Priority ranking of Chinese patent medicine prescriptions for type 2 diabetes mellitus (syndrome of deficiency of both Qi and Yin): based on analytic hierarchy process (AHP) / 中国中药杂志

Clinical expertise, patient preference, and the best evidence are the three elements of evidence-based medicine. Based on high-level and high-quality evidence, qualitative and quantitative analysis of the prescribing decisions of physicians is beneficial to improving clinical efficacy. A mature methodological system is available for the retrieval, analysis, summary, evaluation, and recommendation of the evidence, but there are still few studies on physicians' prescribing decisions. How to analyze the trend of physicians' prescribing decisions based on the priority ranking in addition and subtraction of prescriptions? Analytic hierarchy process(AHP) is a method for decision making, which arranges the elements of the decision problem into overall goal, criteria, and operational sub-criteria, and uses the matrix eigenvector method to solve the problem. This study aims to analyze the priority of physicians' prescribing decisions for diabetes mellitus with deficiency of both Qi and Yin based on AHP. To be specific, a database of diabetes mellitus cases with deficiency of both Qi and Yin was established and AHP was used to yield the priority ranking of Chinese patent medicine prescriptions in specific clinical scenarios. In the selected cases of diabetes mellitus with deficiency of both Qi and Yin, Xiaoke Pills was the best prescription for the treatment of type 2 diabetes mellitus(deficiency of both Qi and Yin)(normalized=0.388), followed by Liuwei Dihuang Pills(normalized=0.269), Qishen Capsules(normalized=0.230), and Shengmai Injection(normalized=0.113). According to the analysis the available data, for type 2 diabetes mellitus(deficiency of both Qi and Yin), Xiaoke Pills was the most effective prescription in specific scenarios. When the physicians' prescribing decisions are consistent with the evidence, quantitative analysis of physicians' cognition will boost the evidence-based medical decision-making. However, the research results are also affected by the quality of literature, evidence level and priority, which are thus have some limitations. It is recommended that further small data research based on individual cases be carried out to lay a evidence-based basis for the clinical decision-making of type 2 diabetes mellitus.

Network Meta-analysis of efficacy and safety of Chinese patent medicines in treatment of ankylosing spondylitis / 中国中药杂志

To evaluate the efficacy and safety of Chinese patent medicines in the treatment of ankylosing spondylitis(AS) by frequency network Meta-analysis. Randomized controlled trials(RCTs)of Chinese patent medicines for AS were retrieved from CNKI, Wanfang, VIP, CBM, PubMed, EMbase and Cochrane Library databases from the time of database establishment to January 2021. The quality of the included RCTs was evaluated according to the Cochrane bias risk standard, and the data was analyzed by RevMan 5.3 and Stata/MP 15.1. A total of 12 kinds of Chinese patent medicines in 55 RCTs were included. According to Meta-analysis, in term of the effectiveness, the top three optimal medication regimens were Biqi Capsules, Yishen Juanbi Pills and Yaobitong Capsules combined with western medicine. The top three interventions to reduce the erythrocyte sedimentation rate(ESR)were Yishen Juanbi Pills, Xianling Gubao Capsules and Fufang Xuanju Capsules combined with western medicine. The top three interventions to reduce the C-reactive protein(CRP)were Biqi Capsules, Xianling Gubao Capsules and Fufang Xuanju Capsules combined with western medicine. In terms of the safety, top three optimal medication regimens were Total Glucosides of Paeony Capsules, Yishen Juanbi Pills, and Wangbi Tablets combined with western medicine. This network Meta-analysis suggests that Chinese patent medicines combined with conventional western medicine can effectively improve the joint pain symptoms of AS patients and reduce the acute inflammatory indicators, with high safety. However, the literature included in this study is generally of low methodological quality, and the conclusion needs to be verified by high-quality research.

Clinical trials and evaluation of Chinese patent medicine for chronic obstructive pulmonary disease / 中国中药杂志

The clinical randomized controlled trials(RCTs) of Chinese patent medicine in the treatment of chronic obstructive pulmonary disease(COPD) were reviewed and analyzed to provide references for clinical research, guideline development, policy formulation, and quality improvement of clinical evidence. On the basis of the collection in the Traditional Chinese Medicine(TCM) Clinical Evidence Database System(EVDS), CNKI, Wanfang, SinoMed, Cochrane Library, PubMed, EMbase were searched for RCTs of Chinese patent medicine for COPD as a source of clinical evidence from database inception to December 31, 2019. The publication time, sample size, intervention and control measures, course of treatment, outcome indicators, and methodological quality of the trials were analyzed and evaluated. A total of 733 RCTs of Chinese patent medicine for COPD were included, among which 228 RCTs had a sample size higher than 100, accounting for 31.1% of total RCTs. Eighty-eight Chinese patent medicines were involved, including 40 oral medicines and 48 injections. A total of 327 RCTs mentioned intervention and control measures(Chinese patent medicine + conventional treatment vs conventional treatment), accounting for 43.0%. In addition, 94.40% of the RCTs reported the course of treatment, and 53.20% of the RCTs determined 8-14 d as the intervention course. The evaluation indicators adopted were numerous, among which physicochemical indicators(70.57%) and symptoms/signs(24.35%) were the most frequently employed. The operation of allocation concealment and blinding was not standard. Registration and the procedure related to ethics were mostly missing. The results indicate that there are prominent methodological problems in the clinical trials of Chinese patent medicine in the treatment of COPD, affecting the reliability and practicability of the trials. It is necessary to further standardize the design, implementation, and quality control of clinical trials of Chinese patent medicine in the treatment of COPD, highlight the clinical value of Chinese patent medicine for COPD, and improve the quality of evidence.

