Estoque e descarte de medicamentos no domicílio: uma revisão sistemática / Storage and disposal of pharmaceuticals at home: a systematic review

Resumo Este estudo teve como objetivo analisar a evidência científica nacional e internacional existente sobre o motivo do estoque e a forma de descarte dos medicamentos no domicílio. Realizou-se uma revisão sistemática da literatura de 2001 a 2016 nas bases de dados PubMed, Lilacs e Elsevier's Scopus Database, utilizando os seguintes unitermos: "Disposal of medicines in household", "Disposal of expired drugs", "Residential expired drugs", "Management of expired medications in household". Foram selecionados 33 estudos originais após aplicação dos critérios de inclusão e exclusão. Os estudos analisados demonstraram que os principais motivos de estoque no domicílio foram: automedicação; guarda para uso futuro e sobras de tratamentos anteriores. E quanto ao descarte dos medicamentos, prevalecem práticas inadequadas, como descarte no lixo comum e na rede de esgoto. Alguns países têm adotado programas de orientação sobre o armazenamento e o descarte correto, no entanto, foi apenas encontrado um estudo que descreve um programa nacional gratuito, para orientar essas práticas. A partir das evidências cientificas verificou-se a importância do incentivo para a elaboração e a implementação de políticas públicas voltadas para o uso e descarte adequado de medicamentos no domicílio.

Abstract This study's objective was to analyze Brazilian and international scientific evidence on the reasons people store medication at home and the disposal methods used. This systematic literature review includes studies published from 2001 to 2016 and indexed in PubMed, Lilacs and Elsevier's Scopus Database, using the following key words: Disposal of medicines in household, Disposal of drugs expired, Residential expired drugs, Management of expired medications in household. Thirty-three studies were selected after applying inclusion and exclusion criteria. The studies reveal that the main reasons people keep a stock of medicines at home include the possibility of future use, leftovers from previous treatments, and self-medication. Inappropriate disposal methods prevail, such as throwing medicines in the household trash or flushing them into the sewer. Some countries have adopted programs to educate on proper storage and disposal of medicines, though only one study describes a national program guiding these practices that is free of charge. Evidence shows there is a need to implement public policies intended to provide guidance on the proper storage and disposal of medicines at home.

Casos de dengue e coleta de lixo urbano: um estudo na Cidade do Recife, Brasil / Cases of dengue and urban waste collection: a study in the City of Recife

Resumo O objetivo desse estudo foi identificar quais categorias de lixo urbano apresentam associação com casos de dengue e, em seguida, avaliar o impacto da coleta de lixo sobre os casos da doença na cidade do Recife. Foram utilizados dados da pesagem categorizada de lixo, juntamente com os casos confirmados de dengue no município. Os dados foram analisados através do coeficiente de correlação de Pearson para as treze categorias de lixo, seguido pela Regressão Linear Multivariada, selecionando as variáveis pelo método de "stepwise". Identificou-se a existência de correlação negativa entre o total de casos de dengue em sete categorias: lixo domiciliar (r = -0,835), resíduos diferenciados (r = -0,835), resíduos de operações especiais (r = -0,711), entulhos (r = -0,687), coleta seletiva (r = -0,425) e pneus (r = -0,423). O modelo de regressão foi capaz de explicar 75% da variação, apontando que um incremento de 1.000 toneladas na coleta de lixo doméstico proporciona uma redução de 0,032 casos de dengue enquanto que o mesmo incremento na coleta de pneus é capaz de reduzir 0,465 casos da doença. Os resultados demonstram que a coleta de lixo possui um forte impacto negativo nos casos de dengue e podem ser adotados como estratégia de prevenção pelos governos municipais.

Abstract The scope of this study was to identify which categories of urban waste are associated with cases of dengue and to evaluate the impact of garbage collection on dengue infection in the City of Recife (Brazil). Data from categorized waste weighing and the confirmed cases of dengue in the city were used. The data were analyzed using Pearson's correlation coefficient for the 13 categories of urban garbage, followed by Multivariate Linear Regression, selecting the variables by the stepwise method. A negative correlation between dengue infections in seven categories was identified: household garbage (r = -0.835), differentiated residues (r = -0.835), special operations residues (r = -0.711), building rubble (r = -0.687), selective waste collection (r = -0.425) and tires (r = -0.423). The regression model was able to explain 75% of the variation, indicating that an increase of 1,000 tons in household garbage collection provides a decrease of 0.032 in cases of dengue, while the same increase in tire collection esults in a decrease of 0.465. The results show that garbage collection has a strong negative impact on dengue cases and can be adopted as a prevention strategy by municipal governments.

