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Background Evidence on patient medication knowledge and associated factors within primary care patients is limited, especially in developing countries. Objective To estimate the prevalence and investigate the role of individual and contextual factors on insufficient medication knowledge among primary care patients. Setting Public community pharmacies in a health pole city (234,937 inhab.) in Minas Gerais State, Brazil. Methods Exit-survey conducted with a representative sample of 1221 patients (≥ 18 years) interviewed after dispensing. Data collected for medicines included its name, therapeutic indication, dosage, time of administration, treatment duration, side effects and warnings. Information were compared to the prescription and official guidelines. Descriptive statistics and logistic regression analysis were applied. Main outcome measure Insufficient patient medication knowledge. Results Prevalence of insufficient medication knowledge was 30.1%. Side effects (96.3%) and warnings (71.1%) had the highest percentage of misses. Musculoskeletal system drugs presented the lowest knowledge score (mean = 5.9; SD = 1.9). Significant determinants of insufficient medication knowledge with respective odds ratio (OR) were: level of education (≤ 3 years, OR 1.50; 95% CI 1.06–2.11 and 4–7 years, OR 1.37; 95% CI 1.02–1.84), number of comorbidities (≤ 2, OR 1.36; 95% CI 1.04–1.77), use of prescription drugs in the last 15 days (no, OR 2.22; 95% CI 1.31–3.76) and number of people able to lend money (no person, OR 1.34; 95% CI 1.04–1.74). Conclusion Counselling and monitoring practices should be tailored to patients with less schooling, that are initiating treatment and with low disease burden. Equally important is the need to implement strategies to increase the patient’s level of social capital to improve treatment knowledge.

Resumo Estudo transversal da disponibilidade de medicamentos prescritos na Atenção Primária, com amostra probabilística de 1221 usuários das farmácias públicas de município polo de saúde em Minas Gerais, em 2017. Foram estimados indicadores de disponibilidade dos medicamentos e realizou-se regressão logística hierárquica, segundo o modelo comportamental de uso de serviços de saúde. Apenas 39,3% dos usuários receberam todos os medicamentos nas quantidades prescritas. Os medicamentos mais e menos disponíveis foram, respectivamente, os que atuam no sistema digestivo/metabolismo, e no sangue e órgãos hematopoiéticos. A disponibilidade integral do tratamento se mostrou associada a mais escolaridade (≥ 8 anos OR: 1,7; IC 95%: 1,3-2,4); proximidade até a farmácia (≤15 min OR: 1,7; IC 95%: 1,2-2,3); ausência de gastos privados com medicamentos (OR: 2,2; IC 95%: 1,7-2,9) e menor número de medicamentos prescritos (≤ 2 OR: 3,2; IC 95%: 2,3-4,4; 3/4 OR: 1,6; IC 95%: 1,2-2,1). Esses resultados mostram diferenças na disponibilidade de medicamentos dentro do SUS, evidenciando a necessidade de reorganização da rede de atendimento dos serviços de dispensação e do planejamento das aquisições de medicamentos, além da proposição de políticas públicas que priorizem a população mais vulnerável. Abstract This is a cross-sectional study on the availability of prescribed medicines in Primary Health Care (PHC), with a probabilistic sample of 1,221 users of public pharmacies in a health pole municipality in Minas Gerais, in 2017. Medicine availability indicators were estimated, and a hierarchical logistic regression was performed, according to the behavioral model of health service use. Only 39.3% of patients received all medicines in the prescribed quantities. The most and the least available medicines were, respectively, those for the digestive system/metabolism, and for blood and hematopoietic organs. Full availability of the prescribed treatment was associated with higher schooling (≥ 8 years OR: 1.7; 95% CI: 1.3-2.4); proximity to the pharmacy (≤15 min OR: 1.7; 95% CI: 1.2-2.3); absence of out-of-pocket expenditure on medicines (OR: 2.2; 95% CI: 1.7-2.9), and a smaller number of prescription drugs (≤ 2 OR: 3.2; 95% CI: 2.3-4.4; 3/4 OR: 1.6; 95% CI: 1.2-2.1). These results showed differences in medicine availability within the Brazilian Unified Health System (SUS), and highlighted the need to reorganize the dispensing services network and pharmaceutical procurement planning, as well as to develop public policies to protect the vulnerable population.

Resumo Medicamentos neuropsiquiátricos são utilizados para variadas condições neurológicas e psiquiátricas. O objetivo deste artigo é analisar evolução e determinantes dos gastos públicos com esses medicamentos em Minas Gerais de 2010 a 2017. Dados do Sistema Integrado de Administração de Materiais e Serviços (SIAD) foram usados para estimar volumes de aquisição e gastos. Realizou-se análise de decomposição e, para os medicamentos antiparkinsonianos foi avaliado o elenco adquirido, aplicando-se, ainda, a técnica de Drug Utilization (DU90%). O gasto anual diminuiu 36%, passando de R$ 111,7 milhões em 2010 para R$ 40,9 milhões em 2017, tendo como fatores determinantes a queda de preços e de volume, associada às mudanças do drugmix, optando-se pela aquisição de produtos, em média, mais caros. Destaca-se o aumento dos gastos para a classe dos antiparkinsonianos, porém, com significativa mudança no elenco adquirido. Esse estudo contribuiu para um melhor entendimento dos gastos públicos com medicamentos neuropsiquiátricos. A redução do volume pode elevar o risco de desabastecimento. Com relação aos antiparkinsonianos, não há evidências que sugiram aumento da oferta para a população. Abstract Neuropsychiatric drugs are used for a wide variety of neurological and psychiatric conditions. This article aims to analyze the trend and determinants of public expenditure of these medicines in Minas Gerais, from 2010 to 2017. Data from the Integrated Materials and Services Administration System (SIAD) database were used to estimate volumes of acquisition and expenditure. A breakdown analysis was performed, and the list of purchased drugs was reviewed, and the Drug Utilization technique (DU90%) applied concerning anti-Parkinson drugs. Annual expenditure dropped by 36%, from R$ 111.7 million in 2010 to R$ 40.9 million in 2017, and the determinant factors were the falling prices and volume, associated with changes in the drug mix, which favored the acquisition, on average, of more expensive products. Higher levels of expenditure for anti-Parkinson drugs stand out, however, with a significant change in the list purchased. This study contributed to a better understanding of public spending on neuropsychiatric drugs. A reduced volume can increase the risk of shortages. Regarding anti-Parkinson drugs, there is no evidence to suggest an increased supply to the population.