Clinical trials and evaluation of Chinese patent medicine for influenza / 中国中药杂志

The clinical randomized controlled trial(RCT) of Chinese patent medicine in the treatment of influenza were reviewed and analyzed to provide basic information for clinical decision and related research. On the basis of the collection in the Traditional Chinese Medicine(TCM) Clinical Evidence Database System(EVDS), CNKI, Wanfang, VIP, SinoMed, EMbase, PubMed, and Cochrane Library were searched for RCTs of Chinese patent medicine for influenza published from database inception to July 25, 2021. The publication time, sample size, intervention and control measures, course of treatment, outcome indicators, and methodological quality of the trials were analyzed and evaluated. Ninety-two RCTs of Chinese patent medicine for influenza published between 2005 and 2021, were included, among which 17 RCTs(18.48%) had a sample size higher than 200 and the average sample size was about 145. Twenty-seven Chinese patent medicines were involved, including twenty-one oral medicines and six injections. The Chinese patent medicines in trials reported in more than five papers included Lianhua Qingwen Capsules/Gra-nules, Tanreqing Injection, and Reduning Injection. Fourteen intervention protocols were reported, of which Chinese patent medicine+western medicine+conventional treatment vs western medicine+conventional treatment(20.65%) was the most frequently employed. Additionally, 85.87% of the RCTs reported the course of treatment, and 80.43% of the RCTs determined 3-7 d as the intervention course. Forty-five outcome indicators were extracted, which were used 434 times, including symptoms/signs, physicochemical detection, safety events, TCM symptoms/syndromes, quality of life, long-term prognosis, and economic evaluation. Symptoms/signs(61.52%) exhibited the highest frequency. Methodological problems were prevalent in the included trials. The findings reveal that there are few clinical trials on influenza treatment by Chinese patent medicine, and the methodological problems are prominent, affec-ting the reliability and practicability of the trials. In the future research, the value characteristics of Chinese patent medicine should be highlighted and the quality control in the whole process should be strengthened based on the scientific and rigorous design.

Clinical trials and evaluation of Chinese patent medicine for stroke / 中国中药杂志

To systematically collect and analyze clinical randomized controlled trial(RCT) of Chinese patent medicine treatment for stroke in 2020, in order to provide basic information for clinical decision-making and related research. On the basis of the collection in the Traditional Chinese Medicine(TCM) Clinical Evidence Database System(EVDS), CNKI, Wanfang, SinoMed, Cochrane Library, PubMed, EMbase were searched for RCTs of Chinese patent medicine for stroke in 2020. The publication, sample size, intervention and control measures, course of treatment, outcome indicators, methodological quality and other contents were statistically analyzed.A total of 68 RCTs studies on Chinese patent medicine for stroke were included in 2020, of which 29(42.60%) were RCTs with sample size>100 cases. A total of 41 kinds of proprietary Chinese medicines were involved, including 23 kinds of oral proprietary Chinese medicines and 18 kinds of injections. A total of 18 intervention/control cases were included in RCTs, and 19 cases(Chinese patent medicine+Western medicine vs Western medicine) were applied in RCTs, accounting for 27.90%. The duration of treatment was reported in 91.18% of the studies, and the intervention duration was 8-14 days in 50.00% of the studies. Evaluation indexes were widely used, among which physical and chemical testing indexes(49.36%) were the most widely used. According to the methodological quality evaluation, the overall methodological quality of the study is not high, especially the implementation of the allocation hidden, blind method is not accurate, and the registration, ethics and other links are often missing. In conclusion, 2020 implementation of proprietary Chinese medicine in the treatment of stroke research methodology problems is outstanding, the similar function scale large range of optional, no specification selection criteria, reliability and practicability of the impact study, need to further standardize the proprietary Chinese medicine in the treatment of stroke study design, implementation and quality control, and highlight the value of proprietary Chinese medicine in the treatment of stroke and improve the quality of the evidence.

Clinical trials and evaluation of Chinese patent medicine for heart failure / 中国中药杂志

The present study systematically collected, analyzed, and evaluated randomized controlled trial(RCT) of Chinese patent medicine in the treatment of heart failure to provide references for follow-up clinical research design, guideline update, and policy formulation, and promote the improvement of clinical evidence quality. On the basis of the collection in the Traditional Chinese Medicine(TCM) Clinical Evidence Database System(EVDS), CNKI, VIP, Wanfang, SinoMed, PubMed, and Web of Science were searched for RCTs of Chinese patent medicine in the treatment of heart failure from database inception to December 31, 2020. The di-sease type, publication time, sample size, intervention/control setting, course of treatment, evaluation indexes, and methodological quality were analyzed and evaluated. A total of 1 631 RCTs were included, including 1 622 in Chinese and 9 in English. It was first published in 1995, with the largest number of publications in 2016. There were only 56 RCTs(3.43%) with a sample size≥200. Seventy-eight types of Chinese patent medicines were involved, including 49 types of oral drugs and 29 types of injections. There were 34 intervention/control protocols, which were dominated by Chinese patent medicine+conventional treatment vs conventional treatment, accounting for 28.51%(n=465). About 94.0% of RCTs reported the course of treatment, mainly 14-56 days. The evaluation indexes were mainly physical and chemical tests and symptoms/signs, and left ventricular ejection fraction(LVEF) was the most frequently used measurement index. In enumeration indexes, clinical efficacy(response rate) was used the most frequently. Methodologically, 92.0% of the research subjects were rated as high risk of blindness. There were only 13 RCTs(0.80%) reporting registered information. It is necessary to further standardize the design, implementation, and quality control of clinical studies in order to improve the quality of evidence and avoid research waste.