Conhecimento e comportamento autorreferidos sobre descarte domiciliar de medicamentos / Authorreferated knowledge and behavior on disposal of domiciliary medicines / Conocimiento y comportamiento autorreferidos sobre descarte domiciliar de medicamentos

Objetivo: Analisar o conhecimento e comportamento autorreferidos sobre o descarte domiciliar de medicamentos. Método: Estudo transversal tipo survey, com dados coletados por meio de um questionário em maio de 2017, na cidade de Picos­PI, com amostra de 153 residências. Resultados: Sobre o conhecimento autorreferido, apesar de 139 (90,8%) afirmarem ter ciência sobre o risco ambiental, 144 (94,1%) relataram não ter conhecimento sobre local adequado de realizar o descarte,104 (68,0%) admitiram que o modo como descarta os medicamentos no ambiente traz algum risco individual e 118 (77,1%) perceberam a existência de risco coletivo. Quanto ao comportamento, 107 (69,9%) afirmaram já ter descartado medicamento devido ao fato do prazo de validade vencido, e a maioria afirmou realizar o descarte dentro da embalagem original e no lixo doméstico, 124 (81,0%). Conclusão: O conhecimento e comportamento autorreferidos demonstram fragilidades que comprometem a saúde pública e ambiental

Objective: To analyze the self-reported knowledge and behavior on the disposal of medicines. Method: A cross-sectional study with data collected through a questionnaire in May 2017, in the city of Picos-PI, with a sample of 153 residences. Results: Regarding the selfreported knowledge, 139 (90.8%) stated that they had knowledge about environmental risk, 144 (94.1%) reported having no knowledge of the appropriate disposal site. 104 (68.0%) admit that the way they dispose of medicines in the environment poses some individual risk and 118 (77.1%) perceive the existence of a collective risk. Regarding the behavior, 107 (69.9%) stated that they had discarded medication due to the fact that the expiration date had expired, and the majority stated that they disposed of 124 (81.0%) in the original packaging and household waste. Conclusion: Self-reported knowledge and behavior demonstrate fragilities that compromise public and environmental health

Objetivo: Analizar el conocimiento y el comportamiento autorreferidos sobre el descarte domiciliar de medicamentos. Método: Estudio transversal tipo survey, con datos recogidos por medio de un cuestionario en mayo de 2017, en la ciudad de Picos-PI, con muestra de 153 residencias. Resultados: Sobre el conocimiento autorreferido a pesar de 139 (90,8%) afirmar tener ciencia sobre el riesgo ambiental, 144 (94,1%) relató no tener conocimiento sobre el lugar adecuado de realizar el descarte. (68,0%) admite que el modo en que descarta los medicamentos en el ambiente trae algún riesgo individual y 118 (77,1%) percibe la existencia de riesgo colectivo. En cuanto al comportamiento, 107 (69,9%) afirmaron ya haber descartado medicamento debido al hecho del plazo de validez vencido, y la mayoría afirmó realizar el descarte dentro del embalaje original y en la basura doméstica, 124 (81,0%). Conclusión: El conocimiento y comportamiento autorreferidos demuestran fragilidades que comprometen la salud pública y ambiental

