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BackgroundAlthough relapsing-remitting multiple sclerosis (RRMS) has a chronic course, little information is known about the comparison between the disease-modifying therapies (DMT) for long-term outcomes. We aimed to conduct a systematic review of randomized clinical trial (RCT) extension and observational studies to examine the efficacy and safety of all available DMT for RRMS, compare the evidence with that derived from mid-term studies, and investigate whether the published long-term data are robust and reliable enough to inform clinical decision-making concerning RRMS treatment.MethodPubMed, Scopus, and manual searches were performed until October 2019. The clinical outcomes of long- and mid-term studies were compared. ROBINS-I was used to assess the methodological qualities of the long-term studies. PROSPERO number CRD42019123361.ResultsNineteen long-term studies (9,018 participants) were included in the systematic review. All studies presented serious or critical risks of bias that were mainly due to confounding, selection, and missing data biases. The annualised relapse rates (ARR) observed in the long-term studies are lower (better) than those from the mid-term studies for most treatments. The main reason for this ARR decrease could be a selection bias for good responders in the long-term studies, since many studies show a loss of patients between the mid- and long-term phases. The safety profiles depend on the study, follow-up, report, and outcome (i.e., discontinuation or number of patients with at least one serious adverse event).ConclusionThe currently available long-term data for patients with RRMS exhibit serious or critical risks of bias that preclude robust comparisons between long-term studies. High quality comparative observational studies with long-term follow-ups or RCT extensions with intention-to-treat analyses are needed to support clinical and regulatory practice. Until reliable long-term evidence is available, neurologists should continue to base their conduct on mid-term studies, patient`s experience and, most importantly, patient`s needs and predictor factors, according to personalized medicine.

Funding Acknowledgements Department of Cardiovascular Imaging / Brazilian Society of Cardiology OBJECTIVES To perform the cost-effectiveness analysis of three-dimensional transesophageal echocardiography (3DTEE) in comparison to two-dimensional transesophageal echocardiography (2DTEE) for the anatomic-functional evaluation and surgical planning of severe primary mitral regurgitation. METHODS: a complete economic study was based on a systematic review of 3DTEE and 2DTEE accuracy and private health system costs of two different surgical interventions: mitral valve plasty and mitral valve replacement. The prevalence of common postoperative complications was also predicted for elective procedures: atrial fibrillation (8.6%); acute myocardial infarction (1.4%); thrombosis (3.5%); bleeding (1.5%); endocarditis (6.3%). The decision tree method was adopted as a data analysis model. The Bayes" theorem was used based on sensitivity and specificity measurements. The costs, considering literature and professional tables, were: 3DTEE = US$ 349; 2DTEE = US$ 204; diagnostic evaluation = US$ 597; surgical procedure = US$ 3,643; surgical treatment = US$ 374. RESULTS: The deterministic analysis of the diagnostic test shows that 3DTEE (non-dominated) is superior to 2DTEE (absolutely dominated). The 3DTEE presents a cost reduction of US$ 1,147 and incremental effectiveness (true identification) of 22% when compared to 2DTEE. The multivariate probabilistic sensitivity analysis showed that after 100,000 iterations, the diagnosis based on the 3DTEE becomes the first choice regardless of the willingness to pay threshold. CONCLUSIONS: 3DTEE was cost-effective compared to 2DTEE. Thus, 3DTEE is a potential device to promote health compared to 2DTEE for surgical planning of severe primary mitral regurgitation Abstract P201 Figure. Sensitivity Analysis

Made available in DSpace on 2019-10-03T17:32:00Z (GMT). No. of bitstreams: 0 Previous issue date: 2019. Added 1 bitstream(s) on 2019-10-04T16:21:01Z : No. of bitstreams: 1 S1516-31802019005006101.pdf: 91945 bytes, checksum: 5ac2217f6db07c64824a5fde384ec8c5 (MD5) Universidade de São Paulo Faculdade de Ciências Farmacêuticas de Ribeirão Preto Universidade Federal do Paraná Department of Pharmacy Universidade Estadual Paulista School of Pharmaceutical Sciences Department of Drugs and Medicines Universidade Estadual Paulista School of Pharmaceutical Sciences Department of Drugs and Medicines

