar vinculado à proteção gástrica causada por polimedicação. Este estudo representa oportunidade inédita para observar o perfil de consumo autorreferido desses medicamentos no Brasil e pode, portanto, subsidiar estratégias para promoção de seu uso racional.

Objective: Antidepressant use is increasing worldwide, but national data on psychotropic drug use by depressed patients in Brazil is lacking. Methodology: Between 2013 and 2014, a representative sample of urban adult individuals were asked if they had a diagnosis of chronic disease, had a medical indication for drug treatment, and were taking chronic medications at the time for each reported diagnosis. We analyzed the frequencies of reported depression and the medications related to this disease. Results: Overall, 6.1% of respondents reported depression. The prevalence increased with age - 9.5% among the elders - was higher among women (8.9%) and in the south of the country (8.9%). As a single disease, the prevalence of depression was higher among young people (17.6%). Among those with multimorbidity, the prevalence of depression rose to 25.7%. Of those who reported depression, 81.3% had medical indication for treatment and 90.3% were under treatment - this proportion was lower among young people (84.5%) and those living in the poorest region (78.6%). Antidepressants accounted for 47.2% of psychotropic drugs taken by respondents with depression, with regional differences - only 30% used antidepressants in the North. Polypharmacy was reported by 22% of those with depression and other chronic diseases. Conclusion: Depression in Brazil, is common among young adults as a single chronic disease and highly prevalent among people with chronic multimorbidity, especially the young. The treatment gap was larger among young people and in the less developed regions of the country. RESUMO: Objetivo: O uso de antidepressivos está aumentando em todo o mundo, mas faltam dados nacionais sobre o uso de drogas psicotrópicas por pacientes deprimidos no Brasil. Metodologia: Entre 2013 e 2014, uma amostra representativa de indivíduos adultos urbanos foi questionada sobre a presença diagnóstica de doença crônica, a indicação médica para tratamento medicamentoso e o uso de medicamentos crônicos à época de cada diagnóstico relatado. Foram analisadas as frequências de depressão relatada e os medicamentos relacionados a essa doença. Resultados: No geral, 6,1% dos entrevistados relataram depressão. A prevalência aumentou com a idade (9,5% entre os idosos) foi maior entre as mulheres (8,9%) e no sul do país (8,9%). Como doença única, a prevalência de depressão foi maior entre os jovens (17,6%). Entre aqueles com multimorbidade, a prevalência de depressão subiu para 25,7%. Dos que relataram depressão, 81,3% tinham indicação médica para tratamento e 90,3% estavam em tratamento - essa proporção foi menor entre os jovens (84,5%) e os que moram na região mais pobre (78,6%). Os antidepressivos representaram 47,2% dos medicamentos psicotrópicos tomados pelos entrevistados com depressão, com diferenças regionais - apenas 30% usavam antidepressivos no Norte. Polifarmácia foi relatada por 22% das pessoas com depressão e outras doenças crônicas. Conclusão: A depressão no Brasil é comum entre adultos jovens como doença crônica única e altamente prevalente entre as pessoas com multimorbidade crônica, principalmente os jovens. A lacuna de tratamento foi maior entre os jovens e nas regiões menos desenvolvidas do país.

Background: Medication use during pregnancy is a common practice that has been increasing in recent years. The aim of this study is to describe medication use among pregnant women from the 2015 Pelotas (Brazil) Birth Cohort Study. Methods: This paper relies on a population-based cohort study including 4270 women. Participants completed a questionnaire about the antenatal period, including information about medication use. We performed descriptive analyses of the sample and the medications used and adjusted analyses for the use of medications and self-medication. Results: The prevalence of medication use was 92.5% (95% CI 91.7&ndash, 93.3), excluding iron salts, folic acid, vitamins, and other minerals. The prevalence of self-medication was 27.7% (95% CI 26.3&ndash, 29.1). In the adjusted analysis, women who had three or more health problems during pregnancy demonstrated higher use of medicines. Self-medication was higher in lower income groups and among smokers and multiparous women (three pregnancies or more). Acetaminophen, scopolamine, and dimenhydrinate were the medications most commonly used. Conclusions: This study describes the pattern of drug use among pregnant women in a population-based cohort study, with a high prevalence of self-medication. Greater awareness of the risks of self-medication during pregnancy is required, focusing on groups more prone to this practice, as well as ensuring qualified multidisciplinary prenatal care.

Introduction: In Brazil, little is known about the trends of chronic respiratory diseases, which was estimated as the third leading cause of deaths in 2017 worldwide. Methods: We analyzed Global Burden of Disease (GBD) 2017 estimates for prevalence, incidence, mortality, disability-adjusted life years (DALY), a summary measure of years of life lost (YLLs) and years lived with disability (YLDs), and risk factors attributable to chronic respiratory diseases in Brazil from 1990 to 2017. Results: The overall estimates have decreased for all ages and both sexes, and for age-standardized rates. For age-adjusted prevalence, there was a 21% reduction, and nearly 16% reduction for incidence. There was a 42% reduction in mortality for both sexes, though the rate of deaths for men was 30% greater than the rate in women. The increase in the number of DALY was essentially due to the population growth and population ageing. We observed a 34% increase in the absolute number of DALY in Brazil over the study period. The majority of the DALY rates were due to Chronic Obstructive Pulmonary Disease (COPD). For all ages and both sexes, smoking was the main attributable risk factor. Conclusion: In Brazil, although mortality, prevalence and incidence for chronic respiratory diseases have decreased over the years, attention should be taken to the DALYs increase. Smoking remained as the main risk factor, despite the significant decrease of tobacco use, reinforcing the need for maintenance of policies and programs directed at its cessation. RESUMO: Introdução: No Brasil, pouco se sabe sobre as tendências das doenças respiratórias crônicas, que foram estimadas como a terceira principal causa de mortes em 2017 em todo o mundo. Métodos: Analisamos as estimativas do Global Burden of Disease (GBD) 2017 para prevalência, incidência, mortalidade, anos de vida ajustados por incapacidade (DALY), uma medida resumida de anos de vida perdidos (YLL) e anos vividos com deficiência (YLD), e fatores de risco atribuíveis a doenças respiratórias crônicas no Brasil, de 1990 a 2017. Resultados: As estimativas gerais diminuíram para todas as idades e ambos os sexos, assim como para as taxas padronizadas por idade. Para a prevalência ajustada pela idade, houve uma redução de 21% e, aproximadamente, 16% para a incidência. Houve uma redução de 42% na mortalidade para ambos os sexos, embora a taxa de mortes para homens tenha sido 30% maior do que a taxa para mulheres. O aumento no número de DALY deveu-se ao crescimento e envelhecimento da população. Observamos um aumento de 34% no número absoluto de DALYs no Brasil durante o período do estudo. A maioria das taxas de DALY foi devido a Doença Pulmonar Obstrutiva Crônica (DPOC). Para todas as idades e ambos os sexos, tabagismo foi o principal fator de risco atribuível. Conclusão: No Brasil, embora a mortalidade, a prevalência e a incidência de doenças respiratórias crônicas tenham diminuído ao longo dos anos, maior atenção deve ser dada ao aumento dos DALYs. O tabagismo permaneceu como principal fator de risco, apesar da redução significativa do seu uso, reforçando a necessidade de manutenção de políticas e programas direcionados à sua cessação.

Background: This study describes medication use by women up to 3 months postpartum and evaluates the association between medication use by women who were still breastfeeding at 3 months postpartum and weaning at 6 and 12 months. Methods: Population-based cohort, including women who breastfed (n = 3988). Medications were classified according to Hale&rsquo, s lactation risk categories and Brazilian Ministry of Health criteria. Duration of breastfeeding was analysed using Cox regression models and Kaplan-Meier curves, including only women who were still breastfeeding at three months postpartum. Results: Medication use with some risk for lactation was frequent (79.6% regarding Hale&rsquo, s risk categories and 12.3% regarding Brazilian Ministry of Health criteria). We did not find statistically significant differences for weaning at 6 or 12 months between the group who did not use medication or used only compatible medications and the group who used medications with some risk for lactation, according to both criteria. Conclusions: Our study found no association between weaning rates across the different breastfeeding safety categories of medications in women who were still breastfeeding at three months postpartum. Therefore, women who took medications and stopped breastfeeding in the first three months postpartum because of adverse side-effects associated with medications could not be addressed in this analysis.

To classify the drugs used during childbirth in relation to risks in breastfeeding, by using different sources of information and determining their disagreements.Cross-sectional study, within the 2015 Pelotas Birth Cohort. Information about the use of drugs was collected, classified and compared regarding risk according to: 1) Brazil Ministry of Health Manual (MS), 2) World Organization (WHO), 3) Newton and Hale's classification and 4) American Academy of Pediatrics (AAP).A total of 1,409 mothers participated, and they had used 14,673 medicines, with 143 different drugs, of which 28 showed discordant classification with regard to breastfeeding risk. These 28 drugs included the following: morphine (64%), classified by AAP and WHO as compatible and as judicious use use by MS and Newton and Hale; hyoscine (23%), classified as judicious use by MS and compatible (A) by AAP; and metoclopramide (18%), classified as compatible by MS, of effects unknown (D) by AAP, and should be avoided according to WHO. Of the total drugs, 49.7% were classified as compatible during breastfeeding. Almost all women used oxytocin (97.4%), followed by lidocaine (75%), ketoprofen (69%), cephalothin (66%) and diclofenac (65%), which were classified as compatible.There was extensive use of drugs by mothers in labor during admission, most of the drugs being classified at the same risk and almost half classified as compatible with breastfeeding. However, there was disagreement between the sources for 19.6% of the drugs analyzed, which could endanger the infant's health or leave doubts about the use of the drug or breastfeeding.

To estimate the prevalence of off-label drug use by age in children 12 years old and younger in Brazil.Population-based cross-sectional study (National Survey on Access, Use and Promotion of Rational Use of Medicines - PNAUM), including 7,528 children aged 12 years or younger. Face-to-face interviews were used to collect the data in the domiciles. The age-related off-label classification was carried out using the electronic medication compendium of National Agency of Sanitary Surveillance (ANVISA). Sociodemographic characteristics, presence of chronic disease, use of health services and characteristics of the informant were collected. Data were expressed by relative frequencies and 95% confidence intervals. Pearson's chi-square test was used to evaluate the statistical significance of the differences between the groups, with a significance level of 5%. Main outcome measure was the prevalence of off-label use.The prevalence of off-label use by age was 18.7% (95%CI 16.4 - 21.3). Children younger than 2 years old presented the highest prevalence of off-label use. The most frequently used off-label drugs by age were amoxicillin, nimesulide and the combination of phenylephrine and brompheniramine.The off-label use of drugs by age is common in the Brazilian pediatric population, especially among children under two years old.

Background Many low- and middle-income countries recommend micronutrient supplements for pregnant women to improve their nutritional status, prevent possible deficiencies and avoid fetal healgth consequences. This study evaluated the influence of socioeconomic status on the use of folic acid, iron salts and other vitamins and minerals among pregnant women in the 2015 Pelotas Birth Cohort. Methods This population-based birth cohort study was carried out with 4270 women. Participants were interviewed during pregnancy and at the maternity hospital about the antenatal period; including the use of iron salts, vitamins and other minerals. Descriptive analyses were performed to characterize the sample. The analyses were adjusted according to socioeconomic variables (maternal education, ethnicity, household income). Results The overall prevalence of the use of folic acid, iron salts or other vitamins and minerals was 91.0% (95% CI: 90.1–91.8). Specifically, 70.9% (95% CI: 69.5–72.3) used folic acid, 72.9% (95% CI: 71.5–74.3) used iron compounds, and 31.8% (95% CI: 30.3–33.2) used other vitamins or minerals. In the adjusted analysis, the use of iron salts was associated with nonwhite mothers, with ≤4 years of education and whose family income was less than or equal to the monthly minimum wage. The use of folic acid and other vitamins and minerals was associated with white mothers who were more highly educated and had a higher family income. Conclusion Although folic acid and other vitamins and minerals were more frequently used in white, richer and more educated mothers, which indicates inequality, iron supplements were more frequently used in the poorer, less educated nonwhite mothers, suggesting the opposite association for this supplement.