This is a cross-sectional study on the availability of prescribed medicines in Primary Health Care (PHC), with a probabilistic sample of 1,221 users of public pharmacies in a health pole municipality in Minas Gerais, in 2017. Medicine availability indicators were estimated, and a hierarchical logistic regression was performed, according to the behavioral model of health service use. Only 39.3% of patients received all medicines in the prescribed quantities. The most and the least available medicines were, respectively, those for the digestive system/metabolism, and for blood and hematopoietic organs. Full availability of the prescribed treatment was associated with higher schooling (≥ 8 years OR: 1.7; 95% CI: 1.3-2.4); proximity to the pharmacy (≤15 min OR: 1.7; 95% CI: 1.2-2.3); absence of out-of-pocket expenditure on medicines (OR: 2.2; 95% CI: 1.7-2.9), and a smaller number of prescription drugs (≤ 2 OR: 3.2; 95% CI: 2.3-4.4; 3/4 OR: 1.6; 95% CI: 1.2-2.1). These results showed differences in medicine availability within the Brazilian Unified Health System (SUS), and highlighted the need to reorganize the dispensing services network and pharmaceutical procurement planning, as well as to develop public policies to protect the vulnerable population.Estudo transversal da disponibilidade de medicamentos prescritos na Atenção Primária, com amostra probabilística de 1221 usuários das farmácias públicas de município polo de saúde em Minas Gerais, em 2017. Foram estimados indicadores de disponibilidade dos medicamentos e realizou-se regressão logística hierárquica, segundo o modelo comportamental de uso de serviços de saúde. Apenas 39,3% dos usuários receberam todos os medicamentos nas quantidades prescritas. Os medicamentos mais e menos disponíveis foram, respectivamente, os que atuam no sistema digestivo/metabolismo, e no sangue e órgãos hematopoiéticos. A disponibilidade integral do tratamento se mostrou associada a mais escolaridade (≥ 8 anos OR: 1,7; IC 95%: 1,3-2,4); proximidade até a farmácia (≤15 min OR: 1,7; IC 95%: 1,2-2,3); ausência de gastos privados com medicamentos (OR: 2,2; IC 95%: 1,7-2,9) e menor número de medicamentos prescritos (≤ 2 OR: 3,2; IC 95%: 2,3-4,4; 3/4 OR: 1,6; IC 95%: 1,2-2,1). Esses resultados mostram diferenças na disponibilidade de medicamentos dentro do SUS, evidenciando a necessidade de reorganização da rede de atendimento dos serviços de dispensação e do planejamento das aquisições de medicamentos, além da proposição de políticas públicas que priorizem a população mais vulnerável.

Background Evidence on patient medication knowledge and associated factors within primary care patients is limited, especially in developing countries. Objective To estimate the prevalence and investigate the role of individual and contextual factors on insufficient medication knowledge among primary care patients. Setting Public community pharmacies in a health pole city (234,937 inhab.) in Minas Gerais State, Brazil. Methods Exit-survey conducted with a representative sample of 1221 patients (≥ 18 years) interviewed after dispensing. Data collected for medicines included its name, therapeutic indication, dosage, time of administration, treatment duration, side effects and warnings. Information were compared to the prescription and official guidelines. Descriptive statistics and logistic regression analysis were applied. Main outcome measure Insufficient patient medication knowledge. Results Prevalence of insufficient medication knowledge was 30.1%. Side effects (96.3%) and warnings (71.1%) had the highest percentage of misses. Musculoskeletal system drugs presented the lowest knowledge score (mean = 5.9; SD = 1.9). Significant determinants of insufficient medication knowledge with respective odds ratio (OR) were: level of education (≤ 3 years, OR 1.50; 95% CI 1.06-2.11 and 4-7 years, OR 1.37; 95% CI 1.02-1.84), number of comorbidities (≤ 2, OR 1.36; 95% CI 1.04-1.77), use of prescription drugs in the last 15 days (no, OR 2.22; 95% CI 1.31-3.76) and number of people able to lend money (no person, OR 1.34; 95% CI 1.04-1.74). Conclusion Counselling and monitoring practices should be tailored to patients with less schooling, that are initiating treatment and with low disease burden. Equally important is the need to implement strategies to increase the patient's level of social capital to improve treatment knowledge.

Background: Medicines availability in public healthcare systems varies from 17.6% to 88.6%. However, accurate measures of this indicator taking into account each prescribed medicine and the respective quantity required for the entire treatment are scarce. The aim of this study is to evaluate the availability of medicines in primary care and to identify its associated factors. Methods: Exit survey in 2017 with 1221 primary care users in a medium-sized municipality (234,937 inhab.), Minas Gerais state, Brazil. Each prescribed medicine was considered available if dispensed in adequate quantity for the duration prescribed. Prescriptions were classified as: totally filled, partially filled and unavailable. Pearson’s Chi-Square test was used to examine the association of full prescription availability with individual sociodemographic and health status variables at a significance level of 5%. Results:1186 prescriptions were analyzed, totaling 4039 medicines [mean = 3,4; Min = 1; Max = 11]. Prevalence of prescriptions totally filled was 39.4%, partially filled 48.23% and unavailable, 12.48%. The most and least available therapeutic groups were antiparasitic (100%) and anti-infectious (38,6%), respectively. Significant associations between full availability of the prescription and younger age (p = 0.000); more schooling (p = 0.000); poor perception of health (p = 0.001) and fewer comorbidities (p = 0.000) were identified. Conclusion: This study used a variety of indicators to characterize the availability of prescription medicines. The results show the need of implementing improvements in public policies to promote adequate access to medicines and reduce inequalities, especially among the most vulnerable populations.

Background: Patients’ knowledge of their pharmacotherapy impacts the correct use of their drugs and, consequently, is paramount to the effectiveness of the prescribed treatment.Methods:Exit surveys administered to a representative sample of 1221 adult patients (≥18 years) from pharmaceutical services at primary care in a health pole municipality (234,937 inhab.) from the midwest macrorregion in Minas Gerais State, Brazil. Data on medical prescriptions and dispensed medications were collected and one of the prescribed drugs was randomly selected for analysis. Patients’ responses to the following itens: drug name, dosage, frequency of administration, indication, directions of use, treatment duration, warnings (patient’ attitudes when doses are missed, contraindications, side effects and interactions) were compared with prescription and/or literature and scored. Subsequently an overall level of knowledge index was constructed with the following cutoff points: less than 8 points (insufficient), 8 to 10 points (regular) and 11 points or more (good). Results:The level of knowledge of pharmacotherapy was considered insufficient for 30.8% of the patients, regular for 64.0% and good for 5.2% of them. Misinformation was more concentrated on warnings (side effects (96.3%), interactions (91.0%), missed doses (71.1%)) and indication (53.5%). Conclusion:The low level of treatment knowledge indicates the need for investment on redirecting patients’ counseling and monitoring work practices among primary care professionals.

Neuropsychiatric drugs are used for a wide variety of neurological and psychiatric conditions. This article aims to analyze the trend and determinants of public expenditure of these medicines in Minas Gerais, from 2010 to 2017. Data from the Integrated Materials and Services Administration System (SIAD) database were used to estimate volumes of acquisition and expenditure. A breakdown analysis was performed, and the list of purchased drugs was reviewed, and the Drug Utilization technique (DU90%) applied concerning anti-Parkinson drugs. Annual expenditure dropped by 36%, from R$ 111.7 million in 2010 to R$ 40.9 million in 2017, and the determinant factors were the falling prices and volume, associated with changes in the drug mix, which favored the acquisition, on average, of more expensive products. Higher levels of expenditure for anti-Parkinson drugs stand out, however, with a significant change in the list purchased. This study contributed to a better understanding of public spending on neuropsychiatric drugs. A reduced volume can increase the risk of shortages. Regarding anti-Parkinson drugs, there is no evidence to suggest an increased supply to the population.Medicamentos neuropsiquiátricos são utilizados para variadas condições neurológicas e psiquiátricas. O objetivo deste artigo é analisar evolução e determinantes dos gastos públicos com esses medicamentos em Minas Gerais de 2010 a 2017. Dados do Sistema Integrado de Administração de Materiais e Serviços (SIAD) foram usados para estimar volumes de aquisição e gastos. Realizou-se análise de decomposição e, para os medicamentos antiparkinsonianos foi avaliado o elenco adquirido, aplicando-se, ainda, a técnica de Drug Utilization (DU90%). O gasto anual diminuiu 36%, passando de R$ 111,7 milhões em 2010 para R$ 40,9 milhões em 2017, tendo como fatores determinantes a queda de preços e de volume, associada às mudanças do drugmix, optando-se pela aquisição de produtos, em média, mais caros. Destaca-se o aumento dos gastos para a classe dos antiparkinsonianos, porém, com significativa mudança no elenco adquirido. Esse estudo contribuiu para um melhor entendimento dos gastos públicos com medicamentos neuropsiquiátricos. A redução do volume pode elevar o risco de desabastecimento. Com relação aos antiparkinsonianos, não há evidências que sugiram aumento da oferta para a população.