Background Randomised clinical trials (RCTs) and observational studies have reported adverse events that preclude the use of disease-modifying therapies (DMTs) in relapsing–remitting multiple sclerosis (RRMS) in the long term or in specific populations, however, little is known about the relationship between the use of DMTs and frequency of undesirable events. We aimed to conduct a systematic review and network meta-analyses (NMAs) of RCTs and observational studies to synthesise the evidence on the safety of all available DMTs for patients with RRMS. Methods PubMed, Scopus and a manual search were performed. Bayesian NMAs of safety outcomes reported in RCTs and observational studies assessing DMTs as monotherapies were conducted. Results Forty-seven studies were included in the systematic review. Considering all studies, 368 and 149 different safety outcomes were reported for at least one study and two studies, respectively. Considering clinical trials, 22 NMAs were conducted for 16 outcomes. Regarding geometry metrics, the median number of studies, DMTs, common comparator, strong edge, and patients were 5 (IQR 5–9), 5 (IQR 4–8), 44%, 33%, and 3998 (IQR 3380–6761). In summary, most comparisons showed similar risk of safety events for DMTs and placebo for all outcomes. Considering cohort studies, only three meta-analyses were conducted. Conclusion Safety outcomes are poorly reported in primary studies of DMTs in RRMS, precluding the conduction of robust meta-analyses. Therefore, the current available data on safety of these drugs is not contributing to regulatory and clinical decision making, with adverse event reports underbalanced compared to efficacy outcomes.

Objectives To identify drug interactions of potentially inappropriate medications and mental and behavioral disorders, according to explicit potentially inappropriate medications criteria-based tools. Methodology A systematic scoping review was conducted in February 2020. Study characteristics, potentially inappropriate medications, drug interactions, rationale, and therapeutic management proposed were extracted. The commercialization and potentially inappropriate medications standard as essential in Brazil and in the world were identified. Therapeutic management was proposed for the most cited potentially inappropriate medications. Results 36 tools including 151 drug interactions, in addition to 132 potentially inappropriate medications with concerns related to six mental and behavioral disorders were identified. Cognitive impairment and dementia were the most frequently disorders reported and antipsychotics, anticholinergics, and benzodiazepines were the pharmacological classes more involved in the drug interactions. Despite the tools recommended risperidone and quetiapine when the use of antipsychotics were inevitable; levodopa + carbidopa for Parkinson's disease; and short and intermediate half-life benzodiazepines; the quality of the evidence needs to be assessed. In this review, sleep hygiene; deprescription; medication review; and clinical monitoring of adverse drug reactions are strongly recommended. In addition, to consider agomelatine, bupropion, moclobemide and melatonin as potential safer options for benzodiazepines. Conclusion Knowing the clinical conditions or risk morbidities associated with the use of potentially inappropriate medications and management of these medications for safer therapeutic equivalents or non-pharmacotherapeutic alternatives are relevant for patient safety.

