Potentially Inappropriate Medication: A Pilot Study in Institutionalized Older Adults.

Institutionalized older adults often face complex medication regimens, increasing their risk of adverse drug events due to polypharmacy, overprescribing, medication interactions, or the use of Potentially Inappropriate Medications (PIM). However, data on medication use and associated risks in this population remain scarce. This pilot study aimed to characterize the sociodemographic, clinical and pharmacotherapeutic profiles, and the use of PIM among institutionalized elders residing in Residential Structures for Elderly People (ERPI) in the Faro municipality, located in the Portuguese region of the Algarve. We conducted a cross-sectional study in a non-randomized sample of 96 participants (mean age: 86.6 ± 7.86 years) where trained researchers reviewed medication profiles and identified potentially inappropriate medications using the EU(7)-PIM list. Over 90% of participants exhibited polypharmacy (≥5 medications), with an average of 9.1 ± 4.15 medications per person. About 92% had potential drug interactions, including major and moderate interactions. More than 86% used at least one potentially inappropriate medication, most commonly central nervous system drugs. This pilot study demonstrates that institutionalized older adults may be at high risk of potential medication-related problems. Implementing comprehensive medication review programs and promoting adapted prescribing practices are crucial to optimize medication use and improve the well-being of this vulnerable population.

Mediterranean Diet Favors Vitamin K Intake: A Descriptive Study in a Mediterranean Population.

The Mediterranean diet (MD) is associated with improved longevity and the prevention and management of chronic inflammatory diseases (CIDs). Vitamin K, which is present in MD core components such as leafy green vegetables, is also known as a protective factor for CIDs. Estimates of vitamin K intake in Mediterranean settings are still scarce, and the association between MD and vitamin K intake is yet to be established. This study analyzed vitamin K intake and MD adherence in the Algarve region, in Portugal. We conducted a cross-sectional study in a nonrandom sample of adults using an online questionnaire which included a validated food-frequency questionnaire and a screener for MD adherence. A total of 238 participants were recruited (68% women and 32% men). Adherence to the MD was low (11%). Only 10% of the participants had vitamin K intake below the adequate intake. Adherence to the MD was positively correlated with vitamin K intake (r = 0.463; p < 0.001) and age (r = 0.223; p < 0.001). Our findings underscore the importance of promoting adherence to the MD for optimal vitamin K intake, and future research should focus on developing effective interventions to promote this dietary pattern, particularly among younger individuals and men.

New Food Frequency Questionnaire to Estimate Vitamin K Intake in a Mediterranean Population.

Vitamin K is a multifunctional micronutrient essential for human health, and deficiency has been linked to multiple pathological conditions. In this study, we aimed to develop and validate a new food frequency questionnaire (FFQ) to estimate total vitamin K intake, over the course of a 30-day interval, in a Portuguese, Mediterranean-based, population. We conducted a prospective study in a non-random sample of 38 healthy adult volunteers. The FFQ was designed based on a validated Portuguese FFQ used in nationally representative studies and on literature reviews, to include foods containing ≥5 µg of vitamin K/100 g and foods with a lower vitamin K content, yet commonly included in a Mediterranean diet. Vitamin K intake was estimated from 24 h recalls and six days of food records. The final FFQ included 54 food items which, according to regression analyses, explains 90% of vitamin K intake. Mean differences in vitamin K intake based on food records (80 ± 47.7 µg/day) and on FFQ (96.5 ± 64.3 µg/day) were statistically non-significant. Further, we found a strong correlation between both methods (r = 0.7; p = 0.003). Our results suggest that our new FFQ is a valid instrument to assess the last 30 days of vitamin K intake in the Portuguese Mediterranean population.

Characterization of Potential Intoxications with Medicines in a Regional Setting.