Development of a novel compound microbial agent for degradation of kitchen waste

Abstract Large quantities of kitchen waste are produced in modern society and its disposal poses serious environmental and social problems. The aim of this study was to isolate degradative strains from kitchen waste and to develop a novel and effective microbial agent. One hundred and four strains were isolated from kitchen waste and the 84 dominant strains were used to inoculate protein-, starch-, fat- and cellulose-containing media for detecting their degradability. Twelve dominant strains of various species with high degradability (eight bacteria, one actinomycetes and three fungi) were selected to develop a compound microbial agent "YH" and five strains of these species including H7 (Brevibacterium epidermidis), A3 (Paenibacillus polymyxa), E3 (Aspergillus japonicus), F9 (Aspergillus versicolor) and A5 (Penicillium digitatum), were new for kitchen waste degradation. YH was compared with three commercial microbial agents-"Tiangeng" (TG), "Yilezai" (YLZ) and Effective Microorganisms (EM), by their effects on reduction, maturity and deodorization. The results showed that YH exerted the greatest efficacy on mass loss which decreased about 65.87% after 14 days. The agent inhibited NH3 and H2S emissions significantly during composting process. The concentration of NH3 decreased from 7.1 to 3.2 ppm and that of H2S reduced from 0.7 to 0.2 ppm. Moreover, E4/E6 (Extinction value460nm/Extinction value665nm) of YH decreased from 2.51 to 1.31, which meant YH had an obvious maturity effect. These results highlighted the potential application of YH in composting kitchen waste.

Analytical study on the RoHS of plastic from waste electrical and electronic appliances

This study was conducted to identify emission characteristics of certain hazardous substances contained in the plastic of used home electrical and electronic appliances keeping in view compliance with the Restriction of Hazardous Substances [RoHS] Directive and to estimate the possibility of safe recycling practices. According to the results, the concentration of cadmium, lead, mercury and chromium were found below than Maximum Concentration Value [MCV] of RoHS, while the concentration of total bromine [T-Br] was exceeded the standard limitations in the samples of plastic from e-waste. Over 90% of the plastics used in housing cover of display electronic products were composed of Polystyrene [PS] 53.9% and PS-flame retardants 36.4%.Peak of each hazardous substance in total samples also showed higher values of bromine, cadmium and lead. In order to enhance cleaner recycling of waste electronic appliances in accordance with the allowance of RoHS Directive, the use of brominated flame retardants in plastic and chrominated synthetic resins should be restricted and applications of metal surface finishing such as coating and painting of high molecules synthetic resins should be minimized

Resíduos sólidos de serviços de saúde: uma fotografia do comprometimento da equipe de enfermagem / Residuos sólidos de servicios de salud: una fotografía del comprometimiento del equipo de enfermería / Solid waste of health services: a photograph of the commitment of nursing staff

O presente trabalho investigou os conhecimentos e atitudes dos profissionais da equipe de enfermagem do Hospital de Clínicas de Porto Alegre (HCPA), Rio Grande do Sul, em relação ao descarte dos resíduos sólidos dos serviços de saúde (RSSS). Realizou-se uma pesquisa de natureza exploratória descritiva, através de uma abordagem qualitativa. Os dados foram obtidos a partir de entrevistas semi-estruturadas aplicadas a 24 profissionais da equipe de enfermagem. Os dados foram categorizados através da análise de conteúdo, tendo sido identificadas quatro categorias: Significado da expressão resíduos sólidos de serviços de saúde; Separação dos resíduos sólidos dos serviços de saúde; Realização do curso/conhecimento e Profissionais que não realizam a separação. Os resultados ratificaram a importância de tratar com maior seriedade a questão apresentada, reforçando a necessidade do acesso às orientações adequadas.

El presente trabajo pretiende investigar los conocimientos y actitudes de los profesionales del equipo de enfermería del Hospital de Clínicas de Porto (HCPA), Rio Grande do Sul, Brasil, en relación al descarte de los residuos sólidos de los servicios de salud (RSSS). Fue realizada una pesquisa de naturaleza exploratoria descriptiva, a través de un abordaje cualitativo. Los datos fueron obtenidos a partir de encuestas semi estructuradas aplicadas a 24 profesionales del equipo de enfermaje. Se buscó la categorización de los datos a través del análisis de contenido. Fueron identificadas cuatro categorías: Significado de la palabra residuos sólidos de servicios de salud; Separación de los residuos sólidos de los servicios de salud; Realización del curso/conocimiento y Profesionales que no realizan la separación. Con los resultados, se ratificó la importancia de tratar con mayor seriedad la cuestión presentada, reforzando la necesidad del acceso a las orientaciones adecuadas.