Carolina Dagli-Hernandez,1 Rosa Camila Lucchetta,1 Tales Rubens de Nadai,2 José Carlos Fernandez Galduróz,3 Patricia de Carvalho Mastroianni1 1Department of Drugs and Medications, School of Pharmaceutical Sciences of the UNESP – Univ Estadual Paulista, Araraquara, 2Department of Surgery and Anatomy, Americo Brasiliense State Hospital, 3Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil Objectives: To evaluate which indirect method for assessing adherence best reflects highly active antiretroviral therapy (HAART) effectiveness and the factors related to adherence. Method: This descriptive, cross-sectional study was performed in 2012 at a reference center of the state of São Paulo. Self-report (simplified medication adherence questionnaire [SMAQ]) and drug refill parameters were compared to the viral load (clinical parameter of the effectiveness of pharmacotherapy [EP]) to evaluate the EP. The “Cuestionario para la Evaluación de la Adhesión al Tratamiento Antiretroviral” (CEAT-VIH) was used to evaluate factors related to adherence and the EP and, complementarily, patient self-perception of adherence was compared to the clinical parameter of the EP. Results: Seventy-five patients were interviewed, 60 of whom were considered as adherent from the clinical parameter of the EP and ten were considered as adherent from all parameters. Patient self-perception about adherence was the instrument that best reflected the EP when compared to the standardized self-report questionnaire (SMAQ) and drug refill parameter. The level of education and the level of knowledge on HAART were positively correlated to the EP. Forgetfulness, alcohol use, and lack of knowledge about the medications were the factors most frequently reported as a cause of nonadherence. Conclusion: A new parameter of patient self-perception of adherence, which is a noninvasive, inexpensive instrument, could be applied and assessed as easily as self-report (SMAQ) during monthly drug refill, since it allows monitoring adherence through pharmaceutical assistance. Therefore, patient adherence to HAART could be evaluated using self-perception (CEAT-VIH) and the viral load test. Keywords: health literacy, anti-HIV agents, patient compliance, antiretroviral therapy, highly active, acquired immunodeficiency syndrome

Study objective The use of benzodiazepines and the development of dementia is controversial, with studies indicating that benzodiazepines could be either a protective factor or a risk factor for dementia, or no association may exist between the two. Our objective was to identify whether such an association exists. Design Systematic review and meta-analysis of 12 prospective and retrospective cohort studies and case-control studies. Participants A total of 981,133 (in the systematic review) and 980,860 (in the meta-analysis) adults or elderly individuals. Measurements and main results A search of the PubMed, LILACS, and Cochrane Central Register of Controlled Trials databases, as well as a manual search of the reference lists of the included publications and reviews, was performed. We included studies that reported the incidence of dementia and in ever users of benzodiazepines. Data were analyzed by using a random effects model in R software. Quality of the evidence was assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) certainty ratings system. The results of the main meta-analysis suggest that benzodiazepines can be a risk factor for developing dementia (odds ratio 1.38, 95% confidence interval 1.07-1.77; I2 = 98%; 95% prediction interval 0.58-3.25; very low certainty). Conclusion Our results suggest an association between the use of benzodiazepines and the development of dementia. However, the current evidence lacks the power to infer differences between the effects of Alzheimer's disease and vascular dementias, long-acting and short-acting benzodiazepines, and various exposure loads (duration and dose). Future long-term prospective cohort studies are necessary, with adequate adjustments for confounding variables, strategies to minimize reverse causality, reporting of subgroups aimed at greater homogeneity of findings, adequate statistical power to identify high-magnitude effects, and defined daily dose analyses for dose-response gradient.

Made available in DSpace on 2021-06-25T11:07:26Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-01-01 Potentially Inappropriate Medication for the elderly (PIM) are drugs in which the safety risks may exceed the benefits, especially when there are safer alternatives. The use of PIM is associated with increased hospitalizations and it is estimated that one every five prescriptions presents at least one PIM. In this context, there are several assessment tools for identification of PIM. The first assessment tool developed was Beers criteria and since its publication, new tools have been developed. The objective of this scoping review is to explore studies presenting assessment tools of PIM to map characteristics, justifications, and therapeutic equivalents. This review will consider studies that developed or validated an assessment tool of PIM. Electronic searches will be performed in PubMed and Scopus with no time limit. Two researchers, independently, will select registries and extract data of studies and tool characteristics, PIM and potentially inappropriate interaction, condition, justification, and therapeutic equivalents. The findings will be presented in narrative form including tables and figures to aid in data presentation, where appropriate. Faculdade de Ciências Farmacêuticas de Araraquara Universidade Estadual Paulista “Júlio de Mesquita Filho” – UNESP Faculdade de Ciências Farmacêuticas de Araraquara Universidade Estadual Paulista “Júlio de Mesquita Filho” – UNESP