Exploration and practice of post-marketing survival benefit evaluation of Chinese patent medicine for cancer / 中国中药杂志

Traditional Chinese medicine(TCM) is an important feature of cancer treatment in China. The methods to tap the advantages of TCM, reasonably evaluate and accurately apply Chinese patent medicines have become current research hotspots and difficulties. TCM takes syndrome differentiation and treatment as the core, with the characteristics of overall regulation and multi-targets efficacy. Therefore, the post-marketing survival benefit evaluation of Chinese patent medicines for cancer is different from that in modern medicine. The primary treatment goals in cancer patients include to improve the disease control rate and prolong their survival time. At present, Chinese patent medicines for cancer patients are lacking indepth studies on survival benefit at the post-marketing stage. In addition, the characteristics of individualized treatment with TCM have also increased the complexity of clinical research on TCM. Therefore, it is of certain practical significance and necessity to evaluate the survival benefit of Chinese patent medicines for cancer after marketing. Based on this, in this paper, we first summarized the technical methodological means of survival benefit evaluation at this stage, and then explored the post-marketing survival benefit evaluation of Chinese patent medicines for cancer from three aspects: the evaluation of cancer treatment effect based on survival time and quality of life, treatment-related toxicity and the auxiliary effect of TCM, and the improvement effect for tumor-related symptoms. Based on the practices of early clinical researches, and according to the insufficient efficacy evaluation of current clinical research on Chinese patent medicines, this paper proposed to improve the evaluation system for clinical researches on Chinese patent medicines, establish the evaluation method with TCM characteristics, clarify the dominant population, lay a theoretical foundation for the evaluation of post-marketing survival benefits of Chinese patent medicines for cancer in the future, and promote the modernization process of TCM.

Tendência da prática de automedicação entre idosos brasileiros entre 2006 e 2010: Estudo SABE / Self-medication practice trend among the Brazilian elderly between 2006 and 2010: SABE Study

RESUMO: Introdução: Automedicação retrata o princípio do próprio indivíduo buscar espontaneamente por algum medicamento que considere adequado para resolver um problema de saúde. Essa prática é ainda pouco explorada entre idosos de acordo com outros estudos baseados em dados populacionais. Objetivo: Examinar as tendências da prática de automedicação dos idosos do Estudo SABE entre 2006 e 2010. Método: Estudode base populacional cujos dados foram obtidos do Estudo Saúde, Bem-Estar e Envelhecimento (SABE). Aamostra de 2006 foi constituída de 1.258 idosos e a de 2010, de 865 idosos que utilizaram medicamentos. Resultados: Observou-se redução da automedicação de 42,3% em 2006 para 18,2% em 2010. Em ambos os períodos, as classes terapêuticas predominantes foram as dos medicamentos com ação no sistema nervoso (27,9% em 2006 e 29,6% em 2010) e trato alimentar e metabolismo (25,5% em 2006 e 35,9% em 2010). Entreos medicamentos mais usados nos anos de 2006 e 2010 estão os analgésicos/anti-inflamatórios e vitaminas. Houve tendência a declínio da utilização de medicamentos potencialmente inapropriados entre 2006 (26,4%) e 2010 (18,1%). Oidoso foi o principal responsável pela indicação da automedicação em 2006 (65,2%) e 2010 (66,5%). Conclusão: A extensão da prática de automedicação nos idosos do SABE apresentou redução entre 2006 e 2010, porém o emprego de medicamentos que oferecem risco à saúde ainda foi relatado. Desse modo, os achados reforçam a importância de monitorar, avaliar e educar continuamente os idosos acerca dos riscos e benefícios do consumo de medicamentos, sobretudo daqueles isentos de prescrição.

ABSTRACT: Introduction: Self-medication involves the concept of the spontaneous search by the individual for some drug that he or she considers appropriate to solve a health problem. Self-medication practice is little explored by the elderly according to other studies based in population data. Objective: To examine the trends in self-medication practice among the Brazilian elderly between 2006 and 2010. Methods: This is a population-based study whose data were obtained from the Health, Well-being and Ageing Study (SABE Study). Thesample consisted of 1,257 elderly people in 2006 and 865 in 2010, who used drugs. Results: The findings showed self-medication reduction from 42.3% in 2006 to 18.2% in 2010. In both periods, predominant utilized therapeutic classes were those acting on the nervous system (27.9% in 2006, and 29.6% in 2010) and on the alimentary tract and metabolism (25.5% in 2006, and 35.9% in 2010). The most commonly used medicines in 2006 and 2010 were analgesics, anti-inflammatories, and vitamins. There was a tendency to decrease the use of potentially inappropriate medicines between 2006 (26.4%) and 2010 (18.1%). The elderly themselves were the main responsible for the decision about the drug use in 2006 (62.5%) and 2010 (66.5%). Conclusion: Theextent of self-medication practice among the elderly who participated in the study decreased between 2006 and 2010, but the use of medicines that offer risks to health was still reported. Thus, the findings reinforce the importance of monitoring, evaluating, and continuously educating the elderly about risks and benefits of drug consumption, particularly over-the-counter medicines.