This work investigated the knowledges and attitudes of the professionals of the nursing group of the Hospital de Clínicas de Porto Alegre (HCPA), Rio Grande do Sul, Brazil, on solid residues in health services (SRHS). Was realized a search for exploratory descriptive nature, through a qualitative approach. The data were obtained from semi-structured interviews applied to 24 professionals of the nursing group. The categorization of the data came through content analysis. Four categories were identified: Meaning of the word solid residues in health services; Separation of solid residues of the health services; Realization of the course/knowledge and professionals who not do the separation. With the results, was confirmed the importance to treat more seriously this question presented, emphasizing the need for access to appropriate guidance.

Bacteriological profile of biomedical waste: Management guidelines.

Biomedical waste (BMW) is generated in hospitals, research institutions, health care teaching institutes, clinics, laboratories, blood banks, animal houses and veterinary institutes. Hospital waste management has been brought into focus in India recently, particularly with the notification of the BMW (Management and Handling) Rules, 1998. This study was conducted in Sharda hospital, Greater Noida with the aim to find out bacteriological profile of BMW with study of practices being followed in management and disposal of this waste with standard procedure. Total 500 cases of biomedical waste samples were taken in the study for bacterial culture, 136 samples of biomedical waste showed growth of bacterias. Pseudomonas species was the predominant bacteria isolated from these cultures. This study also suggests about the optimum practice which is to be followed in management of biomedical waste.

Evaluation of stability parameters in in-vessel composting of municipal solid waste

Composting is a reliable technology for production of stabilized organic matter that is suitable for agriculture, but this process should be carefully monitored with appropriate indices. Quality of compost is important from maturity and stability viewpoint, but in most compost factories proper attention is not paid to it. This study was designed to evaluate the stability indices in municipal solid waste composting, for selecting the best index in quality monitoring of the wastes. Processed and shredded municipal solid waste from Isfahan compost plant was used as raw material in an in-vessel composting process. A cylindrical reactor with 1 m height and 50 cm diameter made of Pyrex glass was designed. Air was supplied at a specifically flow rate 0.2 L/min.kg to maintain aerobic condition. NH[4][+]/ NO[3] ratio, dehydrogenase enzyme activity [DA], pH, oxidation reduction potential [ORP or Eh] and specific oxygen uptake rate [SOUR] were used as stability indices. These parameters were measured during 40 days of composting process. Changes in these parameters during this period were surveyed and analyzed. Statistical analysis was carried out to choose best of them. Results showed that among the indices, SOUR can show the different stages of microbial decomposition and a numerical value for compost stability also SOUR value less than 2 mg O[2]/gVS.h can show the full stability of compost

status of solid waste management in Gaza city and the dustmen' views: an environmental study

This study investigates the dustmen's opinion about collecting and moving of solid waste into the dump, the problems of waste management, and how to improve work in Gaza city and Al-Shati' Refugee Camp. So, a questionnaire of 87 open ended and non open ended items was designed and distributed among 230 dustmen in the summer of 2007. Results revealed that most of the residents put their waste in simple plastic bags which are always found torn out due to kids, rodents, dogs, and rubbish diggers. Therefore, dustmen prefer special plastic bags. In addition, results revealed that the municipality collects the waste found in front of houses for nearly 70% of Gaza population twice a day to once every two days, and that there are two methods of collecting and moving waste into the dump: collecting from house to house, and collecting from garbage containers. Sometimes the two methods go together; however, the first is preferable. Furthermore, the study pointed out some problems that hinder the work of management because of workers, municipality, residents and waste containers. Moreover, results showed that workers refused privatizing the system of collecting the waste. Finally, the study recommends collecting waste from house to house as well as changing the existing methods into a new proposed one

[Evaluating the quantity and composition of solid waste generated in Kashan during 2009-10]