The objective was to estimate the prevalence of artificial sweetener use by the adult Brazilian population and users' characteristics. Analysis of data from the Brazilian National Survey on Access, Utilization, and Promotion of Rational Use of Medicines (PNAUM, 2014), a nationwide population-based survey. The target outcome was self-reported use of sweeteners by Brazilians 20 years and older. The independent variables were sex, age, major geographic region of Brazil, schooling in complete years, and economic status according to the Brazilian Economic Classification Criterion of the Brazilian Association of Research Companies (ABEP). The health condition indicators were: self-reported noncommunicable diseases (NCDs), number of NCDs, and body mass index (BMI). Prevalence of sweetener use in the Brazilian adult population was 13.4% (95%CI: 12.5-14.3), and it was higher in females and in persons 60 years or older, in the Northeast and Southeast, among individuals from economic classes A and B, and among obese individuals. Persons with chronic diseases (especially diabetes) showed the highest prevalence of use of sweeteners, and their use increased with the number of reported comorbidities. Prevalence of use of artificial sweeteners was 13.4% and was associated with sociodemographic and health characteristics.O objetivo foi estimar a prevalência do uso de adoçantes pela população adulta brasileira e características dos usuários. Análise de dados da Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM, 2014), um inquérito nacional de base populacional. O desfecho de interesse foi o uso autorreferido de adoçantes entre brasileiros com 20 anos ou mais. As variáveis analisadas foram sexo, idade em anos completos, região do Brasil, escolaridade em anos completos e classificação econômica segundo o Critério Classificação Econômica Brasil da Associação Brasileira de Empresas de Pesquisa (ABEP). Os indicadores das condições de saúde foram: relato de doença crônica não transmissíveis (DCNT), número de DCNT e índice de massa corporal (IMC). A prevalência do uso de adoçantes na população adulta brasileira foi de 13,4% (IC95%: 12,5-14,3), sendo maior entre as pessoas do sexo feminino e no grupo com 60 anos ou mais, nas regiões Nordeste e Sudeste, entre pessoas da classe econômica A/B e entre indivíduos obesos. As pessoas com doenças crônicas (em especial diabetes) foram as que mostraram maior prevalência de uso de adoçantes, sendo o uso maior quanto maior o número de comorbidades relatadas. A prevalência de uso de adoçantes foi de 13,4% e mostrou-se associada a características sociodemográficas e de saúde.El objetivo fue estimar la prevalencia del uso de edulcorantes por parte de la población adulta brasileña y las características de los usuarios. Análisis de datos de la Encuesta Nacional de Acceso, Utilización y Promoción del Uso Racional de Medicamentos (PNAUM, 2014), una encuesta nacional de base poblacional. El resultado de interés fue el uso autoinformado de edulcorantes entre brasileños con 20 años o más. Las variables analizadas fueron: sexo, edad (años completados), región de Brasil, escolaridad (años completados), así como la clasificación económica según el Criterio Clasificación Económica Brasil de la Asociación Brasileña de Empresas de Investigación (ABEP). Los indicadores de las condiciones de salud fueron: informe de enfermedades crónicas (DCNT), número de DCNT e índice de masa corporal (IMC). La prevalencia del uso de edulcorantes en la población adulta brasileña fue de un 13,4% (IC95%: 12,5-14,3), siendo mayor entre las personas de sexo femenino y en el grupo con 60 años o más, en las regiones Nordeste y Sudeste, entre personas de clase económica A/B y entre individuos obesos. Las personas con enfermedades crónicas (en especial diabetes) fueron las que mostraron una mayor prevalencia de uso de edulcorantes, siendo el uso mayor, cuanto mayor fuera el número de comorbilidades informadas. Conclusiones: la prevalencia de uso de edulcorantes fue de un 13,4% y se mostró asociada a características sociodemográficas y de salud.

PurposeTo estimate the prevalence of use of analgesics in Brazil; and to characterize this use, according to sociodemographic and health-related characteristics.MethodsA cross-sectional population-based study (National Survey on Access, Use and Promotion of Rational Use of Medicines, PNAUM) was conducted between September 2013 and February 2014. A total of 41,433 people of all ages in Brazilian urban households were interviewed. Occasional use (within the last 15 days) and continuous use of non-opioid analgesics, opioid analgesics and non-steroidal anti-inflammatory drugs were investigated, regardless of whether this use occurred through prescription or self-medication. The main outcome was the use of at least one analgesic.ResultsThe majority of the individuals were female (52.8%), aged between 20 and 59 years (57.2%), with 1 to 8 years of schooling (45.6%). The overall prevalence of analgesic use was 22.8% [95% CI: 21.4-24.2]. The use of analgesics was significantly higher among women, adults and elderly (20 years or more), highly educated individuals and respondents who referred: diagnosis of one or more chronic diseases, using three or more medications, possession of health insurance and with one or more emergency care admittances or hospitalizations within the last year. Non-opioid analgesics were the agents most used (18.5% of the sample), followed by non-steroidal anti-inflammatory drugs (6.9%) and opioid analgesics (0.5%). The most commonly used drugs were metamizole (37.8% of all analgesics), paracetamol (25.3%) and diclofenac (10.7%). These drugs were used mainly to manage occasional health conditions, particularly pain.ConclusionOne in five Brazilians used some analgesic, especially non-opioid analgesics, to manage acute health problems such as painful conditions.

O estudo teve como objetivo verificar a prevalência do uso, aquisição e fontes de saís de ferro e vitaminas para crianças entre 0 e 12 anos de idade no Brasil. Foi realizado um estudo transversal de base populacional (Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – PNAUM), incluindo 7.528 crianças até 12 anos de idade. As informações foram obtidas através de questionários respondidos pelos pais ou responsáveis, sobre o uso de sais de ferro e vitaminas nos 15 dias anteriores à entrevista; formas de financiamento e fontes de aquisição, características sociodemográficas e presença de doenças crônicas. Foram realizadas análises descritivas e bivariadas, e as principais variáveis foram expressas como frequências relativas com intervalos de 95% de confiança (IC95%). A prevalência do uso de sais de ferros foi 1,6% (IC95%: 1,2-2,1), com prevalência maior entre crianças com menos de 1 ano de idade (8,5%; IC95%: 6,3-11,5) e residentes da Região Sudeste (2,3%; IC95%: 1,5-3,4). A prevalência do uso de vitaminas foi 4,8% (IC95%: 4,2-5,6), com prevalência maior entre crianças com menos de 1 ano (24,3%;IC95%: 20,3-28,7) e residentes da Região Norte (8,6%; IC95%: 6,2-11,7). A aquisição ocorreu por reembolso direto em 41,6% (IC95%: 27,9-56,7) dos sais de ferro e em 82,4% (IC95%: 76,3-87,2) das vitaminas. Os sais de ferro foram adquiridos predominantemente através das farmácias do SUS (51,5%; IC95%: 36,4-66,4), e as vitaminas em farmácias comerciais (80,6%; IC95%: 77,4-85,6). Os resultados sugerem que o uso de sais de ferro na população pediátrica brasileira é por baixo, com uma redução no uso conforme aumenta a idade da criança, além de diferenças regionais e aquisição gratuita, predominantemente do SUS. To verify the prevalence of use, purchase and sources of iron salts and vitamins by children aged from 0 to 12 years in Brazil. Population-based transversal study (Brazilian National Survey on Access, Utilization, and Promotion of Rational Use of Medicines – PNAUM), including 7,528 children up to 12 years of age. Information was obtained through questionnaires answered by the children’s tutors, about the use of iron salts and vitamins 15 days before the interview; forms of financing, and sources of obtainment, sociodemographic characteristics, and presence of chronic disease. Descriptive and bivariate analyses were performed and the main variables were expressed by relative frequencies and 95% confidence intervals (95%CI). The prevalence of use of iron salts was 1.6% (95%CI: 1.2-2.1), with higher prevalence among children under 1 year old (8.5%; 95%CI: 6.3-11.5) and residents of the southeastern region (2.3%; 95%CI: 1.5-3.4). Prevalence of use of vitamins was 4.8% (95%CI: 4.2-5.6), with higher prevalence among children under 1 year old (24.3%; 95%CI: 20.3-28.7) and residents of the northern region (8.6%; 95%CI: 6.2-11.7). Purchase occurred by direct reimbursement for 41.6% (95%CI: 27.9-56.7) of the iron salts, and for 82.4% (95%CI: 76.3-87.2) of the vitamins. The iron salts were predominantly obtained from SUS pharmacies (51.5%; 95%CI: 36.4-66.4), and the vitamins from commercial pharmacies (80.6%; 95%CI: 77.4-85.6). The results suggested the use of iron salts in the Brazilian pediatric population was low, with reduction in use as age increased, regional differences and free-of-charge obtainment, predominantly from SUS. Este trabajo tiene el fin de verificar la prevalencia de uso, adquisición y fuentes de sales de hierro y vitaminas por parte de niños desde 0 a 12 años de edad en Brasil. Se trata de un estudio transversal, basado en población (Encuesta Nacional sobre el Acceso, Uso y Promoción de Uso Racional de Medicinas – PNAUM por sus siglas en portugués), que incluye a 7.528 niños de hasta 12 años de edad. La información se obtuvo a través de cuestionarios respondidos por los tutores de los niños, sobre el uso de sales de hierro y vitaminas 15 días antes de la entrevista; formas de financiación, y fuentes de adquisición, características sociodemográficas, y presencia de alguna enfermedad crónica. Se realizaron análisis descriptivos y bivariados, además las variables principales se plasmaron mediante frecuencias relativas e intervalos del 95% de confianza (IC95%). La prevalencia del uso de sales de hierro fue de un 1,6% (IC95%: 1,2-2,1), con una prevalencia más alta entre niños por debajo de un 1 año de edad (8,5%; IC95%: 6,3-11,5) y residentes de la Región sudeste (2,3%; IC95%: 1,5-3,4). La prevalencia del uso de vitaminas fue de un 4,8% (IC95%: 4,2-5,6), con una prevalencia más alta con niños menores de 1 año de edad (24,3%; IC95%: 20,3-28,7) y residentes de la Región nordeste (8,6%; IC95%: 6,2- 11,7). La adquisición tuvo lugar por reembolso directo en un 41,6% (IC95%: 27,9-56,7) de sales de hierro, y por un 82,4% (IC95%: 76,3-87,2) de las vitaminas. Las sales de hierro se obtuvieron predominantemente en farmacias del SUS (51,5%; IC95%: 36,4-66,4), y las vitaminas en farmacias comerciales (80,6%; IC95%: 77,4-85,6). Los resultados sugirieron el consumo de las sales de hierro en la población pediátrica brasileña fue por bajo, con una reducción en su consumo a medida que la edad aumentaba, además de diferencias regionales, y su obtención gratuita, predominantemente del SUS.

OBJECTIVE: Trace the pattern of drug use during delivery hospitalization. METHOD: Cross-sectional study carried out from June to October 2015, included in the 2015 Pelotas births cohort. All women living in the urban area of the city who were hospitalized for delivery were part of the sample. We collected information regarding drug prescription and drug use by mothers during the whole period of hospitalization. Sociodemographic data were obtained in interview after delivery, and other data were obtained from medical charts. The drugs were classified according to the Anatomical Therapeutic Chemical system. RESULTS: All study participants (1,392 women) used at least one drug, with the mean amount being larger the higher the age of the mother, both prepartum/during delivery and postpartum. It was also higher in cases of spinal anesthesia or general anesthesia, cesarean deliveries, school hospitals, and longer hospitalizations. Analysis of the sample as a whole showed no significant difference in the number of drugs used according to hospitalization type, but when stratified by length of hospital stay the mean was higher in SUS hospitalizations than in private and health insurance hospitalizations. Drugs for the nervous system were the most used (30.5%), followed by drugs for the alimentary tract and metabolism (13.8%). The use of anti-infective agents and drugs that act on the cardiovascular and respiratory systems was higher in mothers who underwent cesarean delivery. This study showed high drug consumption in the delivery hospitalization period, and showed cesarean delivery and epidural anesthesia as the main factors related to high drug consumption in this period. CONCLUSIONS: We found high drug consumption in the delivery hospitalization period, and the main factors were cesarean delivery and epidural anesthesia. Drugs that act on the nervous system were the most used. RESUMO OBJETIVO: Identificar o padrão de uso dos medicamentos durante a internação para o parto. MÉTODO: Estudo transversal realizado de junho a outubro de 2015, inserido na coorte de nascimentos de Pelotas de 2015. Todas as mulheres residentes na zona urbana da cidade que foram internadas para o parto fizeram parte da amostra. Foram coletadas informações referentes à prescrição e uso de medicamentos pela mãe durante todo o período de internação. Dados sociodemográficos foram obtidos na entrevista realizada após o parto, e os demais nos prontuários. Os medicamentos foram classificados de acordo com o sistema Anatomical Therapeutic Chemical. RESULTADOS: Todas as participantes do estudo (1.392 mulheres) utilizaram pelo menos um medicamento, sendo a quantidade média maior quanto maior a idade da mãe, tanto no momento pré/durante o parto como no pós-parto. Também foi maior em casos de raquianestesia ou anestesia geral, partos cesarianos, hospitais escola e internações mais prolongadas. Na análise da amostra como um todo, não houve diferença significativa no número de medicamentos utilizados de acordo com o tipo de hospitalização, mas quando estratificada por período de internação, a média foi maior nas internações pelo SUS que nas internações particulares e por convênios. Medicamentos para o sistema nervoso foram os mais utilizados (30,5%), seguidos dos que atuam no trato alimentar e metabolismo (13,8%). O uso de anti-infecciosos e fármacos que atuam nos sistemas cardiovascular e respiratório foi maior em mães que fizeram cesariana. Este estudo evidenciou elevado consumo de medicamentos no período de internação para o parto, e o parto cesariano e a anestesia peridural como os principais fatores relacionados ao consumo elevado de medicamentos neste período. CONCLUSÕES: Evidenciou-se elevado consumo de medicamentos no período de internação para o parto, sendo os principais fatores a cesariana e a anestesia peridural. Os medicamentos que atuam no sistema nervoso foram os mais utilizados.