The Portuguese Poison Information Center (from Portuguese-CIAV) is a call center that offers medical assistance in case of possible intoxication with any kind of product, including medicines. This center´s main goal is to inform and guide the general public and health professionals. This work aimed to analyze and compare data corresponding to the telephone calls from the Algarve region (South of Portugal), received by CIAV during 2019 and 2020, regarding potential intoxications with medicines. To this end, data provided by CIAV on possible cases of medication intoxication in the Algarve region were collected, including the number of calls received, the place of origin of the call, the age group and sex of the intoxicated individual, the route of exposure to the drug, the circumstances of contact with the substance, the existence of symptoms, and the drug or drugs involved in the potential intoxication. The results showed that the number of cases slightly decreased in 2020 (n = 1261) compared with 2019 (n = 1340), with a high number of cases of intoxication in children between one and four years old in both years (21.2%; n = 152 in 2019; 16.4%; n = 115 in 2020). The drugs belonging to the locomotor system group (paracetamol and ibuprofen) were the main drugs involved, followed by the central nervous system pharmacotherapeutic group, namely benzodiazepines (diazepam and alprazolam). Paracetamol was the main drug responsible for the calls to CIAV (n = 71 in 2019; n = 63 in 2020), while for the remaining drugs there were fluctuations in their positions between both years. In some cases, this swinging may be explained by the possible changes in therapy due to potential interactions with drugs used for the treatment of symptoms of COVID-19 or perhaps related to misleading information released by the media about the use of some drugs, such as ibuprofen, during lockdown periods. Although there has been a decrease in calls to report possible drug intoxication in the Algarve region, the profile of calls was very similar. Paracetamol was the drug with the highest number of reported cases and the group of psychotropic drugs showed the largest increase between 2019 and 2020.

Tea Tree Oil: Properties and the Therapeutic Approach to Acne-A Review.

Acne vulgaris is an inflammatory dermatological pathology that affects mostly young people. However, it can also appear in adulthood, mainly in women. It has a high psychosocial impact, not only at the time of active lesions but also due to the consequences of lesions such as scarring and hyperpigmentation. Several factors are involved in the physiopathology of acne and the constant search for active ingredients is a reality, namely phytotherapeutic ingredients. Tea tree oil is an essential oil extracted from Melaleuca alternifolia (Maiden & Betch) Cheel with known antibacterial, anti-inflammatory, and antioxidant properties, making it a candidate for the treatment of acne. This review aims to describe the various properties of tea tree oil that make it a possible ingredient to use in the treatment of acne and to present several human studies that have evaluated the efficacy and safety of using tea tree oil in the treatment of acne. It can be concluded that tea tree oil has good antibacterial, anti-inflammatory, and antioxidant properties that result in a decrease in the number of inflammatory lesions, mainly papules, and pustules. However, given the diversity of study designs, it is not possible to draw concrete conclusions on the efficacy and safety of this oil in the treatment of acne.

Knowledge Assessment During the Medication Process Use by Older Patients on Clinical Routine: A Pilot Study.

Objectives: The consumption of medicines has been increasing over the last decades. The lack of medication knowledge (MK) may affect the process of medication use and, consequently, may lead to negative health outcomes. This study carried out a pilot study using a new tool to assess MK in older patients in a daily clinical practice. Materials and Methods: An exploratory cross-sectional study was conducted, including older patients (≥65 years), taking two or more medicines, followed in a regional clinic. Data were collected during a structured interview, which included an algorithm for assessing MK regarding the identification of the medicines and its use and storage conditions. Health literacy and treatment adherence were also assessed. Results: The study enrolled 49 patients, mainly between 65 and 75 years (n: 33; 67.3%) and polymedicated (n: 40; 81.6%), taking a mean of 6.9 ± 2.8 medicines per day. A lack of MK (score <50%) was observed in 15 (30.6%) participant patients. "Drug strength" and "storage conditions" were the items which presented the lowest score. MK was positively correlated with higher scores for health literacy and treatment adherence. Younger patients (age <65 years old) also had a higher MK score. Conclusion: This study showed that the applied tool could evaluate the MK of the participants and identified specific gaps regarding MK within the process of medicine use. Further studies, with more participants, will allow the confirmation of these findings and will stimulate the development of specific strategies to improve MK, thus contributing to better health outcomes.

Health literacy assessment: Translation and cultural adaptation to the Portuguese population.

RATIONALE, AIMS, AND OBJECTIVES: Health literacy (HL) has been widely referenced as a determinant of health outcomes, making the assessment of low HL a fundamental step to plan educational interventions. This study aimed to translate and adapt the Short Assessment of Health Literacy-Spanish and English (SAHL-S&E) questionnaire into European Portuguese. METHODS: The SAHL-S&E questionnaire was translated using the recommendations of the International Society for Pharmacoeconomics and Outcomes Research. One hundred fifty-three Portuguese native speakers aged over 18 years old were included in this study, enrolled among users of community pharmacies in the Algarve region (Portugal). RESULTS: The translation of the questionnaire used showed a good internal consistency (Cronbach α: .812), and a statistically significant (F = 5.05 P < .001) interrater reliability. Over a third of subjects (37.9%) achieved a score less than or equal to 14, which is indicative of low HL. CONCLUSION: This tool, intended to be used in the European Portuguese population, can be used for low HL screening.

