Accesibilidad, disponibilidad y asequibilidad de medicamentos para Niños con Enfermedad Renal Crónica en Guatemala / Access, availability and affordability of medications for children with Advanced Chronic Kidney Disease in Guatemala

El artículo tiene como objetivo analizar la disponibilidad, acceso y asequibilidad de los medicamentos para niños con Enfermedad Renal Crónica (ERC) en tratamiento con hemodiálisis (HD) en un país de bajos a medianos ingresos. Se llevó a cabo un estudio transversal para determinar los medicamentos más utilizados en una unidad de hemodiálisis pediátrica, incluyendo el nombre del medicamento, dosis, frecuencia, forma farmacéutica y vía de administración. Dos farmacias dentro del perímetro del hospital, una pública y una privada, fueron consultadas para determinar el costoy disponibilidad de medicamentos genéricos y de marca. De un total de 30 pacientes de la unidad de hemodiálisis, 22 expedientes fueron revisados. En general 94% de marca se encontraban disponibles en las farmacias consultadas en comparación a un 52% de los medicamentos genéricos. En farmacias públicas, 41% de medicamentos de marca y 29% de medicamentos genéricos se encontraban disponibles. El costo promedio para un mes de tratamiento con medicamentos de marca adquiridos en una farmacia privada era de $495.00 vs $299.00 en una farmacia pública. Para medicamentos genéricos, el costo promedio correspondía a $414.00 y $239.00 en farmacias privadas y públicas respectivamente. En promedio, los medicamentos de marca adquiridos en una farmacia privada requieren 41 días de trabajo en un mes a comparación de 25 días si se adquieren en una farmacia pública. Los medicamentos genéricos adquiridos en farmacias privadas corresponden a 34 días de trabajo vs 20 días en farmacias públicas. En general existió un acceso limitado a medicamentos genéricos y los medicamentos poseen un costo general más elevado a comparación de otros países lo que implica un posible impacto en la adherencia terapéutica y los padecimientos secundarios de la ERC en los pacientes pediátricos en Guatemala. Esta realidad se puede aplicar a otros países de bajos a medianos ingresos.

This article aims to analyze the availability, access, and affordability of medications for children with advanced Chronic Kidney Disease (CKD) treated with hemodialysis (HD) in a low to middle income country (LMIC). A cross- sectional chart review was carried out to determine the most common medications used in an HD pediatric unit, including medication name, dose, frequency, dosage form, and route of administration. Two pharmacies within the hospital perimeter, one public and one private, were consulted to determine medication cost and availability for generic and brand-name equivalents. From 30 patients attending the HD unit, 22 records were reviewed. Overall, 94 % of brand name medications were available at pharmacies consulted, versus and 52% of generic medications. In public pharmacies, 41% of brand name, and 29% of generic medications were available. The average cost for a full month´s treatment for brand name drugs in the private pharmacy was 495.00 USD versus 299.00 USD in the public pharmacy. For generic drugs, the average cost was 414.00 USD, and 239.00 USD in private and public pharmacies respectively. On average, brand-name drugs in the private pharmacy cost 41 days' wages versus 25 in the public pharmacy. Generic drugs in the private pharmacy cost 34 days' wages versus 20 in the public pharmacy. Overall, there was limited access to generic medications, medications had an overall high cost compared to other countries both of which have the potential to impact treatment adherence and overall outcomes of CKD5 pediatric patients in Guatemala. This reality can be translated to other LMIC.

Factors associated with non-treatment of hypertension and gender differences at baseline in the ELSA-Brasil cohort

The treatment of arterial hypertension (AH) contributes to the reduction of morbidity and mortality. Gender differences are likely to play a role, as non-treatment is associated with clinical and sociodemographic aspects. The aim of this study was to investigate the factors associated with non-treatment of AH and gender differences in hypertensive individuals from the ELSA-Brasil cohort. The study was conducted with 5,743 baseline hypertensive cohort participants. AH was considered if there was a previous diagnosis or if systolic blood pressure (SBP) was ≥140 and/or diastolic BP (DBP) was ≥90 mmHg. Sociodemographic and anthropometric data, lifestyle, comorbidities, and use of antihypertensive medications were evaluated through interviews and in-person measurements. Treatment with renin-angiotensin-aldosterone system inhibitors (RAASi) or other antihypertensive medications and non-treatment were evaluated with multivariate logistic regression. Non-treatment was observed in 32.8% of hypertensive individuals. Of the 67.7% treated individuals, 41.1% received RAASi. Non-treatment was associated with alcohol consumption in women (OR=1.41; 95%CI: 1.15-1.73; P=0.001), lowest schooling level in men (OR=1.70; 95%CI: 1.32-2.19; P<0.001), and younger age groups in men and women (strongest association in males aged 35-44 years: OR=4.58, 95%CI: 3.17-6.6, P<0.001). Among those using RAASi, a higher proportion of white, older individuals, and with more comorbidities was observed. The high percentage of non-treatment, even in this civil servant population, indicated the need to improve the treatment cascade for AH. Public health policies should consider giving special attention to gender roles in groups at higher risk of non-treatment to reduce inequities related to AH in Brazil.