This article sought to evaluate the conformity between recommendations regarding antidepressant use during breastfeeding found in drug package inserts with recommendations from science-based bibliographic sources. We evaluated the standard drug package inserts of 23 antidepressants with active registration in Brazil. The presence of contraindications of antidepressant use during breastfeeding was compared with information present in the Brazilian Ministry of Health technical manual, the book Medications and Mothers' Milk and on the databases LactMed, Micromedex and UpToDate. In most drug package inserts (62.5%), antidepressants are contraindicated during breastfeeding. Among bibliographical sources, that percentage varied between 0% and 25%. The study shows a low conformity between drug package inserts and bibliographical sources, alerting to the need for revising the content and presentation of information present in antidepressant drug package inserts in Brazil.O objetivo deste artigo foi avaliar a conformidade entre as recomendações de uso de medicamentos antidepressivos durante a amamentação, presentes em bulas, e as recomendações de fontes bibliográficas baseadas em evidências científicas. Foram avaliadas as bulas padrão de 23 antidepressivos com registro ativo no Brasil. A presença de contraindicação do uso do antidepressivo durante a amamentação foi comparada com as informações presentes no manual técnico do Ministério da Saúde, no livro Medications and Mothers’ Milk e nas bases de dados LactMed, Micromedex e UpToDate. Na maioria das bulas (62,5%), o antidepressivo é contraindicado na amamentação. Entre as fontes bibliográficas, esse percentual variou de 0% a 25%. O estudo aponta para baixa conformidade entre bulas e fontes bibliográficas, alertando sobre a necessidade de revisão do conteúdo e forma de apresentação das informações presentes nas bulas dos antidepressivos no Brasil.El objetivo de este artículo fue evaluar la conformidad entre las recomendaciones de uso de medicamentos antidepresivos durante la lactancia, presentes en prospectos, y las recomendaciones de fuentes bibliográficas, basadas en evidencias científicas. Se evaluaron los prospectos estándar de 23 antidepresivos con registro activo en Brasil. La presencia de contraindicaciones en el consumo de antidepresivos durante la lactancia se comparó con la información presente en el manual técnico del Ministerio de la Salud, en el libro Medications and Mothers’ Milk, y en las bases de datos LactMed, Micromedex y UpToDate. En la mayoría de los prospectos (62,5%), el antidepresivo está contraindicado durante la lactancia. Entre las fuentes bibliográficas el porcentaje varió de 0% a 25%. El estudio señala la escasa conformidad entre prospectos y fuentes bibliográficas, alertando sobre la necesidad de revisión del contenido, así como de la forma de presentación de la información que aparece en los prospectos de los antidepresivos en Brasil.

The study aimed to estimate the prevalence of self-reported chronic respiratory diseases and the indication, access to, and use of medicines, as well as their sources, in the Brazilian adult population. Data were analyzed on adults 20 years and older from the National Survey on Access, Utilization, and Promotion of Rational Use of Medicines in Brazil (PNAUM), conducted from September 2013 to February 2014. Prevalence of chronic respiratory diseases was 3% (95%CI: 2.7-3.3). Of these individuals, 58.1% (95%CI: 51.8-64.0) had an indication for pharmacological treatment. Of those with indication for treatment, 77.1% (95%CI: 71.0-82.8) were using at least one of the prescribed drugs. Total access to therapy was 91.4% (95%CI: 79.9-96.6), and more than half of individuals with chronic respiratory diseases purchased at least one of the drugs in retail pharmacies (57.3%). The most frequently reported drug class was the association of a corticosteroid plus a long-acting beta-2 agonist in inhalation form, the most common example of which was the association budesonide/formoterol (20.3%; 95%CI: 16.0-25.4). According to our study, prevalence of self-reported chronic respiratory diseases was lower than in previous studies published on the Brazilian population. Nearly half of the population reporting chronic respiratory diseases did not have an indication for pharmacological treatment. Among those with such indication, approximately one-fourth were not using medications during the study period, and for those who were on medication, although access was high, they had to pay for their medicines.O objetivo foi estimar a prevalência de doenças respiratórias crônicas autorreferidas, a indicação, o acesso e o uso de medicamentos, bem como fontes de obtenção, na população adulta brasileira. Foram analisados dados de adultos com idade maior ou igual a 20 anos, provenientes da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM), realizada entre setembro de 2013 e fevereiro de 2014. A prevalência de doenças respiratórias crônicas foi de 3% (IC95%: 2,7-3,3). Desses, 58,1% (IC95%: 51,8-64,0) tinham indicação de tratamento farmacológico. Daqueles com indicação de tratamento, 77,1% (IC95%: 71,0-82,8) estavam utilizando pelo menos um dos medicamentos indicados. O acesso total à terapia foi de 91,4% (IC95%: 79,9-96,6), sendo que mais da metade das pessoas com doenças respiratórias crônicas adquiria pelo menos um de seus medicamentos em farmácias comerciais (57,3%). A classe de medicamentos mais referida foi a associação beta-2 agonista de longa duração e corticosteroides sob a forma inalatória, cujo representante mais frequente foi a associação budesonida/formoterol (20,3%; IC95%: 16,0-25,4). De acordo com o nosso estudo, a prevalência de doenças respiratórias crônicas autorreferida foi inferior a trabalhos previamente publicados para a população brasileira. Verificou-se que quase metade da população que referiu doenças respiratórias crônicas não tinha indicação de tratamento farmacológico. Já aqueles com indicação, aproximadamente um quarto não utilizava os medicamentos no período do estudo e, para os que usavam, embora o acesso fosse elevado, precisavam pagar para adquirir seus tratamentos.El objetivo fue estimar la prevalencia de enfermedades respiratorias crónicas autoinformadas, la indicación, el acceso y el uso de medicamentos, así como fuentes de obtención, en población adulta brasileña. Se analizaron datos de adultos con una edad mayor o igual a 20 años, provenientes de la Encuesta Nacional sobre Acceso, Utilización y Promoción del Uso Racional de Medicamentos en Brasil (PNAUM), realizada entre septiembre de 2013 y febrero de 2014. La prevalencia de enfermedades respiratorias crónicas fue de un 3% (IC95%: 2,7-3,3). De estos, un 58,1% (IC95%: 51,8-64,0) tenían indicación de tratamiento farmacológico. De aquellos con indicación de tratamiento, un 77,1% (IC95%: 71,0-82,8) estaban utilizando, por lo menos, uno de los medicamentos indicados. El acceso total a la terapia fue de un 91,4% (IC95%: 79,9-96,6), siendo que más de la mitad de las personas con enfermedades respiratorias crónicas adquiría por lo menos uno de sus medicamentos en farmacias comerciales (57,3%). La clase de medicamentos más referida fue la asociación beta-2 agonista de larga duración y corticosteroides en forma inhalatoria, cuyo representante más frecuente fue la asociación budesonida/formoterol (20,3%; IC95%: 16,0-25,4). De acuerdo con nuestro estudio, la prevalencia de enfermedades respiratorias crónicas autoinformada fue inferior a trabajos previamente publicados para la población brasileña. Se verificó que casi la mitad de la población que refirió enfermedades respiratorias crónicas no tenía indicación de tratamiento farmacológico. Ya aquellos que tenían indicación, aproximadamente un cuarto, no utilizaba los medicamentos en el período del estudio y, para los que lo usaban, aunque el acceso fuese elevado, necesitaban pagar para adquirir sus tratamientos.

This study aimed to investigate the validity of patient-reported anemia and therapeutic use of iron supplements, compared to hemoglobin values recorded on the patient's prenatal card. The study used data from the 2015 Pelotas (Brazil) birth cohort. For validation of self-reported anemia, we included all mothers with hemoglobin values recorded on their prenatal card (N = 3,419), while validation of self-reported therapeutic use of iron supplements included those who had hemoglobin values recorded on their prenatal care and who reported having used medicines containing ferrous sulfate during pregnancy. Anemia was defined as at least one record of hemoglobin ≤ 11g/dL on the prenatal card (gold standard). Prevalence of anemia according to the gold standard was 35.9% (34.3-37.5), while patient-reported anemia was 42.2% (40.8-43.7), and patient-reported therapeutic use of iron supplements was 43.2% (41.3-45.1). Sensitivity of patient-reported anemia was 75.2% (72.8-77.6) and specificity was 75.1% (73.3-76.9). For patient-reported therapeutic use of iron supplements, sensitivity was 66.4% (63.5-69.2) and specificity was 71.9% (69.7-74.0). Specificity of patient-reported anemia and patient-reported therapeutic use of iron supplements in mothers with ≥ 12 years of schooling was 78.4% (75.4-81.4) and 79.5% (76.1-82.9), respectively. In the study population, for every five postpartum women that reported anemia or therapeutic use of iron supplements, three were telling the truth. The specificity of both self-reports was high in mothers with ≥ 12 years of schooling.O objetivo deste estudo é investigar a validade do autorrelato de anemia e de uso terapêutico de sais de ferro, frente à informação de hemoglobina da carteira da gestante. O estudo utiliza dados da coorte de nascimentos de 2015 de Pelotas, Rio Grande do Sul, Brasil. Para a validação do autorrelato de anemia, foram incluídas todas as mães que tinham registro de hemoglobina na carteira da gestante (N = 3.419), ao passo que, para a validação do autorrelato de uso terapêutico de sais de ferro, foram incluídas as que tinham registro de exames de hemoglobina na carteira da gestante e que relataram haver utilizado algum medicamento com sulfato ferroso em sua composição durante a gestação. Anemia foi definida como, pelo menos, um registro de hemoglobina ≤ 11g/dL na carteira da gestante (padrão-ouro). A prevalência de anemia conforme padrão-ouro foi 35,9% (34,3-37,5), ao passo que a de anemia autorrelatada foi 42,2% (40,8-43,7), e o autorrelato de uso terapêutico de sais de ferro, 43,2% (41,3-45,1). A sensibilidade do autorrelato de anemia foi 75,2% (72,8-77,6) e a especificidade, 75,1% (73,3-76,9). Para o autorrelato de uso terapêutico de sais de ferro, a sensibilidade foi 66,4% (63,5-69,2) e a especificidade, 71,9% (69,7-74,0). A especificidade do autorrelato de anemia e do autorrelato de uso terapêutico de sais de ferro entre mães com ≥ 12 anos de escolaridade foi 78,4% (75,4-81,4) e 79,5% (76,1-82,9). Na população estudada, com alta prevalência de anemia, de cada cinco puérperas que relataram anemia ou uso terapêutico de sais de ferro, três relatavam a verdade. A especificidade de ambos os autorrelatos foi mais elevada entre mães com ≥ 12 anos de escolaridade.El objetivo de este estudio es investigar la validez del autoinforme de anemia y uso terapéutico de sales de hierro, respecto a la información sobre la hemoglobina, presente la cartilla de la embarazada. El estudio utiliza datos de la cohorte de nacimientos en Pelotas, Rio Grande ddo Sul, Brasil, 2015. Para la validación del autoinforme de anemia, se incluyeron a todas las madres que tenían un registro de hemoglobina en la cartilla de la embarazada (N = 3.419), al mismo tiempo que, para la validación del autoinforme del uso terapéutico de sales de hierro, se incluyeron a quienes tenían registro de exámenes de hemoglobina en la cartilla de la embarazada, y que informaron haber utilizado algún medicamento con sulfato ferroso en su composición durante la gestación. La anemia se definió como, por lo menos, un registro de hemoglobina ≤ 11g/dL en la cartilla de la embarazada (patrón ideal). La prevalencia de anemia, según el patrón ideal, fue de un 35,9% (34,3-37,5), mientras que la de la anemia autoinformada fue de un 42,2% (40,8-43,7), y el autoinforme de uso terapéutico de sales de hierro, 43,2% (41,3-45,1). La sensibilidad del autoinforme de anemia fue de un 75,2% (72,8-77,6) y la especificidad, 75,1% (73,3-76,9). Para el autoinforme de uso terapéutico de sales de hierro, la sensibilidad fue 66,4% (63,5-69,2) y la especificidad, 71,9% (69,7-74,0). La especificidad del autoinforme de anemia y del autoinforme de uso terapéutico de sales de hierro entre madres con ≥ 12 años de escolaridad fue 78,4% (75,4-81,4) y 79,5% (76,1-82,9). En la población estudiada, con una alta prevalencia de anemia, de cada cinco puérperas que informaron anemia o uso terapéutico de sales de hierro, tres relataban la verdad. La especificidad de ambos autoinformes fue más elevada entre madres con ≥ 12 años de escolaridad.

