Clinical Consumption of Compound Opioid Analgesics in China: A Retrospective Analysis of National Data 2015-2018.

Compound opioid analgesics (COA) are widely used for cancer pain relief, but few studies investigated the use of that. We aimed to report the characteristics and trend of COA consumption in different regions and health facilities in China. The procurement data of two types of COA, compound codeine phosphate (CCP) and oxycodone and acetaminophen (OAA), in all medical institutions of 20 provinces from 2015 to 2018 were used. Data were presented as defined daily dose for statistical purpose (SDDD) and expenditures per million inhabitants per day. The annual consumption of COA and ratio of two combinations were compared among regions and institutions. We found, during 2015-2018, COA consumption increased at an average rate of 7.32% in SDDD and 19.19% in expenditures, while OAA accounted for most of the consumption. Highest COA consumption appeared in Northern China, with 121.72 SDDD and 1689.87 RMB (2015), whereas the lowest COA consumption was only 11.28 SDDD appearing in Southern China. The ratio of OAA and CCP (in SDDD) was highest in Southern China (53.14 in 2018), whereas lowest in West North (0.37 in 2018). In terms of institutions, tertiary had the highest COA consumption, with 16.74 SDDD and 292.73 RMB (2018). The SDDD of OAA was 27.44 times of that of CCP in tertiary, while it was only 0.11 in primary. Overall, COA consumption is on an upward trend and different among regions and health institutions in either amount or types of COA. These findings call for establishment of COA management regulations.

Pediatric drug regulation: International perspectives.

There was a time when the predominant approach to exposing children to new drugs was to protect children from research. This has evolved over the past several decades into protecting children through research. To encourage pediatric studies and approval of pediatric medicines, governments have provided financial incentives as well as obligations/requirements for pharmaceutical companies to carry out pediatric studies in certain circumstances. The unique considerations for children have been acknowledged by the various governments and drug regulatory agencies through international dialogue and cooperation among patient and patient care representatives, regulatory agencies, and academic, clinical and manufacturing stakeholders. We describe pediatric drug regulation in five of the largest international drug regulatory agencies and additionally discuss efforts at international cooperation and discussion in pediatric drug regulation.

Antibiotic use on German pig farms - A longitudinal analysis for 2011, 2013 and 2014.

To study antibiotic use in livestock in a temporal context with the development of antimicrobial resistance, long-term changes in antibiotic use must be mapped and their possible causes must be explored. Therefore, the present work assesses the changes in antibiotic use over time in German livestock husbandry. In addition, factors associated with antibiotic use were analyzed to identify possible strategies for further reducing antimicrobial usage. For 2011, 2013 and 2014, antibiotic usage data were collected and examined within the VetCAb project. Three hundred participating pig holdings provided information on their antibiotic use based on obligatory application and delivery forms (ADFs) filled in by their veterinarian as well as information on their current stabling capacities for each production type held. Data on sow, piglet, weaner and fattening pig holdings were described separately, using the semi-annual treatment frequency (TF) to measure antibiotic consumption. Multiple linear mixed models were used to investigate the effects of time, farm size, region and farm management category on the treatment frequency. The study yielded significant time changes with p-values below 0.001 in antibiotic administration with a decreasing median TF in piglets from 3.8 in the first half of 2011 (IQR = 1.1-10.6) to 1.7 in the second half of 2014 (IQR = 0.2-4.5) and in fattening pigs from 5.1 in the first half of 2011 (IQR = 0.2-15.4) to 0.7 in the second half of 2014 (IQR = 0.1-6.7). Meanwhile the TF fluctuated between 8.2 and 12.2 in weaners during the observational period (IQRs between zero (lower quartile) and 37.9 (upper quartile)). Piglet, weaner and fattening pig holdings belonging to the upper third of the holdings in size used significantly more antibiotics than the other holdings investigated. Particularly for weaner and fattening pig holdings, a higher TF was noted for farms without breeding units. The region was only a significant factor in weaners. In conclusion, for 2011, 2013 and 2014, the present study shows a clear reduction in antibiotic treatment frequency in German pig holdings. In addition, the association with various factors such as herd size and farm organization on the antibiotic usage frequency is indisputable. Therefore, these factors should be included in monitoring systems and considered when evaluating intervention measures.

History and Current Use of Antimicrobial Drugs in Veterinary Medicine.