Resumo A alocação de recursos com a aquisição de medicamentos é um dos maiores desafios para a efetivação da assistência farmacêutica no SUS. No entanto, poucos estudos avaliam a evolução desses gastos no nível estadual, especialmente com as classes dos antidepressivos, ansiolíticos e hipnótico-sedativos. O objetivo do estudo foi analisar e identificar os determinantes dos gastos com essas classes terapêuticas em Minas Gerais. Foram utilizados dados de compras públicas do Sistema Integrado de Administração de Materiais e Serviços (SIAD-MG) entre 2010 e 2015. Estimaram-se os gastos e volumes totais, além dos gastos com medicamentos não constantes nas listas de medicamentos essenciais. As análises de “Top 10” e de “Drug Cost 90%” identificaram os medicamentos responsáveis pelo maior gasto, e a análise de decomposição estabeleceu os determinantes da variação das despesas. Os gastos com as três classes totalizaram R$ 81 milhões e aumentaram 2,5 vezes entre 2010 e 2015, passando de R$ 7,5 milhões para R$ 18,7 milhões. Os antidepressivos representaram 89% dos gastos e 71% do volume adquirido. O preço foi o principal fator determinante do aumento das despesas, especialmente na classe dos antidepressivos. Os aumentos dos gastos ressaltam a necessidade de aprimoramento dos procedimentos de compra adotados pelo estado. Abstract The allocation of financial resources on medicines procurement is one of the greatest challenges to the effectiveness of the Pharmaceutical Services in the Brazilian National Health System. However, there are few studies evaluating this expenditure trends at state level, especially with antidepressants, anxiolytics, hypnotics and sedatives. The study evaluated public expenditure trends and drivers for these therapeutic classes in Minas Gerais state, Brazil, by using data from SIAD database [Sistema Integrado de Administração de Materiais e Serviços] from 2010 to 2015. Total expenditure, volume and also expenditures with medicines not included in the essential lists were estimated. The top 10 medicines in terms of expenditure and drugs accounting for 90% of the total cost were identified. Decomposition analysis was conducted to assess the drivers of expenditure. Expenditure in the period totaled R$ 81 million and increased 2.5 times from 2010 to 2015. Antidepressants accounted for 89% of expenses and 71% of volume. Price contributed positively to the expenditure variation during the period, especially in antidepressants. The results highlight the need of improvement of public procurement procedures adopted by Minas Gerais state.

RESUMO: Introdução: As leishmanioses representam uma importante carga de doença nos países tropicais, apresentando índices significativos de morbimortalidade nos locais onde ocorrem, incluindo o Brasil. Nesse contexto, a participação popular nas ações profiláticas pode ser determinante para o êxito das estratégias de controle. Objetivo: Por isso, o presente estudo teve o objetivo de investigar o conhecimento da população sobre as leishmanioses e a ocorrência de fatores de risco peridomiciliares associados à população no município de Formiga, Minas Gerais. Métodos: Foi realizado um inquérito domiciliar com uma amostra de 427 indivíduos entre maio e julho de 2011. Resultados: Apenas 7,5% dos moradores mostraram conhecimento sobre as leishmanioses, sendo principalmente as mulheres (OR = 3,15; IC95% 1,30 - 7,65). A prevalência de riscos peridomiciliares foi de 95%. Associação estatisticamente significativa foi encontrada entre maior escolaridade e menos fatores de risco peridomiciliares (OR = 0,45; IC95% 0,28 - 0,72) e entre o local de residência e maior número desses fatores de risco (OR = 1,84; IC95% 1,19 - 2,85). Conclusão: Os resultados demonstram que há baixo nível de conhecimento sobre as leishmanioses por parte da população. Além disso, a maioria dos respondentes está sujeita a algum fator de risco peridomiciliar, fato que pode contribuir para a manutenção do ciclo da doença no município.

Immunosuppressants are recommended for treatment of autoimmune diseases, and in transplant therapy. The high cost of these drugs has been causing an important impact on global pharmaceutical spending.Analyzing immunosuppressant expenditure in Brazil, using data from the Federal Procurement System database (SIASG), between 2010 and 2015.The pharmaceutical products were classified in accordance with the Anatomical, Therapeutic and Chemical (ATC) classification system recommended by World Health Organization (WHO) and aggregated by volume and by expenditure. The expenditure variation was decomposed into three broad categories: price effects, quantity effects, and drug mix effects.During the period, annual expenditure increased by 49%, ranging from USD 494.5 million in 2010 to USD 738.7 million in 2015, while purchased quantities increased by 294%, ranging from 49.8 million in 2010 to 196.5 million in 2015. Two factors drove expenditures: the quantity effect and the drug-mix effect.These findings may contribute to understand immunosuppressant spending trends and the factors that influence them in order to formulate effective cost containment strategies and design optimum drug policy. Rigorous evaluations are recommended to reduce the drug-mix effect, including systems to monitor price, effectiveness, safety, therapeutic value and budget impact of pharmaceutical innovations.

The costs of medicines pose a growing burden on healthcare systems worldwide. A comprehensive understanding of current procurement processes provides strong support for the development of effective policies. This study examined Brazilian Federal Government pharmaceutical procurement data provided by the Integrated System for the Administration of General Services (SIASG) database, from 2006 to 2013. Medicine purchases were aggregated by volume and expenditure for each year. Data on expenditure were adjusted for inflation using the Extended National Consumer Price Index (IPCA) for December 31, 2013. Lorenz distribution curves were used to study the cumulative proportion of purchased therapeutic classes. Expenditure variance analysis was performed to determine the impact of each factor, price and/or volume, on total expenditure variation. Annual expenditure on medicines increased 2.72 times, while the purchased volume of drugs increased 1.99 times. A limited number of therapeutic classes dominated expenditure each year. Drugs for infectious diseases drove the increase in expenditures from 2006 to 2009 but were replaced by antineoplastic and immunomodulating agents beginning in 2010. Immunosuppressants (L04), accounted for one third of purchases since 2010, showing the most substantial growth in expenditures during the period (250-fold increase). The overwhelming price-related increase in expenditures caused by these medicines is bound to have a relevant impact on the sustainability of the pharmaceutical supply system. We observed increasing trends in expenditures, especially in specific therapeutic classes. We propose the development and implementation of better medicine procurement systems, and strategies to allow for monitoring of product price, effectiveness, and safety. This must be done with ongoing assessment of pharmaceutical innovations, therapeutic value and budget impact.