Introduction: The written information on medicines has been acknowledged as an important tool for health education. Objective: To analyze the use and understanding of medicine package inserts by users and assess sociodemographic and medical factors associated with their comprehension. Method: Data in this analysis are part of the PNAUM National Survey - a cross-sectional population-based study conducted in Brazil. Descriptive statistics and the Pearson χ2 tests were performed to compare proportions between sociodemographic and medical characteristics, as well as use and understanding of medicine package inserts. Results: A total of 28.427 individuals responded to questions related to medicine package inserts. From these, 59.6% (95%CI 57.7 - 61.5) said they usually read the inserts, and 98.4% (95%CI 98.0 - 98.8) considered them necessary. Among people who read the medicine package inserts, more than half indicated difficulties with legibility (57.4%; 95%CI 55,2 - 59,6) and readability (54.1%; 95%CI 52.1 - 56.1). People from a lower education level reported greater difficulty in understanding them. Conclusion: The larger portion of the population usually read medicine package inserts. Nevertheless, people have difficulty in reading and understanding them. Introdução: A informação escrita sobre medicamentos tem sido reconhecida como uma ferramenta importante para a educação em saúde. Objetivo: Analisar o uso e compreensão de bulas de medicamentos pelos usuários e avaliar fatores sociodemográficos e médicos associados ao seu uso e compreensão. Método: Osdados nesta análise fazem parte da PNAUM - um estudo transversal de base populacional realizado nas cinco regiões brasileiras. Estatísticas descritivas e teste de χ2 de Pearson foram utilizados para comparar proporções entre características sociodemográficas e médicas, uso e compreensão das bulas. Resultados: Um total de 28.427 indivíduos responderam a questões relativas a bulas. Desse total, 59,6% (IC95% 57,7 - 61,5) responderam que geralmente leem as bulas e 98,4% (IC95% 98,0 - 98,8) as consideraram necessárias. Entre as pessoas que leram as bulas, mais da metade indicou dificuldades de legibilidade (57,4%; IC95% 55,2 - 59,6) e de leiturabilidade (54,1%; IC95% 52,1 - 56,1) das bulas. As pessoas com menos educação relataram maior dificuldade em compreendê-las. Conclusões: A maioria da população tem o costume de ler as bulas, no entanto as pessoas consideram-nas difíceis de ler e compreender.

Health literacy has been evaluated in several countries by tools developed for local language and culture. This study aimed to adapt and to validate the Health Literacy Test (TLS) for the Brazilian Portuguese language based on the Test of functional health literacy in adults (TOFHLA).The TLS, translated and adapted to the Brazilian scenario based on the Test of functional health literacy in adults, was administered to 302 users of a clinic of a University in Santa Catarina from September to October 2013. Cronbach's Alpha coefficient, Spearman's correlation and Analysis of Variance were used to assess the internal consistency, the correlation between the parts of the test and association between sociodemographic variables and the score of the Test, respectively.The average score of the test was 72,2, and 54.6% of participants had adequate health literacy, 19.2% had marginal health literacy and 26.2% had inadequate health literacy. The average score of the test was inversely related to the age of the participants and directly related to the level of education. There was no significant difference in the other sociodemographic characteristics. The internal consistency (Cronbach's alpha) was 0.953. The coefficients for the numerical and reading passages were 0.808 and 0.951, respectively. All the sections correlated positively and significantly with the Test, and also with each other.The validation of this test provides a new instrument to determine the literacy level in Brazilian adults.O letramento em saúde é avaliado em diversos países por instrumentos adaptados ao idioma e à cultura locais. O objetivo deste trabalho foi realizar a adaptação transcultural para a língua portuguesa do Brasil e validar o Teste de Letramento em Saúde (TLS), a partir do Test of Functional Health Literacy in Adults (TOFHLA).O TLS, traduzido e adaptado à realidade brasileira a partir do original em inglês, foi administrado a 302 usuários de uma clínica universitária em Santa Catarina, entre setembro e outubro de 2013. Coeficiente alfa de Cronbach, correlação de Spearman e análise de variância foram utilizados para verificar a consistência interna, a correlação entre suas partes e a associação entre as variáveis sociodemográficas e a pontuação do teste, respectivamente.A pontuação média do teste foi de 72,2, e 54,6% dos participantes apresentaram letramento em saúde adequado, 19,2%, limitado e 26,2%, inadequado. A pontuação média do teste diminuiu com o aumento da idade e aumentou com a elevação da escolaridade. Não houve diferença significativa para as demais características sociodemográficas. O coeficiente alfa de Cronbach foi de 0,953. Para a parte numérica e para os trechos de leitura, os coeficientes apresentados foram de 0,808 e 0,951, respectivamente. Todos os trechos correlacionaram-se positiva e significativamente com o teste, e também entre si.A validação do TLS oferece um instrumento para a determinação do nível de letramento em adultos brasileiros.

The aim of this study was to describe the prevalence of adverse drug events (ADEs) and associated factors reported by users of medicines in Brazil. This was a cross-sectional population-based study conducted from September 2013 to February 2014 with data from the Brazilian National Survey on Access, Use, and Promotion of Rational Use of Medicines (PNAUM). The study included all individuals that reported the use of medicines and identified, among them, all those reporting at least one problem with the medicine's use. A descriptive analysis was performed to estimate ADE prevalence and 95% confidence intervals (95%CI) among the target variables. Crude and adjusted prevalence ratios were calculated using Poisson regression to investigate factors associated with ADEs. Overall ADE prevalence in Brazil was 6.6% (95%CI: 5.89-7.41), and after multivariate analysis, higher prevalence was associated with female gender, residence in the Central and Northeast regions, consumption of more medicines, "bad" self-rated health, and self-medication. The drugs most frequently reported with ADEs were fluoxetine, diclofenac, and amitriptyline. The most frequent ADEs were somnolence, epigastric pain, and nausea. Most reported ADEs were mild, avoidable, and associated with medicines used frequently by the population. The study provided knowledge on the size of the problem with use of medicines in Brazil.O presente trabalho tem como objetivo descrever a prevalência e fatores associados a eventos adversos a medicamentos (EAM) referidos por usuários de medicamentos no Brasil. Trata-se de um estudo transversal de base populacional, realizado no período de setembro de 2013 a fevereiro de 2014, com dados coletados na Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM). Foram consideradas todas as pessoas que referiram o uso de medicamentos; entre elas, foram identificadas as que referiram pelo menos um problema com o uso do medicamento. Realizou-se uma análise descritiva para estimar a prevalência e os intervalos de 95% de confiança (IC95%) de EAM entre as variáveis estudadas, e foram calculadas as razões de prevalência bruta e ajustada, pela regressão de Poisson, na investigação dos fatores associados aos EAM. A prevalência de EAM no Brasil foi de 6,6% (IC95%: 5,89-7,41), sendo maior e estatisticamente significante após a realização da análise multivariada, entre pessoas do sexo feminino; residentes nas regiões Centro-oeste e Nordeste; que consumiam maior número de medicamentos; que percebiam seu estado de saúde como “ruim”; e que se automedicavam. Os EAM foram mais relatados para os medicamentos fluoxetina, diclofenaco e amitriptilina. Os EAM mais referidos pelos entrevistados foram sonolência, dor epigástrica e náuseas. Os EAM mais referidos pelos entrevistados foram de natureza leve, considerados evitáveis e estiveram associados a medicamentos de uso frequente pela população. Em razão desse estudo, foi possível conhecer a dimensão do problema ocasionado pelo uso de medicamentos no Brasil.El presente trabajo tiene como objetivo describir la prevalencia y factores asociados a eventos adversos con medicamentos (EAM), informados por usuarios de medicamentos en Brasil. Se trata de un estudio transversal de base poblacional, realizado durante el período de septiembre de 2013 a febrero de 2014, con datos recogidos en la Encuesta Nacional sobre el Acceso, Utilización y Promoción del Uso Racional de Medicamentos en Brasil (PNAUM). Se consideraron a todas las personas que informaron del uso de medicamentos; entre ellas, se identificaron a las que informaron de por lo menos un problema con el uso del medicamento. Se realizó un análisis descriptivo para estimar la prevalencia y los intervalos de confianza a 95% (IC95%) de EAM entre las variables estudiadas, y se calcularon las razones de prevalencia bruta y ajustada, por la regresión de Poisson, en la investigación de los factores asociados a los EAM. La prevalencia de EAM en Brasil fue de un 6,6% (IC95%: 5,89-7,41), siendo mayor y estadísticamente significante tras la realización del análisis multivariado, entre personas del sexo femenino; residentes en las regiones Centro-Oeste y Nordeste; que consumían un mayor número de medicamentos; que percibían su estado de salud como “malo”; y que se automedicaban. Se informaron de más EAM en medicamentos como: fluoxetina, diclofenaco y amitriptilina. Los EAM más referidos por los entrevistados fueron somnolencia, dolor epigástrico y náuseas. Los EAM más referidos por los entrevistados fueron de naturaleza leve, considerados evitables y estuvieron asociados a medicamentos de uso frecuente por la población. Con motivo de este estudio, fue posible conocer la dimensión del problema ocasionado por el uso de medicamentos en Brasil.

ObjectiveTo evaluate the labeling preferences of medication users and characterize their perceptions of the comprehensibility and readability of medication labels.MethodsWe conducted a population-based cross-sectional study of medication users aged 18 years or older in 10 Brazilian capital cities. Perceptions of the comprehensibility and readability of medication labels in relation to sociodemographic characteristics were evaluated by Poisson regression models with robust variance. Labeling preferences were assessed through questions addressing possible improvements and through the use of digitally simulated packages.ResultsOf 6,255 medication users interviewed, more than half found it difficult or very difficult to read (50.8%) and/or understand (52.0%) medication labels. Difficulties were more pronounced for participants aged 40 years or older, with lower levels of education, and non-whites. Increasing the font size (93.7%), describing the indications for use (95.9%) and contraindications (95.6%) on the label, and highlighting the expiration date (96.3%) were the most widely accepted improvements. In the evaluation of simulated packages, users preferred factors that improved readability, such as increased font size, use of graphic elements and color to highlight the concentration of the active ingredient, and contrast between the font color and background. The new simulated package design, with increased font size, color to highlight the concentration and contrast between the font color and background, was preferred over the standard design by 77.0% of participants.ConclusionBased on users' perceptions, increased font size and use of graphic elements and color to emphasize critical information, such as expiration date and concentration, are factors that contribute to making medication labels clearer to users. Pharmaceutical industries and policy makers should consider these items when developing labels and defining policies on this issue.

To describe people with diabetes in Brazil and to compare their sociodemographic characteristics, access and self-reported adherence to diabetes prescribed drugs.Data analysis from the National Survey on Access, Use and Promotion of the Rational Use of Medicines, a household survey, with sampling by clusters, according to sex and age domains and national and macro-regional representativeness. Adults (≥ 20 years old) who reported having diabetes constituted the sample. The weighted frequencies of the variables in the sample were analyzed and the Pearson χ2 test was applied to evaluate the statistical significance of the differences between the strata for the data of access, form of financing and adherence to the drugs, considering the level of significance of 5%.We found a higher proportion of women, people over 60 years and economy class C. Most participants reported having two or more comorbidities, in addition to diabetes, and taking five or more drugs. Regarding access, 97.8% say they have access to prescription drugs for diabetes and 70.7% say they get them totally free of charge. There was low adherence to anti-diabetic treatment, with significant macro-regional differences (p = 0,001), and greater vulnerability in the South and Northeast regions.Better access to diabetes medicines in the country has been demonstrated. However, to improve the efficiency of health public spending, it is necessary to achieve higher rates of adherence to treatment.Descrever as pessoas com diabetes no Brasil e comparar suas características sociodemográficas, o acesso e a adesão autorreferida aos medicamentos prescritos.Análise de dados oriundos da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos, um inquérito domiciliar, com plano amostral por conglomerados, segundo domínios de sexo e idade e representatividade nacional e macrorregional. Os adultos (≥ 20 anos) que referiram ter diabetes constituíram a amostra. Analisaram-se as frequências ponderadas das variáveis na amostra e aplicou-se o teste do χ2 de Pearson para avaliar a significância estatística das diferenças entre os estratos para os dados de acesso, forma de financiamento e adesão aos medicamentos, considerando o nível de significância de 5%.Encontrou-se uma maior proporção de mulheres, de maiores de 60 anos e da classe econômica C. A maioria referiu ter duas ou mais comorbidades além do diabetes e tomar cinco ou mais medicamentos. Quanto ao acesso, 97,8% dizem ter acesso aos medicamentos prescritos para diabetes e 70,7%, que os obtêm de forma totalmente gratuita. Verificou-se baixa adesão ao tratamento farmacológico, com diferenças macrorregionais significativas (p = 0,001) e maior vulnerabilidade nas regiões sul e nordeste.Demonstrou-se melhor acesso aos medicamentos para diabetes no país. Entretanto, para melhorar a eficiência dos gastos públicos, ficou demonstrada a necessidade de melhorar a adesão ao tratamento medicamentoso.