This chapter briefly reviews the history and current use of antimicrobials in animals, with a focus on food animals in the more economically developed countries. It identifies some of the differences between human medical and food animal use, particularly in growth promotional and "subtherapeutic" use of medically-important antibiotics in animals. The public health impact of the extensive use of antibiotics in food animals for these purposes, differences internationally in such usage, and the major changes in current practices now underway in agricultural use are summarized. The emerging framing of the dimensions of antimicrobial resistance within a "One Health" framework is focusing global efforts to address the antimicrobial resistance crisis in a collaborative manner. The rapidly evolving development and application of practices of antimicrobial stewardship in animal is a critical part of the huge global effort to address antimicrobial resistance. The outcome is still uncertain.

Antibiotic use in South Korea from 2007 to 2014: A health insurance database-generated time series analysis.

BACKGROUND: Inappropriate antibiotic use significantly contributes to antibiotic-resistance, resulting in reduced antibiotic efficacy and increasing physical burden and cost of disease. The goal of this study was to explore antibiotic usage patterns in South Korea using 2007-2014 health insurance claims data. METHODS: We used the Health Insurance Review & Assessment Service data, which represents nearly the entire population of South Korea, to discern patterns in antibiotic prescribing practices. The daily dose, as defined by the World Health Organization ([defined daily doses]/1000 inhabitants/day, [DID]), was used as a measure of antibiotic use. Subgroup analyses were performed on the basis of patient characteristics (sex, age, and disease) and provider characteristics (type of medical institution). RESULTS: Antibiotic use in DID increased from 23.5 in 2007 to 27.7 in 2014. The ≤ 6 years old age group showed the highest level of usage at 59.21 DID in 2014, and showed an increasing trend each year. DIDs of beta-lactam antibacterials, penicillins (J01C), other beta-lactam antibacterials (J01D), lincosamides and streptogramins (J01F), quinolone antibacterials (J01M), and other antibacterials (J01X) increased over time. CONCLUSION: This study provides valuable statistics regarding antibiotic usage in South Korea; this is important for guiding health policy with regard to antibiotic usage. There is a need for further study exploring antibiotics use and resistance.

Resíduos alimentares, infecções parasitárias e evidência do uso de plantas medicinais em grupos pré-históricos das Américas / Food waste, parasitic infections and evidence of the use of medicinal plants in groups of prehistoric Americas

A paleoparasitologia utiliza como principal instrumento de estudo a análise de coprólitos e sedimentos retirados do solo de sítios arqueológicos, latrinas e da área pélvica de esqueletos. Associando-se dados da arqueologia, antropologia e paleoparasitologia, entre outras ciências, é possível obter resultados consistentes sobre modo de vida e saúde das populações no passado. Neste trabalho foram analisadas amostras de três regiões diferentes das Américas. Um total de 59 amostras de coprólitos e sedimentos provenientes de sítios arqueológicos localizados na área arqueológica de São Raimundo Nonato, que engloba o Parque Nacional Serra da Capivara (PNSC), Piauí, Brasil, foram analisadas. Esta região apresenta sítios com datações bastante antigas obtidas na área do Parque, com evidência de atividades humanas datadas aproximadamente de 50.000 anos; 12 amostras provenientes do sítio arqueológico Antelope Cave, localizado no Arizona, EUA. Assim como o PNSC, este sítio possui a presença de cerâmica e a iniciação da agricultura pelos grupos pré-históricos naquela região; e 15 amostras retiradas diretamente da região pélvica de sepultamentos provenientes do sambaqui Cubatão I, localizado em Joinville, Santa Catarina, Brasil. Este sítio arqueológico é, na verdade, um desafio metodológico devido ao clima e a atividade biótica do solo da região que não permitem boas condições de preservação do material arqueológico. A análise de resíduos alimentares destas diferentes regiões arqueológicas forneceu dados a respeito da dieta de populações antigas e a relação entre a presença de parasitos e o encontro de plantas com propriedades anti-helmínticas, e ainda foi possível a determinação de casos de falso parasitismo.