Effectiveness of a new non-hydrogen peroxide bleaching agent after single use - a double-blind placebo-controlled short-term study

Abstract Tooth whitening represents perhaps the most common aesthetic procedure in dentistry worldwide. The efficacy of bleaching depends on three aspects: bleaching agent, bleaching method, and tooth color. Objective: This in vivo study aimed to examine whitening effects on frontal teeth of the upper and lower jaws using an over-the-counter (OTC) non-hydrogen peroxide bleaching agent in comparison to a placebo after one single use. Material and methods: Forty subjects (25 female; 15 male) participated in this double-blind randomized placebo-controlled trial. The subjects were randomly allocated to two groups (n=20). The test group received the OTC product (iWhite Instant) and the placebo group received an identically composed product except for the active agents. Each subject was treated with a prefilled tray containing iWhite Instant or the placebo for 20 minutes. The tooth shade of the front teeth (upper and lower jaws) was assessed before (E_0), immediately after (E_1) and 24 h after treatment (E_2), using a shade guide (VITA classical). Statistical testing was accomplished using the Mann-Whitney U test (p<0.001). The dropout rate was 0%. Results: There were no significant differences at E_0 between placebo and test groups regarding the tooth color. Differences in tooth color changes immediately after (ΔE1_0) and 24 h after treatment (ΔE2_0) were calculated for both groups. The mean values (standard deviations) of tooth color changes for ΔE1_0 were 2.26 (0.92) in the test group and 0.01 (0.21) in the placebo group. The color changes for ΔE2_0 showed mean values of 2.15 (1.10) in the test group and 0.07 (0.35) in the placebo group. For ΔE1_0 and ΔE2_0 significant differences were found between the groups. Conclusion: In this short-term study, the results showed that a non-hydrogen peroxide bleaching agent has significant whitening effects immediately and 24 h after a single-use treatment.

Automedicação em estudantes de enfermagem do Estado do Amazonas - Brasil / La automedicación por los estudiantes de enfermería del Estado de Amazonas - Brasil / Self-medication Among Nursing Students in the State of Amazonas - Brazil

RESUMO Objetivo Determinar a prevalência e os fatores associados à automedicação entre estudantes de enfermagem. Método Estudo transversal realizado com 116 estudantes de enfermagem de uma universidade pública do Estado do Amazonas – Brasil, no período de março a abril de 2014. Utilizou-se questionário constituído por variáveis socioeconômicas e de consumo de medicamentos. Foi realizada a análise bivariada e a regressão logística – nível de significância de 5%. Resultados A prevalência de automedicação foi de 76,0%, motivada especialmente pela percepção de que o problema de saúde não requeria visita ao médico (46,6%). Metade dos estudantes relataram queixas álgicas. Os grupos farmacológicos mais consumidos foram anti-inflamatórios não esteroides (63,2%) e antibióticos (11,1%). O desconhecimento das implicações negativas da prática da automedicação foi associado à automedicação (OR=6,0). Conclusão A alta prevalência de automedicação, além de poder levar a reações adversas retrata também o uso irracional de medicamentos pelos estudantes, especialmente, quando considerado o papel destes futuros profissionais na segurança do paciente.

RESUMEN Objetivo Determinar la prevalencia y los factores asociados con la automedicación entre estudiantes de enfermería. Métodos Estudio transversal con 116 estudiantes de enfermería de una universidad pública en Amazonas - Brasil, en el período de marzo y abril del 2014. Se utilizó un cuestionario que consta de los niveles socioeconómicos y el consumo de drogas. Se realizó un análisis bivariante y regresión logística -nivel de significación del 5%. Resultados La prevalencia de la automedicación fue de un 76,0%, motivada especialmente por la constatación de que el problema de salud requiere no visitar al médico (46,6%). La mitad de los estudiantes reportaron quejas de dolor. Los grupos de fármacos más consumidos fueron los antiinflamatorios no esteroide (63,2%) y antibióticos (11,1%). Ignorar las implicaciones negativas de la práctica de la automedicación se asoció con la automedicación (OR = 6,0). Conclusión La alta prevalencia de la automedicación, pueden dar lugar a reacciones adversas, retrata el uso irracional de los medicamentos por los estudiantes, especialmente teniendo en cuenta el papel de estos futuros profesionales de la seguridad del paciente.

ABSTRACT Objective To determine the prevalence of self-medication and associated factors among nursing students. Method This is a cross-sectional study with 116 nursing students from the public university in the state of Amazonas, Brazil, from March to April 2014. Data were collected using a questionnaire with socioeconomic and medicine use variables. The data were subjected to bivariate analysis and logistic regression at a significance level of 5%. Results The prevalence of self-medication was 76.0%, chiefly motivated by the belief that the health condition did not require a medical appointment (46.6%). Half of the students reported pain-related complaints. The most commonly used pharmacological groups were non-steroidal anti-inflammatory drugs (63.2%) and antibiotics (11.1%). Lack of awareness of the negative implications of self-medication was associated with self-medication (OR = 6.0). Conclusion The high prevalence of self-medication that may lead to adverse reactions reveals the students’ irrational use of medicines, especially considering the role of these future professionals in patient safety.

Nonprescribed use of tranquilizers and use of other drugs among Brazilian students

Objectives: To describe patterns of nonprescribed use of tranquilizers by students aged 10 to 18 years and assess the sociodemographic characteristics of these adolescents and their use of other substances. Methods: A randomized and stratified sample of 47,979 students from state and private schools of the 27 Brazilian state capitals completed a self-report questionnaire. Poisson regression was used to estimate the associations between tranquilizer use and sociodemographic factors, as well as the use of other psychotropic substances. Results: The lifetime prevalence of nonprescribed use of tranquilizers was 3.9%. Use was most common among girls, wealthier adolescents, and those from private schools. An association was found between use of tranquilizers and lifetime use of alcohol (prevalence ratio [PR] = 3.15; 95% confidence intervals [95%CI] 2.58-3.85), tobacco (PR = 2.61; 95%CI 2.31-2.95), illicit drugs (PR = 3.70; 95%CI 3.19-4.29), and other prescription drugs (PR = 7.03; 95%CI 6.18-7.99). As the number of substances adolescents reported having used increased, so did the nonprescribed use of tranquilizers. Conclusions: Nonprescribed use of tranquilizers by adolescents might indicate the use of other substances, including high-risk combinations such as tranquilizers and alcohol. The risks of this association should be addressed during the early stages of drug prevention programs. .