Estratégia para promover a higienização das mãos em unidade de terapia intensiva / Strategy to promote hand hygiene in intensive care unit / Estrategia de promoción a la higienización de las manos en unidad de cuidados intensivos

Realizou-se um estudo observacional prospectivo para avaliar o efeito de uma estratégia para promover a adesão da higienização das mãos a esse procedimento por profissionais de saúde de uma unidade de terapia intensiva. Foi aplicado um instrumento estruturado para coleta de dados de adesão à higienização das mãos por profissionais de saúde antes e após intervenção em unidade de terapia intensiva de hospital da região noroeste do Paraná em 2009. Para análise dos dados, taxa de adesão pela razão entre o número de procedimentos realizados e o número de alertas que requerem o procedimento foi medido. Também foram utilizados os testes qui-quadrado e exato de Fisher para comparação dos dados antes e após a intervenção. Após a intervenção, houve aumento significativo na taxa geral de conformidade de 21,7% para 28%, p = 0,039, na categoria de técnicos de enfermagem, em anti-séptico de fricção, antes do contato com o paciente antes dos procedimentos limpos e assépticos. Em contrapartida, a adesão não melhorou entre enfermeiros, médicos e momentos após o contato com o paciente. A intervenção associada ao incentivo ao uso de preparações alcoólicas contribuiu para melhorar significativamente a adesão geral à higienização das mãos pelos profissionais de saúde.

A prospective observational study was conducted to evaluate the effect of a strategy to promote hand hygiene adhesion to this procedure by health professionals in an intensive care unit. It was applied a structured instrument to collect data regarding adhesion to hand hygiene by healthcare workers before and after an intervention in an intensive care unit of a hospital in the northwestern region of Paraná in 2009. For data analysis, the rate of accession by the ratio between the number of procedures performed and number of alerts requiring the procedure was measured. It was also used used chi-square and Fisher exact tests for comparison of data before and after intervention. After the intervention, a significant increase in overall compliance rate of 21.7% to 28%, p = 0.039, in the category of nursing technicians, in rubbing antiseptic, before contact with the patient before the clean and aseptic procedures. In contrast, adhesion did not improve among nurses, doctors and moments after the contact with the patient. The intervention associated with the encouragement of the use of alcoholic preparations contributed to significantly improve overall adhesion to hand hygiene by health professionals.

Estudio observacional prospectivo para evaluar el efecto de una estrategia de promoción a la higienización de las manos, en la adhesión de los profesionales de la salud, en una Unidad de Cuidados Intensivos (UCI). Se utilizó un instrumento estructurado para los datos referentes a la adhesión a la higienización de las manos de los sujetos, antes y después de una intervención en una UCI de un hospital de la Región Noroeste de Paraná en 2009. Para el análisis de los datos, se midió el índice de adhesión por la razón entre el número de higienizaciones realizadas y el número de indicaciones que requerían el procedimiento. Se utilizaron las pruebas Chi-cuadrado y exacta de Fisher para la comparación de los datos antes y después de la intervención. Hubo aumento significativo en la tasa de adhesión global a la higienización de las manos, de un 21,7% a un 28%, p= 0,039, en la categoría de los técnicos de enfermería, en la fricción antiséptica, antes del contacto con el paciente y antes de los procedimientos limpios y asépticos. Por otro lado, la adhesión no mejoró entre los enfermeros, médicos y en los momentos posteriores al contacto con el paciente. La intervención con énfasis en la promoción de higienización de las manos, asociada al incentivo de la utilización de preparaciones alcohólicas, contribuyó para mejorar significativamente la adhesión global a la higienización de las manos por los profesionales de salud.