Introduction Despite the significant impact of cardiovascular disease (CVD), there is not yet an analytical decision tool for assessing efficiency of interventions to prevent primary CVD events in Brazil. Therefore, we sought to adapt a Scottish CVD Policy Model to be used in the proposed population. Methods Calibration consisted of identifying multiplicative factors for linear predictors of existing survival analysis models to produce predictions that closely match observed data (Life-table and Brazilian cohort study). Target data were life expectancy (LE) and cumulative incidence of coronary heart disease (CHD), cerebrovascular disease (CBVD), fatal CVD and fatal non-CVD. Root-Mean-Square-Error (RMSE) was used to estimate differences between predictions and observations. Acceptance criteria were defined as a fit of less than one year for LE and 1% for cumulative incidence. Male and female models were built separately. Results The original model underestimated LE (RMSE=2.85 for men and 1.91 for women), CHD and CBVD for women (RMSE=0.044 and 0.041, respectively). The calibration process identified multiplicative factors to reach acceptance criteria for the four target data mentioned above (RMSE=0.61, 0.21, 0.016 and 0.017, respectively). Over prediction was identified only for CHD events in men (RMSE=0.031) being further calibrated (RMSE=0.008). All other target data met the acceptance criteria. Overall, the calibrated model predicts properly to individuals aging 35-80 years old, diabetics or not, smokers or not, with or without family history of CVD, and presenting at least one of the risk factors uncontrolled: Systolic Blood Pressure, Total Cholesterol or HDL-Cholesterol. Discussion This is the first decision analytic model capable of assessing efficiency of interventions that prevent primary CVD events in Brazil. In future research, independent external validation should be carried out to corroborate the reliability of the model outputs.

The aim of this study was to evaluate efficacy and safety of amfepramone, fenproporex and mazindol as a monotherapy for the treatment of obese or overweight patients. A systematic review of primary studies was conducted, followed by a direct meta-analysis (random effect) and mixed treatment comparison. Medline and other databases were searched. Heterogeneity was explored through I2 associated with a p-value. Of 739 identified publications, 25 were included in the meta-analysis. The global evaluation of Cochrane resulted in 19 studies with a high level of bias and six with unclear risk. Due to the lack of information in primary studies, direct meta-analyses were conducted only for amfepramone and mazindol. Compared to placebo, amfepramone resulted in higher weight loss in the short-term (