Epidemiologia do uso de medicamentos entre idosos em area urbana do Nordeste do Brasil / Epidemiologia del uso de medicamentos entre ancianos en area urbana del Noreste de Brasil / Epidemiology of medication use among the elderly in an urban area of Northeastern Brazil

OBJETIVO Analisar o uso de medicamentos entre idosos e os fatores associados. MÉTODOS Estudo transversal com 400 indivíduos maiores de 60 anos residentes na área de abrangência da Estratégia Saúde da Família, em Recife, PE, em 2009. Os indivíduos foram selecionados por amostra probabilística sistemática, com coleta de dados de base domiciliar. Foram avaliadas variáveis socioeconômicas e demográficas, estilo de vida, condições de saúde e nutricionais. A variável independente foi uso de medicamentos. O diagrama analítico envolveu análises estatísticas uni e multivariadas. RESULTADOS A prevalência de uso de medicamentos foi de 85,5%. A polifarmácia (> 5 medicamentos) ocorreu em 11% dos casos. Dos 951 medicamentos relatados, 98,2% foram por prescrição médica e 21,6% foram considerados inseguros para idosos. Os medicamentos de uso nos sistemas cardiovascular (42,9%), nervoso central (20,2%), digestório e no metabolismo orgânico (17,3%) foram os mais utilizados. O uso de polifarmácia associou-se à escolaridade (p = 0,008), à saúde autorreferida (p = 0,012), à doença crônica autorreferida (p = 0,000) e ao número de consultas médicas ao ano (0,000). CONCLUSÕES A proporção de uso de medicamentos é elevada entre idosos, inclusive daqueles considerados inadequados, e há desigualdades entre grupos de idosos quando se considera escolaridade, quantidade de consultas médicas e saúde autorreferida. .

OBJETIVO Analizar el uso de medicamentos entre ancianos y los factores asociados MÉTODOS Estudio transversal con 400 individuos mayores de 60 años residentes en área abarcada por la Estrategia Salud de la Familia, en Recife, PE, Brasil, 2009. Los individuos fueron seleccionados por muestreo probabilístico sistemático, con colecta de datos de tipo domiciliar. Se evaluaron variables socioeconómicas y demográficas, estilo de vida, condiciones de salud y nutricionales. La variable independiente fue el uso de medicamentos. El diagrama analítico involucró análisis estadísticos uni y multivariados. RESULTADOS La prevalencia del uso de medicamentos fue de 85,5%. La polifarmacia (> 5 medicamentos) ocurrió en 11% de los casos. De los 951 medicamentos relatados, 98,2% fueron por prescripción médica y 21,6% fueron considerados inseguros para ancianos. Los medicamentos de uso en los sistemas cardiovascular (42,9%), nervioso central (20,2%), digestivo y en el metabolismo orgánico (17,3%) fueron los más utilizados. El uso de polifarmacia se asoció con la escolaridad (p=0,008), la salud auto-referida (p=0,012), la enfermedad crónica auto-referida (p=0,000) y el número de consultas médicas por año (p=0,000). CONCLUSIONES La proporción de uso de medicamentos es elevada entre ancianos, inclusive en aquellos considerados inadecuados, y desigualdades entre grupos de ancianos al considerarse la escolaridad, cantidad de consultas médicas y la salud auto-referida. .

OBJECTIVE To analyze medication use and associated factors among the elderly. METHODS A population-based cross-sectional study was carried out with a sample of 400 elderly people aged over 60 living in the urban area covered by the Family Health Strategy program in Recife, Northeastern Brazil in 2009. Individuals were selected by systematic random sampling and household data were collected. Demographic, socio-economic, lifestyle factors including nutrition practices and health variables were evaluated. Medication use was the independent variable. Univariate and multivariate statistical analysis were performed. RESULTS : The prevalence of medication use was 85.5%. Polypharmacy (> 5 drugs) occurred in 11% of cases. Of the 951 drugs reported, 98.2% were prescribed by doctors and 21.6% were considered unsafe for the elderly. The most commonly prescribed groups were: cardiovascular drugs (42.9%), central nervous system agents (20.2%) and drugs with an effect on the digestive tract and metabolism (17.3%). The use of polypharmacy was associated with education (p = 0.008), self-reported health (p = 0.012), self-reported chronic disease (p = 0.000) and the number of doctor appointments per year (0.000). CONCLUSIONS The results of this study indicate a high proportion of medication use among the elderly, including of those considered unsuitable, and inequality among groups of elderly individuals regarding the use ofmedication, when education, number of doctor appointments and self-reported health are considered. .

Investigation of Consumer Attitudes, Intentions and Brand Loyal Behavior on the OTC Drugs in Bangladesh.

Aims: To investigate the consumers’ attitudes and intentions to exhibit brand loyal behavior of Bangladeshi consumer on over the counter (OTC) drugs. Study Design: A cross- sectional survey. Place and Duration of Study: Consumers from the five major hospitals (Dhaka, Bangladesh) had been surveyed between January 2012 and June 2012. Methodology: The study was conducted among 100 OTC consumers in Bangladesh. Data were collected through questionnaire surveys and personal interviews. Results: The experimental data suggest that direct experience with the product, price range and brand reliance are important determinants of repetitive purchase behavior on OTC drugs. Cost sensitivity had a vital effect on intention to further purchase (r = .02, p =0.05). Moreover, earlier experience with the brand was critical in determining trustworthiness, beliefs, price sensitivity and purchase behavior. The behaviors of OTC consumers are influenced by a different set of factors. Previous experience and price sensitivity is dependent (Chi square = 31.603; p = 0.01. Furthermore, medical experience and buying an OTC product is dependent and the result were also found significant (Chi square = 32.292; p = 0.01). Conclusion: Present study shows that branding and prior experience remains the major influences to buy an OTC drug in Bangladesh.