OBJECTIVE To analyze the existence of differences in the use of generic medicines in Brazil according to demographic and socioeconomic variables and acquisition sources of the medicines. METHODS Population-based cross-sectional study, conducted with data from the Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines). Data collection took place between September, 2013 and February, 2014 in homes of Brazilian cities (urban area). The use of medicines has been investigated in relation to the treatment of chronic diseases and, in the case of acute events, regarding use over the previous 15 days. Generics were identified by visualization of packaging presented by the users of the medicines. The independent variables used were sex, age, education level, economic class, and region of the Country. The statistical significance of differences between the groups was evaluated by Pearson’s Chi-squared test, considering a 5% significance level. RESULTS The prevalence of generic medicines use was 45.5% (95%CI 43.7–47.3). There was no difference considering education level. The prevalence was higher in females (47.0%; 95%CI 44.9–49.0) than in males (43.1%; 95%CI 40.5–45.8), and were higher with increasing age. Generic medicines were more used in the economic class C (47.0%; 95%CI 44.9–49.1) and in the South (50.6%; 95%CI 46.6–54.6) and Southeast (49.9%; 95%CI 46.8–53.0) regions. Generics accounted for 37.3% of the medicines provided by the Brazilian Unified Health System. CONCLUSIONS Currently, there is a choice of purchase or free provision by the Brazilian Unified Health System, characterized by quality assurance and reduced price regarding branded medicines considered as reference. In the private market, a considerable part of the population is choosing generic medicines thanks to the availability of this option for virtually all medicines most used by the population. RESUMO OBJETIVO Analisar se há diferença no uso de medicamentos genéricos no Brasil segundo variáveis demográficas, socioeconômicas e fontes de obtenção dos medicamentos. MÉTODOS Estudo transversal de base populacional, conduzido com dados da Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM), com coleta de dados entre setembro de 2013 e fevereiro de 2014 em residências de municípios brasileiros urbanos. O uso dos medicamentos foi investigado em relação ao tratamento de doenças crônicas e, no caso de eventos agudos, quanto ao uso nos últimos 15 dias. Os genéricos foram identificados por visualização das embalagens apresentadas pelos usuários dos medicamentos. As variáveis independentes utilizadas foram sexo, idade, escolaridade, classe econômica e região do País. A avaliação da significância estatística das diferenças entre os grupos foi analisada pelo teste Qui-quadrado de Pearson, considerando nível de significância de 5%. RESULTADOS A prevalência de uso de genéricos foi de 45,5% (IC95% 43,7–47,3). Não houve diferença por escolaridade, as prevalências foram maiores no sexo feminino (47,0%; IC95% 44,9–49,0) em relação ao masculino (43,1%; IC95% 40,5–45,8) e foram crescentes com o aumento da idade. Maiores usos de genéricos foram encontrados na classe econômica C (47,0%; IC95% 44,9–49,1) e nas regiões Sul (50,6%; IC95% 46,6-54,6) e Sudeste (49,9%; IC95% 46,8–53,0). Observou-se ainda que os genéricos representaram 37,3% dos medicamentos disponibilizados pelo Sistema Único de Saúde . CONCLUSÕES Pode-se concluir que hoje existe uma alternativa de compra ou fornecimento gratuito pelo Sistema Único de Saúde, caracterizada por garantia de qualidade e preço reduzido em relação aos medicamentos de marca comercial considerados como referência. No mercado privado, boa parte da população está optando pelo uso de medicamentos genéricos, graças à disponibilidade dessa opção para praticamente todos os medicamentos mais utilizados pela população.

Objetivo: analisar a prevalência e os fatores associados à utilização de medicamentos por automedicação no Brasil. Métodos: este estudo transversal de base populacional foi realizado com dados da Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de medicamentos (PNAUM), coletados de setembro de 2013 a fevereiro de 2014, por meio de entrevistas em domicílio. Todas as pessoas que referiram usar qualquer medicamento sem prescrição por médico ou dentista foram classificadas como praticantes de automedicação. Foram calculadas razões de prevalência bruta e ajustada (regressão de Poisson) e seus respectivos intervalos de confiança de 95% na investigação dos fatores associados ao consumo de medicamentos por automedicação. As variáveis independentes foram: aspectos sociodemográficos, de condições de saúde e de acesso e utilização de serviços de saúde. Adicionalmente, foram identificados os medicamentos mais consumidos por automedicação. Resultados: a prevalência da automedicação no Brasil foi de 16,1% (IC95% 15,0–17,5), sendo maior na região Nordeste (23,8%; IC95% 21,6–26,2). Após análise ajustada, automedicação mostrou-se associada a ser do sexo feminino, pertencer às faixas etárias 10-19 anos, 20-29 anos, 40-59 anos e 60 anos ou mais, residir na região Norte, Nordeste ou Centro-Oeste, e ter uma ou duas ou mais doenças crônicas. Os analgésicos e os relaxantes musculares foram os grupos terapêuticos mais utilizados por automedicação, sendo a dipirona o fármaco mais consumido. No geral, a maioria dos medicamentos usados por automedicação foram classificados como isentos de prescrição (65,5%). Conclusões: a automedicação é prática corrente no Brasil e envolve, principalmente, o uso de medicamentos isentos de prescrição, devendo os usuários ficarem atentos aos seus possíveis riscos. Objective: to analyze the prevalence and associated factors regarding the use of medicines by self-medication in Brazil. Methods: this cross-sectional population-based study was conducted using data from the PNAUM (National Survey on Access, Use and Promotion of Rational Use of Medicines), collected between September 2013 and February 2014 by interviews at the homes of the respondents. All people who reported using any medicines not prescribed by a doctor or dentist were classified as self-medication practitioners. Crude and adjusted prevalence ratios (Poisson regression) and their respective 95% confidence intervals were calculated in order to investigate the factors associated with the use of self-medication by medicines. The independent variables were: sociodemographic characteristics, health conditions and access to and use of health services. In addition, the most commonly consumed medicines by self-medication were individually identified. Results: the self-medication prevalence in Brazil was 16.1% (95%CI 15.0–17.5), with it being highest in the Northeast region (23.8%; 95%CI 21.6–26.2). Following the adjusted analysis, self-medication was observed to be associated with females, inhabitants from the North, Northeast and Midwest regions and individuals that have had one, or two or more chronic diseases. Analgesics and muscle relaxants were the therapeutic groups most used for self-medication, with dipyrone being the most consumed medicines. In general, most of the medicines used for self-medication were classified as non-prescriptive (65.5%). Conclusions: self-medication is common practice in Brazil and mainly involves the use of non-prescription medicines; therefore, the users of such should be made aware of the possible risks.

OBJECTIVE To analyze factors associated with low adherence to drug treatment for chronic diseases in Brazil. METHODS Analysis of data from Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - Brazilian Survey on Access, Use and Promotion of Rational Use of Medicines), a population-based cross-sectional household survey, based on a probabilistic sample of the Brazilian population. We analyzed the association between low adherence to drug treatment measured by the Brief Medication Questionnaire and demographic, socioeconomic, health, care and prescription factors. We used Poisson regression model to estimate crude and adjusted prevalence ratios, their respective 95% confidence interval (95%CI) and p-value (Wald test). RESULTS The prevalence of low adherence to drug treatment for chronic diseases was 30.8% (95%CI 28.8-33.0). The highest prevalence of low adherence was associated with individuals: young adults; no education; resident in the Northeast and Midwest Regions of Brazil; paying part of the treatment; poor self-perceived health; three or more diseases; reported limitations caused by a chronic disease; using five drugs or more. CONCLUSIONS Low adherence to drug treatment for chronic diseases in Brazil is relevant, and regional and demographic differences and those related to patients’ health care and therapy regime require coordinated action between health professionals, researchers, managers and policy makers. RESUMO OBJETIVO Analisar fatores associados à baixa adesão ao tratamento farmacológico de doenças crônicas no Brasil. MÉTODOS Análise de dados oriundos da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM), inquérito domiciliar de base populacional, de delineamento transversal, baseado em amostra probabilística da população brasileira. Analisou-se a associação entre baixa adesão ao tratamento medicamentoso mensurado pelo Brief Medication Questionnaire e fatores demográficos, socioeconômicos, de saúde, assistência e prescrição. Foi utilizado modelo de regressão de Poisson para estimar as razões de prevalência brutas e ajustadas, os respectivos intervalos de 95% de confiança (IC95%) e p-valor (teste de Wald). RESULTADOS A prevalência de baixa adesão ao tratamento farmacológico de doenças crônicas foi de 30,8% (IC95% 28,8–33,0). As maiores prevalências de baixa adesão estiveram associadas a indivíduos: adultos jovens; que nunca estudaram; residentes na região Nordeste e Centro-Oeste do País; que tiveram que pagar parte do tratamento; com pior autopercepção da saúde; com três ou mais doenças; que referiam limitação causada por uma das doenças crônicas; e que faziam uso de cinco medicamentos ou mais. CONCLUSÕES A baixa adesão ao tratamento medicamentoso para doenças crônicas no Brasil é relevante e as diferenças regionais, demográficas e aquelas relacionadas à atenção à saúde do paciente e ao regime terapêutico requerem ações coordenadas entre profissionais de saúde, pesquisadores, gestores e formuladores de políticas para o seu enfrentamento.

Objetivo: descrever aspectos metodológicos do inquérito domiciliar da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM) quanto ao desenho e implementação da amostragem e da amostra efetivamente obtida, seus instrumentos e implementação do campo. Métodos: estudo transversal de base populacional com amostra probabilística em três estágios da população residente nos domicílios localizados na zona urbana do Brasil. O trabalho de campo foi desenvolvido entre setembro de 2013 e fevereiro de 2014. O instrumento de coleta de dados incluiu questões relativas a: informações do domicílio, dos moradores e dos entrevistados; doenças crônicas e medicamentos utilizados; uso de serviços de saúde; doenças e eventos agudos tratados com medicamentos; uso de contraceptivos; uso de serviços de farmácia; comportamentos que podem afetar o uso de medicamentos; bulas e embalagens; estilo de vida e planos de saúde. Resultados: foram realizadas 41.433 entrevistas em 20.404 domicílios e 576 conglomerados que correspondem a 586 setores censitários distribuídos nas cinco regiões do Brasil, segundo oito domínios definidos por grupos de idade e sexo. Conclusões: os resultados obtidos no inquérito podem ser utilizados como uma linha de base para futuros estudos que pretendam avaliar o impacto de ações governamentais nas áreas de acesso e de utilização de medicamentos. Para estudos locais que venham a usar um método compatível, a PNAUM pode servir como ponto de referência para avaliação de variações do espaço e da população. Com ampla avaliação dos aspectos relacionados aos medicamentos, a PNAUM é uma grande fonte de dados para as mais variadas análises, que podem ser conduzidas tanto no meio acadêmico como no âmbito governamental. Objective: to describe methodological aspects of the household survey National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM) related to sampling design and implementation, the actual obtained sample, instruments and fieldwork. Methods: a cross-sectional, population-based study with probability sampling in three stages of the population living in households located in Brazilian urban areas. Fieldwork was carried out between September 2013 and February 2014. The data collection instrument included questions related to: information about households, residents and respondents; chronic diseases and medicines used; use of health services; acute diseases and events treated with drugs; use of contraceptives; use of pharmacy services; behaviors that may affect drug use; package inserts and packaging; lifestyle and health insurance. Results: in total, 41,433 interviews were carried out in 20,404 households and 576 urban clusters corresponding to 586 census tracts distributed in the five Brazilian regions, according to eight domains defined by age and gender. Conclusions: the results of the survey may be used as a baseline for future studies aiming to assess the impact of government action on drug access and use. For local studies using a compatible method, PNAUM may serve as a reference point to evaluate variations in space and population. With a comprehensive evaluation of drug-related aspects, PNAUM is a major source of data for a variety of analyses to be carried out both at academic and government level.

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. 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).