Objectives: this observational study aimed to describe the discrepancies identified during medication reconciliation on patient admission to cardiology units in a large hospital. Methods: the medication history of patients was collected within 48 hours after admission, and intentional and unintentional discrepancies were classified as omission, duplication, dose, frequency, timing, and route of drug administration. Results: most of the patients evaluated were women (58.0%) with a mean age of 59 years, and 75.5% of the patients had a Charlson comorbidity index score between 1 and 3. Of the 117 discrepancies found, 50.4% were unintentional. Of these, 61.0% involved omission, 18.6% involved dosage, 18.6% involved timing, and 1.7% involved the route of drug administration. Conclusion: this study revealed a high prevalence of discrepancies, most of which were related to omissions, and 50% were unintentional. These results reveal the number of drugs that are not reincorporated into the treatment of patients, which can have important clinical consequences. RESUMO Objetivos: este estudo observacional teve como objetivo descrever discrepâncias encontradas na realização de conciliação medicamentosa de pacientes admitidos em unidades de cardiologia de um hospital de grande porte. Métodos: a história de medicação dos pacientes foi coletada dentro de 48h após a admissão, e as discrepâncias, identificadas como intencionais ou não intencionais, foram classificadas como de: omissão, duplicidade, dose, frequência, intervalo e via. Resultados: a maioria dos pacientes incluídos pertençia ao sexo feminino (58,0%), com idade média de 59 anos, e com índice de comorbidades de Charlson entre 1 e 3 (75,5% dos casos). Das 117 discrepâncias encontradas, 50,4% foram não intencionais. Dessas, 61,0% foram de omissão, 18,6% de dose, 18,6% de intervalo e 1,7% de via de administração. Conclusão: o estudo mostra a alta prevalência de discrepâncias, principalmente de omissão, sendo quase metade não intencionais. Esse dado remete ao número de medicamentos que não são reincorporados ao tratamento dos pacientes, podendo repercutir em consequências clínicas importantes. RESUMEN Objetivos: este estudio observacional tuvo como objetivo describir discrepancias encontradas en la realización de la conciliación medicamentosa de pacientes admitidos en unidades de cardiología de un hospital de gran porte. Métodos: la historia de medicación de los pacientes fue recolectada dentro de 48h después de la admisión, y las discrepancias, identificadas como intencionales o no intencionales, fueron clasificadas como: omisión, duplicidad, dosis, frecuencia, intervalo y vía. Resultados: la mayoría de los pacientes incluidos pertenecía al sexo femenino (58,0%), con edad promedio de 59 años, y con índice de comorbilidad de Charlson entre 1 y 3 (75,5% de los casos). De las 117 discrepancias encontradas, 50,4% fueron no intencionales. De estas, 61,0% fueron de omisión, 18,6% de dosis, 18,6% de intervalo y 1,7% de vía de administración. Conclusión: el estudio muestra la alta prevalencia de discrepancias, principalmente de omisión, siendo casi mitad de ellas no intencionales. Ese dato nos indica el número de medicamentos que no son reincorporados al tratamiento de los pacientes, lo que puede repercutir en consecuencias clínicas importantes.

OBJETIVO: Identificar domicílios atendidos pela estratégia saúde da família (ESF) que possuíam estoque de medicamentos, avaliar as condições de armazenamento e conhecer o modo de uso dos medicamentos. MÉTODOS: O estudo foi conduzido em um município do Estado de São Paulo que possui duas unidades da ESF, com 1 867 domicílios cadastrados; a amostra foi definida por meio de sorteio aleatório estratificado. A coleta de dados foi realizada por meio de entrevistas semiestruturadas de julho a outubro de 2008. RESULTADOS: Foi entrevistado um morador em cada um dos 280 domicílios visitados. Foram encontrados medicamentos em 255 domicílios (91,1%). Dos 326 locais de guarda de medicamentos, 217 (75,8%) eram inadequados (de fácil acesso a crianças ou expostos a umidade, luz). Das 2 578 especialidades farmacêuticas encontradas, 2 059 (79,9%) tinham algum problema de segurança ou identificação, o que foi observado em 236 (84,3%) domicílios. Dos 280 entrevistados, 179 (63,9%) eram usuários de medicamentos. Desses, 24 estavam se automedicando, apenas um com medicamento que não exigia prescrição. Somente 44 usuários tinham a prescrição do medicamento. O medicamento era usado de forma diferente da prescrição por 21 entrevistados, por desacordo posológico ou interrupção do tratamento. CONCLUSÕES: A maioria dos domicílios estudados armazenava os medicamentos de forma inadequada. As discordâncias em relação às orientações médicas prescritas podem levar a resultados negativos, como ineficácia por uso de doses abaixo do prescrito, intoxicações por doses acima do prescrito, reações adversas e não adesão terapêutica.OBJECTIVE: To identify families served by the family health strategy (FHS) storing medicines at home, to evaluate storage conditions, and to investigate medicine use practices. METHODS: The study was conducted in a municipality in the state of São Paulo with two FHS units serving 1 867 households. The sample was selected by means of stratified random sampling. Data collection was conducted through semistructured interviews from July to October 2008. RESULTS: One resident was interviewed in each of the 280 households visited. Medicines were found in 255 households (91.1%). Of 326 storage locations, 217 (75.8%) were inadequate (easily accessible to children or exposed to moisture, light). Of the 2 578 medicines identified, 2 059 medicines (79.9%) in 236 (84.3%) households had safety or identification problems. Of the 280 respondents, 179 (63.9%) used medications. Of these, 24 were self-medicating, only one with an over-the-counter drug. Only 44 users had the prescription for their medication, and 21 did not follow the prescription in terms of dosage or had interrupted the treatment. CONCLUSIONS: Non-adherence to recommended treatment can lead to negative outcomes, such as inefficiency (using dosages lower than prescribed), poisoning (using dosages higher than prescribed), and other adverse reactions.