Análise das propagandas dos medicamentos isentos de prescrição veiculadas em revistas para prescritores na área médica / Analysis of advertisements for OTC drugs aimed at prescribers in the medical

O presente artigo apresenta uma análise da qualidade das propagandas de medicamentos isentos de prescrição destinadas à classe médica, baseado na nova RDC no 96, de 17 de dezembro de 2008. Para análise coletou-se 16 fascículos da Revista Brasileira de Medicina (RBM) a partir de agosto 2009 a dezembro de 2010. Para averiguação da qualidade, elaborou-se um questionário dividido em três partes. Ao todo 160 peças publicitárias foram encontradas, em que 27 delas eram referentes aos medicamentos isentos de prescrição, contemplando nove indústrias farmacêuticas. Observou-se que nenhuma das peças publicitárias cumpriu na íntegra as novas regras exigidas na legislação vigente (RDC 96/08), apresentando infrações desde identificação da mesma até as proibições de figuras humanas e mensagens subjetivas. Portanto, concluiu-se que: há necessidade de implantação de um instrumento mais efetivo de fiscalização, a fim de melhorar à qualidade das propagandas para poderem ser usadas como fonte fidedigna de informação e atualização aos prescritores.

This article presents an analysis of the quality of advertisements for over-the-counter (OTC) drugs addressed to the medical profession, based on the new Anvisa resolution RDC 96 (17/12/2008). For this analysis, 16 volumes of the Brazilian Journal of Medicine (RBM) were collected, from August 2009 to December 2010. To investigate the quality of the adverts, we prepared a questionnaire divided into three parts. In total, 160 advertisements were found, of which 27 were related to drugs exempt from prescription, from 9 laboratories. It was observed that none of the advertisements complied fully with the new rules, as required by legislation (RDC 96/08), with violations ranging from identification of the advert to prohibitions of human figures and subjective messages. Therefore, it was concluded that there is a need to implement more effective monitoring, so as to improve the quality of the adverts, so they can be used as a reliable source of information and update by prescribers.

Utilização de medicamentos por gestantes usuárias do Sistema Único de Saúde no município de Santa Rosa (RS, Brasil) / Prescribed and unprescribed drug use among pregnant patients attended by the Unified Health System in Santa Rosa (State of Rio Grande do Sul, Brazil)

Com o objetivo de descrever o uso de medicamentos prescritos e não prescritos, realizou-se um estudo descritivo em gestantes em pré-natal no Sistema Único de Saúde (SUS) no município de Santa Rosa, Estado do Rio Grande do Sul. Os dados sobre o uso de medicamentos foram coletados através de entrevista estruturada e consulta aos prontuários das gestantes. A prevalência do uso de medicamentos foi de 90 por cento, correspondendo a uma média de uso de 4,1 medicamentos por gestante, dos quais 83,6 por cento foram prescritos e 16,4 por cento foram utilizados por automedicação. Do total de medicamentos, 17,5 por cento estão incluídos na categoria C de risco ao feto. O uso de medicamentos é frequente, e a maioria das gestantes utilizou um ou mais fármacos prescritos ou não prescritos. Esses dados sugerem a necessidade de medidas de intervenção para promover o uso racional de medicamentos durante a gestação.

In order to ascertain the use of prescribed and unprescribed drugs among pregnant patients of the Unified Health System (SUS), a descriptive study comprised of a sample of pregnant women was carried out in the city of Santa Rosa, State of Rio Grande do Sul, Brazil. Data were collected by means of structured interviews and consultation of patient records of pregnant women in the prenatal period. The prevalence of drug use was 90 percent, corresponding to an average of 4.1 drugs per pregnant woman, of which 83.6 percent were prescribed and 16.4 percent were self-medicated. Of this total, 17.5 percent of the drugs were included in fetal risk category C. The use of drugs during pregnancy is frequent and the majority of the pregnant women used one or more prescribed and unprescribed drugs during pregnancy. These data suggest the need for preventive measures to promote rational drug use during pregnancy.

Drug utilization patterns in pregnant women: a case study at the Mount Hope Women's Hospital in Trinidad, West Indies / Patrones de utilización de medicamentos en las mujeres embarazadas: un caso de estudio en el Hospital de Mujeres Mount Hope en Trinidad, West Indies

OBJECTIVE: To explore drug (prescription, over-the-counter and herbal) utilization in pregnant women attending a public sector tertiary healthcare institution. METHODS: This was a cross-sectional case study in women attending antenatal clinics at the Mount Hope Women's Hospital. Women (506) who consecutively presented for routine care at the antenatal clinic were interviewed on the medication they took. Descriptive statistics and logistic regression for predictors of drug use were done using SPSS 16. RESULTS: There were 200 (39.5%) primigravidae, 306 (60.5%) multigravidae and 299 (59%) women were in the third trimester of pregnancy. Most women (69.8%) were between 20-35 years of age. Women took an average of 1.32, 1.22 and 0.94 prescribed drugs in each trimester, respectively. Multivitamins (59.8%) and iron/folic acid (54.2%) were the most frequently prescribed drugs. Regardless of trimester, only 20% of women took supplemental calcium. Very few women (2.4%) took herbal medications. Paracetamol was the most common over-the-counter (OTC) medication in all trimesters. Women with secondary level education were most likely to use OTC iron/folic acid (p = 0.02), paracetamol and histamine2 receptor antagonists [H2RAs] (p = 0.001). More primigravidae took non-steroidal anti-inflammatory drugs (p = 0.02) and more women in the first trimester used antiemetics (p = 0.001). Age group (p = 0.048), marital status (p = 0.001) and the trimester of pregnancy (p = 0.001) were predictors of drug utilization. CONCLUSION: Overall, women in tertiary healthcare institutions took medication as prescribed particularly multivitamins and iron/folic acid. More women with higher education took OTC paracetamol, iron/folic acid and vitamin supplements. Herbal supplements were rarely used. Research on drug utilization in primary care facilities is recommended.