Relationship between the number of glaucoma medications, ocular surface disorder, and treatment adherence / Relação entre o número de medicamentos para glaucoma, distúrbio da superfície ocular e adesão ao tratamento

ABSTRACT Purpose: To determine the relationship of ocular surface disease, the number of glaucoma medications prescribed and its influence on treatment adherence. Methods: In this cross-sectional study, demographic data of patients with glaucoma were collected, and patients completed the ocular surface disease index questionnaire and the glaucoma treatment compliance assessment tool. Ocular surface parameters were assessed by "Keratograph 5M." Patients were stratified into two groups according to the amount of prescribed ocular hypotensive eye drops (Group 1, one or two classes of medications; Group 2, three or four classes) Results: In total, 27 eyes of 27 patients with glaucoma were included: 17 using 1 or 2 topical medications (Group 1) and 10 eyes using 3 or 4 classes (Group 2). For the Keratograph assessment, patients using ≥3 medications had significantly smaller tear meniscus height (0.27 ± 0.10 vs. 0.43 ± 0.22; p=0.037). The analysis of Ocular Surface Disease Index questionnaire showed higher scores among the groups using more hypotensive eye drops (18.67 ± 13.53 vs. 38.82 ± 19.72; p=0.004). Regarding the glaucoma treatment compliance assessment tool, Group 2 had worse scores in components of forgetfulness (p=0.027) and barriers due to lack of drops (p=0.031). Conclusion: Patients with glaucoma using more hypotensive eye drops had worse tear meniscus height and ocular surface disease index scores than those using fewer topical medications. Patients using three or four drug classes had worse predictors of glaucoma adherence. Despite worse ocular surface disease results, no significant difference in self-reported side effects was found.

RESUMO Objetivo: Determinar a relação entre doença da superfície ocular (OSD), número de medicamentos prescritos para o glaucoma, e como isso influencia na adesão ao tratamento. Métodos: Neste estudo transversal, pacientes com glaucoma foram submetidos à coleta de dados demográficos, preenchimento do questionário Ocular Surface Disease Index e do Glaucoma Treatment Compliance Assessment Tool. Os parâmetros da superfície ocular foram avaliados pelo "Keratograph 5M". Indivíduos foram estratificados em 2 grupos de acordo com a quantidade de colírios hipotensores oculares prescritos (Grupo 1: uma ou duas classes de medicamentos; Grupo 2: três ou quatro classes). Resultados: No total, 27 olhos de 27 pacientes com glaucoma foram incluídos: 17 usando 1 ou 2 medicamentos tópicos (Grupo 1) e 10 olhos usando 3 ou 4 classes (Grupo 2). Na avaliação do Keratograph, os pacientes em uso de 3 ou mais medicamentos apresentaram altura do menisco lacrimal significativamente menor (0,27 ± 0,10 vs. 0,43 ± 0,22; p=0,037). Análise do questionário OSDI mostrou escores mais altos entre o grupo que usou mais colírios hipotensores (18,67 ± 13,53 vs. 38,82 ± 19,72; p=0,004). Em relação ao Glaucoma Treatment Compliance Assessment Tool, o Grupo 2 apresentou piores escores nos componentes de esquecimento (p=0,027) e barreiras por falta de colírios (p=0,031). Conclusão: O estudo demonstrou que pacientes com glaucoma usando mais colírios hipotensivos apresentaram piores escores de altura do menisco lacrimal e Ocular Surface Disease Index, em comparação com aqueles que usaram menos medicamentos tópicos. Pacientes em uso de 3 ou 4 classes de colírios tiveram piores preditores de adesão ao glaucoma. Apesar dos piores resultados de doença da superfície ocular, não houve diferença significativa nos efeitos colaterais relatados.

Therapeutic Adherence According to the Morisky Scale in Patients with Hypertension

Abstract Background In view of the high prevalence of hypertension and the importance of adequate drug therapy in the prevention of complications, it is necessary to know the adherence to drug treatment in this population. Objective To verify adherence to antihypertensive drug treatment in Brazilian patients with hypertension using the Morisky-Green Test (MGT), relating it with demographic data. Methods Prospective, observational, multicenter, national registry study, with 2,578 hypertensive patients participating in study I, the Brazilian Cardiovascular Registry of Arterial Hypertension (I-RBH), recruited in the five regions of Brazil. The analyses carried out on the data were descriptive statistics, qui-square tests, ANOVA, and logistic regression, adopting 5% as the significance level for the tests. Results The research shows that 56.13% of patients in the sample were female; 56.71% were elderly (≥ 65 years); 55.86% were White; 52.37% were from the Southeast Region; and 59.74% were non-adherent. Logistic regression showed an independent relationship between patients' age, ethnicity, and region with medication adherence. Conclusion Adherence to treatment is the key to reducing high rates of cardiovascular complications. The study brings a successful outcome in the relationship between the factors ethnicity, age, and region of patients with hypertension and medication adherence. To this end, it is necessary to understand these factors, considering systematic evaluation in the care of patients with hypertension and other chronic non-communicable diseases. This study is a significant contribution to multidisciplinary teams, as it highlights which risk factors interfere with medication adherence, incorporating better strategies in health education.

Prevalence of errors causing events allegedly attributable to vaccination/immunization: systematic review and meta-analysis / Prevalencia de errores causantes de acontecimientos supuestamente atribuibles a la vacunación/inmunización: revisión sistemática y metanálisis / Prevalência de erros que causaram eventos supostamente atribuíveis à vacinação/imunização: revisão sistemática e metanálise

ABSTRACT Objective: To identify the prevalence of errors that caused events supposedly attributable to vaccination or immunization. Method: Systematic literature review with meta-analysis carried out on the Medline, Cochrane Library, Cinahl, Web of Science, Lilacs, Scopus; Embase; Open Grey; Google Scholar; and Grey Lit databases; with studies that presented the prevalence of immunization errors that caused events or that provided data that allowed this indicator to be calculated. Results: We evaluated 11 articles published between 2010 and 2021, indicating a prevalence of 0.044 errors per 10,000 doses administered (n=762; CI95%: 0.026 - 0.075; I2 = 99%, p < 0.01). The prevalence was higher in children under 5 (0.334 / 10,000 doses; n=14). The predominant events were fever, local pain, edema and redness. Conclusion: A low prevalence of errors causing events was identified. However, events supposedly attributable to vaccination or immunization can contribute to vaccine hesitancy and, consequently, have an impact on vaccination coverage.