Através deste estudo, avaliou-se o nível de conhecimento e conduta dos farmacêuticos, responsáveis técnicos (RT) em drogarias, quanto a alguns aspectos da legislação farmacêutica e sanitária. Foram entrevistados 45 RT em 2007, sendo que 19 desconheciam a definição dos medicamentos de referência, 21 do genérico e 25 do similar. Todos sabiam da permissão de aplicação de medicamentos injetáveis. Porém, apenas dois sabiam da permissão da aplicação de penicilínicos, metade desconhecia que é permitido fracionar medicamentos fracionáveis em drogaria, 18 não sabiam dispensar corretamente uma prescrição pelo princípio ativo e 37 acreditavam que o farmacêutico pode intercambiar qualquer medicamento de marca pelo genérico. A maioria dos RT apresentou nível regular e insatisfatório de conduta e de conhecimento sobre a legislação profissional e sanitária, o que sinaliza um problema na formação acadêmica e de atualização permanente, podendo comprometer as diretrizes da política nacional de medicamentos. Palavras-chave: Legislação de Medicamentos. Legislação Farmacêutica. Legislação Sanitária, Conhecimentos. Condutas e Prática em Saúde. Atitude do Pessoal de Saúde. ABSTRACT Assessment of knowledge and behavior of pharmacists with technical responsibility for drugstores This paper is a study of the level of knowledge and conduct of the legally responsible pharmacist-in-charge (PIC) at drugstores, regarding certain aspects of pharmaceutical and health legislation. In 2007, 45 PICs were interviewed, of whom 19 did not know the definition of original (innovative) branded drugs, 21 of generic drugs and 25 of similar branded drugs. All PICs knew that it is permitted to administer injectable drugs in the drugstore. However, only two knew that penicillins can be injected, half of them did not know that certain medicines can be fractionated in drugstores, 18 did not know how to dispense correctly a prescription for an active ingredient and 37 believed that the pharmacist can swap any brand name drug with its generic counterpart. Most PICs showed an unsatisfactory level of conduct and knowledge of the professional and health legislation, which points to problems in the undergraduate and in-service training of pharmacists, that could jeopardize the national drug policy guidelines. Keywords: Legislation, Drug. Legislation, Pharmacy. Legislation, Health. Health Knowledge. Attitudes, Practice. Attitude of Health Personnel.

This is an experience report on clinical pharmacy in New York, United States of America, in a teaching hospital, describing the results of drug therapy monitoring in critically ill patients, as well as interventions to solve or prevent identified drug therapy problems. The cross-sectional study was conducted by the clinical staff at the Surgical Intensive Care Unit during August 20th to 24th, 2012. Blood counts, serum levels of certain antibiotics, microbiological cultures and their antibiotic susceptibility, possible drug interactions, dosage of each drug prescribed and the compatibility between the route of administration and pharmaceutical form were assessed daily through review of electronic medical records. Twenty seven patients were followed up and 16 drug therapy problems were identified: Unnecessary drug therapy (seven), adverse drug reaction (four), needs additional drug therapy (two), noncompliance (two) and dosage too low (one). After evaluation, the drug therapy problems and their pharmaceutical interventions were reported to clinical pharmaceutical responsible for the Surgical ICU, as well as the multidisciplinary team. Further, the clinical outcomes were monitored and interventions were classified as to its acceptance. Data demonstrate that clinical pharmacists can contribute to the security and proper use of medications, as the trigger tools for intensive monitoring helps in early detection of drug therapy problems and patient safety.