Paleoparasitology uses, as the main tool to study, the analysis of coprolites andsediments removed from the land of archaeological sites, latrines and the pelvic area of skeletons. Joining data from archeology, anthropology and paleoparasitology, among other sciences, it is possible to obtain solid results on livelihoods and health of people in the past. On this study were analyzed samples from three different regions of the Americas. A total of 59 samples of coprolites and sediments from archaeological sites located in thearchaeological area of São Raimundo Nonato, which includes the National Park Serra da Capivara (PNSC), located in Pernambuco, Brazil, were analyzed. This region has sites with the oldest dating obtained in the Park, with human activities recorded from 50.000 years BP; 12 samples from the archaeological site of Antelope Cave, located in Arizona, USA. This site, just like PNSC, has features such as the presence of pottery and the initiation of agriculture by prehistoric groups in the region, and 15 samples taken directly from the pelvic region of burials from the sambaqui Cubatão I, located in Joinville, Santa Catarina, Brazil. This archaeological site is actually a methodological challenge due to the climate and soil biotic activity in the region that don't allow good conditions of preservation of the archeological material. The analysis of alimentary residues of these different archaeological areas supplied dataregarding the diet of old populations and the relationship between the presence ofparasites and the encounter of plants with anthelminthic properties, and it was still possible the determination of cases of false parasitism.

A importância e a história dos estudos de utilização de medicamentos / The importance and the history of studies on medicine use

No mundo atual, onde há ampla necessidade de racionalização de recursos, sobretudo nos países mais pobres, esses estudos apresentam-se como alternativa que permite reduzir custos sem perda de qualidade nos tratamentos médicos, além de terem como função detectar possíveis abusos no uso dos medicamentos ou a ocorrência de eventos adversos. Os medicamentos representam boa parcela dos gastos públicos com saúde e não são substâncias inócuas. Essas são as duas principais razões pelas quais, cada vez mais, se reconhece a necessidade e a importância dos estudos que analisam os tratamentos medicamentosos, em especial nos hospitais, e os dados relativos ao consumo em si. Os últimos possibilitam a aplicação da farmacoeconomia e da farmacoepidemiologia como ferramentas no combate à utilização inadequada de medicamentos e a gastos desnecessários. A pesquisa tornou possível confirmar a importância da ocorrência desses estudos, especialmente em hospitais, visando à redução do gasto com medicamentos. A detecção de desvios, ineficácia e eventos adversos com a utilização inadequada de medicamentos possibilita, em nível macro, o desenvolvimento de políticas governamentais e, em nível micro, a realização de intervenções educativas - ambas as medidas tendo como objetivo a utilização dos medicamentos de forma racional.

There is a worldwide concern about rational drug use and medical treatment approach. In developing countries, the rational drug use represents an alternative that allows cost reduction without loosing quality in treatment. Although appropriate use of drugs may be indeed of vital importance, drugs represent a double edged word due to their potential adverse effects. The drug utilization studies are tools for detection of possible abuses on its use or the occurrence of adverse events, preventing unappropriate use and unnecessary expenses (pharmacoepidemiology and pharmacoeconomy). However, a few resources are intended for monitoring rational drug use. Moreover, there are limited data on the use of therapeutic agents in hospitals. This research confirmed the importance of these studies, especially in hospitals, to cost reduction and more secure drug use. The observation of deviations, inefficacy and adverse events on the drug utilization makes possible the development of government political and of education interventions, with the aim of rational drug utilization.

Naturalização e medicalização do corpo feminino: o controle social por meio da reprodução / Naturalization and medicalization of the female body: social control through reproduction

Trata-se de pesquisa bibliográfica sobre a recorrência do processo de naturalização como alicerce da medicalização do corpo feminino. Este processo institui uma forma de controle social com base na reprodução biológica, em que padrões de comportamento e diferenças de classe social, raça/etnia são ordenados/redescritos. Assim, se mantém a hegemonia masculina, patriarcal e de classe, e se aprofundam as desigualdades sociais e de gênero. Destaca-se a importância do desenvolvimento e da complexidade da tecnologia - que afastam as classes populares das tomadas de decisão sobre o próprio corpo e a saúde reprodutiva - e da escola sobretudo, em aulas de ciências e educação física para manter e perpetuar a hegemonia burguesa.

This study discusses, through bibliographic research, the recurrence of naturalization as the basis for medicalization of the female body, as a means of social control through biological reproduction, whereby behavioral standards, social class, ethnic and race differences are rearranged/redefined. Through this process male, patriarchal and class predominance is maintained and the rift of social and gender inequalities grow wider. It is important to identify the role of technological developments and its complexities - which do not allow lower-income classes to take decisions in regard to their own bodies and reproductive health - and schooling specially through science and physical education classes whereby upper-class predominance is sustained.