RESUMEN Objetivo: Identificar la prevalencia de errores que causaron eventos supuestamente atribuibles a la vacunación o inmunización. Método: Revisión sistemática de la literatura con metaanálisis realizada en las bases de datos Medline, Cochrane Library, Cinahl, Web of Science, Lilacs, Scopus; Embase; Open Grey; Google Scholar; y Grey Lit; con estudios que presentaran la prevalencia de errores de inmunización que causaron eventos o que aportaran datos que permitieran calcular este indicador. Resultados: Se evaluaron 11 artículos publicados entre 2010 y 2021, indicando una prevalencia de 0,044 errores por cada 10.000 dosis administradas (n=762; IC95%: 0,026 - 0,075; I2 = 99%, p < 0,01). La prevalencia fue mayor en niños menores de 5 años (0,334 / 10.000 dosis; n=14). Los eventos predominantes fueron fiebre, dolor local, edema y enrojecimiento. Conclusión: Se identificó una baja prevalencia de eventos causantes de errores. Sin embargo, los eventos supuestamente atribuibles a la vacunación o inmunización pueden contribuir a la indecisión sobre la vacunación y, en consecuencia, repercutir en la cobertura vacunal.

RESUMO Objetivo: Identificar a prevalência de erros que causaram eventos supostamente atribuíveis à vacinação ou imunização. Método: Revisão sistemática da literatura com metanálise realizada nas bases Medline, Cochrane Library, Cinahl, Web of Science, Lilacs, Scopus; Embase; Open Grey; Google Scholar; e Grey Lit; com estudos que apresentassem prevalência de erros de imunização que causaram eventos ou que disponibilizassem dados que permitissem o cálculo deste indicador. Resultados: Avaliou-se 11 artigos publicados entre 2010 e 2021, apontando prevalência de 0,044 erros por 10.000 doses administradas (n=762; IC95%: 0,026 - 0,075; I2= 99%, p < 0,01). A prevalência foi maior em crianças menores de 5 anos (0,334 / 10.000 doses; n=14). Quanto aos eventos, predominou-se: febre, dor local, edema, rubor. Conclusão: Identificou-se uma prevalência baixa de erros que causaram eventos. Entretanto, os eventos supostamente atribuíveis à vacinação ou imunização podem contribuir para a hesitação vacinal e, consequentemente, impactar nas coberturas vacinais.

The impact of the socioeconomic factor on Parkinson's disease medication adherence: a scoping review / O impacto do fator socioeconômico na adesão à medicação na doença de Parkinson: uma revisão de escopo

Abstract Background Therapeutic adherence is a decisive issue on chronic disease management in patients requiring long-term pharmacotherapy, such as Parkinson's disease (PD). Although it is well known that socioeconomic factor is a barrier to medication adherence in many chronic diseases, its impacts on PD still need to be investigated. Objective Explore what and how socioeconomic factors impact medication adherence in people with PD. Methods We carried out a scoping review across three databases to identify studies exploring what and how socioeconomic factors impact medication adherence in people with PD considering eight attributes: 1. educational level, 2. disease-related knowledge, 3. income, 4. cost of medication, 5. drug subsidy (meaning presence of subsidies in the cost of medication), 6. employability, and 7. ethnicity (black, indigenous, immigrants). Results Of the 399 identified studies (Embase = 294, Medline = 88, LILACS = 17), eight met inclusion criteria. We identified factors covering the eight attributes of socioeconomic impact, and all of them negatively impacted the medication adherence of people with PD. The most prevalent factor in the studies was low patient educational level (four studies), followed by costs of medications (three studies), income (three studies), and disease-related knowledge (three studies). Distinctly from most of the studies selected, one of them evidenced suboptimal adherence in individuals receiving the medication free of charge, and another one could not find correlation between suboptimal adherence and educational level. Conclusion Socioeconomic factors negatively impact medication adherence in PD patients. This review provides basis for developing patient and population-based interventions to improve adherence to treatment in PD.

Resumo Antecedentes A adesão à medicação é um componente crucial no manejo correto da doença de Parkinson (DP) e, embora esteja bem estabelecido que o fator socioeconômico é uma barreira à adesão medicamentosa em muitas doenças crônicas, seus impactos na DP ainda precisam ser investigados. Objetivo Explorar quais são e como os fatores socioeconômicos afetam a adesão à medicação em pessoas com DP. Métodos Realizamos uma revisão de escopo em três bases de dados para identificar estudos que explorassem quais e como os fatores socioeconômicos impactam na adesão à medicação em pessoas com DP, considerando oito atributos: 1. nível educacional, 2. conhecimento relacionado à doença, 3. renda, 4. custo de medicamentos, 5. subsídio de medicamentos (ou seja, presença de subsídios no custo dos medicamentos), 6. empregabilidade e 7. etnia (negra, indígena, imigrantes). Resultados Dos 399 estudos identificados (Embase = 294, Medline = 88, LILACS = 17), oito preencheram os critérios de inclusão. Identificamos fatores que abrangem os oito atributos de impacto socioeconômico e todos impactaram negativamente na adesão medicamentosa de pessoas com DP. Foram mais prevalentes o baixo nível educacional do paciente (quatro estudos), custos dos medicamentos, nível de renda e conhecimento relacionado à doença (três estudos cada). Diferentemente da maioria dos estudos selecionados, um deles evidenciou adesão subótima em indivíduos que receberam a medicação gratuitamente, e outro não encontrou correlação entre adesão subótima e nível educacional. Conclusão Fatores socioeconômicos impactam negativamente a adesão ao tratamento medicamentoso em pessoas com DP. Esta revisão fornece base para o desenvolvimento de intervenções baseadas em pacientes e populações no intuito de melhorar a adesão ao tratamento farmacológico de pessoas com DP.