OBJETIVO: Explorar el uso de los medicamentos (con prescripción, sin receta médica, herbarios) en mujeres embarazadas que asisten a una institución terciaria de atención a la salud pública dentro del sector público. MÉTODOS: Se trató de un estudio transversal de mujeres que asisten a las clínicas prenatales en el Hospital de Mujeres Mount Hope. Las mujeres (506) que consecutivamente se presentaron para cuidados de rutina en la clínica prenatal, fueron entrevistadas acerca de la medicación que tomaban. Se hicieron estadísticas descriptivas y se hizo una regresión logística para los predictores del uso del medicamento usando SPSS 16. RESULTADOS: Había 200 (39.5%) primerizas, 306 (60.5%) multíparas, y 299 (59%) embarazadas en su tercer trimestre. La mayoría de las mujeres (69.8%) tenían entre 20-35 años de edad. Las mujeres tomaban un promedio de 1.32, 1.22 y 0.94 medicamentos prescritos en cada trimestre, respectivamente. Las multivitaminas (59.8%) y el hierro/ácido fólico (54.2%) fueron los medicamentos más frecuentemente prescritos. Con independencia del trimestre, sólo 20% de las mujeres tomaron suplemento de calcio. Muy pocas mujeres (2.4%) tomaban medicaciones herbarias. El paracetamol fue el medicamento sin receta más común en todos los trimestres. Las mujeres con nivel de educación secundaria presentaban una mayor probabilidad de usar hierro/ácido fólico (p = 0.02), el paracetamol y los antagonistas de los receptores de la histamina-2- [H2RAs] (p = 0.001). Un mayor número de primerizas tomaron medicamentos anti-inflamatorios no esteroideos (p = 0.02) y más mujeres en el primer trimestre usaron anti-eméticos (p = 0.001). El grupo etario (p = 0.048), el estado matrimonial (p = 0.001) y el trimestre de embarazo (p = 0.001) fueron predictores de la utilización de medicamentos. CONCLUSIÓN: En general, las mujeres en las instituciones terciarias de atención a la salud tomaron la medicación como fue prescrita, en particular las multivitaminas y el hierro/ácido fólico. Más mujeres con mayor escolaridad tomaron medicamentos sin recetas: paracetamol, hierro/ácido fólico y suplementos de vitamina. Raramente se usaron suplementos herbarios. Se recomienda la investigación del uso de medicamentos en centros de atención primaria.

Use of analgesics in adults with pain complaints: prevalence and associated factors, Turkey / Uso de analgésicos por adultos com queixas de dor: prevalência e fatores associados, Turquia / Uso de analgésicos em adultos que padecen dolores: prevalência y factores asociados, Turquia

OBJECTIVE: Use of analgesics has been increasingly recognized as a major public health issue with important consequences in Turkey. The objective of the study was to determine the prevalence and patterns of analgesics usage and associated factors in adults with pain complaints. METHODS: A cross-sectional study was conducted in 15 cities selected from five demographic regions in Turkey. The study sample population comprised 1.909 adults 18-65 age groups suffering from pain. The sampling method was multi-step stratified weighted quota-adjusted sampling. Data were collected by face-to-face interviews using a semi-structured survey questionnaire consisting of 28 questions. Odds ratios were produced by logistic regression analyses. RESULTS: The prevalence of analgesic use was 73.1 percent, and it was higher in females (75.7 percent; p<0.05), in subjects 45-54 years (81.4 percent; p<0.05), in subjects in rural areas (74.6 percent; p<0.05), in subjects in northern region (84.3 percent; p<0.05), in illiterate subjects (79.1 percent; p>0.05), and in subjects of lower socioeconomic status (74.1 percent; p>0.05). One in ten of the participants used non-prescription analgesics. Non-prescription analgesics were more prevalent among the 55-65 age groups (18.1 percent; p<0.05), among female (11.6 percent; p>0.05), among the urban population (10.7 percent; p>0.05), and in subjects of lower middle socioeconomic status (13.2 percent; p<0.05). Logistic regression showed statistically significant ORs only for age groups, duration of education, socioeconomic status, and demographic regions (p<0.05). CONCLUSIONS: The results showed that the prevalence of analgesic use and prescription analgesic use is high in Turkey, and their use is related to sociodemographic characteristics.