OBJECTIVE To analyze the access to medicines to treat non-communicable diseases in Brazil according to socioeconomic, demographic, and health-related factors, from a multidimensional perspective. METHODS Analysis of data from the National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM), household survey, sampling plan by conglomerates with representativeness of the Brazilian population and large areas of the country, according to sex and age domains. Data collected in 2013–2014 with sample of adults (≥ 20 years) who reported having non-communicable diseases and medical indication for use of medicines (n = 12,725). We assessed the prevalence of access to medicines for self-reported non-communicable diseases, considering four dimensions: availability, geographic accessibility, acceptability, and affordability. We applied Pearson’s Chi-square test to assess the statistical significance of the differences between strata, considering the level of significance of 5%. We found prevalence of 94.3%, 5.2%, and 0.5% for full, partial, and null access, respectively. Higher prevalence was observed among seniors in the South compared to the Northeast; for those who reported having one non-communicable disease compared to those who reported having two or more; for those who needed one medicine compared to those who needed three or more; and for those who self-assessed their health as good or very good. Geographic accessibility was similar in the Unified Health System and in the private pharmacies (72.0%). Total availability of medicines was 45.2% in the Unified Health System, 67.4% in the Popular Pharmacy Program, and 88.5% in private pharmacies. Acceptability was 92.5% in the Unified Health System, 97.8% in the Popular Pharmacy Program, and 98.7% in private pharmacies. As to affordability, 2.6% of the individuals failed to take the medicines they should in the 30-day period prior to the interview due to financial difficulty. Prevalence of full access to medicines for non-communicable diseases in Brazil is high and presents significant differences for age group, region of the country, number of non-communicable diseases, and for medicines prescribed and self-assessment of health. The major barriers to access to medicines were identified in the dimensions analyzed. RESUMO OBJETIVO Analisar o acesso a medicamentos para tratar doenças crônicas não transmissíveis no Brasil segundo fatores socioeconômicos, demográficos e de saúde, sob perspectiva multidimensional. MÉTODOS Análise de dados da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM), inquérito domiciliar, plano amostral por conglomerados com representatividade da população brasileira e grandes regiões do País, segundo domínios de sexo e idade. Dados coletados em 2013-2014 com amostra constituída por adultos (≥ 20 anos) que referiram ter doenças crônicas não transmissíveis e indicação médica para usar medicamentos (n = 12.725). Avaliou-se a prevalência de acesso aos medicamentos para doenças crônicas não transmissíveis autorreferidas, considerando quatro dimensões: disponibilidade, acessibilidade geográfica, aceitabilidade e capacidade aquisitiva. Aplicou-se teste Qui-quadrado de Pearson para avaliar a significância estatística das diferenças entre os estratos, considerando o nível de significância de 5%. RESULTADOS Foram encontradas prevalências de 94,3%, 5,2% e 0,5% para acesso total, parcial e nulo, respectivamente. Maiores prevalências ocorreram entre os idosos, na região Sul comparada à região Nordeste; naqueles que referiram ter uma doença crônica não transmissível comparados aos que referiram ter duas ou mais; naqueles que precisavam de um medicamento comparados aos que precisavam de três ou mais; e naqueles que autoavaliaram sua saúde como boa ou muito boa. A acessibilidade geográfica foi semelhante no Sistema Único de Saúde e nas farmácias privadas (72,0%). A disponibilidade total de medicamentos foi de 45,2% no Sistema Único de Saúde, 67,4% no Programa Farmácia Popular e 88,5% nas farmácias privadas. A aceitabilidade foi de 92,5% no Sistema Único de Saúde, 97,8% no Programa Farmácia Popular e 98,7% nas farmácias privadas. Quanto à capacidade aquisitiva, 2,6% dos indivíduos não tomou os medicamentos que deveria nos 30 dias anteriores à entrevista devido à dificuldade financeira. CONCLUSÕES A prevalência do acesso total aos medicamentos para doenças crônicas não transmissíveis no Brasil é alta e apresenta diferenças significativas por faixa etária, região do País, número de doenças crônicas não transmissíveis e de medicamentos prescritos e autoavaliação da saúde. Foram identificadas as principais barreiras ao acesso a medicamentos nas dimensões analisadas.

OBJECTIVE To assess the prevalence of the use of medicines and other products for therapeutic purposes in the Brazilian pediatric population and test whether demographic, socioeconomic and health factors are associated with use. METHODS A cross-sectional population-based study (National Survey on Access, Use and Promotion of Rational Use of Medicines – PNAUM), including 7,528 children aged 12 or younger, living in urban areas in Brazil. Medicine use to treat chronic or acute diseases was reported by the primary caregiver present at the household interview. Associations between independent variables and medicine use were investigated by Poisson regression. RESULTS The overall prevalence of medicine use was 30.7% (95%CI 28.3–33.1). The prevalence of medicine use for chronic diseases was 5.6% (95%CI 4.7–6.7) and for acute conditions, 27.1% (95%CI 24.8–29.4). The factors significantly associated with overall use were five years old or under, living in the Northeast region, having health insurance and using health services in the last 12 months (emergency visits and hospitalizations). The following were associated with drug use for chronic diseases: age ≥ 2 years, Southeast and South regions, and use of health services. For drug use in treating acute conditions, the following associated factors were identified: ≤ 5 years, North, Northeast or Midwest regions, health insurance, and one or more emergency visits. The most commonly used drugs among children under two years of age were paracetamol, ascorbic acid, and dipyrone; for children aged two years or over they were dipyrone, paracetamol, and amoxicillin. CONCLUSIONS The use of medicine by children is considerable, especially in treating acute medical conditions. Children using drugs for chronic diseases have a different demographic profile from those using drugs for acute conditions in relation to gender, age, and geographic region. RESUMO OBJETIVO Estimar a prevalência de uso de medicamentos e outros produtos com finalidade terapêutica na população pediátrica brasileira e testar se fatores demográficos, socioeconômicos e médicos estão associados ao uso. MÉTODOS Estudo transversal de base populacional (Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – PNAUM), incluindo 7.528 crianças com 12 anos ou menos de idade, residentes na zona urbana do território brasileiro. O uso de medicamentos para tratar doenças crônicas ou agudas foi referido pelo principal cuidador da criança presente na entrevista domiciliar. Associações entre as variáveis independentes e o uso de medicamentos foram investigadas por meio de regressão de Poisson. RESULTADOS A prevalência de uso global de medicamentos foi de 30,7% (IC95% 28,3–33,1). A prevalência de uso de medicamentos para doenças crônicas foi de 5,6% (IC95% 4,7–6,7) e para condições agudas, 27,1% (IC95% 24,8–29,4). Os fatores significativamente associados com o uso global foram ter no máximo cinco anos de idade, residir na região Nordeste, ter plano de saúde e utilizar serviços de saúde nos últimos 12 meses (consultas de emergência e internações). Associaram-se ao uso de medicamentos para doenças crônicas: idade ≥ 2 anos, regiões Sudeste e Sul e utilização de serviços de saúde. Para o uso de medicamentos em condições agudas, foram identificados os seguintes fatores associados: ≤ 5 anos, Norte, Nordeste ou Centro-Oeste, plano de saúde e uma ou mais consultas de emergência. Os medicamentos com maior prevalência de uso pelas crianças menores de dois anos foram paracetamol, ácido ascórbico e dipirona; nas crianças com 2 ou mais anos, foram dipirona, paracetamol e amoxicilina. CONCLUSÕES O uso de medicamentos na população infantil é substancial, principalmente no tratamento de condições médicas agudas. As crianças usuárias de medicamentos para doenças crônicas apresentam perfil demográfico diferente das usuárias de medicamentos para condições agudas, em relação ao sexo, à idade e à região geográfica.

OBJECTIVE To analyze the prevalence of medicine use by the Brazilian population and its distribution according to sociodemographic factors. METHODS Study using data from the Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), a nationwide household survey of a representative sample of the Brazilian urban population. The data were collected between September 2013 and February 2014. The overall use of medicines, defined as the use of any medicine, use of medicines for treating chronic medical conditions and for acute health conditions, was evaluated. The independent variables included gender, age group, socioeconomic position, and region of Brazil. Analyzes included prevalence calculations, 95% confidence intervals (95%CI) and Pearson Chi-square tests to evaluate the differences between groups, considering a 5% level of significance. RESULTS The prevalence of medicines use was 50.7% (95%CI 49.3–52.2), with 39.3% (95%CI 37.5–41.1) accounting for men and 61.0% (95%CI 59.3–62.6) for women. Medicines use was observed to increase with increasing age, except among children within the zero to four years age group. The lowest prevalence for medicines use was found among those with a low socioeconomic position and those who reside in the North region of Brazil. The prevalence of medicine use to treat chronic diseases was 24.3% (95%CI 23.3–25.4), whereas it was 33.7% (95%CI 32.1–35.4) for treating acute diseases. CONCLUSIONS We found extensive variability in the prevalence of medicines use across regions of Brazil. The poorest regions (North, Northeast, and Midwest) have a lower prevalence of medicines use to treat chronic diseases, indicating the need to minimize inequalities in access to medicines within the country. RESUMO OBJETIVO Analisar a prevalência do uso de medicamentos pela população brasileira e sua distribuição segundo aspectos sociodemográficos. MÉTODOS Estudo com dados da Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM), pesquisa nacional de base populacional, realizada entre setembro de 2013 e fevereiro de 2014 em residências de municípios urbanos. Avaliou-se o uso de todos os medicamentos (global), uso de medicamentos para doenças crônicas e uso de medicamentos para doenças agudas. As variáveis independentes utilizadas foram sexo, idade, classificação econômica e região do País. Foram calculados prevalências e intervalos de confiança de 95% (IC95%) e aplicado teste Qui-quadrado de Pearson para avaliação das diferenças entre os grupos, considerando o nível de significância de 5%. RESULTADOS A prevalência global de uso de medicamentos foi de 50,7% (IC95% 49,3–52,2), sendo 39,3% (IC95% 37,5–41,1) no sexo masculino e 61,0% (IC95% 59,3–62,6) no sexo feminino. Observou-se aumento nas prevalências de uso com a idade (exceto de zero a quatro anos). As menores prevalências de uso ocorreram no grupo mais pobre e na região Norte do País. A prevalência de uso de medicamentos para doenças crônicas foi de 24,3% (IC95% 23,3–25,4) e para doenças agudas foi de 33,7% (IC95% 32,1–35,4). CONCLUSÕES Existe grande variabilidade nas prevalências globais de uso de medicamentos por regiões brasileiras. As regiões consideradas mais pobres (Norte, Nordeste e Centro-Oeste) apresentam menores prevalências de uso de medicamentos para doenças crônicas, o que indica a necessidade de minimizar as desigualdades no acesso aos medicamentos dentro do País.

OBJECTIVE To describe the magnitude of the expenditure on medicines in Brazil according to region, household size and composition in terms of residents in a situation of dependency. METHODS Population-based data from the national household survey were used, with probabilistic sample, applied between September 2013 and February 2014 in urban households. The expenditure on medicines was the main outcome of interest. The prevalence and confidence intervals (95%CI) of the outcomes were stratified according to socioeconomic classification and calculated according to the region, the number of residents dependent on income, the presence of children under five years and residents in a situation of dependency by age. RESULTS In about one of every 17 households (5.3%) catastrophic health expenditure was reported and, in 3.2%, the medicines were reported as one of the items responsible for this situation. The presence of three or more residents (3.6%) and resident in a situation of dependency (3.6%) were the ones that most reported expenditure on medicines. Southeast was the region with the lowest prevalence of expenditure on medicines. The prevalence of households with catastrophic health expenditure and on medicines in relation to the total of households showed a regressive tendency for economic classes. CONCLUSIONS Catastrophic health expenditure was present in 5.3%, and catastrophic expenditure on medicines in 3.2% of the households. Multi-person households, presence of residents in a situation of economic dependency and belonging to the class D or E had the highest proportion of catastrophic expenditure on medicines. Although the problem is important, permeated by aspects of iniquity, Brazilian policies seem to be protecting families from catastrophic expenditure on health and on medicine. RESUMO OBJETIVO Descrever a magnitude do gasto catastrófico em medicamentos no Brasil segundo região, tamanho das famílias e composição familiar em termos de moradores em situação de dependência. MÉTODOS Utilizados dados de inquérito domiciliar nacional, de base populacional, com amostra probabilística, aplicado entre setembro de 2013 e fevereiro de 2014 em domicílios urbanos. O gasto catastrófico em medicamentos foi o principal desfecho de interesse. As prevalências e intervalos de confiança de 95% (IC95%) desses desfechos foram estratificados segundo classificação socioeconômica e calculadas de acordo com a região, o número de moradores dependentes da renda, a presença de crianças menores de cinco anos e de moradores em situação de dependência, por idade. RESULTADOS Em cerca de um de cada 17 domicílios (5,3%) foi relatado gasto catastrófico em saúde e, em 3,2%, os medicamentos foram reportados como um dos itens responsáveis por esta situação. Presença de três ou mais moradores (3,6%) e morador em situação de dependência jovem (3,6%) foram as situações com maior relato de gasto catastrófico em medicamentos. O Sudeste foi a região com menor prevalência de gasto catastrófico em medicamentos. As prevalências de domicílios com gasto catastrófico em saúde e medicamentos em relação ao total de domicílios apresentaram tendência regressiva para as classes econômicas. CONCLUSÕES O gasto catastrófico em saúde esteve presente em 5,3% e o gasto catastrófico em medicamentos, em 3,2% dos domicílios. Domicílios pluripessoais, presença de moradores em situação de dependência econômica e pertencimento à classe D ou E tiveram a maior proporção de gasto catastrófico em medicamentos. Ainda que o problema se mostre importante, permeado por aspectos de iniquidade, as políticas brasileiras parecem estar protegendo as famílias do gasto catastrófico em saúde e em medicamentos.