Isoniazid use, effectiveness, and safety for treatment of latent tuberculosis infection: a systematic review

ABSTRACT Background: The treatment strategy for latent tuberculosis infection is to reduce the number of tuberculosis cases and consequently reduce the transmission of pathogenic bacteria. This study aimed to determine the safety, effectiveness, and adherence of isoniazid use for latent tuberculosis infection treatment. Methods: To identify studies on isoniazid use for latent tuberculosis infection, five electronic databases were searched. The methods and results are presented in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Most studies (53) used isoniazid for 9 months. The prevalence of use and adherence to treatment varied considerably (18% to 100%), and were evaluated by participant completion of isoniazid treatment for latent tuberculosis infection. The adverse events most frequently reported were hepatotoxicity, gastric intolerance, and neuropathy; the rates of occurrence ranged from < 1% to 48%. In the studies that evaluated the effectiveness of isoniazid for latent tuberculosis infection, the rate varied from 0 to 19.7% for patients who did not have active tuberculosis after the follow-up period. Conclusions: The importance of maintaining follow up for patients using isoniazid should be emphasized due to the risk of developing adverse events. Despite the treatment challenges, the rates of patients who used isoniazid and developed active tuberculosis during the follow-up period were low. We believe that isoniazid continues to contribute to tuberculosis control worldwide, and better care strategies are required.

Relación del apoyo social percibido y el logro de las metas de compensación de los pacientes con hipertensión arterial y diabetes mellitus / Relationship of perceived social support and the compensation goals of patients with arterial hypertension and diabetes mellitus

INTRODUCCIÓN: Las enfermedades crónicas son un problema actual que presentan altos porcentajes de descompensación en pacientes hipertensos y diabéticos, que hace interesante evaluar los determinantes sociales que influyen en la situación, como el apoyo social. OBJETIVO DEL ESTUDIO: fue relacionar el apoyo social percibido, adherencia a medicamentos, literacidad y variables sociodemográficas con el logro de compensación en pacientes con hipertensión arterial y diabetes mellitus. METODOLOGÍA: De tipo descriptivo correlacional de corte transversal. RESULTADOS: Se estudió a 600 personas, con un promedio de edad de 62,9 años, 63,5% mujeres. Un 64,66% son diabéticos y 89,5% hipertensos (46,9% y 43,33% descompensados respectivamente). El apoyo social percibido fue alto y presentan una inadecuada adherencia al tratamiento farmacológico y una adecuada literacidad en salud (57,6%). Se realiza un análisis de relaciones que demuestran relación significativa entre una menor percepción de apoyo instrumental y ser mujer; la percepción del apoyo de interacción social disminuye con el aumento de la edad y en relación con el apoyo afectivo, disminuye la percepción a mayores años de estudios. Al realizar una regresión logística, entre la percepción de apoyo social baja y los niveles de compensación de los parámetros de compensación no se evidencia una relación estadísticamente significativa. Se evidencia una asociación entre las personas con menos de 8 años de estudio y presentar presiones arteriales elevadas. DISCUSIÓN: Existe dificultad en la medición del concepto de apoyo social, dado que el sentido y significancia es personal. Las patologías crónicas como estresores debe ser un elemento que continúe estudiándose con estudios longitudinales y experimentales. Las estrategias clínicas para la compensación de la hipertensión y la diabetes deben ir más allá del apoyo social, considerando las crecientes complicaciones y proyecciones de mortalidad. CONCLUSIÓN: Se destaca la importancia de abordar el apoyo social considerando su naturaleza subjetiva y contextual, aunque no se estableció una correlación directa con el logro terapéutico. Se señala la inadecuada adherencia al tratamiento farmacológico, la asociación entre baja escolaridad y presiones arteriales elevadas.

INTRODUCTION: Chronic diseases are a current problem since there are high percentages of decompensation in hypertensive and diabetic patients, which makes it interesting to evaluate the social determinants that influence and social support as a multidimensional concept. OBJECTIVE: To relate the perceived social support, medication adherence, literacy and sociodemographic variables with the achievement of compensation in patients with arterial hypertension and / or diabetes mellitus. METHODOLOGY: Descriptive correlational descriptive study is performed methodologically. RESULTS: 600 people were studied, with an average age of 62.9 years, 63.5% women. 64.66% are diabetic and 89.5% hypertensive (46.9% and 43.33% decompensated respectively). The perceived social support was high and showed inadequate adherence to drug treatment and adequate literacy (57.6%). An analysis of relationships that are significantly related between a lower perception of instrumental support and being a woman is performed; the perception of social interaction support with increasing age and in relation to affective support, the perception of older years of studies. When performing a logistic regression, there is no statistically significant relationship between the perception of low social support and the compensation levels of the compensation parameters. There is evidence of an association between children under 8 years of study and presentation of high arterial references. DISCUSSION: There is difficulty in measuring the concept of social support, since the meaning and meaning is personal. Chronic pathologies as stressors should be an element that continues to study with longitudinal and experimental studies. Clinical strategies for the compensation of hypertension and diabetes must go beyond social support, considering the increasing complications and mortality projections. CONCLUSION: Emphasizes the importance of addressing social support considering its subjective and contextual nature, though no direct correlation with therapeutic achievement was established. Highlights inadequate adherence to pharmacological treatment, the association between low education and elevated blood pressure.