This cross-sectional study assesses the prevalence and examines the role of social and demographic factors, health conditions, health system characteristics and contextual factors of under-utilization of medication for financial reasons among elderly women. Participants in the Greater Metropolitan Belo Horizonte Health Survey (GMBH) and the eleventh phase of the Bambuí Cohort Study of the Elderly were assessed. Among elderly women in the GMBH, the prevalence of under-utilization was 11.4%, and in Bambuí, the rate was 5.4%. Self-perception of health (OR, 3.46; 95%CI, 1.32_9.10); daily life limitations (OR, 2.75; 95% CI, 1.31-5.78) and perception of help (OR, 2.36; 95% CI, 1.07-5.25) had independent associations with under-utilization among GMBH residents. A poor perception of both cohesion in the neighborhood (OR, 2.38; 95% CI, 1.02-5.56) and the physical environment (OR, 2.58; 95% CI, 1.10-6.03) significantly increased the likelihood of under-utilization among Bambuí residents. These results provide important clues to identifying possible risk factors for under-utilization, highlighting the need to develop strategies targeting the amplification of the involvement between elderly women and their community to reduce the extent of under-utilization in later life. Este estudo transversal apresenta estimativas de prevalência e avalia o papel dos fatores sociodemográficos, condições de saúde, características do sistema de saúde e contextuais na subutilização de medicamentos por motivos financeiros entre as mulheres mais idosas. Participantes do Inquérito de Saúde da Região Metropolitana de Belo Horizonte (RMBH) e do décimo primeiro seguimento do Estudo de Coorte de Idosos de Bambuí foram avaliadas. Na RMBH, a prevalência da subutilização foi de 11,4%, e em Bambuí, foi de 5,4%. Autopercepção de saúde (OR = 3,46; IC95% = 1,329,10); limitações da vida diária (OR = 2,75; IC95% = 1,31-5.78) e percepção de ajuda (OR = 2,36; IC95% = 1,07-5,25) apresentaram associações independentes com a subutilização para as residentes na RMBH. Já a pior percepção de coesão ao bairro de moradia (OR = 2,38; IC95% = 1,02-5,56) e a pior percepção do ambiente físico (OR = 2,58; IC95% = 1,10-6,03) aumentaram significativamente a chance de subutilização em Bambuí. Estes resultados apresentam importantes evidências na identificação de fatores de risco para a subutilização e apontam para a necessidade de desenvolver estratégias para ampliar a integração das idosas em sua comunidade de modo a reduzir o impacto da subutilização na velhice.

Medicamentos são um componente essencial da terapêutica, no entanto, informações sobre seu consumo em população trabalhadora são escassas. Para estimar a prevalência, caracterizar o perfil daqueles consumidos e avaliar os fatores associados ao seu uso em trabalhadores foi realizado estudo seccional de dados da linha de base da Coorte "PROSEC" (n=417). A prevalência de consumo de pelo menos um medicamento foi de 72,4%, destacando-se fármacos com ação no sistema nervoso (25,4%), especialmente analgésicos (17,8%). Fatores associados ao uso de qualquer número de medicamentos (pAlthough medication is acknowledged as a key element in treating health problems, there is little information available on the use of medication by hospital workers. To estimate the prevalence and describe the patterns of medication consumption by hospital workers and to identify the factors associated with such consumption in this population, data from the "PROSEC" baseline cohort were analyzed (n=417). The prevalence of overall medication consumption was 72.4%, most of which was for nervous complaints (25.4%), especially analgesics (17.8%). Use of any amount of medication was independently associated with gender, number of medically diagnosed conditions and health problem in the two weeks prior to the interview. Use of a drug was significantly associated with income whereas self-diagnosed health problems were independently related with the use of two or more pharmaceutical products. The high prevalence of medication usage in this population, with analgesics being the most consumed medication, should be seen as a cause for concern, since many consumers are unaware that these products are not exempt from risk. Women and individuals in poor health are the main candidates for intervention programs in order to promote adequate and proper use of these pharmaceutical products.

Background: In Brazil, 99.7 % of malaria cases occur in the Amazon region. Although the number of cases is decreasing, the country accounted for almost 60 % of cases in the Americas Region, in 2013. Novel approaches for malaria treatment open the possibility of eliminating the disease, but suboptimal dispensing and lack of adherence influence treatment outcomes. The aim of this paper is to show the results on dispensing practices, non-adherence and determinants of non-adherence to treatment of non-complicated malaria. Methods: The study was conducted in six high-risk municipalities with Plasmodium vivax and Plasmodium falciparum transmission in the Brazilian Amazon and based on the theoretical framework of the Mafalda Project, which included investigation of dispensing and adherence. The World Health Organization Rapid Evaluation Method has been used to estimate sample size. Individuals over 15 years of age with malaria were approached at health facilities and invited to participate through informed consent. Data was collected in chart review forms focusing on diagnosis, Plasmodium type, prescribing, and dispensing (kind, quantity, labelling and procedures). Follow-up household interviews complemented data collection at health facility. Non-adherence was measured during the implementation phase, by self-reports and pill-counts. Analysis was descriptive and statistical tests were carried out. Determinants of non-adherence and quality of dispensing were assessed according to the literature. Results: The study involved 165 patients. Dispensing was done according to the national guidelines. Labelling was adequate for P. vivax but inadequate for P. falciparum medicines. Non-adherent patients were 12.1 % according to self-reports and 21.8 % according to pill-counts. Results point to greater non-adherence among all P. falciparum patients and among malaria non-naive patients. More patients informed understanding adverse effects than `how to use' anti-malarials. Conclusions: Non-adherent patients were mostly those with a P. falciparum diagnosis and those in their second or more malaria episode. New taxonomies and concepts on adherence stress the importance of focusing on the individual patient. Interventions targeted to and tailored for malaria patients must be addressed by health policy and implemented by managers and clinicians.

Dados do Sistema de Vigilância de Violências e Acidentes (VIVA) de 2009 foram utilizados para examinar características sociodemográficas, desfechos e tipos de acidentes e violências que levaram a atendimento em 74 serviços sentinela situados em 23 capitais brasileiras e no Distrito Federal. A análise incluiu 25.201 indivíduos com idade > 20 anos (10,1% com > 60 anos), dos quais 89,3% foram vítimas de acidentes e 11,9% de violências. A hospitalização foi o desfecho de 11,1% dos casos. Em comparação à população geral, observou-se ainda um excesso de homens e da cor da pele não branca entre vítimas de acidentes e, sobretudo, de violência. O perfil desses eventos entre os mais velhos diferiu dos mais jovens (20-59 anos), com destaque para a menor contribuição do álcool, o predomínio de ocorrências no domicílio, a maior importância relativa das quedas e a maior vulnerabilidade a atropelamentos e a agressões por familiares. Políticas para a prevenção de acidentes e violências devem levar em conta as especificidades desses eventos na população mais velha.