Solid waste management is considered to be one of the most immediate and serious environmental problems confronting urban governments in developing countries. Qualitative and quantitative variety of waste composition, uncontrolled urban development and the lack of appropriate waste management technology cause particular problems that solving them needs a careful study and the coordination of science and experience in the form of a proper management. This descriptive study was carried out on solid wastes generated in Kashan over a limited timeframe of 12 months during 2009-10. One sample was randomly taken per month according to the standard instruction and subsequently the physical analysis of it was performed. The average daily waste generation rate in Kashan is 185 tons, of which 75.5% are putrescible materials. The average daily waste generation is tantamount to 638 g/capita while the average density of the waste 194 kg/m[3] at transfer station. The most frequent metal measured in the leachate solid waste was iron. According to the results high percentages of solid wastes in Kashan were allocated to plastic and corruptible materials, and then the paper and cardboard. Considering that the prevention of adverse environmental effects of solid waste is a priority and applying proper management techniques can help to achieve this, public education for the waste separation at the source, waste reduction and subsequently reduction of the leachate volume as well as the proper manner of recycling, collection and disposal of the waste are recommended

Improved sanitary landfill design using recirculation of anaerobically treated leachates: generation of advanced design criteria

In Latin America, the most accepted disposal systems for Municipal Solid Waste (MSW) are landfills, which nowadays have low rates of stabilization. The objective of this study was to develop design criteria for sanitary landfills which lead to a reduction in the stabilization times of MSW, based on experiment results obtain from a pre-pilot scale operation of two sanitary landfills (0.5 Ton), one with recirculation of leachates treated in an anaerobic digester and the other with recirculation of untreated leachates. This was complemented by another pilot scale sanitary landfill (1440 Ton) with recirculation of leaches treated in an anaerobic filter, and additionally by a computer simulation of leachate generation through the water balance of a theoretical cell of MSW (850 Ton), in which the initial humidity of the MSW and the type of final cover were evaluated. The results obtained on the pre-pilot scale indicate that recirculation of anaerobically treated leachates, when compared to the recirculation of untreated leachates, increased the rate of MSW stabilization, projecting a stabilization time reduction of 72 percent. In the pilot sanitary landfill an increase in the settling rate of around 200 percent was observed when operating with the recirculation of anaerobically treated leachates as opposed to operation without recirculation. The water balance carried out on the theoretical cell of MSW demonstrated the importance to leachate generation of both the initial landfill water saturation and the type of final barrier. From these results it may be stated that it is important for landfill design to maintain waste humidity close to its field capacity along with an adequate leachate application rate.

Studies on production and characterization of enriched urban waste composts and their influence on crops productivity.

Enriched compost produced with use of municipal solid wastes (MSW) recorded narrow C:N ratio at the end of decomposition period than municipal solid wastes decomposed without enrichers. To enhance the decomposition rate, quality of municipal solid wastes and enrichers/amendments are found very significant for production of compost. Nutrient content particularly nitrogen, phosphorus and potassium could be enhanced with addition of organic amendment/enrichers. Response of different crops for composts produced with addition of different enrichers like night soil, 25% distillery sludge and bio-fertilizers (Azospirillum sp and Bacillus sp) was conspicuous compared to the compost derived from municipal solid wastes alone with respect to increased growth and yield of crops. Among the enriched composts, night soil enriched compost significantly increased the response of potato and groundnut crops. According to farmer's opinion obtained with matrix scoring, chemical fertilizers and sheep penning are cheaper compared to pit compost or urban solid waste compost. While chemical fertilizers are considered to have adverse effects on soil more than pit compost, tank silt, sheep penning and urban solid waste. Weed infestation is associated more with urban waste than other sources. For dry land, agriculture urban waste could be useful due to good moisture holding capacity. Crop yields could be improved under low rainfall condition whenever pit compost or urban solid waste is used.

Biochemical methane potential of vegetable wastes.

Anaerobic digestion of vegetable waste slurry carried out in the laboratory using 2.5L capacity bottle reactors for 60 days at ambient temperature conditions resulted in a biogas yield of 0.391 L/g of VS fed. The methane content of the biogas generated from the reactors was in the range of 67%-70%. The biochemical methane potential obtained from the laboratory was 0.269 L CH4/g VS added.

Effect of sugar factory effluent on some physico-chemical properties of soils--a case study.

The effect of irrigation by sugar factory effluent (spentwash) and the well water from adjoining area has been studied in Wardha district, Maharashtra. The effluent had high TDS (422-608 mgL(-1)), COD (1152-17680 mgL(-1)) and BOD(380-650 mgL(-1)) than well water (TDS 240 mgL(-1), COD 3.8 mgL(-1) and BOD 1.2 mgL(-1)). There found some nutrients, viz. N, P, K, Zn, Cu, Fe, Mn in surface layer of soil in different seasons. Heavy metals (Cd, Co, Cr, Ni, Pb) were found to be within the permissible limits.