Potentially inappropriate medications with older people in intensive care and associated factors: a historic cohort study

ABSTRACT BACKGROUND: The epidemiology of potentially inappropriate medications (PIMs) in critical care units remains limited, especially in terms of the factors associated with their use. OBJECTIVE: To estimate the incidence and factors associated with PIMs use in intensive care units. DESIGN AND SETTING: Historical cohort study was conducted in a high-complexity hospital in Brazil. METHODS: A retrospective chart review was conducted on 314 patients aged ≥ 60 years who were admitted to intensive care units (ICUs) at a high-complexity hospital in Brazil. The dates were extracted from a "Patient Safety Project" database. A Chi-square test, Student's t-test, and multivariable logistic regression analyses were performed to assess which factors were associated with PIMs. The statistical significance was set at 5%. RESULTS: According to Beers' criteria, 12.8% of the identified drugs were considered inappropriate for the elderly population. The incidence rate of PIMs use was 45.8%. The most frequently used PIMs were metoclopramide, insulin, antipsychotics, non-steroidal anti-inflammatory drugs, and benzodiazepines. Factors associated with PIMs use were the number of medications (odds ratio [OR] = 1.17), length of hospital stay (OR = 1.07), and excessive potential drug interactions (OR = 2.43). CONCLUSIONS: Approximately half of the older adults in ICUs received PIM. Patients taking PIMs had a longer length of stay in the ICU, higher numbers of medications, and higher numbers of potential drug interactions. In ICUs, the use of explicit methods combined with clinical judgment can contribute to the safety and quality of medication prescriptions.

Experiences of schizophrenia patients with treatment buddy support during the COVID-19 pandemic

Background: Schizophrenia is a major psychiatric disorder affecting physical, psychosocial, and cognitive functioning. Treatment includes pharmacological and psychotherapeutic interventions. Adherence to prescribed medication is critical but reportedly low, because of side effects, failure to understand instructions, a lack of insight about the condition, cognitive deficits, and financial difficulties. Interventions to promote adherence to medication are required. This study introduced a treatment buddy to provide the patient with virtual support in adherence to medication. Aim: The aim of this study was to explore the participants' lived experiences of a treatment buddy support. Setting: A specialised psychiatric clinic in a resource-constrained district of KwaZulu-Natal, South Africa. Methods: A qualitative study design, using semi-structured one-on-one interviews, was used to collect in-depth data from 24 participants, suffering from schizophrenia and who had been offered virtual treatment buddy support for 6 months. Data were analysed using thematic analysis. Results: The intervention improved adherence to medication. Participants indicated that the text messages served as reminders to take their medication daily. An alleviation of associated problems such as sleeping difficulties was observed. Participants were willing to encourage other patients suffering from schizophrenia to join 'treatment buddy services'. Conclusion: The virtual treatment buddy support increased awareness of the importance to adhere to antipsychotic medications among patients suffering from schizophrenia and helped to resolve other schizophrenia-related problems experienced by the participants. Contribution: The study has provided a supportive intervention that can be utilised by mental health institutions to address poor adherence to medication by patients suffering from schizophrenia.

Clinical value of genetic polymorphism analysis of hypertension drugs for individualized treatment of hypertension patients in the southern Anhui region / 中国临床药理学与治疗学

AIM: To analyze the distribution frequency of gene polymorphisms of β receptor blockers, angiotensin receptor antagonists, angiotensin converting enzyme inhibitors, calcium antagonists, and diuretics in hypertensive patients from southern Anhui province, and provide a theoretical basis for gene detection of hypertension drugs and personalized medication. METHODS: Drug gene testing information from 839 hospitalized patients with hypertension at Yijishan Hospital of Wannan Medical College from July 2021 to April 2023 were collected, and the distribution frequency of each gene locus were analyzed. RESULTS: The genotype frequencies of ACE (I/D) I/I, I/D, and D/D were 42.1%, 46.0%, and 11.9%, respectively. the genotype frequencies of ADRB1 (1165G>C) G/G, G/C, and C/C were 8.3%, 40.0%, and 51.6%, respectively. The genotype frequencies of AGTR1 (1166A>C) A/A, A/C, and C/C were 90.2%, 9.8%, and 0.0%. The genotype frequencies of CYP2C9*3 (1075A>C) *1/*1, *1/*3, and *3/*3 were 91.3%, 8.7%, and 0.0%, respectively; the genotype frequencies of CYP2D6* 10 (100C > T) *1/*1, *1/*10, and *10/*10 were 25.0%, 36.6%, and 38.4%, respectively. The genotype frequencies of CYP3A5*3 (6986A>G) *1/*1, *1/*3, and *3/*3 were 7.0%, 39.0%, and 54.0%, respectively. The frequencies of NPPA (2238T>C) T/T, T / C, and C / C genotypes were 97.9%, 2.1%, and 0.0%, respectively. In addition, there was a significant difference in the genotype distribution frequency of multiple drug related gene loci in southern Anhui compared to other regions in China (P< 0.05). CONCLUSION: The genotype distribution frequency of hypertensive drug related gene loci had certain bias in southern Anhui, and were significant different from other regions in China, indicating that conducting genetic polymorphism testing of hypertensive drugs had certain guiding significance for the individualized application of hypertensive drugs in southern Anhui.