Fluência e compreensão leitora em escolares com dificuldades de leitura / Fluency and reading comprehension in students with reading difficulties

OBJETIVO: Caracterizar o desempenho de escolares com dificuldade de leitura, em tarefas de decodificação e compreensão leitora e buscar correlações entre ambas. MÉTODOS: Foram avaliados 60 escolares (29 meninas) que cursavam do 3º ao 5º ano do Ensino Fundamental na rede pública do município de São Paulo. Trinta escolares (Grupo Pesquisa - GP), dez de cada ano, foram indicados por seus professores por apresentarem queixas ou indícios de dificuldades de leitura. Outros trinta, indicados como bons leitores, pareados por gênero, idade e escolaridade ao GP, compuseram o Grupo de Comparação (GC). Todos os escolares foram avaliados quanto aos parâmetros de fluência de leitura de itens isolados (palavras e pseudopalavras) e texto, e de compreensão leitora de texto narrativo (nível de leitura, número e tipo de ideias identificadas, acertos às questões de múltipla escolha). RESULTADOS: O GP apresentou valores de fluência e compreensão leitoras mais baixos que o GC. Diferentes padrões de correlações positivas e negativas, de fracas a ótimas, entre os parâmetros de decodificação e compreensão foram encontradas nos dois grupos. No GP foram observados baixos valores de taxa e acurácia de leitura correlacionados a baixos valores de compreensão e melhora da decodificação, mas não da compreensão, conforme avançaram os anos escolares. No GC, observou-se correlação entre os diferentes parâmetros de fluência avaliados, mas nenhum desses parâmetros correlacionou-se com as variáveis de compreensão leitora. CONCLUSÃO: Os escolares com dificuldades de leitura e de escrita apresentam baixos valores de parâmetros da fluência e da compreensão leitora. Fluência e compreensão correlacionam-se no grupo com dificuldades, mostrando que as alterações da decodificação influenciam a compreensão leitora, a qual não melhora com a escolaridade.

PURPOSE: To characterize the performance of students with reading difficulties in decoding and reading comprehension tasks as well as to investigate the possible correlations between them. METHODS: Sixty students (29 girls) from 3rd to 5th grades of public Elementary Schools were evaluated. Thirty students (Research Group - RG), ten from each grade, were nominated by their teachers as presenting evidences of learning disabilities. The other thirty students were indicated as good readers, and were matched by gender, age and grade to the RG, composing the Comparison Group (CG). All subjects were assessed regarding the parameters of reading fluency (rate and accuracy in words, pseudowords and text reading) and reading comprehension (reading level, number and type of ideas identified, and correct responses on multiple choice questions). RESULTS: The RG presented significantly lower scores than the CG in fluency and reading comprehension. Different patterns of positive and negative correlations, from weak to excellent, among the decoding and comprehension parameters were found in both groups. In the RG, low values of reading rate and accuracy were observed, which were correlated to low scores in comprehension and improvement in decoding, but not in comprehension, with grade increase. In CG, correlation was found between different fluency parameters, but none of them was correlated to the reading comprehension variables. CONCLUSION: Students with reading and writing difficulties show lower values of reading fluency and comprehension than good readers. Fluency and comprehension are correlated in the group with difficulties, showing that deficits in decoding influence reading comprehension, which does not improve with age increase.

Fluency and reading comprehension in students with reading difficulties.

PURPOSE: To characterize the performance of students with reading difficulties in decoding and reading comprehension tasks as well as to investigate the possible correlations between them. METHODS: Sixty students (29 girls) from 3rd to 5th grades of public Elementary Schools were evaluated. Thirty students (Research Group - RG), ten from each grade, were nominated by their teachers as presenting evidences of learning disabilities. The other thirty students were indicated as good readers, and were matched by gender, age and grade to the RG, composing the Comparison Group (CG). All subjects were assessed regarding the parameters of reading fluency (rate and accuracy in words, pseudowords and text reading) and reading comprehension (reading level, number and type of ideas identified, and correct responses on multiple choice questions). RESULTS: The RG presented significantly lower scores than the CG in fluency and reading comprehension. Different patterns of positive and negative correlations, from weak to excellent, among the decoding and comprehension parameters were found in both groups. In the RG, low values of reading rate and accuracy were observed, which were correlated to low scores in comprehension and improvement in decoding, but not in comprehension, with grade increase. In CG, correlation was found between different fluency parameters, but none of them was correlated to the reading comprehension variables. CONCLUSION: Students with reading and writing difficulties show lower values of reading fluency and comprehension than good readers. Fluency and comprehension are correlated in the group with difficulties, showing that deficits in decoding influence reading comprehension, which does not improve with age increase.

Monitorization of drug content in furosemide and lorazepam tablets stored in multidose pill boxes.