El presente estudio pretende discutir, por medio de investigación bibliográfica, la recurrencia del proceso de naturalización como fundamento de la medicalización del cuerpo femenino. Este proceso instituye una forma de control social con base en la reproducción biológica, en que patrones de comportamiento y diferencias de clase social, de raza/ etnia son ordenados/ redescriptos. Así se mantiene la hegemonía masculina, patriarcal y de clase y se aumentan las desigualdades sociales y de género. Se destaca la importancia del desarrollo y de la complejidad de la tecnología - que distancian a las clases populares de las tomas de decisión sobre el propio cuerpo y la salud reproductiva - y de la escuela - sobre todo en las clases de ciencias y educación física - para mantener y perpetuar la hegemonía burguesa.

Evidencias del consumo de drogas en Europa durante la Prehistoria / Evidence for drug-taking in Prehistoric Europe

Objetivo. Se estudia el consumo de drogas en la Prehistoria. Las primeras referencias escritas en este sentido se remontan al III milenio a.C., lo que implica un largo proceso de familiarización progresiva con estas sustancias que posiblemente se habría iniciado en la Prehistoria. Métodos. Para apoyar nuestra hipótesis nos vamos a servir de referencias a drogas vegetales en los textos de los autores grecolatinos y de evidencias arqueológicas. Entre estas últimas cabe destacar la recuperación de macrorrestos de vegetales psicoactivos en yacimientos prehistóricos, la presencia de alcaloides y metabolitos de drogas en diversos utensilios y restos esqueléticos, respectivamente, y las representaciones artísticas de plantas con estas propiedades. Resultados. Se ha podido documentar la presencia de vegetales con propiedades psicoactivas (efedra, adormidera, marihuana, miembros de las Solanaceae, cornezuelo de centeno, etc.) en varios yacimientos prehistóricos de Europa. No obstante, este hecho no siempre implica su empleo como drogas. Conclusiones. El consumo de drogas en Europa se inició en la Prehistoria, empleándose estas sustancias en la celebración de rituales y prácticas medicinales

Objective. The antiquity of drug-consumption in Europe is considered here. The oldest references implying this habit date back to the 3rd Millennium BC suggesting earlier beginnings, perhaps in Prehistoric times. Methods. References to drug plants among the Classical writers, and archaeological evidence are examined to support this hypothesis. Among the latter, we note the retrieval of macrofossil remains of psychoactive plants, the presence of drug alkaloids in utensils and metabolites in skeletal remains, and artistic depictions of plant species with these properties. Results. Diverse psychoactive plants (Ephedra spp, opium poppy, hemp, ergot, some members of the Solanaceae) have been recovered in prehistoric sites of Europe. This does not imply, however, the exploitation of the psychoactive properties of these species in all cases. Conclusions. Drug-taking is a long-established habit whose origin can be traced back to Prehistory. In those times, drugs were consumed both in ritual ceremonies and medical treatments

Observations on the history of the development of antimicrobials and their use in poultry feeds.

Antimicrobials are powerful tools, but controversy and conflict often follow power. The development of antimicrobials was marked by personal attacks, political intrigue, internal conflicts, and lawsuits. Such controversy and conflict has continued. The early history of supplementing animal feeds with antimicrobials parallels the isolation and identification of vitamin B12. Vitamin B12 was isolated and characterized in 1948, but further research showed that several feed ingredients, including dried mycelia of certain fungi, were more potent as growth promoters in the diet of chicks than was vitamin B12 alone. The growth-promoting component in fungal mycelia was shown to have antimicrobial activity. A total of 32 antimicrobial compounds are approved for use in broiler feeds in the U.S. without a veterinary prescription. Fifteen compounds are listed for treatment of coccidiosis, 11 are listed as growth promotants, and six are listed for other purposes. Seven compounds are also used in human medicine. These compounds include bacitracin, chlotetracycline, erythromycin, lincomycin, novobiocin, oxytetracycline, and penicillin. No published estimates of antimicrobial use in animals exist at present, and estimates of that use differ markedly. The Union of Concerned Scientists (UCS) estimates usage at 30.6 million pounds, nearly 50% (49.85%) higher than the Animal Health Institute (AHI) estimate of 20.42 million pounds. AHI surveyed their members (the manufacturers of antimicrobials) to obtain their estimates, whereas USC calculated their estimates using published data and the following general formula: antimicrobial use = number of animals treated x average days treated x average dose.