Effects of the timing of satisfactory sedation with preoperative oral midazolam on anesthesia induction and recovery in children undergoing adenotonsillectomy / 中国临床药理学与治疗学

AIM: To investigate the effect of the timing of satisfactory sedation with preoperative oral midazolam on anesthesia induction and recovery in children undergoing adenotonsillectomy. METHODS: A total of 147 children undergoing elective adenotonsillectomy, with ASA physical status orⅡ, aged 2-7 years were selected from November 2022 to June 2023 in the Second Affiliated Hospital of Wenzhou Medical University. The children were orally administered 0.5 mg/kg midazolam in preoperative waiting area and were divided into 10-20 min (rapid onset, M1 group) and 21-30 min (slow onset, M2 group) based on the satisfactory sedation time, or equal volume of sugar pear drink orally (blank control group, C group). Children in all three groups received a general anesthesia method of propofol+fentanyl combined with sevoflurane induction and sevoflurane maintenance. The primary outcome measures were the induction compliance checklist (ICC) score and the pediatric anesthesia emergence delirium (PAED) score in the post-anesthesia care unit (PACU) to assess the occurrence of emergence agitation (EA), and the secondary outcome measures included the parental separation anxiety scale (PSAS), sedation Ramsay score, surgery duration, recovery time, PACU stay time, discharge time, the incidence of perioperative respiratory adverse events (PRAE) and other adverse events in the ward. RESULTS: 147 children were included in the result analysis, with 49 cases in each group. The proportion of perfect induction (ICC=0) were significantly higher in two M groups than that in group C (95.9% vs. 91.8% vs. 61.2%, P=0.001). The maximum and average PAED score in PACU in group M1 showed a significantly higher (6.4±5.0 vs. 4.4 ± 4.1, P=0.029; 5.2 ± 4.5 vs. 3.4 ± 3.6, P=0.030), and the incidence of EA was significantly higher than those in group C (10.2% vs. 30.6%, P=0.022), and increased compared to the group M2 (OR= 0.581, 95%CI 0.231-1.463, P=0.354). There was no statistically significant difference in the maximum and average PAED scores, incidence of EA between group M2 and group C (P>0.05). The Ramsay score and PSAS score in two M groups were higher, PACU stay time and recovery time was longer than those in group C (P0.05). CONCLUSION: Preoperative oral midazolam can improve the ICC and PSAS scores of children during induction, but it also leads to prolonged recovery time and PACU retention time. The rapid onset of midazolam did not result in better induction and recovery quality, but instead increased the incidence of EA and postoperative pain score.

Application of narrative pharmacy in cardiovascular pharmacy clinic / 中国药房

OBJECTIVE To explore the effects of narrative pharmacy management on medication compliance， negative emotions， and quality of life in patients with cardiovascular disease complicated with negative emotions. METHODS A total of 49 patients with drug use problems and negative emotions attending the cardiovascular pharmacy clinic of Wuhan First Hospital from February to August 2023 were selected as the study objects， narrative pharmacy model was applied for patient management during their visits； pharmaceutical care and emotional management were performed after 2 weeks of treatment and a follow-up visit was conducted to evaluate and record the management effect one month later. RESULTS Adopting a narrative pharmacy management model， 49 patients were involved in 114 drug related consultation questions. Compared with the visit， after one month of management， the number of medication types taken by patients significantly decreased [4.00 （2.00， 6.00） vs. 3.00 （1.50， 5.00）， P＜0.05]， the incidence of adverse reactions significantly decreased （32.65% vs. 2.04%， P＜0.001）， the rate of blood pressure and lipid compliance significantly increased （30.61% vs. 95.92%， P＜0.001）， and the score of the patient’s medication compliance significantly improved （[ 3.94±2.44） vs. （6.78±2.07）， P＜0.01]. The depression score significantly decreased [3.00 （2.00， 4.50） vs. 2.00 （0.00， 3.00）， P＜0.001]， the anxiety score significantly reduced [3.00 （2.00， 4.50） vs. 1.00 （0.00， 2.00）， P＜0.001]， quality of life score was significantly improved [22.00 （19.00， 22.00） vs. 23.00 （23.00， 24.50）， P＜0.01]. In the satisfaction survey， there was a slight increase in the overall satisfaction proportion （91.84% vs. 97.96%， P＞0.05）. CONCLUSIONS The application of narrative pharmacy in cardiovascular pharmacy clinic can improve patient compliance， reduce adverse drug reactions， enhance the effectiveness of drug treatment， avoid drug interactions， effectively improve the anxiety and depression， and ultimately improve the quality of life.

Literature analysis of ADR after the listing of apatinib / 中国药房

OBJECTIVE To explore the characteristics and regulations of adverse drug reactions （ADR） caused by apatinib， and to provide a reference for the safe use of apatinib in clinic. METHODS Case and group reports on ADR and safety evaluation of apatinib were retrieved from Chinese and English databases such as CNKI， Wanfang medical network， VIP and PubMed since its listing in 2014， literature data were extracted and statistically analyzed after screening. RESULTS Totally 101 cases were included， involving 221 ADR. In the above cases， the male-to-female ratio was 1.24∶1， with the highest proportion of patients aged 51 to 70 years， most of the patients were given a dose of 500 mg or more， and the patients given low dose of apatinib combined with other antitumor drugs were also likely to have ADR. One to two types of adverse reaction were the most common， while the types could reach up to six. Most ADR occurred within 30 days after medication， and the systems/organs involved were mainly the cardiovascular system damage，skin and its accessories damage， gastrointestinal system damage and urinary system damage； the main clinical manifestations were hypertension/aggravation，hand-foot syndrome，abdominal pain diarrhea and albuminuria， etc. Hypertension/aggravation， hand-foot syndrome and myelosuppression were the most common serious ADR. Most ADR could be improved/cured by suspension of administration， dose downregulation and symptomatic treatment. All 4 patients who died had underlying diseases， and their ECOG scores all ≥2 points. Special ADR （such as reversible posterior encephalopathy syndrome， psychiatric disorders， and cognitive impairment） were mostly caused by apatinib itself， or may be caused by apatinib in combination with the primary or underlying disease. CONCLUSIONS Advanced age， large dose， combination medication， underlying diseases and poor physical condition might be the high risks for ADR caused by apatinib. It is recommended to monitor the blood pressure，urine protein and skin of hands and feet of all patients with medication on a daily basis，pay attention to the occurrence of special ADR， and timely detect abnormal states and give effective intervention，so as to avoid the aggravation of ADR and other secondary ADR.