OBJECTIVE To analyze the patterns and legal requirements of methylphenidate consumption. METHODS We conducted a cross-sectional study of the data from prescription notification forms and balance lists of drugs sales – psychoactive and others – subject to special control in the fifth largest city of Brazil, in 2006. We determined the defined and prescribed daily doses, the average prescription and dispensation periods, and the regional sales distribution in the municipality. In addition, we estimated the costs of drug acquisition and analyzed the individual drug consumption profile using the Lorenz curve. RESULTS The balance lists data covered all notified sales of the drug while data from prescription notification forms covered 50.6% of the pharmacies that sold it, including those with the highest sales volumes. Total methylphenidate consumption was 0.37 DDD/1,000 inhabitants/day. Sales were concentrated in more developed areas, and regular-release tablets were the most commonly prescribed pharmaceutical formulation. In some regions of the city, approximately 20.0% of the prescriptions and dispensation exceeded 30 mg/day and 30 days of treatment. CONCLUSIONS Methylphenidate was widely consumed in the municipality and mainly in the most developed areas. Of note, the consumption of formulations with the higher abuse risk was the most predominant. Both its prescription and dispensation contrasted with current pharmacotherapeutic recommendations and legal requirements. Therefore, the commercialization of methylphenidate should be monitored more closely, and its use in the treatment of behavioral changes of psychological disorders needs to be discussed in detail, in line with the concepts of the quality use of medicines. OBJETIVO Analisar padrões e requisitos legais do consumo de metilfenidato. MÉTODOS Estudo transversal realizado em Belo Horizonte, MG, em 2006. Foram analisados dados de notificações de receitas de metilfenidato e de balanços de vendas de medicamentos – psicoativos e outros – sujeitos a controle especial. Determinou-se a dose diária definida, a dose diária prescrita, o período médio de prescrição e de dispensação, bem como a distribuição regional das vendas desse medicamento no município. Foram estimados, ainda, os gastos com a aquisição do medicamento e analisado o perfil de consumo individual do fármaco por meio da Curva de Lorenz. RESULTADOS Os dados dos balanços mensais de comercialização de psicotrópicos cobriram toda a comercialização notificada do fármaco, enquanto aqueles coletados nas notificações de receita cobriram 50,6% das farmácias que o comercializaram, incluindo aquelas de maior volume de venda. O consumo de metilfenidato foi 0,37 DDD/1.000 habitantes/dia. As vendas concentraram-se em áreas mais desenvolvidas e as formulações farmacêuticas de liberação não controlada foram as mais prescritas. A prescrição e a dispensação com dosagens > 30 mg/dia e período de tratamento > 30 dias apresentaram valores em torno de 20,0% em algumas regiões da cidade. CONCLUSÕES O consumo de metilfenidato apresentou-se elevado no município, maior em áreas mais favorecidas economicamente e predominando o consumo de formulações com maior risco de abuso. Tanto a prescrição quanto a dispensação apresentaram características não compatíveis com as recomendações farmacoterapêuticas e determinações legais. O controle de venda do fármaco deve ser monitorado e a farmacoterapia das alterações comportamentais amplamente rediscutida em concordância com os conceitos do uso de medicamentos com qualidade.

To assess the prevalence of disability and its association with social capital among community-dwelling elderly.The study was based on 2nd Health Survey of Belo Horizonte Metropolitan Region - 2010, that included 1,995 community-dwelling elderly, randomly sampled. The exposure of interest was social capital, measured by confidence in neighborhood, perception of the physical environment, sense of cohesion in housing, and neighborhood perception of help. Socio-demographic variables, health conditions and use of health services were considered in the analysis with the purpose of adjustment.Approximately one third of participants (32.6%) were unable to at least one instrumental activity of daily living (IADL) and/or basic activity of daily living (ADL); the prevalence of disability in ADL/IADL was 18.1%, and only in IADL was 14.6%. Elderly with functional disabilities had higher odds of poor social capital, but only the sense of cohesion in housing neighborhood showed to be independently associated with functional disability (OR = 1.80; 95%CI 1.12 - 2.88).Our results show the importance of social capital in research on associated factors of functional disability and indicate the need to implement public policies for social and environmental areas, since the needs of the elderly require measures beyond those typical of the health sector.

The safety of biological agents used to treat psoriasis remains uncertain.The authors determined the frequency and severity of adverse effects associated with use of biologic agents for psoriasis through patient-registered lawsuits to the government of Sao Paulo, Brazil.Sources of information included legal records, dispensing pharmacy data and interviews with patients. Research staff conducted telephone interviews with patients who used biologic drugs during 2004 - 2011, inquiring about medication-related adverse drug reactions (ADRs) and serious adverse events (SAEs).Of the 218 patients identified, 15 proved ineligible or refused participation. 203 patients were interviewed, with 111 (54.7%) taking infliximab, 43 (21.2%) efalizumab, 35 (17.2%) etanercept and 14 (6.9%) adalimumab. Of 84 (41.4%) patients who experienced one or more ADR related to biological agents, 57 (67.9%) experienced one or more SAE. The only risk factor associated with ADRs was comorbidity odds ratio = 6.54 (95% confident interval [CI] 3.20 - 13.32), p0.0001.Biologic agents were associated with high rates of ADRs and SAEs. The data suggests that for patients taking a biologic agent to treat psoriasis and who have one or more comorbidities, warnings of possible adverse events and enhanced surveillance are warranted.

Leishmaniasis represents an important burden of diseases in tropical countries, with significant levels of morbidity and mortality where they occur, including in Brazil. In this context, popular participation in prophylactic actions can be decisive for the success of the control strategies.For this reason, this study aimed at investigating the population's knowledge concerning leishmaniasis and the occurrence of peridomiciliary risk factors associated with the population of Formiga, Minas Gerais.A household questionnaire with a sample of 427 individuals was conducted between May and July 2011.Only 7.5% of the residents presented knowledge regarding leishmaniasis, most of them being women (OR = 3.15; 95%CI 1.30 - 7.65). The prevalence of peridomiciliary risks was 95%. A statistically significant association was found between higher education levels and less peridomiciliary risk factors (OR = 0.45; 95%CI 0.28 - 0.72) and between the place of residence and a higher number of risk factors (OR = 0.84; 95%CI 1.19 - 2.85).The results demonstrate that the population has low levels of knowledge about leishmaniasis. Moreover, the majority of respondents are subject to some peridomiciliary risk factor, which may contribute to the maintenance of the disease cycle in the city.