Francisco Vélez de Arciniega en la polémica de la coloquíntida

Se presenta la edición y estudio de un manuscrito escrito en 1611 por Francisco Vélez de Arciniega sobre el uso de la Coloquíntida ( Citrullus colocynthis (L) Schrader). Purgante enérgico, constituían objeto de controversia tanto su interés como la forma de aplicación. Vélez de Arciniega, notable boticario, buen conocedor de la farmacia antigua y moderna, participa en una interesante discusión científica que muestra la modernización del uso de los medicamentos (AU)

Farmacoepidemiologia no Brasil: evoluçäo e perspectivas / Pharmacoepidemiology in Brazil: evolution and prospects

Apresenta o desenvolvimento da farmacoepidemiologia no Brasil. Enfatiza o papel dos programas de educaçäo continuada em farmacologia. Ressalta o papel do programa de formaçäo em farmácia clínica da Organizaçäo Pan-Americana de Saúde, onde vários profissionais brasileiros tiveram o primeiro contato com o Programa de farmacovigilância por Monitorizaçäo Intensiva Hospitalar. Refere também às primeiras teses de doutorado sobre medicamentos defendidas na Universidade de Säo Paulo. Relata a tentativa da Divisäo de Medicamentos do Ministério da Saúde do Brasil de se direcionar para a farmacovigilância. Tece consideraçöes sobre a I Oficina de Trabalho sobre medicamentos organizada pelas Secretarias Municipal e Estadual de Saúde de Säo Paulo. Enfatiza a criaçäo da Sociedade Brasileira de Vigilância de Medicamentos, e sua importância como estimuladora da farmacoepidemiologia. Analisa o impulso do setor dinamizado pela implantaçäo dos Centros de Informaçöes de Medicamentos, no país. Conclui que já existem condiçöes para se incrementar a pesquisa farmacoepidemiológica no Brasil. (AU)

[Centenary of Becquerel. The main stages of discovery and use of radionuclides (1896-1996)]. / Centenaire Becquerel. Les grandes étapes de la découverte et de l'utilisation des radioéléments (1896-1996).

The french scientists Henri Becquerel, Pierre and Marie Curie, Frédéric and Irène Joliot-Curie contributed decisively to the discovery and use of radionuclides. Besides them, Antoine Lacassagne, Robert Courrier, Pierre Süe developed the research in Chemistry and Biology. After 1945, medical applications were initiated by Charlie Fisher, Maurice Tubiana, Henri Jammet, in France. Marcel Guillot, student and assistant of Marie Curie, pharmacist himself, inserted pharmacists in research, development, control and teaching of medical radionuclides. Marcel Guillot defined the first pharmaceutical regulations and worked out the first monographs in french and european pharmacopoeias.

[Treatment with antiepileptics of mentally retarded patients. Experiences from the 1980s a challenge in the 1990s]. / Behandling med antiepileptika hos pasienter med psykisk utviklingshemning. Erfaring fra 1980-årene gir utfordring i 1990-årene.

Epilepsy is the most frequent additional handicap in mentally retarded persons. Brain injury and mental retardation may predispose to side effects of antiepileptic drugs (AEDs) on the central nervous system. 63 institutionalized mentally retarded patients were treated for epilepsy in the 1980s. AED treatment was carefully monitored, aiming at the lowest effective dose and an optimal balance between seizure control and adverse effects. In 15 patients, AEDs could be withdrawn. Drugs with less cognitive side effects, such as carbamazepine and valproate, were preferred to longer established drugs, such as phenobarbital and phenytoin. A pronounced decrease in the frequency of seizures was achieved during the study. Based on the calculated Defined Daily Doses, the prescription of AEDs was reduced by 18%. Phenobarbital constituted 39% of the AED consumption at the beginning and 7% at the end of the study. The corresponding figures for phenytoin were 20 and 16%. The fraction of carbamazepine increased from 31 to 44% and that of valproate from 6 to 32%. Less sedative side effects were reported. Several factors other than AEDs may have modified control of seizure in this long term study. These issues are discussed. After the reform of the system of care for the mentally retarded in Norway, it is a challenge to the health authorities to provide an adequate comprehensive epilepsy service to this group of patients.