OBJECTIVE To analyze the access to and use of medicines for high blood pressure among the Brazilian population according to social and demographic conditions. METHODS Analysis of data from Pesquisa Nacional Sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), a nationwide cross-sectional, population-based study, with probability sampling, carried out between September 2013 and February 2014 in urban households in the five Brazilian regions. The study evaluated the access and use of medicines to treat people with high blood pressure. The independent variables were gender, age, socioeconomic status and Brazilian region. The study also described the most commonly used drugs and the percentage of people treated with one, two, three or more drugs. Point estimations and confidence intervals were calculated considering the sample weights and sample complex plan. RESULTS Prevalence of high blood pressure was 23.7% (95%CI 22.8–24.6). Regarding people with this condition, 93.8% (95%CI 92.8–94.8) had indication for drug therapy and, of those, 94.6% (95%CI 93.5–95.5) were using the medication at the time of interview. Full access to medicines was 97.9% (95%CI 97.3–98.4); partial access, 1.9% (95%CI 1.4–2.4); and no access, 0.2% (95%CI 0.1–0.4). The medication used to treat high blood pressure, 56.0% (95%CI 52.6–59.2) were obtained from SUS (Brazilian Unified Health System), 16.0% (95%CI 14.3–17.9) from Popular Pharmacy Program, 25.7% (95%CI 23.4–28.2) were paid for by the patients themselves and 2.3% (95%CI 1.8–2.9) were obtained from other locations. The five most commonly used drugs were, in descending order, hydrochlorothiazide, losartan, captopril, enalapril and atenolol. Of the total number of patients on treatment, 36.1% (95%CI 34.1–37.1) were using two medicines and 13.5% (95%CI 12.3–14.9) used three or more. CONCLUSIONS Access to medicines for the treatment of high blood pressure may be considered high and many of them are available free of charge. The most commonly used drugs are among those recommended as first-line treatment for high blood pressure control. The percentage of people using more than one drug seems to follow the behavior observed in other countries. RESUMO OBJETIVO Analisar o acesso e a utilização de medicamentos para a hipertensão na população brasileira segundo condições sociais e demográficas. Análise dos dados da Pesquisa Nacional Sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos, estudo nacional de delineamento transversal de base populacional, com amostra probabilística, realizado entre setembro de 2013 e fevereiro de 2014 em domicílios urbanos nas cinco regiões do Brasil. Avaliou-se o uso e acesso aos medicamentos para os cuidados com pessoas que apresentam hipertensão arterial. As variáveis independentes utilizadas foram sexo, idade, nível socioeconômico e região do País. Também foram descritos os fármacos mais utilizados e a proporção de pessoas tratadas com um, dois, três ou mais fármacos. As estimativas de ponto e os intervalos de confiança foram calculados considerando os pesos amostrais e o plano complexo da amostra. A prevalência de hipertensão arterial foi de 23,7% (IC95% 22,8–24,6). Das pessoas com a condição, 93,8% (IC95% 92,8–94,8) tinham indicação de tratamento com medicamentos e, destes, 94,6% (IC95% 93,5–95,5) estavam usando os medicamentos no momento da entrevista. O acesso total aos medicamentos foi de 97,9% (IC95% 97,3–98,4); o acesso parcial, de 1,9% (IC95% 1,4–2,4); e o acesso nulo, de 0,2% (IC95% 0,1–0,4). Dos medicamentos utilizados para tratar a hipertensão, 56,0% (IC95% 52,6–59,2) foram obtidos no SUS, 16,0% (IC95% 14,3–17,9), no Programa Farmácia Popular, 25,7% (IC95% 23,4–28,2) pago do próprio bolso e 2,3% (IC95% 1,8–2,9) em outros locais. Os cinco fármacos mais utilizados foram, em ordem descrente, hidroclorotiazida, losartana, captopril, enalapril e atenolol. Do total de tratados, 36,1% (IC95% 34,1–37,1) estavam usando dois fármacos e 13,5% (IC95% 12,3–14,9) utilizavam três ou mais fármacos. CONCLUSÕES : O acesso aos medicamentos para tratamento da hipertensão pode ser considerado elevado e grande parte desses medicamentos é obtida gratuitamente. Os fármacos mais utilizados estão entre os preconizados como de primeira linha para o controle de hipertensão arterial. A proporção de pessoas utilizando mais de um fármaco parece seguir o comportamento observado em outros países.

The scope of this article was to estimate the prevalence of medication use in children between zero and six years old, analyzing the associated socio-demographic characteristics, and evaluating the adequacy of the medication with respect to pediatric recommendations and restrictions per age group. A cross-sectional study was conducted by means of cluster sampling on a sample comprised of children aged six or under, residents of a city in the south of Brazil. A standardized questionnaire about medication use 15 days prior to the interview was applied. A descriptive analysis was carried out, and the association between medication use and socio-demographic factors was evaluated, as well as the analysis of the pediatric adequacy of the most prevalent medication. Of the 687 children evaluated, 52% used at least one drug in the period. Associations between medication use and socio-demographic characteristics were not found, with the exception of per capita monthly income. The most prevalent medication was paracetamol (17.1%), followed by amoxicillin (9.5%) and dipyrone (8.4%). Among the ten drugs most used in children, six had pediatric restrictions for the age group. The results indicate significant use of medication, including medication with age restrictions, particularly for children under two years of age.

Background. To estimate the exposure to medicines with unknown fetal risk during pregnancy and to analyze the maternal characteristics associated with it.Methods. A questionnaire was administered to 4,189 mothers of children belonging to the 2004 Pelotas (Brazil) birth cohort study about use of any medicine during gestation. We evaluated the associations between use of medicines with unknown fetal risk and the independent variables through logistic regression models. Unknown fetal risk was defined as medicines in which studies in animals have revealed adverse effects on the fetus, and no controlled studies in women, or studies in women and animals, are available.Results. Out of the 4,189 women, 52.5% used at least one medicine from unknown fetal risk. Use of these medicines was associated with white skin color, high schooling, high income, six or more antenatal care consultations, hospital admission during pregnancy, and morbidity during gestation.Conclusion. The use of unknown fetal risk medicines is high, suggesting that their use must be addressed with caution with the aim of restricting their use to cases in which the benefits are greater than the potential risks.

Prenatal care in traditional primary care units (UBS) and Family Health Strategy units (ESF) was evaluated by a cross-sectional study from July 2009 to February 2010 in Santa Maria, Rio Grande do Sul State, Brazil. Seven hundred and ninety-five postpartum women who had received prenatal care in either of the two types of units were interviewed. Four quality levels were used: level 1 (Kessner index modified by Takeda); level 2, which adds clinical obstetric procedures to level 1; level 3, which adds laboratory tests to level 1; and level 4, which includes all the above parameters. Prenatal care in the Family Health Strategy was superior to that of traditional primary care at all levels, with statistically significant differences in levels 1 and 2. Pregnant women received more guidance and prenatal care was superior in the Family Health Strategy. The study favored the Family Health Strategy, but improvement is still needed in the performance of procedures and laboratory tests in order to enhance prenatal care and strengthen primary care.

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.

To develop and test an instrument to evaluate patients' level of knowledge about drug prescription.This study was conducted with users registered with the Family Health Strategy clinics of the city of Santa Cruz do Sul, Southern Brazil, selected by consecutive sampling. Name of the medication, therapeutic indication, drug dosage, times of administration, forms of use, duration of treatment, attitude when doses are missed, possible adverse effects and interactions were included in this study. Each item of the scale was weighted, according to the importance for safe prescribed drug use. The questionnaire was tested by applying an interview to users in 2006 and by analyzing 320 prescriptions. Descriptive statistics, prevalence ratios and chi-square test were calculated for categorical variables and the Tukey test was calculated to compare means.The level of knowledge about drug therapy was considered good in 11.3% of participants, fair in 42.5%, and insufficient in 46.3%. The highest levels of knowledge were observed in times of administration, therapeutic indication and duration of treatment. The lowest levels occurred in drug dosage, adverse effects and attitude when one or more drug doses are missed.The proposed instrument enabled the analysis of the magnitude of the gap existing between what the patients must know and what they actually know about their medications. Thus, key aspects of prevention, education and follow-up can be detected to avoid problems associated with unsafe drug use.

This study compared the Municipal Essential Medicines Lists (REMUME) and examined adherence by prescribers and availability of essential medicines in the health units affiliated with the Unified National Health System (SUS). Data were collected on lists and medicines prescribed to 2,411 patients enrolled consecutively in primary or secondary care services in Brazilian municipalities. Of 5,222 prescribed medicines, 76.4% were present on the REMUME, 76.8% on the National List of Essential Medicines (RENAME), and 63% on the World Health Organization (WHO) list. Among the most frequently prescribed medications, one or more did not belong to the respective REMUME. Of all medicines prescribed, 76.1% were available in the inspected facilities; for essential medicines, the availability increased to 88.1%. Prescription in disagreement with the REMUME may result from the unavailability of medicines in the inspected facilities or the lists' inadequacy for the level of care.

The objective was to evaluate the association between prophylactic iron supplementation and prematurity and low birth weight. Pregnant women 20 years and older with 21 to 28 weeks of gestational age were enrolled consecutively in prenatal services in the Unified National Health System in six Brazilian State capitals between 1991 and 1995. Socio-demographic data and information on iron supplementation up until the 28th gestational week were obtained by means of an interview. Outcomes and other variables were collected from medical records. Anemia was present in 31.3% of the 3,865 women. Among anemic women (hemoglobin11.0g/dL), 29.8% were taking iron supplements, as compared to 16.7% among non-anemic women (hemoglobinor = 11.0g/dL). After adjusting for potential confounders, iron was not associated with prematurity (OR = 0.88; 95%CI: 0.73-1.07), low birth weight (OR = 0.99; 95%CI: 0.75-1.31), or very low birth weight (OR = 0.58; 95%CI: 0.29-1.13). The results suggest that iron supplementation up to the 28th gestational week does not reduce the risk of prematurity, low birth weight, or very low birth weight.

Este estudo avalia a associação do uso do misoprostol e de outros produtos utilizados para induzir a menstruação com anomalia congênita. Foram arroladas consecutivamente 4.856 mulheres com vinte anos de idade ou mais, procedentes de serviços de pré-natal do Sistema Único de Saúde em seis capitais brasileiras. Dados sócio-demográficos e o uso de medicamentos foram obtidos por meio de entrevista, entre a 21a e a 28a semanas de gestação. Outros dados, incluindo informações sobre o parto e o diagnóstico de anomalia congênita, realizado pelo médico que assistiu o recém- nascido, foram obtidos no prontuário. Potenciais confundidores foram ajustados por meio de regressão logística. O uso de produtos para induzir a menstruação foi relatado por 707 gestantes (14,6%), das quais 120 (17%) referiram-se ao misoprostol. Após ajustamento para o centro de realização da pesquisa, foi verificada uma associação positiva entre misoprostol e anomalias congênitas (RC = 2,64; IC95%: 1,03-6,75); para hormônios sexuais também foi verificada uma associação positiva (RC = 2,24; IC95%: 1,06-4,74). Os resultados sugerem que o uso de misoprostol ou hormônios sexuais durante a gravidez aumenta o risco de anomalia congênita. This study evaluated the association between use of misoprostol and other drugs to induce menstruation, and congenital anomalies. A sample of 4,856 pregnant women 20 years and older were enrolled consecutively in prenatal services in the Unified National Health System, in six Brazilian State capitals. Data on socio-demographics and use of medicines were obtained using an interview from the 21st to 28th week of pregnancy. Other data, including information on delivery and diagnosis of congenital anomalies by the attending neonatal physician were obtained from patient charts. Potential confounders were adjusted by logistic regression. Use of drugs to induce menstruation was reported by 707 women (14.6%), of whom 120 (17%) reported use of misoprostol. After adjusting for the study center, a positive association was observed between misoprostol and congenital anomalies (OR = 2.64; 95%CI: 1.03-6.75); a positive association was also observed for sex hormones (OR = 2.24; 95%CI: 1.06-4.74). The results suggest that the use of misoprostol or sex hormones during pregnancy increases the risk of congenital anomalies.