Management of waste from stone processing industry.

Characteristics of waste generated in stone processing industries, impact of its current disposal practices and waste recycling potential were assessed by field studies. The physical and chemical characteristics of waste are comparable to construction materials like sand and cement. The environmental issues due to the disposal of waste including that on ambient air quality were identified at respective disposal sites. It was found that the waste can be used to replace about 60% of sand and 10% of cement in concrete. Similarly the waste can replace 40% of clay in clay bricks with affecting its compressive strength.

A novel eco-friendly approach for textile sludge.

Solid waste management is a very serious problem in both human settlements and industrial establishments. In such cirumstances, management of sludge in textile industry has now become a burning issue due to its surplus volume and undesired characteristics. In such grim scenario, an attempt has been made to effectively dispose of the sludge generated in the treatment units of the textile sectors of Tirupur (India). The main objective of this research work was to study the suitability of utilizing sludge in the manufacture of bricks. It thus serves two important purposes, namely - efficient management of textile sludge and production of useful by-product, which fetches cash to the industry and a low cost construction material to the public. The sludge was collected from the effluent treatment plant and it was analyzed to explore its characteristics. Then the bricks, made up of this sludge, were tested for water absorption, compressive strength, presence of soluble salts and drop test, and the results were compared with those of ordinary bricks.

Value added eco-friendly products from tannery solid wastes.

Chrome shavings are the prominent solid wastes in tanning industry. Since chromium is known for its toxicity, the disposal of chrome shavings has been identified as a serious problem from the environmental point of view. At present, the popular utilization mode for chrome shavings is the manufacture of leather boards and related products. But this does not offer complete utilization of chrome shavings. Moreover, return per ton of chrome shavings is low if used for leather board production. In view of this, two processes have been developed to offer an alternative and better solution for the disposal of chrome shavings.The first process is preparation of parchment like membrane and the second process is related to development of leather like material. These products are analyzed for their mechanical behavior and other physicochemical properties. Parchment membrane can be used in the preparation of lampshades, chandeliers, wall hangers, table tops etc. and leather like material can be used in the preparation of chappal uppers, hand bags, purses, valets etc. The utilization of the chrome shavings in preparation of those two products not only reduces the environmental pollution but at the same time value added products can also be obtained.

Removal of trace chromium (VI) from contaminated water: bio-sorption by Ipomea aquatica.

Ipomea aquatica is a wetland plant, which floats in water bodies and is being used as a vegetable. This plant has ability to remove Cr(VI) from the contaminated water by transforming Cr (VI) to Cr (III). This adsorption of Cr(VI) basically takes place in roots of this plant. The contact time required to bring down Cr(VI) concentration below the permissible level (0.05 mg/1) is 30 to 40 days for this plant, and that varies with varying initial concentration. The lower level of contamination requires greater contact time than the higher one to bring down Cr(VI) below the permissible level. Recovery (94 +/- 1%) of chromium from the treated plant has been reported in this paper, and at the same time disposal problem also dose not arise. The study revealed that the plant Ipomea aquatica adsorbs Cr(VI) from the contaminated water very slowly compared to the other reported plants.

Ecofriendly approach of urban solid waste management: a case study of Jalgaon city, Maharashtra.

In India, the traditional methods are used for urban solid waste management. These practices are associated with degradation of the urban environment Hence, an environmentally sound garbage management system is required for the urban waste management. The concept of waste minimization needs to be adopted in such systems. It is possible to implement certain corrective measures at collection, storage, transport and disposal of urban solid waste to minimize the adverse impacts on the environment The present investigations are emphasized on generation, characterzation and ecofriendly disposal of solid waste generated in Jalgaon city, Maharashtra. In the present study the waste generation at source was studied in the various income groups of the city. The per capita waste generation was studied by sampling the waste directly from the source of generation. The study reveals that the waste generation is large in the high-income group followed by middle and low-income group public. Further the physicochemical characterization of the waste was also studied. The data generated will help to develop environmentally sound and economically feasible solid waste management system for Ihe city.