OBJETIVO: O uso de analgésicos tem sido amplamente reconhecido com um grande problema de saúde pública com importantes conseqüências na Turquia. O objetivo do estudo foi determinar a prevalência e os padrões de uso de analgésicos por adultos e os fatores associados às queixas de dores. MÉTODOS: Estudo transversal conduzido em 15 cidades selecionadas de cinco regiões demográficas da Turquia. A amostra estudada incluiu grupos etários de 1.909 adultos (18-65 anos) que sofrem de dores. O método de amostragem seguiu estratificação com pesos ajustados para cada estrato amostrado. Os dados foram coletados em entrevistas face-a-face, usando um questionário de levantamento semi-estruturado, composto por 28 questões. Foram calculados os odds raios por meio de regressão logística. RESULTADOS: A prevalência de uso de analgésicos foi de 73,1 por cento, sendo significativamente (p<0,05) maior em mulheres (75,7 por cento; p<0,05), em sujeitos de 45-54 anos (81,4 por cento; p<0,05), naqueles residentes em área rural (74,6 por cento; p<0,05), na região norte (84,3 por cento; p<0.05), em analfabetos (79,1 por cento; p>0,05), e em sujeitos de status socioeconômico mais baixo (74,1 por cento; p>0,05). Um em cada dez participantes usou analgésico sem prescrição médica. A não-prescrição foi mais prevalente entre sujeitos do grupo etário 55-65 (18,1 por cento; p<0,05), entre mulheres (11,6 por cento; p>0,05), entre a população urbana (10,7 por cento; p>0,05), e em sujeitos de classe econômica média-baixa (13,2 por cento; p<0,05). A regressão logística mostrou OR significantes apenas para grupos etários, anos de estudo, status socioeconômico e região demográfica (p<0,05). CONCLUSÕES: Os resultados mostraram que a prevalência de uso de analgésico e sua prescrição de uso são altas na Turquia, e esses usos são relacionados a características sociodemográficas.

OBJETIVO: El uso de analgésicos ha sido reconocido como el mayor problema de salud pública con importantes consecuencias en Turquía. El objetivo del estudio fue determinar la prevalencia y patrones de uso de analgésicos y factores asociados en adultos que padecen de dolores. MÉTODOS: Se condujo un estudio transversal en 15 ciudades seleccionadas de cinco regiones demográficas en Turquía. La muestra poblacional comprendió 1.909 adultos agrupados en edades entre 18-65 años que sufrían de dolor. Se realizó un muestreo multi-etapa estratificado ajustado. Los datos fueron colectados en entrevistas cara a cara usando un cuestionario semi-estructurado que consistía de 28 preguntas. Los Odds ratio fueron obtenidos por análisis de regresión logística. RESULTADOS: La prevalencia en el uso de analgésicos fue de 73,1 por ciento y fue superior en mujeres (75,7 por ciento; p<0,05), en individuos con edades entre 45-54 años (81,4 por ciento; p<0,05), en individuos de áreas rurales (74,6 por ciento; p<0,05), en individuos de la región norte (84,3 por ciento; p<0,05), en analfabetas (79,1 por ciento; p<0,05) y en individuos de clase social baja (74,1 por ciento; p<0,05). Uno de cada diez de los participantes usa analgésicos sin prescripción médica. La no prescripción médica fue más prevalente en los grupos entre 55-65 años (18,1 por ciento; p<0,05), entre mujeres (11,6 por ciento; p<0,05), entre la población urbana (10,7 por ciento; p<0,05) y en individuos de clase media y baja (13,2 por ciento; p<0,05). La regresión logística mostró ORs significativos estadísticamente sólo para grupos etarios, duración de la educación, status socioeconómico, y regiones demográficas (p<0,05). CONCLUSIONES: Los resultados mostraron que la prevalencia del uso de analgésico y prescripción para el uso de analgésicos es alta en Turquía, y su uso esta relacionado con características sociodemográficas.

Self-medication: initial treatments used by patients seen in an ophthalmologic emergency room

OBJECTIVE: This study seeks to identify practices of self-medication in the treatment of ocular emergencies. We examine patients' use of both homemade preparations and manufactured products before seeking specialized care. MATERIALS AND METHODS: We conducted a cross-sectional analytic survey of consecutive patients seen in the ophthalmology emergency room of a teaching hospital. RESULTS: The sample included 561 subjects, 51.3 percent males and 48.7 percent females, with a mean age of 39.8 years. Prior to seeking emergency care, 40.5 percent reported self-medicating; 29.4 percent used a homemade preparation (13.9 percent referred to an industrialized product like boric acid as a homemade preparation), and 11.1 percent used a manufactured product. The most frequently used products included a boric acid solution (53.3 percent), a normal saline solution (35.7 percent), herbal infusions (6.1 percent) and breast milk (4.8 percent). Viral conjunctivitis was the most frequent diagnosis (24.4 percent), followed by the presence of a corneal foreign body (7.4 percent). No significant differences were found in the self-treatment of ocular injuries according to gender (p = 0.95), level of education (p = 0.21) or age (p = 0.14). In addition, self-medication practices were not related to the medically judged severity of the condition. CONCLUSION: Patients often attempt to treat conditions that require ophthalmologic emergency care by self-medicating with homemade or manufactured products. The most widely used products include boric acid, normal saline, leaf infusions and breast milk. This behavior occurs independently of educational level, gender, age or the nature of the ocular condition. Self-medication is a culturally driven practice that is used even in cases of acute ocular injuries.

Implementación y Evaluación del Sistema de Suministro de Medicamentos en el Centro de Salud 2 de Quito / Implementation and Evaluation of the System of Supply of Medications in the Center of Health 2 of Quito

La presente investigación se centra en el manejo de medicamentos en el Centro de Salud 2 de Quito, unidad de atención primaria del Ministerio de Salud y tiene tres momentos: un diagnóstico de base, un proceso de implementación del Sistema integrado de manejo de medicamentos y una evaluación final.La investigación inicial reveló que el manejo de medicamentos en el Centro de Salud era ineficiente, no satisfacía a los clientes externos, y no propiciaba las buenas prácticas de prescripción ni el uso racional de los medicamentos.En la fase de intervención, que duró diecisiete meses, se implementó y monitorizó cada componente del Sistema integrado de manejo de medicamentos se planificó y ejecutó un proceso de educación continua dirigido a prescriptores