Objetivos: Avaliar prescrições de antimaláricos segundo indicadores de qualidade e descrever relatos de eventos adversos entre gestantes com malária não complicada. Métodos: Estudo descritivo de prontuários de gestantes maiores de 15 anos, residentes em municípios de alto risco na Amazônia Legal. Antimaláricos caracterizados segundo frequência de prescrição, tipo de plasmódio e de unidade de saúde de atendimento, e de possíveis eventos adversos. Para comparação das variáveis estudas utilizou-se o teste do qui-quadrado de Pearson. Resultados: Foram avaliados 262 prontuários de gestantes. A maioria das gestantes pesquisadas recebeu diagnóstico de infecção por P. vivax (71,2%). Cloroquina foi o fármaco mais prescrito (65,6%). Fármacos não recomendados foram encontrados em 9,0% e 16,2% das prescrições para P. vivax e P. falciparum , respectivamente. Prescrições para P. falciparum , em proporção significativamente maior, contiveram esquemas e posologia e/ou duração do tratamento não adequados ao protocolo oficial (p = 0,001), bem como sem especificação da posologia (p = 0,004). Não houve diferenças significativas entre hospitais de referência e unidades básicas de saúde quanto aos esquemas de tratamento, proporções de prescrições contendo esquemas de tratamento não adequados e sem especificação da posologia. Cloroquina foi o fármaco mais envolvido em ocorrências de eventos adversos. Conclusões: Os resultados mostraram deficiências na prescrição de antimaláricos para gestantes, especialmente quanto à adequação ao protocolo oficial. Aim: To evaluate antimalarial prescriptions according to quality indicators and to describe adverse events reports among pregnant women with uncomplicated malaria. Methods: Descriptive study of medical files of pregnant women 15 years and older, residents in high-risk municipalities in the Brazilian Amazon. Antimalarial medicines were characterized by frequency of prescription, type of plasmodium and health care facilities where prescribing took place, and by possible adverse events. Variables were compared by Pearson’s chi-square. Results: A total of 262 medical files were evaluated. Most patients were diagnosed for Plasmodium vivax 71,2%. Chloroquine was the commonest prescribed antimalarial (65.6%). Of P. vivax prescriptions, 9.0%, and 16.2% of P. falciparum prescriptions presented antimalarials not recommended in the official protocol. Prescriptions for P. falciparum , in significantly higher proportion, did not adhere to the official protocol in regard to type of antimalarial and dose/duration of treatment (p = 0,001). They also lacked information on dose and dosing interval (p = 0,004). There were no significant differences among reference centers and basic health care units in respect to the prescribed antimalarials, to prescriptions containing antimalarials not recommended in the official protocol or in respect to lack of dosing information. Chloroquine was the antimalarial most related to the occurrence of adverse events. Conclusion: The findings indicate that there are flaws in antimalarial prescribing for pregnant women, especially in respect to their adequacy to the official protocol.

Malaria in pregnancy is associated with increased risks of maternal anemia, spontaneous abortion, low birth weight, premature delivery and other adverse effects on health. In Brazil, disease transmission is highly concentrated in the multi-state region that constitutes the Brazilian Amazon (more than 99% of all cases). This study, conducted between the first bimesters of 2007 and 2008, aims to identify the local barriers to prompt and effective case management of malaria in pregnancy and was carried out in health facilities located in three endemic municipalities of the Brazilian Amazon (Manaus, Presidente Figueiredo and Porto Velho). The study design combined both qualitative and quantitative descriptive methods. The qualitative design involved semi-structured interviews with health personnel who routinely deal with malaria care. The quantitative design involved a review of medical records of pregnant women in the visited health facilities. Additionally, data were abstracted from SIVEP-Malaria Epidemiological Surveillance Information System (Brasil, 2007) and Primary Care Information System (SIAB) databases. Flaws were detected in diagnosis (only 6.8% of women tested for malaria) and treatment (for Plasmodium falciparum infections, only 44.8% of patients received recommended first-line therapy; 10.2% of prescription presented treatments were not found in national guideline and 7.3% of the prescriptions for Plasmodium vivax and 17.9% of the prescriptions for P. falciparum were not sanctioned by the official guidelines). Training (only 37.3% had had some training), knowledge and counseling were also sub-optimal. These results indicated the need to improve the health-worker performance through training. Close supervision and feedback on the health-worker performance are also needed. These findings also highlighted the need to put into practice a series of government recommendations that encourage close collaboration between the National Malaria Control Program and Primary Health Care actions in order to achieve safer pregnancies.

Medicamentos são um componente essencial da terapêutica, no entanto, informações sobre seu consumo em população trabalhadora são escassas. Para estimar a prevalência, caracterizar o perfil daqueles consumidos e avaliar os fatores associados ao seu uso em trabalhadores foi realizado estudo seccional de dados da linha de base da Coorte "PROSEC" (n=417). A prevalência de consumo de pelo menos um medicamento foi de 72,4%, destacando-se fármacos com ação no sistema nervoso (25,4%), especialmente analgésicos (17,8%). Fatores associados ao uso de qualquer número de medicamentos (p

To evaluate antimalarial prescriptions according to quality indicators and to describe adverse events reports among pregnant women with uncomplicated malaria.Descriptive study of medical files of pregnant women 15 years and older, residents in high-risk municipalities in the Brazilian Amazon. Antimalarial medicines were characterized by frequency of prescription, type of plasmodium and health care facilities where prescribing took place, and by possible adverse events. Variables were compared by Pearson's chi-square.A total of 262 medical files were evaluated. Most patients were diagnosed for Plasmodium vivax 71,2%. Chloroquine was the commonest prescribed antimalarial (65.6%). Of P. vivax prescriptions, 9.0%, and 16.2% of P. falciparum prescriptions presented antimalarials not recommended in the official protocol. Prescriptions for P. falciparum , in significantly higher proportion, did not adhere to the official protocol in regard to type of antimalarial and dose/duration of treatment (p = 0,001). They also lacked information on dose and dosing interval (p = 0,004). There were no significant differences among reference centers and basic health care units in respect to the prescribed antimalarials, to prescriptions containing antimalarials not recommended in the official protocol or in respect to lack of dosing information. Chloroquine was the antimalarial most related to the occurrence of adverse events.THE findings indicate that there are flaws in antimalarial prescribing for pregnant women, especially in respect to their adequacy to the official protocol.

Data from the Brazilian Surveillance System for Violence and Accidents (VIVA) in 2009 were used to examine socio-demographic characteristics, outcomes, and types of accidents and violence treated at 74 sentinel emergency services in 23 Brazilian State capitals and the Federal District. The analysis included 25,201 individuals aged20 years (10.1%60 years); 89.3% were victims of accidents and 11.9% victims of violence. Hospitalization was the outcome in 11.1% of cases. Compared to the general population, there were more men and non-white individuals among victims of accidents, and especially among victims of violence. As compared to younger adults (20-59 years), accidents and violence against elderly victims showed less association with alcohol, a higher proportion of domestic incidents, more falls and pedestrian accidents, and aggression by family members. Policies for the prevention of accidents and violence should consider the characteristics of these events in the older population.