BACKGROUND: Therapeutic nonadherence is a major health problem, particularly when therapeutic regimens are complex and long-lasting. Therefore, tools such as multidose pill boxes have been designed to provide the means for higher therapeutic compliance. However, no studies are available reporting on their capacity to keep the drug content of the stored tablets unaltered. OBJECTIVE: This work aimed at monitoring the drug content of tablets stored in multidose boxes for a period of two weeks. MATERIALS AND METHODS: Furosemide and lorazepam were selected as model drugs, given their frequent chronic use, which is coherent with the profile of medicines susceptible of storage in the referred boxes. Variations of the tablets drug content were assessed as a function of temperature (25°C and 40°C) and the presence of blister. RESULTS AND DISCUSSION: The obtained results allowed concluding that concerning temperature, only lorazepam tablets registered drug content alterations and only when stored at 40°C. On the other side, it was concluded that the absence of blister does not compromise the drug content of the studied tablets. CONCLUSION: In the specific conditions of this study, the storage of these medicines in multidose boxes is considered reliable and adequate.

Evaluation of a sunscreen during a typical beach period.

PURPOSE: Amongst the radiations reaching the Earth's surface, the ultraviolet rays are the ones receiving most attention from the scientists, given their damaging potential for humans exposed to them. To minimize the harm caused by such exposure, human beings are strongly recommended to use sunscreens, which are pharmaceutical preparations containing filters that confer protection against radiation. As this protection is strongly dependent on the properties of these filters, it is very important to ensure their stability even when under aggressive conditions, such as the typical high temperatures of summer in South Europe. In this study, a commercial sunscreen emulsion was tested in vitro for a period of time intended to simulate a beach period of 15 days, with regard to the maintenance of its sun protection factor (SPF). Moreover, the organoleptic characteristics were also monitored by macroscopic analysis. MATERIALS AND METHODS: To perform this study, temperature conditions similar to those observed from June to August in Faro (Portugal) were simulated in vitro. The SPF was determined by spectrophotometry, with subsequent application of the Mansur equation. RESULTS AND CONCLUSION: No significant alterations were observed during the considered period under the specific conditions of this study.

Fenologia da gravioleira (Annona muricata) em área de cerrado do Amapá, Brasil

This study evaluated the phenology of soursop (Annona muricata L.) cultivated in a savanna area. Four trees were randomly chosen from each of six cultivars of the Embrapa Amapá experimental collection in a savanna ecosystem. The cultivars were: soursop A, soursop B, FAO II, Morada, Lisa and M-415 of Embrapa Amazonia Oriental. The climate type is Ami and the soil is classified as a Typic Haplorthox. Leaf fall happened in all soursop cultivars in May and June (after harvest) and September and October (dry season). Flowering occurred during the rainy season, with extremes in February and July. Annual flower prodution was superior in soursop (115) and FAO II (97). Fruit development was expressive from December to March. Fruit set stood out on soursop A (9%) and FAO II (6,7%). Peak of the fruit harvest was in March, except for soursop A which was in May.

O trabalho teve como objetivo avaliar a fenologia de graviola (Annona muricata L.) cultivada em área de cerrado do Amapá. Foram escolhidas quatro plantas, ao acaso, de seis progênies de graviola, da coleção do Campo Experimental do Cerrado, no Centro de Pesquisa Agroflorestal do Amapá (CPAF-Embrapa). As progênies avaliadas foram a graviola A, graviola B, FAO II, Morada, Lisa e plantas oriundas da matriz 415 (M-415) da coleção do Centro de Pesquisa Agroflorestal da Amazônia Oriental (CPATU-Embrapa). O clima é do tipo Ami e o solo é um Latossolo Amarelo arenoso distrófico. Foram observadas queda de folhas em todas as progênies de graviola após a safra (maio a julho) e na seca estacional (setembro a outubro). A floração ocorreu durante o período chuvoso, com picos em fevereiro e julho. A produção anual de flores foi superior na graviola (115) e FAO II (97). A frutificação foi expressiva de dezembro a março. O vingamento de frutos sobressaiu-se na graviola A (9%) e FAO II (6,7%). O pico da colheita foi no mês de março, exceto para a graviola A que foi em maio.

Reflexäo sobre a atuaçäo do psicólogo no contexto hospitalar junto à clínica de neurocirurgia / Performance of the psychologist in the hospitalar context beside neurosurgery clinic

A recuperaçäo e reintegraçäo social de um paciente acometido por uma doença neurológica envolve a atuaçäo de uma equipe multidisciplinar. Neste contexto, a psicóloga pode interferir näo só frente ao paciente (manipulando sua ansiedade) mas principalmente junto à família, aos membros da equipe paramédica e mesmo envolvendo a própria equipe neurocirúrgica