Comparison of 3 evaluation criteria for potentially inappropriate medications in elderly patients with femoral neck fracture / 中国药房

OBJECTIVE To analyze the prevalence of potentially inappropriate medication （PIM） in elderly patients with femoral neck fractures at admission and compare the concordance of 3 evaluation criteria. METHODS A retrospective study was conducted to review the data of elderly patients with femoral neck fractures admitted to the Department of Orthopedics in Northern Jiangsu People’s Hospital from July 2022 to June 2023. The PIMs were identified according to the Criteria of Potentially Inappropriate Medications for Older Adults in China：2017 edition （hereinafter referred to as Chinese criteria）， American Geriatrics Society 2023 Updated AGS Beers Criteria® for Potentially Inappropriate Medication in Older Adults （hereinafter referred to as 2023 Beers criteria）， third version criteria for screening tool of older people’s prescriptions for potentially inappropriate medication （hereinafter referred to as STOPP criteria version 3）. The concordance of the 3 evaluation criteria was compared by using Kappa statistics. RESULTS A total of 246 patients were included in this study； 49 patients （19.92%） with 77 PIMs were detected by the Chinese criteria， 64 patients （26.02%） with 118 PIMs were detected by the 2023 Beers criteria， and 41 patients （16.67%） with 67 PIMs were detected by the STOPP criteria version 3； 22 patients met all three criteria simultaneously. The concordance among the three criteria showed moderate agreement （0.417≤Kappa≤0.486） when compared in pairs. CONCLUSIONS There are certain differences in the PIM evaluated by the three criteria， but the prevalence of PIMs is below 30% according to the different H202134） criteria. Benzodiazepines， antipsychotics， antidepressants， and other drugs may increase the risk of patients falling again.

Analysis of information labeling in instructions of antitussive and expectorant drugs in 34 children’s medical institutions / 中国药房

OBJECTIVE To understand the information labeling of children’s medication in the instructions of antitussive and expectorant drugs commonly used in children’s medical institutions， analyze the existing problems， and propose relevant suggestions. METHODS The instructions for 100 antitussive and expectorant drugs commonly used in 20 tertiary children’s hospitals （centers） and 14 maternal and child health hospitals （centers） with regional representativeness in China were collected， and the information labeling of children’s medication in the instructions was investigated and analyzed. RESULTS There were only 7 kinds of antitussive and expectorant drugs for children， and the others were non-specific drugs for children. Among antitussive and expectorant drugs， tablets accounted for 18.00%， injections for 18.00%， and capsules for 4.00%. Among 100 antitussive and expectorant drugs， 72 （72.00%） labeled the usage and dosage for children， 63 （63.00%） labeled the medication items for children， 59 （59.00%） indicated the information of children in the precautions， and pharmacokinetic parameters for children were absent. Compared with imported antitussive and expectorant drugs or the drugs manufactured by joint ventures， there were many missing labeling of medication information for children with Chinese drugs. Among 63 kinds of drug instructions labeled with medication items for children， various instructions information had little guiding significance. CONCLUSIONS There is a lack of labeling in the instructions of antitussive and expectorant drugs for children， and the proportion of special drugs for children remains low. Pediatric drug information in the instructions has little guiding significance for pediatric medication. Relevant departments should further promote the completeness of pediatric medication information in the instructions of antitussive and expectorant drugs to ensure the rational use of children’s medication.

Medication Ideas for Depression from Wenyang Jieyu Prescription / 中国实验方剂学杂志

Depression is a complex emotional and mental disorder. The traditional Chinese medicine （TCM） methods for treating depression mainly include soothing the liver and relieving depression. Our research team proposes that depression is caused by Yang Qi deficiency and obstructed Qi movement， which are closely related to neurological and psychological changes induced by early traumatic experiences. Therefore， we suggest that the treatment should focus on warming Yang， replenishing Qi， and promoting Qi movement and have formulated Wenyang Jieyu prescription based on Erxiantang for warming yang and Xiaoyaosan for relieving depression. The experiment with the mouse model of early trauma induced by maternal separation showed that Wenyang Jieyu prescription significantly improved the mouse activity and environmental exploration， reduced the immobility time in forced swimming and tail suspension tests， alleviated the behaviors such as aversion to darkness and fear of open space， enhanced social interaction and social cognitive abilities， altered decision-making biases， reduced depression-like behaviors， and improved the decision-making patterns. Additionally， the prescription lowered the serum level of cortisol， inhibited the cortisol surge in the dexamethasone/corticotropin-releasing hormone （Dex/CRH） test， up-regulated the expression of mineralocorticoid receptor （MR） and 11β-hydroxysteroid dehydrogenase 2 （11β-HSD2） in the hippocampus， down-regulated the expression of glucocorticoid receptor （GR） and corticotropin-releasing hormone receptor 1 （CRHR1）， inhibited the methylation of GR exon 1 and the expression of DNA methyltransferase 1 （DNMT1）， and restored the negative feedback of the hypothalamic-pituitary-adrenal （HPA） axis. Furthermore， Wenyang Jieyu prescription up-regulated the protein level of brain-derived neurotrophic factor （BDNF）， elevated the levels of postsynaptic density protein 95 （PSD95） and synaptophysin （Syn）， decreased the cell apoptosis index and B-cell lymphoma （Bcl-2）-associated X （Bax）/Bcl-2 ratio， suppressed the expression of Caspase-3， and enhanced the neuroplasticity and anti-apoptotic capacity in the hippocampus. Considering the research results， related articles， and clinical experience， we conclude that depression should be treated with liver-soothing and depression-relieving herbs， which can be supplemented with spleen-invigorating and Qi-regulating herbs to alleviate depressive symptoms. The Yang-warming and kidney-tonifying herbs can be used to eliminate the root cause and prevent relapse. Additionally， the wind-dispersing herbs can be supplemented to regulate the Qi movement throughout the body， thereby enhancing the efficacy of depression-relieving treatment.