The objective of this study is to assess the prevalence of and risk factors for the non-medical use of psychoactive medicines among students at public and private schools of Passo Fundo, Southern Brazil. A cross-sectional study was carried out using a questionnaire administered to 5,057 students from the 5th grade of elementary school to the 3rd year of high school. The questionnaire contained questions about the use of amphetamines, tranquilizers, barbiturates, anticholinergics, opioids, appetite stimulants, and anabolic steroids. Of the sample total, 7.7% had consumed tranquilizers sometime during their lives, 6.4% had used amphetamines, 2.2% had used anabolic steroids, and 1.1% had used barbiturates. Female students reported significantly greater consumption of tranquilizers and amphetamines, while anabolic steroid use was more prevalent among males. The pattern of psychoactive medicine consumption among children and adolescents students is comparable with the pattern among adults. The findings of this research suggest the need to include children and adolescents in media campaigns and other education programs to prevent the non-medical use and abuse of psychoactive medicines.

Sir, In Brazil, the main use of misoprostol is to induce abortion, even though this practice is illegal. There are only two situations in which abortion is not a criminal act: when the pregnant woman’s life is at risk and when pregnancy has resulted from rape or incest. The use of misoprostol as an abortion-inducing substance may lead to a situation in which the pregnancy is not lost [1], thereby generating anxiety regarding the risk to the fetus and the pregnant woman. Case and case-control studies have suggested that the use of misoprostol in unsuccessful abortions may be associated with congenital malformations, for example in children with limb reduction defects and/or Mobius Sequence [2, 3] and anomalies of the central nervous system [4]. However, in one cohort study correlating the use of misoprostol with teratogenic effects, no difference was found in the rates of congenital malformations between 86 cases of exposure to misoprostol during pregnancy and 86 cases without exposure to this drug [5]. In this letter, we report an association observed between the use of misoprostol during the first trimester of pregnancy and congenital malformation of the child or fetal death, from the Brazilian Study of Gestational Diabetes, a cohort of women attending prenatal services at public hospitals in six Brazilian cities, between February 1991 and June 1995. Data relating to the use of misoprostol and other substances with the potential to induce abortion during the pregnancy (obtained during the first phase of the cohort) and data relating to the neonate’s state of health (obtained during the third phase of the cohort) were analyzed. Interviews were held with 5,564 women aged 20 years or over who were between their 21st week and 28th week of pregnancy (Table 1). Information on the use of substances with the potential to induce abortion was obtained from the interviews with the pregnant women. The diagnosis of congenital malformation was made by the attending doctor and entered in the pregnant woman’s records. The present analysis included the pregnant women who were followed through to the third phase of the cohort, thus resulting in a sample of 4,862 women (87.4% of the initial sample). Use of substances with the potential to induce abortion was reported by 707 pregnant women (14.6%); of these, 120 declared that they had used misoprostol during the first trimester of pregnancy. More cases of congenital malformation were found in the group exposed to misoprostol than in the unexposed group (RR=2.39), with threshold significance (95% CI 0.99–5.80) (Table 2). Using a logistic regression model that included the variables of skin color, marital situation and research center, the risk increased slightly (RR=2.61; 95% CI 1.01–6.75). The malformations that occurred in the sample of pregnant women who made use of misoprostol were: syndactyly, twisted foot, meningomyelocele, microcephaly and fingernail defects. A significant difference was also observed between the women with and without exposure to misoprostol, in relation to fetal death (RR=2.63; 95% CI 1.17–5.88 (Table 3). After adjustment using the regression model, the relative risk increased to 3.21 (95% CI 1.34–7.68). The data available in the literature on the effects on the fetus and child mostly come from case reports and case-control studies of limited sample size. Moreover, they do not include adverse events other than the congenital malformations that are important for the outcome of the pregnancy. The prospective populationbased study that included a cohort of 86 cases and 86 externally selected controls did not have sufficient T. da Silva Dal Pizzol (&) University of Passo Fundo, Rua Paissandu, 1973, apto 604, Passo Fundo, Rio Grande do Sul, 99010-102, Brasil E-mail: tatiane@saude.upf.tche.br

OBJECTIVE To analyze the prevalence of current use of oral and injectable contraceptives by Brazilian women, according to demographic and socioeconomic variables and issues related to access to those medicines. METHODS A cross-sectional, population-based analytical study with probability sampling based on data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), carried out between September 2013 and February 2014 in 20,404 Brazilian urban households. Prevalence was calculated based on reports from non-pregnant women aged 15-49 on the use of oral or injectable contraceptives. The independent variables were gender, age, level of education, socioeconomic class, Brazilian region and marital status. Also analyzed were access, means of payment, sources, and reported medicines. Statistical analyses considered 95% confidence intervals (95%CI) and Pearson Chi-square test to evaluate the statistical significance of differences between groups, considering a 5% significance level. RESULTS Prevalence of use was 28.2% for oral contraceptives (OC) and 4.5% for injectable contraceptives (IC). The highest prevalence of oral contraceptives was in the South region (37.5%) and the lowest in the North region (15.7%). For injectable contraceptives there was no difference between regions. Access was higher for oral contraceptive users (90.7%) than injectable contraceptives users (81.2%), as was direct payment (OC 78.1%, IC 58.0%). Users who paid for contraceptives acquired them at retail pharmacies (OC 95.0% and IC 86.6%) and at Farmácia Popular (Popular Pharmacy Program) (OC 4.8% and IC 12.7%). Free of charge contraceptives were mostly obtained from the Brazilian Unified Health System – SUS (OC 86.7%; IC 96.0%). Free samples were reported by 10.4% of users who did not pay for oral contraceptives. Most of paying users did not try to obtain contraceptives from SUS. Monophasic combined oral contraceptives were the most frequently reported (71.6%) and low-level levonorgestrel + ethinylestradiol combination accounted for 38.7% of them. The most frequently reported medicines are included in the Relação Nacional de Medicamentos Essenciais (RENAME – National List of Essential Medicines. CONCLUSIONS Most women aged 15 to 49 who reported using contraceptives had access to the medicine and use monophasic combined oral contraceptives of appropriate efficiency and safety purchased by direct payment, mainly from retail pharmacies. RESUMO OBJETIVO Analisar a prevalência do uso atual de contraceptivos orais e injetáveis por mulheres brasileiras, segundo variáveis demográficas, socioeconômicas e aspectos relacionados ao acesso a esses medicamentos. MÉTODOS Estudo transversal, analítico, baseado nos dados da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM), de base populacional e amostra probabilística, realizada entre setembro/2013 e fevereiro/2014, em 20.404 domicílios urbanos brasileiros. A prevalência foi calculada a partir do relato das mulheres de 15 a 49 anos, não grávidas, sobre o uso de contraceptivos orais ou contraceptivos injetáveis. As variáveis independentes foram sexo, idade, escolaridade, nível socioeconômico, região geográfica e situação conjugal. Também foram analisados acesso, fontes de financiamento, fontes de obtenção e medicamentos citados. As análises estatísticas consideraram intervalos de confiança de 95% (IC95%) e teste Qui-quadrado de Pearson para avaliação da significância estatística das diferenças entre os grupos, considerando o nível de significância de 5%. RESULTADOS A prevalência de uso de contraceptivos orais (CO) foi 28,2% e de contraceptivos injetáveis (CI), 4,5%. A prevalência de contraceptivos orais foi maior no Sul (37,5%) e menor no Norte (15,7%). Para contraceptivos injetáveis não houve diferença entre as regiões. O acesso foi maior para as usuárias de contraceptivos orais (90,7%) do que de contraceptivos injetáveis (81,2%), assim como o pagamento por desembolso direto (CO 78,1%; CI 58,0%). As usuárias que pagaram pelo contraceptivo compraram na farmácia comercial (CO 95,0% e CI 86,6%) e na Farmácia Popular (CO 4,8% e CI 12,7%). A principal fonte de obtenção gratuita foi o SUS (CO 86,7%; CI 96,0%). Amostra grátis foi citada por 10,4% das usuárias que não pagaram pelos contraceptivos orais. A maioria das usuárias que pagaram, não tentou obter no SUS. Contraceptivos orais combinados monofásico foram os mais citados (71,6%) e a combinação levonorgestrel+etinilestradiol de baixa concentração representou 38,7% destes. Os medicamentos mais citados constam na Relação Nacional de medicamentos Essenciais. CONCLUSÕES A maioria das mulheres entre 15 e 49 anos que referiram usar contraceptivos obteve acesso ao medicamento, usa contraceptivos orais combinados monofásico, de eficácia e segurança adequada, obtido com pagamento do próprio bolso, principalmente, nas farmácias comerciais.

OBJECTIVE To analyze the free access to medicines for the treatment of chronic diseases in the Brazilian population, according to demographic and socioeconomic factors. We also analyzed the most used pharmacological groups, according to funding source: free-of-charge or out-of-pocket paid. METHODS Analysis of data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), a population-based household survey, of cross-sectional design, based on probabilistic sample of the Brazilian population. We analyzed as outcome the prevalence of free access (free-of-charge) to all medicines for treatment of the reported chronic diseases, in the last 30 days. We studied the following independent variables: sex, age group, education in complete years of school, economic class, health plan, and geographical region of residence. We estimated the prevalences and 95% confidence intervals (95%CI) and applied the Pearson’s Chi-squared test to assess the differences between the groups, considering a 5% significance level. RESULTS About half of adults and older adults who have had full access to the treatment of chronic diseases in Brazil obtained all needed medicines for free (47.5%; 95%CI 45.1–50.0). The prevalences of free access were higher among men (51.4%; 95%CI 48.1–54.8), age group of 40-59 years (51.1%; 95%CI 48.1–54.2), and in the poorest social classes (53.9%; 95%CI 50.2–57.7). The majority of medicines that act on the cardiovascular system, such as diuretics (C03) (78.0%; 95%CI 75.2–80.5), beta-blockers (C07) (62.7%; 95%CI 59.4–65.8), and the agents that work in the renin-angiotensin system (C09) (73.4%; 95%CI 70.8–75.8), were obtained for free. Medicines that act on the respiratory system, such as agents against obstructive airway diseases (R03) (60.0%; 95%CI 52.7–66.9) were mostly paid with own resources. CONCLUSIONS Free access to medicines for treatment of chronic diseases occurs to a considerable portion of the Brazilian population, especially for the poorest ones, indicating decreased socioeconomic inequalities, but with differences between regions and between some classes of medicines. RESUMO OBJETIVO Analisar o acesso gratuito ao tratamento medicamentoso para doenças crônicas na população brasileira, segundo fatores socioeconômicos e demográficos. Analisaram-se também os grupos farmacológicos mais utilizados, segundo fonte de financiamento: gratuito ou pago do próprio bolso. MÉTODOS Análise de dados oriundos da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM), inquérito domiciliar de base populacional, de delineamento transversal, baseado em amostra probabilística da população brasileira. O desfecho analisado foi a prevalência de acesso gratuito (sem pagamento) a todos os medicamentos para tratamento das doenças crônicas referidas, nos últimos 30 dias. As variáveis independentes investigadas foram: sexo, faixa etária, escolaridade em anos completos de estudo, classe econômica, plano de saúde e região geográfica de residência. Foram estimadas as prevalências e calculados intervalos de 95% de confiança (IC95%) e aplicado o teste Qui-quadrado de Pearson para avaliação das diferenças entre os grupos, considerando nível de significância de 5%. RESULTADOS Cerca de metade dos adultos e idosos que tiveram acesso total ao tratamento de doenças crônicas no Brasil obtiveram todos os medicamentos que necessitavam gratuitamente (47,5%; IC95% 45,1–50,0). As prevalências de acesso gratuito foram maiores entre os homens (51,4%; IC95% 48,1–54,8), na faixa etária de 40-59 anos (51,1%; IC95% 48,1–54,2) e nas classes sociais mais pobres (53,9%; IC95% 50,2–57,7). Grande parte dos medicamentos que atuam no sistema cardiovascular, como os diuréticos (C03) (78,0%; IC95% 75,2–80,5), betabloqueadores (C07) (62,7%; IC95% 59,4–65,8) e os agentes que atuam no sistema renina-angiotensina (C09) (73,4%; IC95% 70,8–75,8) foram obtidos de forma gratuita. Os medicamentos que atuam no sistema respiratório como os agentes contra doenças obstrutivas das vias aéreas (R03) (60,0%; IC95% 52,7–66,9) foram na sua maioria pagos do próprio bolso. CONCLUSÕES O acesso gratuito aos medicamentos para tratamento das doenças crônicas ocorre para uma considerável parcela da população brasileira, principalmente para os mais pobres, indicando diminuição das desigualdades socioeconômicas, mas com diferenças regionais e entre algumas classes de medicamentos.