In order to investigate the association between satisfaction with the neighborhood environment and self-rated health among older elderly, data from 814 participants of the eleventh wave of the Bambuí Cohort Study of Aging were analyzed using robust Poisson regression analyses. Those elderly with higher satisfaction with their neighborhoods (PR = 0.75; 95%CI: 0.63-0.87) were less likely to report worse self-rated health. The number of chronic diseases (two, PR = 1.69; 95%CI: 1.05-2.70, three or more, PR = 1.99, 95%CI: 1.27-3.13), difficulty in performing daily activities (PR = 1.51; 95%CI: 1.28-1.78), presence of depressive symptoms (PR = 1.68; 95%CI: 1.44-1.95) and frequency of leisure-time exercise in previous 90 days (less than once a week, PR =1.24; 95%CI: 1.03-1.50) were all positively and significantly associated with poor self-rated health. This study provided empirical evidence that satisfaction with the neighborhood environment was associated with the health of the older elderly. The findings further suggest the potential importance of including this indicator in analyses of place and health among the elderly. Para investigar a associação entre a satisfação com a vizinhança e a percepção de saúde entre idosos mais velhos, foram analisados os dados de 814 participantes do 11º seguimento do Estudo de Coorte de Idosos de Bambuí, por meio da regressão de Poisson robusta. Idosos mais satisfeitos com sua vizinhança apresentaram melhor percepção de saúde (RP = 0,75; IC95%: 0,63-0,87). A percepção de saúde foi significativamente pior para idosos com múltiplas condições crônicas (duas, RP = 1,69; IC95%: 1,05-2,70 e três ou mais, RP = 1,99; IC95%: 1,27-3,13), para aqueles com dificuldade de realizar atividades da vida diária (RP = 1,51; IC95%: 1,28-1,78), com sintomas depressivos (RP = 1,68; IC95%: 1,44-1,95) e com menor frequência de exercícios físicos durante os períodos de lazer nos últimos 90 dias (menos que uma vez por semana, RP = 1,24; IC95%: 1,03-1,50). Os resultados evidenciam a existência de associação entre satisfação com a vizinhança e percepção de saúde, bem como apontam para a necessidade de incluir esse indicador em futuras pesquisas sobre saúde urbana entre idosos.

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

O objetivo deste trabalho foi estimar a prevalência e avaliar os fatores associados à subutilização de medicamentos por motivos financeiros em amostra representativa de 1.134 idosos, residentes na Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil. A prevalência da subutilização foi de 12,9%, estando independentemente associada à renda pessoal mensal inferior a dois salários mínimos (RP = 0,57; IC95%: 0,34-0,97), à filiação a plano privado de saúde (RP = 0,68; IC95%: 0,46-0,99), à freqüência com que o profissional de saúde esclareceu sobre a saúde/tratamento (raramente/nunca, RP = 1,79; IC95%: 1,10-2,90), à auto-avaliação de saúde (razoável, RP = 1,66; IC95%: 0,95-2,90 e ruim/muito ruim, RP = 2,49; IC95%: 1,38-4,48) e ao número de condições crônicas (uma, RP = 2,51; IC95%: 0,99-6,35; duas, RP = 3,51; IC95%: 1,40-8,72 e três ou mais, RP = 4,52; IC95%: 1,79-11,41). Os resultados confirmam a importância dos aspectos sócio-econômicos para a subutilização, mas indicam que sua determinação também está ligada à qualidade da comunicação médico-paciente. Evidencia-se ainda uma situação de risco para idosos em piores condições de saúde. The aim of this study was to estimate the prevalence of cost-related underuse of medicines and associated factors in a representative sample of 1,134 elderly individuals in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil. Prevalence of cost-related underuse was 12.9%. After adjustments in the multivariate model, cost-related underuse was higher in individuals with income less than twice the minimum wage (PR = 0.57; 95%CI: 0.34-0.97), without health plan coverage (PR = 0.68; CI95%: 0.46-0.99), with low frequencies of physician-patient dialogue concerning health/treatment (rarely/never, PR = 1.79; 95%CI: 1.10-2.90), with fair to poor self-rated health (PR = 1.66; 95%CI: 0.95-2.90 and PR = 2.49; 95%CI: 1.38-4.48, respectively), and with multiple comorbidities (one, PR = 2.51; 95%CI: 0.99-6.35; two, PR = 3.51; 95%CI: 1.40-8.72 and three or more, PR = 4.52; 95%CI: 1.79-11.41). Our results suggest adherence problems within this population due to a communication gap between seniors and physicians on treatment-related aspects and to the lack of health plan coverage. Especially worrisome is the high risk of cost-related underuse among elderly with poor health.

The aim of this study was to estimate the prevalence of cost-related underuse of medicines and associated factors in a representative sample of 1,134 elderly individuals in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil. Prevalence of cost-related underuse was 12.9%. After adjustments in the multivariate model, cost-related underuse was higher in individuals with income less than twice the minimum wage (PR = 0.57; 95%CI: 0.34-0.97), without health plan coverage (PR = 0.68; CI95%: 0.46-0.99), with low frequencies of physician-patient dialogue concerning health/treatment (rarely/never, PR = 1.79; 95%CI: 1.10-2.90), with fair to poor self-rated health (PR = 1.66; 95%CI: 0.95-2.90 and PR = 2.49; 95%CI: 1.38-4.48, respectively), and with multiple comorbidities (one, PR = 2.51; 95%CI: 0.99-6.35; two, PR = 3.51; 95%CI: 1.40-8.72 and three or more, PR = 4.52; 95%CI: 1.79-11.41). Our results suggest adherence problems within this population due to a communication gap between seniors and physicians on treatment-related aspects and to the lack of health plan coverage. Especially worrisome is the high risk of cost-related underuse among elderly with poor health.

Os Antiinflamatórios Não-Esteróides (AINE) estão entre os medicamentos mais utilizados no mundo. Estima-se que mais de 30 milhões de pessoas tomem AINE diariamente, apesar de sua toxicidade e de seus efeitos adversos, principalmente gastrointestinais. O presente trabalho utilizou dados seccionais da Fase 1 (1999) de um estudo de coorte (Estudo Pró-Saúde) coletados entre 4.030 funcionários técnico-administrativos de uma universidade no Rio de Janeiro, nos quais foram aplicados questionários autopreenchíveis. Nesse estudo, os AINE apareceram entre os principais produtos consumidos nas duas semanas que antecederam à pesquisa, com prevalência de 7%. Verificou-se que as mulheres têm maior chance de serem usuárias (OR = 2,11; IC 95%: 1,59 - 2,79). Os dados foram submetidos a análise multivariada, tendo sido propostos modelos logísticos por sexo. A carga horária trabalhada na semana foi um importante preditor do uso de AINE (OR = 1,03; IC 95%: 1,01 - 1,04, para homens, e OR = 1,02; IC 95%: 1,00 - 1,03, para mulheres). Dor incapacitante e artrose também se mostraram relevantes, com OR = 2,89 (IC 95%: 1,77 - 4,71) e OR = 2,29 (IC 95%: 1,10 - 4,75), respectivamente, para os homens, e OR = 2,65 (IC 95%: 1,89 - 3,70) e OR = 2,00 (IC 95%: 1,37 - 2,93), respectivamente, para as mulheres. Outros preditores importantes foram a hérnia de disco (OR = 2,27; IC 95%: 0,93 - 5,54) para os homens, e LER (OR = 1,64; IC 95%: 1,15 - 2,35), cálculos vesical (OR = 1,85; IC 95%: 1,00 - 3,45) e renal (OR = 1,81; IC 95%: 1,12 - 2,91) para as mulheres. Mulheres e indivíduos com maior carga horária de trabalho semanal constituem grupos mais vulneráveis, em termos de uso irracional, e, portanto, mais sujeitos a programas de intervenção. Os resultados apontam para a importância das condições de trabalho no processo de desencadeamento de doenças. Non-steroidal Anti-inflammatory Drugs (NSAIDs) are some of the most widely used drugs worldwide. It is estimated that over 30 million people take NSAIDs daily, despite their background of toxicity and adverse effects. The present study used Phase 1 (1999) sectional data from a cohort study (the Pró-Saúde Study) collected among 4,030 technical-administrative employees of a university in Rio de Janeiro through a multidimensional self-administered questionnaire. According to the results, NSAIDs were some of the most frequently consumed drugs, with a 7% prevalence of usage. The likelihood of being a NSAID user was two-fold in women, with an odds ratio (OR) of 2.11 (95%CI: 1.59-2.79). A multivariate analysis was performed and different logistic models were proposed according to gender. The week workload was identified as an important predictor of the use of NSAIDs (OR=1.03; 95%CI: 1.01-1.04 for men and OR=1.02; CI95%: 1.00-1.03 for women). Incapacitating pain and arthrosis were also associated with NSAID use; among men, the OR was 2.89 (95%CI: 1.77-4.71) and 2.29 (95%CI: 1.10-4.75), respectively; and among women the OR was 2.65 (95%CI: 1.89-3.70) and 2.00 (95%CI: 1.37-2.93), respectively. Other important predictors were slipped disk (OR=2.27; 95%CI: 0.93-5.54) for men, and cumulative trauma disorders (OR=1.64; IC95%: 1.15-2.35), bladder stones (OR=1.85; 95%CI: 1.00-3.45) and kidney stones (OR=1.81; 95%CI: 1.12-2.91) for women. Women and individuals with a greater week workload constitute the most vulnerable subgroups, in terms of irrational use, being, therefore, the best targets for intervention programs. The results point toward the importance of work conditions in disease-generating processes.