Made available in DSpace on 2013-08-12T19:00:10Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-05-01 Made available in DSpace on 2013-09-30T18:06:32Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-05-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:24:51Z No. of bitstreams: 0 Made available in DSpace on 2014-05-20T13:24:51Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-05-01 Objective. To identify families served by the family health strategy (FHS) storing medicines at home, to evaluate storage conditions, and to investigate medicine use practices.Methods. The study was conducted in a municipality in the state of São Paulo with two FHS units serving 1 867 households. The sample was selected by means of stratified random sampling. Data collection was conducted through semistructured interviews from July to October 2008.Results. One resident was interviewed in each of the 280 households visited. Medicines were found in 255 households (91.1%). of 326 storage locations, 217 (75.8%) were inadequate (easily accessible to children or exposed to moisture, light). of the 2 578 medicines identified, 2 059 medicines (79.9%) in 236 (84.3%) households had safety or identification problems. of the 280 respondents, 179 (63.9%) used medications. of these, 24 were self-medicating, only one with an over-the-counter drug. Only 44 users had the prescription for their medication, and 21 did not follow the prescription in terms of dosage or had interrupted the treatment.Conclusions. Non-adherence to recommended treatment can lead to negative outcomes, such as inefficiency (using dosages lower than prescribed), poisoning (using dosages higher than prescribed), and other adverse reactions. Univ Estadual Paulista UNESP, Fac Ciencias Farmaceut, Dept Farmacos & Medicamentos, Araraquara, SP, Brazil UNESP, Fac Ciencias Farmaceut, Dept Farmacos & Medicamentos, Araraquara, SP, Brazil Univ Fed São Paulo UNIFESP, Dept Psicol, São Paulo, Brazil Univ Estadual Paulista UNESP, Fac Ciencias Farmaceut, Dept Farmacos & Medicamentos, Araraquara, SP, Brazil UNESP, Fac Ciencias Farmaceut, Dept Farmacos & Medicamentos, Araraquara, SP, Brazil

To identify families served by the family health strategy (FHS) storing medicines at home, to evaluate storage conditions, and to investigate medicine use practices.The study was conducted in a municipality in the state of São Paulo with two FHS units serving 1 867 households. The sample was selected by means of stratified random sampling. Data collection was conducted through semistructured interviews from July to October 2008.One resident was interviewed in each of the 280 households visited. Medicines were found in 255 households (91.1%). Of 326 storage locations, 217 (75.8%) were inadequate (easily accessible to children or exposed to moisture, light). Of the 2 578 medicines identified, 2 059 medicines (79.9%) in 236 (84.3%) households had safety or identification problems. Of the 280 respondents, 179 (63.9%) used medications. Of these, 24 were self-medicating, only one with an over-the-counter drug. Only 44 users had the prescription for their medication, and 21 did not follow the prescription in terms of dosage or had interrupted the treatment.Non-adherence to recommended treatment can lead to negative outcomes, such as inefficiency (using dosages lower than prescribed), poisoning (using dosages higher than prescribed), and other adverse reactions.

Summary Antiobesity pharmacotherapy remains the main point of disagreement among both scientists and regulators. This is probably due to small sample sizes, high levels of heterogeneity, and low methodological quality. For many years, Brazil was one of the largest consumers of appetite suppressants worldwide, with evidence of irrational use of this drug class. Therefore, the country was the scene of a debate that divided the Brazilian Health Surveillance Agency (Anvisa - Agência Nacional de Vigilância Sanitária) and medical societies over the maintenance record of diethylpropion, mazindol and fenproporex. In this context, this commentary presents new arguments to contribute to the discussion, as well as recommendations for future studies.