The influence of renally inappropriate medication on the frailty of elderly patients with diabetes / 中国药房

OBJECTIVE To investigate the effects of renally inappropriate medication （RIM） on the frailty of elderly patients with diabetes. METHODS The data of elderly patients with diabetes mellitus admitted to a third-grade class A hospital in Yunnan province from January to December 2022 were collected， and Beers criteria （2019 edition） and Chinese version of FRAIL scale were used to evaluate RIM and the frailty of the patients； the patients were divided into the trial group （with RIM） and the control group （without RIM） according to whether there was RIM. The propensity score matching was used to balance confounding factors between two groups， and the influence of RIM on the frailty of elderly diabetic patients was analyzed by the Logistic regression model. RESULTS Among the 367 patients， 80 patients （21.80%） had RIM， the drugs involved RIM were spironolactone （82.56%）， rivaroxaban （13.95%） and gabapentin （3.49%）. After reaching the balance between groups using the propensity score matching method， the incidence of frailty was 77.94% in trial group and 27.94% in control group （P＜0.001）； the difference was not statistically significant in other confounding factors between the two groups （P＞0.05）. Results of Logistic regression analysis showed that the risk of frailty in the experimental group was 3.118 times that of the control group （odds ratio was 3.118，95% confidence interval was 1.758-5.530， P＜0.001）. CONCLUSIONS RIM is a risk factor for the frailty of elderly patients with diabetes， which can be considered as an indicator for early identification and screening of the frailty of elderly diabetes patients.

Lo clásico y lo nuevo en el tratamiento del sobrepeso y la obesidad / The classic and the new in the treatment of overweight and obesity

Así como planteamos en la primera entrega de esta serie de artículos de actualización sobre la obesidad, resulta urgente revisar el abordaje tradicional que la comunidad médica le ofrece a las personas con cuerpos gordos. En este segundo artículo desarrollaremos en profundidad diferentes alternativas terapéuticas para los pacientes que desean bajar de peso:plan alimentario, actividad física, tratamiento farmacológico y cirugía metabólica. (AU)

As we proposed in the first issue of this series of articles, it is urgent to review the traditional approach that the medical community offers to people with fat bodies. This second article will develop different therapeutic alternatives for patients who want to lose weight: eating plans, physical activity, pharmacological treatment, and metabolic surgery. (AU)

Automedicación en salud bucal en Bogotá: estudio etnográfico

Introducción: la automedicación en salud bucal es una práctica censurada por la biomedicina; sin embargo, es una actividad frecuente que sintetiza la interacción de las personas con diferentes modelos de atención a la salud, en donde se materializa la trama estructural y simbólica del campo sanitario. El objetivo de este estudio fue comprender los saberes y prácticas sobre automedicación salud bucal en Bogotá. Métodos: investigación cualitativa con enfoque etnográfico. Se utilizaron herramientas como observación participante, entrevista etnográfica y diario de campo. Se eligieron siete familias de Bogotá a partir de una muestra tipológica ideal. Resultados: existen barreras de acceso a la atención odontológica que se incrementan a través de mecanismos de segregación que se relacionan con la estructura urbana de la ciudad, barreras que motivan la utilización de diversos medicamentos frente a las dolencias. La boca tiene diversos significados. Se reconoce la caries y sus efectos, y en su prevención se usan sedas, pastas, enjuagues y cepillos, elementos que proceden de la industria farmacéutica. El padecimiento más común es la odontalgia y para tratarla se utilizan principalmente analgésicos de origen farmacéutico. Conclusiones: la automedicación en salud bucal es un proceso consciente que realizan los sujetos desde sus propios razonamientos y recursos, con el propósito de prevenir y atender sus dolencias. Esta práctica se relaciona con las representaciones sociales sobre la boca, con el acceso a los servicios de atención odontológica, y con la disposición y obtención de insumos terapéuticos.

Introduction: self-medication in oral health is a practice censured by biomedicine; however, it is a frequent activity that synthesizes the interaction of people with different models of health care, where the structural and symbolic fabric of the health field materializes. The objective was to understand the knowledge and practices on oral health self-medication in Bogota. Methods: qualitative research with ethnographic approach. Tools such as participant observation, ethnographic interview and field diary were used. Seven families from Bogota were chosen from an ideal typological sample. Results: there are barriers to access to dental care that are increased through segregation mechanisms that are related to the urban structure of the city, barriers that motivate the use of various medications in the face of ailments. The mouth has diverse meanings. Caries and its effects are recognized, and in its prevention silks, pastes, rinses and brushes are used, elements that come from the pharmaceutical industry. The most common ailment is odontalgia, and analgesics of pharmaceutical origin are mainly used to treat it. Conclusions: self-medication in oral health is a conscious process carried out by the subjects from their own reasoning and resources, to prevent and treat their ailments. This practice is related to social representations about the mouth, to access to dental care services, and to the availability and obtaining of therapeutic supplies.