This study investigated structural and organizational characteristics of the Pharmaceutical Services based on Primary Health Care (PHCPS) from the viewpoints of users and pharmacists. A mixed method design was applied, combining one-to-one semi-structured interviews with four pharmacists in charge of five public dispensing facilities and 69 users, with a secondary database analysis. Data were collected from February to August 2014 in Divinópolis, a municipality in Minas Gerais State. PHCPS were similar in terms of general activities performed and staff profile and background. While users were concerned about medicines’ availability and improvements related to the PHCPS’ conveniences and personnel, pharmacists pointed out problems regarding infrastructure to storage. Despite most users had low information on how to use their medicines, no pharmacists declared to participate in medicines dispensing activities. There was a low match between users and pharmacists viewpoints and advantages for concentrate medicines dispensing in a smaller number of facilities were not clear. Resumo Este estudo investigou características estruturais e organizacionais de serviços farmacêuticos na Atenção Primária à Saúde, a partir do ponto de vista de farmacêuticos e de usuários. Foi utilizado delineamento de métodos mistos, combinando entrevistas semiestruturadas com 69 usuários e 4 farmacêuticos responsáveis pelos 5 serviços que dispensam medicamentos para a população, com análise de dados provenientes de banco de dados municipal. Coletaram-se os dados de fevereiro a agosto de 2014, em Divinópolis, município de Minas Gerais. Os serviços foram similares em termos das atividades realizadas e do perfil profissional dos trabalhadores. Enquanto os usuários preocupavam-se com a disponibilidade de medicamentos e desejavam a melhoria da estrutura dos serviços e dos recursos humanos, os farmacêuticos apontaram problemas relativos ao armazenamento dos medicamentos. Apesar da maioria dos usuários relatarem poucas informações sobre a utilização de seus medicamentos, nenhum farmacêutico declarou participar de atividades de dispensação. Houve pouca concordância entre os pontos de vistas de usuários e de farmacêuticos. A vantagem de se concentrar a dispensação de medicamentos em um número reduzido de unidades dispensadoras não foi observada na prática.

The aim of this study was to examine the association between social capital and cost-related non-adherence (CRN) in an elderly population, using data from 1,134 respondents to the Greater Metropolitan Belo Horizonte Health Survey. CRN was lower for those elderly with a better perception of attachment to their neighbourhoods (PR = 0.68; 95%CI: 0.50-0.94), with more social contacts (one to five, PR = 0.49; 95%CI: 0.30-0.80 and more than five, PR = 0.42; 95%CI: 0.26-0.67), and with private health insurance coverage (PR = 0.64; 95%CI: 0.45-0.93). Meanwhile, CRN was significantly higher for those with fair to poor self-rated health (PR =1.66; 95%CI: 0.95-2.90 and PR = 2.62; 95%CI: 1.46-4.71 respectively), with multiple comorbidities (two, PR = 3.45; 95%CI: 1.38-8.62 and three or more, PR = 4.42; 95%CI: 1.74-11.25), and with a lower frequency of physician-patient dialogue about health/treatment (rarely/never, PR = 1.91; 95%CI: 1.16-3.13). These findings highlight the need to take into account the social context in future research on CRN.

RESUMO: Objetivo: Estimar a prevalência da incapacidade funcional e sua associação com o capital social entre idosos residentes na comunidade. Metodologia: O estudo foi baseado nos dados do Segundo Inquérito de Saúde da Região Metropolitana de Belo Horizonte - 2010, coletados junto a 1.995 idosos residentes em comunidade, amostrados probabilisticamente. A exposição de interesse foi o capital social, considerando os itens confiança na vizinhança, percepção do ambiente físico, sensação de coesão ao bairro de moradia e percepção de ajuda. Foram consideradas na análise, com o propósito de ajustamento, variáveis sociodemográficas, descritoras de condições de saúde e de utilização de serviços de saúde. Resultados: Cerca de 1/3 dos participantes (32,6%) apresentou-se incapaz para pelo menos uma das atividades instrumentais de vida diária (AIVD) e/ou atividades básicas de vida diária (ABVD); a prevalência da incapacidade para ABVD/AIVD foi de 18,1% e da incapacidade exclusiva para AIVD foi de 14,6%. Os idosos incapazes para AIVD e para AIVD/ABVD apresentaram chances mais elevadas de pior capital social, mas apenas o elemento de sensação de coesão ao bairro de moradia mostrou-se independentemente associado à incapacidade funcional (OR = 1,80; IC95% 1,12 - 2,88). Conclusões: Nossos resultados evidenciaram a importância do capital social na investigação dos fatores associados à incapacidade funcional e apontam para a necessidade de que outras políticas públicas sejam implementadas, nas áreas social e ambiental, visto que as necessidades dos idosos demandam medidas que vão além daquelas próprias do setor saúde. ABSTRACT: Objective: To assess the prevalence of disability and its association with social capital among community-dwelling elderly. Methods: The study was based on 2nd Health Survey of Belo Horizonte Metropolitan Region - 2010, that included 1,995 community-dwelling elderly, randomly sampled. The exposure of interest was social capital, measured by confidence in neighborhood, perception of the physical environment, sense of cohesion in housing, and neighborhood perception of help. Socio-demographic variables, health conditions and use of health services were considered in the analysis with the purpose of adjustment. Results: Approximately one third of participants (32.6%) were unable to at least one instrumental activity of daily living (IADL) and/or basic activity of daily living (ADL); the prevalence of disability in ADL/IADL was 18.1%, and only in IADL was 14.6%. Elderly with functional disabilities had higher odds of poor social capital, but only the sense of cohesion in housing neighborhood showed to be independently associated with functional disability (OR = 1.80; 95%CI 1.12 - 2.88). Conclusions: Our results show the importance of social capital in research on associated factors of functional disability and indicate the need to implement public policies for social and environmental areas, since the needs of the elderly require measures beyond those typical of the health sector.